A Avaliação Ambiental Estratégica (AAE) é um instrumento que tem como objetivo dar suporte à tomada de decisão, informando as possíveis consequências para o meio ambiente derivadas de ações estratégicas (Políticas, Planos e Programas) e, desta forma, possibilita a inserção de questões ambientais nos níveis estratégicos do planejamento. A efetividade da AAE tem sido foco de estudos recentes, contribuindo para o seu aprimoramento. No Brasil, apesar de iniciativas institucionais para a formalização da AAE, esse instrumento não é regulamentado, o que torna sua prática sujeita a grande variabilidade. A fim de suprir a lacuna de informações quanto aos procedimentos e à influência dessas avaliações na tomada de decisão, este trabalho teve como objetivo analisar a efetividade da prática brasileira do instrumento. Para isso, analisou-se a efetividade processual de 26 AAEs (72% do total de AAEs identificadas neste trabalho, realizadas entre 1997 e 2012) e a efetividade substantiva de três delas, valendo-se de procedimentos qualitativos de pesquisa. Os resultados mostram que, de modo geral, a prática brasileira não é consistente em termos de procedimentos, havendo grande variação entre as etapas desenvolvidas em cada caso, o que parece se relacionar com os motivadores e/ou elaboradores da avaliação. Além disso, a AAE não tem influenciado a tomada de decisão principal, sendo mais voltada para a mitigação do objeto avaliado. No entanto, notam-se alguns efeitos positivos indiretos, em especial com relação à organização e disponibilização de informações e a promoção da comunicação entre instituições e setores. Evidencia-se, então a necessidade de se refletir sobre o uso da AAE no contexto brasileiro, sobretudo discutindo-se objetivos e diretrizes procedimentais para o instrumento, de modo a evitar a variabilidade e inadequações observadas na pesquisa, bem como buscar a sua incorporação em momentos mais adequados ao timing do planejamento, para que a AAE seja, de fato, considerada na decisão. / The purpose of the Strategic Environmental Assessment (SEA) is to support decision-making, advising possible consequences of strategic actions (Politics, Plans and Programmes), thus ensuring that environmental issues are taken into account as soon as possible in strategic planning. Recently, SEA effectiveness is being studied intending to improve its practice. In Brazil, regardless some institutional initiatives to formalize the SEA, it is not legally required and there is no national guidelines, which makes the SEA practice. In order to fill in the gap of information about the proceedings and the influence of these SEA practices in decision making, the purpose of this study was to analyse the effectiveness of Brazilian SEA, reviewing the procedural effectiveness for 26 SEAs (72% of all the identified Brazilian SEA done between 1997 and 2012) and the substantive effectiveness for three cases. The results shown that, generally, Brazilian practice is not procedurally consistent, being highly dependent on the stakeholders involved. Besides, SEA does not influence the main decisionmaking and is focused in mitigation actions. Nevertheless, the SEA achieved some positive effects, e.g. publishing important information about planning process, and improving the communication between institutions and sectors. These findings suggest that it is necessary to discuss the SEA use in Brazilian context, especially considering and defining its goals and proceedings to avoid the variability and inadequacies observed, as well as enhancing its use in strategic levels and at more appropriate timing, intending to really contribute to decision process.

