Estruturação de projetos de PPP e concessão no Brasil: diagnóstico do modelo brasileiro e propostas de aperfeiçoamento

Esta publicação foi realizada com recursos do Programa de Fomento à Participação Privada. Este programa é resultado de um esforço conjunto entre IFC, BNDES e BID

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

The original version of this article unfortunately contained a mistake

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

The Chilean Law of Concessions of Public Works

La concesión de obra pública es una de las modalidades en que se ma- nifiesta la asociación público - privada en Chile. En virtud de esta, el Estado encarga a un privado la ejecución, conservación o reparación de una obra pública fiscal a cambio del derecho a explotarla en los términos estipulados en el respectivo contrato de concesión. Se trata de un sistema relativamente nuevo con resultados tremendamente exitosos para un país como Chile: 67 proyectos adjudicados por una inversión aproximada de US$11.700 millones. Gran parte del éxito de este sistema se atribuye a la existencia un estatuto jurídico que cautela y garantiza adecuadamente los intereses de todos los actores involucrados, sean estos partes del contrato o terceros que se relacionan con ellas. En el presente documento, el autor realiza una revisión a la evolución histórica de la Ley de Concesiones de Obras Públicas hasta su más reciente modificación en 2010, con la Ley 20.410. Por razones de desarrollo, se revisan las que –a juicio del autor– son las principales modificaciones introducidas por cada una de las leyes pro- mulgadas. El objetivo del trabajo es exponer, en el concierto internacional esa evolución, teniendo en consideración que este estatuto jurídico es de habitual difusión en foros internacionales. Sin lugar a dudas, la principal conclusión de este artículo es que la Ley de Concesiones de Obras Públicas de Chile es producto de un largo y costoso aprendizaje. The concession of public work is one of the modalities in which the associa- tion public - private in Chile is demonstrated. By virtue of this one, the State entrusts to the private one the execution, conservation or repair of a public fiscal work in exchange for the right to exploit it in the terms stipulated in the respective contract of concession. It is a question of a relatively new sys- tem with tremendously successful results for a country as Chile: 67 projects awarded by an approximate investment of US$11.700 million. Great part of the success of this system is attributed to the existence of a juridical statute that protects and guarantees adequately the interests of all the involved ac- tors, be these reports of the contract or third that relate to her. In the present document, the author does a review to the historical evolution of the Law of Concessions of Public Works up to its more recent modification in 2010. For reasons of development, the principal modifications introduced by each of the promulgated laws are being checked according to the opinion of the author. The aim of the work is to exhibit, in the international concert this evolution, having in consideration that this juridical statute is of habitual diffusion in international forums. No doubt, the main conclusion of this article is that the Law of Concessions of Public Works of Chile is a product of a long and costly learning process.

The Chilean Law of Concessions of Public Works

La concesión de obra pública es una de las modalidades en que se ma- nifiesta la asociación público - privada en Chile. En virtud de esta, el Estado encarga a un privado la ejecución, conservación o reparación de una obra pública fiscal a cambio del derecho a explotarla en los términos estipulados en el respectivo contrato de concesión. Se trata de un sistema relativamente nuevo con resultados tremendamente exitosos para un país como Chile: 67 proyectos adjudicados por una inversión aproximada de US$11.700 millones. Gran parte del éxito de este sistema se atribuye a la existencia un estatuto jurídico que cautela y garantiza adecuadamente los intereses de todos los actores involucrados, sean estos partes del contrato o terceros que se relacionan con ellas. En el presente documento, el autor realiza una revisión a la evolución histórica de la Ley de Concesiones de Obras Públicas hasta su más reciente modificación en 2010, con la Ley 20.410. Por razones de desarrollo, se revisan las que –a juicio del autor– son las principales modificaciones introducidas por cada una de las leyes pro- mulgadas. El objetivo del trabajo es exponer, en el concierto internacional esa evolución, teniendo en consideración que este estatuto jurídico es de habitual difusión en foros internacionales. Sin lugar a dudas, la principal conclusión de este artículo es que la Ley de Concesiones de Obras Públicas de Chile es producto de un largo y costoso aprendizaje. The concession of public work is one of the modalities in which the associa- tion public - private in Chile is demonstrated. By virtue of this one, the State entrusts to the private one the execution, conservation or repair of a public fiscal work in exchange for the right to exploit it in the terms stipulated in the respective contract of concession. It is a question of a relatively new sys- tem with tremendously successful results for a country as Chile: 67 projects awarded by an approximate investment of US$11.700 million. Great part of the success of this system is attributed to the existence of a juridical statute that protects and guarantees adequately the interests of all the involved ac- tors, be these reports of the contract or third that relate to her. In the present document, the author does a review to the historical evolution of the Law of Concessions of Public Works up to its more recent modification in 2010. For reasons of development, the principal modifications introduced by each of the promulgated laws are being checked according to the opinion of the author. The aim of the work is to exhibit, in the international concert this evolution, having in consideration that this juridical statute is of habitual diffusion in international forums. No doubt, the main conclusion of this article is that the Law of Concessions of Public Works of Chile is a product of a long and costly learning process.

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat