Thesis (M.H.A.)--University of Michigan, 1962.

Aproximadamente 40% dos casos de Linfoma não Hodgkin (LNH) se originam fora dos linfonodos, sendo então denominados linfomas extralinfonodais. No trato gastrointestinal (TGI), o estômago é o local mais freqüentemente envolvido, representado pelo linfoma MALT e pelo linfoma difuso de grandes células B (LDGCB). No Brasil, apesar da sua freqüência e importância, existem poucos dados epidemiológicos em relação aos linfomas, especialmente no que se refere aos linfomas de origem extralinfonodal. Para avaliar as características dos linfomas primários gástricos em uma população brasileira, 60 casos foram avaliados retrospectivamente. Trinta e oito (63,3%) foram classificados como LDGCB e 22 (36,6%) como MALT. Entre os dois grupos, não houve diferenças significativas em termos de sexo, idade, sintomas dispépticos, sintomas B, presença de massa Bulky, infiltração de medula óssea, estádio, infecção por H. pylori, achados laboratoriais e endoscópicos. Foram adotados diferentes protocolos de tratamento. A taxa de remissão completa foi de 73,1% no LDGCB e de 95% no linfoma MALT. A taxa de sobrevida livre de doença em 7 anos foi de 84,8% no LDGCB e de 94,1% no linfoma MALT. A taxa de sobrevida global em 7 anos foi de 65,7% no LDGCB e de 92,9% em 5 anos no linfoma MALT. Como não conseguimos demonstrar diferenças entre os dois tipos histológicos, concluímos que o diagnóstico histológico correto é essencial para a terapêutica mais adequada. / Approximately 40% of the non-Hodgkins Lymphoma arises outside lymph node tissue, being then termed extranodal lymphoma. In the gastrointestinal tract, gastric is the commonest localization represented by MALT and diffuse large B-cell lymphoma (DLBCL). In Brazil, despite its importance and frequency there are very few epidemiological data concerning lymphomas, specially the extranodal ones. In order to study the primary gastric lymphoma features in a Brazilian population, 60 patients were retrospectively evaluated. Thirty eight cases (63.3%) were classified as DLBCL and 22 (36.6%) as MALT lymphoma. There were no significant differences between the 2 groups in terms of sex, age, gastric symptoms, B symptoms, Bulky disease, bone marrow infiltration, stage, H. pylori infection, laboratory and endoscopic findings. Different treatment methods were adopted. The complete remission rate was 73.1% for DLBCL and 95% for MALT lymphoma. The disease free survival in 7 years was 84.8 for DLBCL and 94.1% for MALT lymphoma. The 7 year overall survival (OS) rate for DLBCL was 65.7% and 5 year OS for MALT was 92.9%. Because we could not demonstrate differences between the two histological groups, we conclude that the correct histological diagnosis is essential for choosing the best therapeutic approach.

A utilização de um modelo computacional para simular o consumo energético de edificações para diferentes fins tornou-se prática comum. Entretanto, para que suas finalidades sejam válidas para prédios em fase de operação é necessário que a simulação passe por uma fase denominada calibração, ou seja, ajuste de seus parâmetros de entrada para verificar que seu resultado esteja coerente com a realidade. Dado esta necessidade, este trabalho tem como objetivo a calibração da energia elétrica simulada por um modelo EnergyPlus do Hospital Universitário da Universidade de São Paulo (HU-USP). Na busca por este objetivo, faz-se a revisão do estado da arte sobre metodologias de calibração baseadas em evidência, ou seja, no qual os ajustes nos parâmetros de entradas baseiam-se em informações coletadas acerca do edifício real. Pela comparação destas metodologias, selecionou-se aquela proposta por Raftery, Keane e O donnell (2011) cuja aplicação mostrou-se mais generalizada para diferentes tipologias de edifícios. As medições disponíveis do HU-USP contra o qual as simulações foram confrontadas foram: consumo de prédio, consumo de uma das duas centrais de água gelada do prédio e medição de 16 equipamentos modulares do tipo split. Os indicadores estatísticos resultantes da comparação destas medições revelaram que, ao final do processo de calibração, apenas o consumo do prédio pôde ser considerado calibrado. A partir da simulação calibrada foram avaliadas quatro alternativas de eficiência energética, duas no sistema de iluminação e duas no sistema de climatização. As experiências acumuladas na calibração da simulação do HU-USP e a identificação de melhores práticas na literatura permitiram, ao final, a elaboração de uma nova metodologia que engloba a abordagem de um prédio