Critical Access Hospitals (CAHs) – the predominant type of hospital operating in rural areas – play an integral role in the US healthcare system, providing care for over 7 million rural residents each year who might otherwise have no local access to urgent care or inpatient services. This dissertation examines three aspects of care delivery in CAHs – effectiveness, cost/efficiency, and access – each of which has separate implications for policy and practice. The first study addresses effectiveness and evaluates the performance of CAHs on specific patient safety indicators compared to small Prospective Payment System (PPS) hospitals. A total of 35,674 discharges from 136 non-federal general hospitals with fewer than 50 beds were included in the analyses: 14,296 from 100 CAHs and 21,378 from 36 PPS hospitals. Outcome measures included six bivariate indicators of adverse events of surgical care that were developed from Agency for Healthcare Research and Quality Patient Safety Indicators. Multiple logistic regression models were developed to examine the relationship between hospital adverse events and CAH status. The results indicated that compared to PPS hospitals, CAHs are less likely to have any observed (unadjusted) adverse event on all six indicators, four of which are statistically significant. After adjusting for patient mix and hospital characteristics, CAHs perform better on three of the six indicators. Accounting for the number of discharges eliminated the differences between CAHs and PPS hospitals in the likelihood of adverse events across all indicators except one. Tele-emergency (tele-ED) services can address several challenges facing emergency departments (EDs) in rural areas. The second study investigates access and characterizes the impact of a rural-ED-based telemedicine program on discharge disposition in terms of patient transfer, local hospital admission, and routine discharge. This study tests the hypothesis that telemedicine enhances access by allowing patients to receive care in the local community, and does so by looking at the probability of transfer and local admissions before and after telemedicine was implemented in CAHs. The results indicate that in the post-telemedicine period, patients were 38% less likely to be admitted to the local inpatient facility than to be routinely discharged [aOR=0.62, 95%CI=(0.57,0.67)] after adjusting for age, sex, race, time of visit, clinical diagnosis, CPT code, number of diagnoses, and admitting hospital. The third study addresses cost and efficiency by modeling the financial implications of using the same telemedicine program to avoid transfers and estimating the costs and benefits associated with tele-ED implementation in CAHs. Analysis is based on 9,048 tele-ED encounters generated by the Avera eEmergency program in 85 rural hospitals across seven states between October 2009 and February 2014. For each non-transfer patient, physicians indicated whether the transfer was avoided because of tele-ED activation. The cost-benefit analysis is conducted from the hospital, patient, and societal perspectives, and includes technology costs, local hospital revenues, and patient-associated savings. The results show that 1,175 avoided transfers could be attributed to tele-ED. From a rural hospital perspective, tele-ED costs around $1,739 to avoid a single transfer but saves approximately $5,563 in avoided transportation and indirect patient costs. From a societal perspective, tele-ED results in a net savings of $3,823 per avoided transfer while accounting for tele-ED technology costs, hospital revenues, and patient-associated savings. This study highlights various stakeholder perspectives on the financial impact of tele-ED in avoiding patient transfers in rural EDs. Telemedicine has the potential to reduce the number of transfers of ED patients and generate some revenue for rural hospitals despite associated technology costs, while incurring substantial patient savings.

A Avaliação Ambiental Estratégica (AAE) é um instrumento que tem como objetivo dar suporte à tomada de decisão, informando as possíveis consequências para o meio ambiente derivadas de ações estratégicas (Políticas, Planos e Programas) e, desta forma, possibilita a inserção de questões ambientais nos níveis estratégicos do planejamento. A efetividade da AAE tem sido foco de estudos recentes, contribuindo para o seu aprimoramento. No Brasil, apesar de iniciativas institucionais para a formalização da AAE, esse instrumento não é regulamentado, o que torna sua prática sujeita a grande variabilidade. A fim de suprir a lacuna de informações quanto aos procedimentos e à influência dessas avaliações na tomada de decisão, este trabalho teve como objetivo analisar a efetividade da prática brasileira do instrumento. Para isso, analisou-se a efetividade processual de 26 AAEs (72% do total de AAEs identificadas neste trabalho, realizadas entre 1997 e 2012) e a efetividade substantiva de três delas, valendo-se de procedimentos qualitativos de pesquisa. Os resultados mostram que, de modo geral, a prática brasileira não é consistente em termos de procedimentos, havendo grande variação entre as etapas desenvolvidas em cada caso, o que parece se relacionar com os motivadores e/ou elaboradores da avaliação. Além disso, a AAE não tem influenciado a tomada de decisão principal, sendo mais voltada para a mitigação do objeto avaliado. No entanto, notam-se alguns efeitos positivos indiretos, em especial com relação à organização e disponibilização de informações e a promoção da comunicação entre instituições e setores. Evidencia-se, então a necessidade de se refletir sobre o uso da AAE no contexto brasileiro, sobretudo discutindo-se objetivos e diretrizes procedimentais para o instrumento, de modo a evitar a variabilidade e inadequações observadas na pesquisa, bem como buscar a sua incorporação em momentos mais adequados ao timing do planejamento, para que a AAE seja, de fato, considerada na decisão. / The purpose of the Strategic Environmental Assessment (SEA) is to support decision-making, advising possible consequences of strategic actions (Politics, Plans and Programmes), thus ensuring that environmental issues are taken into account as soon as possible in strategic planning. Recently, SEA effectiveness is being studied intending to improve its practice. In Brazil, regardless some institutional initiatives to formalize the SEA, it is not legally required and there is no national guidelines, which makes the SEA practice. In order to fill in the gap of information about the proceedings and the influence of these SEA practices in decision making, the purpose of this study was to analyse the effectiveness of Brazilian SEA, reviewing the procedural effectiveness for 26 SEAs (72% of all the identified Brazilian SEA done between 1997 and 2012) and the substantive effectiveness for three cases. The results shown that, generally, Brazilian practice is not procedurally consistent, being highly dependent on the stakeholders involved. Besides, SEA does not influence the main decisionmaking and is focused in mitigation actions. Nevertheless, the SEA achieved some positive effects, e.g. publishing important information about planning process, and improving the communication between institutions and sectors. These findings suggest that it is necessary to discuss the SEA use in Brazilian context, especially considering and defining its goals and proceedings to avoid the variability and inadequacies observed, as well as enhancing its use in strategic levels and at more appropriate timing, intending to really contribute to decision process.

