Trends in revisional bariatric surgery using the MBSAQIP database 2015-2017

BackgroundThe third most common bariatric surgery is revisional bariatric surgery. The American College of Surgeons tracks outcomes using the Metabolic and Bariatric Surgery Accreditation Quality Initiative Program database. We used this database to examine trends in revisional bariatric surgery.ObjectiveTo evaluate how trends in bariatric revisional surgery have changed in recent years.SettingUniversity Hospital, United States.MethodsThe Metabolic and Bariatric Surgery Accreditation Quality Initiative Program database for 2015 to 2017 was examined for revisions of bariatric surgery. Patients who underwent revisional bariatric surgery were identified by the primary Current Procedural Terminology code, the REVCONV and PREVIOUS_SURGERY field as well as secondary Current Procedural Terminology codes. There is no exact code for sleeve gastrectomy (SG) to laparoscopic Roux-en-Y gastric bypass (LRYGB), so we used 43644 (GB)+REVCONV+PREVIOUS_SURGERY for this.ResultsFor the years 2015 to 2017 there were 57,683 revisions/conversions of 528,081 patients. The number of revisions increased over the study period by 5213 cases. The most common revision was laparoscopic adjustable gastric band (LAGB) to SG with 15,433 cases and the second was LAGB to LRYGB with 10,485 cases. There were 14,715 LAGB removals. It is more difficult to track SG to LRYGB but there were 8491 unlisted cases, which may have been sleeve to bypass.ConclusionLAGBs are being taken out or converted, and this group makes up the largest portion of revisions and conversions. It is difficult to track SG to LRYGB, but the number of unlisted cases continues to climb. This will likely surpass LAGB conversions with time. The Metabolic and Bariatric Surgery Accreditation Quality Initiative Program should be modified to capture revisions/conversions of SG.     

Hospital visiting in obstetrics and gynecology: a tool for the advancement of training.

OBJECTIVE: To assess the improvement of obstetric and gynecologic training brought about by peer influence in Europe. METHODS: In 1996, the European Board and College of Obstetrics and Gynecology (EBCOG) initiated a visiting process by international and local peers to improve training and decrease differences in health care standards. RESULTS: A large number of visits of obstetrics and gynecology departments have been conducted across Europe at teaching hospitals by the Hospital Visiting Committee. Compliance with the structured approach of the visiting policy and problems met during these visits are reported. CONCLUSION: The program focuses on the continuous improvement of the competencies of all persons trained in the obstetrics and gynecology departments of teaching hospitals throughout Europe. It also increases the understanding of diversity in training methods and can gradually lead to the convergence of training and health care standards in Europe.     

泰国医院评审历程及对我国的启示

医院评审是促进医疗质量持续改进的有效手段。对泰国医院评审认证的发展历程、核心理念和标准框架、评审员遴选和培训、评审流程与评审周期、评审结果等进行梳理,指出其具有注重持续改进和风险管理、评审的多元性、融入大爱理念、广泛开展评审标准细化项目等特点。在全面了解泰国医院评审认证体系的基础上,提出了对我国医院评审工作的思考,如:与医保支付体系对接,加强评审员体系建设,注重体现医院功能定位等     

《三级医院评审标准》新旧版本比较分析及建议

《三级医院评审标准(2020 年版》的颁布是一个里程碑式的事件。其新增前置否决条款;强化定量指标条款;整合简化现场条款,体现了评审标准对医院管理“指挥棒”和“风向标”的作用。与《三级综合医院评审标准(2011 年版)》相比有显著差异,体现了与时俱进的特点。新标准不仅强调了医院的社会属性和公益责任,并且凸显了医院的法制意识和安全意识;也契合新时代要求,通过评审引导医院加快技术进步,深化内涵质量建设,提升可持续发展能力,从而助力医院进入高质量发展阶段。     

Documento de consenso de la Sociedad Española de Anestesiología y Reanimación (SEDAR), Sociedad Española de Medicina Interna (SEMI) y Sociedad Española de Medicina de Urgencias y Emergencias (SEMES) para la definición de competencias mínimas de ecografía en Cuidados Intensivos y Urgencias y la obtención del Diploma acreditativo

The use of ultrasound as a clinical diagnostic tool and guide of bedside procedures has become an indispensable examination in the acute critically ill patient. The training of professionals in minimum skills of knowledge, management and indications of use of ultrasound required to be defined by the Scientific Societies. The Intensive Care Ultrasound Working Group of the Spanish Society of Anesthesiology and Resuscitation (SEDAR), of the Spanish Society of Internal Medicine (SEMI) and the Spanish Society of Emergency Medicine (SEMES) has developed this consensus document in which the recommended training program and the minimum competencies to be achieved with regard to the use of Ultrasound in Intensive Care, Anesthesia and Emergency medicine are defined.This document defines the training program and the skills to acquire in order to achieve the diploma in lung, abdominal and vascular ultrasound. This document can serve as a guide to define the skills to be acquired in the training programs of residents (MIRs) of specialists working in intensive care, anesthesia, and emergency medicine.     

Osteopathic education: The link between mission and accreditation

ObjectiveThis commentary promotes the role of accreditation in meeting a school's mission.BackgroundUnderstanding the parallels between the growth of osteopathic educational institutions and the increase in educational standards over time places a historical perspective on this subject.DataThe concept of minimum competence, exceeding minimum competence, and their link to the assurance of quality in osteopathic medical education is explored. Knowing that a school's mission speaks to excellence and quality, and that the accreditation process is a way to ensure quality, mission and accreditation are therefore linked.ConclusionThrough the accreditation process, we ensure that our schools' missions are met, and we assure our students and the public that we deliver an osteopathic medical education of the highest quality.     

Retinal Laser Damage Thresholds as a Function of Image Diameter

The eyes of rhesus monkeys were exposed to argon (514.5 nm) and ruby (694.3 nm) laser irradiation using various retinal image diameters which were estimated by microphotometric techniques. The experimental design for both wavelengths produced image diameters of 40μ to 50μ for the “minimal” case and approximately 500μ to 1,000μ for the larger irradiance series employed. Extramacular retinal exposure sites were examined by ophthalmoscopic and histopathological techniques. Flat preparations of the pigmented epithelium and sensory layers of the retina were utilized in the confirmation of damage at low power levels. All data were statistically analyzed to establish trends, and results were compared for the wavelengths employed. Results indicate that retinal damage is primarily dependent on energy distribution as a function of image diameter and exposure duration.     

第二周期医院评审的特点及未来趋势

医院评审是深化医药卫生体制改革的一项重要工作。第二轮评审工作即将开展，介绍了新评审办法的重大变化及未来趋势。     

Systematic Plan of Evaluation Part II: Assessment of Program Outcomes

As an accrediting agency recognized by the U.S. Department of Education (USDE) and the Council for Higher Education Accreditation (CHEA), the Accreditation Commission for Education in Nursing (ACEN) has established Accreditation Standards and Criteria for the evaluation of nursing programs, including the evaluation of outcomes. This article focuses on the essential components and processes for systematic evaluation of program outcomes, including licensure examination pass rate, program completion rate, and job placement rate.