Transformação digital na enfermagem perioperatória / Digital transformation in perioperative nursing / Transformación digital en enfermería perioperatoria

Objetivo: Promover a reflexão sobre os efeitos da transformação digital na enfermagem perioperatória. Métodos: Estudo reflexivo baseado em dados da literatura associado a prática do autor na enfermagem perioperatória e no projeto de automação. Resultados: evidenciou-se um misto de competências para enfermagem perioperatória, como atividades relacionadas a busca pelo hospital digital, uso da inteligência artificial e robótica. Conclusão: a reflexão deste tema incentiva o enfermeiro na busca de pesquisa, desenvolvimento digital e novos conhecimentos na área digital associados à sua prática clínica. (AU)

Objective: To promote reflection on the effects of digital transformation in perioperative nursing. Methods: Reflective study based on literature data associated with the author's practice in perioperative nursing and automation project. Results: a mix of skills for perioperative nursing was evidenced, such as activities related to the search for the digital hospital, use of artificial intelligence and robotics. Conclusion: the reflection on this theme encourages nurses to search for research, digital development and new knowledge in the digital area associated with their clinical practice. (AU)

Objetivo: Promover la reflexión sobre los efectos de la transformación digital en la enfermería perioperatoria. Métodos: Estudio reflexivo basado en datos de la literatura asociados a la práctica del autor en enfermería perioperatoria y proyecto de automatización. Resultados: se evidenció una mezcla de habilidades para la enfermería perioperatoria, como actividades relacionadas con la búsqueda del hospital digital, uso de inteligencia artificial y robótica. Conclusión: la reflexión sobre este tema anima al enfermero a buscar investigación, desarrollo digital y nuevos conocimientos en el área digital asociados a su práctica clínica. (AU)

El humo del electrocauterio, el riesgo olvidado y minimizado de la cirugía / Smoke from electrocautery, the forgotten and minimized risk of surgery

Introducción. La nueva era de la cirugía es cada vez más dependiente de la tecnología, y un ejemplo de ello es el uso generalizado de electrocauterio como parte primordial de la práctica quirúrgica. El humo quirúrgico es un subproducto de la disección y la coagulación de los tejidos producidas por los equipos de energía, que representa múltiples riesgos potenciales para la salud del grupo quirúrgico, sin embargo, se han minimizado los peligros causados por la exposición de manera frecuente y acumulativa a este aerosol. Métodos. Se realizó un análisis crítico, desde una posición reflexiva de la información disponible, estableciendo los posibles riesgos relacionados con la exposición al humo quirúrgico. Discusión. Es visible la necesidad imperativa de establecer directrices nacionales, pautas normativas y recomendaciones estandarizadas para cumplir con las exigencias dadas por los sistemas de gestión en salud ocupacional y seguridad del trabajo, cuyo objetivo principal es hacer efectivo el uso de mascarillas quirúrgicas apropiadas, la implementación de programa de vigilancia epidemiológica ambiental en sala de cirugía, la priorización del uso constante de aspiradores y sistemas de evacuación, y la ejecución de programas educativos de sensibilización dirigidos al personal implicado. De igual manera, se abre la inquietud de la necesidad de nuevos estudios para definir con mayor precisión el peligro de este aerosol. Conclusión. Se recomienda de manera responsable utilizar todas las estrategias preventivas existentes para intervenir en salas de cirugía los riesgos minimizados y olvidados del humo quirúrgico.

