Reflections on Moral Governance Path of Public Health Emergencies / 中国医学伦理学

Moral governance is an important social practice activity to improve social norms, cultivate citizens’ moral character, and cultivate citizens’ legal literacy. The changes of the social environment under public health emergencies have brought new changes and challenges to the work of moral governance. Under the background of normalization epidemic prevention and control, it is necessary to accurately understand and deeply grasp the risks of social and environmental changes caused by public health emergencies, fully combine the needs of public health emergency management, and be targeted in the content and requirements of moral governance. At the same time, it is significant to actively transform governance ideas, and improve the effectiveness of moral governance through multi-dimensional path innovation such as value and orientation, resources and methods, technology and carrier, strategies and means.

Study of Deliberate Self-Poisoning Among Adult Females in A Tertiary Care Hospital

Background: Poisoning is a common medico-social problem in our country causing around 300,000 episodes and around 2000 deaths per year. Attempted suicide among adult females are a major public health problem. The number of self-poisoning in females are increasing in our country day by day. The incidence, nature, etiology, age group affected and the outcome of self-poisoning in females of our country is different from that of the western world. Objective: The objective of the study was to analysis the socio-demographic profile & pattern of deliberate self-poisoning among adult females admitted in the Medicine Department, Dhaka Medical College Hospital. Material and Methods: This was a descriptive cross sectional study conducted in the Department of Medicine, Dhaka Medical College Hospital from January 2016 to June 2016. 100 admitted female participants were enrolled in this study as study population. A purposive sampling method was applied for sampling from study population. Results: The age of the participants were from 18 to 55 years with the mean age of 28.19 (± 9.84) years. Most number of the participants were in 21-29 year’s age group (42%) followed by ?20 year’s (29%). House wife (30%) was the most common occupation followed by student (25%). Most of the participants were from lower economic class (51%), followed by middle class (41%). 48% participants were in primary level, 24% in secondary level and 22% were illiterate. Most of the participants were married (51%), followed by unmarried (35%), divorced (9%) and widow (5%). 62% participants from rural and 38% from urban area. 75% were Muslim and 25% were Hindu. 55% were from the joint family and 45% were from the nuclear family. Most of the self-poisoning occurred between 6 am to 12 pm (42%), followed by 6 pm to 12 am (30%), 12 pm to 6 pm (20%) and 12 am to 6 am (8%). Insecticide was the most common poison materials (43%), followed by drug ingestion (30%), household detergent (13%), rodenticide (6%) and others (8%). Maximum participants reported the reason for self-poisoning was family disharmony (35%) followed by romantic disappointment (27%). 17% participants reported previous suicidal attempt and 11% had previous psychiatric disorder. Nearly half of the participants (43%) sought medical care within 2 hours and one fourth participants (31%) within 4 hours. About two-thirds of the participants (66%) received primary medical care from different govt. hospitals. Most of the female participants with self-poisoning were recovered completely (71%), while 20% participants recovered with complications and 9% participants died. In the study, fatality rate was found 33.3% in rodenticide and 16.3% in insecticide poisoning. Conclusions: As evident from the study, by intervene these problems by various measures might be helpful to prevent many of deliberate self-harm. Early diagnosis and prompt institution of appropriate treatment can make a favorable outcome in deliberate self-poisoning of female participants.

A qualitative study of the reasons for low patient safety incident reporting among Indonesian nurses / Um estudo qualitativo das razões para baixa notificação de incidentes de segurança do paciente entre enfermeiros indonésios / Un estudio cualitativo de las razones de la baja notificación de incidentes de seguridad del paciente entre las enfermeras de Indonesia

ABSTRACT Objectives: to investigate the reasons for low patient safety incident reporting among Indonesian nurses. Methods: this qualitative case study was conducted among 15 clinical nurses selected purposively from a public hospital in Lampung, Indonesia. Interview guidelines were used for data collection through face-to-face in-depth interviews in July 2022. The thematic approach was used to analyze the data. Results: in this present study, seven themes emerged (1) Understanding incident reporting; (2) The culture; (3) Consequences of reporting; (4) Socialization and training; (5) Facilities; (6) Feedback; and (7) Rewards and punishments. Final Considerations: these findings should be considered challenges for the patient safety committee and hospital management to increase patient safety incident reporting, particularly among nurses in the hospital.

RESUMO Objetivos: investigar os motivos da baixa notificação de incidentes de segurança do paciente entre enfermeiros indonésios. Métodos: este estudo de caso qualitativo foi conduzido entre 15 enfermeiros clínicos selecionados intencionalmente de um hospital público em Lampung, Indonésia. Utilizou-se roteiro de entrevista para a coleta de dados por meio de entrevistas presenciais em profundidade em julho de 2022. A abordagem temática foi utilizada para análise dos dados. Resultados: neste estudo, emergiram sete temas: (1) Compreender a comunicação de incidentes; (2) A cultura; (3) Consequências da notificação; (4) Socialização e treinamento; (5) Instalações; (6) Comentários; e (7) Recompensas e punições. Considerações Finais: esses achados devem ser considerados desafios para o comitê de segurança do paciente e a gestão hospitalar para aumentar a notificação de incidentes de segurança do paciente, principalmente entre os enfermeiros do hospital.