A centrifugação é o principal método utilizado para fracionar o Sangue Total (ST) nos componentes sanguíneos: Concentrados de Hemácias (CH), Concentrados Plaquetas (CP), Plasma e Crioprecipitado, (também chamados de Hemocomponentes). Com intuito de prevenir ou controlar hemorragias, os CP obtidos por centrifugação tornaram-se o padrão no atendimento inicial aos pacientes com baixas contagens de plaquetas. Porém, para obter uma unidade terapêutica (UT), no Hemocentro RP, é necessário agregar seis CP, formando o Pool de CPST (PCP), o que leva a exposição do receptor a vários doadores diferentes. O CP obtido por aférese (CPAF), advindo de equipamento que permite a seleção já na coleta, fornece a dose necessária em apenas uma doação. Baseado no levantamento de dados internos do Hemocentro de RP o presente estudo analisou, através da metodologia de Custeio Baseado em Atividade (ABC), os custos atribuídos às distintas metodologias para a produção dos CP, sabendo que no Hemocentro RP, os CP são dispensados como UT independente da forma de obtenção. Os resultados obtidos foram utilizados na Análise de Custo-Efetividade, evidenciando que a coleta por Centrifugação de ST com a produção de PCP foi mais custo efetiva em 2015 do que a coleta de aférese, porém, por uma diferença relativamente pequena, devido ao grande percentual de obtenção de dupla Unidade Terapêutica (CPAF2). / Centrifugation is the main method used for fractionating Total Blood (TB) to blood components: Red Cells Concentrate (CR), Platelet Concentrates (PC), Plasma and Cryoprecipitate (also called Hemocomponents). In order to prevent or control bleeding, CPs obtained by centrifugation became the standard treatment of patients with low platelet counts. However, to obtain a therapeutic unit (TU), at Hemocentro RP, it is necessary to get together six PCs, forming a Pool of TBPC (PCP), exposing the receptor to several different donors. PC obtained by apheresis (CPAF), which is provided by a equipment that allows selective collection, achieve the dose necessary for the selection in just one donation. Based on the collection of internal data from the Hemocentro RP, the present study analyzed, through the methodology of ActivityBased Costing (ABC), the costs attributed to the different methodologies for the production of PCs knowing that in the Hemocenter RP PCs are dispensed as TU independent of the way of obtaining. The results obtained were used in the CostEffectiveness Analysis, showing collecting by TB Centrifugation producing PC is more cost-effective, however CPAF was almost as effective as in 2015, a great achievement of Dual Therapeutic Unit in a single donation (CPAF2).

