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Dilema: O caso retrata a difícil decisão da família de Alfredo por doar, ou não, os órgãos do falecido. Esta decisão é influenciada pela qualidade dos serviços prestados pelo hospital à família, assim como pela habilidade dos profissionais de linha de frente em lidarem com a família em um momento tão sensível. Jorge, coordenador da Central Estadual de Transplantes (CET), precisa agir para aumentar o número de “sim” às doações de órgãos de doadores falecidos. Mas o que fazer? Como desenvolver as competências dos profissionais que trabalhavam na CET? Como melhorar a qualidade dos serviços prestados às famílias dos potenciais doadores? Objetivos educacionais: O caso foi escrito com o objetivo pedagógico de trabalhar em sala de aula conceitos relevantes no campo da gestão e qualidade de serviços: o conceito e as cinco dimensões de qualidade percebidas em serviços, discutidos por Parasuraman (confiabilidade, presteza, segurança, empatia, tangíveis); as três dimensões para avaliação da qualidade de serviços de saúde, propostos por Donabedian (estrutura, processo, resultado); a importância das pessoas para a entrega de serviços de qualidade em contextos adversos e de alto contato, considerando as quatro características distintivas dos serviços, concebidas por Kotler (intangibilidade, inseparabilidade, perecibilidade, variabilidade), o conceito de “hora da verdade” na prestação de serviços, introduzido por Jan Carlzon, e de “espelho de satisfação” funcionário-cliente. Contextualização: O dilema se dá no hospital em que Alfredo foi encaminhado após sofrer um grave acidente de bicicleta – envolvendo traumatismo craniano. A gravidade da lesão resultou na morte do paciente, com diagnóstico de morte encefálica pela equipe médica, critério que permite a doação de órgãos. A discussão do caso se passa nesse contexto, em que o paciente permanece internado, enquanto sua família é comunicada do falecimento e da opção de doar seus órgãos. Tema principal: conceito de qualidade em serviços e a importância das pessoas para a entrega de serviços de qualidade, em contextos adversos e de alto contato. Público: estudantes de pós-graduação – formação executiva, mestrado ou doutorado. Originalidade / valor: A originalidade do caso se dá pelo fato de discutir conceitos de gestão da qualidade de serviços em contextos adversos e de alto desgaste emocional, como é o caso de doação de órgãos de doador falecido.

This research explores how drones can improve the blood supply chain (BSC) in the delivery of blood components. This analysis is done considering the lean principles, and the aim is to understand c...

Biological medicines have grown in importance for treating some chronic diseases better than regular chemical medication. However, they demand specialised services in the biopharmaceutical supply c...

Brazil has the most extensive public program for organ transplantation in the world, and the Brazilian National Health System (SUS) provides full coverage of all costs involved in organ donation, transplants, and post-transplant. Despite the relevance of the subject and the shortage of organs for transplants, transplantation process efficiency assessments are still uncommon in Brazil and abroad. This study aims to evaluate the efficiency of the Brazilian states and the Federal District in transforming potential organ donors into actual donations. We applied data envelopment analysis (DEA) in conjunction with the bootstrap technique, using organ transplantation data from 2018. The bootstrap methods applied (bootstrap technique, the bootstrap-biased scores of efficiency, and the bootstrap bias-corrected scores of efficiency) allow to obtain a confidence interval for DEA scores and provide greater robustness to studies based on DEA methodology. The bootstrap bias-corrected model indicates that there is significant room for improvement in terms of converting potential donors into actual donors. The mean corrected score is 0.55, signalizing that altogether the Brazilian states could maximize in 45% the number of transplanted organs without necessarily increasing the pool of potential donors. The study provides insights into the Brazilian processes of organ donation and transplantation, helping to identify locations in need of resource allocation improvements. Given the scarcity of studies with a joint application of DEA and bootstrap techniques in this crucial health activity, we also intend to methodologically contribute to this type of benchmark analysis, emphasizing the importance of considering measurement errors, randomness, and bias at DEA models.

Background Organ transplantation has been for years one of the best treatment options for several medical conditions, and, all over the world, thousands of people need an organ transplant. However, the process through which an organ goes from a brain-dead patient to a new recipient is a complex and delicate one. Research questions This study aims at identifying and assessing the main risks, their impact, and their relevance on the organ donation-transplantation (ODT) process in Brazil. Design To identify and to assess the risks of the process, we interviewed coordinators at the 10 State Transplantation Centers in Brazil, which is responsible for over 90% of donations that occurred in Brazil in 2019. We applied the Failure Mode and Effect Analysis method to calculate the risks in terms of severity, occurrence, and detection. The scores obtained from each risk were used to elaborate a ranking comparing the impact of 1 risk in relation to the others. Main findings The interviewees identified 30 risks throughout the ODT process in Brazil. Most of them are related to insufficient human and material resources, lack of staff training and commitment, and poor infrastructure or logistical aspects. Conclusions This study complements findings from previous studies and add new risks, based on the Brazilian state coordinators’ point of view. It highlights the most critical weaknesses of the process and serves as a basis for future studies to delve deeper into each of those risks.

Purpose This study aims at verifying the impact of literacy on over-the-counter (OTC) drug consumer vulnerability as evaluated by health literacy and label comprehension. Design/methodology/approach The item response theory (IRT) was used to estimate the health literacy of two groups and the two-way analysis of variance tests was used to test the hypotheses for the existence of mean differences between the two populations. The convenience sample involved 188 OTC consumers: 94 (50%) poorly literate and 94 (50%) university students/graduates. Findings University consumers/graduates have a level of health literacy and label comprehension that is superior to those presented by poor literate consumers. Also, age does not influence the level of health literacy by OTC drug users but has a significant impact on the understanding of OTC drug labels. Finally, the level of schooling and the “age group,” simultaneously, does not impact the understanding of OTC drug labels or health literacy. Research limitations/implications This study has added in the field of knowledge by investigating the behavior of poor literate consumers in Brazil, a developing country. The results may be relevant to Marketing professionals, especially those in the pharmaceutical industry, and to police makers, as they help identify the main problems faced by poorly literate consumers. Practical implications It is necessary to raise awareness of the dangers of self-medication and wrong use of medications, mainly focused on people with low literacy. As a suggestion, a simple glossary presented along with the label could provide explanations of scientific terms, thus increasing health literacy and reducing the vulnerability of the consumers. Social implications This study showed that when using common words such as gastritis to define a health problem, there is a higher degree of correctness. These results suggest the adoption of a more straightforward language and more precise explanations. By doing that, the pharmaceutical industry and policymakers will improve their social impact by increasing consumer power and taking care of the health of the most vulnerable population: the illiterate people. Originality/value This study contributes to the international literature, as it enhances and clarifies the knowledge about the customers’ power and vulnerability in developing countries. It fills a gap by evaluating label comprehension and heath literacy at the same time, giving an academic contribution for pharmaceutical consumers’ studies.