Introduction. The new era of surgery is increasingly dependent on technology, and an example of this is the widespread use of electrocautery as a primary part of surgical practice. Surgical smoke is a byproduct of the dissection and coagulation of tissues produced by energy equipment, which represents multiple potential health risks for the surgical group; however, the dangers caused by cumulative exposure have been minimized. Methods. A critical analysis was carried out from a reflective position of the available information, establishing the possible risks related to exposure to surgical smoke. Discussion. The imperative need to establish national normative guidelines and standardized recommendations to comply with the demands given by the occupational health and work safety management systems, whose main objective is to make effective the use of appropriate surgical masks, implementation of environmental epidemiological surveillance program in the operating room, prioritizing the constant use of vacuum cleaners and evacuation systems, and carrying out educational awareness programs aimed at the personnel involved. Likewise, there is concern about the need for new studies to more precisely define the danger of this aerosol. Conclusion. It is recommended to responsibly use all existing preventive strategies to intervene in operating rooms to minimize the forgotten risks of surgical smoke.

Reflexiones para optimizar el triaje en cirugía / Reflections to optimize triage in surgery

Introducción: La categorización de las urgencias quirúrgicas es una necesidad en razón al continuo desequilibrio entre la oferta y la demanda de servicios quirúrgicos en la mayoría de las instituciones donde se encuentra habilitada la prestación del servicio. Hay abordajes en el tema, con estrategias de priorización de los casos quirúrgicos, que consideran escalas y flujogramas, pero su ausente validez externa y las particularidades de las instituciones y aseguradores, han limitado una generalización de los resultados. Métodos: Se efectúa una conceptualización del triaje de las urgencias quirúrgicas con planteamientos críticos y reflexivos soportados en la evidencia. Se identifican, asimismo, las posibles oportunidades para la investigación. Discusión: Los beneficios potenciales de un triaje quirúrgico en situaciones de urgencia, son extensivos a todos los actores del sistema de salud, disminuyen la posibilidad de desenlaces y repercusiones económicas negativas para las instituciones y los aseguradores. La teoría de las colas ofrece el soporte para un entendimiento del tema y contribuye en las soluciones. Su adopción es escasa como parte de una estrategia local de priorización quirúrgica en un contexto de urgencia. Conclusión:La creación de estrategias que establezcan el triaje para el paciente con una urgencia quirúrgica están influenciadas por la participación continua y efectiva de los actores involucrados en el proceso y en su impacto en los desenlaces clínicos

Introduction: Categorizing surgical emergencies is necessary due to the continued imbalance between the supply and demand of surgical services in most institutions where the service is enabled. There are approaches to the subject, with strategies for prioritizing surgical cases, which consider scales and flowcharts, but their lack of external validity and the particularities of the institutions and insurers have limited the generalization of the results. Methods: A conceptualization of the triage of surgical emergencies is carried out with critical and reflective approaches supported by evidence. Potential research opportunities are also identified. Discussion: The potential benefits of surgical triage in emergent situations are extensive to all health system actors, reducing the possibility of adverse outcomes and economic repercussions for institutions and insurers. Queuing theory offers support for understanding the issue and contributes to solutions. However, its adoption is scarce in an emergency as part of a local surgical prioritization strategy. Conclusion: The creation of strategies that establish triage for the patient with a surgical emergency is influenced by the continuous and effective participation of the actors involved in the process and its impact on clinical outcomes

Clinical Prediction Model for Diabetic Kidney Disease Based on Optical Coherence Tomography Angiography / 中山大学学报(医学科学版)

ObjectiveTo construct and validate a clinical prediction model for diabetic kidney disease （DKD） based on optical coherence tomography angiography （OCTA）. MethodsThis study enrolled 567 diabetes patients. The random forest algorithm as well as logistic regression analysis were applied to construct the prediction model. The model discrimination and clinical usefulness were evaluated by receiver operating characteristic curve （ROC） and decision curve analysis （DCA）， respectively. ResultsThe clinical prediction model for DKD based on OCTA was constructed with area under the curve （AUC） of 0.878 and Brier score of 0.11. ConclusionsThrough multidimensional verification， the clinical prediction nomogram model based on OCTA allowed for early warning and advanced intervention of DKD.

