Clinical outcomes of aspergillosis among paediatric and adult inpatients: A multicentre study in a Brazilian metropolitan area.

BACKGROUND: Invasive Aspergillosis (IA) is a disease of significant clinical relevance, especially among immunosuppressed patients, and is associated with high mortality rates. In this study, we evaluated the epidemiological features and clinical outcomes in children and adults with IA. METHODS: This was an observational, multicentre, prospective surveillance study of inpatients with IA at two different hospitals in Campinas, Brazil, between 2018 and 2021. RESULTS: A total of 44 patients were identified (54.5% males), with a median age of 42 years (interquartile range (IQR):19.25-59 years, varying between 1 and 89 years). The following baseline conditions were identified: 61.4% were oncohaematological patients and 20.5% were solid organ transplant recipients. Among oncohaematological patients, 77.8% exhibited severe or persistent neutropenia. The median time between the onset of neutropenia and the diagnosis of fungal infection was 20 days (IQR: 10.5-26 days; range, 0-68 days). The interval between neutropenia onset and fungal infection was longer in paediatric than in general hospital (average, 29 vs. 13.4 days; median 26 vs 11 days; p=0.010). After the diagnosis of IA, the survival rates were 44.2% and 30.0% at 180 and 360 days, respectively. Survival was greater in patients aged ≤ 21 years (p = 0.040; log-rank test). They observed no difference in IA mortality related to COVID-19 pandemic. CONCLUSION: High mortality associated with IA was observed in both hospitals. Individuals over the age of 21 have a lower survival rate than younger patients.

COVID-19 and invasive fungal coinfections: A case series at a Brazilian referral hospital.

BACKGROUND: COVID-19 co-infections have been described with different pathogens, including filamentous and yeast fungi. METHODOLOGY: A retrospective case series study conducted from February to December 2020, at a Brazilian university hospital. Data were collected from two hospital surveillance systems: Invasive fungal infection (IFI) surveillance (Mycosis Resistance Program - MIRE) and COVID-19 surveillance. Data from both surveillance systems were cross-checked to identify individuals diagnosed with SARS-CoV-2 (by positive polymerase chain reaction (PCR)) and IFI during hospital stays within the study period. RESULTS: During the study period, 716 inpatients with COVID-19 and 55 cases of IFI were identified. Fungal co-infection with SARS-CoV-2 was observed in eight (1%) patients: three cases of aspergillosis; four candidemia and one cryptococcosis. The median age of patients was 66 years (IQR 58-71 years; range of 28-77 years) and 62.5% were men. Diagnosis of IFI occurred a median of 11.5 days (IQR 4.5-23 days) after admission and 11 days (IQR 6.5-16 days) after a positive PCR result for SARS-CoV-2. In 75% of cases, IFI was diagnosed in the intensive care unit (ICU). Cases of aspergillosis emerged earlier than those of candidemia: an average of 8.6 and 28.6 days after a positive PCR for SARS-CoV-2, respectively. All the patients with both infections ultimately died. CONCLUSION: A low rate of COVID-19 co-infection with IFI was observed, with high mortality. Most cases were diagnosed in ICU patients. Aspergillosis diagnosis is highly complex in this context and requires different criteria.

Reuse of pacemakers and implantable cardioverter-defibrillators: systematic review, meta-analysis and quality assessment of the body of evidence.

BACKGROUND: Pacemakers (PMs) and implantable cardioverter-defibrillators (ICDs) have reduced mortality and improved the quality of life of cardiac patients. However, the high cost of these devices prevents their large-scale incorporation, particularly in low-income countries, where reusing explanted PMs/ICDs has become an alternative. METHODS: A systematic review and meta-analysis were conducted of studies that compare infection rates, device-related deaths, malfunction and premature battery depletion in patients with reused PM and ICD implants and those with new devices. The quality of the body of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework. RESULTS: The meta-analysis demonstrated no significant intergroup differences in infection rates (OR 0.98; 95% CI 0.60-1.60), device malfunction (OR 1.58; 95% CI 0.56-4.48) or premature battery depletion (OR 1.96; 95% CI 0.81-4.72) and no device-related deaths. Based on GRADE assessment, confidence in estimates for the outcomes infection rate and device-related death was rated as moderate. CONCLUSION: The results of this analysis enabled us to conclude that PMs and ICDs can be safely and effectively reused. As such, every effort should be made to overcome regulatory, technical and ethical barriers to ensure implantation.