The objective of the article is to develop a conceptual model that jointly examines the perception of doctors and patients regarding the quality of services provided by public and private hospitals...

This article maps risk perception across the pharmaceutical supply chain (PSC) in Brazil. Our paper employs the method orders-of-magnitude analytic hierarchy process to rank risks as perceived by i...

Estudos indicam melhorias efetivas em importantes indicadores da gestão, beneficiando a instituição e os pacientes. as perspectivas são positivas, mas também devem ser consideradas as limitações das pesquisas analisadas.

To identify the managerial actions proposed and employed to reduce the waiting time to initiate oncological treatments in the public health system and its application in Latin America.We searched seven databases in December 2020. Search terms were conceptualized into three groups: waiting time, cancer, and terms related to public sector. The eligibility criteria included theoretical or empirical academic articles written in English, Spanish, or Portuguese, that focused on managerial solutions to face oncological healthcare queues' dilemma.The search returned 1 255 articles, and 20 were selected and analysed in this review. Results show that most of the proposals are related to the process and people dimensions. The actions related to the process dimension were mainly associated with programming new treatment pathways and integrating cancer systems. People's dimension initiatives referred mostly to task forces and groups of specialists. Some initiatives were related to implementing technological solutions and the technology dimension, mainly concerning radiotherapy devices' acquisition.Few studies focus on analysing actions to minimize waiting time to initiate oncological treatments. The prevalence of conceptual and illustrative case studies indicates the lack of research maturity on this theme. Future studies should focus on setting the field's theoretical foundations, considering the existing paradigms, or developing new ones. There is a need for empirical studies applying a multidisciplinary approach to face the oncological treatment waiting time challenge and proposing new and innovative initiatives.Identificar las medidas gerenciales propuestas y empleadas para reducir el tiempo de espera para iniciar el tratamiento oncológico y su aplicación en el sistema público de salud en América Latina.Se realizaron búsquedas en siete bases de datos en diciembre del 2020. Se conceptualizaron los términos de búsqueda en tres grupos: tiempo de espera, cáncer y términos relacionados con el sector público. Entre los criterios de aceptabilidad se incluyeron artículos académicos teóricos o empíricos escritos en inglés, español o portugués acerca de soluciones gerenciales para enfrentar el dilema de los tiempos de espera en la atención médica oncológica.La búsqueda arrojó como resultado 1 255 artículos; para esta revisión se seleccionaron y analizaron 20. Los resultados muestran que la mayoría de las propuestas están relacionadas con dos dimensiones: el proceso y los pacientes. Las medidas relacionadas con el proceso se asociaron principalmente con la planificación de nuevas vías de tratamiento y la integración de los sistemas oncológicos. Las iniciativas relacionadas con los pacientes se referían principalmente a equipos de trabajo y grupos de especialistas. Algunas iniciativas estuvieron relacionadas con la dimensión de tecnología y soluciones tecnológicas, principalmente con la compra de equipos de radioterapia.Pocos estudios se centran en analizar medidas que minimicen el tiempo de espera para iniciar los tratamientos oncológicos. La prevalencia de estudios de casos conceptuales e ilustrativos indica la falta de madurez de la investigación sobre este tema. Los estudios futuros deben centrarse en establecer las bases teóricas del campo, considerar los paradigmas existentes o elaborar nuevos paradigmas. Es necesario realizar estudios empíricos que apliquen un enfoque multidisciplinario para afrontar el reto del tiempo de espera para recibir tratamiento oncológico y que propongan iniciativas nuevas e innovadoras.Identificar ações gerenciais propostas e adotadas para reduzir o tempo de espera para o início do tratamento oncológico no sistema de saúde pública e sua aplicação na América Latina.Foram feitas buscas em sete bancos de dados em dezembro de 2020. Os termos de busca foram conceituados em três grupos: tempo de espera, câncer e termos relacionados ao setor público. Os critérios de elegibilidade incluíam artigos acadêmicos teóricos ou empíricos escritos em inglês, espanhol ou português, cujo foco fossem soluções gerenciais para enfrentar o dilema das filas para atendimento oncológico.A busca retornou 1255 artigos, dos quais 20 foram selecionados e analisados nesta revisão. Os resultados mostram que a maioria das propostas está relacionada às dimensões de processo e pessoas. As ações relacionadas à dimensão de processo estavam associadas principalmente ao desenvolvimento de novos percursos assistenciais e à integração dos sistemas de atendimento oncológico. Já as iniciativas na dimensão de pessoas se referiam principalmente a forças-tarefa e grupos de especialistas. Algumas iniciativas estavam relacionadas à implementação de soluções tecnológicas e à dimensão tecnológica, sobretudo no que se refere à aquisição de dispositivos de radioterapia.Poucos estudos se concentram na análise de ações para minimizar o tempo de espera para início do tratamento oncológico. A prevalência de estudos de caso conceituais e ilustrativos indica a falta de maturidade da pesquisa sobre esse tema. Futuros estudos devem se concentrar em definir fundamentos teóricos da área, considerar os paradigmas existentes ou desenvolver novos paradigmas. São necessários estudos empíricos que utilizem uma abordagem multidisciplinar para enfrentar o desafio do tempo de espera para o tratamento oncológico e que proponham iniciativas novas e inovadoras.

Purpose: To identify how physicians can help polypharmacy patients deal with their disease condition by focusing on the non-clinical factors of care processes. Therefore, this study aims to answer the following specific questions: (1) What are the causes of polypharmacy? (2) How do patients experience the consequences of polypharmacy? (3) How can the service coproduction concept help physicians manage and reduce polypharmacy? Methodology: We applied a qualitative exploratory study. Data were collected by in-depth interviews, and the material was analyzed considering three coproduction dimensions - knowledge, skills, and motivation. Main results: This research found that several non-clinical factors may cause polypharmacy and trigger problematic phenomena. Accordingly, several initiatives that add value for patients who are in polypharmacy were suggested. Academic contributions: This research increases the knowledge about the non-clinical polypharmacy factors and possible initiatives to mitigate this condition. It is also essential because there are few studies focused on this subject in developing countries like Brazil. Practical contributions: This study proposed several interventions that physicians can use to manage polypharmacy.