Relationship between influencing factors of operation time and postoperative complications in hand-assisted laparoscopic living donor nephrectomy / 器官移植

Objective To identify the influencing factors of operation time of hand-assisted laparoscopic living donor nephrectomy, and to analyze the relationship between influencing factors and the severity of postoperative complications. Methods Clinical data of 91 donors who underwent hand-assisted laparoscopic nephrectomy were retrospectively analyzed. The correlation between preoperative baseline data of donors and operation time was analyzed. The relationship between operation time and postoperative complications was assessed and the threshold of operation time was determined. Results Multiple donor renal arteries, thick perirenal and posterior renal fat, metabolic syndrome, high Mayo adhesive probability (MAP) score and Clavien-Dindo score prolonged the operation time. By analyzing the receiver operating characteristic (ROC) curve, we found that when the operation time was ≥138 min, the incidence of postoperative complications of donors was significantly increased (P<0.05). Conclusions For donors with multiple renal arteries, thick perirenal and posterior renal fat, metabolic syndrome and high MAP score and Clavien-Dindo score, experienced surgeons should be selected to make adequate preoperative preparation and pay close attention after surgery, so as to timely detect postoperative complications and reduce the severity of complications, enhance clinical prognosis of the donors.

Ultrassonografia na prática assistencial do enfermeiro do bloco operatório: revisão de escopo / Ultrasound in the care practice of the nurse in the operating room: scope review

OBJETIVO: identificar na literatura científica aplicações para o uso da ultrassonografia por enfermeiros no bloco operatório. MÉTODO: revisão de escopo realizada de acordo com a metodologia proposta pelo Instituto Joanna Briggs para responder à pergunta norteadora: Quais os possíveis usos da ultrassonografia por enfermeiros do bloco operatório? Os artigos foram buscados nas principais bases internacionais de literatura científica e cinzenta. Os descritores utilizados serão ultrassonografia e centros cirúrgicos. A pesquisa se orientou pelo acrônimo P-C-C: P ­ Participantes: Equipe de Enfermagem do Centro Cirúrgico; C ­ Conceito: Ultrassonografia; C - Contexto: Centro Cirúrgico. Registro do protocolo: osf.io/p8zne. RESULTADOS: os estudos encontrados versavam sobre três usos principais da ultrassonografia para enfermeiros perioperatórios no cenário do bloco operatório: avaliação gástrica (N=7), avaliação de conteúdo vesical (N=10) e auxiliar para punção periférica venosa e arterial (N=3). CONCLUSÃO: os enfermeiros perioperatórios devem buscar formação para práticas avançadas incluindo o uso de ultrassonografia como auxiliar em sua prática.

OBJECTIVE: To identify applications for using ultrasonography by nurses in the operating room in the scientific literature. METHOD: Scope review carried out according to the methodology proposed by the Joanna Briggs Institute to answer the guiding question: What are the possible uses of ultrasound by nurses in the operating room? The articles were sought in the main international scientific and gray literature bases. The descriptors used will be ultrasonography and surgical centers. The research was guided by the acronym P-C-C: P ­ Participants: Surgical Center Nursing Team; C - Concept: Ultrasound; C - Context: Surgical Center. Protocol Registration: osf.io/p8zne. RESULTS: The studies found covered three main uses of ultrasound for perioperative nurses in the operating room scenario: gastric evaluation (N=7), evaluation of vesical content (N=10), and auxiliary for venous and arterial peripheral puncture (N=3). CONCLUSION: Perioperative nurses should seek training for advanced practices, including using ultrasound to aid in their practice.

