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Search Results: 1 - 10 of 228332 matches for " Oliveira Gláucia Maria Moraes de "
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Desempenho e gastos do SUS com revasculariza??es do miocárdio no Estado do Rio de Janeiro, de 1999 a 2008
Oliveira, Gláucia Maria Moraes de;Klein, Carlos Henrique;Silva, Nelson Albuquerque de Souza e;
Arquivos Brasileiros de Cardiologia , 2011, DOI: 10.1590/S0066-782X2011005000108
Abstract: background: expenses with coronary artery bypass grafting (cabg) surgery and coronary angioplasty (ca) represented a significant cost to sus. objective: to analyze sus expenses with cabg and ca and their performance in hospitals in the state of rio de janeiro (srj), from 1999 to 2008. methods: the information came from paid haa in hospitals with more than 100 revascularization procedures. mortality rates were adjusted by poisson (with covariates age, length of hospital stay and icu expenses). mean relative cost indices were calculated by dividing the mean value of the cost fraction spent in each hospital by the mean expense in the srj in u.s. dollars. stata software was used for statistical analysis. results: a total of 10,983 cabg and 19,661 ca were paid by sus in 20 hospitals during the 10 years, with mean values of us$ 3,088.12 and 2,183.93, respectively. the mortality rate in cabg varied from 9.2%-1999 to 7.7%-2008, with ranges of 5.0%-9.2% and in ca, from 1.6%-1999 to 1.5%-2008, with ranges of 0.9%-2.3%. the hospitals decreased the number of cabg procedures and doubled ca procedures. age, time of hospital stay and icu costs significantly correlated with lethality in cabg and ca paid by sus in the srj. on average, hospital service costs represented 41% of the total cost of cabg and 18% of ca, and with ortheses and prostheses, 55% in ca and 28% in cabg. conclusion: it is clear the need to improve the quality of healthcare service in institutions that perform cabg and ca paid by sus.
Mortalidade por insuficiência cardíaca: análise ampliada e tendência temporal em três estados do Brasil
Gaui, Eduardo Nagib;Klein, Carlos Henrique;Oliveira, Gláucia Maria Moraes de;
Arquivos Brasileiros de Cardiologia , 2010, DOI: 10.1590/S0066-782X2010000100010
Abstract: background: heart failure (hf) is a chronic disease with high prevalence and mortality rates. the mortality due to hf in brazil has been studied more frequently using hospitalization data. objective: to evaluate the mortality rates due to hf by sex and age range, in three states of brazil, rio de janeiro, s?o paulo and rio grande do sul, from 1999 to 2005. methods: the data were obtained from death certificates assessed in the three states. the mortality due to hf was assessed in the restricted (underlying cause of death), comprehensive (mentioned in any line of the death certificate) and extended (all codes with the presence of hf) forms. results: the specific rates of mortality presented a clear decrease trend in the age groups, except in the group aged 80 years or older. the rates increased with age and were clearly higher among men up to 80 years of age. the rates of mortality due to hf were 3-fold higher in the comprehensive than in the restricted form of analysis. the extended form of analysis also added 20% of deaths in which hf was present. conclusion: the results of this study demonstrated a decrease trend in the mortality rates due to hf when considering the three states - around 43% of brazil - from 1999 to 2005. the methodology of multiple causes of death, in addition to the underlying ones, allows us to present a more comprehensive dimension of the importance of hf as cause of death. the adequate selection of the codes of the international classification of diseases (icd), which comprehend the totality of the hf phenomenon, remains a challenge for further studies.
Complica??es e tempo de interna??o na revasculariza??o miocárdica em hospitais públicos no Rio de Janeiro
Carvalho, Marcio Roberto Moraes de;Silva, Nelson Albuquerque de Souza e;Oliveira, Gláucia Maria Moraes de;Klein, Carlos Henrique;
Revista Brasileira de Terapia Intensiva , 2011, DOI: 10.1590/S0103-507X2011000300009
Abstract: objective: to evaluate associations between post-operative complications in patients who survive surgery and in-hospital deaths and lengths of hospital stays of patients who undergo coronary artery bypass graft surgery methods: patients who underwent coronary artery bypass graft surgery and survived the operating theater were randomly selected. information on complications and hospital lengths of stay until hospital discharge or death were retrospectively collected based on medical records and declarations of death. these aspects were estimated according to the presence of complications, frequency of complications, mortality, relative risk and attributable population risk. mean hospital lengths of stay were compared using wald's statistics. results: medical records indicating deaths in the operating theater were excluded, and 86.9% of the included records reported complications; the greatest loss of information (43.9%) was related to kidney failure. hyperglycemia was estimated as the most frequent complication (74.6%), with an attributable risk of 31.6%. the population's attributable risks were greater than 60% for low cardiac output (77.0%), kidney failure (64.3%) and cardiorespiratory failure (60.4%). twelve different situations were identified for paired combinations of significant differences between average post-operative hospitalization times and complications, according to the outcome of discharge or death. conclusion: several complications were identified during the postoperative period of coronary artery bypass graft surgery, with different frequencies and impacts on mortality. control of the myocardium at the risk of ischemia, hemodynamic stabilization and volume replacement strategies may be effective for controlling mortality rates and shortening hospital lengths of stay.
