EVELINDA MARRAMON TRINDADE
Índice h a partir de 2011
11
Projetos de Pesquisa
Unidades Organizacionais
PAHC, Hospital das Clínicas, Faculdade de Medicina
17 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 17
- Estratificação de risco cirúrgico como instrumento de inovação em programas de cirurgia cardíaca no Sistema Único de Saúde do Estado de São Paulo: ESTUDO SP-SCORE-SUS(2013) MEJIA, Omar Asdrubal Vilca; LISBOA, Luiz Augusto Ferreira; DALLAN, Luis Alberto Oliveira; POMERANTZEFF, Pablo Maria Alberto; TRINDADE, Evelinda Marramon; JATENE, Fabio Biscegli; KALIL FILHO, RobertoCardiovascular diseases represent the greatest burden of morbidity and mortality for the health system and cardiac surgery has an important impact on their resolutivity. The association and correlation of patients' demographic and clinical relevant information with the resources required for each stratum represent the possibility to adapt, improve and innovate into the healthcare programs. This project aims to remodel the ""InsCor"" risk score for the formulation of the SP-SCORE (Sao Paulo System for Cardiac Operative Risk Evaluation) in order to better reflects the complexity of cardiac surgical care. The participating hospitals include the Health Technology Assessment Centers in of the Health Secretariat' HTA Network of Sao Paulo State (HTA-NATSs / SES-SP). The SP-SCORE will use 10 variables of the InsCor model and others 8 variables with presumed influence in Brazil. The primary endpoints are morbidity and mortality. Bootstrap technique besides automated selection of variables (stepwise) will be used to develop a parsimonious model by multiple logistic regression. This project will contribute for the SUS-SP regionalized health-care (RRAS) sustainability and financing of the CABG and/or heart valve surgery programs promoting equitable allocation, increasing access and effectiveness, as well as characterizing the magnitude of available resources and its impact.
- Investigation Route of the Coronary Patient in the Public Health System in Curitiba, Sao Paulo and in Incor - IMPACT Study(2014) CERCI, Juliano J.; TRINDADE, Evelinda; PRETO, Daniel; CERCI, Rodrigo Julio; LEMOS, Pedro A.; CESAR, Luiz Antonio Machado; PRETO, Luis; STINGHEN, Luiz; MARTINEZ, Catia; MENEGHETTI, Jose ClaudioBackground: The investigation of stable coronary artery disease (CAD) and its treatment depend on risk stratification for decision-making on the need for cardiac catheterization and revascularization. Objective: To analyze the procedures used in the diagnosis and invasive treatment of patients with CAD, at the Brazilian Unified Health System (SUS) in the cities of Curitiba, Sao Paulo and at InCor-FMUSP. Methods: Retrospective, descriptive, observational study of the diagnostic and therapeutic itineraries of the Brazilian public health care system patient, between groups submitted or not to prior noninvasive tests to invasive cardiac catheterization. Stress testing, stress echocardiography, perfusion scintigraphy, catheterization and percutaneous or surgical revascularization treatment procedures were quantified and the economic impact of the used strategies. Results: There are significant differences in the assessment of patients with suspected or known CAD in the metropolitan region in the three scenarios. Although functional testing procedures are most often used the direct costs of these procedures differ significantly (6.1% in Curitiba, 20% in Sao Paulo and 27% in InCor-FMUSP). Costs related to the procedures and invasive treatments represent 59.7% of the direct costs of SUS in Sao Paulo and 87.2% in Curitiba. In InCor-FMUSP, only 24.3% of patients with stable CAD submitted to CABG underwent a noninvasive test before the procedure. Conclusion: Although noninvasive functional tests are the ones most often requested for the assessment of patients with suspected or known CAD most of the costs are related to invasive procedures/treatments. In most revascularized patients, the documentation of ischemic burden was not performed by SUS.
