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Benchmarking na gestão de unidades de saúde: Relevância, aplicabilidade e construção de um modelo de Benchmarking para o serviço de Fisioterapia de Medicina Física e Reabilitação do Hospital de Braga
No full textO trabalho realizado aborda a temática do Benchmarking em Gestão de Unidades de Saúde, a criação de um modelo de Benchmarking e indicadores não clínicos para a Fisioterapia do serviço de Medicina Física e Reabilitação do Hospital de Braga.
Um modelo de Benchmarking adota várias fases que integram passos específicos que estruturam o processo, tornando-o uma ferramenta poderosa na análise comparativa e de melhoria continua.
De acordo com a proposta apresentada, foi construído um modelo de Benchmarking específico para o serviço, focando os esforços na análise de indicadores e medidas para possibilitar a medição do sucesso dos processos determinados pela gestão inerentes ao funcionamento do serviço.
Esta abordagem premiou a análise do impacto dos processos determinados pela gestão do serviço no Acesso e Equidade do utente do SNS no serviço de Fisioterapia de Medicina Física e Reabilitação do Hospital de Braga.
Os indicadores foram submetidos a aprovação por parte dos Fisiatras e Fisioterapeutas do serviço de Medicina Física e Reabilitação, sendo validados e apresentados para futuras considerações
Realizou-se uma análise do investimento na implementação do modelo construído.
Como conclusão a ferramenta do Benchmarking na saúde poderá abordar indicadores de processo não clínicos. Existe potencial para a recolha de dados e utilidade dos indicadores, como a criação de outros adaptados à realidade dos parceiros no Benchmarking. A ferramenta do Benchmarking nos moldes em que foi proposta é útil e poderá ser potenciadora de melhoria de performance, criação e reforço de laços
Stroke and Cardiac Papillary Fibroelastoma: Mechanical Thrombectomy after Thrombolytic Therapy
Get PDFWe describe a case of a 34-year-old man with a sudden development of right hemiparesis and aphasia because of infarction of the left middle cerebral artery that was submitted to intravenous (IV) recombinant tissue plasminogen activator and mechanical thrombectomy. Transesophageal echocardiogram showed a small mass on the anterior leaflet of the mitral valve. Cardiac surgery was performed, and histological examination of the removed material was consistent with cardiac papillary fibroelastoma (CPF). Experience in using IV thrombolysis for the treatment of embolic stroke because of CPF is limited. To the best of our knowledge, only 3 patients are reported in literature in whom acute ischemic stroke and associated CPF were treated with thrombolytic therapy. A discussion of the efficacy of IV thrombolysis and the possible superiority of mechanical thrombectomy is included
Prevalence of Frey’s Syndrome after Parotidectomy
Get PDFIntroduction: Frey’s syndrome is characterized by facial sweating, flushing and heat sensation in the parotid area. Its prevalence is
highly variable. Methods: The present study included 33 selected patients, submitted to superficial parotidectomy. To the included
patients, a clinical interview was conducted and Minor’s test, for objective evaluation of Frey’s syndrome, was applied. The degree of
Frey’s syndrome severity was determined according to Luna Ortiz’s model and by using a 0-10 numeric scale. Results: Of the 33 initially
selected patients, only 27 (81,8%) showed up for assessment at Hospital de Braga. Of the seven patients who referred sweating,
only one classified it as “excessive”, giving it grade 6 on a “0-10” scale, while all of the others classified it as “1”, “2” or “3”. Minor’s
test was positive in seven patients, one of which didn’t have any clinical complaints. According to Luna-Ortiz’s surgical severity model,
three patients (42, 9%) were assessed as having moderate Frey’s syndrome and four patients (57,1%) had severe disease. Conclusion:
The incidence of this condition, as determined by Minor’s test, is 26,9%, similarly to what is found in other studies
Schimmelpenning syndrome
Get PDFSchimmelpenning syndrome (SS) includes an organoid nevus that follows the lines of Blaschko and defects of brain, eyes, bones, or other systems. We report a case of a 3-month old female infant, who presented with several thin plaques, with irregular borders, yellowish color, which had a verrucous appearance, following the lines of Blaschko, mainly occupying the left side of posterior trunk, the left face, the right side of the anterior trunk, and the right upper limb. These plaques had been present since birth. In addition, she had a flat salmon to yellow nevus on the left parietal and temporal region of the scalp, with a bald patch. She was diagnosed after birth with an interauricular communication. The skin biopsy from the lesion of the right arm revealed an epidermal nevus that occupied the epidermis completely. Routine and other complementary laboratory blood tests, including platelet count, thyroid function tests, 25-hydroxy-vitamin D, parathyroid hormone, and plasma and urinary levels of calcium and phosphorus were negative. Cerebral magnetic resonance and renal ultrasound were normal. The diagnosis of SS was established. She is being followed in the clinics of Dermatology, Cardiology, Pediatrics, and Pediatric Neurology. We report this case to point out the importance of investigating patients with epidermal nevus to identify associated conditions
Emergencies after endoscopic procedures
Get PDFEndoscopy adverse events (AEs), or complications, are a rising concern on the quality of endoscopic care, given the technical advances and the crescent complexity of therapeutic procedures, over the entire gastrointestinal and bilio-pancreatic tract. In a small percentage, not established, there can be real emergency conditions, as perforation, severe bleeding, embolization or infection. Distinct variables interfere in its occurrence, although, the awareness of the operator for their potential, early recognition, and local organized facilities for immediate handling, makes all the difference in the subsequent outcome. This review outlines general AEs' frequencies, important predisposing factors and putative prophylactic measures for specific procedures (from conventional endoscopy to endoscopic cholangio-pancreatography and ultrasonography), with comprehensive approaches to the management of emergent bleeding and perforation
Mesalamine-induced myocarditis following diagnosis of Crohn's disease: a case report
Get PDFMesalamine is a common treatment for Crohn's disease, and can be rarely associated with myocarditis through a mechanism of drug hypersensitivity. We present the case of a 19-year-old male who developed chest pain two weeks after beginning mesalamine therapy. The electrocardiogram showed slight ST-segment elevation with upward concavity in the inferolateral leads; blood tests demonstrated elevated troponin I and the echocardiogram revealed moderately depressed left ventricular systolic function with global hypocontractility. Cardiac magnetic resonance imaging confirmed the diagnosis of myocarditis, revealing multiple areas of subepicardial fibrosis. The onset of symptoms after mesalamine, and improvement of chest pain, cardiac biomarkers and left ventricular systolic function after discontinuing the drug, suggest that our patient suffered from a rare drug-hypersensitivity reaction to mesalamine