RESUMEN Objetivos: investigar las razones de la baja notificación de incidentes de seguridad del paciente entre las enfermeras de Indonesia. Métodos: este estudio de caso cualitativo se llevó a cabo entre 15 enfermeras clínicas seleccionadas intencionalmente de un hospital público en Lampung, Indonesia. Se utilizó un guión de entrevista para la recolección de datos a través de entrevistas presenciales en profundidad en julio de 2022. Se utilizó el enfoque temático para el análisis de datos. Resultados: en este estudio surgieron siete temas: (1) Comprender la notificación de incidentes; (2) La cultura; (3) Consecuencias de la notificación; (4) Socialización y capacitación; (5) Instalaciones; (6) Comentarios; y (7) Recompensas y Castigos. Consideraciones Finales: estos hallazgos deben ser considerados desafíos para el comité de seguridad del paciente y la gerencia del hospital para aumentar la notificación de incidentes de seguridad del paciente, especialmente entre las enfermeras del hospital.

Incidentes críticos na convivência familiar e social de idosos com hiv/aids / Critical incidents in family and social life of elderly people with hiv/aids / Incidentes críticos en la interacción familiar y social de personas mayores con vih/sida

O aumento das Infecções Sexualmente Transmissíveis e dos casos de contágio pelo HIV/AIDS na população idosa reflete aspectos da prática sexual e vulnerabilidades que podem estar sendo enfrentadas por essas pessoas em seu convívio social e familiar. Objetivo: descrever, por meio de incidentes críticos, as situações, comportamentos e consequências relacionadas à descoberta do HIV/AIDS por pessoas idosas soropositivas. Método: estudo descritivo, com abordagem qualitativa, realizado no Centro de Infectologia de um município da região sul do estado do Ceará, utilizando a Técnica de Incidente Crítico (TIC), nos meses de fevereiro a setembro de 2020. Participaram 25 idosos cadastrados no serviço, com idades entre 55 e 77 anos. Os dados foram coletados por meio de entrevista semiestruturada e o conteúdo analisado com auxílio do software IRaMuTeQ por meio de categorias temáticas. Resultados: os dados empíricos contendo as situações, comportamentos e consequências (incidentes críticos) elucidaram quatro categorias empíricas: descoberta do diagnóstico de HIV/AIDS; sentimentos, estigmas e preconceitos vivenciados; soropositividade e reflexos no convívio familiar e social; e mudanças no comportamento sexual após diagnóstico de HIV/AIDS. Conclusão: as relações familiares e sociais vivenciadas e os desafios enfrentados pelas pessoas idosas com HIV/AIDS constituíram incidentes críticos complexos, afetando-as desde o momento do diagnóstico, com impactos negativos sobre seus modos de vida familiar e social, que dificultam a convivência inclusiva e não estigmatizante dentro e fora de casa.

The increase of Sexually Transmitted Infections and cases of HIV/AIDS in the elderly population reflects aspects of sexual practice and vulnerabilities that may be faced by these people in their social and family life. Objective: to describe, through critical incidents, the situations, behaviors and consequences related to the discovery of HIV/AIDS by seropositive elderly people. Method: a descriptive study with a qualitative approach, conducted at the Infectious Diseases Center of a city in the southern region of the state of Ceará, using the Critical Incident Technique (CIT), from February to September 2020. Twenty-five elderly people enrolled in the service, aged 55 to 77 years, participated. The data were collected through semi-structured interviews and the content analyzed with the help of IRaMuTeQ software through thematic categories. Results: The empirical data containing situations, behaviors and consequences (critical incidents) elucidated four empirical categories: discovery of the HIV/AIDS diagnosis; feelings, stigmas and prejudices experienced; seropositivity and reflections on family and social life; and changes in sexual behavior after the diagnosis of HIV/AIDS. Conclusion: the family and social relationships experienced and the challenges faced by elderly people with HIV/AIDS constituted complex critical incidents, affecting them from the moment of diagnosis, with negative impacts on their family and social lifestyles, which hinder inclusive and non-stigmatizing coexistence inside and outside the home.

El aumento de las Infecciones de Transmisión Sexual y de los casos de VIH/Sida en la población anciana refleja aspectos de la práctica sexual y vulnerabilidades que pueden enfrentar estas personas en su vida social y familiar. Objetivo: describir, a través de incidentes críticos, las situaciones, comportamientos y consecuencias relacionadas con el descubrimiento del VIH/SIDA por personas mayores seropositivas. Método: estudo descritivo, com abordagem qualitativa, realizado no Centro de Infectologia de um município da região sul do estado do Ceará, utilizando a Técnica de Incidente Crítico (TIC), nos meses de fevereiro a setembro de 2020. Participaron 25 ancianos registrados en el servicio, con edades comprendidas entre 55 y 77 años. Os dados foram recolhidos através de entrevistas semiestructuradas e o conteúdo foi analisado com a ajuda do software IRaMuTeQ através de categorias temáticas. Resultados: los datos empíricos que contienen las situaciones, comportamientos y consecuencias (incidentes críticos) elucidaron cuatro categorías empíricas: descripción del diagnóstico de VIH/SIDA; sentimientos, estigmas y preconceptos vividos; seropositividad y reflejos en la convivencia familiar y social; y cambios en el comportamiento sexual tras el diagnóstico de VIH/SIDA. Conclusão: as relações familiares e sociais vividas e os desafios enfrentados pelos idosos com HIV/AIDS constituem incidentes críticos complexos, afetando-as desde o momento do diagnóstico, com impactos negativos sobre seus modos de vida familiar e social, que dificultam a convivência inclusiva e não estigmatizante dentro e fora de casa.