Cost-utility analysis of outpatient parenteral antimicrobial therapy (OPAT) in the Brazilian national health system.

BACKGROUND: Outpatient parenteral antimicrobial therapy (OPAT) has been used for decades in different countries to reduce hospitalization rates, with favorable clinical and economic outcomes. This study assesses the cost-utility of OPAT compared to inpatient parenteral antimicrobial therapy (IPAT) from the perspective of a public university hospital and the Brazilian National Health System (Unified Health System -SUS). METHODS: Prospective study with adult patients undergoing OPAT at an infusion center, compared to IPAT. Clinical outcomes and quality-adjusted life year (QALY) were assessed, as well as a micro-costing. Cost-utility analysis from the hospital and SUS perspectives were conducted by means of a decision tree, within a 30-day horizon time. RESULTS: Forty cases of OPAT (1112 days) were included and monitored, with a favorable outcome in 97.50%. OPAT compared to IPAT generated overall savings of 31.86% from the hospital perspective and 26.53% from the SUS perspective. The intervention reduced costs, with an incremental cost-utility ratio of -44,395.68/QALY for the hospital and -48,466.70/QALY for the SUS, with better cost-utility for treatment times greater than 14 days. Sensitivity analysis confirmed the stability of the model. CONCLUSION: Our economic assessment demonstrated that, in the Brazilian context, OPAT is a cost-saving strategy both for hospitals and for the SUS.

Conception and validation of a protocol for reuse of non-irrigated electrophysiology catheters in a Brazilian teaching hospital.

PURPOSE: Since the Brazilian current legislation permits the reuse of single-use devices under a validated processing protocol, the main purpose of our study was to develop and validate a method for reusing non-irrigated electrophysiology catheter (EC). METHODS: Manual and mechanical processing by ultrasonic washer was associated with the use of enzymatic solution and hydrogen peroxide with a final rinse with filtered water. Validation of the cleaning process, as well as catheter integrity, was done by observing the ECs in stereoscopic microscope at ×60 magnification, followed by HemoCheck-S® (HCS) test to monitor the presence of residual blood on their surfaces. Ethylene oxide (EO) was used for sterilization, and the final validations of the processing were performed by assays of sterility, pyrogenicity, and EO residuals. Lastly, a cost-minimization study was performed. RESULTS: Cleaning process demonstrated absence of organic material detectable by HCS at the surfaces of the ECs. Assays for sterility were negative, and assays of EO residuals and endotoxins showed levels under established standards. The number of reuses was settled to a maximum of seven uses for the ECs with handle and ten uses for ECS without handle. The cost-minimization study showed an 84% savings, when considering seven reuses. CONCLUSIONS: Processing of ECs was validated at all stages. Therefore, reuse of ECs under the conditions that we designed was considered safe for patients and cost-effective for our institution.

Critérios para avaliação de novas tecnologias para esterilização / Criteria for evaluation of new sterilization technologies / Criterios para evaluación de nuevas tecnologías para esterilización

Objetivo: Discorrer sobre critérios e métodos que devem nortear a avaliação de novas tecnologias para esterilização. Método: Estudo de revisão narrativa mediado pela busca e interpretação da legislação nacional relacionada aos processos de esterilização, normas técnicas e documentos que embasam os aspectos construtivos, funcionais e da segurança das tecnologias para esterilização. Resultados: Foram discutidos tópicos relevantes à segurança dos processos de esterilização, como a prova de esterilidade, simulação do ciclo nas piores condições de carga, compatibilidade com sistemas de barreira estéril, testes de biocompatibilidade, controle de processos e avaliação econômica. Conclusão: Os resultados beneficiarão diretamente três segmentos principais; os fabricantes, no desenvolvimento e na solicitação de registro de novas tecnologias para esterilização; a Agência Nacional de Vigilância Sanitária, na adoção oficial de uma lista de exigências junto ao fabricante no momento de petição de registro de novos equipamentos; e os serviços de saúde, no consumo de novas tecnologias para esterilização.

