Professor Aristides Leão. Much more than spreading depression

Professor Leão described cortical spreading depression (CSD) in 1944 and changed the way migraine pathophysiology is scientifically conceived. This Brazilian professor and researcher developed his career in Rio de Janeiro. Because of him, the city once became the CSD world capital, attracting scientists from many laboratories around the globe. Aristides Leão was first and foremost a naturalist, a man genuinely interested in birds, fishes, plants, shells, and neuroscience. He could easily fascinate whoever would come for a chat, leaving no question without answers. He was born in 1914 and died in 1993. This report focuses on his life, family, habits, and hobbies, describing a little of Leão apart from CSD and the year of 1944.     

Computerized system for managing nursing care indicators at Hospital São Paulo

Indicators are tools that permit to define parameters that will be used to make comparisons between a result and its expected value, as well as to add a value of judgement in this regard. The purpose of this study is to describe the experience of a group of nurses in the development of a computerized system to manage nursing care indicators at Hospital S?o Paulo. Four stages were used to implement the indicator management system: developing a nursing care indicator handbook; performing a manually registered pilot test; developing the computerized system; and performing the pilot test of the computerized system in eleven units at the hospital.     

Normative prenatal evaluation at a philanthropic maternity hospital in São Paulo

This cross-sectional study counted with the participation of 301 pregnant women seen in 2009 at a philanthropic maternity hospital in the city of S?o Paulo (a prenatal support program named Pré-Natal do Amparo Maternal - PN-AM). The objectives of this study were to evaluate the prenatal care according to the initial gestational age, the number of appointments that were held, the continuity of the assistance, and relate the appropriateness with the socio-demographic, obstetric and local variables of the initial prenatal care. The analysis criteria used was initiating prenatal care before 120 days of gestation and attending at least six appointments. The relationship between the variables was analyzed using the Chi-Square Test. Results showed that 41.5% of the pregnant women initiated prenatal care at another health care service and transferred spontaneously to the PN-AM; 74.1% initiated the prenatal care early and 80.4% attended at least six appointments; 63.1% met both criteria simultaneously. Appropriate prenatal care showed a statistically significant difference for mother's age, steady partner, employment, place of residence, having a companion during the appointment and place where prenatal care was initiated.     

The front door of the Ribeirão Preto health system for diagnosing tuberculosis

The first contact of TB (tuberculosis) patients with the health system occurs at the front door and is essential to access to diagnosis. The objective of this study was to identify and analyze patients' first contact with the health system for TB diagnosis in Ribeir?o Preto. The study was based on an instrument of the Primary Care Assessment Tool, adapted for TB care in Brazil. Structure interviews were conducted with 100 TB patients diagnosed between June 2006 and July 2007. Of all patients, 61% were referred to the diagnosis place and only 29% sought the service spontaneously; 66% sought for primary care services, and 34% for secondary and tertiary services. Public services diagnosed 89% of all cases, 44% of which were diagnosed in emergency services. A total 88% of patients were not from the area covered by the service. Although patients have sought for primary care services, close to their houses, the diagnosis occurred in secondary and tertiary health care.     

An educational process to strengthen primary care nursing practices in São Paulo, Brazil