- Improving preoperative risk-of-death prediction in surgery congenital heart defects using artificial intelligence model: A pilot study(2020) CHANG JUNIOR, Joao; BINUESA, Fabio; CANEO, Luiz Fernando; TURQUETTO, Aida Luiza Ribeiro; ARITA, Elisandra Cristina Trevisan Calvo; BARBOSA, Aline Cristina; FERNANDES, Alfredo Manoel da Silva; TRINDADE, Evelinda Marramon; JATENE, Fabio Biscegli; DOSSOU, Paul-Eric; JATENE, Marcelo BiscegliBackground Congenital heart disease accounts for almost a third of all major congenital anomalies. Congenital heart defects have a significant impact on morbidity, mortality and health costs for children and adults. Research regarding the risk of pre-surgical mortality is scarce. Objectives Our goal is to generate a predictive model calculator adapted to the regional reality focused on individual mortality prediction among patients with congenital heart disease undergoing cardiac surgery. Methods Two thousand two hundred forty CHD consecutive patients' data from InCor's heart surgery program was used to develop and validate the preoperative risk-of-death prediction model of congenital patients undergoing heart surgery. There were six artificial intelligence models most cited in medical references used in this study: Multilayer Perceptron (MLP), Random Forest (RF), Extra Trees (ET), Stochastic Gradient Boosting (SGB), Ada Boost Classification (ABC) and Bag Decision Trees (BDT). Results The top performing areas under the curve were achieved using Random Forest (0.902). Most influential predictors included previous admission to ICU, diagnostic group, patient's height, hypoplastic left heart syndrome, body mass, arterial oxygen saturation, and pulmonary atresia. These combined predictor variables represent 67.8% of importance for the risk of mortality in the Random Forest algorithm. Conclusions The representativeness of ""hospital death"" is greater in patients up to 66 cm in height and body mass index below 13.0 for InCor's patients. The proportion of ""hospital death"" declines with the increased arterial oxygen saturation index. Patients with prior hospitalization before surgery had higher ""hospital death"" rates than who did not required such intervention. The diagnoses groups having the higher fatal outcomes probability are aligned with the international literature. A web application is presented where researchers and providers can calculate predicted mortality based on the CgntSCORE on any web browser or smartphone.
- Chagas' cardiomyopathy: The economic burden of an expensive and neglected disease(2013) ABUHAB, Abrao; TRINDADE, Evelinda; AULICINO, Gabriel Barros; FUJII, Sandra; BOCCHI, Edimar Alcides; BACAL, FernandoBackground: Chagas' cardiomyopathy (CC) is a rising etiology for heart failure (HF) that previously was restricted to some countries of Latin America. The chronic CC cases cause now a profound socio-economic impact. However this issue has not been well studied if compared to other causes of HF. The objective of this study was to assess the cost burden of CC during acute decompensated HF admissions (ADHF), and compare this cost to the other etiologies of HF. Methods and results: By the end of 2006 we started a five year follow-up of 577 consecutive adult patients admitted at a high complexity cardiology university hospital in the city of Sao Paulo, Brazil. This study shows the data of the first admission of each patient of this follow-up. Patients were divided in two groups: CC (58 patients) and non-chagasic (NC) (519 patients). Mortality was different among groups, 19/58 (32.8%) in CC vs 113/519 (21.8%) in NC (p=0.046). The prevalence of signs of inadequate perfusion was higher in the CC group at admission, but in a multivariated analysis chagasic etiology and presence of diabetes were independent predictors of higher costs per day of hospitalization adjusted by mortality. Median costs per day were US$308 (277-542) vs US$467 (323-815) for NC and CC respectively (p<0.001). Conclusion: Treating ADHF patients with CC etiology was more expensive and mortality was higher in this population at the first admission of this follow-up. This could be explained by the severity of Chagas' cardiomyopathy disease.
