A experiência da unidade autónoma de gestão de cirurgia do Centro Hospitalar de São João E.P.E modelos de gestão intermédia hospitalar

As organizações de saúde são muito particulares devido à sua missão, aos recursos que mobilizam, aos processos que dinamizam, à produção que realizam e ainda à envolvente externa onde se inserem (Reis, 2007). Os sucessivos esforços que têm sido utilizados na reforma na saúde, sobretudo a partir de 1988, têm sido uma constante da agenda política na tentativa de aumentar a eficiência dos serviços prestados, a efetividade dos resultados e a responsabilidade dos profissionais. A empresarialização do Hospital de São João operada a partir de 2006, com a publicação do Dec.Lei 233/05 de 29 de Dezembro, tornou como imperativo estratégico a alteração profunda do modelo de gestão até então praticado. Este era caracterizado por uma forte componente administrativa, de cariz burocrática, e sob ponto de vista económico assentava em sucessivos deficits e no permanente aumento e descontrolo da despesa. Tomando como pressuposto que a única via de modificar esse padrão passava entre outras medidas pela efetivação de uma gestão descentralizada, vieram a ser criadas seis estruturas intermédias de gestão designadas por “Unidades Autónomas de Gestão”. Estas tinham como objetivo aumentar o valor em saúde, melhorar a gestão dos serviços clínicos, potenciando desse modo a qualidade e efetividade dos cuidados prestados, bem como a eficiência dos recursos utilizados. Neste sentido, o propósito deste trabalho centra-se em demonstrar que a implementação de um modelo de gestão descentralizado como é o caso da Unidade Autónoma de Gestão de Cirurgia, doravante designada por UAGC, constituiu uma opção gestionária eficaz e altamente promissora na governação clínica, desmistificando o mito da “ingovernabilidade dos hospitais centrais” como era apanágio do Hospital S. João. Cremos que a descentralização da gestão enquanto forma de reengenharia da organização interna dos hospitais constitui um importante instrumento no sentido de orientar e motivar o comportamento dos gestores (sejam eles clínicos ou não) para o cumprimento dos objetivos institucionais, através da implementação de políticas de desconcentração de poderes, competências e responsabilidades. Embora existam outros modelos de organização ao nível da gestão intermédia, na verdade, a implementação destas estruturas descentralizadas traduziu-se numa inegável mais valia organizativa e gestionária do CHSJ. como os indicadores de desempenho mais à frente tentarão demonstrar. Temos consciência que este modelo está longe de ser perfeito, e que por vezes não é corretamente entendido pelos profissionais, que o encaram como uma necessidade de cariz exclusivamente económica. Porém o caminho já percorrido pela UAGC ao longo destes 5 anos permite-nos afirmar que é possível “fazer mais” com “os mesmos recursos”, desde que exista uma clara estratégia de ação suportada em programas concretos e exequíveis, praticados num clima social participado e responsabilizante

Exploring direct costs of primary hip and knee arthroplasties healthcare-associated infections: A retrospective study

Hip or knee arthroplasty healthcare-associated infections (HAI) are a public health problem that induces the increase of morbidity and mortality rates and poses an economic problem with significant impact on hospitals budget. The infection rate in primary hip and knee arthroplasties range between 1.5% and 2.5%, and is considered one of the main reasons for surgeries non-effectiveness. A retrospective study was carried out in S. João Hospital Center, EPE (CHSJ) to calculate HAI rate in primary hip and knee arthroplasties, and to analyse their direct costs, for a better understanding of their economic impact. Four hundred and eighty seven arthroplasties were studied and infection was noticed in 11 cases: 3 after hip and 8 after knee arthroplasties. Data collected from infected patients-related costs were compared with the average cost of non-infected patients (standard). An incidence rate of 2.17% for hip arthroplasties and 2.25% for knee arthroplasties was found. Results showed that patients with infection remained in hospital 7.45 times longer than uninfected patients and incurred hospital costs almost 3.8 times higher. This work shows how important is the quantification of additional HAI costs to allow hospital managers to weigh the cost/benefit ratio and better justify investments in HAI prevention and control programmes.info:eu-repo/semantics/publishedVersio

Reprocessamento de dispositivos médicos de uso único: resultados clínicos e financeiros

