Delayed colorectal cancer care during covid-19 pandemic (decor-19). Global perspective from an international survey

Background The widespread nature of coronavirus disease 2019 (COVID-19) has been unprecedented. We sought to analyze its global impact with a survey on colorectal cancer (CRC) care during the pandemic. Methods The impact of COVID-19 on preoperative assessment, elective surgery, and postoperative management of CRC patients was explored by a 35-item survey, which was distributed worldwide to members of surgical societies with an interest in CRC care. Respondents were divided into two comparator groups: 1) ‘delay’ group: CRC care affected by the pandemic; 2) ‘no delay’ group: unaltered CRC practice. Results A total of 1,051 respondents from 84 countries completed the survey. No substantial differences in demographics were found between the ‘delay’ (745, 70.9%) and ‘no delay’ (306, 29.1%) groups. Suspension of multidisciplinary team meetings, staff members quarantined or relocated to COVID-19 units, units fully dedicated to COVID-19 care, personal protective equipment not readily available were factors significantly associated to delays in endoscopy, radiology, surgery, histopathology and prolonged chemoradiation therapy-to-surgery intervals. In the ‘delay’ group, 48.9% of respondents reported a change in the initial surgical plan and 26.3% reported a shift from elective to urgent operations. Recovery of CRC care was associated with the status of the outbreak. Practicing in COVID-free units, no change in operative slots and staff members not relocated to COVID-19 units were statistically associated with unaltered CRC care in the ‘no delay’ group, while the geographical distribution was not. Conclusions Global changes in diagnostic and therapeutic CRC practices were evident. Changes were associated with differences in health-care delivery systems, hospital’s preparedness, resources availability, and local COVID-19 prevalence rather than geographical factors. Strategic planning is required to optimize CRC care

O cargo público de livre provimento na organização da administração pública federal brasileira: uma introdução ao estudo da organização da direção pública na perspectiva de estudos organizacionais Public position filled by appointment in the Brazilian federal administration: an introduction to the study of public management organization from the organizational studies perspective

A organização da administração pública federal brasileira é raramente abordada na pesquisa no campo de estudos organizacionais (EOs). Privilegia-se a tomada de decisão, seguindo-se a tradição de pesquisa operacional de cunho funcionalista. Contudo, direção é mais complexa e inclui decisão. A direção na administração pública federal brasileira se dá exclusivamente por meio de cargos de livre provimento. Tal realidade permite entender a direção como ação eminentemente política, cristalizada na organização da administração pública. Este artigo possui caráter metodológico e demonstra que o cargo público de livre provimento possui centralidade na organização da administração pública federal brasileira. Identifica, ainda, práticas de operação e interações no exercício da direção pública.<br>The organization of the Brazilian federal public administration is seldom addressed by organizational studies (OS) research. The decision-making process is privileged, according to the tradition of functionalist operational research. However, managing is more complex than decision-making, which is included by it. Management level in Brazilian federal public administration is completely filled by appointment. This reality makes us understand management as an utterly political action, crystallized in the public administration organization. This article has a methodological perspective and demonstrates that public positions filled by appointment are central to the Brazilian federal public administration,. It also identifies practices and interactions of public management