- A tomografia por emissão de pósitrons com 2-[18F]-fluoro-2-desoxi-D-glicose é custo-efetiva em pacientes com câncer de pulmão não pequenas células no Brasil(2012) CERCI, Juliano Julio; TAKAGAKI, Teresa Yae; TRINDADE, Evelinda; MORGADO, Roberta; MORABITO, Fausto; MUSOLINO, Rafael Silva; SOARES JUNIOR, José; MENEGHETTI, José CláudioOBJECTIVE: To evaluate the accuracy and cost-effectiveness of metabolic staging (MS) with FDG-PET as compared with the conventional staging (CS) strategy in the preoperative staging of non-small cell lung cancer (NSCLC). MATERIALS AND METHODS: A total of 95 patients with initial diagnosis of NSCLC were staged before undergoing treatment. The MS and CS results were compared with regard to treatment definition and incidence of futile thoracotomies with both strategies. RESULTS: Metabolic staging with FDG-PET upstaged 48.4% and downstaged 5.3% of the patients, and would lead to change in the treatment of 41% of cases. Thoracotomy was considered as futile in 47% of the patients with CS, and in 19% of the patients with MS. The cost of futile thoracotomies in eight patients with MS was R$ 79,720, while in 31 patients with CS it would be R$ 308,915. Just such saving in costs would be more than enough to cover the costs of all FDG-PETs (R$ 126,350) or FDG-PET/CTs (R$ 193,515) for the 95 patients. CONCLUSION: The metabolic staging with FDG-PET is more accurate than CS in patients with NSCLC. Both FDG-PET and FDG-PET/CT are cost-effective methods and their utilization is economically justifiable in the Brazilian public health system.
- COVID-19-related hospital cost-outcome analysis: The impact of clinical and demographic factors(2021) MIETHKE-MORAIS, Anna; CASSENOTE, Alex; PIVA, Heloisa; TOKUNAGA, Eric; COBELLO, Vilson; GONCALVES, Fabio Augusto Rodrigues; LOBO, Renata dos Santos; TRINDADE, Evelinda; D'ALBUQUERQUE, Luiz Augusto Carneiro; HADDAD, LucianaIntroduction: Although patients' clinical conditions have been shown to be associated with coronavirus disease (COVID-19) severity and outcome, their impact on hospital costs are not known. This economic evaluation of COVID-19 admissions aimed to assess direct and fixed hospital costs and describe their particularities in different clinical and demographic conditions and outcomes in the largest public hospital in Latin America, located in Sao Paulo, Brazil, where a whole institute was exclusively dedicated to COVID-19 patients in response to the pandemic. Methods: This is a partial economic evaluation performed from the hospital's perspective and is a prospective, observational cohort study to assess hospitalization costs of suspected and confirmed COVID-19 patients admitted between March 30 and June 30, 2020, to Hospital das Clinicas of the University of Sao Paulo Medical School (HCFMUSP) and followed until discharge, death, or external transfer. Micro- and macro-costing methodologies were used to describe and analyze the total cost associated with each patient's underlying medical conditions, itinerary and outcomes as well as the cost components of different hospital sectors. Results: The average cost of the 3254 admissions (51.7% of which involved intensive care unit stays) was US$12,637.42. The overhead cost was its main component. Sex, age and underlying hypertension (US$14,746.77), diabetes (US$15,002.12), obesity (US$18,941.55), chronic renal failure (US$15,377.84), and rheumatic (US$17,764.61), hematologic (US $15,908.25) and neurologic (US$15,257.95) diseases were associated with higher costs. Age strata >69 years, reverse transcription polymerase chain reaction (RT-PCR)-confirmed COVID-19, comorbidities, use of mechanical ventilation or dialysis, surgery and outcomes remained associated with higher costs. Conclusion: Knowledge of COVID-19 hospital costs can aid in the development of a comprehensive approach for decision-making and planning for future risk management. (C) 2021 Sociedade Brasileira de Infectologia.
