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1.
Braz J Cardiovasc Surg ; 34(5): 588-595, 2019 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-31719010

RESUMO

OBJECTIVE: To evaluate the efficacy of triclosan-coated suture for the reduction of infection in saphenectomy wounds of patients undergoing coronary artery bypass graft (CABG) surgery. METHODS: A total of 508 patients who underwent saphenectomy in CABG surgery were included in a prospective, randomized, double-blind trial from February/2011 to June/2014. Patients were randomized into the triclosan-coated suture group (n= 251) and the conventional non-antibiotic suture group (n=257). Demographic (gender and age), clinical (body mass index, diabetes, and use of analgesics), and intraoperative (cardiopulmonary bypass and cross-clamp times) variables and those related to the saphenectomy wound (pain, dehiscence, erythema, infection, necrosis, and hyperthermia) were measured and analyzed. RESULTS: Of the 508 patients who underwent saphenectomy, 69.9% were males and 40.2% were diabetic. Thirty-three (6.5%) patients presented infection: 13 (5.3%) with triclosan and 20 (7.9%) with conventional suture (P=0.281). Among diabetic patients (n=204), triclosan suture was used in 45.1% with four cases of infection; conventional suture was used in 54.9% of them, with 11 cases of infection. Most patients (94.3%) underwent on-pump CABG. Wound pain was observed in 9.9% of patients with triclosan-coated suture and in 17.9% with conventional suture (P=0.011). Wound hyperthermia was found in 1.6% of patients with triclosan-coated suture and in 5.4% of those with conventional suture (P=0.028). CONCLUSION: Triclosan-coated suture shows lower infection rate in saphenectomy of patients undergoing CABG, although the differences were not statistically significant. Pain and wound hyperthermia were less frequent in patients with triclosan-coated sutures compared with conventional sutures.


Assuntos
Anti-Infecciosos Locais/uso terapêutico , Ponte de Artéria Coronária/métodos , Poliglactina 910/uso terapêutico , Veia Safena/cirurgia , Infecção da Ferida Cirúrgica/prevenção & controle , Técnicas de Sutura , Triclosan/uso terapêutico , Adulto , Idoso , Idoso de 80 Anos ou mais , Índice de Massa Corporal , Ponte de Artéria Coronária/efeitos adversos , Complicações do Diabetes , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Dor Pós-Operatória/prevenção & controle , Estudos Prospectivos , Reprodutibilidade dos Testes , Estatísticas não Paramétricas , Fatores de Tempo , Resultado do Tratamento
2.
Rev. bras. cir. cardiovasc ; 34(5): 588-595, Sept.-Oct. 2019. tab, graf
Artigo em Inglês | LILACS-Express | ID: biblio-1042049

RESUMO

Abstract Objective: To evaluate the efficacy of triclosan-coated suture for the reduction of infection in saphenectomy wounds of patients undergoing coronary artery bypass graft (CABG) surgery. Methods: A total of 508 patients who underwent saphenectomy in CABG surgery were included in a prospective, randomized, double-blind trial from February/2011 to June/2014. Patients were randomized into the triclosan-coated suture group (n= 251) and the conventional non-antibiotic suture group (n=257). Demographic (gender and age), clinical (body mass index, diabetes, and use of analgesics), and intraoperative (cardiopulmonary bypass and cross-clamp times) variables and those related to the saphenectomy wound (pain, dehiscence, erythema, infection, necrosis, and hyperthermia) were measured and analyzed. Results: Of the 508 patients who underwent saphenectomy, 69.9% were males and 40.2% were diabetic. Thirty-three (6.5%) patients presented infection: 13 (5.3%) with triclosan and 20 (7.9%) with conventional suture (P=0.281). Among diabetic patients (n=204), triclosan suture was used in 45.1% with four cases of infection; conventional suture was used in 54.9% of them, with 11 cases of infection. Most patients (94.3%) underwent on-pump CABG. Wound pain was observed in 9.9% of patients with triclosan-coated suture and in 17.9% with conventional suture (P=0.011). Wound hyperthermia was found in 1.6% of patients with triclosan-coated suture and in 5.4% of those with conventional suture (P=0.028). Conclusion: Triclosan-coated suture shows lower infection rate in saphenectomy of patients undergoing CABG, although the differences were not statistically significant. Pain and wound hyperthermia were less frequent in patients with triclosan-coated sutures compared with conventional sutures.

3.
J. coloproctol. (Rio J., Impr.) ; 39(3): 223-230, June-Sept. 2019. tab
Artigo em Inglês | LILACS-Express | ID: biblio-1040328

RESUMO

ABSTRACT Background: Colorectal cancer survival is better in hereditary nonpolyposis colorectal cancer patients than in sporadic colorectal cancer patients and even for hereditary nonpolyposis colorectal cancer with colorectal cancer is not consensual that extensive colectomy is preferable to partial colectomy. This study analyzes and compares the long-term results of these two groups of patients submitted to curative subtotal colectomy or total colectomy. Methods: Between 2002 and 2018, 68 patients with colorectal cancer without familial adenomatous polyposis were submitted to a total or subtotal colectomy in a single tertiary center. The patients were divided in two groups: hereditary nonpolyposis colorectal cancer patients (with Amsterdam criteria) and sporadic colorectal cancer patients (the others). The presence of Amsterdam criteria for hereditary nonpolyposis colorectal cancer and germline mutation for mismatch repair genes was confirmed by clinical records. Results and survival were analyzed following surgery. Results: We obtained a sporadic colorectal cancer group with 31 patients and a hereditary nonpolyposis colorectal cancer group with 37 patients. The two groups differ in age but not in gender, tumor stage or surgical morbidity. The overall survival and disease-free survival were good in both groups but even better for hereditary nonpolyposis colorectal cancer group with statistical significance when comparing the two groups. Conclusion: Total or subtotal colectomy for colorectal cancer provides a good survival. These surgical procedures should be considered the first option for colorectal cancer in young hereditary non polyposis colorectal cancer patients. In those cases, they provide good long-term results, avoiding the risk of metachronous colorectal cancer and the surveillance is restricted only to the remaining need for rectum.


