Território e territorialidade no contexto hospitalar: uma abordagem interdisciplinar

Este artigo trata o hospital como território de organização complexa, atravessado por múltiplos interesses, que ocupa lugar crítico na prestação de serviços de saúde, lugar de construção de identidades profissionais, com grande reconhecimento social. O objetivo diz respeito a compreender o hospital na perspectiva interdisciplinar. Para tanto, buscou-se o referencial teórico referente às concepções de território e territorialidade, oriundas da geografia e de outros campos do conhecimento, como a ciência da saúde e a filosofia. A partir da interação entre estas disciplinas aborda-se o hospital como território de produção de atos de saúde formado por segmentos e superfícies, agenciamentos entre profissionais e usuários que se entrecortam em um emaranhado de linhas de segmentaridade; nós, redes e malhas que revelam a produção territorial; poder e disciplinamento e o saber-poder que revelam as relações sociais, efetivadas entre os sujeitos e o objeto, ou seja, as relações que se concretizam no território e significam territorialidade. Concluiu-se, então, que o território hospitalar, como os demais territórios, é a expressão concreta e abstrata do espaço apropriado, produzido, formado em sua multidimensionalidade, pelos atores sociais que o (re)definem constantemente em suas cotidianidades, num campo de forças relacionalmente emaranhado por poderes nas mais variadas intensidades

Cost Analysis of Capecitabine vs 5-Fluorouracil-Based Treatment for Metastatic Colorectal Cancer Patients

The aim was to evaluate the cost of capecitabine vs conventional combination chemotherapics such as 5-fluorouracil (5-FU) for the treatment of metastatic colorectal cancer (mCRC) in Italy. The study was a multicenter, retrospective longitudinal treatment-cost analysis. Patients older than 18 years, diagnosis of mCRC and at least 3 completed cycles of chemotherapy with oral capecitabine or 5-FU also in association with other chemotherapic agents were enrolled. Direct healthcare resources attributable to mCRC treatment were quantified using 2007 prices and tariffs. The analysis was conducted from the National Health Service perspective with a 6-month time horizon. A total of 231 patients affected by mCRC (55% males; mean age 63.7 +/- 10.31 yrs) were studied. Total direct costs per patient per month in capecitabine and 5-FU groups were (sic)1,001.66 +/- (sic)434.93 and (sic)3,172.81 +/- (sic)1,232.37 respectively (p<0.0001). Oral capecitabine therapy cost the health service less than intravenous therapies

SUBJETIVIDADE E ENFRENTAMENTO DA MORTE: CONSTRUINDO GESTÃO DE PESSOAS NA COTIDIANIDADE

O presente estudo objetivou compreender como, em local cujo trabalho exige enfrentamento com a morte, são pensadas e construídas,na cotidianidade, práticas de trabalho e de gestão de pessoas. Esse é um estudo qualitativo, no qual foi realizado o acompanhamento da rotina de 4 agentes funerários, 1 diretor de plantão, 1 gerente administrativo e 1 maquiadora necrotérica em seu contexto de trabalho, uma empresa funerária de pequeno porte em Porto Alegre. Para a coleta de dados, utilizaram-se técnicas etnográficas (CAVEDON, 2003), sendo a interpretação realizada por meio de análise de conteúdo (MINAYO, 2010). Os achados foram agrupados em quatro categorias que, entende-se, integram o processo de subjetivação do fazer/saber diante da morte: 1) redimensionando as certezas; 2) os saberes no/do trabalho frente à ressignificação da morte; 3) ser trabalhador atravessado pela representação da morte em sociedade;e 4) gestão se configurando no contexto da morte.Vimos que esses profissionais criam, reinventam suas maneiras de fazer, a partir de um processo de ressignificar e naturalizar a morte, sendo o ambiente organizacional, em consonância com Certeau (2008), um espaço onde trabalhadores fazem a gestão do seu cotidiano e de si mesmos com seus próprios significados.

61. Rapid and portable, lab-on-chip, point-of-care genotyping for evaluating clopidogrel metabolism

Background: Dual antiplatelet therapy with aspirin and a platelet P2Y12 receptor inhibitors (clopidogrel, prasugrel, ticagrelor) is a cornerstone of antithrombotic treatment in patients with acute coronary syndromes (ACS). Clopidogrel has been the standard of care for nearly a decade; however, its clinical efficacy is influenced by a considerable inter-patient variability in response, clearly associated to cytochrome P (CYP) enzyme genetic variations. We used a novel point-of-care lab-on-chip instrument to genotype ACS patients in order to identify carriers of the ATB-binding cassette ABCB1 3435, CYP2C19*2 and CYPC2C19*17 alleles and adjust the pharmacological approach accordingly. Methods and results: Between October 2012 and January 2013, 160 ACS patients were enrolled at the Cardiology Unit of the Ospedale Niguarda Ca Granda and genotyped at the patients' point-of-care using the newly developed Q3 portable real-time PCR instrument which remarkably scored the CYP2C19*2, CYP2C19*17, and ABCB13435 alleles in a time of 70 min from DNA extraction to final genotype calls; concordance with the other gold-standard genotyping techniques was 100%. Conclusions: The Q3 instrument proved to be as reliable as the current conventional techniques. As genotyping in the ACS setting cannot be delegated to centralised clinical laboratories for reasons of time, genotyping at the patients' bedside provides an opportunity to conduct large-scale randomised trials in order to assess whether adding genotype data to clinical variables improves clinical outcomes. (C) 2015 Elsevier B.V. All rights reserved

Clinical, histopathological and molecular characterization of hypoplastic myelodysplastic syndrome

Diagnostic criteria for hypoplastic myelodysplasic syndrome (h-MDS) have not been clearly established, making the differential diagnosis from other bone marrow failure syndromes (BMF) challenging. In this study, we aimed to delineate clinical, histopathological, and molecular features of h-MDS, based on a large and well-annotated cohort of patients with bone marrow (BM) hypocellularity. The study included 534 consecutive adult patients with hypocellular BM (278 h-MDS and 136 aplastic anemia), and 727 with normo- or hypercellular MDS (n-MDS). Comparison of clinical features of patients with h-MDS as defined by BM cellularity ≤25% (n = 204) or reduced age-adjusted cellularity (n = 74) did not reveal significant differences. We developed a diagnostic score to discriminate h-MDS from non-malignant BMF based on histological and cytological variables with the highest specificity for MDS (h-score). The information from chromosomal abnormalities and somatic mutation patterns was then integrated into a cyto-histological/genetic score (hg-score). This score was able to segregate two groups of h-MDS with a significantly different risk of blast progression (P < 0.001). The integration of cyto-histological and genetic features in adult patients with hypocellular BM facilitated segregation into two distinct groups, one with clinical and genetic features highly consistent with myeloid neoplasm, and one with features more consistent with non-malignant BMF