- Immunothrombosis and COVID-19-a nested post-hoc analysis from a 3186 patient cohort in a Latin American public reference hospital(2023) LIMA, Clarice Antunes de; GONCALVES, Fabio Augusto Rodrigues; BESEN, Bruno Adler Maccagnan Pinheiro; PEREIRA, Antonio Jose Rodrigues; PERAZZIO, Sandro Felix; TRINDADE, Evelinda Marramon; FONSECA, Luiz Augusto Marcondes; SUMITA, Nairo Massakazu; PINTO, Vanusa Barbosa; DUARTE, Alberto Jose da Silva; MANIN, Carolina Broco; LICHTENSTEIN, ArnaldoObjective: COVID-19 is associated with an elevated risk of thromboembolism and excess mortality. Difficulties with best anticoagulation practices and their implementation motivated the current analysis of COVID-19 patients who developed Venous Thromboembolism (VTE). Method: This is a post-hoc analysis of a COVID-19 cohort, described in an economic study already published. The authors analyzed a subset of patients with confirmed VTE. We described the characteristics of the cohort, such as demographics, clinical status, and laboratory results. We tested differences amid two subgroups of patients, those with VTE or not, with the competitive risk Fine and Gray model. Results: Out of 3186 adult patients with COVID-19, 245 (7.7%) were diagnosed with VTE, 174 (5.4%) of them dur-ing admission to the hospital. Four (2.3% of these 174) did not receive prophylactic anticoagulation and 19 (11%) discontinued anticoagulation for at least 3 days, resulting in 170 analyzed. During the first week of hospitaliza-tion, the laboratory most altered results were C-reactive protein and D-dimer. Patients with VTE were more criti-cal, had a higher mortality rate, worse SOFA score, and, on average, 50% longer hospital stay. Conclusion: Proven VTE incidence in this severe COVID-19 cohort was 7.7%, despite 87% of them complying completely with VTE prophylaxis. The clinician must be aware of the diagnosis of VTE in COVID-19, even in patients receiving proper prophylaxis.
- Use and misuse of biomarkers and the role of D-dimer and C-reactive protein in the management of COVID-19: A post-hoc analysis of a prospective cohort study(2021) GONCALVES, Fabio Augusto Rodrigues; BESEN, Bruno Adler Maccagnan Pinheiro; LIMA, Clarice Antunes de; CORA, Aline Pivetta; PEREIRA, Antonio Jose Rodrigues; PERAZZIO, Sandro Felix; GOUVEA, Christiane Pereira; FONSECA, Luiz Augusto Marcondes; TRINDADE, Evelinda Marramon; SUMITA, Nairo Massakazu; DUARTE, Alberto Jose da Silva; LICHTENSTEIN, ArnaldoOBJECTIVE: Coronavirus disease 2019 (COVID-19) is associated with high mortality among hospitalized patients and incurs high costs. Severe acute respiratory syndrome coronavirus 2 infection can trigger both inflammatory and thrombotic processes, and these complications can lead to a poorer prognosis. This study aimed to evaluate the association and temporal trends of D-dimer and C-reactive protein (CRP) levels with the incidence of venous thromboembolism (VTE), hospital mortality, and costs among inpatients with COVID-19. METHODS: Data were extracted from electronic patient records and laboratory databases. Crude and adjusted associations for age, sex, number of comorbidities, Sequential Organ Failure Assessment score at admission, and D-dimer or CRP logistic regression models were used to evaluate associations. RESULTS: Between March and June 2020, COVID-19 was documented in 3,254 inpatients. The D-dimer level >= 4,000 ng/mL fibrinogen equivalent unit (FEU) mortality odds ratio (OR) was 4.48 (adjusted OR: 1.97). The CRP level >= 220 mg/dL OR for death was 7.73 (adjusted OR: 3.93). The D-dimer level >= 4,000 ng/mL FEU VTE OR was 3.96 (adjusted OR: 3.26). The CRP level >= 220 mg/dL OR for VTE was 2.71 (adjusted OR: 1.92). All these analyses were statistically significant (p <0.001). Stratified hospital costs demonstrated a dose-response pattern. Adjusted D-dimer and CRP levels were associated with higher mortality and doubled hospital costs. In the first week, elevated D-dimer levels predicted VTE occurrence and systemic inflammatory harm, while CRP was a hospital mortality predictor. CONCLUSION: D-dimer and CRP levels were associated with higher hospital mortality and a higher incidence of VTE. D-dimer was more strongly associated with VTE, although its discriminative ability was poor, while CRP was a stronger predictor of hospital mortality. Their use outside the usual indications should not be modified and should be discouraged.
