A systematic review of capacity assessment tools in pediatric surgery: Global Assessment in Pediatric Surgery (GAPS) Phase I

Background

The Lancet Commission on Global Surgery highlighted global surgical need but offered little insight into the specific surgical challenges of children in low-resource settings. Efforts to strengthen the quality of global pediatric surgical care have resulted in a proliferation of partnerships between low-and middle-income countries (LMICs) and high-income countries (HICs). Standardized tools able to reliably measure gaps in delivery and quality of care are important aids for these partnerships. We undertook a systematic review (SR) of capacity assessment tools (CATs) focused on needs assessment in pediatric surgery.

Risk factors for major complications after liver resection: A large liver resection study from Morocco and audit of a non-Eastern/non-Western experience

Background and Study AimsIn developing countries, endemic indications, blood shortages, and the scarcity of liver surgeons and intensive care providers can affect liver resection (LR) outcomes, but these have been rarely addressed in the literature. Therefore, in this study we determined risk factors for major complications after LR in a North African general surgery and teaching department.Patients and MethodsFrom January 2010 to December 2015, 213 consecutive LRs were performed on 203 patients. All patients underwent a postoperative follow-up of >90 days. Postoperative complications were assessed according to the Clavien–Dindo (CD) classification of surgical complications. A score of CD ≥III is considered as major postoperative complications. In this study, we analyzed the variables assumed to affect these complications.ResultsThe overall 90-day complication rate was 35.7% (n = 76), including a CD ≥III of 14% (n = 30) and a mortality rate of 6.1% (n = 14). According to the multivariate analysis, a preoperative performance status (PS) of ≥2 (P = 0.011; odds ratios [OR], 6.8; 95% confidence intervals [CI], 1.55–29.8), an estimated intraoperative blood loss of >500 ml (P = 0.002; OR, 3.71; 95% CI, 1.23–11.20), and bilioenteric anastomosis (P < 0.004; OR, 7.76; 95% CI, 1.5–3.89) were independent risk factors for major complications after LR.ConclusionWe recommend that, in the setting of a non-Eastern/non-Western general surgery and teaching department, patients with a PS of ≥2 should undergo a specific selection and preoperative optimization protocol; intermittent clamping indications should be extended; and special attention should paid to patients undergoing LR associated with biliary reconstruction, such as for perihilar cholangiocarcinoma.     

Quality improvement training for burn care in low-and middle-income countries: A pilot course for nurses

BackgroundThere is an urgent need to empower practitioners to undertake quality improvement (QI) projects in burn services in low-middle income countries (LMICs). We piloted a course aimed to equip nurses working in these environments with the knowledge and skills to undertake such projects.MethodsEight nurses from five burns services across Malawi and Ethiopia took part in this pilot course, which was evaluated using a range of methods, including interviews and focus group discussions.ResultsCourse evaluations reported that interactive activities were successful in supporting participants to devise QI projects. Appropriate online platforms were integral to creating a community of practice and maintaining engagement. Facilitators to a successful QI project were active individuals, supportive leadership, collaboration, effective knowledge sharing and demonstrable advantages of any proposed change. Barriers included: staff attitudes, poor leadership, negative culture towards training, resource limitations, staff rotation and poor access to information to guide practice.ConclusionsThe course demonstrated that by bringing nurses together, through interactive teaching and online forums, a supportive community of practice can be created. Future work will include investigating ways to scale up access to the course so staff can be supported to initiate and lead quality improvement in LMIC burn services.     

Avanzando en la sistematización del benchmarking en servicios de salud pública

Continuous management improvement should be an aspiration for all public sector organizations. External comparison or benchmarking identifies good practices in similar organizations. For public health services, it is not easy to obtain such indicators. The objectives of this paper are to describe the process of conducting a benchmarking exercise for a public health agency, and to share its results. For this purpose, agencies that may be compared were identified, and their websites were searched for annual reports or other documents with indicators of the activities or results of public health services. Limitations and contextual aspects of the indicators of the different organizations were identified, as well as ways to improve their comparability. Finally, a set of 19 indicators is proposed, as an initial core for quality management comparisons.     

持续质量改进在体检科护理质量管理中的应用效果探讨

目的探究持续质量改进在体检科护理质量管理中的应用效果。方法该次将该院在2018年7-12月的体检者200名作为研究的对象,视为对照阶段,采取常规护理管理方法;将该院2019年1-6月的体检者200名作为观察阶段对象,在护理管理工作中采取持续质量改进管理模式,进一步对比两个阶段患者对于体检科工作质量的评分。结果在体检工作质量、服务态度、体检满意度这3个模块,观察阶段评分对照阶段比较均明显更高,差异有统计学意义(P<0.05)。结论持续质量改进应用于体检科护理质量管理中,可有效提升体检服务品质,值得推广应用。     

经肺动脉与支气管动脉血管造影的CTA观察原发肺癌的血供

目的用支气管动脉(BA)和肺动脉(PA)造影CTA观察肺癌血供情况。方法前瞻性观察6例支气管肺癌患者,分别行体循环动脉和肺动脉数字减影血管造影(DSA)后,留置BA导管与PA导管行CTBA与CTPA,观察BA与PA对肺癌的血供。结果CTPA上,无体动脉与左心强化的图像上肿瘤未见强化,有体动脉或左心强化的图像上见肿瘤边缘强化,CT强化值为10.0~45.6 Hu。CTBA上肿瘤部分明显强化,CT强化值为150.3~320.7 Hu,可见杂乱无章的肿瘤血管影,3例见纵隔淋巴结强化。结论本组病例观察表明原发性肺癌由BA为主的多发体循环动脉供血,未发现PA参与供血。     

Perception and use of the results of patient satisfaction surveys by care providers in a French teaching hospital.

OBJECTIVE: . The aim of this study was to assess clinical staff's opinions on the results of in-patient satisfaction surveys and their use within the quality improvement process. SETTING: The institution is a 2200-bed teaching hospital of tertiary health care employing 8000 professionals. Patient satisfaction surveys are carried out each year using a validated questionnaire mailed to a random sample of patients. The specific results of each department are sent to the medical and paramedical managers. METHODS: We conducted a questionnaire survey on 500 care providers randomly selected in every medical and surgical department. RESULTS: A total of 261 questionnaires were returned and analysed. Overall, 94% of responders had a favourable opinion of the patient satisfaction surveys. They considered that the patient was able to judge hospital service quality, especially in its relational, organizational, and environmental dimensions. The specific results for the department were less well known than the overall hospital results (60 versus 76%). These results were formally discussed in the department according to 40% of responders; 40% declared that these data resulted in improvement actions and considered that they led to modifications in their behaviour with patients. CONCLUSIONS: Despite a declared interest in satisfaction surveys, the results remain underused by hospital staff and insufficiently discussed within teams.