This literature review maps recent studies addressing supply chain management (SCM) in the healthcare sector through a systematic approach that synthesises 74 empirical studies (2006–2016). Our app...

The case reports the trajectory of a telemedicine platform in Brazil. Conexa, a company that already operated with a telemedicine B2B model, took advantage of the regulatory change during the coronavirus pandemic (COVID-19) and launched Docpass, a B2C platform. The pandemic not only brought about a change in legislation, but also provided a context that reduced cultural barriers to the adoption of such a service for both doctors and patients. The case is recommended for Strategy and Innovation disciplines, more specifically in sessions dedicated to business models based on platforms, when the following learning objectives are worked on: (a) diagnosis of COVID-19 effects in a telemedicine business by comparing before, during, and after the pandemic; (b) understanding the network effects present on the platforms and their reflections in terms of value; (c) understanding the competitive dynamics in a platform ecosystem. O caso narra a trajetória de uma plataforma de telemedicina no Brasil. A Conexa, uma empresa que já operava com modelo B2B com telemedicina, aproveitou a mudança de regulamentação durante a pandemia do coronavírus (COVID-19) e lançou a Docpass, uma plataforma B2C. A pandemia não trouxe somente a mudança na legislação, como também propiciou um contexto que reduziu as barreiras culturais para a adoção de tal serviço tanto para médicos quanto para pacientes. O caso é recomendado para disciplinas de Estratégia e Inovação, mais especificamente em sessões dedicadas aos modelos de negócios baseados em plataformas, quando forem trabalhados os seguintes objetivos de aprendizagem: (a) diagnóstico sobre desdobramentos do COVID-19 em um negócio de telemedicina comparando-se o antes, o durante e o depois; (b) compreensão dos efeitos de rede presentes nas plataformas e seus reflexos em termos de valor; (c) compreensão da dinâmica competitiva em um ecossistema de plataforma.

In July 2017, the board of directors of Hospital São Felipe, a traditional hospital located in Minas Gerais, met to discuss the results of the satisfaction survey conducted at the hospital, where it was clear there was great customer dissatisfaction with the emergency service. In the previous year, the hospital emergency service received, on average, about 6,300 patients a month, divided in three specialties: general clinic, orthopedics, and ophthalmology. The director of emergency services had twenty days to submit a plan of action to address the problems identified in the emergency area, particularly those related to the waiting lines: wait time, lack of comfort, inattention of employees, and so on. The first action taken by the director was to collect data that would enable him to analyze wait times during the process: What time did the patient arrive at the emergency service? How long the patient waited to be attended by the receptionist? How long the patient waited for triage? and so on. With these data, he believed that he would have a better understanding of the process flow and would be able to propose solutions to the problem of waiting lines in the emergency area. The case was written with the educational goal of working with the concept of capacity management in services and with ways to deal with the demand variability, especially in high-touch and unpredictable services, as in the case of an emergency service.

In July 2017, the board of directors of Hospital São Felipe, a traditional hospital located in Minas Gerais, met to discuss the results of the satisfaction survey conducted at the hospital, where it was clear there was great customer dissatisfaction with the emergency service. In the previous year, the hospital emergency service received, on average, about 6,300 patients a month, divided in three specialties: general clinic, orthopedics, and ophthalmology. The director of emergency services had twenty days to submit a plan of action to address the problems identified in the emergency area, particularly those related to the waiting lines: wait time, lack of comfort, inattention of employees, and so on. The first action taken by the director was to collect data that would enable him to analyze wait times during the process: What time did the patient arrive at the emergency service? How long the patient waited to be attended by the receptionist? How long the patient waited for triage? and so on. With these data, he believed that he would have a better understanding of the process flow and would be able to propose solutions to the problem of waiting lines in the emergency area. The case was written with the educational goal of working with the concept of capacity management in services and with ways to deal with the demand variability, especially in high-touch and unpredictable services, as in the case of an emergency service. Em julho de 2017, a diretoria do Hospital São Felipe, tradicional estabelecimento privado localizado em Minas Gerais, se reuniu para discutir os resultados da pesquisa de satisfação realizada no hospital, em que ficou clara a grande insatisfação dos clientes com o atendimento da emergência. No ano anterior, a emergência do hospital atendera, em média, a cerca de 6.300 pacientes/mês, divididos nas três especialidades: clínica médica, ortopedia e oftalmologia. Ao diretor da emergência foi dado um prazo de 20 dias para apresentar um plano de ação para resolver os problemas identificados em sua área, particularmente os relacionados à espera. A primeira atitude tomada pelo diretor da emergência foi coletar dados que viabilizassem analisar os tempos de espera ao longo do processo. De posse dos dados, ele acreditava que teria uma melhor compreensão do fluxo do processo e que seria capaz de propor soluções para o problema da espera na emergência. O caso foi escrito, com dados fictícios, com o objetivo pedagógico de trabalhar em sala de aula o conceito de gestão de capacidade em serviços e meios de lidar com a variabilidade do processo e da demanda, como é o caso de uma emergência hospitalar.

PurposeThis paper aims to identify the kind of work environment that should be offered by hospital leaders to their nursing staff in Brazil to generate job satisfaction, organizational commitment and organizational citizenship behaviour within their field of expertise.Design/methodology/approachA survey was applied to 171 nurses and 274 nursing technicians who work at five private hospitals in Brazil. Both factor analysis and regression analysis were used to analyse the study model.FindingsThe results indicate that to stimulate positive behaviours and attitudes among nursing staff, managers should mainly be concerned about establishing a clear and effective communication with their professionals to ensure role clarity, promote a good working environment and encourage relationships based on trust.Research limitations/implicationsThe limitations of the study are absence of the researcher while the questionnaires were filled out and the fact that the sample comprised respondents who made themselves available to participate in the research.Practical implicationsThis study contributes to elucidate the factors that can promote a good internal climate for nursing staff, assisting hospital leaders to face the huge managerial challenges of managing, retaining and advancing these professionals.Originality/valueThe findings contribute to the body of knowledge in leadership among nursing professionals in developing countries. Hospital leaders in Brazil should encourage trusting relationships with nursing professionals through clear, effective and respectful communications, besides investing in team development and promoting a good working environment.

