Programas para mejorar la recuperación posoperatoria / Enhanced Recovery After Surgery Programs

RESUMEN Los programas de recuperación mejorada después de cirugía (Enhanced Recovery After Surgery, ERAS por sus siglas en inglés) constituyen un conjunto de acciones aplicadas al paciente quirúrgico en el periodo perioperatorio. Estos buscan reducir el impacto de la cirugía en la respuesta metabólica y endocrina y logran una recuperación más temprana de mayor calidad. El objetivo del trabajo fue difundir los principios y ventajas potenciales de estos programas, para su implementación en centros de nuestro país. Se realizó una revisión de publicaciones relacionadas con programas ERAS y sus intervenciones, desde enero 1995 hasta marzo 2018 en base de datos, MEDLINE, CUMED, y bibliotecas SciELO y Cochrane- Cochrane Library Plus, así como revista de acceso abierto PLoS Medicine. Los programas ERAS, se han extendido gradualmente a otros procedimientos y especialidades quirúrgicas. Investigaciones enfocadas en ellos están demostrando sus potencialidades y expansión. Para implementarlos se necesita voluntad institucional y enfoque multidisciplinario, y para sostener sus resultados es esencial auditarlos periódicamente. La aplicación de los programas ERAS se ha relacionado con reducción de estadía hospitalaria, complicaciones y costos, sin aumento en reingresos ni en mortalidad. Su implementación adecuada se considera segura y conveniente para pacientes e instituciones(AU)

ABSTRACT Enhanced Recovery After Surgery, ERAS, programs are a set of actions applied to the surgical patient in the perioperative period. These seek to reduce the impact of surgery on the metabolic and endocrine response and to achieve an earlier recovery of higher quality. The objective of the work was to spread the principles and potential advantages of these programs, for their implementation in centers of our country. A review was carried out of publications related to ERAS programs and their interventions, from January 1995 to March 2018, in the database MEDLINE, CUMED, and the libraries SciELO and Cochrane-Cochrane Library Plus, as well as the open access journal PLoS Medicine. The ERAS programs have been gradually extended to other surgical procedures and specialties. Research focused on them is demonstrating their potential and expansion. To implement them, institutional will and a multidisciplinary approach are needed, while, in order to sustain their results, it is essential to audit them periodically. The application of the ERAS programs has been related to reduction of hospital stay, complications and costs, without increase in readmissions or mortality. Its proper implementation is considered safe and convenient for patients and institutions(AU)

A sustentabilidade de iniciativas inovadoras na gestão do SUS a partir da experiência de Aracaju: entre o instituinte e o instituído / The sustainability of innovative initiatives in the SUS management based on the Aracaju city experience: between the instituting and the instituted one

Este trabalho tem como objeto as estratégias de construção de sustentabilidade do Projeto Saúde Todo Dia, no SUS de Aracaju- SE. As dimensões estudadas foram o Projeto deSaúde Municipal, a Política de Educação Permanente, o SAMU e a Política de Saúde Mental, no período de 2001 a meados de 2008. A abordagem do objeto se deu através de entrevistas semi-estruturadas com membros das três gestões da saúde no período, ligados às quatro dimensões descritas. Observaram-se diferentes trajetórias nas dimensões estudadas ao longo das gestões, com continuidades e descontinuidades, a partir das quais se construíram eixos de análise baseados nas Relações entre Política de Saúde e Dinâmica da Política Municipal, nas Lógicas e Modos de Operar da Gestão Formal, na Articulação entre Projeto Setorial e Sociedade Civil e em Perspectivas de Sustentabilidade. Adotando como referência o conceito de Sustentabilidade Instituinte, produzido no decorrer do trabalho, concluiu-se que no Projeto Saúde Todo Dia foram produzidas inúmeras inovações nos modelos de atenção e de gestão, desencadeadas algumas estratégias de construção de sustentabilidade, em sua maioria de elementos estruturados, sendo mais limitadas, porém, as iniciativas de construção micropolítica junto aos trabalhadores e usuários, bem como as tentativas de constituição de redes de coletivos e de movimentos junto a estes segmentos.

This study has as the object the strategies for the sustainability construction of the project “Saúde Todo Dia”, in the health system of Aracaju, Northeast of Brazil. The aspects studied were the Health Municipality Project, the Permanent Education in Health Policy, the Emergency Medical Mobile Service (SAMU), and the Mental HealthPolicy, in the period from 2001 to middle 2008. The approach of the object of study was performed through semi-structured interviews with members of the three health administrations of the period, who were connected to the four aspects described. Different trajectories were observed in the studied aspects throughout the administrations, with continuances and discontinuances from which some analysis axis were constructed, such as: Relations between Health Policies and Municipal PolicyDynamics, Acting Ways of Formal Management, Mediations between Management and Health Workers, Articulation between Health Sector Project and Civil Society, andSustainability Perspectives. Following as the reference concept the “InstitutingSustainability”, produced during the study, it was concluded that in the Projeto Saúde Todo Dia countless innovations in the care and manegement models were produced, and triggered some construction strategies of sustainability. However, the micropoliticsconstruction initiatives with health workers and community members were more limited, as well as the attempts of the constitution of collective and movements networks with these segments.