The Spedale di Santa Maria della Scala and the Construction of Siena

The Spedale di Santa Maria della Scala was central to the development of architecture and infrastructure in early modern Siena. A major landowner and patron, the hospital institution oversaw the construction of a wide range of buildings throughout the commune, and also played a crucial role in the perpetuation of a distinctly Sienese corpus of technical knowledge. Archival records attest to the presence of the Spedale’s building workshop, which contributed workers, materials and expertise to both the institution’s projects, as well as those involving Siena’s infrastructure and defences. Several fifteenth-century model books trace the technical tradition spearheaded by the Scala. Assembled by individual practitioners, the books bolstered a collective memory, delineating the ideas and structures that made Siena a place.

Costs of treating community-acquired bacterial bronchopneumonia in pediatric patients

Relevance. Health management has not escaped the pressure of the current epidemiological situation. In a complex scenario, characterized by the COVID-19 pandemic, the daily dynamics become more complex and greater agility is required for decision-making. Much of the success of those decisions is determined by access to timely information, especially in crisis conditions and limited resources. For this reason, health organizations are interested in knowing the costs of pathologies that frequently constitute causes of hospitalization. In this sense, community - acquired bacterial bronchopneumonia stands out, which is a disease that frequently causes hospitalization of pediatric patients. Objective. This article aims to carry out a partial retrospective financial evaluation in order to determine the costs associated with the treatment of community-acquired bacterial bronchopneumonia in pediatric patients. Materials and methods. The study was developed from the perspective of the health institution General Hospital Guillermo Luis Fernndez Hernndez - Baquero in the city of Moa. For this, the analysis - synthesis and comparative methods were used, as well as the methodology to calculate and analyze disease costs. Results. The research focused on the January-March quarters of the years 2017 and 2018 and provided valuable accounting information regarding the direct and indirect costs of the treatment of the pathology in question, which serves as a tool for the correct management of the hospital institution. Conclusion . The direct costs exceeded the indirect costs and the items that most affected the total cost were the salaries of the workers, food, and medicines used to treat the disease. The need to develop digital health was evidenced, with special emphasis on digital medical records to facilitate access to them and thus avoid the loss of information due to its deterioration. The study provides useful information to the management of the health institution, which serves as support for budget analysis and future projections.

Robotic Myomectomy: Until Achieving Reproductive Success, Step by Step

Surgeons who practice robotic surgery in benign gynecological conditions agree that in some cases, blood loss and transfusions are reduced, the time of hospital stay and of reintegration to daily activities is less, although commonly in the first cases of each surgeon surgical time may be longer than laparoscopic surgery depending on the learning curve of each. As in any other surgical technique, it is important that the surgeon is trained and certified in accordance with the guidelines that each hospital institution indicates for the practice of robotic surgery and is constantly updated through the tools provided by robotic surgery to ensure the correct use of this technology and always maintain the skill looking for the safety of the patient at all times. Uterine fibroids, are the most common benign tumors that appear in women of reproductive age. Depending on their location, number and size, the symptoms they produce vary in frequency and severity. Robotic myomectomy has shown that with a surgical team that operates frequently, it is superior to conventional laparoscopic myomectomy, even in the area of ​​cost/benefit. Robotic myomectomy is an accessible, efficient and flattering pathway for patients with fibroids who want a pregnancy.

Comfort and safety for the oncological client with indication of central venous catheter use: The intentionality of nurses

Objective: To understand the expectations of the educational actions of 41 nurses in the nursing consultation for oncologic clients when they indicate a central venous catheter (CVC) for treatment. Method: Phenomenological qualitative research with 41 nurses indicating the use of CVC for treatment in oncologic clients of two units of a federal public hospital institution located in the city of Rio de Janeiro and specialized in oncology. Semi-structured interviews were used and the data were analyzed according to Alfred Schütz's conceptions. Results: It was possible to identify the following categories: promoting comfort and safety for both the client and the professional; demystifying the use of the central venous catheter for the client; obtaining the client's collaboration. Conclusion: The findings of the study revealed that the nurses aim to promote comfort and safety for the oncologic client throughout the treatment to prevent complications, even in cases where there is no prospect of cure. These professionals aim to sensitize the client to a possible change in behavior and that should be shared among the professionals of the multidisciplinary team of an interdisciplinary knowledge, the client, the family member in the search for the quality of appropriate and unique treatment.

Fatores associados às internações de longa permanência em instituição hospitalar de alta complexidade/Factors associated with long-term hospitalizations in a high complexity hospital institution

Objetivo: analisar os fatores associados às internações hospitalares de longa permanência de pacientes atendidos pelo Sistema Único de Saúde em instituição de alta complexidade. Método: estudo transversal quantitativo a partir de dados secundários de internações hospitalares de 2013 a 2015. Calculou-se a razão de prevalência por Regressão de Poisson bruta e ajustada. Resultados: das 12.689 internações nos anos de estudo, 645 foram de longa permanência (>30 dias), com uma prevalência de 5,1%. Predominaram entre o sexo masculino (62%), > 60 anos de idade (52,6%). As causas mais frequentes da hospitalização foram doenças do aparelho circulatório (33,5%) e causas externas (22,3%). O óbito ocorreu para 45,6%. Na análise bivariada, estiveram estatisticamente associadas às internações de longa permanência as variáveis: sexo, idade (60 anos e mais) o baixo ou a não escolaridade dos indivíduos, ser da 17ª regional de saúde, ter sido internado na especialidade neurocirurgia e ter necessitado de internação em UTI. No entanto, permaneceram no modelo final sexo masculino, residir na regional de saúde do município em análise e ter necessitado de internação em Unidade de Terapia Intensiva. (p<0,001). Conclusão: Estratégias de promoção da saúde voltadas à saúde do homem devem ser desenvolvidas pelo município, especialmente considerando que os mesmos são os que mais perdem a vida pela ausência de cuidados com a saúde e em decorrência dos agravos resultantes de causas externas.