Purpose The purpose of this paper is to estimate the performance of Brazilian hospitals’ services and to examine contextual variables in the socioeconomic, demographic and institutional domains as predictors of the performance levels attained. Design/methodology/approach The paper applied a two-stage approach of the technique for order preference by similarity to the ideal solution (TOPSIS) in public hospitals in 92 Rio de Janeiro municipalities, covering the 2008–2013 period. First, TOPSIS is used to estimate the relative performance of hospitals in each municipality. Next, TOPSIS results are combined with neural networks in an effort to originate a performance model with predictive ability. Data refer to hospitals’ outpatient and inpatient services, based on frequent indicators adopted by the healthcare literature. Findings Despite a slight performance increase over the period, substantial room for improvement is observed. The most important performance predictors were related to the demographic and socioeconomic status (area in square feet and GDP per capita) and to the juridical nature and type of ownership of the healthcare facilities (number of federal and private hospitals). Practical implications The results provide managerial insights regarding the performance of public hospitals and opportunities for better resource allocation in the healthcare sector. The paper also considers the impact of external socioeconomic, demographic and institutional factors on hospitals’ performance, indicating the importance of integrative public health policies. Originality/value This study displays an innovative context for applying the two-stage TOPSIS technique, with similar efforts not having been identified in the healthcare literature.

The Brazilian Public Health System, facing a national economic and political crisis, operates with tight budgets and poor physical infrastructure. Among the services it delivers, organ transplantation represents a complex process wherein inefficient resource allocation is a relevant issue. This study examines the technical and scale efficiency of the Brazilian public services in kidney transplantation, assessing the conversion of physical and labor inputs into kidney transplants using data envelopment analysis. This longitudinal analysis used a secondary database from the Brazilian Registry of Transplants having, as a unit of analysis, 23 Brazilian states that performed kidney transplants from 2013 to 2015. The Malmquist index is applied to examine productivity changes. Data were adjusted per million of population, and factors were extracted by principal component analysis. The results indicate that most states operate in a technically inefficient manner, resulting in a low mean efficiency score. Overall efficiency worsened during the analyzed period, and there was a significant disparity in performance between states, with higher scores in the South and Southeast—the most developed and wealthiest regions—than in the North and Northeast. The results provide managerial insights into the delivery of organ transplantation by the Brazilian public services on both the national and state levels, helping to identify opportunities for better resource allocation in this activity. Given the scarcity of studies that systematically assess and benchmark organ donation and transplantation, this work represents an innovative context of application and may be useful for the community of relevant policymakers, academics, and health professionals.

Os hospitais têm procurado melhorar seu desempenho e a inovatividade tem sido destacada como um aliado nessa missão. O objetivo da pesquisa foi verificar se a percepção de inovatividade dos gestores de hospitais está relacionada com o desempenho de suas organizações. A inovatividade foi definida como uma medida da capacidade da empresa de inovar e foi operacionalizada mediante variáveis relacionadas à inovatividade organizacional e à inovatividade percebida da firma. O desempenho foi definido pela eficiência do hospital em utilizar os recursos disponíveis para prestar serviços. Os resultados de um survey, realizado com gestores de 20 hospitais privados pertencentes a maior operadora de planos de saúde do Brasil, mostraram que a inovatividade percebida possui relação inversa com a eficiência técnica: quanto maior a capacidade ou propensão da empresa a inovar, tanto percebida pela cultura interna da organização quanto por sua forma de atuar no mercado, menor a eficiência técnica do hospital.

Background The relevance that adherence to treatment plays in liver transplantation, and the impact this factor may have on the success of treatment, are fundamental in assessing the variables which affect patient adherence during the pretransplantation period. Objectives This study aims to determine factors that affect liver transplant candidates' adherence to treatment, and analyze the association between adherence, socioeconomic and demographic factors, clinical characteristics, and patient understanding about the disease and liver transplantation. Methods This epidemiological, observational, and prospective study included 62 patients registered in the technical database of the Universidade Federal de Sao Paulo during the period November 2012–May 2014. The dependent variable was adherence to treatment among liver transplantation candidates, and the independent variables included understanding the disease and the transplantation process, and depression and anxiety symptoms among liver transplantation candidates. Results Work situation ( P = .038), understanding about the disease ( P = .002), and use of laxatives ( P = .045) were the factors related to statistically significant adherence, and it can be concluded that implementation of an educational program may increase adherence up to 3.48 times in the pretransplantation phase, as adherence was 3.48 times lower in patients who reported little or no knowledge of the disease or the procedure.

Resumo Objetivo Identificar, nas literaturas nacional e internacional, a prática avançada em enfermagem como contribuição ao cuidado seguro. Métodos Estudo de revisão integrativa, conduzido nas bases de dados indexadas Pubmed, EBSCO, Proquest e Web of Science no período de junho a agosto de 2018 para responder as perguntas norteadoras: (1) “Quais os estudos que existem na literatura nacional e internacional que relacionam práticas avançadas e segurança do paciente?” e (2) “Como as práticas avançadas em enfermagem podem contribuir para a segurança do paciente?” Os critérios de inclusão foram: artigos acadêmicos, publicados em periódicos com resumo e texto completo, disponíveis nos idiomas português, inglês ou espanhol, e que tivessem adotado método empírico de investigação do tema em análise. Não foi realizada restrição quanto o ano de publicação. Resultados A busca nas bases de dados resultou em 91 referências obtidas inicialmente, e após análise a amostra final constitui-se de 12 artigos. Conclusão Os resultados desta revisão integrativa evidenciaram que as práticas avançadas em enfermagem exercem uma relação positiva sobre a segurança do paciente. Resumen Objetivo Identificar, en la literatura nacional e internacional, la práctica avanzada de enfermería como una contribución a la atención segura. Método Estudio de revisión integrativa, realizado en las bases indexadas Pubmed, EBSCO, Proquest y Web of Science, de junio a agosto de 2018 para responder a las preguntas orientadoras: (1) “¿Qué estudios existen en la literatura nacional e internacional relacionando las prácticas avanzadas con la seguridad del paciente? y (2) “¿Cómo pueden contribuir las prácticas avanzadas de enfermería a la seguridad del paciente? Los criterios de inclusión fueron: artículos académicos publicados en revistas con resúmenes y textos completos, disponibles en portugués, inglés o español, y que hubieran adoptado método empírico para la investigación del tema analizado. No hubo restricciones respecto del año de publicación. Resultados La búsqueda en las bases de datos dio como resultado 91 referencias obtenidas inicialmente. Después del análisis, la muestra final incluyó 12 artículos. Conclusión Los resultados de esta revisión integrativa mostraron que las prácticas avanzadas de enfermería ejercen una relación positiva en la seguridad del paciente. Abstract Objective To identify, in the national and international literature, advanced practices in nursing that contribute to safe care. Methodology An integrative review study was conducted in the indexed databases of PubMed, EBSCO, Proquest and Web of Science from June to August 2018 to answer the guiding questions: (1) What studies in the national and international literature relate advanced practices and patient safety?; and (2) How can advanced practices in nursing contribute to patient safety? The inclusion criteria were: academic articles published in journals (abstract and full text) in Portuguese, English or Spanish, adopting an empirical method of investigation of the study subject. The study had no restriction regarding the publication year. Results The search in databases resulted in 91 references obtained at first; after analysis, the final sample consisted of 12 studies. Conclusion The results of this integrative review showed that advanced practices in nursing have a positive relation to patient safety.