RESUMO Introdução: A sobrevivência do cancro colorretal é melhor em pacientes com cancro colorretal hereditário não associado a polipose do que em pacientes com cancro colorretal esporádico. Mesmo em casos de cancro colorretal hereditário sem polipose, a preferência pela colectomia total em relação à parcial não é consensual na literatura. Este estudo analisa e compara os resultados a longo prazo destes dois grupos de pacientes submetidos à colectomia curativa subtotal ou total. Métodos: Entre 2002 e 2018, 68 pacientes com cancro colorretal sem polipose adenomatosa familiar foram submetidos a colectomia total ou subtotal em um único centro terciário. Os pacientes foram divididos em dois grupos: aqueles com cancro colorretal hereditário sem polipose (de acordo com os critérios de Amsterdão) e os com cancro colorretal esporádico (os demais). Os critérios de Amsterdão para cancro colorretal hereditário sem polipose e a presença de mutação germinativa para os genes de reparação de ADN foram confirmados por consulta dos registros clínicos. Os resultados e a sobrevivência foram analisados após a cirurgia. Resultados: No presente estudo, 31 pacientes foram incluídos no grupo de cancro colorretal esporádico e 37 no grupo de cancro colorretal hereditário sem polipose. Diferenças significativas foram observadas em relação à idade, mas não ao gênero, estadio do tumor ou morbilidade cirúrgica. A sobrevivência global e a sobrevivência livre de doença foram boas em ambos os grupos, mas os resultados foram ainda melhores no grupo de cancro colorretal hereditário sem polipose, com significado estatístico. Conclusão: A colectomia total ou a colectomia subtotal para o cancro colorretal proporcionam uma boa sobrevivência e devem ser consideradas a primeira opção de tratamento em pacientes jovens com cancro colorretal hereditário sem polipose. Nestes pacientes, uma cirurgia cólica mais extensa permite a obtenção de bons resultados a longo prazo; reduz o risco de cancro colorretal metácrono e restringe a vigilância endoscópica ao reto remanescente.

4.
J. bras. econ. saúde (Impr.) ; 11(2): 112-118, Agosto/2019.
Artigo em Português | LILACS, ECOS | ID: biblio-1021040

RESUMO

Objetivo: Determinar a factibilidade econômica da técnica de cateterismo central em veia jugular interna guiada pelo ultrassom comparado à técnica-padrão, sob a perspectiva pagadora do Sistema Único de Saúde brasileiro. Métodos: Análise de custo-efetividade utilizando modelo de árvore de decisão sob uma população de pacientes adultos em um cenário de uma unidade terciária. Os custos diretos dos materiais e procedimentos foram estimados utilizando bancos de registros de compras nacionais. Os desfechos foram a ocorrência ou não da punção arterial acidental grave (principal complicação associada ao sítio de punção). Também foram conduzidas análises de sensibilidade determinística e probabilística, bem como curva de aceitabilidade. Resultados: A intervenção onerou o modelo em R$ 53,81. A razão de custo-efetividade incremental calculada foi de R$ 17.936,66 por complicação grave evitada e a curva de aceitabilidade evidenciou que a técnica é custo-efetiva sob uma intenção de pagar de R$ 18.125,00. Na análise de sensibilidade probabilística, 63,6% das simulações mostraram-se custo-efetivas. Conclusão: A intervenção é custo-efetiva, contribuindo para a redução das complicações graves, e o resultado pode proporcionar segurança para tomadas de decisões quanto à padronização do uso da ultrassonografia como orientador do procedimento.


Objective: To determine the economic feasibility of the central catheterization technique in the internal jugular vein guided by the ultrasound compared to the standard technique, under the perspective of the Brazilian Unified Health System. Methods: Cost-effectiveness analysis using decision tree model under a population of adult patients in a tertiary unit scenario. The direct costs of the materials and procedures were estimated using banks of national procurement records. The outcomes were the occurrence or not of severe accidental arterial puncture (the main complication associated with the puncture site). Analyzes of deterministic and probabilistic sensitivity were also conducted, as well as acceptability curve. Results: The intervention cost the model in R$ 53.81. The calculated incremental cost-effectiveness ratio was R$ 17,936.66 due to a serious complication avoided and the acceptability curve showed that the technique is cost-effective under an intention to pay R$ 18,125.00. In the probabilistic sensitivity analysis, 63.6% of the simulations were cost-effective. Conclusion: The intervention is cost-effective, contributing to the reduction of severe complications and the result can provide security for decision making regarding the standardization of the use of ultrasonography as a guideline of the procedure


Assuntos
Humanos , Cateterismo Venoso Central , Ultrassonografia de Intervenção , Avaliação de Custo-Efetividade , Veias Jugulares
5.
BMC Infect Dis ; 19(1): 750, 2019 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-31455279