com as características de edificações públicas brasileiras. / The use of a computational model for simulation of the energy consumption of buildings for different goals has become common practice. However, in order to use it to simulate operating buildings, it is necessary that the simulation undergoes a process called calibration. This means adjusting simulation input to certify that its output consistently represents the reality. This work objective is to calibrate the electric energy simulated by an energy model of the University Hospital of the University of São Paulo (HU-USP). The state of the art is reviewed in search of evidence-based calibration methodologies. This type of methodologies uses data collected from the real building to change the simulation input. It was selected the methodology proposed by Raftery, Keane and O donnell (2011) which was evaluated as the most generalized approach between the methodologies reviewed. The available measurements of HU-USP against which the simulations were confronted were: building electricity consumption, one (of the two) chilled water plant electricity consumption and the electricity measurement of 16 split type air conditioner. The statistical indicators resulted in comparisons of the measurements revealed, at the end of the calibration process, that only the consumption of the building could be considered calibrated. From the calibrated calibration, four energy efficiency alternatives were simulated, two concerning the lighting system and two concerning the air conditioning system. From the experience accumulated through the calibration of HU-USP electric energy consumption simulation and the identification of the best practices in the literature, it was elaborated a new methodology that includes an approach that deal with brazilian public buildings features.

A problemática deste trabalho foi originada pela recente criação do Hospital de Ensino Odontológico da Faculdade de Odontologia da Universidade Federal do Rio Grande do Sul. Para tanto, foram pesquisadas quais formas de caracterização jurídica poderiam ser mais adequadas para a gestão do HEO visando apurar alternativas de desburocratização de processos de aquisições e contratação de pessoal. A partir dessa pesquisa são discutidas três alternativas: Organizações Sociais, Fundações de Apoio e Órgão Auxiliar com destaque orçamentário. Também é proposta uma sistemática para apoiar a gestão de custos do hospital com a finalidade de manter a instituição sustentável econômico e financeiramente. A sistemática preliminarmente proposta está estrutura num roteiro com 7 fases: (i) Compreensão da estrutura organizacional da empresa; (ii) Identificação dos centros de custos; (iii) Identificação dos recursos consumidos pelos centros de custos e distribuição dos custos pelos centros de custos; (iv) Identificação das atividades desenvolvidas na instituição; (v) Quantificação dos recursos consumidos pelas atividades desenvolvidas detalhando os insumos e custos fixos; (vi) Análise dos resultados; (vii) Proposição de melhorias. Por fim são apresentados os resultados possíveis de serem implementados, conclusões e propostas de melhorias e de trabalhos futuros sobre o tema. / The problematic of this work was originated by the recent creation of the Dental Teaching Hospital of the Faculty of Dentistry of the Federal University of Rio Grande do Sul. For this purpose, it was investigated which forms of juridical characterization could be more adequate for the management of HEO in order to determine alternatives of debureaucratization of procurement processes and hiring of personnel. Based on this research, three alternatives were discussed: Social Organizations, Support Foundations and Auxiliary Organ with budgetary emphasis. A system was also proposed to support the hospital's cost management in order to keep the institution economically and financially sustainable. The systematics preliminarily proposed is structure in a script with 7 phases: (i) Understanding of the organizational structure of the company; (ii) Identification of cost centers; (iii) Identification of resources consumed by cost centers and distribution of costs by cost centers; (iv) Identification of the activities carried out at the institution; (v) Quantification of the resources consumed by the activities developed detailing the inputs and fixed costs; (vi) Analysis of results; (vii) Proposals for improvements. Finally, this study presents the possible results to be implemented, conclusions and proposals for improvements and future work on the theme.

