Claudio Luiz Lottenberg

Georeferencing deaths from stroke in São Paulo: an intra-city stroke belt?

Background The role of socioeconomic status in the worldwide stroke burden has been studied with various methods using vital statistics and research-generated data. Aim The objective of our study was to describe the stroke mortality rates and the stroke mortality distribution, and to evaluate the association between stroke mortality rates and geographical distribution with the human development index in São Paulo, Brazil. Methods This ecological study evaluated a historical series of stroke mortality in São Paulo, Brazil, from 2004 to 2010. Standard stroke mortality rate per 100 000 inhabitants at each year, the address of residence assumed as the place of living, and the human development index applied as a social indicator were used in order to evaluate if stroke mortality correlated with socioeconomic status. Results The mean standardized stroke mortality in São Paulo decreased from 66 to 46-7 per 100 000 inhabitants from 2004 to 2010. Stroke mortality differed according to human development index strata with an almost three times higher stroke mortality in the lowest when compared with the highest human development index stratum. Visual inspection of the map of the districts with high stroke mortality disclosed regional clusters with high mortality in the east, northwest, and south regions, a finding suggestive of the presence of a stroke belt inside the city of São Paulo. Conclusions In conclusion, between 2004 and 2010, stroke mortality rates decreased by 28-5% in São Paulo. A geographical pattern in stroke mortality could be observed, with considerable differences according the human development index level of the place of living.

Effect of implementing an acute myocardial infarction guideline on quality indicators

ABSTRACT Objective: To evaluate the compliance rates to quality of care indicators along the implementation of an acute myocardial infarction clinical practice guideline. Methods: A clinical guideline for acute myocardial infarction was introduced on March 1st, 2005. Patients admitted for acute myocardial infarction from March 1st, 2005 to December 31st, 2012 (n=1,431) were compared to patients admitted for acute myocardial infarction before the implementation of the protocol (n=306). Compliance rates to quality of care indicators (ASA prescription on hospital admission and discharge, betablockers on discharge and door-to-balloon time) as well as the length of hospital stay and in-hospital mortality were compared before and after the implementation of the clinical guideline. Results: The rates of ASA prescription on admission, on discharge and of betablockers were higher after guideline implementation: 99.6% versus 95.8% (p<0.001); 99.1% versus 95.8% (p<0.001); and 95.9% versus 81.7% (p<0.001), respectively. ASA prescription rate increased over time, reaching 100% from 2009 to 2012. Door-to-balloon time after versus before implementation was of 86(32) minutes versus 93(51) (p=0.20). The length of hospital stay after the implementation versus before was of 6(6) days versus 6(4) days (p=0.34). In-hospital mortality was 7.6% (before the implementation), 8.7% between 2005 and 2008, and 5.3% between 2009 and 2012, (p=0.04). Conclusion: The implementation of an acute myocardial infarction clinical practice guideline was associated with an increase in compliance to quality of care indicators.

Redução do custo em cirurgia de coluna em um centro especializado de tratamento

ABSTRACT Objective To compare the estimated cost of treatment of spinal disorders to those of this treatment in a specialized center. Methods An evaluation of average treatment costs of 399 patients referred by a Health Insurance Company for evaluation and treatment at the Spine Treatment Reference Center of Hospital Israelita Albert Einstein. All patients presented with an indication for surgical treatment before being referred for assessment. Of the total number of patients referred, only 54 underwent surgical treatment and 112 received a conservative treatment with motor physical therapy and acupuncture. The costs of both treatments were calculated based on a previously agreed table of values for reimbursement for each phase of treatment. Results Patients treated non-surgically had an average treatment cost of US

Disseminated fusariosis with endophthalmitis in a patient with hematologic malignancy

1,650.00, while patients treated surgically had an average cost of US

Advanced units: quality measures in urgency and emergency care.

18,520.00. The total estimated cost of the cohort of patients treated was US

Haiti's earthquake: a multiprofessional experience

1,184,810.00, which represents a 158.5% decrease relative to the total cost projected for these same patients if the initial type of treatment indicated were performed. Conclusion Treatment carried out within a center specialized in treating spine pathologies has global costs lower than those regularly observed.

Implementation of a sepsis protocol in a community hospital using a Telemedicine Program

1 Hospital Albert Einstein, Sao Paulo, SP, Brasil. Autor correspondente: Guilherme Fleury Perini – Hospital Israelita Albert Einstein, Istituto Israelita de Ensino e Pesquisa, Avenida Albert Einstein, 627/701, Bloco A – Morumbi – CEP: 05652-900 – Sao Paulo, SP, Brasil – Tel.: (11) 2151-8709 – E-mail: guiperini@einstein.br Data de submissao: 2/8/2012 – Data de aceite: 24/2/2013 Figura 1. Tomografia computadorizada de orbitas mostrando delaminacao lateral, medial e anterior do globo ocular esquerdo, compativel com endoftalmite Figura 2. Exame anatomopatologico do olho esquerdo, mostrando abscesso intraocular

Impact of Knowledge Transfer Through the Implementation of an Emergency Telemedicine Program in a Brazilian Community Hospital

Objective To evaluate, through care indicators, the quality of services rendered to patients considered urgency and emergency cases at an advanced emergency care unit. Methods We analyzed data from managerial reports of 64,891 medical visits performed in the Emergency Care Unit of the Ibirapuera Unit at Care during the period from June 1st, 2012 through May 31st, 2013. The proposed indicators for the assessment of care were rate of death in the emergency care unit; average length of stay of patients in the unit; rate of unplanned return visits; admission rate for patients screened as level 1 according to the Emergency Severity Index; rate of non-finalized medical consultations; rate of complaints; and door-to-electrocardiogram time. Results The rate of death in the emergency care unit was zero. Five of the 22 patients classified as Emergency Severity Index 1 (22.7%) arrived presenting cardiac arrest. All were treated with cardiopulmonary resuscitation and reestablishment of vital functions. The average length of stay of patients in the unit was 3 hours, 33 minutes, and 7 seconds. The rate of unscheduled return visits at the emergency care unit of the Ibirapuera unit was 13.64%. Rate of complaints was 2.8/1,000 patients seen during the period Conclusion The model of urgency and emergency care in advanced units provides an efficient and efficaious service to patients. Both critically ill patients and those considered less complex can receive proper treatment for their needs.

Fusariose disseminada com endoftalmite em paciente com neoplasia hematológica Disseminated fusariosis with endophthalmitis in a patient with hematologic malignancy

INTRODUCTION On January 12, 2010 an earthquake of 7.0 on the Richter scale struck Haiti, the poorest country in America. The quake’s epicenter was in Leogane with extension to almost all the country also hitting Port-au-Prince, the country’s capital. This disaster caused a huge destruction and devastated more than 250,000 of houses and commercial buildings and left more than a million of homeless people. In the aftermath, this catastrophe caused 230,000 deaths and more than 30,000 wounded people (). () [...]