Erro médico e seu potencial Iatrogênico: Uma revisão sistemática / Medical error and Iatrogenic potential: A systematic review

Introdução: o erro médico tem histórico desde o início da prática da Medicina. Através do desenvolvimento tecnológico, o fluxo de informações permitiu maior esclarecimento do paciente, bem como maior evidencia não só do erro médico, mas do evento adverso, um dano não intencional oriundo da assistência de saúde prestada ao paciente. Neste contexto incluem-se também a iatrogenia (dano negativo ao paciente) e as ações voltadas para a segurança do paciente. Objetivo: analisar as investigações científicas mundiais acerca do erro médico e seu potencial iatrogênico. Métodos: revisão sistemática de artigos compreendidos entre 2015 e 2019 que englobavam assuntos acerca do erro médico, iatrogenia e qualidade da assistência à saúde. Resultados: dos 485 encontrados, foram selecionados 11 artigos. Em pacientes com idade avançada há maior ocorrência de eventos adversos, e estes são mais frequentes em internações cirúrgicas. As taxas de iatrogenia grave e morte foram relativamente pequenas, porém de grande impacto para o paciente, familiares e profissionais da saúde. As condições de trabalho e infraestrutura não são favoráveis à completa execução da Política de Segurança do Paciente, além de dificultar o registro de informações. Isso também justifica o fato de os dados nacionais não refletirem a realidade, sugerindo subnotificação. Conclusão: os resultados comprovando que este tema se trata de um problema de saúde pública, com grandes consequências para todos os envolvidos, reafirmam que as ações relacionadas à Segurança do Paciente necessitam de maior investimento no âmbito nacional

Transfronteirizações na América do Sul: uma agenda de pesquisa sobre dinâmicas territoriais nas fronteiras meridional e setentrional do Brasil

Este artigo trata de uma agenda de pesquisa em desenvolvimento sobre cenários de dinâmicas territoriais transfronteiriças com atenção em políticas territoriais dirigidas às conexões de infraestruturas sul-americanas e a áreas protegidas no norte amazônico / Planalto das Guianas. A agenda de pesquisa e seus problemas regionais estão localizados em regiões de fronteiras brasileiras no extremos sul e norte, isto é: i) as fronteiras do Mercosul no Arco Sul do Brasil - estados do Rio Grande do Sul, Santa Catarina e Paraná ao longo do Uruguai, Argentina e Paraguai (macrorregião da Bacia do Prata) e ii) a fronteira franco-brasileira no Arco Norte do Brasil - Estado do Amapá ao longo da Guiana Francesa (macrorregião do Planalto das Guianas)

Influence of treatment with and without extractions on the growth pattern of dolichofacial patients

OBJECTIVE: The objective of this retrospective study was to compare, by means of lateral cephalograms, the facial growth pattern changes due to the treatment with and without extractions of four first premolars in dolichofacial individuals. METHODS: Groups 1 and 2 were constituted of 23 dolichofacial patients each, with Class II malocclusion, division 1 and initial age average of 12.36 and 12.29 years, respectively. Patients from Group 1 were treated without extractions and Group 2 was treated with extraction of the four first premolars, given that both used occipital headgear. Groups were compatibilized according to age, treatment period, gender and malocclusion severity. The t test was applied for intergroups comparison. RESULTS: Most variables (SN.PP, SN.Ocl and FMA) did not present statistically significant difference between groups. CONCLUSION: Although the treatment with extractions tend to reduce the mandibular plane angle (SN.GoGn) and the facial axis (NS.Gn), the analyzed treatment protocols did not affect in a clinically relevant way the facial growth pattern

Prevalence and Severity of Asthma, Rhinitis, and Atopic Eczema in 13- to 14-Year-Old Schoolchildren from Southern Brazil

The objective of this study was to investigate the prevalence and severity of asthma, rhinitis, and atopic eczema in schoolchildren from southern Brazil. A cross-sectional study was carried out with the International Study of Asthma and Allergies in Childhood phase III written questionnaire. The questionnaire was self-applied by 2,948 randomly selected schoolchildren aged 13 to 14 years. The lifetime prevalence rates of symptoms were as follows: wheezing, 40.8%; rhinitis, 40.7%; eczema, 13.6%; self-reported asthma, 14.6%; rhinitis, 31.4%; eczema, 13.4%. Rhinitis was reported by 55% of adolescents with current asthma (60% females vs 46.9% males). Girls 13 to 14 years of age had higher prevalence rates of asthma, rhinitis, and eczema than boys had. Atopic eczema was reported by 42.7% of girls and 31.4% of boys with asthma. The prevalence rates were statistically significant for symptoms of asthma, rhinitis, and atopic eczema in females. However, there were no statistically significant differences between the sexes in regard to reported asthma and bronchospasm induced by exercise

Comparing financing models for supplementary healthcare in appendectomy: activity-based costing (fee-for-service) vs. diagnosis related group remuneration (bundled payment) – a systematic review and meta-analysis