RESUMO

BACKGROUND: Dengue is an arbovirus that has rapidly spread worldwide, and the incidence of dengue has greatly increased in recent decades. The actual numbers of dengue cases are underreported, and many cases are not classified correctly. Recent estimates indicate that 390 million dengue infections occur per year (95% CI, 284-528 million), of which 96 million (67-136 million) are symptomatic infections of any severity. One of the goals of the World Health Organization is to reduce dengue mortality by 50% by the year 2020. The use of a vaccine can be an important strategy to achieve this goal. Vaccines for dengue are in various stages of development; in Brazil, only one commercial formulation is available (CYD-TDV), which was developed by Sanofi Pasteur. METHODS: To evaluate the efficacy of Dengue vaccine, a systematic review with a meta-analysis was conducted using randomized controlled clinical trials published between 2000 and 2017 that were identified in the MEDLINE databases via PubMed, LILACS, Cochrane Library, and EMBASE. The selection was performed by two reviewers independently, with disagreements resolved by a third reviewer. RESULTS: Seven clinical trials were included, with a total of 36,371 participants (66,511 person-years) between the ages of 2 and 45 years. The meta-analysis using the random-effects model estimated the efficacy of the vaccine at 44%, with a range from 25 to 59% and high heterogeneity (I2 = 80.1%). The serotype-stratified meta-analysis was homogeneous, except for serotype 2, with the heterogeneity of 64.5%. Most of the vaccinated individuals had previous immunity for at least one serotype, which generated safety concerns in individuals without previous immunity. CONCLUSIONS: Compared with other commercially available vaccines, the dengue vaccine showed poor efficacy.


Assuntos
Vacinas contra Dengue/farmacologia , Dengue/prevenção & controle , Adolescente , Adulto , Brasil , Criança , Pré-Escolar , Dengue/imunologia , Vacinas contra Dengue/imunologia , Humanos , Pessoa de Meia-Idade , Ensaios Clínicos Controlados Aleatórios como Assunto , Sorogrupo
6.
Value Health Reg Issues ; 20: 149-153, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31445328

RESUMO

BACKGROUND: Cryoablation is a new technology for ablation of atrial fibrillation (AF), effective and safe when compared with standard radiofrequency (RF) ablation. Nevertheless, the economic impact of its incorporation is unknown, especially considering the public health system of a developing country. This study analyzed the budget impact of cryoablation incorporation for treatment of paroxysmal AF in the Brazilian public health system. METHODS: The budget impact was calculated as the cost difference between the current scenario (RF ablation guided by electroanatomic mapping) and the new scenario (cryoablation). The cost of each intervention was obtained by multiplying the price of a single procedure by the number of candidates for it. Other technologies (RF ablation guided by intracardiac echocardiography or with a nonirrigated catheter) were considered in a sensitivity analysis. RESULTS: The budget impact showed savings of $43 097 096.84 with cryoablation. In the sensitivity analysis, cryoablation resulted in cost savings compared with RF ablation guided by intracardiac echocardiography, whereas in comparison to RF ablation with the nonirrigated catheter, cryoablation was more expensive. A market share assessment, performed using an incorporation rate of 3% per year, indicated savings of approximately $800 000 per 5 years. CONCLUSIONS: Cryoablation of AF resulted in cost savings compared with the current scenario (RF ablation guided by electroanatomic mapping). When alternative technologies were considered, cryoablation was more expensive than RF ablation with a nonirrigated catheter, but it also resulted in savings compared with RF ablation guided by intracardiac echocardiography. Overall, cryoablation of AF may reduce expenditures in the Brazilian public health system.

7.
Artigo em Inglês | MEDLINE | ID: mdl-31250676

RESUMO

Background: Information about how individual characteristics influence preferences about health states valuation are scare. The purpose of this study is to identify predictors of the EuroQol with five dimensions and 3 levels - EQ 5D-3L time-tradeoff valuation. Research design and methods: We analyzed a dataset with a probabilistic sample of 5774 individuals. Two sets of independent variables for testing were defined: a set of forced variables composed of 10 dummy variables for EuroQol levels 2 and 3 of each health dimension and a set of demographic variables. Results: The strongest predictors of health valuation were the self-reported health state and the 'belief in God,' with 0.11 utility units for each VAS unit and 0.11 utility units for 'yes' for the 'belief in God' parameter.Age had an impact of 0.0190 utility units for each 10-year interval. Having children had a small effect (0.0338 utility units for 'yes'), and the other characteristics studied had no significant impact. Conclusions: People who believe in God (or the afterlife) and those of greater age seem to be less prone to forgoing life years to avoid health problems. In our sample, older individuals valued health state higher than younger individuals.

8.
Rev Esp Enferm Dig ; 111(6): 488-490, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31140287

RESUMO

Hemangiolymphangioma is a very rare benign vascular tumor that affects the gastrointestinal tract in less than 1% of cases. We present the case of an asymptomatic 52-year-old female referred for endoscopic colorectal cancer screening. A sub-epithelial pediculated polypoid lesion in the splenic angle of the colon was identified. An endoscopic ultrasonography with a miniprobe was performed, which identified an anechoic lesion in the submucosal layer. Surgery was performed and the histologic findings were compatible with two hemangiolymphangioma lesions. This is one of the few cases reported in the literature of hemangiolymphangioma diagnosed by miniprobe endoscopic ultrasonography and the first to describe two lesions in the same patient.

9.
Artigo em Inglês | MEDLINE | ID: mdl-31106611

RESUMO

Objectives: To evaluate health-related-quality-of-life and derive health-state-utility (HSU) from breast cancer patients, before and after routine therapy at a Brazilian reference public cancer center. Methods: In a prospective cohort study, a consecutive sample of outpatients newly diagnosed with breast cancer was submitted to two interviews (baseline, 6-month) to complete EQ-5D-3L/VAS and EORTC-QLQ-C30/BR23 questionnaires. Demographic and clinical information was reviewed from medical records. Results: For 196 patients, EQ-5D domains of pain/discomfort and anxiety/depression were mainly affected, but partially improved overtime, while mobility/usual activities/self-care worsened after therapy. EORTC-QLQ-C30/BR23 scales mostly affected were emotional functioning, insomnia, pain, sexual enjoyment and future self-health perspective at baseline, while financial difficulties, insomnia, fatigue and therapy side-effects at follow-up. Overtime mean scores were 71.4 (95%CI68.5-74.4) and 76.1 (95%CI73.3-78.8) for EQ-5D-VAS, and 0.712 (95%CI0.686-0.737) and 0.732 (95%CI0.707-0.757) for HSU. HSU was 0.689 (95%CI0.648-0.730) in stages III-IV, and 0.692 (95%CI0.652-0.731) under two/three chemotherapy regimens. Conclusion: In a context of impairments in emotional functioning, sexual enjoyment, symptoms burden, and poor future self-health perspective, breast cancer produced a mean HSU of 0.712. After routine care, there was a small improvement in quality of life, with lower HSU particularly in advanced disease and multiple chemotherapy regimens.

