多元文化需求就医服务体系构建及应用

目的调查外籍患者多元文化服务需求,构建就医服务体系,探究应用效果。方法采用“外籍患者多元文化服务需求问卷”,对某院2020年1月-6月372例外籍就诊患者进行调查,识别其多元文化服务需求,建立就医服务体系。结果外籍患者对语言交流的需求度最高（98.39%）,对医院环境的需求度最低（65.59%）。应用基于多元文化需求的就医服务体系后,外籍患者在语言交流、专业知识、隐私保护、饮食习惯、就诊流程、社交礼仪、医务人员服务态度和医院环境等方面的满意度均得以提高（P＜0.05）。结论多元文化服务需求调查在外籍患者就医服务体系构建中具有重要作用,有助于提高外籍患者就医满意度。     

一例促皮质素静脉外渗至局部皮肤坏死的案例解析与改进

对1例癫痫性痉挛患儿采用促皮质素静脉给药时发生静脉外渗至局部皮肤坏死的案例进行解析。针对事件发生原因,制定并采取措施:静脉穿刺难度事前评估,优化临床监护,加强相关知识培训,以肌肉注射代替静脉滴注等,避免了此类事件的再次发生,提升了临床合理用药水平,确保了患者安全。     

我国医疗质量安全不良事件分类的思考

患者安全问题已经成为世界各国医疗质量管理关注的焦点,从国家层面对医疗质量安全不良事件进行统一定义和分类具有重要意义。通过总结世界卫生组织、美国、英国以及我国目前不良事件分类及严重程度分级情况,结合我国相关上报数据,分析存在问题,建议国家及各级卫生行政部门发挥引导推动作用,医疗机构利用现有国家医疗质量安全相关平台,参考借鉴相关分类,开展同质化医疗质量安全管理工作。     

患者安全文化调查问卷HS-OPSC 2.0版的评价与思考

患者安全文化测评有助于评估医疗机构的安全状况。美国医疗健康研究与质量机构（AHRQ）发布的HSOPSC是患者安全文化测评工具的典型代表。2019年,AHRQ根据相关意见和建议修订完成了HSOPSC 2.0版,在保留1.0版优势的基础上精简了维度和条目数量,具有良好的信度和效度,可以作为我国医疗机构患者安全文化测评的有效工具。但由于测量结果的定量特征,建议辅以定性研究对潜在文化价值和更深层次文化假设进行深入分析,同时思考如何将测评结果与干预措施结合起来,以更好地评估干预效果。     

El manejo de la torsión testicular en Urgencias: lecciones aprendidas de las reclamaciones por responsabilidad profesional médica

ObjectiveTo evaluate emergency care for testicular torsion in medical professional liability claims.MethodClaims related to testicular torsion from 2000 to 2018 were located. The assistance provided and the association with medical professional liability were analyzed.ResultsEighty complaints were identified, testicular pain was reported in 83.75% of first consultations, with a mean evolution time of 15.5 h. The mean time to diagnosis was 7.98 days. The first consultation was at the hospital in 75.1% of cases, but an ultrasound was performed only in 7.5%. When testicular torsion diagnosis was performed, 97.3% had undergone ancillary tests. The medical professional liability was significantly associated with non-criminal proceedings and with less than 6 h of symptoms’ evolution, and, within this subgroup, without undergoing an ultrasound scan.ConclusionsLate consultations, wrong diagnosis and late diagnosis are claimed. When medical professional liability are claimed by means of non-criminal law, the existence of responsibility is frequently considered, even more in those cases when the consultation took place before 6 h of evolution with no ancillary tests having been performed.     

Mortality prognostication scores do not predict long-term,health-related quality of life after burn: A burn model system national database study

ObjectiveDespite improved mortality rates after burn injury, many patients face significant long-term physical and psychosocial disabilities. We aimed to determine whether commonly used mortality prognostication scores predict long-term, health-related quality of life after burn injury. By doing so, we might add evidence to support goals of care discussions and facilitate shared decision-making efforts in the hours and days after a life-changing injury.MethodsWe used the multicenter National Institute of Disability, Independent Living and Rehabilitation Research Burn Model System database (1994–2019) to analyze SF-12 physical (PCS) and mental component (MCS) scores among survivors one year after major burn injury. Ninety percent of the observations were randomly assigned to a model development dataset. Multilevel, mixed-effects, linear regression models determined the relationship between revised Baux and Ryan Scores and SF-12 measures. Additionally, we tested a model with disaggregated independent and other covariates easily obtained around the time of index admission: age, sex, race, burn size, inhalation injury. Residuals from the remaining 10% of observations in the validation dataset were examined.ResultsThe analysis included 1606 respondents (median age 42 years, IQR 28–53 years; 70% male). Median burn size was 16% TBSA (IQR 6–30) and 13% of respondents sustained inhalation injury. Higher revised Baux and Ryan Scores and age, burn size, and inhalation injury were significantly correlated with lower PCS, but were not correlated with MCS. Female sex, black race, burn size, and inhalation injury correlated with lower MCS. All models poorly explained the variance in SF-12 scores (adjusted r² 0.01–0.12).ConclusionHigher revised Baux and Ryan Scores negatively correlated with long-term physical health, but not mental health, after burn injury. Regardless, the models poorly explained the variance in SF-12 scores one year after injury. More accurate models are needed to predict long-term, health-related quality of life and support shared decision-making during acute burn care.     

Contralateral prophylactic mastectomy: A narrative review of the evidence and acceptability

The uptake of contralateral prophylactic mastectomy (CPM) has increased steadily over the last twenty years in women of all age groups and breast cancer stages. Since contralateral breast cancer is relatively rare and the breast cancer guidelines only recommend CPM in a small subset of patients with breast cancer, the drivers of this trend are unknown. This review aims to evaluate the evidence for and acceptability of CPM, data on patient rationales for choosing CPM, and some of the factors that might impact patient preferences. Based on the evidence, future recommendations will be provided. First, data on contralateral breast cancer risk and CPM rates and trends are addressed. After that, the evidence is structured around four main patient rationales for CPM formulated as questions that patients might ask their surgeon: Will CPM reduce mortality risk? Will CPM reduce the risk of contralateral breast cancer? Can I avoid future screening with CPM? Will I have better breast symmetry after CPM? Also, three different guidelines regarding CPM will be reviewed. Studies indicate a large gap between patient preferences for radical risk reduction with CPM and the current approaches recommended by important guidelines. We suggest a strategy including shared decision-making to enhance surgeons’ communication with patients about contralateral breast cancer and treatment options, to empower patients in order to optimize the use of CPM incorporating accurate risk assessment and individual patient preferences.     

Applying international organization for standards 9001 to create an effective surgical quality committee

BackgroundEfforts to improve surgical safety are limited by several factors and no consensus exists regarding the most effective way to improve surgical quality. The use of ISO 9001 quality standards within healthcare is recognized but has not been widely applied for improving surgical outcomes.MethodsA surgical quality committee was created using ISO 9001:2015 standards. Quality objectives were assessed to understand how any suggested changes will be impacted due to risks and opportunities inherent in the system.ResultsThe initial quality focus was on surgical site infections in 5 services. Change in surgical infection ratio from 2018 to 2019 showed significant improvement: coronary bypass 1.288 vs. 0.901; Colon 1.359 vs. 0.589; Hysterectomy 2.119 vs. 1.022; Knee 1.391 vs. 0.306; Hip 0 vs. 0.302.ConclusionsThis is one of the first studies using ISO 9001 to improve surgical quality. The results indicate both acceptance and success of applying continual improvement strategies.