Objective: To discuss criteria and methods that should ideally guide the evaluation of new sterilizing technologies. Method: Narrative review by means of search and interpretation of national legislation related to sterilization processes, as well as technical standards and documents that support constructive, functional, and safety aspects of sterilization technologies. Results: Topics relevant to the safety of sterilization processes, such as sterility testing, simulation of cycle under the worst load conditions, compatibility with sterile barrier systems, biocompatibility tests, process control, and economic evaluation, were discussed. Conclusion: The results will directly benefit three major segments: manufacturers while developing and requesting registration of new technologies; The National Sanitary Surveillance Agency when officially adopting a list of requirements with the manufacturer at the time of new equipment registration request; And health services, which will consume these new sterilization technologies.

Objetivo: Discurrir sobre criterios y métodos que deben guiar la evaluación de nuevas tecnologías para esterilización. Método: Estudio de revisión narrativa mediado por la búsqueda e interpretación de la legislación nacional relacionada a los procesos de esterilización, normas técnicas y documentos que basan los aspectos constructivos, funcionales y de la seguridad de las tecnologías para esterilización. Resultados: Fueron discutidos tópicos relevantes a la seguridad de los procesos de esterilización, como la prueba de esterilidad, simulación del ciclo en las peores condiciones de carga, compatibilidad con sistemas de barrera estéril, pruebas de bio-compatibilidad, control de procesos y evaluación económica. Conclusión: Los resultados beneficiarán directamente tres segmentos principales; los fabricantes, en el desarrollo y en la solicitud de registro de nuevas tecnologías para esterilización; la Agencia Nacional de Vigilancia Sanitaria, en la adopción oficial de una lista de exigencias junto al fabricante al momento de petición de registro de nuevos equipos; y los servicios de salud, en el consumo de nuevas tecnologías para esterilización.

Avaliação de danos em nasofibroscópio flexível desinfetado com ácido peracético / Assessment of damages in flexible naso-fibroscope disinfected with peracetic acid / Evaluación de daños en nasofibroscopio flexible desinfectado con ácido peracético

Objetivo: Avaliar a ocorrência de possíveis danos em nasofibroscópios causados pela desinfecção em ácido peracético. Método: Pesquisa aplicada. Três nasofibroscópios novos, submetidos à desinfecção com ácido peracético, foram acompanhados e fotografados em microscópio esteroscópio, ao longo de 18 meses, para avaliar o comportamento do polímero e da fibra do nasofibroscópio, relacionado ao uso desse desinfetante. Houve capacitação das equipes de enfermagem e médica com ênfase no manuseio correto e no processamento seguro das fibras. Resultados: As fibras foram analisadas e fotografadas regularmente, durante o período do estudo, totalizando 3.979 usos. Foi observado, em todas as fibras, craquelamento do excedente de material adesivo em torno da área de vedação das fibras, sem comprometimento funcional. Um nasofibroscópio flexível (NFF), após mais de 2.000 usos, apresentou fissuras superficiais na cobertura da ponta distal da fibra, sem, contudo, comprometer o teste de vedação. Conclusão: O ácido peracético, na formulação utilizada e no período estudado, não causou danos funcionais ou oxidação nos NFFs, apesar de o fabricante recomendar a desinfecção por solução de aldeídos.

Objective: To evaluate possible damages in naso-fiberscopes caused by disinfection with peracetic acid. Method: Applied research. Three new naso-fiberscopes subjected to disinfection with peracetic acid were monitored and photographed under stereoscopic microscope, for 18 months, to evaluate the behavior of the polymer and fiber naso-fiberscopes, related to the use of this disinfectant. Nurses and medical team were trained with emphasis on the correct handling and safe processing of the fibers. Results: Fibers were regularly analyzed and photographed during the study period, totaling 3,979 uses. In all fibers, cracking of the excess adhesive material around the fiber sealing area was observed, without functional impairment. After more than 2,000 uses, a flexible naso-fiberscope (FNF) developed surface cracks at the distal tip of the fiber cover, without however compromising the sealing test. Conclusion: The peracetic acid did not cause functional damage or oxidation in the FNFs, in the formulation used and during the study period, although the manufacturer recommends aldehydes solution to disinfect.

