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Background: An increase in the use of automated systems has optimised the drug dispensing process in hospitals. Methods: This case study describes the implementation of automated drug dispensing system and presents the preliminary results of automated pharmaceutical dispensing with robots (PillPick® and BoxPicker®, ©Swisslog Healthcare) at Hospital Sírio-Libanês, a private tertiary hospital in Brazil. Results: During the study period, between 2013 (pre-automation) and 2017 (post-automation) the number total of medication errors has not changed post-automation, but there was significant reduction in error in the dispensing phase with a relative risk of 0.84 (95% confidence interval: 0.70-0.99) withal a reduction in the numbers of returned items, breakages, and loss of medications, although that delivery times have increased.. Conclusion: The study results suggest that the use of robotic systems in the central pharmacy may improve hospital pharmacy management and generate only a few errors in dispensing pharmaceuticals.

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Background and study aims Gastrointestinal cancer is an important cause of death worldwide. Remote populations are especially vulnerable to these conditions due to reduced access to screening and adequate treatment. In this context, the Belterra project was designed as a pilot taskforce to deliver gastrointestinal screening to an underserved Amazonian population and to spread knowledge and practice to local health workers. This study aimed to describe the implementation and present the results of the Belterra Project. Patients and methods The project took place between October 2014 and December 2017 in Belterra, Pará, Brazil. Public-private partnerships were obtained and were essential for funding. The project required complex logistic solutions to provide gastrointestinal screening to every inhabitant between 50 and 70 years of age, including medical equipment and personal transportation to a remote area. Subjects were asked about their medical history, and received a physical examination, endoscopic examinations, and stool tests. Results Over the course of 19 expeditions, we screened 2,022 inhabitants of Belterra, aged 50 to 70 years. Five colorectal and six gastric adenocarcinomas were diagnosed, as were several lower-stage lesions. Overall, 26 % of the participants undergoing colonoscopy showed some type of colonic lesion. Conclusions Notwithstanding the geographical, cultural, and financial barriers, this study suggests that the implementation of a gastrointestinal cancer screening program for remote Brazilian populations is feasible, reaching high adherence. Although logistics is very demanding, such campaigns may be a good strategy to provide mass gastrointestinal cancer screening for underserved populations.

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OBJECTIVE: To evaluate the costs and patient safety of a pilot implementation of an automated dispensing cabinet in a critical care unit of a private tertiary hospital in São Paulo/Brazil. METHODS: This study considered pre- (January-August 2013) and post- (October 2013-October 2014) intervention periods. We considered the time and cost of personnel, number of adverse events, audit adjustments to patient bills, and urgent requests and returns of medications to the central pharmacy. Costs were evaluated based on a 5-year analytical horizon and are reported in Brazilian Reals (R$) and US dollars (USD). RESULTS: The observed decrease in the mean number of events reported with regard to the automated drug-dispensing system between pre- and post-implementation periods was not significant. Importantly, the numbers are small, which limits the power of the mean comparative analysis between the two periods. A reduction in work time was observed among the nurses and administrative assistants, whereas pharmacist assistants showed an increased work load that resulted in an overall 6.5 hours of work saved/day and a reduction of R$ 33,598 (USD 14,444) during the first year. The initial investment (R$ 206,065; USD 88,592) would have been paid off in 5 years considering only personnel savings. Other findings included significant reductions of audit adjustments to patient hospital bills and urgent requests and returns of medications to the central pharmacy. CONCLUSIONS: Evidence of the positive impact of this technology on personnel time and costs and on other outcomes of interest is important for decision making by health managers.