- Consistency of FDG-PET Accuracy and Cost-Effectiveness in Initial Staging of Patients With Hodgkin Lymphoma Across Jurisdictions(2011) CERCI, Juliano J.; TRINDADE, Evelinda; BUCCHERI, Valeria; FANTI, Stefano; COUTINHO, Artur M. N.; ZANONI, Lucia; LINARDI, Camila C. G.; CELLI, Monica; DELBEKE, Dominique; PRACCHIA, Luis F.; PITELA, Felipe A.; SOARES JR., Jose; ZINZANI, Pier Luigi; MENEGHETTI, Jose C.Introduction: Two hundred ten patients with newly diagnosed Hodgkin's lymphoma (HL) were consecutively enrolled in this prospective trial to evaluate the cost-effectiveness of fluorine-18 ((18)F)-fluoro-2-deoxy-D-glucose-positron emission tomography (FDG-PET) scan in initial staging of patients with HL. Methods: All 210 patients were staged with conventional clinical staging (CCS) methods, including computed tomography (CT), bone marrow biopsy (BMB), and laboratory tests. Patients were also submitted to metabolic staging (MS) with whole-body FDG-PET scan before the beginning of treatment. A standard of reference for staging was determined with all staging procedures, histologic examination, and follow-up examinations. The accuracy of the CCS was compared with the MS. Local unit costs of procedures and tests were evaluated. Incremental cost-effectiveness ratio (ICER) was calculated for both strategies. Results: In the 210 patients with HL, the sensitivity for initial staging of FDG-PET was higher than that of CT and BMB in initial staging (97.9% vs. 87.3%; P < .001 and 94.2% vs. 71.4%, P < 0.003, respectively). The incorporation of FDG-PET in the staging procedure upstaged disease in 50 (24%) patients and downstaged disease in 17 (8%) patients. Changes in treatment would be seen in 32 (15%) patients. Cumulative cost for staging procedures was $3751/patient for CCS compared to $5081 for CCS + PET and $4588 for PET/CT. The ICER of PET/CT strategy was $16,215 per patient with modified treatment. PET/CT costs at the beginning and end of treatment would increase total costs of HL staging and first-line treatment by only 2%. Conclusion: FDG-PET is more accurate than CT and BMB in HL staging. Given observed probabilities, FDG-PET is highly cost-effective in the public health care program in Brazil.
- R Cardiac Surgery Costs According to the Preoperative Risk in the Brazilian Public Health System(2015) TITINGER, David Provenzale; LISBOA, Luiz Augusto Ferreira; MATRANGOLO, Bruna La Regina; DALLAN, Luis Roberto Palma; DALLAN, Luis Alberto Oliveira; TRINDADE, Evelinda Marramon; ECKL, Ivone; KALIL FILHO, Roberto; MEJIA, Omar Asdrubal Vilca; JATENE, Fabio BiscegliBackground: Heart surgery has developed with increasing patient complexity. Objective: To assess the use of resources and real costs stratified by risk factors of patients submitted to surgical cardiac procedures and to compare them with the values reimbursed by the Brazilian Unified Health System (SUS). Method: All cardiac surgery procedures performed between January and July 2013 in a tertiary referral center were analyzed. Demographic and clinical data allowed the calculation of the value reimbursed by the Brazilian SUS. Patients were stratified as low, intermediate and high-risk categories according to the EuroSCORE. Clinical outcomes, use of resources and costs (real costs versus SUS) were compared between established risk groups. Results: Postoperative mortality rates of low, intermediate and high-risk EuroSCORE risk strata showed a significant linear positive correlation (EuroSCORE: 3.8%, 10%, and 25%; p < 0.0001),as well as occurrence of any postoperative complication (EuroSCORE: 13.7%, 20.7%, and 30.8%, respectively; p = 0.006). Accordingly, length-of-stay increased from 20.9 days to 24.8 and 29.2 days (p < 0.001). The real cost was parallel to increased resource use according to EuroSCORE risk strata (R$ 27.116,00 +/- R$ 13.928,00 versus R$ 34.854,00 +/- R$ 27.814,00 versus R$ 43.234,00 +/- R$ 26.009,00, respectively; p < 0.001). SUS reimbursement also increased (R$ 14.306,00 +/- R$ 4.571,00 versus R$ 16.217,00 +/- R$ 7.298,00 versus R$ 19.548,00 +/- R$935,00; p < 0.001). However, as the EuroSCORE increased, there was significant difference (p < 0.0001) between the real cost increasing slope and the SUS reimbursement elevation per EuroSCORE risk strata. Conclusion: Higher EuroSCORE was related to higher postoperative mortality, complications, length of stay, and costs. Although SUS reimbursement increased according to risk, it was not proportional to real costs.