Os Hospitais Universitários (HUs) enfrentam muitos problemas em sua gestão financeira. Assim, receitas insuficientes para suprir despesas culminam numa situação deficitária. O índice de inadimplência dos hospitais é alto; por conseqüência, o prazo de pagamento dos fornecedores prorrogado. No ano de 2006, foi estabelecida uma reestruturação financeira e orçamentária denominada Plano Operativo Anual (POA), juntamente com o Ministério da Saúde e o Ministério da Educação, no intuito de tentar minimizar o déficit dos HUs. Tendo em vista tal situação, este trabalho de pesquisa visa a relatar como um Sistema Integrado de Gestão (ERP) pode aprimorar, bem como monitorar, o desempenho do POA e sua eficácia servindo de instrumento de orçamento das receitas hospitalares baseados em metas. A partir deste contexto, teremos como ponto de partida o estudo do caso do aprimoramento quanto à inserção do Hospital Universitário Gaffrée e Guinle (HUGG) no Sistema Único de Saúde (SUS), através da contratação dos serviços de saúde ofertados pelo hospital e seu respectivo modelo de financiamento, bem como os mecanismos de acompanhamento e avaliação das atividades de atenção, gestão, ensino e pesquisa. Com isso, ocorre a agilização dos procedimentos diários, maior eficiência na gestão hospitalar. Evita-se assim; entre outros; problemas concernentes ao setor financeiro da instituição. / The University Hospitals have to face many problems with its financial administration. So, insuficient proceeds in order to cover expences go up in a defective situation. The rates of hospital breaches are big; in consequence of that, the period of payment for the suppliers is postponed.In the year of 2006 a finantial and budgetary restructure was estabilished, which was called Anual Action Plan (POA) between the Health Ministery and the Education Ministery, with thepurpose to try to minimize the deficit of these hospitals. In order to solve this problem, this research intends to relate how an Integrated System of Administration is able to get better,as well as to monitorade, the performance of this plan and its eficiency, just being the instrument of the hospital rates based on targets. From this context we will have as the starting point the study of the improvement case as long as the insertion of the Gaffrèe Guinle University Hospital - HUGG in the Unique System of Health SUS through the contract of the health services offered by the hospitaland its respective financial model, as well as the mechanisms of following and evaluation of the attention, administration, teaching and research activities. So, this procedures will provide the agility of such plan,promoting bigger eficiency on the hospital administration,avoiding problems such as the related above.

Em meados dos anos 80, especialistas da área de saúde ficaram frente ao desafio de reformular a funcionalidade e a maneira como eram organizados as instituições de saúde e os sistemas de saúde disponibilizados à população. O cenário de grande desigualdade e agravamento das precárias condições de vida das populações tornou incisiva a busca por alternativas, que permitissem maior equidade e possibilitassem serviços de melhor qualidade no âmbito da saúde pública. Assim, surgiu a necessidade de alteração do estilo gerencial dos Hospitais Universitários brasileiros, que atendem à população pelo Sistema Único de Saúde. Tornou-se necessário, então, o desenvolvimento de sistemas de indicadores para auxiliar a gestão e a avaliação, com intuito de melhorar a eficiência dos serviços prestados. No entanto, apesar da eficiência do hospital ser importante para avaliação de serviços de saúde, a mesma sofre a influência de diferentes variáveis que não estão, necessariamente, sob o controle dos gestores. Nesse contexto, o objetivo do presente trabalho é analisar a influência do entorno na eficiência dos Hospitais Universitários Federais brasileiros. Para o alcance do objetivo proposto foram utilizadas a Análise Envoltória de Dados e a econometria, com a utilização da regressão linear pelo método dos mínimos quadrados generalizados. Os resultados demonstraram que o entorno possui influencia significativa na eficiência dos HUFs, sendo que a população, a formação em medicina e o nível de desenvolvimento são grandezas diretamente proporcionais. Por outro lado, o PIB e a formação na área da saúde (exceto médicos) possuem relação inversa com a eficiência. / In the mid-80s, health experts were facing the challenge of reformulating the functionality and the organization of public health institutions and health systems. The great inequality scenario and the precarization of living conditions of the population has increased the search for alternatives that would allow greater equity and would enable better quality services in the field of public health. Thus, the need to change the management method of Brazilian University Hospitals, (BUH) which serve the population by the Unified Health System. It then became necessary the development of system indicators to assist the management and evaluation, in order to improve the efficiency of services provided. However, despite the efficiency of the hospital being important for the evaluation of health services, it is influenced by different variables that are not necessarily under the control of managers. In this context, the objective of this study is to analyze the influence of the environment on the efficiency of Brazilian Federal University Hospitals. In order to achieve the proposed objective, it was used the data envelopment analysis and econometrics, using linear regression by the method of generalized least squares. The results showed that the environment has a significant influence on the efficiency of BUHs, being the population, medical training and the level of development directly related to it. On the other hand, GDP and training in health (except medical) have an inverse relationship with efficiency.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2010.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2010. / Härtill 4 uppsatser.