10.
J. bras. econ. saúde (Impr.) ; 11(1): 73-86, Abril/2019.
Artigo em Português | LILACS, ECOS | ID: biblio-1005734

RESUMO

Objetivos: Fazer uma proposta para atualização da diretriz com maior padronização dos métodos e realizar análise crítica dos pontos considerados mais relevantes para a formulação de um estudo de análise de impacto orçamentário. Métodos: Revisão da literatura, extração de dados, seleção de etapas básicas para a execução de uma análise de impacto orçamentário, apresentação dos resultados para debate com especialistas. Resultados: Foram recuperados 1.215 títulos, dos quais seis foram elegíveis para síntese qualitativa e definição da estrutura analítica para projetar e construir um modelo de impacto orçamentário: perspectiva da análise; estimar a população-alvo; horizonte temporal; taxa de incorporação da nova tecnologia ao mercado (market share); estimar os custos; fontes de dados; taxa de desconto e apresentação do resultado final. Recomendações: perspectiva da análise deve ser a do pagador; estimativa da população elegível a partir de dados epidemiológicos oriundos do Instituto Brasileiro de Geografia e Estatística (IBGE) preferencialmente; horizonte temporal de dois a cinco anos; buscar a taxa de incorporação em órgãos oficiais; custos diretos estimados a partir da autorização de internação hospitalar e portais de compras governamentais; fontes de dados oficiais e apresentação de resultados em tabela e o impacto incremental ano a ano. Conclusões: Avaliação de Impacto Orçamentário é uma ferramenta feita para auxiliar o gestor, que prima por tentar garantir equilíbrio fiscal ao sistema diante das inúmeras demandas da sociedade. Essa característica é fundamental no mundo atual, onde transparência e a responsabilidade nos gastos são exigências cada vez mais frequentes por parte do cidadão.


Objectives: To make a proposal to update the guideline with a standardization of the methods and do a critical analysis of the points considered most relevant to the formulation of a study of Budget Impact Analysis. Methods: Literature review, data extraction, selection of basic steps to do a budget impact analysis, presentation of results for discussion with experts. Results: 1,215 titles were retrieved, of which 6 were eligible for qualitative synthesis and definition of the analytical framework to design and build a model of budgetary impact: analysis perspective; estimate the target population; temporal horizon; rate of incorporation of the new technology into the market ("market share"); estimate costs; data sources; discount rate and presentation of the final result. Recommendations: the perspective of the analysis should be that of the payer; the estimation of the eligible population from epidemiological data from the Brazilian Institute of Geography and Statistics (IBGE) preferably; time horizon of 2 to 5 years; rate of incorporation with official data; direct costs estimated from hospital admission authorization and government shopping sites; official data sources and presentation of results in table and incremental impact year by year. Conclusions: Budget Impact Analysis is a tool designed to assist the manager, that trying to guarantee a fiscal balance to the system against the innumerable demands of society. This characteristic is fundamental in today's world where transparency and responsibility in spending are increasingly frequent demands on the part of the citizen.


Assuntos
Humanos , Sistema Único de Saúde , Tecnologia Biomédica
11.
Rev Bras Epidemiol ; 22: e190006, 2019 Mar 14.
Artigo em Português, Inglês | MEDLINE | ID: mdl-30892469

RESUMO

INTRODUCTION: The lack of availability of the Therasuit Method by the Unified Health System associated with its high cost has led to the prosecution of this treatment. The study aimed to outline the profile of this judicialization, as well as to estimate the direct costs resulting from compliance with the deferred judicial decisions. METHOD: Weanalyzed the cases submitted to the Court of Justice of Rio de Janeiro between January 2013 and January 2017, in which the Therasuit Method was applied. Demographic, clinical, advocacy and legal data were extracted, as was the timing of the court's decision and the required technology budgets. RESULTS: Atotal of 11 processes was analyzed. The authors had a mean age of 6.8 years and a median of 6, the majority being male, and resident in thestate capital. Quadriparesis was the most reported condition. The gratuity of justice was requested by all, and the Public Defender's Officewas used by 9 of the 11 processes. The judicial decisions at first instance were considered. In all of processes there was application of the legal tool called guardianship. The time of the judicial decision was on average of 266.5 days with a median of 35.5. The deferral index was 90%, totaling an annual direct cost of R$501,894.09. DISCUSSION: The judicialization of this treatment can cause an unforeseen displacement of public funds, transgressing the principles of equity and the integrality of Unified Health System. CONCLUSION: It was observed a high rate of deferred processes, resulting in a high cost spent by the Public Power to attend a small portion of patients.