Resumo Este estudo visa compreender como as comunidades online podem contribuir, no Brasil, para aumentar a adesão de pacientes crônicos ao tratamento prescrito pelo médico. Para tanto, realizou-se a netnografia da comunidade Diabetes: vivendo e aprendendo – troca de informações, considerando como arcabouço teórico as dimensões da adesão propostas pela Organização Mundial de Saúde – OMS. A análise evidencia os impactos da Cibercultura sobre os processos de saúde e doença, provocando mudanças nas relações médico-paciente, no empoderamento do paciente e na gestão individual de sua condição crônica. Os resultados mostraram também uma influência positiva das interações estabelecidas na comunidade sobre os fatores multidimensionais do modelo de adesão proposto pela OMS, conduzindo ainda à possibilidade de inclusão de uma sexta dimensão referente à conectividade. As principais motivações identificadas para participação na comunidade foram o acesso a informações sobre a doença e o tratamento, o compartilhamento de experiências e o suporte social. Assim, a proposição de políticas de saúde que auxiliem os doentes crônicos a atenderem tais necessidades tende a contribuir para aumentar a adesão ao tratamento. Abstract This study aims to understand how online communities can contribute to increasing the adherence of chronic patients to the treatment prescribed by the physician in Brazil. For this purpose, we applied the netnography method to analyze the community Diabetes: vivendo e aprendendo – troca de informações (free translation: “Diabetes: living and learning – information exchange”), considering the dimensions of adherence proposed by the World Health Organization (WHO) as a theoretical framework. The analysis shows the influence of cyberculture on health and disease processes, resulting in changes in physician-patient relationships, patient empowerment, and individual management of own chronic condition. The results also showed a positive influence of the interactions established in the community on the multidimensional factors of the adherence model proposed by the WHO1, also leading to the possibility of including a sixth related to connectivity. The primary motivations identified for community participation were access to information on the disease and treatment, the sharing of experiences and social support. Thus, the proposition of health policies that help chronic patients meet these needs tends to contribute to increased adherence to treatment.

O objetivo desta pesquisa é identificar o que motiva os gestores hospitalares a buscar a acreditação. Foi realizado um survey com os 154 hospitais que atuam no Brasil e que no momento da pesquisa já possuíam ou estavam em processo de acreditação; destes, 101 (66%) responderam ao questionário. Os resultados indicam que a motivação para a busca da acreditação é um construto multidimensional e que aumentar a segurança do paciente é um dos principais motivadores. Surpreendentemente, a acreditação é vista como o início de um processo em direção ao alcance da qualidade e não como o coroamento final deste processo.

This study examines the development of learning capabilities through the implementation of a quality management program in services, based on a case study of transplantation management. The findings show how the introduction of an online system, based on a quality management program, underpinned the knowledge-building capacity of the organization. The results contribute to service literature by addressing how a quality management program links to organizational learning process directly and through building-up organizational knowledge. The implementation of a quality management program allows knowledge building through identification and socialization of tacit knowledge and combination of explicit knowledge. The development of learning capabilities fostered by the introduction of this program occurs under conditions that contribute to the building-up of organizational knowledge. Organizational learning is enhanced during this implementation through an incremental process that detects errors and corrects b...

Establishing an organization to promote organ donation and a good organ procurement team assure quality and improve performance on organ donation rates. Brazil's organ procurement structure is based on 2 models disseminated worldwide: the “Spanish model,” based on in-house coordinators, and the “American organ procurement organization (OPO) model,” with extra-hospital coordinators. In 2006, Brazil's Federal Government had formally introduced the in-house coordination model for every hospital equipped with a mechanical ventilator bed. In January 2012, the Rio de Janeiro State OPO, Programa Estadual de Transplantes, introduced an innovation in the organization of the in-house coordination model in 4 selected public hospitals with high organ donation potential. It consisted in launching full-time in-house coordination teams, with ≥1 physician and 2 nurses per hospital fully dedicated to organ procurement. The objectives were to observe the impact of this innovation in referral and organ donor conversion rates and to analyze the importance of middle managers in health care innovation implementation. Comparing the year before implementation (2011) and the year of 2014 showed that this innovation led to an overall increase in referrals—from 131 to 305 per year (+132%) and conversion rates—from 20% to 42% per year—resulting in an increase in number of donors from 26 to 128 per year (+390%). Despite wide variations among hospitals in the outcomes, our results seem very encouraging and express a positive impact of this model, suggesting that dissemination to other hospitals may increase the number of donors and transplants in our region.

This study aims to understand how online communities can contribute to increasing the adherence of chronic patients to the treatment prescribed by the physician in Brazil. For this purpose, we applied the netnography method to analyze the community Diabetes: vivendo e aprendendo - troca de informações (free translation: "Diabetes: living and learning - information exchange"), considering the dimensions of adherence proposed by the World Health Organization (WHO) as a theoretical framework. The analysis shows the influence of cyberculture on health and disease processes, resulting in changes in physician-patient relationships, patient empowerment, and individual management of own chronic condition. The results also showed a positive influence of the interactions established in the community on the multidimensional factors of the adherence model proposed by the WHO1, also leading to the possibility of including a sixth related to connectivity. The primary motivations identified for community participation were access to information on the disease and treatment, the sharing of experiences and social support. Thus, the proposition of health policies that help chronic patients meet these needs tends to contribute to increased adherence to treatment.Este estudo visa compreender como as comunidades online podem contribuir, no Brasil, para aumentar a adesão de pacientes crônicos ao tratamento prescrito pelo médico. Para tanto, realizou-se a netnografia da comunidade Diabetes: vivendo e aprendendo – troca de informações, considerando como arcabouço teórico as dimensões da adesão propostas pela Organização Mundial de Saúde – OMS. A análise evidencia os impactos da Cibercultura sobre os processos de saúde e doença, provocando mudanças nas relações médico-paciente, no empoderamento do paciente e na gestão individual de sua condição crônica. Os resultados mostraram também uma influência positiva das interações estabelecidas na comunidade sobre os fatores multidimensionais do modelo de adesão proposto pela OMS, conduzindo ainda à possibilidade de inclusão de uma sexta dimensão referente à conectividade. As principais motivações identificadas para participação na comunidade foram o acesso a informações sobre a doença e o tratamento, o compartilhamento de experiências e o suporte social. Assim, a proposição de políticas de saúde que auxiliem os doentes crônicos a atenderem tais necessidades tende a contribuir para aumentar a adesão ao tratamento.