Objetivo: Evaluar la ocurrencia de posibles daños en nasofibroscopios causados por la desinfección en ácido peracético. Método: Estudio aplicado. Tres nasofibroscopios nuevos, sometidos a la desinfección con ácido peracético, fueron acompañados y fotografiados en microscopio esteroscopio, a lo largo de 18 meses, para evaluar el comportamiento del polímero y de la fibra del nasofibroscopio, relacionado al uso de ese desinfectante. Hubo capacitación de los equipos de enfermería y médica con énfasis en el manejo correcto y en el procesamiento seguro de las fibras. Resultados: Las fibras fueron analizadas y fotografiadas regularmente, durante el período del estudio, totalizando 3.979 usos. Fue observado, en todas las fibras, craquelado del excedente de material adhesivo alrededor del área de sellado de las fibras, sin comprometimiento funcional. Un nasofibroscopio flexible (NFF), tras más de 2.000 usos, presentó fisuras superficiales en la cobertura de la punta distal de la fibra, sin, con todo, comprometer el test de sellado. Conclusión: El ácido peracético, en la formulación utilizada y en el período estudiado, no causó daños funcionales u oxidación en los NFFs, a pesar del fabricante recomendar la desinfección por solución de aldehídos.

Economic evaluation of outpatient parenteral antimicrobial therapy: a systematic review.

INTRODUCTION: Outpatient parenteral antimicrobial therapy (OPAT) consists of providing antimicrobial therapy by parenteral infusion without hospitalization. A systematic review was performed to compare OPAT and hospitalization as health care modalities from an economic perspective. Areas covered: We identified 1455 articles using 13 electronic databases and manual searches. Two independent reviewers identified 35 studies conducted between 1978 and 2016. We observed high heterogeneity in the following: countries, infection site, OPAT strategies and outcomes analyzed. Of these, 88% had a retrospective observational design and one was a randomized trial. With respect to economic analyses, 71% of the studies considered the cost-consequences, 11% cost minimization, 6% cost-benefit, 6% cost-utility analyses and 6% cost effectiveness. Considering all 35 studies, the general OPAT cost saving was 57.19% (from -13.03% to 95.47%). Taking into consideration only high-quality studies (6 comparative studies), the cost saving declined by 16.54% (from -13.03% to 46.86%). Expert commentary: Although most studies demonstrate that OPAT is cost-effective, the magnitude of this effect is compromised by poor methodological quality and heterogeneity. Economic assessments of the issue are needed using more rigorous methodologies that include a broad range of perspectives to identify the real magnitude of economic savings in different settings and OPAT modalities.

Avaliação de tecnologias no centro cirúrgico, recuperação pós-anestésica e centro de material e esterilização / Technology assessment in the surgical center, post-anesthetic recovery, and central sterile supply department / Evaluación de la tecnología en el centro quirúrgico, recuperación pos anestésica y centro de material y esterilización

Introdução: As tecnologias em saúde são essenciais no centro cirúrgico (CC), na recuperação pós-anestésica (RPA) e no centro de material e esterilização (CME). Por isso, há grande pressão para sua incorporação tecnológica, o que demanda alto investimento e elevados custos operacionais. Objetivos: Refletir sobre os conceitos e princípios da avaliação de tecnologias em saúde (ATS) e discutir exemplos de sua aplicação no contexto do CC, da RPA e do CME. Resultados: A metodologia de ATS permite análise dos impactos clínicos, sociais e econômicos da incorporação de tecnologias, buscando melhorar a qualidade de atendimento e a saúde da população. O Ministério da Saúde tem patrocinado diversas iniciativas para difusão dos princípios de ATS que visam subsidiar os gestores para a tomada de decisão em incorporação tecnológica, tanto no âmbito do sistema de saúde quanto nas instituições hospitalares. Conclusão: A equipe de enfermagem deve, na tomada de decisões, apropriar-se da metodologia de ATS para análise crítica do real benefício das tecnologias do bloco operatório.

