ABSTRACT
Background: Surgical informed consent is an essential part of a surgical procedure that is based on good communication between patients and physicians. Informed consent is an important part of medical practices worldwide that goes beyond just a signature; it equips patients with knowledge that helps them in making decisions. Aim: We aimed to evaluate the surgical team’s role and level of knowledge of informed consent for an upcoming procedure. Methods: Between May 2018 and June 2018, we conducted a cross-sectional study among 255 doctors at King Abdulaziz University Hospital, Jeddah, Saudi Arabia to evaluate their experiences of obtaining patient consent. Data for this research were collected using a 14-point questionnaire and entered into Microsoft Excel. Statistical analysis was performed with SPSS, version 21. Descriptive statistics and a chi-squared test were applied to analyze the data. Results: Of the 188 participants who returned the questionnaire, 95.2% had experience obtaining surgical consent. Approximately 35.5% of interns, 78.9% of junior residents, 87.5% of senior residents, and 54.5% of specialists mentioned that they always take consent from patients; 37.2% reported knowledge of “all” steps of surgical procedures. Seventy-seven participants claimed to know “all” the risks of surgical procedures. Interns were the least comfortable while taking consent. Conclusion: SIC is an essential ethical skill and an integral part of any surgical procedure. Senior doctors, who are the most eligible and qualified, usually facilitate the SIC process. Nevertheless, SIC is also facilitated by a non-negligible number of unqualified junior doctors.
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The concept and the importance of non-technical skills, relevant influence factors and assessment tools were reviewed. Introduction of non-technical skills measuring tool used at home and abroad from object, content, evaluation method, the result and the application status, then puts forward thinking for the lack of assessment tools. To evaluate the present situation of non-technical skills of the surgical team and members as well as to offer suggestion to improve training effect.
ABSTRACT
The concept and the importance of non-technical skills, relevant influence factors and assessment tools were reviewed. Introduction of non-technical skills measuring tool used at home and abroad from object, content, evaluation method, the result and the application status, then puts forward thinking for the lack of assessment tools. To evaluate the present situation of non-technical skills of the surgical team and members as well as to offer suggestion to improve training effect.
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Objective: To assess the quality of isolated coronary artery bypass grafting (CABG) in order to provide the decision support for medical quality management. Methods: Clinical information for adult patients who received CABG in our hospital during 2014 was collected. End point events were defined by major complications and mortality within 30 days after the operation. Taking SinoSCORE as risk variables, hierarchical Logistic regression model was conducted to make risk adjustment, Bootstrap method was used for simulation, we obtained RSMCR (risk-standardized major complication rate) and 95%CI. Results: There were 138/3785 (3.65%) patients with single CABG suffered from end point events.The range of un-adjusted end point events was (2.53%-6.09%) among 9 surgical teams (units), pre-operative risk condition was different among 9 units, SinoSCORE showed P<0.05 and with risk adjustment,the range of RSMCRs was(3.12%-4.82%); after Bootstrap simulation, one unit had the upper limit of RSMCR 95%CI(2.85%-3.61%) which was lower than the average and another unit had the lower limit of RSMCR 95%CI (3.81%-5.40%) which was higher than the average, RSMCR in the rest 7 units was similar. Conclusion: We made an objective evaluation for surgery quality in 9 adult care units by risk adjustment method andprovided a decision-making basis for improving medical quality management.
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Medical care on the battlefield is the core and basis of echelons of care.This review summarizes the background and characteristics of medical care units on the battlefield from the birth and growth of mobile army surgical hospitals before being replaced by forward surgical teams and combat support hospitals, since the United States Armed Forces began to lead the world military revolution during and after the World WarⅡ.Quick adaptation to the combat envi-ronment and the combat modes is the main reason that medical care units on the battlefield are adjusted continuously.This paper may provide some ideas for the development of our medical care units on the battlefield in the future.
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The U.S.Armed Forces Forward Surgical Team ( FST) was first used in the Gulf War , while Operation Iraqi Freedom and Operation Enduring Freedom represented the largest military operations to date in which the FST has been utilized.The FST was an integral and major component of the Medical Brigade and provided support for echelon Ⅱmedical care.This paper describes the development of FST , investigates the roles, organization and training of FST and finally brings forward some enlightenment for health service development of Chinese PLA .
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Objective To select the best plan for establishing frontline surgical team (FST) for emergency medical relief based on the characteristics of health service for non-battle military missions, hoping to provide theoretical reference and evidence for establishing FST. Methods This study proposed 4 options to setup FST, including establishing a new one (PI), integration of professional operation teams (P2), selected group from field medical unit (P3), and modification of existing field medical team (P4). The analytic hierarchy process (AHP) was used to analyze the relevant factors influencing the establishment of FST, in an effort to build a hierarchical model diagram and to form a judgment matrix score of four scenarios; the four programs was evaluated by consulting experts and calculating the index weights and general weights. Results The consistency of matrix test results was judged as CR<0. 10, with the weights of the program scores being P1 =0. 213 8, P2 = 0. 242 0, P3 = 0.205 4, and P4 = 0. 338 8. Conclusion Application of AHP can achieve satisfactory result in selecting optimal plan for establishing FST; the optimal option to establish FST is to convert the existing field medical team (P4).
ABSTRACT
A prática da degermação cirúrgica das mãos e antebraço da equipe como preparo pré-operatório teve sua origem há 150 anos e faz parte das medidas de controle para a prevenção de infecção hospitalar até os dias de hoje. Apesar dos avanços nas formulações dos anti-sépticos, o uso de artefatos como escova e esponja ainda persiste na maioria dos hospitais sem uma reavaliação quanto a sua real necessidade. Realizou-se um estudo comparativo da redução da carga microbiana da pele após a degermação cirúrgica das mãos com gluconato de clorexidina a 2% sob fricção com escova, fricção com esponja e fricção sem artefato. A eficácia dos três métodos de degermação foi avaliada segundo o método de "caldo de luva" em 32 voluntários. O contingente microbiano foi similar no momento inicial nos três métodos avaliados. Os resultados dos voluntários dos casos considerados válidos segundo os critérios de inclusão identificaram uma redução significativa da carga microbiana após a degermação cirúrgica das mãos com o uso da escova e sem artefato, sendo equivalente nos três métodos avaliados, o que subsidia a possibilidade de excluir o uso de artefato nos procedimentos da degermação das mãos e antebraço da equipe cirúrgica como preparo pré-operatório
The practice of surgical disinfection of the hands and forearms as preoperative preparation dates back 150 years and forms part of the control measures for the prevention of hospital infecction up to present times. Despite advances in the formulations of antiseptics, the use of the artefact, the use of the artefact as brush and sponge still continues in the majority of hospitals without any re-evaluation as to its real necessity. A comparative study into the reduction of microbial load in the skin after surgical disinfection of the hands using chlorhexidine gluconate at 2% scrubbing with a brush, scrubbing with a sponge, and scrubbing with no artefact, was carried out. The effectiveness of the three methods of disinfection were evaluated according to a method of "glove broth" in 32 volunteers. The microbial growth was similar at the onset of the three methods evaluated. The results of volunteers in the cases considered valid according to the inclusion criteria identified a significant reduction in the microbial load after surgical disinfection of the hands with the use of a brush, sponge and no artefact was equal in the three methods evaluated, wich supports the possibility of excluding the use of an artefact in the disinfection procedures of the hands and forearms of the surgical team as preoperative procedure