Health and safety incidents at a power utility in the Eastern Cape province of South Africa

Background: Many high-risk and construction-related activities are performed in the course of distributing electricity throughout South Africa, including working at heights, driving, operating electrical networks, excavation work, and maintenance of electrical structures. South Africa has one power utility that provides electricity to the entire country. Different sectors of the utility are distributed throughout the nine provinces, with eight sectors in the Eastern Cape province. Objective: We sought to compare health and safety incidents, and their causes, between the sectors in the Eastern Cape province. Methods: Incident data from 2015 to 2019 were extracted from the power utility's Systems, Applications and Products in Data Processing of Environmental Health and Safety (SAP EH&S) database. The most common health and safety incidents and their reported causes are compared across sectors and described as counts and frequencies. Results: There were 614 health and safety incidents recorded in the study period with motor vehicle accidents being the most common overall (n = 482, 78.5%). Incidents related to damage to equipment (n = 48, 7.8%), operating errors (n = 16, 2.8%), falls (n = 15, 2.4%), hand injuries (n = 13, 2.1%), and insect/animal bites (n = 13, 2.1%) were also recorded. Workers ignoring safety rules was the most common reported cause of these health and safety incidents (n = 449, 73.1%). Conclusion: Motor vehicle accidents, damage to property, operating errors, falls, and hand injuries were frequently reported in the energy utility sectors in the Eastern Cape province. The most common recorded cause was workers ignoring health and safety rules. Training workers on the importance of reporting incidents, including near misses, can potentially reduce the frequency of health and safety incidents.

Research on Public Health Emergency Collaborative Governance System with Grassroots Communities as the Core / 中国医学伦理学

Grassroots communities, as the forefront of the transformation of national system and mechanism, the reformation of social structure, the change of interest pattern, and the transition of ideological consciousness, have long been the focus of government work, academic research, and social practitioners. Based on the theory of collaborative governance, aiming at the problems existing in the emergency management of public health emergencies in grassroots communities at present, this paper put forward the construction measures of public health emergency collaborative governance system with grassroots communities as the core, including improving the grassroots community emergency management organizational structure, consolidating the standardized foundation of grassroots community emergency collaborative management, enhancing the awareness of grassroots community emergency collaborative management, and strengthening the interactivity of the grassroots community information communication system. It is hoped to provide necessary reference for promoting the reform of public health emergency governance system.

Incidencia de flebitis en pacientes pediátricos con catéter periférico en una institución de Manizales / Incidence of phlebitis in patients with peripheral catheter in a health care institution in Manizales (Colombia)

Introducción: El cuidado de enfermería en áreas clínicas requiere conocimiento, habilidad y experiencia. El tratamiento de una persona hospitalizada usualmente necesita un acceso venoso, en este procedimiento pueden presentarse complicaciones, siendo la flebitis e infiltración las principalmente reportadas. Objetivo: Determinar la incidencia de flebitis en pacientes pediátricos con catéter corto periférico de acuerdo con el grado de la misma y diversos factores implicados en su aparición. Materiales y métodos: Estudio cuantitativo, prospectivo, observacional y documental realizado entre octubre 2018 a febrero 2019. Resultados: Se encontró una tasa de incidencia de flebitis de 18,5%. De 849 niños con catéter venoso periférico, 157 reportaron flebitis; de ellos 52,2% presentaron flebitis grado I; 29,9%, grado II; 15,3% grado III y 2,5% grado IV. El 78% de los niños presentó peso y talla adecuados para la edad. La flebitis identificada se relacionó al catéter preventivo y asociado a medicamentos como cefalotina y dipirona, así como la presentación en la etapa de infancia y adolescencia de flebitis grado I. Conclusiones: La identificación de la flebitis, sus grados y correlación con las variables sociodemográficas y clínicas, permiten establecer acciones de cuidado y fomento de estrategias para mejorar la atención y los estándares de alta calidad.

Introduction: Nursing care in clinical areas requires knowledge, skills, and experience. Treatment of a hospitalized person usually requires venous access, which carries frequently reported complications such as phlebitis and infiltrations. Objective: To determine the incidence of phlebitis in patients with short peripheral catheter according to its grade and various factors involved in its appearance. Materials and methods: Quantitative, prospective, observational, and documentary study carried out between October 2018 and February 2019. Results: An incidence rate of phlebitis of 18.5% was observed. Phlebitis was reported in 157 out of 849 children with peripheral venous catheter. Grade I, II, III, and IV phlebitis was documented in 52.2%, 29.9%, 15.3%, and 2.5%. respectively. 78% of the children showed adequate weight and height for their age group. These cases of phlebitis were related to preventive catheter and associated with the use of medications such as cephalothin and dipyrone. In the case of grade I phlebitis, it was more frequent in childhood and adolescent populations. Conclusions: The identification of phlebitis, its grades, and its correlation with sociodemographic variables is necessary to establish health care actions and promote strategies in order to improve care and achieve high quality standards.