Contexte. L’augmentation de la participation au dépistage organisé des cancers et la réduction des inégalités sociales et géographiques de participation représentent un enjeu de santé publique majeur. Objectifs. Evaluer l’efficience de 2 interventions visant à augmenter la participation et à réduire les inégalités dans le dépistage organisé des cancers en France. Méthodes. Nous avons réalisé une analyse coût-efficacité du point de vue du financeur: 1) d’une invitation à une unité de mammographie mobile (MM) dans le dépistage du cancer du sein à partir de données rétrospectives (n=37461), 2) d’un accompagnement personnalisé (AP) («patient navigation») dans le dépistage du cancer colorectal à partir d’un essai contrôlé randomisé (n=16250). Résultats. Le coût incrémentiel par dépistage supplémentaire comparé au dépistage habituel était: 1) de 611€ [492-821] pour l‘invitation au MM (+3.8% [2,8-4,8], +23.21€ [22.64-23.78]), et 2) de 1212€ [872-1978] pour l‘AP (+3.3% [1.5-5.0], +39.70€). L’efficacité et l’efficience étaient plus importantes dans les zones défavorisées et dans les zones éloignées pour le MM, alors qu’elles étaient moins favorables dans les zones défavorisées pour l’AP. Conclusion. La MM et l’AP peuvent réduire les inégalités en étant plus efficient dans les zones éloignées et les zones défavorisées pour la MM, alors que pour y parvenir, l’AP devrait cibler les sujets défavorisés, bien que n’étant pas la stratégie la plus efficiente. Les recherches doivent être poursuivies pour déterminer les conditions optimales de l’intégration du MM dans le dépistage, et pour améliorer l’efficacité et l’efficience de l’AP, qui ne peut être recommandé en l’état pour l’instant. / Background. Increasing participation in organized cancers screening and reducing social and geographical inequalities in participation represent a major public health issue. Objectives. To determine the costeffectiveness of 2 interventions aiming at increasing participation and reducing inequalities in organized cancer screening in France Methods. We conducted a cost-effectiveness analysis from the payer's perspective: 1) of an invitation to a mobile mammography unit (MM) unit for breast cancer screening from retrospective data (n = 37461), 2) of a patient navigation program (PN) for colorectal cancer screening from a randomized controlled trial (n = 16250). Results. The incremental cost per additional screen compared with usual screening was: 1) € 611 [492-821] for the invitation to the MM (+ 3.8% [2.8-4.8], + € 23.21 [22.64-23.78] ), and 2) of € 1 212 [872-1 978] for PN (+ 3.3% [1.5-5.0], + 39.70 €). Effectiveness and cost-effectiveness were greater in deprived areas and in remote areas for MM, whereas they were less favorable in deprived areas for PN. Conclusion. MM and PN can reduce inequalities while being more efficient in remote areas and in deprived areas for MM, while, to achieve this, PN should target deprived people, even if being not the most efficient strategy. Research needs to be pursued to determine the optimal conditions for MM integration in organized breast cancer screening, and to improve the effectiveness and cost-effectiveness of PN, which can not be recommended as experimented for now.

Since 2012-2013 influenza season, World Health Organization (who) recommends the formulation of tetravalent vaccines. Globally, many countries already use tetravalent vaccines in their national immunization programs, while in Latin America only a small number. Two Influenza b lineages co-circulate, their epidemiological behavior is unpredictable. On average they represent 22.6% of influenza cases and more than 50% in predominant seasons. The lack of concordance between recommended and circulating strains was 25 and 32% in the 2010-2017 and 2000-2013 seasons, respectively. There are no clinical differences between influenza A and B. It occurs more frequently from five to 19 years of age. Influenza b has a higher proportion of attributable deaths than influenza a (1.1 vs. 0.4%), or 2.65 (95% ci 1.18-5.94). A greater number of hospitalizations when the strains mismatch (46.3 vs. 28.5%; p <.0001). Different evaluations have demonstrated its cost effectiveness. The compilation of this information supports the use of quadrivalent vaccines in Latin American countries. / Revisión por pares

Human interference with the Earth’s climate, through the release of greenhouse gasses (GHGs), is estimated to have already increased average statewide temperatures in California by 1.7° Fahrenheit (F), with a further 2.7°F of warming expected by mid-century. The negative impacts of increased temperatures may be especially acute in mid-latitude cities that currently enjoy a mild climate, such as Los Angeles (LA), which are projected to warm to a point that will significantly affect human health and well being. The built environment increases urban temperatures through building materials that readily absorb heat from the sun, a lack of vegetation, a lack of pervious surface area, and anthropogenic heat. Local governments can take action to help their cities adapt to future temperatures through changes to building materials, urban design and infrastructure. This study evaluates six urban design strategies for reducing temperatures and therefore adapting to increased heat in LA: cool roofs, cool pavements, solar panels, tree planting, structural shading and green roofs. The methods used in this analysis include a cost-effectiveness analysis, key stakeholder interviews, and case studies from other cities in the US. Findings indicate that cool roofs are the most cost-effective strategy for urban heat island mitigation, with cool pavements and tree planting also cost-effective. Findings from stakeholder interviews indicate that political feasibility is high for all strategies except structural shading, which was thought to be costly and difficult to implement. However, significant political barriers were also identified for tree planting and green roofs. Findings from four case studies indicate that climate adaptation policies should emphasize co-benefits, include flexible design standards, and provide financial or performance-based incentives for property owners or developers. Specific recommendations for implementing climate adaptation measures are provided for urban planners, policy makers, urban designers and architects in Los Angeles.