Assuntos
Paralisia Cerebral/terapia , Custos de Cuidados de Saúde/legislação & jurisprudência , Acesso aos Serviços de Saúde/legislação & jurisprudência , Programas Nacionais de Saúde/legislação & jurisprudência , Direitos do Paciente/legislação & jurisprudência , Modalidades de Fisioterapia/instrumentação , Adolescente , Brasil , Paralisia Cerebral/economia , Criança , Pré-Escolar , Feminino , Acesso aos Serviços de Saúde/economia , Humanos , Masculino , Programas Nacionais de Saúde/economia , Modalidades de Fisioterapia/economia
12.
Rev. bras. epidemiol ; 22: e190006, 2019. tab
Artigo em Português | LILACS-Express | ID: biblio-990727

RESUMO

RESUMO: Introdução: O Método Therasuit possui alto custo e não é disponibilizado pelo Sistema Único de Saúde, o que tem ocasionado a judicialização desse tratamento. O estudo visou traçar o perfil dessa judicialização, bem como estimar os custos diretos decorrentes do cumprimento das decisões judiciais deferidas. Método: Foram analisados processos submetidos ao Tribunal de Justiça do Rio de Janeiro entre janeiro de 2013 e janeiro de 2017, no qual foi solicitado o Método Therasuit. Os dados demográficos, clínicos, advocatícios e jurídicos foram extraídos, assim como o tempo da decisão judicial e os orçamentos da tecnologia requerida. Resultados: O total de 11 processos foi analisado. Os autores tinham uma média de idade de 6,8 anos e mediana de 6, sendo a maioria do sexo masculino e residentes na capital do estado. A quadriparesia foi a condição mais relatada. A gratuidade de justiça foi solicitada por todos, e a Defensoria Pública foi utilizada em 9 dos 11 processos analisados. Foram consideradas as decisões judiciais em primeira instância. O tempo da decisão judicial foi em média de 266,5 dias com uma mediana de 35,5. Em todos houve requerimento da ferramenta jurídica tutela antecipada. O índice de deferimento foi de 90%, totalizando um custo direto anual de R$501.894,09. Discussão: A judicialização desse tratamento pode ocasionar um deslocamento não previsto de verba pública, podendo impactar nos princípios da equidade e na integralidade do Sistema Único de Saúde. Conclusão: Constatou-se elevada taxa de processos deferidos, acarretando um alto custo despendido pelo Poder Público para atender a uma pequena parcela de pacientes.


ABSTRACT: Introduction: The lack of availability of the Therasuit Method by the Unified Health System associated with its high cost has led to the prosecution of this treatment. The study aimed to outline the profile of this judicialization, as well as to estimate the direct costs resulting from compliance with the deferred judicial decisions. Method: Weanalyzed the cases submitted to the Court of Justice of Rio de Janeiro between January 2013 and January 2017, in which the Therasuit Method was applied. Demographic, clinical, advocacy and legal data were extracted, as was the timing of the court's decision and the required technology budgets. Results: Atotal of 11 processes was analyzed. The authors had a mean age of 6.8 years and a median of 6, the majority being male, and resident in thestate capital. Quadriparesis was the most reported condition. The gratuity of justice was requested by all, and the Public Defender's Officewas used by 9 of the 11 processes. The judicial decisions at first instance were considered. In all of processes there was application of the legal tool called guardianship. The time of the judicial decision was on average of 266.5 days with a median of 35.5. The deferral index was 90%, totaling an annual direct cost of R$501,894.09. Discussion: The judicialization of this treatment can cause an unforeseen displacement of public funds, transgressing the principles of equity and the integrality of Unified Health System. Conclusion: It was observed a high rate of deferred processes, resulting in a high cost spent by the Public Power to attend a small portion of patients.

13.
J. bras. econ. saúde (Impr.) ; 10(3): 298-301, dez. 2018.
Artigo em Português | LILACS, ECOS | ID: biblio-986483

RESUMO

As avaliações econômicas são elaboradas com base em modelos teóricos que procuram representar a realidade. Seu objetivo é a alocação eficiente dos recursos disponíveis para a saúde, sendo, portanto, uma exigência para a incorporação de tecnologias em saúde. A literatura sobre falhas e diferenças de métodos que mudem os resultados de estudos de custo-efetividade é escassa. Neste artigo, foi utilizado o desenho de estudo de caso para ilustrar como a escolha de parâmetros e a definição de pressupostos incorporados aos modelos de análise de decisão podem influenciar os resultados e as conclusões das análises de custo-efetividade e custo-utilidade e, por consequência, a alocação de recursos de saúde. Para tanto, pautamo-nos na discussão de três casos, nos quais observamos que a escolha da estimativa da prevalência, da especificidade de um teste e do horizonte temporal gerou resultados de custo-efetividade divergentes. O que motiva as diferentes escolhas pode ser muito diverso; alertamos para o risco das escolhas baseadas em interesses de promover a nova tecnologia


Economic evaluations are based on theoretical models that seek to represent reality. Its objective is the efficient allocation of resources available for health, and it is therefore a requirement for the incorporation of health technologies. There is scarce literature on flaws and methodological choices that can change the results of cost-effectiveness analyses. In this article, we discuss how the choice of parameters and the definition of assumptions incorporated into decision analysis models can influence the results and conclusions of the cost-effectiveness and cost-utility analyzes and, consequently, the allocation of health resources. In order to do so, we discuss three cases, where we observed that the choice of prevalence estimation, test specificity and the time horizon generated divergent cost-effectiveness results. What motivates the different choices can be very diverse; we here warn of the risk of interest-based choices of promoting a new technology


Assuntos
Humanos , Avaliação da Tecnologia Biomédica , Avaliação em Saúde , Análise Custo-Benefício
14.
Value Health Reg Issues ; 17: 88-93, 2018 May 10.
Artigo em Inglês | MEDLINE | ID: mdl-29754016

RESUMO

OBJECTIVES: To assess the measurement equivalence of the original paper version of an adapted tablet version of the EuroQol five-dimensional questionnaire (EQ-5D). METHODS: A randomly selected sample of 509 individuals aged 18 to 64 years from the general population responded to the EQ-5D at two time points separated by a minimum interval of 24 hours and were allocated to one of the following groups: test-retest group (tablet-tablet) or crossover group (paper-tablet and tablet-paper). Agreement between methods was determined using the intraclass correlation coefficient (ICC) and the κ coefficient. RESULTS: In the crossover group, the following ICC values were obtained: 0.76 (confidence interval [CI] 0.58-0.89) for EQ-5D scores and 0.77 (CI 0.68-0.84) for visual analogue scale in subjects responding first to the tablet version; 0.83 (CI 0.75-0.89) for EQ-5D scores and 0.75 (CI 0.67-0.85) for visual analogue scale in subjects responding first to the paper version. In the test-retest group, the ICC was 0.85 (CI 0.73-0.91) for EQ-5D scores and 0.79 (CI 0.66-0.87) for visual analogue scale. The κ values were higher than 0.69 in this group. The internal consistencies of the paper and tablet methods were similar. CONCLUSIONS: The paper and tablet versions of the EQ-5D are equivalent. Test-retest and crossover agreement was high and the acceptability of the methods was similar among individuals.

