Este estudo avaliou a repercussão da implantação Complexo Regulador (CR) do Sistema Público Municipal de Serviços de Saúde para a rede de atenção de Ribeirão Preto-SP. Teve por aporte teórico a avaliação em saúde e como objetivos específicos: avaliar o alcance do CR, de acordo com a dimensão cobertura, nos anos de 2004, 2005 e 2006; avaliar o efeito do CR de acordo com a dimensão efetividade social. Estudo de avaliação normativa e pesquisa avaliativa, sendo adotada abordagem quanti-qualitativa. O cenário foi o CR, em RP/SP, em seu espaço funcional e organizacional de operação das ações regulatórias do sistema de atenção, implantado na Secretaria Municipal da Saúde. As fontes primárias, produzidas junto aos trabalhadores de diferentes categorias profissionais que atuavam na gestão e no nível operacional do CR, foram coletadas por meio de entrevista estruturada tendo como eixo temático: implantação do CR, sua função de ferramenta operacional para atenção básica e a relação entre a intervenção proposta e os resultados alcançados. As fontes secundárias foram: documentos oficiais existentes sobre o CR, Atas do Conselho Municipal de Saúde; artigos de jornais locais, Sistema de Informação Ambulatorial e Hospitalar do DATASUS. Para organização dos indicadores de análise, elaborou-se planilha específica, com dados relativos aos indicadores de cobertura: Indicador de Consultas Básicas; Indicador de Consultas Especializadas, Indicador de Internações de Baixa e Média Complexidade; Indicador de Internações de Alta Complexidade. Na análise dos dados primários, foi realizada a análise temática, sendo articulada à análise dos indicadores produzidos. O estudo mostrou que: o CR provocou alterações na acessibilidade organizacional e eqüidade da rede de saúde, tanto na atenção ambulatorial quanto hospitalar; destacou necessidade de constituição de rede solidária de atenção e apresentou a potência da estratégia em ser ferramenta profícua de avaliação e de gestão. A implantação do CR alterou significativamente o processo de trabalho dos sujeitos. A avaliação ainda apontou que, apesar do pouco tempo de implantação, a estratégia do CR é potencialmente capaz de colaborar na sustentabilidade do SUS, mas se fazem necessários: investimento, divulgação e aperfeiçoamento. / This study aimed to evaluate the publicity of the implementation of the Regulator Complex (CR) of the Municipal Public System of Health Services for the care network of Ribeirão Preto, SP, Brazil. The health evaluation provided the theoretical framework and the specific objectives were: evaluate the CR scope according to the coverage dimension in 2004, 2005 and 2006; evaluate the CR effect in terms of social effectiveness. This is a normative evaluation and an evaluative research with a quantitative qualitative approach. The scenario was the CR in RP/SP in its functional and organizational space of regulatory actions operation of the care system implemented in the Municipal Secretary of Health. The primary sources produced with workers of different professional categories who acted in the CR management and in its operational level were collected through structured interview according to the following thematic axis: implementation of the CR, its function as operational tool for the primary care and the relation between the proposed intervention and the results accomplished. The secondary sources were: CR official documents, Minutes of the Municipal Council of Health; local newspapers, outpatient and hospital DATASUS Information System. For the organization of the analysis indexes, a specific data sheet was elaborated, with data related to the coverage indexes: Primary Consultation index; Specialized Consultation Index, Low and Medium Complexity Hospitalizations Index; High Complexity Hospitalization Index. The thematic analysis was used for the primary data which was coordinated with the indexes produced. The study showed that: the CR caused alterations on the organizational accessibility and equity in the health network, both in the outpatient and the hospital care; highlighted the need of creating a comprehensive care network and presented the power of the strategy as a proficient evaluation and management tool. The CR implementation changed significantly the subjects\' work process. The evaluation also pointed that despite the little time of implementation, the CR strategy has potential to benefit the SUS sustainability, though investment, publicity and improvement are necessary.

This project examines the role of immunization registries and their effect on a health care delivery system. Recent efforts to attain coverage of child populations by recommended vaccines have included initiatives by federal and state agencies, as well as private foundations, to develop and implement statewide community-based childhood immunization registries.

