Evaluation of the Patient Safety Culture in the Western Amazon / Avaliação da cultura de segurança do paciente na Amazônia Ocidental

INTRODUCTION: The safety culture of the patient is a contributing factor for the maintenance of the user's well-being in the health system because, through it, an organized systematization and quality of patient care are obtained, preventing possible intercurrences that can cause damages. OBJECTIVE: To analyze the Patient Safety Culture (PSC) from the perspective of health professionals at the Reference Hospital of the Upper Juruá River, in the Brazilian Western Amazon. METHODS: This is a cross-sectional study developed in a medium-sized public hospital in a municipality in Western Amazonia. The Survey for Patient Safety Culture survey of the Agency for Healthcare Research and Quality was applied to 280 professionals from December 2016 to February 2017. Descriptive analysis of the data and the internal consistency of the instrument were performed. RESULTS: The results indicate the best evaluations in the dimensions of Teamwork in the scopes of the units (60%) and Organizational learning (60%). The aspects with the worst results were the dimensions of non-punitive responses to errors (18%) and frequency of events reported (32%). The internal reliability (Cronbach's Alpha) analysis of the dimensions ranged from 0.35 to 0.90. CONCLUSION: The "culture of fear" seems to predominate in this hospital, however, the study showed that there is scope for improvement in all dimensions of CSP. The values of Cronbach's Alpha presented similarity to the results obtained by the validation process.

INTRODUÇÃO: A cultura de segurança do paciente é fator contribuinte para a manutenção do bem-estar do usuário no sistema de saúde, pois por meio dela obtém-se uma sistematização organizada e de qualidade do cuidado ao paciente, prevenindo possíveis intercorrências que possam trazer danos. OBJETIVO: Analisar a Cultura de Segurança do Paciente (CSP) na perspectiva dos profissionais de saúde no Hospital de Referência do Alto Rio Juruá, na Amazônia Ocidental Brasileira. MÉTODO: Trata-se de um estudo transversal desenvolvido em um hospital público de médio porte em um município da Amazônia Ocidental. O questionário Hospital Survey on Patient Safety Culture, da Agency for Healthcare Research and Quality foi aplicado em 280 profissionais, no período dezembro de 2016 a fevereiro de 2017. Foi realizada a análise descritiva dos dados e a consistência interna do instrumento. RESULTADOS: Os resultados apontam as melhores avaliações nas dimensões de Trabalho em equipe nos âmbitos das unidades (60%) e Aprendizado organizacional (60%). Os aspectos com os piores resultados foram as dimensões de Respostas não punitivas aos erros (18%) e Frequência de eventos relatados (32%). A análise de confiabilidade interna (Alpha de Cronbach) das dimensões variou entre 0,35 a 0,90. CONCLUSÃO: A cultura do medo parece predominar nesse hospital, contudo o estudo demonstrou que há possibilidades de melhoria em todas as dimensões da CSP. Os valores do Alpha de Cronbach apresentaram semelhança com os resultados obtidos pelo processo de validação.

Locally advanced penile carcinoma: classic emasculation or testis-sparing surgery?

The study evaluates the clinical and pathological findings of 16 patients with locally advanced penile carcinoma (PC) submitted to emasculation, and discusses questions related to the usefulness of bilateral orchiectomy.

Between 1999 and 2010, 172 patients with PC were treated. Sixteen (9%) underwent emasculation. Data were retrieved from the institution's database including age, ethnicity, date of surgery, residential setting, level of schooling, time to diagnosis, type of reconstruction, complications, tumor stage and grade, vascular and perineural invasion along with invasion of corpus cavernosum, corpus spongiosum, testicles, scrotum and urethra.

A total of 16 patients (average: 63.1 years) with locally advanced PC were included. All were illiterate or semiliterate rural dwellers and 87% were white. The time to diagnosis was 8-12 months. The mean follow-up time was 31.9 months (1-119). By the time of the last follow-up, only seven patients (43.75%) were alive. Tumors were pT4 (n = 6), pT3 (n = 8), pT2 (n = 2), Grade I (n = 5) and Grade II (n = 11). The histopathological examination revealed invasion of the urethra (n = 13), scrotum (n = 5) and testicles (n = 1). The surgical margin was positive in one patient. Six patients (37.5%) had vascular invasion and 11 (68.7%) had perineural invasion. Currently, only one of the former is alive.

The finding of focal microscopic testicular infiltration in only one of 32 testicles, even in the presence of clinically apparent scrotal invasion, suggests that emasculation without bilateral orchiectomy is a safe treatment option for patients with locally advanced PC. .

The isolated gamma probe technique for sentinel node penile carcinoma detection is unreliable

PURPOSE: Penile carcinoma is a common disease in northeast Brazil. This paper shows the results of the use of isolated gamma probe and discusses the incidence of false negative rates. MATERIALS AND METHODS: From July 2000 to September 2003, 27 newly diagnosed penile carcinoma patients (T1, T2, N0) were included in this prospective study. The isolated gamma probe technique uses the sodium phytate technetium as a tracer and inguinal scanning with probe and after identified the lymph node it is removed. Lymphadenectomies were performed for positive inguinal lymph nodes metastasis. RESULTS: There were 27 patients (mean age 59.6). Follow up was 37 months. Patients from country were 72 percent and illiterate or semi-illiterate were 56.7 percent. The tumors were mostly located in the glans (81.4 percent). They were T1, 52 percent and T2, 48 percent. 81.4 percent of the patients underwent partial penectomy, and 18.6 percent underwent postectomy and excision with wide margins. In 48 percent of the patients, the highest radioactive count rate was located on the left side, while in 41 percent was located on the right side. Only one patient had a positive pathological lymph node metastasis at the moment of the surgery. Additionally 3 patients became inguinal lymph node positive at the follow up. This date yielded a sensibility rate of 25 percent and a false-negative rate of 42.8 percent. CONCLUSION: Isolated gamma probe technique for sentinel node penile carcinoma has a very low sensibility and a high false negative rate. Therefore it is highly advisable the addition of others methods such as lymphoscintigraphy, vital blue, ultrasonography and so on. The isolated gamma probe technique for sentinel node penile carcinoma detection is unreliable.