Risk Factors for Anesthesia-Related Airway Patient Safety Incidents: A Single-Center Retrospective Case-Control Analysis from 2009 to 2022 / 中国医学科学杂志(英文版)

Objective Airway-related patient safety incident (PSI) has always been the top concern of anesthesiologists because this type of incidents could severely threaten patient safety if not treated immediately and properly. This study intends to reveal the composition, prognosis, and to identify risk factors for airway related incidents reported by anesthesiologists. Methods All airway related PSIs reported by anesthesiologists in a Chinese academic hospital between September 2009 and May 2022 were collected from the PSI reporting system. Patients with airway incidents reported were matched 1:1 with controls based on sex and type of surgery. Univariable and multivariable analysis were performed to find risk factors associated with airway incident occurrence, and to evaluate influence of airway PSIs on patient prognosis. Results Among 1,038 PSIs voluntarily reported by anesthesiologists during the study period, 281 cases (27.1%) were airway-related incidents, with an overall reporting incidence of 4.74 per 10,000 among 592,884 anesthesia care episodes. Only ASA physical status was found to be significant independent predictor of these airway PSIs (P = 0.020). Patients with airway PSIs reported had longer extubation time (0.72 ± 1.56 d vs. 0.16 ± 0.77 d, 95%CI: 0.29 to 0.82, P < 0.001), longer ICU length of stay (LOS) (1.63 ± 5.71 d vs. 0.19 ± 0.84 d, 95%CI: 0.57 to 2.32, P= 0.001), longer post operative LOS (10.56 ± 13.09 d vs. 7.59 ± 10.76 d, 95%CI: 0.41 to 5.53, P = 0.023), and longer total in-hospital LOS (14.99 ± 15.18 d vs. 11.62 ± 11.88 d, 95%CI: 0.46 to 6.27,P = 0.024). Conclusions This single-center retrospective case-control study describes the composition of airway-related PSIs reported by anesthesiologists within thirteen years. Airway incidents might influence patient prognosis by elongating extubation time and LOS. Airway PSI data were worth analyzing to improve patient safety.

Kampo Risk Management Based on a Survey on Incident and Accident Cases at Specialized Kampo Medicine Facilities / 日本東洋医学雑誌

The Medical Safety Committee has conducted various activities for patient safety in Japanese traditional Kampo medicines. In this study, we conducted a questionnaire survey to promote the prevention of medical accidents and their recurrence. We received responses from 15 of 19 facilities specializing in Kampo medicine and collected a total of 247 incident and accident cases in the field of Kampo medicine. Cases of side effects included interstitial pneumonia caused by Kampo prescriptions containing Scutellariae Radix, aconite poisoning, and licorice-induced pseudoaldosteronism. Furthermore, we also collected decoction-specific cases, which are unique to facilities specializing in Kampo medicine, for the first time. From the results, we included the following seven points for risk management in the field of Kampo medicine : 1) insufficient recognition to the side effects of Kampo medicines, 2) misunderstanding of the dosages of Kampo products, 3) errors due to similarities in Kampo formulas and crude drug names, 4) preconception of frequently used Kampo prescriptions, 5) contamination in the decoctions, 6) errors related to crude drug items and their dosages that are frequently added or subtracted, 7) errors in hospital wards.

Age differences in the association of physical leisure activities with incident disability among community-dwelling older adults

BACKGROUND@#The relationship between leisure activities (LA) in old age and prevention of disability has not been fully investigated, and age and gender differences of these relationships are unknown. This study aimed to investigate whether physical and cognitive LA predicted incident disability among community-dwelling older adults by age and gender.@*METHODS@#We prospectively observed 8,275 residents aged 65 or above without disability at baseline for 3 years. Incident disability was defined as a new certification of the public long-term care insurance system. LA were classified into two types: physical LA and cognitive LA. The frequency of LA was categorized into frequent (i.e., once a week or more), moderate (i.e., monthly or yearly), and non-engagement. Covariates included age, gender, family number, education, perceived economic situation, body mass index, chronic medical conditions, alcohol consumption, smoking status, regular dental visits, depression, cognitive functioning, and social participation. Multivariable Poisson regression models were used to estimate adjusted cumulative incidence ratio (CIR) and 95% confidence interval (CI) for incident disability. We performed stratified analyses by age groups (i.e., the young-old aged 65-74 and the old-old aged 75-97) and gender (i.e., men and women).@*RESULTS@#The 3-year cumulative incidence of disability was 7.5%. After adjustment for covariates and mutual adjustment for both types of LA, a significant dose-response relationship between more frequent LA and lower risk of incident disability was found in young-old physical LA (P-trend < 0.001), in old-old cognitive LA (P-trend = 0.012), in male cognitive LA (P-trend = 0.006), and in female physical LA (P-trend = 0.030). Compared with people without LA, adjusted CIR (95% CI) of frequent LA was 0.47 (0.30-0.74) in young-old physical, 0.75 (0.58-0.96) in old-old cognitive, 0.65 (0.46-0.89) in male cognitive, and 0.70 (0.52-0.95) in female physical. Regarding the effect modification according to age and gender, only interaction between age and physical LA significantly prevented incident disability (P for interaction = 0.019).@*CONCLUSION@#We found age differences in the association of physical LA with incident disability among community-dwelling older adults. An effective measure to prevent long-term care in the community would be to recommend frequent physical LA for the young-old.

