Impactos financeiros e mercadológicos causados pela implantação de uma unidade ambulatorial de um hospital de grande porte : estudo de caso

Umas das importantes mais importantes decisões estratégicas que está sendo colocada para os hospitais brasileiros diz respeito à decisão de como expandir sua atuação para outros mercados-alvos no qual o mesmo ainda não tem uma boa cobertura. Diversas estratégias estão sendo adotadas, sendo que a abertura de Unidades Satélites é uma delas e que foi adotada por um hospital privado de grande porte do Estado de São Paulo. Sendo assim, o objetivo do trabalho foi realizar um estudo de caso sobre uma dessas unidades, procurando verificar os impactos financeiros e mercadológicos causados pela implantação da mesma. Para isso, foram levantadas informações internas da unidade e entrevistas foram realizadas com alguns gestores ou pessoas que de algumas forma estiveram relacionadas com o processo de implantação e gerenciamento. Além disso, também foram entrevistados usuários, procurando detectar a percepção dos mesmos sobre a Unidade. Os resultados mostraram que os usuários de modo geral estão muito satisfeitos com a Unidade em termos de atendimento. Entretanto, existe uma clara insatisfação com relação à cobertura do setor de assistência supletiva na Unidade. Em virtude desse fato, há uma restrição importante quanto ao acesso à mesma, o que é uma das mais fortes explicações para os resultados financeiros negativos que a Unidade vêm obtendo desde a sua implantação. Dessa forma, fazem-se necessárias melhorias no relacionamento hospital-operadoras a fim de reverter tal situação

Cervicofacial Pain Associated With Eagle's Syndrome Misdiagnosed As Trigeminal Neuralgia.

Eagle's syndrome is characterized by the symptoms of recurrent throat pain, pharyngeal foreign body sensation, dysphagia, referred otalgia, and neck pain. The treatment for Eagle's syndrome can be pharmacologically, surgically, or both. The surgical management consists of two major procedures: the transoral approach or the extraoral-cervical approach. A 64-year-old patient with a severe cervical pain on the left side was evaluated with no defined diagnosis. During physical examination, an elongated styloid process could be palpated and with CT scan image, the Eagle's syndrome diagnosis was done. The patient was successfully submitted to surgical resection of the elongated styloid process on the left side by an extraoral-cervical approach. After 6 months follow-up, the patient referred no symptom after the surgical treatment. The extraoral/cervical approach is a safe alternative that achieves adequate treatment of Eagle's syndrome.16207-1

Aspergillosis Of The Maxillary Sinus Associated With A Zygomatic Implant.

The use of a specially designed implant to be anchored in the zygomatic bone has been proposed in the literature as an alternative to bone grafting in the prosthetic rehabilitation of the severely resorbed maxilla, an option that has few postoperative complications. However, some complications can arise, such as the fungal infection the authors describe in this article. The authors report a case of aspergillosis of the maxillary sinus after zygomatic implant placement. Twelve months after placement of the implant, the patient returned with symptoms of sinusitis, and a computed tomographic scan showed failure in zygomatic implant osseointegration and a radiopaque mass in the left maxillary sinus. The implant was removed, as was a friable brownish-yellow mass from the sinus. Histopathological analysis revealed a noninvasive hyphal mass compatible with Aspergillus. At a 12-month follow up, the patient experienced no recurrence of fungal sinusitis. Zygomatic implant placement is a safe surgical procedure. Nevertheless, postoperative maxillary sinus infections by bacteria, virus and fungus can occur and therefore need to be considered in the diagnosis of infection in the vicinity of dental and maxillofacial implants.1411231-

Cardiac myosin activation with omecamtiv mecarbil in systolic heart failure

BACKGROUND The selective cardiac myosin activator omecamtiv mecarbil has been shown to improve cardiac function in patients with heart failure with a reduced ejection fraction. Its effect on cardiovascular outcomes is unknown. METHODS We randomly assigned 8256 patients (inpatients and outpatients) with symptomatic chronic heart failure and an ejection fraction of 35% or less to receive omecamtiv mecarbil (using pharmacokinetic-guided doses of 25 mg, 37.5 mg, or 50 mg twice daily) or placebo, in addition to standard heart-failure therapy. The primary outcome was a composite of a first heart-failure event (hospitalization or urgent visit for heart failure) or death from cardiovascular causes. RESULTS During a median of 21.8 months, a primary-outcome event occurred in 1523 of 4120 patients (37.0%) in the omecamtiv mecarbil group and in 1607 of 4112 patients (39.1%) in the placebo group (hazard ratio, 0.92; 95% confidence interval [CI], 0.86 to 0.99; P = 0.03). A total of 808 patients (19.6%) and 798 patients (19.4%), respectively, died from cardiovascular causes (hazard ratio, 1.01; 95% CI, 0.92 to 1.11). There was no significant difference between groups in the change from baseline on the Kansas City Cardiomyopathy Questionnaire total symptom score. At week 24, the change from baseline for the median N-terminal pro-B-type natriuretic peptide level was 10% lower in the omecamtiv mecarbil group than in the placebo group; the median cardiac troponin I level was 4 ng per liter higher. The frequency of cardiac ischemic and ventricular arrhythmia events was similar in the two groups. CONCLUSIONS Among patients with heart failure and a reduced ejection, those who received omecamtiv mecarbil had a lower incidence of a composite of a heart-failure event or death from cardiovascular causes than those who received placebo. (Funded by Amgen and others; GALACTIC-HF ClinicalTrials.gov number, NCT02929329; EudraCT number, 2016 -002299-28.)