15.
J. bras. econ. saúde (Impr.) ; 10(1): 64-74, Abr. 2018.
Artigo em Português | LILACS, ECOS | ID: biblio-884396

RESUMO

Objetivo: Identificar os vários critérios utilizados por agências e órgãos governamentais internacionais na Avaliação de Tecnologias em Saúde (ATS). Métodos: Foi realizada uma revisão rápida com busca estruturada na base de dados Medline (via PubMed) e Lilacs complementada por busca na literatura cinzenta, sem restrição de idioma. Incluíram-se estudos da área de saúde que descreviam critérios e que utilizaram o método MCDA (Análise de Decisão Multicritérios) na ATS. Excluíram-se estudos que avaliaram apenas uma tecnologia específica ou contexto restrito. Os critérios foram agregados e sumarizados conforme opinião de especialistas em ATS. Resultados: Foram identificadas 3.746 publicações, sendo 27 selecionadas. Os critérios extraídos foram categorizados e seus respectivos atributos foram listados. Dez categorias foram apresentadas: benefício e risco da intervenção (4 critérios); impacto da doença (4 critérios); impacto econômico (5 critérios); contexto terapêutico da intervenção (4 critérios); qualidade e incerteza da evidência (4 critérios); implementação da intervenção (5 critérios); benefícios para a sociedade (5 critérios); benefícios para o sistema de saúde público (5 critérios); benefícios para a indústria (1 critério); e outros (3 critérios). Os atributos mais prevalentes foram: custo-efetividade; segurança e tolerabilidade; impacto orçamentário para o sistema/plano de saúde; gravidade da doença; equidade; efetividade; custo. Conclusões: Os órgãos decisores utilizam grande variedade de critérios para o MCDA, refletindo visões e valores diferentes entre as culturas. O estudo fornece informação para discussão no contexto brasileiro de uma lista mais ampla e possível padronização de critérios a serem utilizados na tomada de decisão pública ou privada sobre a incorporação de novas tecnologias.


Objective: To identify the various criteria used by international government agencies and bodies in Health Technology Assessment (HTA). Methods: A rapid review was conducted with a structured search in the Medline database (via PubMed) and Lilacs supplemented by a search in the gray literature, without a restriction of language. Inclusion criteria were studies in health context, describing the criteria and using the MCDA (Multicriteria Decision Analysis) method in HTA. We excluded studies that assessed only one specific technology or restricted context. The criteria were aggregated and summarized according to the opinion of HTA experts. Results: A total of 3,746 publications were identified, of which 27 were selected. The extracted criteria were categorized, and their respective attributes were listed. Ten categories were presented: benefit and risk of the intervention (4 criteria); impact of disease (4 criteria); economic impact (5 criteria); therapeutic context of the intervention (4 criteria); quality and uncertainty of evidence (4 criteria); implementation of the intervention (5 criteria); benefits for society (5 criteria); benefits to the public health system (5 criteria); benefits for industry (1 criterion); and others (3 criteria). The most prevalent attributes were: cost-effectiveness; safety and tolerability; budget impact for the health system/plan; disease severity; equity; effectiveness; cost. Conclusions: Decision-makers use a wide variety of criteria for the MCDA, reflecting different views and values across cultures. The study provides information for a discussion in the Brazilian context of a broader list and a possible standardization of criteria to be used in public or private decision making on the incorporation of new technologies.


Assuntos
Humanos , Tomada de Decisões , Técnicas de Apoio para a Decisão , Avaliação da Tecnologia Biomédica
16.
J. coloproctol. (Rio J., Impr.) ; 38(1): 30-36, Jan.-Mar. 2018. tab
Artigo em Inglês | LILACS-Express | ID: biblio-894026

RESUMO

ABSTRACT Background: Functional results after restorative proctocolectomy for ulcerative colitis and familial adenomatous polyposis are variable. We assessed functional results in patients with ileal pouch anal anastomosis and evaluated potential factors associated with poor functional results. Methods: Retrospective cohort study of 38 patients who were submitted to a restorative proctocolectomy with ileal pouch anal anastomosis, in the context of ulcerative colitis and familial adenomatous polyposis, in at tertiary referral center, in the period between 1993 and 2013. Clinical records were analyzed and telephone interviews with protocoled questionnaire to 32 patients (12 ulcerative colitis, 20 familial adenomatous polyposis) were performed. Pouch functional results were also evaluated based in the Oresland score. The functional results were analyzed at four points of the patient outcome. Results: In 25 patients were performed restorative proctocolectomy with ileal pouch anal anastomosis and in 7 patients total colectomy preceded protectomy with ileal pouch anal anastomosis. Protective ileostomy was performed in all patients. There was no mortality and post-operative complications related with the pouch was 12.5% but treated conservatively. The mean follow-up was 13.2 years. Pouch failure occurs in 9.4% (2 in familial adenomatous polyposis and 1 in ulcerative colitis). Familial adenomatous polyposis patients achieved the best outcome but the outcome was acceptable in both groups. The median Oresland score was good with small variations over the years, although the best score being reached at 5 years after the surgery. Conclusions: The long-term results in patients undergoing restorative proctocolectomy with ileal pouch anal anastomosis were good in both groups, although better in familial adenomatous polyposis. In both, the best score of functional results seems to be reached at 5 years after surgery.