Chlamydiae growing in target mucosal human epithelial cells in vitro can transition from their normal developmental cycle progression, alternating between infectious but metabolically inactive elementary bodies to metabolically active but noninfectious reticulate bodies (RBs) and back to elementary bodies, into a state of persistence. Persistence in vitro is defined as viable but noncultivable chlamydiae involving morphologically enlarged, aberrant, and nondividing RBs. The condition is reversible, yielding infectious elementary bodies after removal of the inducers, including penicillin, interferon-gamma, iron or nutrient starvation, concomitant herpes infection, or maturation of the host cell into its physiologically differentiated state. All aberrant RB phenotypes are not the same, owing to differing up- or down-regulated chlamydial gene sets and subsequent host responses. Although all persistence-inducing conditions exist in vivo, key questions include (1) whether or not aberrant chlamydial RBs occur in vivo during the alternating acute-silent chronic-acute chlamydial infection scenario that exists in infected patients and animals and (2) whether such aberrant RBs can contribute to prolonged, chronic inflammation, fibrosis, and scarring.

No / Hospitals are under pressure to reduce waiting times and costs. One strategy that may be effective focuses on optimising the flow of emergency patients. We undertook a patient flow analysis of older emergency patients to identify and address delays in ensuring timely care, without additional resources. Prospective systems redesign study over 2 years. The Geriatric Medicine Directorate in an acute hospital (Sheffield Teaching Hospitals NHS Foundation Trust) with 1920 beds. Older patients admitted as emergencies. Diagnostic patient flow analysis followed by a series of Plan Do Study Act cycles to test and implement changes by a multidisciplinary team using time series run charts. 60% of patients aged 75+ years arrived in the Emergency Department during office hours, but two-thirds of the admissions to GM wards were outside office hours highlighting a major delay. Three changes were undertaken to address this, Discharge to Assess, Seven Day Working and the establishment of a Frailty Unit. Average bed occupancy fell by 20.4 beds (95% confidence interval (CI) -39.6 to -1.2, P = 0.037) for similar demand. The risk of hospital mortality also fell by 2.25% (before 11.4% (95% CI 10.4-12.4%), after 9.15% (95% CI 7.6-10.7%) which equates to a number needed to treat of 45 and a 19.7% reduction in relative risk of mortality. The risk of re-admission remained unchanged. Redesigning the system of care for older emergency patients led to reductions in bed occupancy and mortality without affecting re-admission rates or requiring additional resources.

Indiana University-Purdue University Indianapolis (IUPUI) / Although interprofessional education (IPE) opportunities can help prepare students for future practice and patient-centered care, many health professions students in the country are not educated in an environment with opportunities to learn with, from, or about students from other health professions. With upcoming curricular changes at the Indiana University School of Medicine (IUSM) and the Indiana University School of Nursing (IUSN), IPE remains at the forefront of these changes in both schools. To date, few studies have explored student, faculty, and administrators’ conceptualizations of IPE prior to formal implementation. Additionally, previous studies have not compared IPE conceptualizations across these groups. This multiple-case study explores and compares how groups of stakeholders from the IUSM (Indianapolis) and the IUSN (Indianapolis) conceptualize IPE. Data collection included the examination of discipline-specific public documents and one-on-one interviews (N=25) with pre-licensure students, clinical faculty, and administrators from each school. Coding and extraction of themes transpired through within-case and cross-case analysis and data supported the following findings: the ‘business of medicine’ may prevent IPE from becoming a priority in education; stakeholders’ conceptualizations of IPE are shaped through powerful experiences in education and practice; students desire more IPE opportunities at the institution; stakeholders at the IUSN have a long-standing investment in IPE; and the institution requires a ‘culture shift’ in order to sustain IPE efforts. The findings suggest that IPE belongs in all education sectors and IPE efforts deserve reward and reimbursement. The findings also insinuate that leadership, roles, and team training education belong in IPE and IPE culture requires all individuals’ (e.g., student, faculty, administrators, patients) commitment. Importantly, the institution must continue IPE development, research, and dissemination. These findings can help shape curricula as time progresses, increase the likelihood of developing a successful new curriculum, and prompt ongoing reflection about IPE. This information can influence how institutions approach IPE and may lead to a more successful and informed IPE curriculum in the first years of implementation. And, hopefully what is learned through IPE will be translated into healthcare practice environments.