Objective: To describe the experience of a registered nurse (RN) training process related to the Family Health Program (FHP) developed in the city of São Paulo, Brazil. Background: The FHP is a national, government strategy to restructure primary care services. It focuses on the family in order to understand its physical and social structure in regards to the health–illness process. In the FHP, the RN is a member of a team with the same number as medical doctors – an unprecedented situation. The FHP requires a discussion of the RNs’ practice, by qualifying and empowering them with tools and knowledge. Methods: The training process was based on Freire’s approach founded on critical pedagogy in order to address the fundamental problem of inequalities in health. The first phase included workshops and the second one included a course. The workshops identified the following problems related to the RN’s work: lack of tools to identify the population’s needs; overload of work due to the accumulation of management and assistance activities; difficulties regarding teamwork; lack of tools to evaluate the impact of nursing interventions; lack of tools to improve the participation of the community. The course was organized to tackle these problems under five thematic headings. Results: The RN’s training process allowed the group to reflect deeply on its work. This experience led to the need for the construction of tools to intervene in the reality, mainly against social exclusion, rescuing and adapting of the knowledge accumulated in the healthcare practice, identifying settings which demand institutional solutions and engaging the RN in research groups in order to develop projects according to the complexity of the primary care services. Conclusion: The application of the concept of equity in the health sector represented a reaction against the processes of social exclusion, starting from performance at a local level to become a reality in the accomplishments achieved by the Brazilian National Health System. This training process allowed us to evaluate that partnership, which has produced many concrete results in addressing both parts of the Inequalities in Health dilemma and which is a productive way of building up a new model of health.     

Implementation of computerized material management system at the University of São Paulo University Hospital

This is an experience report on the process of implementing a computerized materials management system at the University Hospital of the University of S?o Paulo. The system was called Materials Management System (SGM). The process comprised four phases: choice of the model and information tool; restructuring of the logistic materials process at the hospital; restructuring of the support areas and establishment of the SGM system itself. A study carried out at the Surgical Center after the establishment demonstrated that, when comparing materials consumption and inventories in the SGM with the Traditional System, the consumed quantity and the cost of inventory materials at the Unit decreased.     

Patient safety in oncology surgery: experience of the São Paulo State Cancer Institute

Patient safety concerns in surgery are increasing. The frequency of surgery-related adverse events and errors is high, and most could be avoided. The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) proposed the Universal Protocol (UP-JCAHO) for preventing wrong site, wrong procedure, and wrong person surgery. In Brazil, very few health-care institutions have adopted this Protocol. Thus, there is a need to improve its dissemination and assess its effectiveness. The aim of the present study was to report the experiences of the Sao Paulo State Cancer Institute (ICESP, acronym in Portuguese) in implementing the UP-JCAHO. The Protocol comprises three steps: pre-operative verification process, marking the operative site and Time out immediately before starting the procedure. The ICESP surgical center (SC) has been functioning since November 2008. The UP-JCAHO is applied to all surgeries. A total 1019 surgeries were performed up to June 2009. No errors or adverse events were registered. The implementation of the UP-JCAHO is simple. It can be a useful tool to prevent error and adverse events in SC.     

Epidemiological profile of Haemophilus influenzae B meningitis in Regional Health Board of Piracicaba--São Paulo-Brazil

The objective of the present study was to characterize the population affected by Hib meningitis from 1992 to 2001, in the Regional Health Board of Piracicaba (S?o Paulo-Brazil) in terms of variables regarding demographics and the health-disease process. Data were collected from disease notification reports, and arranged using the SINAN Data Program. It was observed there was a peak in the incidence of meningitis in 1994 and a peak of deaths in 1999, before the vaccine had been introduced. The most affected group were male children under the age of 5 years, which is in agreement with literature. Most patients received care at public hospitals in the municipalities of Piracicaba and Limeira, which are references for the community of the entire region, which puts into effect one of the axes of the Health System of Brazil (SUS): regionalization. The introduction of the vaccine reduced incidence in about 73%, which corroborates its importance and shows that is necessary to encourage adherence to vaccination.     

The prevalence of headache among elderly in a low-income area of São Paulo, Brazil

There are scarce data about headache prevalence and its characteristics among elderly people. The aim was to carry out a cross-sectional study to determine the 1-year prevalence of tension-type and migraine headaches in people >65 years old in the city of São Paulo, Brazil. All 1615 people living in the study catchment area who agreed to participate in the study answered a questionnaire based in the International Headache Society criteria. Prevalence (mean and 95% confidence interval) of any type of headache in the last year was 45.6% (43.2, 48.0). Prevalence of tension-type headache in the last year was 33.1% (30.8, 35.4): 28.1% (24.6, 31.6) for men and 36.4% (33.4, 39.4) for women; for migraine headaches, prevalence in the last year was 10.6% (9.1, 12.1): 5.1% (3.4, 6.8) for men and 14.1% (11.9, 16.3) for women. One-year prevalence rates of headaches, and especially of migraine headaches, are very high among the elderly in Brazil.     