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OBJECTIVE: To evaluate the costs and patient safety of a pilot implementation of an automated dispensing cabinet in a critical care unit of a private tertiary hospital in São Paulo/Brazil. METHODS: This study considered pre- (January-August 2013) and post- (October 2013-October 2014) intervention periods. We considered the time and cost of personnel, number of adverse events, audit adjustments to patient bills, and urgent requests and returns of medications to the central pharmacy. Costs were evaluated based on a 5-year analytical horizon and are reported in Brazilian Reals (R$) and US dollars (USD). RESULTS: The observed decrease in the mean number of events reported with regard to the automated drug-dispensing system between pre- and post-implementation periods was not significant. Importantly, the numbers are small, which limits the power of the mean comparative analysis between the two periods. A reduction in work time was observed among the nurses and administrative assistants, whereas pharmacist assistants showed an increased work load that resulted in an overall 6.5 hours of work saved/day and a reduction of R$ 33,598 (USD 14,444) during the first year. The initial investment (R$ 206,065; USD 88,592) would have been paid off in 5 years considering only personnel savings. Other findings included significant reductions of audit adjustments to patient hospital bills and urgent requests and returns of medications to the central pharmacy. CONCLUSIONS: Evidence of the positive impact of this technology on personnel time and costs and on other outcomes of interest is important for decision making by health managers.

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ABSTRACT A total of 38,686 colonoscopies were performed between January 1985 and December 2012 at Hospital Sírio-Libanês, in São Paulo, Brazil. Two hundred thirty-four patients (0.6%) had acute lower gastrointestinal bleeding of moderate or severe intensity. A definitive diagnosis was possible in 151 cases, 64.5% of these patients.This study was approved by the Institutional Review Board. Medical charts were reviewed.All examinations were done under sedation by the same medical team.The predominant sources of bleeding were colonic diverticula (73 patients; 31%), ischemic or infectious colitis (18 patients; 7.7%) and radiation proctitis (18 patients; 7.7%).A specific therapeutic intervention was performed on 61 of the 151 patients who had the diagnosis confirmed (40.4%), according to the source of bleeding. Most patients with postpolypectomy bleeding were treated with injection of epinephrine (40%) and clipping (40%). Patients with angiodysplasia were treated predominantly with argon plasma coagulation (42%).Injection of epinephrine was the most frequent treatment, regardless of the source of bleeding (34.4%), followed by argon plasma coagulation (31.1%).Control of active hemorrhage was achieved endoscopically in 98.8% of the patients.Our data shows that early colonoscopy in the management of patients with suspected acute lower gastrointestinal bleeding is a useful tool for diagnosis and treatment.

RESUMO No total, 38.686 colonoscopias foram realizadas entre janeiro de 1985 e dezembro de 2012 no Hospital Sírio-Libanês, em São Paulo, Brasil. 234 pacientes (0,6%) sofriam de sangramento gastrointestinal baixo agudo (SGIBA) de intensidade moderada ou grave. Em 151 casos (64,5% desses pacientes) foi possível estabelecer um diagnóstico definitivo.O estudo foi aprovado pelo Comitê de Revisão Institucional. Os prontuários clínicos foram revisados.Todos os exames foram realizados com o paciente sedado e pela mesma equipe clínica.As origens predominantes de sangramento foram divertículos colônicos (73 pacientes; 31%), colite isquêmica ou infecciosa (18 pacientes; 7,7%) e proctite por radiação (18 pacientes; 7,7%).Uma intervenção terapêutica específica foi realizada em 61 dos 151 pacientes com diagnóstico confirmado (40,4%), de acordo com a origem do sangramento. Em sua maioria, os pacientes com sangramento pós-polipectomia foram tratados com injeção de adrenalina (40%) e por clipping (40%). Os pacientes com angiodisplasia foram tratados predominantemente com coagulação com plasma de argônio (42%).O tratamento mais frequentemente administrado foi a injeção de adrenalina, independentemente da origem do sangramento (34,4%), seguida pela coagulação com plasma de argônio (31,1%).O controle da hemorragia ativa foi obtido por via endoscópica em 98,8% dos pacientes. Nossos dados revelam que o uso precoce da colonoscopia no tratamento de pacientes com suspeita de SGIBA é instrumento útil para o diagnóstico e tratamento.

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The hamartomatous polyps of Peutz-Jeghers Syndrome (PJS) can cause repeated episodes of rectal bleeding and intestinal subocclusion. Laparoscopic treatment of intussusception is rarely reported and must be considered for this clinical condition. We described a 35-year-old male with PJS who presented with rectal bleeding and abdominal pain. One duodenal polyp and two others in the jejunum, which caused intussusception, were visualized on preoperative investigation. Polyps were identified by laparoscopy and removed extracorporeally through enterotomies. All lesions were hamartomas. The patient was discharged on the third postoperative day and has been asymptomatic for more than 2 years. Laparoscopy allows an adequate access to explore and treat small bowel polyps and avoid the classic laparotomy.