ABSTRACT - Introduction: Excellent results regarding clinical efficacy and cost reduction are achieved by using certified reprocessed single-use medical devices (SUMDs). This explains why this practice is common in most hospitals across the USA and Germany. However, this is not a common practice at a national level and there are no reports regarding its use in Portugal. We present our experience using these methods at Centro Hospitalar de São João (CHSJ) in Porto. Objective: The aim of this study was to compare the clinical results and the financial impact of the use of 2 SUMDs, original and reprocessed, namely the linear suture machine GIA CovidienTM and Harmonic ACE® scissors. Method: A group of 733 patients operated in 2014 was evaluated. Of these patients, 316 were operated on with reprocessed SUMDs and 417 with original SUMDs. Variables referring to the clinical and financial results were analyzed through clinical and management information provided by Unidade de Gestão Autónoma de Cirurgia. A comparison between groups was performed using the χ2 test and the Mann-Whitney test. Results: Indicators related to clinical efficacy show that the use of these SUMDs, professionally reprocessed, did not represent any added risk in comparison to the use of original devices. Regarding costs, there is a very significant difference between the use of a new medical device and that of a reprocessed one. In the case of the Harmonic ACE® scissors and of the linear suture machine GIA CovidienTM, savings were up to 50% per device. Conclusion: This study, the first in Portugal, confirms the economic advantages of reprocessing these 2 devices. The financial benefit was obtained with maintenance of the same clinical results as the ones achieved using original devices. These results are in line with the published literature, proving the validity of using SUMDs after professionally certified reprocessing.RESUMO - Introdução: Os excelentes resultados da eficácia clínica e da redução de custos, obtidos com o reprocessamento certificado dos Dispositivos Médicos de Uso Único (DMUU) justificam que seja prática corrente na maior parte dos hospitais, nos Estados Unidos da América e na Alemanha. No entanto, a nível Nacional ainda não é prática comum, não existindo bibliografia sobre a experiência nacional. Apresentamos os resultados obtidos com esta prática no Centro Hospitalar de São João (CHSJ), Porto. Objetivo: Comparar os resultados clínicos e o impacto financeiro da reutilização de dispositivos médicos de uso único, reprocessados profissionalmente. Foram utilizados dois dispositivos de “uso único,” a máquina de sutura linear GIA CovidienTM e a tesoura Harmonic ACE®. Método: Analisamos um grupo de 733 doentes operados em 2014 que inclui todos os doentes operados no referido período e em que foram utilizados estes dispositivos. Destes doentes 316 foram operados com DMUU reprocessados, e 417 com DMUU originais. As variáveis referentes aos resultados clínicos e financeiros foram analisadas através dos respetivos registos clínicos e da informação de gestão fornecida pela Unidade de Gestão Autónoma de Cirurgia. A comparação entre grupos foi realizada pela aplicação dos testes de Qui-quadrado e Mann-Whitney. Resultados: Os indicadores relativos à eficácia clínica, comprovaram que o uso destes DMUU reprocessados profissionalmente utilizados nas intervenções cirúrgicas não representou qualquer risco acrescido em comparação com os dispositivos originais. Em termos financeiros, há uma diferença muito significativa entre a aquisição de um dispositivo médico novo ou reprocessado. A diferença no caso da tesoura Harmonic ACE® e na máquina de sutura linear GIA CovidienTM acarretou poupanças cerca de 50%. Conclusão: Este primeiro estudo, realizado em Portugal, confirma as vantagens económicas do reprocessamento destes dois dispositivos. O benefício financeiro foi obtido com manutenção da mesma qualidade clínica que se obteve com os dispositivos originais. Os resultados obtidos estão em conformidade com os publicados na literatura, o que confirma que a utilização de alguns dispositivos médicos de uso único após reprocessamento profissional é um método eficiente.info:eu-repo/semantics/publishedVersio

Dominant negative effect of polyglutamine expansion perturbs normal function of ataxin-3 in neuronal cells

The physiological function of Ataxin-3 (ATXN3), a deubiquitylase (DUB) involved in Machado–Joseph Disease (MJD), remains elusive. In this study, we demonstrate that ATXN3 is required for neuronal differentiation and for normal cell morphology, cytoskeletal organization, proliferation and survival of SH-SY5Y and PC12 cells. This cellular phenotype is associated with increased proteasomal degradation of a5 integrin subunit (ITGA5) and reduced activation of integrin signalling and is rescued by ITGA5 overexpression. Interestingly, silencing of ATXN3, overexpression of mutant versions of ATXN3 lacking catalytic activity or bearing an expanded polyglutamine (polyQ) tract led to partially overlapping phenotypes. In vivo analysis showed that both Atxn3 knockout and MJD transgenic mice had decreased levels of ITGA5 in the brain. Furthermore, abnormal morphology and reduced branching were observed both in cultured neurons expressing shRNA for ATXN3 and in those obtained from MJD mice. Our results show that ATXN3 rescues ITGA5 from proteasomal degradation in neurons and that polyQ expansion causes a partial loss of this cellular function, resulting in reduced integrin signalling and neuronal cytoskeleton modifications, which may be contributing to neurodegeneration.National Institutes of Health (NIH) ‘(R01NS038712)Fundação para a Ciência e a Tecnologia (FCT) and COMPETE through the project ‘(PTDC/SAU-GMG/ 101572/2008)Fundação para a Ciência e a Tecnologia (FCT) - fellowships SFRH/BD/51059/2010, SFRH/BD/ 78388/2011 and SFRH/BPD/91562/201