Environmental responsibility has been a widespread and relatively recent research theme in the healthcare sector. Considering that the greater life expectancy increases the need for healthcare services and that these services produce negative environmental externalities on human health, it is important to understand the relationship between environmental responsibility and the healthcare sector. This article aims to investigate what motivates hospital managers to adopt environmental responsibility programs and to identify the actions implemented by them. A multiple case study was conducted involving four Brazilian hospitals based in Rio de Janeiro and São Paulo. The results indicate that the main drivers are competitive, ethical and regulatory and that the competitive and regulatory motivators have the potential to establish a baseline for environmental performance that varies across ownership type (public or private). The results also indicate that the comprehensiveness of environmental actions is related to organizational resilience and to the motivators that drive hospitals to adopt those actions. Two conceptual models are proposed to illustrate these findings and offer bases for further research. Resumo A responsabilidade ambiental é um tema de pesquisa amplo e relativamente recente no setor de saúde. Tendo em vista que o aumento da expectativa de vida implica maior necessidade de serviços médicos e que estes, por sua vez, geram externalidades ambientais com efeitos negativos sobre a saúde, é necessária uma compreensão mais profunda da relação entre responsabilidade ambiental e o setor de saúde. Este artigo tem por objetivo investigar o que motiva os gestores de hospitais a buscar e adotar programas de responsabilidade ambiental e identificar as ações implementadas por eles. Um estudo de caso múltiplo foi conduzido em quatro hospitais brasileiros, localizados no Rio de Janeiro e em São Paulo. Os resultados indicam que os principais impulsionadores são concorrência, ética e regulação e que os motivadores concorrência e regulação têm o potencial para estabelecer uma base para o desempenho ambiental, que varia de acordo com tipo de propriedade (pública ou privada). Os resultados também indicam que a abrangência das ações ambientais está relacionada com a resiliência organizacional e com os motivadores que impulsionam hospitais para adotar essas ações. Dois modelos conceituais são propostos para ilustrar estas conclusões e oferecer bases para futuras pesquisas. Resumen La responsabilidad ambiental es un tema de investigación amplio y relativamente reciente en el sector de la salud. Considerando que la mayor esperanza de vida genera la necesidad de más servicios médicos y que estos, a su vez, generan externalidades ambientales con efectos negativos sobre la salud humana, es necesaria una comprensión más profunda de la relación entre responsabilidad ambiental y el sector de salud. Así, este artículo tiene como objetivo investigar las principales razones que motivan a los gestores de hospitales a adoptar programas de responsabilidad ambiental e identificar las acciones implementadas por ellos. Se llevó a cabo un estudio de caso múltiple en cuatro hospitales de Rio de Janeiro y São Paulo. El estudio reveló que los principales factores de motivación son de carácter competitivo, ético y reglamentario, y que los motivadores competitivos y reglamentarios tienen potencial para establecer una base para el mejor desempeño en términos ambientales y este desempeño varía según el tipo de propiedad (pública o privada). Los resultados también indicaron que el alcance de las acciones ambientales se correlaciona con la capacidad de resiliencia organizativa y con los motivadores que impulsan a los hospitales a realizar las acciones de sostenibilidad. Se proponen dos modelos conceptuales para ilustrar estas conclusiones y proporcionar las bases para futuras investigaciones.

The development of the research on innovation in services has resulted in three approaches: technologist, service-based, and integrative. Each has a specific focus on the role of technology and the endogenous or exogenous character of innovations in services. The path chosen by state of the art research in the area has been to consolidate an integrative perspective. New research has used a service-dominant logic which allows an integrated view of economic activities based on the logic of value linked to services. This approach has raised the possibility of expanding the integrative approach, focusing on how innovations change the value proposition of a particular service through a new technology, by innovation in methods or in the service relationship. The aim of the present article is to develop this perspective using empirical research into hospital services. These activities, due to their complexity and strong interaction with different economic and social actors, bring to the fore many of the fundamental theoretical questions surrounding the debate on innovation in services, and provide a new perspective on hospital management. Based on semi-structured interviews, case studies on innovations in hospitals in Brazil and France were conducted from 2006 to 2010. The innovations studied involve new types of relationship with users, adoption of new technologies and innovations stemming from research and development. These case studies identified types, actors, and outcomes of innovation in order to develop an approach based on a broader integrative perspective, involving the analysis of characteristics and the service-dominant logic.

Atopic asthma is a chronic inflammatory disease of the lungs generally marked by excessive Th2 inflammation. The role of allergen-specific IgG in asthma is still controversial; however, a receptor of IgG–immune complexes (IgG-ICs), FcγRIII, has been shown to promote Th2 responses through an unknown mechanism. Herein, we demonstrate that allergen-specific IgG-ICs, formed upon reexposure to allergen, promoted Th2 responses in two different models of IC-mediated inflammation that were independent of a preformed T cell memory response. Development of Th2-type airway inflammation was shown to be both FcγRIII and TLR4 dependent, and T cells were necessary and sufficient for this process to occur, even in the absence of type 2 innate lymphoid cells. We sought to identify downstream targets of FcγRIII signaling that could contribute to this process and demonstrated that bone marrow–derived DCs, alveolar macrophages, and respiratory DCs significantly upregulated IL-33 when activated through FcγRIII and TLR4. Importantly, IC-induced Th2 inflammation was dependent on the ST2/IL-33 pathway. Our results suggest that allergen-specific IgG can enhance secondary responses by ligating FcγRIII on antigen-presenting cells to augment development of Th2-mediated responses in the lungs via an IL-33–dependent mechanism.