就地保育被認為是保育生物多樣性的重點工作之一，而設置保護區是最常見的就地保育做法。本文的研究重點在於如何提昇保護區規劃的效率，內容可分為兩大部份。第一部份為回顧用於保護網絡規劃的保護區選擇問題理論相關研究，將研究演進方向分為保育目標、保育成本與限制條件、演算法、空間配置及有效棲地四類進行探討。第二部份為兩個個案分析。個案一為台灣保護網絡規劃研究，利用三種不同的規劃方式來尋找不同水準保育經費限制下，能使保育目標（受保護物種數）極大化的保護區組合。結果發現以OSL演算法配合互補性原則的規劃方式最佳，無論在何種保育目標水準之下其成本均是最低的。個案二為陽明山國家公園北部保護網絡規劃研究，比較考慮保護區以外土地使用類型對保育的貢獻與否，對物種存活率總和－保育成本間的關係的影響。結果發現在保育水準（物種存活率總和）很低時，兩者達到相同的保育水準所需的成本相差很多。比較保護所有棲地和將所有棲地作為農地兩種情況，假設農地對物種保育有所貢獻時，保護所有棲地能使物種存活率總和提高約1.1；若假設農地對物種保育沒有貢獻，則保護區棲地能使物種存活率總和提高約5.2。

Introdução: O estudo MASS III não mostrou diferença significativa entre a cirurgia de revascularização miocárdica (CRM) com e sem circulação extracorpórea (CEC) em relação ao desfecho composto primário de morte por todas as causas, infarto agudo do miocárdio, acidente vascular cerebral ou revascularização adicional em pacientes com doença coronariana multiarterial. No entanto, a custo-efetividade dessas estratégias permanece desconhecida. Métodos: Pacientes com doença coronariana multiarterial estável e função ventricular esquerda preservada foram randomizados para CRM com CEC (n=153) ou sem CEC (n=155). Os dois grupos eram bem semelhantes quanto às características basais. A análise dos custos foi realizada a partir da perspectiva do sistema público de saúde brasileiro, e as utilities foram avaliadas pelo questionário SF-6D. Um modelo de Markov, com base nos dados de 5 anos de seguimento, foi utilizado para extrapolar os custos e os anos de vida ajustados pela qualidade (QALY) para doença coronariana crônica. Resultados: A qualidade de vida de ambos os grupos melhorou significativamente após a cirurgia durante o seguimento, em comparação com os dados pré-cirurgia, embora os ganhos de vida adquiridos (LYG) e QALYs tenham sido semelhantes entre os grupos durante o seguimento de 5 anos. Os custos para o período total do estudo não diferiram entre os grupos sem e com CEC (R$ 19.180,65 e R$ 19.909,18, respectivamente, p=0,409). Ao longo de um horizonte de tempo ajustado para a expectativa de vida da população do estudo, a razão de custo-efetividade incremental da CRM com versus sem CEC foi R$ 45.274 por QALY ganho, que foi robusto nas simulações de Monte Carlo e nas análises de sensibilidade. Para um limiar de custo-efetividade de R$ 34.212 por QALY ganho, a CRM sem CEC tem 65% de probabilidade de ser custo-efetiva quando comparada com CRM com CEC. Conclusão: Cirurgia de revascularização miocárdica sem CEC é clinicamente tão segura e efetiva quanto a cirurgia com CEC e parece ser uma estratégia economicamente atraente em comparação com a CRM com CEC em pacientes com doença arterial coronariana estável / Background: The MASS III trial revealed that in patients with multivessel coronary disease, no significant difference was observed between on-pump and off-pump coronary artery bypass surgery (CABG) in the primary composite outcome. However, long-term cost-effectiveness of these strategies is unknown. Methods: Patients with stable multivessel coronary artery disease and preserved left ventricular function were randomized to onpump (n=153) or off-pump CABG (n=155). The 2 groups were well matched for baseline characteristics. Costs analysis was conducted from a Brazilian public healthcare system perspective, and health state utilities were assessed using the SF-6D questionnaire. A Markov\'s model based on the 5- year in-trial data was used to extrapolate costs and quality-adjusted life-years (QALY) for chronic coronary disease. Results: Both groups\' quality of life improved significantly after surgery during follow-up compared with baseline, and life-years gained (LYG) and QALY gains were similar between on-pump and off-pump CABG over the 5-year time frame of the trial. The costs for the overall period of the trial - the mean cost in U.S. dollars per patient - did not differ significantly between the off-pump group and the on-pump group ($5674.75 and $5890.29 respectively, p=0.409). Over a lifetime horizon, the incremental cost-effectiveness ratio of on-pump vs. off-pump CABG was $12,576 per QALY gained, which was robust in Monte Carlo replications and in sensitivity analyses. Using a cost-effectiveness threshold of $10,122 per QALY gained, off-pump has 65% probability of being cost-effective versus on-pump CABG. Conclusions: Off-pump CABG was clinically as safe and effective as on-pump CABG and appears to be an economically attractive strategy compared with on-pump CABG among patients with stable coronary artery disease