ABSTRACT Purpose: In Brazil, healthcare services traditionally follow a fee-for-service (FFS) payment system, in which each medical procedure incurs a separate charge. An alternative reimbursement with the aim of reducing costs is diagnosis related group (DRG) remuneration, in which all patient care is covered by a fixed amount. This work aimed to perform a systematic review followed by meta-analysis to assess the effectiveness of the Budled Payment for Care Improvement (BPCI) versus FFS. Methods: Our work was performed following the items of the PRISMA report. We included only observational trials, and the primary outcome assessed was the effectiveness of FFS and DRG in appendectomy considering complications. We also assessed the costs and length of hospital stay. Meta-analysis was performed with Rev Man version 5.4. Results: Out of 735 initially identified articles, six met the eligibility criteria. We demonstrated a shorter hospital stay associated with the DRG model (mean difference = 0.39; 95% confidence interval – 95%CI – 0.38–0.40; p < 0.00001; I2 = 0%), however the hospital readmission rate was higher in this model (odds ratio = 1.57; 95%CI 1.02–2.44, p = 0.04; I2 = 90%). Conclusions: This study reveals a potential decrease in the length of stay for appendectomy patients using the DRG approach. However, no significant differences were observed in other outcomes analysis between the two approaches

Estudo interpretativo do cap. III do estatuto da criança e do adolescente: “do direito à convivência familiar e comunitária”

Foi realizado um estudo, em 1993, pela equipe de pesquisadores do CDH, sobre o Capítulo 111 do Estatuto da Criança e do Adolescente - “Do Direito à Convivência Familiar e Comunitária”, levando-se em conta que o texto do código exige compreensão para ser aplicado. A tarefa foi realizada através do convénio CBIA/CDH n. 154/21/93, sendo a equipe técnica coordenada pelo Prof. Dr. Fernando Lefèvre e contando com o apoio do Promotor de Justiça Dr. Luiz Paulo Aoki para elucidação e discussão das questões jurídicas implícitas na formulação da lei. Este estudo está apresentado em três partes ou capítulos: capitulo I - refere-se à lei (apresenta o texto legal do artigo 19 ao artigo 52); capitulo 2 - explicitação do artigo, objetivando uma melhor compreensão do texto da lei; capitulo 3 - explicitação das bases culturais e das bases psicológicas dos artigos. Este estudo sucedeu a dois outros anteriormente realizados e publicados, um sobre o Cap. I “Do Direito à Vida e à Saúde”, o outro sobre o Cap. IV “Do Direito à Educação, à Cultura, ao Esporte e ao Lazer”, editados pelo CDH com o apoio financeiro do CBIA, sob o título de “Planilha para Operacionalização do ECA”In 1993, the team of researchers of CDH carried out a study on chapter 3 of the Statute of the Child and Adolescent - “The right to family and comrnunity life”, taking into account thatthe text of the statute needs to be understood in order to be applied. The task was accomplished through the agreement CslA/CDH no. 154/21/93, and the technical team was coordinated by Professor Fernando Lefèvre, PhD, with the support of the State Attorney Luiz Paulo Aoki, whoelucidated and discussed the legal issues that were implicit in the formulation of the law. The study is divided into three parts: Chapter I - refers to the law (presents the legal text from article 19 to article 52); Chapter 2 - clarification of the article, so that the law text can be understood; Chapter 3 - explains the cultural and psychological bases of the articles. The present study was carried out after two other studies had been previously conducted and published. One of them isabout Chapter I, “The right to life and health”, and the other is about Chapter 4, “The right to Education, Culture, Sports and Leisure”, published by CDH with the fmancial support of CBIA,under the title “Planilha para Operacionalização do ECA” (Schedule for the Operationalization of the Statute of the Child and Adolescent)

The complete genome sequence of Chromobacterium violaceum reveals remarkable and exploitable bacterial adaptability

Chromobacterium violaceum is one of millions of species of free-living microorganisms that populate the soil and water in the extant areas of tropical biodiversity around the world. Its complete genome sequence reveals (i) extensive alternative pathways for energy generation, (ii) ≈500 ORFs for transport-related proteins, (iii) complex and extensive systems for stress adaptation and motility, and (iv) wide-spread utilization of quorum sensing for control of inducible systems, all of which underpin the versatility and adaptability of the organism. The genome also contains extensive but incomplete arrays of ORFs coding for proteins associated with mammalian pathogenicity, possibly involved in the occasional but often fatal cases of human C. violaceum infection. There is, in addition, a series of previously unknown but important enzymes and secondary metabolites including paraquat-inducible proteins, drug and heavy-metal-resistance proteins, multiple chitinases, and proteins for the detoxification of xenobiotics that may have biotechnological applications

Prevalência de asma, rinite e eczema atópico em escolares de 13 e 14 anos de idade no município de Passo Fundo, Rio Grande do Sul

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