The objective of this research is to identify the factors that influence the migration of free software to proprietary software, or vice-versa. The theoretical framework was developed in light of the Diffusion of Innovations Theory (DIT) proposed by Rogers (1976, 1995), and the Unified Theory of Acceptance and Use of Technology (UTAUT) proposed by Venkatesh, Morris, Davis and Davis (2003). The research was structured in two phases: the first phase was exploratory, characterized by adjustments of the revised theory to fit Brazilian reality and the identification of companies that could be the subject of investigation; and the second phase was qualitative, in which case studies were conducted at ArcelorMittal Tubarão (AMT), a private company that migrated from proprietary software (Unix) to free software (Linux), and the city government of Serra, in Espírito Santo state, a public organization that migrated from free software (OpenOffice) to proprietary (MS Office). The results show that software migration decision takes into account factors that go beyond issues involving technical or cost aspects, such as cultural barriers, user rejection and resistance to change. These results underscore the importance of social aspects, which can play a decisive role in the decision regarding software migration and its successful implementation.

Background Healthcare professionals have a crucial role in organ donation and transplantation processes. Their attitude toward organ donation can affect public opinion and the donation decision made by deceased donors' relatives. The objectives of the study were to analyze the attitude of medical and nursing personnel toward deceased organ donation in two hospitals in Rio de Janeiro, Brazil, and the factors that can affect this attitude. Methods A random sample (n = 162) was selected from the population of nurses and physicians in the hospitals analyzed. The sample was stratified by age, sex, marital status, religion, professional category, and educational level. A validated questionnaire addressing psychosocial aspects of organ donation was used to evaluate attitudes. The χ2 and Mann-Whitney U tests were applied for statistical analysis. Results Of personnel surveyed, 86.4% (n = 140) were in favor of deceased organ donation, whereas 11.1% (n = 18) were not sure and 2.5% (n = 4) were against. The favorable attitude was related to the following aspects: (1) educational level, (2) having spoken with family members about organ donation, (3) having a chronic disease, (4) favorable attitude of one's family, (5) belief that organ donation can save lives, (6) concerns about body manipulation, illegal trade of organs, and organ donation being against God's will, (7) feeling proud of working with organ donation/transplantation, (8) self-assessment of experience and knowledge in organ donation/transplantation activities (P Conclusions Deceased organ donation is well accepted among the healthcare professionals surveyed, and the attitude is affected by socio-personal variables.

Helminths secrete several molecules that can modulate the immune responses, favoring their evasion and perpetuate their survival in the host. These molecules interfere with antigen presentation, cell proliferation and activation, antibody production, cause cell death, and stimulate regulatory responses. Here, we focus on some helminth products and address their immunomodulatory effects in the host immune system and, also, we describe some anti-inflammatory properties of an Ascaris suum-derived immunomodulatory molecule, named PAS-1. This protein is a 200-kDa molecule isolated by affinity chromatography using MAIP-1 (monoclonal antibody which recognizes PAS-1), coupled to Sepharose 4B. It suppresses the inflammatory responses in murine models of delayed-type hypersensitivity, lung allergic inflammation and LPS-induced inflammation into air pouches. PAS-1 also stimulates the secretion of regulatory cytokines such as IL-10 and TGF-beta and primes IFN-gamma-secreting CD8+ and IL-10/ TGF-beta-secreting CD4+CD25+ cell clones that avoid the lung inflammation. Thus, this protein is a potent immunomodulatory component that may be used for therapeutic interventions in inflammatory diseases.

Resumo: O objetivo do presente estudo foi comparar os custos médicos diretos do transplante renal e das terapias renais substitutivas, especificamente a hemodiálise e a diálise peritoneal, sob a perspectiva do Sistema Único de Saúde (SUS). Os custos das terapias renais substitutivas foram extraídos de informações publicadas na literatura. Os itens de custo previstos do transplante renal foram identificados em um hospital privado mediante coleta dos códigos dos procedimentos utilizados para a cobrança do SUS e os demais itens extraídos da literatura. O resultado desta pesquisa indica que, no período dos quatro anos coberto por este estudo, o transplante renal de doador falecido gera uma economia, por paciente, de R$ 37 mil e R$ 74 mil em relação à hemodiálise e à diálise peritoneal, respectivamente. Quanto ao transplante renal de doador vivo, as economias são ainda maiores: R$ 46 mil e R$ 82 mil em relação à hemodiálise e à diálise peritoneal, respectivamente. Este resultado, aliado a análises de sobrevida e qualidade de vida, pode caracterizar o transplante renal como a melhor alternativa do ponto de vista financeiro e clínico, auxiliando na formulação de políticas públicas relacionadas com os transplantes de órgãos no Brasil. Abstract: This study aimed to compare the direct medical costs of renal transplantation and renal replacement therapies, specifically hemodialysis and peritoneal dialysis, from the perspective of the Brazilian Unified National Health System (SUS). Renal replacement therapies costs were based on data published in the literature. Cost items for kidney transplant were identified in a private hospital based on procedure codes used for charging the SUS, and other items were taken from the literature. In the four years covered by the study, cadaver kidney transplant generated per-patient savings of BRL 37,000 and BRL 74,000 compared to hemodialysis and peritoneal dialysis, respectively. Savings were even greater with living donor kidney transplant: BRL 46,000 and BRL 82,000 compared to hemodialysis and peritoneal dialysis, respectively. This result, together with survival and quality-of-life analyses, characterizes kidney transplant as the best clinical and financial alternative, thus supporting public policies for organ transplants in Brazil. Resumen: El objetivo del presente estudio fue comparar los costes médicos directos del trasplante renal y de las terapias renales substitutivas, específicamente la hemodiálisis y la diálisis peritoneal, bajo la perspectiva del Sistema Único de Salud (SUS). Los costes de las terapias renales substitutivas se extrajeron de información publicada en la literatura. Los ítems de coste previstos del trasplante renal se identificaron en un hospital privado, a partir de la recogida de códigos de procedimientos utilizados para el cobro del SUS y los demás ítems extraídos de la literatura. El resultado de esta investigación indica que, en el período de los 4 años cubierto por este estudio, el trasplante renal del donante fallecido genera un ahorro, por paciente, de R$ 37 mil y R$ 74 mil en relación al hemodiálisis y al diálisis peritoneal, respectivamente. En cuanto al trasplante renal del donante vivo, los ahorros son incluso mayores: R$ 46 mil y R$ 82 mil, en relación a la hemodiálisis y a la diálisis peritoneal, respectivamente. Este resultado, junto con análisis de supervivencia y calidad de vida, puede caracterizar el trasplante renal como la mejor alternativa desde el punto de vista financiero y clínico, auxiliando en la formulación de políticas públicas relacionadas con los trasplantes de órganos en Brasil.