Descripción de las características de los incidentes clínicos reportados en el año 2020 al sistema de reporte voluntario de un hospital pediátrico de Costa Rica / Description of the characteristics of the clinical incidents reported in 2020 to the voluntary reporting system of a pediatric hospital in Costa Rica

El objetivo del presente manuscrito fue describir los incidentes clínicos que fueron enviados al sistema de reporte voluntario durante el año 2020, que funciona en el Hospital Nacional de Niños de Costa Rica, perteneciente a la Caja Costarricense de Seguro Social. Se realizó un estudio observacional descriptivo de los datos consolidados que se enviaron durante los meses de enero a diciembre del año 2020. Durante el año 2020 el 1,6% de los pacientes atendidos en el hospital experimentó algún tipo de incidente clínico. El total de egresos disminuyó un 38,4% en comparación con los egresos del año 2019, sin embargo, los incidentes clínicos reportados aumentaron en el año 2020 un 37,6%, especialmente a partir del mes de agosto. No se reportaron eventos centinela en este año. Los servicios que realizaron mayor cantidad de reportes fueron Cuidados Intensivos (14,3%), Cirugía General (12%), Neonatología (9,8%) e Infectología (9%). El día en el cual se reportaron más incidentes fue el miércoles (27,8%), en el primer turno hospitalario se reportaron la mayoría de los casos (48,1%) y estos incidentes ocurrieron predominantemente a individuos masculinos (66%). Respecto de la edad de los pacientes, la mayoría estuvo en el rango de edad de 1 año a menos de 5 años (36,1%), seguido por el rango de edad de mayores de 29 días a menores de 1 año (24,1%). La mayor parte de los casos estuvieron relacionados con el cuidado que se brindaba al paciente (63,9%). El 41,4% de los incidentes requirieron medidas clínicas pero las secuelas fueron transitorias. El 51,1% de los casos ameritó algún tipo de cuidado médico adicional a su esquema terapéutico al ingreso. El 96% de los incidentes clínicos fueron reportados por personal de enfermería. La mayoría de los incidentes clínicos (35,3 %) en este período fueron errores relacionados con notas en el expediente digital.

The objective of this manuscript was to describe the clinical incidents that were sent to the voluntary reporting system during 2020 at the National Children's Hospital of Costa Rica, belonging to the Costa Rican Social Security Fund.A descriptive observational study of the consolidated data that was sent during the months of January to December of the year 2020 was carried out.During 2020, 1.6% of the patients treated in the hospital experienced some type of clinical incident. The total discharges decreased by 38.4% compared to the discharges of the year 2019, however, the reported clinical incidents increased in the year 2020 by 37.6%, especially from the month of August. Sentinel events were not reported this year. The services that made the highest number of reports were Intensive Care (14.3%), General Surgery (12%), Neonatology (9.8%) and Infectiology (9%). The day on which the most incidents were reported was Wednesday (27.8%), in the first hospital shift most of the cases were reported (48.1%) and these incidents occurred predominantly to male individuals (66%). Regarding the age of the patients, the majority were in the age range from 1 year to less than 5 years (36.1%), followed by the age range from over 29 days to under 1 year (24, 1%). Most of the cases were related to the care provided to the patient (63.9%). 41.4% of the incidents required clinical measures but the sequelae were transitory. 51.1% of the cases merited some type of additional medical care to their therapeutic scheme upon admission. 96% of clinical incidents were reported by nursing staff. Most of the clinical incidents (35.3%) in this period were errors related to notes in the digital file.

Sistema hospitalario en situación de crisis: implementación de sistema de comando de incidentes para enfrentar pandemia SARS-CoV-2 en Clínica Las Condes, Chile / Implementation of incident command system to deal with SARS-CoV-2 pandemic in Clínica Las Condes, Chile

La pandemia en Chile generó un desafío de modernización y gestión de los Cuidados Intensivos, haciendo necesario que las unidades de pacientes críticos realizaran un aumento de su capacidad hospitalaria, lo que requiere preparar una infraestructura, un equipamiento mínimo, protocolos y un equipo humano preparado y alineado, para garantizar la seguridad y calidad de atención a los pacientes. Una forma de lograrlo es la incorporación de la estrategia militar de Sistema de Comando de Incidentes, utilizado para enfrentar distintos tipos de desastres, con una estructura modular de comando y sus seccionales de trabajo, con diferentes equipos y líderes para hacer frentes a los variados desafíos. El objetivo de este artículo es describir la instauración del sistema de comando de incidentes en un hospital privado, detallando su conformación y los resultados logrados.

The pandemic in Chile has been a real challenge in terms of modernization and management of intensive care. Critical care units have been forced to increase their hospital capacity in terms of infrastructure, equipment, protocols and human team, while guaranteeing safety and high-quality patient care.One approach to achieve this objective is to develop the army strategy called incident command system that has been used to face different types of disaster. A modular command structure is developed based on the creation of teams each lead by an expert in different areas in order to cope with a variety of upcoming challenges.The objective of this article is to describe the setting up of a successful incident command system in a private hospital, detailing its formation and results obtained.

Diez años de incidentes críticos pediátricos declarados en el Sistema Español de Notificación en Seguridad en Anestesia y Reanimación / Ten years of pediatric critical incidents reported in the Spanish Anesthesia Safety Notification System

OBJETIVES: The aim of this study is to analyze all the pediatric critical incidents (PCI) reported in the Spanish Anesthesiology and Reanimation Safety Notification System in ten years time. MATERIALS AND METHODS: We reviewed all the critical incidents (CI) reported between the years 2009 and 2018 in SEN- SAR online database and we selected those related to newborns and children up to 16 years. RESULTS: 9480 CI were declared; 474 were pediatrics. Infants accounted for the 36% of the PCI, of whom the 44% were children under the age of one. Most of them affected to healthy patients (the 66%) and took place in the operating room (the 49%), during general pediatric surgery (the 19%), otorhinolaryngology (the 15%), orthopedic (the 13%) and radiology procedures (the 5%). The majority of them were medications errors (the 24%), followed by clinical incidents (the 18%) and equipment-related events (14%). Human factor accounted for the 42% of reports ­ both of them in its individual characteristics (the 25%) and in team performance (the 15%). Up to the 30% of the children suffered consequences derived from the incidents. Two fatal events were recorded, both airway related. Improvement measures were de- signed and implemented in the 93% of them. CONCLUSIONS: Designing studies that shed light on the causes of the relative inefficiency of CI Reporting Systems and the factors that condition a lower rate of CI communication in the pediatric setting in comparison with the adult population is necessary.

