Acta Medica Port
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Comparative Study
[Efficiency versus quality in the NHS, in Portugal: methodologies for evaluation].
To proceed to the evaluation of the efficiency and quality in the NHS, based in methodologies of evaluation of management, indicators of benchmarking and indicators of process and outcome. The 1980 and 1990 decades have seen the proliferation of all forms of process indicators as a way to control health services. It is not a coincidence that the increase in managed care has been accompanied by an explosion of process indicators, as it has happened in the health system of the USA. ⋯ The outcome indicator number of episodes of inpatient care due to surgery infection in total days of inpatient care. Those indicators have been aggregated, by a mean. The Composite Indicator of Efficiency and Quality is the mean of the Composite Indicator of Efficiency and the Composite Indicator of Quality, having this one been converted in inverse base.
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Neurocognitive dysfunction is, nowadays, reported as one of the most frequent complications of cardiac surgery, with documented potential to have a negative impact on quality of life. Notwithstanding, the cognitive evaluation is almost exclusively restricted to research contexts, being depreciated in clinical settings. Cognitive functioning changes have mostly been investigated in patients submitted to coronary artery bypass grafting, with data reporting to valvular surgery still being extremely rare. ⋯ A notable variability between results of different studies may arise from diverse investigational methodologies and from factors related with difficulties inherent to the cognitive assessment, such as the diverse methods used for evaluation and the presence of a remarkable number of confounding factors. Investigation on valvular surgery neurocognitive effects is still in a very incipient period, being crucial to accurately establish the exact influence of the specific variables of this particular patient's group, such as the type of surgery and valve prosthesis. Furthermore, the clarification of the pathophysiological mechanisms subjacent to neurocognitive dysfunction might represent an important step to look for potential preventive or therapeutic strategies that could ameliorate brain function after cardiac surgery.
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Dental caries results from a complex interaction between the host and environmental factors and it is an important public health issue. ⋯ Dental caries was more prevalent in the six year old group with a male predominance. Children who brushed their teeth twice a day had less caries and the 12 year old group had more visits to the dentist. To ensure adequate oral hygiene habits it is important that parents supervise their children' habits.
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Elderly drug therapy needs special care considering physiopathological alterations of this age group that increase the risk of adverse drug events occurrence and due to the high number of drugs used. Several tools have been created, as tables of drugs and groups of drugs to be avoided in patients 65 years old and over. Beers Criteria of 2002 update is the most used tool. ⋯ The Portuguese operationalization of the Beers Criteria allows the creation of a tool that helps prescribers to choose drugs and doses for a safer prescription to the elderly. These adapted tables allow benchmarking among studies assessing inappropriateness of use of drugs in different countries using Beers Criteria.
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A retrospective analyses of patients submitted to surgery on a day basis was made through our database. The goal of the study was to identify risk factors of postoperative vomiting associated to day surgery. 2115 patients operated between January 2003 and November 2004 on our day surgery unit were included. 70 patients (3,3%) suffered at least on episode of postoperative vomiting. Several factors were analysed: age, sex, surgical speciality, ASA physical status, anaesthetic technique and the duration of anesthesia. ⋯ Logistic regression was then used to identify the multivariate association strength of these factors. The female sex (Odds ratio =4,94) and the duration of anesthesia when longer than 180 minutes (Odds ratio =8,13), had been associated to a higher incidence of postoperative vomiting, while loco-regional technique (Odds ratio = 0,15) and sedation with local anaesthesia (Odds ratio =0,09) had been associated with a lower incidence. Authors evidence the importance of the identification of postoperative vomiting risk factors that will allow us to establish better guidelines on postoperative nausea and vomiting prophylaxis in these patients and to improve the quality of our clinical care and the satisfaction of our patients.