Since 1998, the Mae de Deus Hospital, a private institution based in Caxias do Sul , RS, Brazil, has been implementing the Eu Sou Mae de Deus Programme in order to assure the excellence of its services. The quality improvement process was structured in four stages: awareness, development, implementation and evaluation. The developed activities have been well evaluated by the physicians as well as the hospital's employees. The customer satisfaction level has also been high, since most of them (73%) have considered excellent the services provided by the hospital in the year 2001.

Successful organ donation in countries adopting informed consent legislation depends on adequate interviewing of potential donors' families. As the number of both referral and effective donors in Brazil increases, health care managers argue whether educational efforts should be directed toward training in-hospital coordinators (IHC)--based on the "Spanish model"--or on the creation of extra-hospital-based professionals (Organ Procurement Organizations [OPOs], the "American model"). Meanwhile, many potential donor families are still approached by intensive care unit (ICU) professionals not trained in donation interviews. The aim of our study was to compare performances in obtaining informed consent from potential donors' families, according to the type of health care professional conducting the interviews: OPO, IHC, or ICU staff. In this retrospective 2-year study performed in Rio de Janeiro, Brazil, we observed an increase in referrals (285 to 411) and consent rates (48.1% to 55.7%). Each year, OPO professionals conducted most family interviews (58.6% and 60.4%, respectively) and obtained better consent rates (63.5% and 64.5%, respectively), when compared to IHC (41.8% and 53.7%, respectively) or untrained ICU professionals (22.1% and 13.4%, respectively). Our results show that adequate professional training is necessary for obtaining family consent for organ donation. Both established international policies for organ procurement and donation, namely the "Spanish model" with its IHCs or the "American model" of extra-hospital OPOs, may equally achieve this task. However, family interviews performed by untrained ICU professionals result in low donation rates and should be discouraged.

Este artigo apresenta resultados de pesquisa realizada em dois hospitais de Vitoria, ES, Brasil, procurando compreender como clientes de servicos de saude percebem a ocorrencia de falhas e as praticas de recuperacao adotadas. Utilizando a Tecnica do Incidente Critico, foram analisadas 311 entrevistas pessoais. As 555 falhas de servicos identificadas foram classificadas de acordo com o modelo proposto com base na revisao de literatura. Em apenas 2% dos relatos, os esforcos de recuperacao foram satisfatorios na percepcao dos clientes. Apesar desse baixo percentual, 62% dos clientes recomendariam os servicos do hospital onde a falha ocorreu. DOI: 10.5585/rgss.v2i2.74

This paper reports on the use of different approaches for assessing efficiency of a sample of major Brazilian for-profit hospitals. Starting out with the bootstrapping technique, several DEA estimates were generated, allowing the use of confidence intervals and bias correction in central estimates to test for significant differences in efficiency levels and input-decreasing/output-increasing potentials. The findings indicate that efficiency is mixed in Brazilian for-profit hospitals. Opportunities for accommodating future demand appear to be scarce and strongly dependent on particular conditions related to the accreditation and specialization of a given hospital.

Anaphylaxis is a life-threatening and systemic disorder that involves several organs and may lead to death. It is believed to be mostly triggered by release of mediators from activated mast cells, basophils and macrophages after allergen exposure. There are two major types of anaphylactic mechanisms: classical and alternative anaphylactic pathways. Classical anaphylactic pathway is triggered by cross-linking of IgE bound to FcRI, high affinity IgE receptors, on mast cell and basophil surfaces to release pre-formed vasoactive amines (e.g. histamine), lipid mediators and neutral proteases from secretory granules upon allergen exposure. The alternative anaphylactic pathway is an IgE-independent mechanism and involves basophils and macrophages. Upon allergen exposure, IgG-immune complexes binds to FcRIII, low affinity activating IgG receptor, and subsequent release PAF (platelet activating factor), but not histamine as major mediator. The understanding of immune mechanisms on triggering anaphylaxis is crucial for understanding how to manipulate the immune system to find better therapeutic interventions. Helminth infection and their products have been demonstrated as potential therapeutic interventions in inflammatory disorders. Helminths use several imunomodulatory strategies to evade and/or modify the host immune response in order to survive in the host, including suppression or inactivation of host antigen-specific immune response. The modulation of the immune system has been considered beneficial for both host and parasites since it could avoid helminth eradication and protect the host from inflammatory responses which may damage host’s tissues and organs. Several helminth immunomodulatory molecules and strategies have been identified and reported, such as eotaxin metalloproteinase, calreticulin, antioxidants and neutrophil inhibitory factor. They interfere with antigen processing and presentation, cell proliferation, cause T cell death, decrease IgE responses, reduce B cell activation and stimulate regulatory T cells. Therefore, these immunomodulatory factors can affect both the inductive and effector immune response, being suitable to modulate the inflammatory, allergic and anaphylactic responses. Our studies have been focused in the immunossuppressive responses induced by roundworms Ascaris suum infection and a protein secreted by these worms named PAS-1

Patients bitten by Loxosceles spiders generally manifest marked local inflammatory reaction and dermonecrosis. This report evaluated edema formation, leukocyte infiltration and release of inflammatory mediators at the injection site of Loxosceles gaucho venom. BALB/c mice were i.d. injected with venom and thereafter paws were disrupted and homogenized to obtain differential counts of migrated cells, as well to assay the levels of cytokines, chemokines and lipid mediators. Increased footpad thickness was detected as soon as 30 min after venom injection, and 24h later was similar to that of the control group. Loxosceles venom mildly augmented the recruitment of leukocytes to the footpad in comparison with PBS-injected mice. Moreover, it stimulated the release of IL-6, MCP-1 and KC at 2 and 24h after venom injection. In addition, higher levels of PGE(2) were detected 30 min after venom injection in comparison with control group. However, the venom failed to increase levels of IL-1 beta, TNF-alpha, TXB(2) and LTB(4). Our results demonstrate that L. gaucho venom evokes an early complex inflammatory reaction, stimulating the secretion of pro-inflammatory cytokines and lipid mediators (PGE(2)), and recruiting leukocytes to the footpad which contribute to the local reaction induced by L. gaucho venom.