OBJETIVOS: Realizar un análisis retrospectivo de todos los incidentes críticos pediátricos (ICP) declarados en el Sistema Español de Notificación en Seguridad en Anestesia y Reanimación en sus primeros diez años. MATERIAL Y MÉTODOS: Se realizó una revisión de los incidentes críticos (IC) declarados entre el 1 de enero de 2009 y el 31 de diciembre de 2018. Se seleccionaron los IC acontecidos en pacientes de 0 a 16 años de edad. RESULTADOS: De los 9.480 IC declarados en ese período, 474 fueron ICP. El 36% ocurrió en lactantes menores de dos años, de los que el 44% fueron menores de un año. La mayoría (66%) ocurrieron en pacientes sanos y tuvieron lugar en quirófano (49%), durante procedimientos de cirugía general pediátrica (19%), de otorrinolaringología (15%), de traumatología (13%) y de radiología (5%). El tipo de IC más declarado fueron los errores de medicación (24%), seguidos de los incidentes clínicos (18%) y de los errores de equipamiento (14%). El factor humano estuvo implicado en el 42% de los IC, tanto en su faceta del individuo (25%) como en las relaciones en equipo (15%). El 30% de los pacientes sufrieron daño. Se registraron dos fallecimientos derivados del incidente, ambos relacionados con la vía aérea. Se implementaron medidas de mejora en un 93% de los casos. CONCLUSIONES: Es necesario profundizar en las causas de la ineficiencia relativa de los Sistemas de Declaración de IC y en las que condicionan una menor tasa de comunicación de IC en el ámbito pediátrico respecto al adulto.

Incidentes de segurança do paciente na Atenção Primária à Saúde (APS) de Manaus, AM, Brasil / Patient safety incidents in Primary Healthcare in Manaus, AM, Brazil / Incidentes de seguridad del paciente en la Atención Primaria de la Salud de Manaus, AM, Brasil

A expressão "segurança do paciente" refere-se à redução a um nível mínimo aceitável do risco de dano desnecessário associado ao cuidado em saúde. Estudos internacionais indicam uma ocorrência de dois a três incidentes de segurança do paciente por 100 consultas na APS, com frequência similar no Brasil. Realizamos um estudo descritivo para identificar incidentes de segurança do paciente na APS de Manaus, AM, Brasil, em 2018, mediante notificações voluntárias de médicos selecionados por amostragem por conveniência. As 105 notificações coletadas permitiram calcular uma incidência de três incidentes de segurança por 1.000 atendimentos no trimestre estudado. Em 82% dos incidentes, houve envolvimento do usuário. Em 39 notificações (37%), houve registro de dano, sendo 33% de dano mínimo, 17% de dano moderado e dois óbitos. Os resultados implicam no incentivo a ações de educação em saúde sobre o tema voltadas aos usuários.(AU)

Patient safety means reducing the risk of unnecessary healthcare-associated damage to a minimum acceptable level. International studies show an occurrence of 2-3 patient safety incidents per 100 primary healthcare appointments, with similar frequency in Brazil. We conducted a descriptive study to identify patient safety incidents in Primary Healthcare in the Brazilian city of Manaus, state of Amazonas, in 2018, by voluntary notification of doctors selected by convenience sampling. The 105 collected notifications enabled to calculate an incidence of 3 safety incidents per 1,000 appointments in the studied quarter. In 82% of the incidents, the user was involved. In 39 notifications (37%), the damage was recorded—33% of them were minimum, 17% moderate, and 2 deaths. The results imply an incentive to actions of health education on user-related topics.(AU)

La seguridad del paciente es la reducción a un nivel mínimo aceptable de riesgo de daño innecesario asociado al cuidado de salud. Estudios internacionales indican una ocurrencia de dos a tres incidentes de seguridad del paciente por 100 consultas en la Atención Primaria de la Salud (APS), con frecuencia similar en Brasil. Realizamos un estudio descriptivo para identificar incidentes de seguridad del paciente en la APS de Manaus, Estado de Amazonas, en 2018, mediante notificaciones voluntarias de médicos seleccionados por muestreo por conveniencia. Las 105 notificaciones colectadas permitieron calcular una incidencia de tres incidentes de seguridad por 1000 atenciones en el trimestre estudiado. En el 82% de los incidentes hubo envolvimiento del usuario. En 39 notificaciones (37%) hubo registro de daño, siendo el 33% de daño mínimo, el 17% de daño moderado y dos fallecimientos. Los resultados implican en el incentivo a acciones de educación en salud sobre la cuestión, enfocadas en los usuarios.(AU)

New cases are they incident or newly discovered / 中华疾病控制杂志

@#New case is a basic concept in epidemiology and often serves as the numerator for the indexes of the frequency of disease in a population． However，the exact definition of new case is still un- clear． Based on the natural history of disease combined with the concept of event-state，this article rede- fines case-related concepts and compares them with traditional concepts． The study found that the so- called new cases in traditional epidemiological studies are actually the cases firstly discovered，including newly discovered cases and identifiable newly incident cases ( disease initiation) ． In the real world，new cases are often difficult to measure，and together with the continuous process of disease development and iceberg phenomenon，those may affect the accuracy of disease frequency measurement and causal infer- ence． A correct understanding of the meaning of case-related concepts，the meanings they reflect，and the differences between them help to rationally interpret the results of epidemiological research．