RESUMO Introdução: Os resultados funcionais após proctocolectomia restauradora em casos de colite ulcerativa e polipose adenomatosa familiar são variáveis. Avaliamos os resultados funcionais em pacientes com anastomose ileoanal e bolsa ileal bem como os fatores potenciais associados a resultados funcionais fracos. Métodos: Estudo retrospectivo de coorte com 38 pacientes submetidos a proctocolectomia restauradora com anastomose ileoanal e bolsa ileal, no contexto de colite ulcerativa e polipose adenomatosa familiar, em um centro de referência terciário, no período entre 1993 e 2013. Analisamos os registos clínicos e realizamos entrevistas telefónicas com um questionário protocolado a 32 pacientes (12 colite ulcerativa, 20 polipose adenomatosa familiar). Também foram avaliados os resultados funcionais da bolsa, com base no escore de Oresland. Os resultados funcionais foram analisados em quatro pontos do desfecho de cada paciente. Resultados: Em 25 pacientes foi realizada proctocolectomia restauradora com anastomose ileoanal e bolsa ileal, e em 7 pacientes uma colectomia total precedeu a protectomia com anastomose ileoanal e bolsa ileal. Todos os pacientes foram submetidos a uma ileostomia protetora. Não ocorreram óbitos e as complicações pós-operatórias relacionadas com a bolsa chegaram a 12,5%, mas foram tratadas conservadoramente. O seguimento médio foi de 13,2 anos. Ocorreu defeito na bolsa em 9,4% (2 em polipose adenomatosa familiar e 1 em colite ulcerativa). Os pacientes com polipose adenomatosa familiar obtiveram o melhor resultado; contudo, em ambos os grupos o resultado foi considerado aceitável. A mediana do score de Oresland foi boa, tendo sido observadas pequenas variações ao longo dos anos, embora o melhor score tenha sido verificado 5 anos após a cirurgia. Conclusões: A longo prazo, os resultados para os pacientes submetidos a proctocolectomia restauradora com anastomose ileoanal e bolsa ileal foram bons em ambos os grupos, embora tenham sido considerados melhores nos pacientes com polipose adenomatosa familiar. Nos dois grupos, o melhor escore de resultados funcionais parece ser alcançado por volta dos 5 anos após a cirurgia.

17.
Pharmacoeconomics ; 36(2): 161-173, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29139001

RESUMO

In Brazil, inclusion and exclusion of health technologies within the Unified Health System (SUS) is the responsibility of the National Committee for Health Technology Incorporation (CONITEC). A recent Cochrane systematic review demonstrated that intramuscular interferon beta 1a (IFN-ß-1a-IM) was inferior to the other beta interferons (IFN-ßs) for multiple sclerosis (MS). As a result, CONITEC commissioned an analysis to review possible disinvestment within SUS. The objective of this paper is to describe the disinvestment process for IFN-ß-1a-IM in Brazil. The first assessment comprised a literature review and mixed treatment comparison meta-analysis. The outcome of interest was the proportion of relapse-free patients in 2 years. This analysis confirmed the inferiority of IFN-ß-1a-IM. Following this, CONITEC recommended disinvestment, with the decision sent for public consultation. More than 3000 contributions were made on CONITEC's webpage, most of them against the preliminary decision. As a result, CONITEC commissioned a study to assess the effectiveness of IFN-ß-1a-IM among Brazilian patients in routine clinical care. The second assessment involved an 11-year follow-up of a non-concurrent cohort of 12,154 MS patients developed by deterministic-probabilistic linkage of SUS administrative databases. The real-world assessment further demonstrated that IFN-ß-1a-IM users had a statistically higher risk of treatment failure, defined as treatment switching or relapse treatment or death, with the assessment showing that IFN-ß-1a-IM was inferior to the other IFN-ßs and to glatiramer acetate in both direct and indirect analysis. In the drug ranking with 40,000 simulations, IFN-ß-1a-IM was the worst option, with a success rate of only 152/40,000. Following this, CONITEC decided to exclude the intramuscular presentation of IFN-ß from the current MS treatment guidelines, giving patients who are currently on this treatment the option of continuing until treatment failure. In conclusion, we believe this is the first example of this new disinvestment process in action, providing an exemplar for other treatments in Brazil as well as other countries.

18.
Physis (Rio J.) ; 28(2): e280209, 2018. tab, graf
Artigo em Português | LILACS | ID: biblio-955473

RESUMO

Resumo Recentemente, inúmeras campanhas nacionais promovidas por hospitais, sociedades médicas e outras organizações têm estimulado o rastreamento do câncer de próstata, em consonância com iniciativas mundiais conhecidas como Novembro Azul. Essas campanhas aconselham a utilização do toque retal acompanhado da dosagem sérica do antígeno prostático específico em faixas etárias definidas. A motivação seria a detecção precoce da neoplasia, com redução de sua mortalidade e das complicações e impactos associados ao seu tratamento. A dosagem do PSA para fins de rastreamento é alvo de grande controvérsia, visto que a maioria dos tumores detectados pelo rastreamento é de evolução lenta e não interfeririam na sobrevida ou na qualidade de vida do paciente. O rastreamento de base populacional não é a indicação de inúmeras instituições estrangeiras e, no Brasil, o Instituto Nacional de Câncer também não recomenda à organização programas de rastreamento desse tipo. O artigo discute os riscos e benefícios associados a esse tipo de estratégia e reforça a preocupação com o uso inadequado e indiscriminado do rastreamento para o câncer de próstata.