Introduction: Health technologies are essential in the surgical center (SC), in post-anesthetic recovery (PAR), and in the Central Sterile Supply Department (CSSD). Therefore, there is great pressure for the incorporation of technology in them, which demands high investment and high operating costs. Objectives: To propose a reflection on the concepts and principles of the health technology assessment (HTA) and to discuss examples of its application in the context of SC, PAR, and CSSD. Results: The HTA methodology allows analysis of clinical, social, and economic impacts of the incorporation of technologies, seeking to improve the quality of care and the health of the population. The Brazilian Ministry of Health has sponsored several initiatives to disseminate the principles of HTA that seek to support managers' decision-making process regarding technological resources, both within the public health system and in private hospitals. Conclusion: The nursing staff must, during the decision-making process, take ownership of the HTA methodology for critical analysis of the real benefit of the surgical center technologies.

Introducción: Las tecnologías de la salud son esenciales en el centro quirúrgico (CQ), en la recuperación post-anestésica (RPA) y en el centro de material y esterilización (CME). Por lo tanto, existe una gran presión para la incorporación de tecnología en ellos, lo que exige una alta inversión y altos costos de operación. Objetivos: Proponer una reflexión sobre los conceptos y principios de evaluación de las tecnologías de salud (ETS) y discutir ejemplos de su aplicación en el contexto de SC, PAR y MSC. Resultados: La metodología ETS permite analizar los impactos clínicos, sociales y económicos de la incorporación de tecnologías, buscando mejorar la calidad de la atención y la salud de la población. El Ministerio de Salud de Brasil ha patrocinado varias iniciativas para difundir los principios de la ETS que buscan apoyar el proceso de toma de decisiones de los gestores con respecto a los recursos tecnológicos, tanto dentro del sistema público de salud como en los hospitales privados. Conclusión: Durante el proceso de toma de decisiones, el personal de enfermería debe apropiarse de la metodología ETS para el análisis crítico del beneficio real de las tecnologías del centro quirúrgico.

Desinfetantes de alto nível alternativos ao glutaraldeído para processamento de endoscópios flexíveis / High-level disinfectants alternative to glutaraldehyde for processing flexible endoscopes / Desinfectantes de alto nivel alternativos al glutaraldehído para procesamiento de endoscopios flexibles

Endoscópios flexíveis são fundamentais em diversas especialidades médicas; em geral são termossensíveis, semicríticos e submetidos à desinfecção de alto nível. O glutaraldeído é largamente utilizado para este fim, devido à alta compatibilidade e baixo custo, porém, a tolerância de micobactérias e a toxicidade ocupacional pressionam por adoção de germicidas alternativos. Foi realizada revisão sistemática com objetivo de buscar evidências sobre a efetividade, toxicidade e potenciais danos causados aos endoscópios pelos germicidas, alternativos ao glutaraldeído, disponíveis no mercado brasileiro. Foram identificadas, em 13 bases eletrônicas, 822 publicações, entre 2008 e 2013. Destas, foram selecionados 23 estudos, considerando a melhor qualidade de evidência disponível. As publicações apontaram para a superioridade do ácido peracético e do ortoftalaldeído quanto à eficácia na desinfecção de alto nível. Somente o ortoftalaldeído apresentou evento adverso claramente relacionado à sua utilização. Não há evidências suficientes para afirmar que algum destes germicidas possui maior potencial de danos aos equipamentos.

Flexible endoscopes are fundamental in various medical specialities; in general they are heat-sensitive, semi-critical, and subject to high level disinfection. Glutaraldehyde is largely used for this purpose, due to its high compatibility and low-cost. However, its tolerance of mycobacteria and occupational toxicity lead to pressure being applied for the adoption of alternative germicides. A systematic review was undertaken aiming to seek evidence regarding the effectiveness, toxicity and potential harm caused to the endoscopes by those germicides which are alternative to glutaraldehyde and which are available on the market in Brazil. A total of 822 publications was identified in 13 electronic databases, between 2008 and 2013. Of these, 23 studies were selected, considering the best quality of evidence available. The publications point to the superiority of peracetic acid and of orthophthaldehyde regarding efficacy in high level disinfection. Only orthophthaldehyde presented an adverse event clearly related to its use. There is insufficient evidence to assert that any of these germicides has greater potential for harm to the equipment.

