TERCEIRIZAÇÃO: O PROCESSO DE IMPLANTAÇÃO E GERENCIAMENTO DOS SERVIÇOS DE LIMPEZA EM UMA UNIVERSIDADE PÚBLICA

RESUMOO trabalho objetiva analisar a forma que foi implementado e gerenciado os serviços terceirizados de limpeza no campus I da Universidade Federal da Paraíba, a partir da visão dos gestores dos centros de ensino. A fundamentação permeia pela terceirização na Administração Pública. Para tanto, a metodologia utilizada na pesquisa é de abordagem qualitativa, descritiva e interpretativista. Assim, para coleta de dados foram realizadas entrevistas semiestruturadas com seis gestores de centro, e para a interpretação dos dados foi realizada a análise do discurso. Os resultados obtidos demonstram que a instituição centraliza muitas decisões relativas à implementação do serviço terceirizado, deixando os gestores de centro à margem desse processo. Já em relação ao impacto do gerenciamento, percebeu-se que no quesito produtividade atende satisfatoriamente, enquanto que a qualidade está abaixo do esperado. E no que se trata dos custos dos serviços terceirizados os entrevistados não tem noção nem controle desses custos. Portanto, este trabalho conclui que os serviços terceirizados de limpeza no campus I da Universidade Federal da Paraíba são muito deficientes, tanto nos seus aspectos gerencial como legal, devendo ser reformulado o meio de gerir tal processo para que possa melhorar a efetividade e, consequentemente, poder atender melhor os usuários desse serviço. PALAVRAS-CHAVE: Terceirização; Administração Pública; Gerenciamento. ABSTRACTThe objective of this work is to analyze the way outsourced cleaning services were implemented and managed in Campus I of the Federal University of Paraíba, based on the view of the managers of the educational centers. The rationale permeates outsourcing in Public Administration. Therefore, the methodology used in the research is a qualitative, descriptive and interpretative. Thus, to collect data were conducted semi-structured interviews with six managers of the center, and the interpretation of the data was performed discourse analysis. The results show that the institution centralizes many decisions regarding the implementation of the outsourced service, leaving the center managers to the margin of this process. Regarding the impact of management, it was noticed that in the question of productivity it meets satisfactorily, while the quality is below expectations. And when it comes to the costs of outsourced services, the interviewees have no idea or control of these costs. Therefore, this work concludes that the outsourced cleaning services in the I campus of the Federal University of Paraíba are very deficient, both in their managerial and legal aspects, and the way to manage this process must be reformulated so that it can improve the effectiveness and, consequently, service users. KEYWORDS: Outsourcing; Public Administration; Management

Impact of MELD allocation policy on survival outcomes after liver transplantation: a single-center study in northeast Brazil

OBJECTIVE: To analyze the impact of model for end-stage liver disease (MELD) allocation policy on survival outcomes after liver transplantation (LT). INTRODUCTION: Considering that an ideal system of grafts allocation should also ensure improved survival after transplantation, changes in allocation policies need to be evaluated in different contexts as an evolutionary process. METHODS: A retrospective cohort study was carried out among patients who underwent LT at the University of Pernambuco. Two groups of patients transplanted before and after the MELD allocation policy implementation were identified and compared using early postoperative mortality and post-LT survival as end-points. RESULTS: Overall, early postoperative mortality did not significantly differ between cohorts (16.43% vs. 8.14%; p = 0.112). Although at 6 and 36-months the difference between pre-vs. post-MELD survival was only marginally significant (p = 0.066 and p = 0.063; respectively), better short, medium and long-term post-LT survival were observed in the post-MELD period. Subgroups analysis showed special benefits to patients categorized as nonhepatocellular carcinoma (non-HCC) and moderate risk, as determined by MELD score (15-20). DISCUSSION: This study ensured a more robust estimate of how the MELD policy affected post-LT survival outcomes in Brazil and was the first to show significantly better survival after this new policy was implemented. Additionally, we explored some potential reasons for our divergent survival outcomes. CONCLUSION: Better survival outcomes were observed in this study after implementation of the MELD criterion, particularly amongst patients categorized as non-HCC and moderate risk by MELD scoring. Governmental involvement in organ transplantation was possibly the main reason for improved survival

Impact of MELD allocation policy on survival outcomes after liver transplantation: a single-center study in northeast Brazil

OBJECTIVE: To analyze the impact of model for end‐stage liver disease (MELD) allocation policy on survival outcomes after liver transplantation (LT). INTRODUCTION: Considering that an ideal system of grafts allocation should also ensure improved survival after transplantation, changes in allocation policies need to be evaluated in different contexts as an evolutionary process. METHODS: A retrospective cohort study was carried out among patients who underwent LT at the University of Pernambuco. Two groups of patients transplanted before and after the MELD allocation policy implementation were identified and compared using early postoperative mortality and post‐LT survival as end‐points. RESULTS: Overall, early postoperative mortality did not significantly differ between cohorts (16.43% vs. 8.14%; p = 0.112). Although at 6 and 36‐months the difference between pre‐ vs. post‐MELD survival was only marginally significant (p = 0.066 and p = 0.063; respectively), better short, medium and long‐term post‐LT survival were observed in the post‐MELD period. Subgroups analysis showed special benefits to patients categorized as non‐hepatocellular carcinoma (non‐HCC) and moderate risk, as determined by MELD score (15‐20). DISCUSSION: This study ensured a more robust estimate of how the MELD policy affected post‐LT survival outcomes in Brazil and was the first to show significantly better survival after this new policy was implemented. Additionally, we explored some potential reasons for our divergent survival outcomes. CONCLUSION: Better survival outcomes were observed in this study after implementation of the MELD criterion, particularly amongst patients categorized as non‐HCC and moderate risk by MELD scoring. Governmental involvement in organ transplantation was possibly the main reason for improved survival

Lymph node dissection for gastric cancer: a critical review

Gastric cancer is one of the most common neoplasms and an important cause of cancer-related death worldwide. Efforts to reduce its high mortality rates are currently focused on multidisciplinary management. However, surgery remains a cornerstone in the management of patients with resectable disease. There is still some controversy as to the extent of lymph node dissection for potentially curable stomach cancer. Surgeons in eastern countries favor more extensive lymph node dissection, whereas those in the West favor less extensive dissection. Thus, extent of lymph node dissection remains one of the most hotly discussed aspects of gastric surgery, particularly because most stomach cancers are now often comprehensively treated by adding some perioperative chemotherapy or chemo-radiation. We provide a critical review of lymph nodes dissection for gastric cancer with a particular focus on its benefits in a multimodal approach

Can HIPEC be used against platinum-resistance and for inducing sensitivity to PARP inhibitors in ovarian cancer?

Hyperthermic intraperitoneal chemotherapy (HIPEC) has emerged as a main comprehensive treatment of epithelial ovarian cancer (EOC). Despite much criticism to this approach, HIPEC has shown cost-effective benefits in both progression-free survival and overall survival for high tumor burden with no important impairment on patient-reported quality of life. On the other hand, the landscape of EOC treatment is changing rapidly and poly (ADP-ribose) polymerase inhibitors (PARPi) currently play an important role in the management of EOC based on recent trials. At this point, an important question to be scrutinized is what to expect from up-front HIPEC in the era of amazing benefits by the PARPi. Herein, we discuss the promising role of combining PARPi and HIPEC in the management of advanced EOC