Serum uric acid and risk of incident diabetes in middle-aged and elderly Chinese adults: prospective cohort study / 医学前沿

The association between serum uric acid and the risk of incident diabetes in Chinese adults remains unknown. This study aimed to investigate this association in a community-dwelling population aged ≥ 40 years in Shanghai, China. Oral glucose tole3rance test was conducted during baseline and follow-up visits. Relative risk regression was utilized to examine the associations between baseline gender-specific serum uric acid levels and incident diabetes risk. A total of 613 (10.3%) incident diabetes cases were identified during the follow-up visit after 4.5 years. Fasting plasma glucose, postload glucose, and glycated hemoglobin A1c during the follow-up visit progressively increased across the sex-specific quartiles of serum uric acid (all Ps < 0.05). The incidence rate of diabetes increased across the quartiles of serum uric acid (7.43%, 8.77%, 11.47%, and 13.43%). Multivariate adjusted regression analysis revealed that individuals in the highest quartile had 1.36-fold increased risk of diabetes compared with those in the lowest quartile of serum uric acid (odds ratio (95% confidence interval) = 1.36 (1.06-1.73)). Stratified analysis indicated that the association was only observed in women. Accordingly, serum uric acid was associated with the increased risk of incident diabetes among middle-aged and elderly Chinese women.

Muertes por incidentes viales en Bello (Antioquia) (2012-2016) / Deaths due to road incidents in Bello (Antioquia) (2012-2016) / Mortes por acidentes rodoviários em Bello (Antioquia) (2012-2016)

Resumen Objetivo: Determinar la estructura de la mortalidad por incidentes viales en el municipio de Bello (Antioquia), entre los años 2012 y 2016. Metodología: Estudio descriptivo, con información obtenida de las bases de datos aerca de defunciones, parque automotor y malla vial del municipio. Se calcularon frecuencias y tasas de mortalidad para las variables pertinentes; con el análisis de correspondencias múltiples se determinó el perfil del fallecido, y para conocer la distribución espacial de las muertes se utilizó un mapa de densidad de Kernel, según el método de clasificación estándar cuantil. Resultados: Se registraron 313 defunciones por incidentes viales, 63 en promedio por año (13,4 por cada 100 000 habitantes), específicamente en los hombres (62 vs. 12 mujeres por 100 000), que tenían entre 19 y 28 años (47,9 %), con básica primaria (32,5 %) y que no estaban asegurados (44 %). Predominaron los incidentes viales por choques (53,0 %) y atropellamientos (41 %), los fines de semana y entre las 0:00 y las 6:00 a. m. (29,2 %); fueron las motocicletas las que más incidentes viales generaron con muertes (74,4 %). Las vías de mayor concentración de víctimas fatales fueron: en una parte de la Autopista Norte -entre las diagonales 50 y 52 (14,0 %), la calle 46 (2,2 %) y la carrera 50 (5,1 %)- y la Autopista Medellín-Bogotá (5,1 %), y en las comunas Suárez y Niquía (2,37 y 1,78 por cada 100 000). Conclusiones: Dado el importante aumento de la incidentalidad vial y, en consecuencia, de las muertes que de ella se deriva, se interroga acerca de la efectividad de las intervenciones emprendidas y se sugiere su valoración.

Abstract Objective: To determine the structure of mortality due to road incidents in the municipality of Bello (Antioquia), from 2012 to 2016. Methodology: Descriptive study with information obtained from the databases about deaths, the automotive fleet, as well as the road network in the municipality. Mortality rates for relevant variables were calculated. Also, the profile of a deceased person was determined via multiple correspondence analysis. Furthermore, the spatial distribution of deaths was found through a Kernel density estimation map according to the quantile standard classification method. Results: 313 deaths caused by road incidents were registered. 63 per year on average (being 13.4 per 100,000 inhabitants). This reality was specifically observed in men (62 vs. 12 women per 100,000), who were 19 to 28 years old (47.9 %), had primary school education (32.5 %), and did not have insurance (44 %). Most road incidents were crashes (53 %) and run-overs (41 %), on weekends and from 0:00 to 6:00 a.m. (29.2 %). Motorcycles caused the most fatal road incidents (74.4 %). The routes with the highest concentration of fatalities were: a segment of the Autopista Norte -between diagonales 50 and 52 (14 %), Calle 46 (2.2 %) and Carrera 50 (5.1 %)- Avenida Medellín-Bogotá (5.1 %), and in the Suárez and Niquía areas (2.37 and 1.78 per 100,000 inhabitants). Conclusions: Given the significant increase of road incidents -and therefore deaths linked to it- the effectiveness of interventions performed so far is brought into question and a reassessment of those interventions is suggested.