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Com a finalidade de se estabelecer as principais afecçoes colorretais observadas em pacientes portadores da síndrome da imunodeficiência adquirida com sintomas intestinais e verificar as alteraçoes endoscópicas relacionadas, foi analisada uma série de 236 colonoscopias realizadas em 186 pacientes. A colonoscopia foi sempre acompanhada de biopsias, mesmo quando nao havia alteraçoes endoscópicas. O diagnóstico mais freqüente foi colite pelo citomegalovírus identificado em 64 exames (27,1 por cento) e se apresentou caracteristicamente com padrao inflamatório ulcerativo. O segundo achado em freqüência foi o Cryptosporidium sp. observado em 31 exames (13,1 por cento), relacionando-se o processo inflamatório sem ulceraçoes. Outros patógenos observados com menor freqüência foram: Mycobacterium sp., Histoplasma capsulatum, Herpes simplex, Isospora sp. Giardia sp., Candida sp. e Campilobacter sp.. As afecçoes neoplásicas foram diagnosticadas em 10 exames (4,2 por cento) e representadas principalmente pelo sarcoma de Kaposi. Os autores concluem que: 1. as afecçoes colorretais mais freqüentes em portadores da AIDS (CMV e Cryptosporidium sp.) apresentam, na maioria das vezes, aspecto colonoscópico característico que podem sugerir diagnóstico; 2. a realizaçao de biopsias é fundamental: a) para confirmaçao diagnóstico; b) para realizaçao do diagnóstico quando da ausência de alteraçoes endoscópicas; c) para identificar a eventual concomitância de patógenos.

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A diarréia é freqüente sintoma apresentado por indivíduos portadores da síndrome da imunodeficiência adquirida. A colonoscopia tem papel preponderante na investigaçao da etiologia da diarréia. O presente estudo foi realizado visando estabelecer probabilidades de diagnósticos para padroes endoscópicos observados. Para tanto, uma série de 86 pacientes portadores de AIDS e diarréia foi estudada prospectivamente. Após estabelecimento de probabilidades de diagnósticos a priori, os pacientes foram submetidos a colonoscopia com biópsias seriadas dos segmentos examinados, mesmo na ausência de alteraçoes endoscópicas. A relaçao dos diagnósticos histopatológicos realizados com os aspectos endoscópicos observados forneceu informaçoes que, combinadas com as probabilidades a priori, originaram as probabilidades de diagnósticos atuais, que representam as probabilidades de determinado padrao endoscópico relacionar-se a um patógeno específico. Os resultados obtidos demonstram que, apesar de determinado achado endoscópico poder sugerir ao colonoscopista um diagnóstico etiológico, este deve ser confirmado através de biópsias e estudo histopatológico.

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Os autores relatam sua experiencia inicial com a cirurgia colorretal por via laparoscopica. Sao relatados sete procedimentos cirurgicos, suas dificuldades e complicaçoes. Discutem aspectos relevantes da tecnica operatoria. Comentam ainda as indicaçoes atuais dessa tecnica, considerando as relaçoes entre seu custo e suas vantagens em relaçao ao metodo tradicional. Seu emprego nas cirurgias oncologicas e, na opiniao dos autore, ainda questionavel, pois embora as ressecçoes colorretais laparoscopicas possam ser realizadas seguindo tecnica oncologica adequada, a onspeçao da cavidade abdominal por esse metodo ainda e precario, o que se pode impedir a radicalidade cirurgica nos casos de cancer

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Os autores apresentam tecnica desenvolvida para facilitar a passagem do cateter por via subcutanea, que vai desde o reservatorio vascular ate o local da flebotomia para a sua introducao no sistema venoso central.Esta tecnica consiste na confeccao de tunel subcutaneo com o auxilio de um fio de Kishner, que pode ser realizado sem anestesia do trajeto, gerando menos trauma local

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