Oncoplastic approach in the conservative treatment of breast cancer: analysis of costs

PURPOSE

To analyze the direct costs of conservative surgical treatment of breast cancer, performed in a university hospital, to the Brazilian National Health Care Public System (SUS), checking the impact of the oncoplastic approach on these costs.

METHODS

One hundred thirty eight breast cancer patients who had undergone conservative treatment with oncoplastic approach (n=36) or not (control group, n=102), in the period from 2005 to 2010, were enrolled. Sociodemographic and clinical data were recorded. The direct costs of the surgical procedure were obtained and analyzed.

RESULTS

Groups did not differ in regard to age (p=0.963), and patients in oncoplastic group had a longer time of hospital stay (p=0.000). The median direct cost for the oncoplastic group was R$461.00 and for the control group was R$229.00 (p=0.000).

CONCLUSION

The oncoplastic approach has generated higher direct costs in conservative surgical treatment of breast cancer to SUS.

Health Service Quality Scale: Brazilian Portuguese translation, reliability and validity

Background

The Health Service Quality Scale is a multidimensional hierarchical scale that is based on interdisciplinary approach. This instrument was specifically created for measuring health service quality based on marketing and health care concepts. The aim of this study was to translate and culturally adapt the Health Service Quality Scale into Brazilian Portuguese and to assess the validity and reliability of the Brazilian Portuguese version of the instrument.

Methods

We conducted a cross-sectional, observational study, with public health system patients in a Brazilian university hospital. Validity was assessed using Pearson’s correlation coefficient to measure the strength of the association between the Brazilian Portuguese version of the instrument and the SERVQUAL scale. Internal consistency was evaluated using Cronbach’s alpha coefficient; the intraclass (ICC) and Pearson’s correlation coefficients were used for test-retest reliability.

Results

One hundred and sixteen consecutive postoperative patients completed the questionnaire. Pearson’s correlation coefficient for validity was 0.20. Cronbach's alpha for the first and second administrations of the final version of the instrument were 0.982 and 0.986, respectively. For test-retest reliability, Pearson’s correlation coefficient was 0.89 and ICC was 0.90.

Conclusions

The culturally adapted, Brazilian Portuguese version of the Health Service Quality Scale is a valid and reliable instrument to measure health service quality.

Flavonoids and antiulcerogenic activity from Byrsonima crassa leaves extracts

Byrsonima crassa Niedenzu (IK) (Malpighiaceae) is used in Brazilian folk medicine for the treatment of diseases related mainly to gastric ulcers. In this study, we evaluated the potential antiulcerogenic effect of three different extracts obtained from the leaves of Byrsonima crassa namely hydromethanolic (80% MeOH), methanolic (MeOH) and chloroformic extracts (CHCl(3)). The oral administration (250, 500 and 1000 mg/kg) of all the extracts reduced the formation of lesions associated with HCl/ethanol administration in mice. The 80% MeOH extract significantly reduced the incidence of gastric lesions by 74, 78 and 92% at doses of 250, 500 and 1000 mg/kg, respectively (P<0.01). The MeOH extract reduced the ulceration by 93 and 99% only at the doses of 500 and 1000 mg/kg (P<0.01). The lower gastroprotective action (69%) was observed when animals were treated with CHCl(3) extract at the dose of 1000 mg/kg (P<0.01). Phytochemical investigation of Byrsonima crassa afforded five known substances: quercetin-3-O-beta-d-galactopyranoside, quercetin-3-O-alpha-l-arabinopyranoside, the biflavonoid amentoflavone, (+)-catechin and (-)-epicatechin. The presence of these phenolic compounds may probably explain the antiulcerogenic effect of the extracts of Byrsonima crassa leaves.