Resumo Objetivo: Determinar a estrutura de mortalidade por incidentes rodoviários no município de Bello (Antioquia), entre 2012 e 2016. Metodologia: Estudo descritivo, com informações obtidas nas bases de dados atinentes aos óbitos, parque automotivo e rede viária do município. As frequências e taxas de mortalidade foram mensuradas para as variáveis salientadas; com a análise de correspondência múltipla, foi determinado o perfil do falecido e, para conhecer a distribuição espacial das mortes, foi utilizado um mapa de densidade de Kernel, de acordo com o método padrão de classificação quantílica. Resultados: foram registradas 313 mortes por acidentes de trânsito, 63 em média por ano (13,4 por 100.000 habitantes), especificamente em homens (62 vs. 12 mulheres por 100.000), com idades entre 19 e 28 anos (47,9%), com ensino fundamental básico (32,5%) e não segurados (44%). Os incidentes nas estradas predominaram por acidentes inter vehiculares (53,0%) e atropelamentos (41%), nos finais de semana e entre as 0:00 e as 6:00 da manhã (29,2%); foram as motos que geraram mais incidentes nas estradas com mortes (74,4 %). As rotas com maior concentração de mortes foram: em uma parte da Rodovia Norte - entre as 50 e 52 diagonais (14,0%), a rua 46 (2,2%) e a rua 50 (5,1%) - Rodovia Medellín- Bogotá (5,1%), e nas comunas de Suárez e Niquía (2,37 e 1,78 por cada 100 000). Conclusões: Dado o aumento significativo da incidentalidade nas rodovias e, consequentemente, das mortes resultantes, questiona-se a eficácia das intervenções realizadas e sugere-se sua avaliação.

An interpretation of the Second consensus on the assessment of sublingual microcirculation in critically ill patients issued by the European Society of Intensive Care Medicine in 2018 / 中华危重病急救医学

The European Society of Intensive Care Medicine (ESICM) issued the second consensus on the assessment of sublingual microcirculation in critically ill patients. This paper interprets the consensus for clinicians about: what is microcirculation, how to observe microcirculation, and the details of microcirculation images collection and parameters analysis. Besides, this paper illustrates the relationship between microcirculation alternation and shock, it also evaluates the present situation and future development of microcirculation monitoring.

Application of ACMMM management model in elderly patients with unsafe events / 中国实用护理杂志

Objective@#To explore the application of ACMMM management model in elderly patients with unsafe events.@*Methods@#A retrospective analysis of elderly patients who had been hospitalized for more than three months at the Chinese People′s Liberation Army General Hospital from May 2017 to May 2018 was performed. According to the patient′s hospitalization time, they were divided into group A and group B. Group A was hospitalized between May 2016 and May 2017 (n=1 258), and group B was hospitalized between June 2017 and May 2018 (n=1 309). Patients in group A were given routine nursing intervention, and patients in group B were combined to implement ACMMM management model intervention on the basis of routine nursing intervention. The incidence of various types of unsafe events in the two groups of patients was compared. The severity of the fall in the two groups of patients was compared. Comparison of nursing satisfaction between the two groups of patients.@*Results@#In group A, 47 patients had unsafe events, 11 patients in group B had unsafe events, and group A had higher incidence of unsafe events than group B (χ2=24.358, P<0.05). In group A, the frequency of pressure sores and burns was higher than that of group B (χ2=7.966, 4.353, 5.800, P<0.05). There was no statistically significant difference in the frequency of occurrence of falling, suffocation, self-injury, and misuse between the two groups (P>0.05). The severity of patients with falls in group A was higher than that in group B (Z=-2.124, P<0.05). The satisfaction of nursing in group B was 79.53%(1 041/1 309), the satisfaction of nursing in group A was 57.15%(719/1 258), and the satisfaction degree in group B was better than that in group A. The data were statistically significant (Z=-15.238, χ2=148.962, P <0.05).@*Conclusions@#The use of ACMMM management model for long-term hospitalized elderly patients with nursing intervention can effectively reduce the incidence of unsafe events in elderly patients, reduce the severity of falls and other related injuries, and effectively improve patient care satisfaction.

Application of ACMMM management model in elderly patients with unsafe events / 中国实用护理杂志

Objective To explore the application of ACMMM management model in elderly patients with unsafe events. Methods A retrospective analysis of elderly patients who had been hospitalized for more than three months at the Chinese People′s Liberation Army General Hospital from May 2017 to May 2018 was performed. According to the patient′s hospitalization time, they were divided into group A and group B. Group A was hospitalized between May 2016 and May 2017 (n=1 258), and group B was hospitalized between June 2017 and May 2018 (n=1 309). Patients in group A were given routine nursing intervention, and patients in group B were combined to implement ACMMM management model intervention on the basis of routine nursing intervention. The incidence of various types of unsafe events in the two groups of patients was compared. The severity of the fall in the two groups of patients was compared. Comparison of nursing satisfaction between the two groups of patients. Results In group A, 47 patients had unsafe events, 11 patients in group B had unsafe events, and group A had higher incidence of unsafe events than group B (χ2=24.358, P<0.05). In group A, the frequency of pressure sores and burns was higher than that of group B (χ2=7.966, 4.353, 5.800, P<0.05). There was no statistically significant difference in the frequency of occurrence of falling, suffocation, self-injury, and misuse between the two groups (P>0.05). The severity of patients with falls in group A was higher than that in group B (Z=-2.124, P<0.05). The satisfaction of nursing in group B was 79.53% (1 041/1 309), the satisfaction of nursing in group A was 57.15%(719/1 258), and the satisfaction degree in group B was better than that in group A. The data were statistically significant (Z=-15.238, χ2=148.962, P <0.05). Conclusions The use of ACMMM management model for long-term hospitalized elderly patients with nursing intervention can effectively reduce the incidence of unsafe events in elderly patients, reduce the severity of falls and other related injuries, and effectively improve patient care satisfaction.