Μια από τις κυριότερες δαπάνες, τις οποίες είναι αναγκαίο να πληρώσουν οι διάφορες χώρες, είναι αυτή για τις υπηρεσίες παροχής υγείας προς τους πολίτες. Από τα μέσα του προηγούμενου αιώνα (δεκαετία 1940), αρκετές προηγμένες χώρες του δυτικού κόσμου, ξεκίνησαν την αναμόρφωση στα συστήματα υγείας τους, αρχικά με την εισαγωγή των Οικονομικών της Υγείας και έπειτα με την Λογιστική Επιστήμη. Η ανάγκη αυτή προήλθε εξαιτίας της προσπάθειας συγκράτησης των δαπανών τους, μέσω και της μείωσης του λειτουργικού κόστους των Νοσοκομείων. Παράλληλα, ενέτειναν τις έρευνες τους όχι μόνο για τη διάρθρωση του λειτουργικού κόστους των Νοσοκομείων τους, αλλά και για τον προσδιορισμό ειδικότερων παραγόντων, οι οποίοι προσαυξάνουν το κόστος. Ένας από τους παράγοντες, οι οποίοι προσδιορίστηκαν, είναι και αυτός της εκπαίδευσης του μελλοντικού ιατρικού και νοσηλευτικού προσωπικού από τα Πανεπιστημιακά Νοσοκομεία. Στην ουσία, πρόκειται για το επιπρόσθετο ποσοστό κόστους το οποίο δαπανούν τα Πανεπιστημιακά Νοσοκομεία, έναντι των Γενικών, για την επιμόρφωση των φοιτητών των Ιατρικών και Νοσηλευτικών Σχολών, ώστε να μπορέσουν να στελεχώσουν μετέπειτα τον τομέα της Υγείας. Στην Ελλάδα, η αρχή της ένταξης της Λογιστικής Επιστήμης στα Νοσοκομεία έγινε με το Π.Δ. 143/2003. Παρόλο όμως το γεγονός της υποχρεωτικής εφαρμογής των αρχών και πρακτικών της Λογιστικής στα Ελληνικά Νοσοκομεία από την 1/1/2004, ελάχιστα είναι αυτά που τις εφάρμοζαν. Από το 2009, που η χώρα εισέρχεται στην οικονομική κρίση, η ανάγκη για διαφάνεια σε όλους τους τομείς των δημοσίων δαπανών καθίσταται επιτακτική και αναγκαία. Αυτό δεν άφησε ανεπηρέαστο τον τομέα της Υγείας και «επέβαλε» στα Νοσοκομεία την έκδοση οικονομικών καταστάσεων και καταστάσεων δαπανών. Η παρούσα διατριβή, πραγματεύεται τον προσδιορισμό του ποσοστού του επιπρόσθετου κόστους το οποίο αναλαμβάνουν τα Πανεπιστημιακά Νοσοκομεία, έναντι των αντίστοιχων Γενικών, στην Ελλάδα. Για τον προσδιορισμό του ποσοστού αυτού, λαμβάνονται υπόψη διάφοροι παράγοντες από την διεθνή βιβλιογραφία, οι οποίοι χρησιμοποιήθηκαν σε παρόμοιες μελέτες. Επίσης, στη παρούσα διατριβή παρουσιάζεται η δομή και οι παράγοντες εκείνοι, που επιδρούν στη διαμόρφωση του λειτουργικού κόστους των Πανεπιστημιακών Νοσοκομείων της Ελλάδας. Για τον προσδιορισμό αυτό, χρησιμοποιήθηκαν οικονομικά και λειτουργικά στοιχεία, τα οποία παραχωρήθηκαν από Πανεπιστημιακό Νοσοκομείο της Ελλάδας. / One of the main expenditure, that countries among world are required to pay, is that for the provision of health services to their citizens. From the middle of last century (decade 1940), several western countries, began to reform their health systems, initially with the introduction of the Health Economics and afterward introducing the Accounting Science in Hospitals. This need derived because of the effort to contain costs and by reducing the operating costs of Hospitals. At the same time, these countries developed their research not only in the structure of the operating costs of Hospitals, but also to identify specific factors that increases the cost. One of these factors were identified, and this is the education, by the Teaching Hospitals, of future medical and nursing staff. In essence it is the additional rate costs that are required to spend by the Teaching Hospitals, for the training of students of medical and nursing schools so that they can later be deployed by the Health Sector In Greece, the principle of inclusion of Accounting Science in Hospitals was done by Presidential decree 143/2003. Although the fact that the application of the principles and practices of Accounting by the Greek Hospitals was