Public-private relationship in surgical hospitalizations through the Unified Health System

Objective: to characterize surgical hospitalizations, length of stay, cost and mortality, according to the legal nature (public and private) of the hospital institution linked to the Unified Health System (Sistema Único de Saúde, SUS). Method: a descriptive study, of the survey type, with retrospective data collection (2008 to 2017) and a quantitative approach. The dependent variables surgical hospitalizations in Brazil, costs, length of stay and mortality and the independent variables regime/legal nature (public and private) were obtained from the Informatics Department of the Unified Health System. The Mann-Whitney test was used for analysis. Results: the average number of hospitalizations through the Unified Health System was 4,214,083 hospitalizations/year, 53.5% occurred in private hired hospitals and 46.5% in public hospitals (p=0.001). The financial transfer was greater for the private sector (60.6%) against 39.4% for the public (p=0.001). The average stay was 4.5 days in the public hospital and 3.1 days in its private counterpart (p<0.001). Mortality was higher in the public (1.8%) than in the private hospital (1.4%) (p<0.001). Conclusion: there was predominance of surgical hospitalizations through the Unified Health System in private hospitals with greater financial transfer to this sector, to the detriment of the public. The diverse evidence produced contributes to the debate and actions to avoid budgetary asphyxiation in the public sector in favor of the private sector.

Association and correlation between stress, musculoskeletal pain and resilience in nurses before hospital accreditation maintenance assessment

Objective: to associate and correlate musculoskeletal pain, stress and resilience of nurses in the maintenance of Hospital Accreditation Certification. Method: longitudinal study in two moments, before and after the Accreditation maintenance visit, March and June 2019, with 53 nurses from a hospital institution. The data collected was: sociodemographic, clinical and occupational variables, stress, osteomuscular pain and resilience. Descriptive variables, Chi-square test, t test, Fisher’s exact test, Pearson’s correlation and Spearman’s correlation coefficient were used. Results: most of the study participants had average stress levels before and after the evaluation. Most of those who reported pain were at medium stress levels at both times. The resilience capacity increased after the evaluation, which demonstrates that the experienced stressors were adequately addressed. There was no significant association between the cortisol levels and the perceived stress. Conclusion: occupational stress and musculoskeletal pain were experienced by nurses during the Accreditation processes. It was evident that individuality permeated the perception of stress and resilience allowed to overcome the tensions experienced. The study identified that there is a need for planning and implementation of actions to collaborate with the nurses in the best confrontation, aiming to promote resilience.

Veno-Arterial Extracorporeal Membrane Oxygenation in the Adult: A Bridge to the State of the Art

Abstract:: Despite the technological improvements of the last 40 years conditions such as refractory cardiogenic shock and cardiac arrest still present a very high mortality rate in the real-world clinical practice. In this light we have performed a review of the techniques, indications, contraindications and results of the so-called Veno-Arterial Extracorporeal Circulatory Membrane Oxygenation (VA-ECMO) in the adult population to evaluate the current results of this temporary cardio-pulmonary support as salvage and/or bridge therapy in patient suffering from refractory cardiogenic shock or cardio-circulatory arrest. The results are encouraging, especially in the setting of refractory cardiogenic shock and in-hospital cardiac arrest. Among a selected population the prompt institution of a VA-ECMO may radically change the prognosis by sustaining vital functions while looking for the leading cause or waiting for the reversal of the temporary cardio-respiratory negative condition. The future directions aim to standardized and shared protocols, miniaturization of the machines and possibly the institution of specialized “ECMO teams” for in and out-of-hospital institution of the tool.

COMO CALCULAR O CUSTO DE TECNOLOGIAS QUE PREVINEM OS ERROS DE MEDICAÇÃO

Objetivo: Relatar a experiência de desenvolvimento de uma metodologia para o cálculo do custo de tecnologias que previnem o erro de medicação em uma instituição hospitalar. Método: Estudo descritivo, do tipo relato de experiência, que descreve uma metodologia desenvolvida para o cálculo do custo de tecnologias que previnem o erro de medicação em instituição hospitalar. Resultados: As tecnologias foram classificadas em leve, leve-dura e dura. Para o cálculo do custo, foi aplicado método de custeio direto, utilizando as variáveis de mão de obra e materiais e/ou equipamentos utilizados para o uso dessas tecnologias. Após cálculo de cada variável individualmente, estas foram somadas obtendo-se os custos das tecnologias preventivas. Conclusões: O conhecimento do método de cálculo desse custo proporciona uma visão real do investimento, auxiliando a tomada de decisão do gestor, e incentivo à prevenção do erro de medicação. HOW TO CALCULATE TECHNOLOGY COST TO PREVENT MEDICATION ERROS ABSTRACT Purpose: To report the experience in the development of a methodology in order to calculate the cost of technology that prevents medication error in a hospital institution. Method: Descriptive study, a case report format, describing a methodology developed to calculate the cost of technology in order to prevent medication error in a hospital institution. Results: Technologies were classified as soft, soft-hard and hard. Direct costing method was applied with a view to calculate the cost by using labor variables and/or equipment for the use of those technologies. Thereafter the calculation of each variable, they were summed and it was possible to obtain the cost of preventive technologies. Conclusion: Awareness about calculation method provides a real overview of the investment; it benefits the manager’s decision taking and encourages the medication error prevention. Descriptors: Patient’s safety. Medication erros. Cost and cost analyses. Investiments in health. Economy and Nursing.