Absence of Ataxin-3 Leads to Enhanced Stress Response in C. elegans

Ataxin-3, the protein involved in Machado-Joseph disease, is able to bind ubiquitylated substrates and act as a deubiquitylating enzyme in vitro, and it has been involved in the modulation of protein degradation by the ubiquitin-proteasome pathway. C. elegans and mouse ataxin-3 knockout models are viable and without any obvious phenotype in a basal condition however their phenotype in stress situations has never been described

Ataxin-3 Plays a Role in Mouse Myogenic Differentiation through Regulation of Integrin Subunit Levels

BACKGROUND: During myogenesis several transcription factors and regulators of protein synthesis and assembly are rapidly degraded by the ubiquitin-proteasome system (UPS). Given the potential role of the deubiquitinating enzyme (DUB) ataxin-3 in the UPS, and the high expression of the murine ataxin-3 homolog in muscle during embryogenesis, we sought to define its role in muscle differentiation. METHODOLOGY/PRINCIPAL FINDINGS: Using immunofluorescence analysis, we found murine ataxin-3 (mATX3) to be highly expressed in the differentiated myotome of E9.5 mouse embryos. C2C12 myoblasts depleted of mATX3 by RNA interference exhibited a round morphology, cell misalignment, and a delay in differentiation following myogenesis induction. Interestingly, these cells showed a down-regulation of alpha5 and alpha7 integrin subunit levels both by immunoblotting and immunofluorescence. Mouse ATX3 was found to interact with alpha5 integrin subunit and to stabilize this protein by repressing its degradation through the UPS. Proteomic analysis of mATX3-depleted C2C12 cells revealed alteration of the levels of several proteins related to integrin signaling. CONCLUSIONS: Ataxin-3 is important for myogenesis through regulation of integrin subunit levels.This work was financed by the Fundacao para a Ciencia e a Tecnologia (FCT) (POCI/SAU-MMO/60412/2002) and by National Institutes of Health/National Institute of Neurological Disorders and Stroke (NIH/NINDS) grant RO1 NS038712 to HLP. MCC, FB, AJR, and RJT were supported by the FCT fellowships (SFRH/BD/9759/2003 and SFRH/BPD/28560/2006), (SFRH/BPD/17368/2004), (SFRH/BD/17066/2004), (SFRH/BD/29947/2006), respectively. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript

"Vem ser"- Projeto de intervenção com mulheres em situação de desemprego de longa duração beneficiárias da Rede Local de Intervenção Social

O presente relatório reflete a construção e o desenvolvimento de um projeto numa Instituição Particular de Solidariedade Social que, tendo como proposta metodológica a investigação ação participativa, contempla a participação dos sujeitos na construção do conhecimento. Projeto este desenvolvido com sete mulheres autodenominadas por “viajantes”. O conhecimento coconstruído com as diversas participantes que integram esta realidade permitiram a conceção e desenvolvimento do projeto “ Vem Ser”, tendo como finalidade a promoção e a melhoria da qualidade de vida, nomeadamente ao nível pessoal, social, laboral, relacional destas mulheres. Sendo este um projeto para o desenvolvimento e (re)valorização de competências pessoais e sociais, promovendo momentos de diálogo, partilha, discussão, negociação e participação, bem como a promovendo de uma maior relação interpessoal, proporcionando a viabilização de uma rede social de suporte afetivo. Para além disto, este projeto também agiu com a intenção de aumentar o envolvimento entre a equipa técnica desta instituição e das participantes deste projeto, procurando envolver as beneficiárias nos seus projetos individuais, aproximando a intervenção realizada às reais necessidades destas mulheres. Avaliado segundo o modelo CIPP, este projeto, reflete a lógica de um projeto de educação social, tendo como propósito a mudança social, através da transformação pessoal das participantes, resultando num processo de mudança pessoal, grupal e institucional de continua construção e progressoThis report reflects the construction and development of a project in an institution of Social solidarity, which grounded theoretically gives priority as research methodology in education and social intervention, participatory action research. The knowledge together with the various participants that integrate this reality led to the design and development of the project "Vem ser", having as purpose the promotion and improvement of the quality of life, particularly the personal level, social, relational, of a group of so-called women by travellers. Being a project of the people and with the people, and actions have been developed which aim for seven women, the development and (re) valuation of personal and social skills, promoting times of dialogue, sharing, discussion, negotiation and participation as well as the promotion of greater interpersonal relationship, giving these a social network of affective support. In addition, this project also acted with the intention of increasing the involvement between the staff of this institution and of the participants, seeking to involve the beneficiaries in their individual projects, providing greater satisfaction in relation to responses to the real needs of these women. Evaluated according to the CIPP model this project reflects the logic of a social education project, having as purpose the social change through personal transformation of participants, resulting in a process and personal change, institutional and group continues building and progress