Blood transfusion utilization and recipient survival at Hospital das Clinicas in São Paulo, Brazil

BACKGROUND: The characteristics of blood recipients including diagnoses associated with transfusion and posttransfusion survival are unreported in Brazil. The goals of this analysis were: 1) to describe blood utilization according to clinical diagnoses and patient characteristics and 2) to determine the factors associated with survival of blood recipients. STUDY DESIGN AND METHODS: A retrospective cross‐sectional analysis was conducted on all inpatients in 2004. Data came from three sources: The first two files consist of data about patient characteristics, clinical diagnosis, and transfusion. Analyses comparing transfused and nontransfused patients were conducted. The third file was used to determine survival recipients up to 3 years after transfusion. Logistic regression was conducted among transfused patients to examine characteristics associated with survival. RESULTS: In 2004, a total of 30,779 patients were admitted, with 3835 (12.4%) transfused. These patients had 10,479 transfusions episodes, consisting of 39,561 transfused components: 16,748 (42%) red blood cells, 15,828 (40%) platelets (PLTs), and 6190 (16%) plasma. The median number of components transfused was three (range, 1‐656) per patient admission. Mortality during hospitalization was different for patients whose admissions included transfusion or not (24% vs. 4%). After 1 year, 56% of transfusion recipients were alive. The multivariable model of factors associated with mortality after transfusion showed that the most significant factors in descending order were hospital ward, increasing age, increasing number of components transfused, and type of components received. CONCLUSION: Ward and transfusion are markers of underlying medical conditions and are associated with the probability of survival. PLT transfusions are common and likely reflect the types of patients treated. This comprehensive blood utilization study, the first of its kind in Brazil, can help in developing transfusion policy analyses in South America.     

Adult ostomy patients in the city of São Paulo: a study of specialized equipment costs

This study was aimed at analyzing the monthly cost of the use of specialized equipment by ostomy patients. It is a retrospective study carried out at two Outpatient Health Centers in S?o Paulo. The data were collected in 635 records of adult ostomy patients assisted in June of 2005. For the costs, the data were obtained in electronic databases and official publications from the State of S?o Paulo Health Secretary, and the results were submitted to the Kolmogorov-Smirnov, Mann-Whitney, Kruskal-Wallis, Bonferroni and Spearman tests. Most of the individuals were female (51%), aged > or = 60 years, with temporary colostomy (64.5%). The average monthly cost was US$ 51.0 per patient, higher for cancer urostomy patients with permanent stomas, with neoplasia in the urinary tract and assisted by the service with a therapist nurse. Statistically significant correlation between the monthly cost and the time with stoma was found. This study has contributed for the assessment of the cost of ostomy patients in the State of S?o Paulo.     

Perception of nurses on the learning evaluation process in training programs in a São Paulo hospital

This study was carried out with nurses of a university hospital in S?o Paulo. It was aimed at understanding their perception regarding the learning evaluation process in the training sessions they attended. In order to collect data, the authors used an instrument with the guiding question: What's your perception of the learning evaluation process in training programs? The discourses were analyzed according to Bardin's referential in the content analysis modality. The results showed opinions in three categories: 1) the difficulties noticed in the evaluation process, in which time availability, negative feelings towards the evaluation and little concern for training results are challenges nurses have to overcome daily; 2) the methodology used in the evaluation process, which should consider the different learning styles, and the experience, life history and previous knowledge of the professionals being trained; and 3) the teaching-learning evaluation process as an accurate indicator of past actions and a quality control of the teaching methods adopted in the training sessions.