Letalidade hospitalar nas angioplastias coronárias no Estado do Rio de Janeiro, Brasil, 1999-2003
Godoy, Paulo Henrique;Klein, Carlos Henrique;Souza-e-Silva, Nelson Albuquerque de;Oliveira, Gláucia Maria Moraes de;
Cadernos de Saúde Pública , 2007, DOI: 10.1590/S0102-311X2007000400012
Abstract: this study analyzes hospital case fatality associated with percutaneous transluminal coronary angioplasties (ptca) covered by the brazilian unified national health system (sus) and performed in hospitals in the state of rio de janeiro from 1999 to 2003. ptca data were obtained from the state health department's database on authorizations for hospital admissions. case fatality rates were estimated according to age, gender, diagnosis, and hospital. overall case fatality was 1.9% in 8,735 ptcas. the lowest rate was associated with angina (0.8%) and the highest rates with acute myocardial infarction (6%) and other diagnoses (7%). in the 50-69-year bracket, case fatality was higher in women. in the over-70 group, it was almost three times that of the youngest group (4% versus 1.4%). there was great variability among ptca case fatality rates in different hospitals (from 0 to 6.5%). ongoing monitoring of ptcas is thus necessary in clinical practice. in conclusion, ptca performance was still unsatisfactory under the unified national health system.
Letalidade por doen as isquêmicas do cora o no Estado do Rio de Janeiro no período de 1999 a 2003
Oliveira Gláucia Maria Moraes de,Klein Carlos Henrique,Silva Nelson Albuquerque de Souza e,Godoy Paulo Henrique
Arquivos Brasileiros de Cardiologia , 2006,
Abstract: OBJETIVO: Estimar a letalidade nos procedimentos de doen as isquêmicas do cora o (DIC) aguda e cr nica e por revasculariza o miocárdica (RVM) e angioplastia coronariana (AC) nos hospitais cadastrados no SIH/SUS (Sistema de Informa es Hospitalares/Sistema único de Saúde) no Estado do Rio de Janeiro (ERJ), de 1999 a 2003. MéTODOS: Os procedimentos considerados de RVM e de AC provieram do Datasus. As taxas foram padronizadas por sexo, idade e gravidade de doen a, tendo como padr o todos os procedimentos de alta complexidade cardiovascular, realizados no ERJ em 2000. Os grupos de DIC s o: angina, infarto agudo do miocárdio, outras DIC agudas e DIC cr nicas. RESULTADOS: As letalidades por angina, IAM, outras DIC agudas e DIC cr nicas foram de 2,8%, 16,2%, 2,9% e 3,9%, respectivamente, no ERJ. As taxas de letalidade, ajustadas por idade, sexo e grupo diagnóstico, nas RVM e AC foram elevadas, variando entre 1,9% e 12,8% nas RVM, e atingindo 3,2% nas AC, e de 2,3% e 11,1%, quando o tratamento clínico era realizado. CONCLUS O: As RVM e AC no tratamento das DIC no ERJ vêm aumentando progressivamente. A letalidade esteve acima do desejável, principalmente nas interna es por DIC cr nicas (5,4% e 1,7%, respectivamente). O tratamento clínico otimizado parece boa op o terapêutica, reservando-se as RVM e AC para os casos de pior prognóstico. A letalidade no IAM com tratamento clínico foi semelhante à existente quando n o se utilizam trombolíticos (16,7%).