The partial removal of carious dentine was studied by means of a literature review and a multicenter randomized controlled clinical trial. The clinical trial compared the effectiveness of an alternative treatment for deep caries lesions and the stepwise excavation in Public Health Services in Brazil. The treatment consists of partial removal of carious dentine followed by restoration in one session. A cost-effectiveness analysis the two treatments was performed. The clinical performance of amalgam and resin restorations placed in deep caries lesions with or without decayed tissue beneath them was also evaluated. Inclusion criteria: patients with ≥ nine years old, permanent molars with deep caries lesions and absence of periapical alterations, pulp sensitivity; absence of spontaneous pain; negative percussion test. The subjects were assigned to: test-group - partial removal of carious dentine (PDR) and restoration, and control-group - stepwise excavation (SW). SW consists of partial removal of carious tissue, indirect pulp capping with calcium hydroxide cement; temporary filling; cavity re-opening after 60 days, removal of the remaining soft carious tissue and filling. Clinical and radiological exams were performed annually. The outcomes were: (1) pulp sensitivity to cold test and absence of periapical alterations, assuming those parameters as indicators of pulp vitality; and (2) success of the restoration. To determine the cost-effectiveness of the treatments, the discounted cash flow method was adopted. The data were submitted to Kaplan-Meier, Log-rank test and logistic regression analysis, P<0.05. There were performed 299 treatments, 146 SW and 153 tests. There were no differences between the groups regarding baseline characteristics - age, gender and family income. The number of teeth evaluated after one and two years were 180 and 122. After one year of treatment performance, the therapy success rates were 97.9% and 74.1% of success in test and control groups respectively (P<0.000). After 2 years of follow-up, therapy survival rates of PDR and SW were 93.7% and 73.3% respectively (P=0.000). A total of 29 therapeutic failures were observed: PDR group - pulpitis (n=3), osteitis (n=1), hyperemia (n=2); SW group - pulpitis (n=15), necrosis (n=6), extraction (n=1) and restoration fracture (n=1). None of the variables studied showed a significant causal influence on the success rate, besides the type of treatment. After two year of follow-up, 181 restorations had been evaluated, 86 from the SW group and 95 from the PDR group; 65.8% were from the resin composite group and 34.2% were amalgam restorations. The survival analysis of the treatment associated with the filling material showed no difference in the rate of success (P=0.564). Regarding the treatment, both groups presented a similar rate of success: SW=95.3% and PDR=94.7% (P=0.928). Resin composite restorations presented 96.8% of success and amalgam restorations presented 94.1% of success (P=0.446). The reason for failure was fracture of filling material. The PDR provides an economy of R$ 143.37 (67.78%) per treatment compare to SW and 2.39% in the overall economy in the annual cost of the public health center. Partial caries removal could be performed as definitive treatment and the procedure of re-opening the cavity to remove the residual infected dentine is not necessary. The maintenance of carious dentine does not interfere in the maintenance of pulp vitality. The presence of decayed tissue in deep caries lesions does not seem to interfere with the survival of the restorations. Performing the partial removal of carious dentine in one session generates benefits for the public finances (direct economy), for the public health services (increase in number of treatments performed) and for the patients (comfort and time).