Fundamentales en diversas especialidades médicas, los endoscopios flexibles son, normalmente, termosensibles, semicríticos y sometidos a la desinfección de alto nivel. El glutaraldehído es muy utilizado para esa finalidad, en razón de la gran compatibilidad y bajo custo, pero la tolerancia de microbacterias y el hecho de ser o no tóxico de modo ocupacional presionan por la adopción de germicidas alternativos. Fue realizada revisión sistemática con el objetivo de buscar evidencias sobre la efectividad, toxicidad y potenciales daños causados a los endoscopios por los germicidas alternativos al glutaraldehído, disponibles en el mercado brasileño. Fueron identificadas, en 13 bases electrónicas, 822 publicaciones, entre 2008 y 2013. De estas, fueron seleccionados 23 estudios, considerando la mejor cualidad de evidencia disponible. Las publicaciones apuntaron para la superioridad del ácido peracético y del ortoftalaldehído cuanto a la eficacia en la desinfección de alto nivel. Solamente el ortoftalaldehído presentó evento adverso claramente relacionado a su utilización. No hay evidencias suficientes para afirmar que algun de estes germicidas presenta mayor potencial de daños a los equipos.

Construction of a manual of work processes and techniques from Centro de Dispensação de Medicamentos de Alto Custo (CEDMAC), Hospital de Clínicas, Unicamp.

The Centers for High Cost Medication (Centros de Medicação de Alto Custo, CEDMAC), Health Department, São Paulo were instituted by project in partnership with the Clinical Hospital of the Faculty of Medicine, USP, sponsored by the Foundation for Research Support of the State of São Paulo (Fundação de Amparo à Pesquisa do Estado de São Paulo, FAPESP) aimed at the formation of a statewide network for comprehensive care of patients referred for use of immunobiological agents in rheumatological diseases. The CEDMAC of Hospital de Clínicas, Universidade Estadual de Campinas (HC-Unicamp), implemented by the Division of Rheumatology, Faculty of Medical Sciences, identified the need for standardization of the multidisciplinary team conducts, in face of the specificity of care conducts, verifying the importance of describing, in manual format, their operational and technical processes. The aim of this study is to present the methodology applied to the elaboration of the CEDMAC/HC-Unicamp Manual as an institutional tool, with the aim of offering the best assistance and administrative quality. In the methodology for preparing the manuals at HC-Unicamp since 2008, the premise was to obtain a document that is participatory, multidisciplinary, focused on work processes integrated with institutional rules, with objective and didactic descriptions, in a standardized format and with electronic dissemination. The CEDMAC/HC-Unicamp Manual was elaborated in 10 months, with involvement of the entire multidisciplinary team, with 19 chapters on work processes and techniques, in addition to those concerning the organizational structure and its annexes. Published in the electronic portal of HC Manuals in July 2012 as an e-Book (ISBN 978-85-63274-17-5), the manual has been a valuable instrument in guiding professionals in healthcare, teaching and research activities.

Construção do manual de processos de trabalho e técnicas do Centro de Dispensação de Medicamentos de Alto Custo (CEDMAC) do Hospital de Clínicas da Unicamp / Construction of a manual of work processes and techniques from Centro de Dispensação de Medicamentos de Alto Custo (CEDMAC), Hospital de Clínicas, Unicamp