Aplica??o do EuroSCORE na cirurgia de revasculariza??o miocárdica em hospitais públicos do Rio de Janeiro
Carvalho, Márcio Roberto Moraes de;Silva, Nelson Albuquerque de Souza e;Klein, Carlos Henrique;Oliveira, Gláucia Maria Moraes de;
Revista Brasileira de Cirurgia Cardiovascular , 2010, DOI: 10.1590/S0102-76382010000200013
Abstract: background: risk stratification models are used to assess the risk of death in surgery. objective: to conduct a critical analysis of the euroscore logistic model (es) application in 2,692 patients undergoing coronary artery bypass grafting (cabg) in four public hospitals in the rio de janeiro municipality, from 1999 through to december 2003. methods: random samples of 150 medical records for surviving and deceased patients were selected at four public hospitals in the city of rio de janeiro. the es was applied, using the logistical model. the observed lethality rate and that forecast by the model were compared. the measurement of the discriminatory power was estimated by the area under the roc curve. results: 546 of the 600 selected medical records were located. a significant difference was noted between the prevalence rates for the risk factors in the brazilian and european populations. the forecast lethality rate was 3.62% (ci-95%: 3.47-3.78) while the estimated observed rate was 12.22% (ci-95%- 10.99-13.46). in all risk ranges, the predicted lethality rate is under-estimated, with notable differences between the predicted and observed rates. the area under the roc curve was estimated at 0.62. conclusion: the differences in the prevalence rates for the risk factors constituting the es, associated with its low power of discrimination, hamper any recommendation of the use of this model in brazil, without the necessary adjustments.
Letalidade e complica??es da cirurgia de revasculariza??o miocárdica no Rio de Janeiro, de 1999 a 2003
Oliveira, Thaís Mendon?a Lips de;Oliveira, Gláucia Maria Moraes de;Klein, Carlos Henrique;Souza e Silva, Nelson Albuquerque de;Godoy, Paulo Henrique;
Arquivos Brasileiros de Cardiologia , 2010, DOI: 10.1590/S0066-782X2010005000091
Abstract: background: coronary artery bypass grafting (cabg) is a consolidated procedure for the treatment of ischemic heart diseases (ihds), which requires continuous assessment. objective: to assess the quality of cabg surgery by reviewing patients' clinical characteristics, mortality rates up to one year after hospital discharge, primary causes of death and postoperative complications, at four public hospitals in rio de janeiro from 1999 to 2003. methods: cabg patient charts were randomly selected. a retrospective review was conducted to collect data on clinical characteristics, complications and deaths from patient medical charts and statements of death (sds). mortality rates were estimated for the hospitalization period and for up to one year after hospital discharge. results: the prevalence of preoperative patient characteristics were: women: 31.9%; arterial hypertension: 90.7%; dyslipidemia: 67.4%; diabetes: 37.2%; current smoking status: 22.9%; obesity: 18.3%; chronic obstructive pulmonary disease: 8.2%; prior stroke: 5.8%; extracardiac artery disease: 12.7%; elevation of creatinine levels: 4.1%; critical preoperative status: 3.7%; recent acute myocardial infarction: 23.5%; unstable angina: 40.8%; acute coronary syndrome: 50.0%; prior cabg: 2.4%; left ventricular dysfunction: 27.3%; left main coronary artery lesion: 3.9%; and associated with lesion in another system: 19.8%. in-hospital mortality rates ranged from 7.0% to 14.3%, and up to one year after hospital discharge from 8.5% to 20.2%. ischemic heart disease (ihd) accounted for more than 80% of the deaths, and the most frequent complications after surgery were hemorrhage or post-procedural low cardiac output. sixty percent of the patients who died had five or more complications, whereas 40% of those who survived had none. conclusion: mortality and complication rates were high. even among those patients who survived, complications were more frequent than expected.
Letalidade por doen?as isquêmicas do cora??o no Estado do Rio de Janeiro no período de 1999 a 2003
Oliveira, Gláucia Maria Moraes de;Klein, Carlos Henrique;Silva, Nelson Albuquerque de Souza e;Godoy, Paulo Henrique;Fonseca, Tania Maria Peixoto;
Arquivos Brasileiros de Cardiologia , 2006, DOI: 10.1590/S0066-782X2006000200009
Abstract: objective: to estimate the lethality rate of acute and chronic ischemic heart disease (ihd) procedures, coronary artery bypass graft (cabg) procedures and percutaneous transluminal coronary angioplasty (ptca) procedures in the hospitals that are registered as service providers for the hospital information system / single healthcare system (sih/sus) plan in the state of rio de janeiro (rj) between 1999 and 2003. methods: the procedures considered as cabgs and ptcas were provided by datasus (sus databank). the rates were standardized in accordance with gender, age, and disease severity. the common factors among these procedures are that they are highly complex cardiovascular procedures performed in rj in the year 2000. the ihd groups are: angina, acute myocardial infarction, other acute ihds and chronic ihds. results: lethality rates for angina, acute myocardial infarction (ami), other acute and chronic ihds were 2.8%, 16.2%, 2.9% and 3.9%, respectively, in the rj. the lethality rates for cabg and ptca, adjusted by age, sex and diagnostic groups, were elevated ranging from 1.9% to 12.8% for cabg procedures and as high as 3.2% for ptca. when medical therapy was performed the rates were 2.3% for cabg and 11.1% for ptca. conclusion: there has been a progressive increase in the number of cabg and ptca procedures to treat ihds in the rj. lethality rates were above the desirable level, mainly for chronic ihd hospital admissions (5.4% and 1.7%, respectively). optimized medical therapy appears to be a worthwhile therapeutic option, reserving cabg and ptca procedures for the cases with the worst prognoses. lethality rates for ami with medical therapy was comparable to current rates when thrombolytics were not used (16.7%).