compulsory from 1/1/2004, few are those who practice it. Since 2009, when the country enters the economic crisis, the need for transparency in all areas of public spending is imperative and necessary. This is not left unaffected by the Health Sector and “forced” Greek Hospitals to issue financial and cost statements. This thesis deals with the determination of the percentage of additional costs that being undertaken by the Teaching Hospitals, opposite the General ones, in Greece. To determine this percentage, several factors from the international literature are taking into account and have been used in similar studies. Also, this thesis shows the structure and the factors that affect the configuration of the operating costs of Teaching Hospitals in Greece. For this assay, financial and operating data are used and were provided by a Teaching Hospital in Greece.

Os Hospitais Universitários (HUs) enfrentam muitos problemas em sua gestão financeira. Assim, receitas insuficientes para suprir despesas culminam numa situação deficitária. O índice de inadimplência dos hospitais é alto; por conseqüência, o prazo de pagamento dos fornecedores prorrogado. No ano de 2006, foi estabelecida uma reestruturação financeira e orçamentária denominada Plano Operativo Anual (POA), juntamente com o Ministério da Saúde e o Ministério da Educação, no intuito de tentar minimizar o déficit dos HUs. Tendo em vista tal situação, este trabalho de pesquisa visa a relatar como um Sistema Integrado de Gestão (ERP) pode aprimorar, bem como monitorar, o desempenho do POA e sua eficácia servindo de instrumento de orçamento das receitas hospitalares baseados em metas. A partir deste contexto, teremos como ponto de partida o estudo do caso do aprimoramento quanto à inserção do Hospital Universitário Gaffrée e Guinle (HUGG) no Sistema Único de Saúde (SUS), através da contratação dos serviços de saúde ofertados pelo hospital e seu respectivo modelo de financiamento, bem como os mecanismos de acompanhamento e avaliação das atividades de atenção, gestão, ensino e pesquisa. Com isso, ocorre a agilização dos procedimentos diários, maior eficiência na gestão hospitalar. Evita-se assim; entre outros; problemas concernentes ao setor financeiro da instituição. / The University Hospitals have to face many problems with its financial administration. So, insuficient proceeds in order to cover expences go up in a defective situation. The rates of hospital breaches are big; in consequence of that, the period of payment for the suppliers is postponed.In the year of 2006 a finantial and budgetary restructure was estabilished, which was called Anual Action Plan (POA) between the Health Ministery and the Education Ministery, with thepurpose to try to minimize the deficit of these hospitals. In order to solve this problem, this research intends to relate how an Integrated System of Administration is able to get better,as well as to monitorade, the performance of this plan and its eficiency, just being the instrument of the hospital rates based on targets. From this context we will have as the starting point the study of the improvement case as long as the insertion of the Gaffrèe Guinle University Hospital - HUGG in the Unique System of Health SUS through the contract of the health services offered by the hospitaland its respective financial model, as well as the mechanisms of following and evaluation of the attention, administration, teaching and research activities. So, this procedures will provide the agility of such plan,promoting bigger eficiency on the hospital administration,avoiding problems such as the related above.