Os Centros de Medicação de Alto Custo (CEDMAC) da Secretaria de Saúde do Estado de São Paulo foram instituídos por projeto em parceria com Hospital das Clínicas da Faculdade de Medicina da USP, patrocinado pela Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP), visando à formação de rede estadual para atendimento integral dos pacientes indicados ao uso de agentes imunobiológicos nas doenças reumatológicas. O CEDMAC do Hospital de Clínicas da Universidade Estadual de Campinas (HC-Unicamp), implementado pela Disciplina de Reumatologia da Faculdade de Ciências Médicas, identificou a necessidade de padronização das condutas da equipe multidisciplinar, frente à especificidade da assistência, verificando a importância da descrição, em formato de manual, dos seus processos de trabalho e técnicas. O objetivo do estudo foi apresentar a metodologia de construção do manual do CEDMAC/HC-Unicamp como ferramenta institucional, visando à qualidade assistencial e administrativa. A metodologia para elaboração dos manuais no HC-Unicamp, desde 2008, tem como premissas ser participativo, multidisciplinar, focado em processos de trabalho, integrado às normas institucionais, com descrição objetiva e didática, formato padronizado e divulgação eletrônica. O Manual do CEDMAC/HC-Unicamp foi construído em dez meses, com o envolvimento de toda equipe multidisciplinar, tendo 19 capítulos sobre processos de trabalho e técnicas, além dos relativos à estrutura organizacional e anexos. Publicado no portal eletrônico dos Manuais HC, em julho de 2012, como e-book, com registro ISBN 978-85-63274-17-5. O Manual tem sido valioso instrumento na orientação dos profissionais da área nas atividades assistenciais, de ensino e pesquisa.

The Centers for High Cost Medication (Centros de Medicação de Alto Custo, CEDMAC), Health Department, São Paulo were instituted by project in partnership with the Clinical Hospital of the Faculty of Medicine, USP, sponsored by the Foundation for Research Support of the State of São Paulo (Fundação de Amparo à Pesquisa do Estado de São Paulo, FAPESP) aimed at the formation of a statewide network for comprehensive care of patients referred for use of immunobiological agents in rheumatological diseases. The CEDMAC of Hospital de Clínicas, Universidade Estadual de Campinas (HC-Unicamp), implemented by the Division of Rheumatology, Faculty of Medical Sciences, identified the need for standardization of the multidisciplinary team conducts, in face of the specificity of care conducts, verifying the importance of describing, in manual format, their operational and technical processes. The aim of this study is to present the methodology applied to the elaboration of the CEDMAC/HC-Unicamp Manual as an institutional tool, with the aim of offering the best assistance and administrative quality. In the methodology for preparing the manuals at HC-Unicamp since 2008, the premise was to obtain a document that is participatory, multidisciplinary, focused on work processes integrated with institutional rules, with objective and didactic descriptions, in a standardized format and with electronic dissemination. The CEDMAC/HC-Unicamp Manual was elaborated in 10 months, with involvement of the entire multidisciplinary team, with 19 chapters on work processes and techniques, in addition to those concerning the organizational structure and its annexes. Published in the electronic portal of HC Manuals in July 2012 as an e-Book (ISBN 978-85-63274-17-5), the manual has been a valuable instrument in guiding professionals in healthcare, teaching and research activities.

Teriparatida no tratamento da osteoporose em mulheres na pós-menopausa atendidas pelo Sistema Único de Saúde / Teriparatide for the treatment of osteoporosis in postmenopausal women assisted by the Brazilian Public Health System

A osteoporose é doença sistêmica que se caracteriza por baixa massa óssea e deterioração da microarquitetura do tecido ósseo, o que aumenta o risco de fraturas. Existe vasto arsenal terapêutico para o seu tratamento. No entanto, no Estado de São Paulo, há demandas judiciais para obtenção de teriparatida. O fármaco estimula a formação de novo tecido ósseo e não está selecionado para uso no SUS.

Portal de manuais do Hospital de Clínicas da Unicamp: amplo acesso às informações institucionais / Portal of Work Manuals of Clinical Hospial of State University of Campinas (HC-UNICAMP): broad access to institutional information

Manuais de trabalho são instrumentos administrativos que permitem sistematizar atividades executadas por diferentes profissionais, estabelecer pontos de controle e mensuração de resultados. Visam reduzir a variedade de produtos ou serviços prestados, subsidiar o treinamento e supervisão dos procedimentos, diminuir o risco de eventos adversos, favorecer revisão dos processos.