Análise exploratória dos fatores relacionados ao prognóstico em idosos com sepse grave e choque séptico
Machado, Roberta de Lima;David, Cid Marcos Nascimento;Luiz, Ronir Raggio;Amitrano, Daniel de Azevedo;Salom?o, Carla de Souza;Oliveira, Gláucia Maria Moraes de;
Revista Brasileira de Terapia Intensiva , 2009, DOI: 10.1590/S0103-507X2009000100002
Abstract: objectives: the objective of this study was to evaluate variables related to intra hospital mortality at 28 days, of aged persons with severe sepsis and septic shock in a clinical icu. methods: one hundred and fifty-two patients aged > 65 years with severe sepsis and septic shock were followed for 28 days and the variables were collected on days 1, 3, 5, 7, 14 and 28 of stay. to compare categorical variables the chi-square test was used and the mann-whitney or t test for continuous variables. all tests were double-tailed, alpha error of 0.05. results: mean age was 82.0 ± 9.0 years and 64.5% were female. mortality was of 47.4%. related to death were the following: acute physiological and chronic heath evaluation ii score (p < 0.001), sequential organ failure assessment score on days 1, 3, 5, 7 (p < 0.001), length of stay in intensive care (p < 0.001), number of organ failures (p < 0.001), high serum lactate on day 3 (p = 0.05), positive troponin i (p < 0.01), echocardiographic variables (systolic diameter p = 0.005; diastolic diameter p = 0.05; shortening fraction p = 0.02), previous renal disease (p = 0.03), shock (p < 0.001), mechanical ventilation (p < 0.001) and lawton scale (p = 0.04). conclusions: shock, elevated lactate, organ failure, especially respiratory were more prevalent in non-survivors. heart dysfunction detected by echocardiographic variables and positive troponin i may play an important role in the mortality of aged patients with sepsis.
Mortalidade por todas as causas e por doen?as cardiovasculares em três estados do Brasil, 1980 a 2006
Soares,Gabriel Porto; Brum,Júlia Dias; Oliveira,Gláucia Maria Moraes de; Klein,Carlos Henrique; Silva,Nelson Albuquerque de Souza e;
Revista Panamericana de Salud Pública , 2010, DOI: 10.1590/S1020-49892010001000004
Abstract: objective: to evaluate mortality from all causes, diseases of the circulatory system (dcs), ischemic heart disease (ihd), and cerebrovascular diseases (cvd) from 1980 to 2006 in rio de janeiro, rio grande do sul, s?o paulo, and their capitals, taking into consideration the impact of deaths due to ill-defined causes. methods: population and mortality data were obtained from the unified health system's data bank (datasus). mortality from the diseases of interest and from ill-defined causes was adjusted by the direct method for adults older than 20 years of age. since the mortality rates from ill-defined causes increased markedly after 1990, proportional mortality rates from ill-defined causes were calculated. linear regression models were used for analysis of trends. results: a relevant decline in all-cause mortality was observed in the three states and capitals. rio de janeiro and its capital had the highest rates of all-cause mortality. dcs mortality declined more than all-cause mortality. proportional mortality from ill-defined causes in rio de janeiro and its capital was higher than in all other states and capitals starting in 1990. cvd mortality fell in the study period, especially in rio de janeiro and its capital. the state of rio de janeiro also had the highest ihd mortality rates until 1993. among the capitals, s?o paulo presented the highest ihd mortality rates starting in 1992. conclusions: the decline in all-cause mortality resulted mainly from the decline in dcs mortality. in turn, the decline in dcs mortality was partly due to the reduction in cvd mortality, especially in the state of rio de janeiro.
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