The casein kinase 1α gene of Drosophila melanogaster is developmentally regulated and the kinase activity of the protein induced by DNA damage

We report the molecular cloning and characterisation of the first CK1 (casein kinase) gene of Drosophila melanogaster (dmCK1). The protein sequence (DMCK1) shares significant homology with other mammalian CK1 protein kinases of the α sub-class. The dmCK1 gene is expressed only in adult females and during early embryonic development as a single transcript. Western blot analysis of total protein extracts of different stages of development show that the gene product is likewise present during early embryogenesis and in adult females. Kinase activity studies show that DMCK1 is active when in vitro translated but inactive when immunoprecipitated from total early embryo extracts. However, after dephosphorylation treatment the immunoprecipitates show high kinase activity. More significantly, DMCK1 kinase activity present in the immunoprecipitates can be specifically activated by γ-irradiation of early embryos. Also, when DMCK1 is immunoprecipitated after irradiation it appears to undergo pho

ATX-3, CDC-48 and UBXN-5: a new trimolecular complex in Caenorhabditis elegans

Ataxin-3 is the protein involved in Machado-Joseph disease, a neurodegenerative disorder caused by a polyglutamine expansion. Ataxin-3 binds ubiquitylated proteins and acts as a deubiquitylating enzyme in vitro. It was previously proposed that ataxin-3, along with the VCP/p97 protein, escorts ubiquitylated substrates for proteasomal degradation, although other players of this escort complex were not identified yet. In this work, we show that the Caenorhabditis elegans ataxin-3 protein (ATX-3) interacts with both VCP/p97 worm homologs, CDC-48.1 and CDC-48.2 and we map the interaction domains. We describe a motility defect in both ATX-3 and CDC-48.1 mutants and, in addition, we identify a new protein interactor, UBXN-5, potentially an adaptor of the CDC-48-ATX-3 escort complex. CDC-48 binds to both ATX-3 and UBXN-5 in a non-competitive manner, suggesting the formation of a trimolecular complex. Both CDC-48 and ATX-3, but not UBXN-5, were able to bind K-48 polyubiquitin chains, the standard signal for proteasomal degradation. Additionally, we describe several common interactors of ATX-3 and UBXN-5, some of which can be in vivo targets of this complex.Authors thank Caenorhabditis Genetics Center (CGC). A.J.R.thanks all the PM group members for helpful discussions, espe-cially A. Teixeira-Castro. A special recognition to T. Hoppe for pro-viding the double mutant strains. This research was supported byFEDER/FCT (POCTI/SAU-MMO/60412/2004), Portuguese-AmericanFoundation for Development (FLAD), and National Ataxia Founda-tion (NAF). AJ.R. and A.F. received FCT scholarships

NEDD8: A new ataxin-3 interactor

Machado-Joseph disease (MJD/SCA3) is an autosomal dominant neurodegenerative disease caused by the expansion of a CAG tract in the coding portion of the ATXN3 gene. The presence of ubiquitin-positive aggregates of the defective protein in affected neurons is characteristic of this and most of the polyglutamine disorders. Recently, the accumulation of the neural precursor cell expressed developmentally downregulated 8 (NEDD8), a ubiquitin-like protein, in the inclusions of MJD brains was reported. Here, we report a new molecular interaction between wild-type ataxin-3 and NEDD8, using in vitro and in situ approaches. Furthermore, we show that this interaction is not dependent on the ubiquitin-interacting motifs in ataxin-3, since the presence of the Josephin domain is sufficient for the interaction to occur. The conservation of the interaction between the Caenorhabditis elegans ataxin-3 homologue (atx-3) and NEDD8 suggests its biological and functional relevance. Molecular docking studies of the NEDD8 molecule to the Josephin domain of ataxin-3 suggest that NEDD8 interacts with ataxin-3 in a substrate-like mode. In agreement, ataxin-3 displays deneddylase activity against a fluorogenic NEDD8 substrate.http://www.sciencedirect.com/science/article/B6T20-4PGY4KR-1/1/1fa5da8c83d1c67f4864d0738ff047e