Desenvolvimento de Sistema de Apoio à Regulação de Urgência e Emergência para região de Campinas / Development of a System for Supporting the Regulation of Urgency and Emergency in the Campinas Area

A regulação dos casos de urgência e emergência exige agilidade e eficácia. No Estado de São Paulo, esses casos são regulados pela Central de Regulação de Oferta de Serviços de Saúde (CROSS), localizada na capital, com profissionais reguladores, que enfrentam o desafio de se inteirarem das diferentes realidades do interior. A região de Campinas agrega 42 municípios com 103 serviços de saúde, gerando dúvidas no referenciamento dos casos, por falta informações relativas aos recursos. O objetivo do artigo é descrever a construção de um Sistema de Apoio à Regulação de Urgência e Emergência para Região de Campinas, por parceria entre o Hospital de Clínicas-Unicamp e o Departamento Regional de Saúde DRS-VII. Teve como premissas seguir a lógica de referenciamento pactuada e substituir o processo manual por sistema eletrônico de fácil manuseio, ágil, gratuito e compatível com qualquer computador. O sistema foi implantado, com êxito, na CROSS e instituições envolvidas, promovendo acesso às informações de forma prática e rápida, permitindo distribuição regular e correta dos casos aos serviços de saúde. Com esta experiência, a CROSS pretende desenvolver sistema semelhante para atender a todas as regiões do Estado de São Paulo.

[Cost analysis of reprocessing disposable forceps used in video-assisted surgery]. / Análise dos custos do reprocessamento de pinças de uso único utilizadas em cirurgia vídeo-assistida.

This study aimed to analyze the reprocessing costs of disposable forceps used in video-assisted surgery. The frequent reuse of these instruments is justified by their high cost. However, few studies have been carried out on this topic. The multiple case study method was applied in three hospitals in the State of São Paulo, using the observation and document analysis techniques. In case number one, the processing cost was R dollars 9.37, R dollars 6.59 for case number two and R dollars 3.31 for case number three. The low cost observed should be analyzed with caution, since it was observed that quality-control plays a role in the final cost. When the quality-control measures are adopted, the reprocessing costs jumped to R dollars 185.19 for case number one, R dollars 595.82 for case number two and to R dollars 363.10 for case number three.

[Calculation of the reprocessing costs of single-use tongs used in video-assisted surgeries]. / Cálculo dos custos do reprocessamento de pinças de uso único utilizadas em cirugía video-assistida.

The frequent reuse of disposable forceps instruments is justified by their high cost. However, few studies have been carried out on this topic. The objective of this study was to develop a methodological proposal for calculating the reprocessing costs for these instruments used in video-assisted surgery. A flowchart was developed for each phase of the reprocessing. This allowed subsequent identification of the cost components in terms of labor, materials and indirect expenses. From these data, a methodological proposal for cost calculation could be created, based on the Full Absorption Costing Method, including the spreadsheet for data collection.

Análise dos custos do reprocessamento de pinças de uso único utilizadas em cirurgia vídeo-assistida / Cost analysis of reprocessing disposable forceps used in video-assisted surgery

O trabalho objetivou analisar os custos do reprocessamento de pinças de uso único, utilizadas em cirurgia vídeo-assistida. O reuso freqüente desses artigos é justificado pelo alto custo, entretanto, poucos estudos foram desenvolvidos sob esse enfoque. Aplicou-se o método de estudo de casos múltiplos, em três instituições hospitalares do Estado de São Paulo, utilizando as técnicas da observação e análise documental. O custo do reprocessamento foi de R$ 9,37 no Caso n° 1, R$ 6,59 no Caso n° 2 e R$ 3,31 no Caso n° 3. O baixo custo verificado deve ser analisado com cautela, pois se verifica que o controle de qualidade tem pequena participação na composição do custo final. Quando todas as medidas de controle de qualidade são adotadas, o custo do reprocessamento passa a ser de R$ 185,19 no Caso n° 1, R$ 595,82 no Caso n° 2 e de R$ 363,10 no Caso n° 3.