Abstract Recently, numerous national campaigns promoted by hospitals, medical societies and other organizations have stimulated prostate cancer screening, in line with worldwide initiatives known as Blue November. These campaigns advise the use of rectal examination accompanied by dosage of serum prostate specific antigen (PSA) levels in defined age groups. The motivation would be the early detection of neoplasia, with reduction of mortality and complications and impacts associated with its treatment. The PSA dosage for screening purposes is highly controversial, since most of such tumors detected by screening are of slow progression and would not interfere with patient survival or quality of life. Population-based screening for prostate cancer is not recommended by numerous foreign institutions, including the National Cancer Institute in Brazil. The article discusses the risks and benefits associated with this type of strategy and reinforces concern about the inappropriate and indiscriminate use of screening for prostate cancer.


Assuntos
Humanos , Masculino , Neoplasias da Próstata/diagnóstico , Qualidade de Vida , Sobrevida , Programas de Rastreamento/efeitos adversos , Mortalidade , Antígeno Prostático Específico , Medicina Baseada em Evidências , Saúde do Homem/tendências , Detecção Precoce de Câncer/tendências
19.
Enferm. foco (Brasília) ; 8(4): 49-53, dez. 2017. tab
Artigo em Português | BDENF - Enfermagem | ID: bde-33674

RESUMO

Objetivo: Analisar produção científica (2005/2016) sobre etapas do Processo de Enfermagem (PE) nos serviços de saúde. Metodologia: Revisão narrativa, com descritores: “Processos de enfermagem” AND “cuidados de enfermagem” or “assistência de enfermagem” AND “sistematização”, “Nursingprocess” AND “Nursingcare” or “Assistance” AND Systematizatión. Resultados: Evidenciaram-se três categorias: estudos que destacam a Legislação do PE; outros que discutem como se configuram as Etapas do PE e por fim artigos que descrevem reflexões sobre a operacionalização na prática do PE. Conclusão: Há problemas na adesão do PE, registros incompletos, desconhecimento e sobrecarga, embora descrito e sustentado legalmente. Fica explicito que para evoluir cientificamente os profissionais são desafiados a superação de problemáticas. Somente com ações fundamentadas e reconhecidas, haverá a qualificação assistencial. (AU)


Objective: To analyze scientific production (2005/2016) on stages of the Nursing Process (PE) in health services. Methodology: Narrative review, with descriptors: “Nursing processes” AND “nursing care” and “nursing care” AND “systematization”, “Nursingprocess” AND “Nursingcare” or “Assistance” AND Systematization. Results: There were three categories: studies highlighting EP Legislation; others that discuss how the EP Steps are configured and finally articles that describe reflections on the operationalization in EP practice. Conclusion: There are problems in EP adherence, incomplete records, lack of knowledge and overload, although described and legally supported. It is explicit that in order to scientifically evolve, professionals are challenged to overcome problems. Only with well-founded and recognized actions will there be the qualification of care. (AU)


Objetivo: Analizar la producción científica (2005/2016) en las etapas del proceso de enfermería (PE) en los servicios de salud. Metodología: Revisión narrativa, con descriptores: “proceso de enfermería” Y “cuidados de enfermería” o “atención de enfermería” Y “sistemática”, “Nursingprocess” Y “Nursingcare” o “asistencia” y sistematización. Resultados: Evidenciaram-se três categorias: estudos que destacam a Legislação do PE; outros que discuten como se configuren como Etapas do PE y por fim artigos que descrevem reflexões sobre a operacionalização na prática do PE Conclusión: Hay problemas en el número de miembros del PE, registros incompletos, la ignorancia y la sobrecarga, aunque se ha descrito y con el apoyo legal. Es explícito de que para desarrollar científicamente profesionales tienen el reto de superar los problemas. Sólo con acciones motivados y reconocidos, habrá una calificación de la asistencia. (AU)


Assuntos
Humanos , Masculino , Feminino , Processo de Enfermagem , Cuidados de Enfermagem , Legislação , Enfermagem
20.
Oncotarget ; 8(35): 58133-58151, 2017 Aug 29.
Artigo em Inglês | MEDLINE | ID: mdl-28938543

RESUMO

Survival improvement in rectal cancer treated with neoadjuvant chemoradiotherapy (nCRT) is achieved only if pathological response occurs. Mandard tumor regression grade (TRG) proved to be a valid system to measure nCRT response. The ability to predict tumor response before treatment may significantly have impact the selection of patients for nCRT in rectal cancer. The aim is to identify potential predictive pretreatment factors for Mandard response and build a clinical predictive model design. 167 patients with locally advanced rectal cancer were treated with nCRT and curative surgery. Blood cell counts in peripheral blood were analyzed. Pretreatment biopsies expression of cyclin D1, epidermal growth factor receptor (EGFR), vascular endothelial growth factor (VEGF) and protein 21 were assessed. A total of 61 single nucleotide polymorphisms were characterized using the Sequenom platform through multiplex amplification followed by mass-spectometric product separation. Surgical specimens were classified according to Mandard TRG. The patients were divided as: "good responders" (Mandard TRG1-2) and "poor responders" (Mandard TGR3-5). We examined predictive factors for Mandard response and performed statistical analysis. In univariate analysis, distance from anal verge, neutrophil lymphocyte ratio (NLR), cyclin D1, VEGF, EGFR, protein 21 and rs1810871 interleukin 10 (IL10) gene polymorphism are the pretreatment variables with predictive value for Mandard response. In multivariable analysis, NLR, cyclin D1, protein 21 and rs1800871 in IL10 gene maintain predictive value, allowing a clinical model design. CONCLUSION: It seems possible to use pretreatment expression of blood and tissue biomarkers, and build a model of tumor response prediction to neoadjuvant chemoradiation in rectal cancer.

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