Metrics of efficient use of operating rooms during the SARS-CoV-2 (COVID-19) pandemic / Métrica de indicadores de uso eficiente de quirófano durante la pandemia por SARS-CoV-2 (COVID-19)

Abstract: Introduction: the COVID-19 pandemic has induced a transformation in the way hospitals function, causing a decrease in the time and efforts dedicated to surgical activity, which in turn has caused delays in the surgery schedule of most hospitals. This represents a major public health problem, significantly compromising the principle of equity that inspires public health systems throughout the world. To address this problem, it would be of the utmost importance to put in place initiatives to measure and improve surgical efficiency. Objective: evaluate indicators of efficiency in the use of operating rooms during the COVID-19 pandemic. Material and methods: a descriptive, longitudinal retrospective study was conducted on 3554 patients scheduled for surgery during a one-year period of the COVID-19 pandemic. Indicators of efficiency in they use of operating rooms were measured. The data was processed using SPSS v-25.0. Results: a total of 3,554 surgeries were scheduled, 1,309 of them emergency surgeries, 1,979 elective surgeries, and 266 deferred surgeries. The following parameters were estimated: Starting time of the procedure (42.32 ± 37.04 min); opportunity for emergency surgeries (104.69 ± 102.55 min); starting time of anesthesia (10.11 ± 9.85 min); starting time of surgery (40.03 ± 24.68 min); time of admission to post-anesthesia care unit/intensive care unit (PACU/ICU) (15.35 ± 29.94 min); turnover or replacement time (177.97 ± 174.33 min); active surgery time (27.70%). Conclusions: the COVID-19 pandemic negatively impacted the indicators of efficient use of operating rooms, posing new challenges for the management and organization of surgical work.

Resumen: Introducción: la pandemia por COVID-19 ha emplazado una transformación hospitalaria, esto acarreó un decremento de la actividad quirúrgica e implicó un aplazamiento en la programación, lo que representó un problema, ya que comprometió sensiblemente el principio de equidad que inspira a los sistemas sanitarios. Así, resultó imperativa la implementación de iniciativas para medir y mejorar la eficiencia quirúrgica. Objetivo: medir los indicadores de uso eficiente del quirófano durante la pandemia por COVID-19. Material y métodos: se realizó un análisis descriptivo, longitudinal y retrospectivo en 3,554 pacientes programados para cirugía, durante la pandemia en un período de un año, además se midieron los indicadores de uso eficiente del quirófano. Los datos fueron procesados en SPSS v-25.0. Resultados: se programaron 3,554 cirugías, 1,309 urgencias, 1,979 electivas, 266 diferidas. Se estimó un tiempo de inicio del procedimiento 42.32 ± 37.04 min, oportunidad para urgencias quirúrgicas 104.69 ± 102.55 min, tiempo de inicio de anestesia 10.11 ± 9.85 min, tiempo de inicio de cirugía 40.03 ± 24.68 min, tiempo para la admisión en la unidad de cuidados postanestésicos/unidad de terapia intensiva (UCPA/UTI) 15.35 ± 29.94 min, tiempo de rotación o recambio 177.97 ± 174.33 min y tiempo quirúrgico activo 27.70%. Conclusiones: la pandemia por COVID-19 impactó negativamente en los indicadores de uso eficiente del quirófano, lo que implicará nuevos retos en la gestión y organización de la jornada quirúrgica para su mejora.

Contribution margin per hour of operating room to reallocate unutilized operating room time: a cost-effectiveness analysis

Abstract Background and objectives: Contribution margin per hour (CMH) has been proposed in healthcare systems to increase the profitability of operating suites. The aim of our study is to propose a simple and reproducible model to calculate CMH and to increase cost-effectiveness. Methods: For the ten most commonly performed surgical procedures at our Institution, we prospectively collected their diagnosis-related group (DRG) reimbursement, variable costs and mean procedural time. We quantified the portion of total staffed operating room time to be reallocated with a minimal risk of overrun. Moreover, we calculated the total CMH with a random reallocation on a first come-first served basis. Finally, prioritizing procedures with higher CMH, we ran a simulation by calculating the total CMH. Results: Over a two-months period, we identified 14.5 hours of unutilized operating room to reallocate. In the case of a random ''first come -first serve'' basis, the total earnings were 87,117 United States dollars (USD). Conversely, with a reallocation which prioritized procedures with a high CMH, it was possible to earn 140,444 USD (p < 0.001). Conclusion: Surgical activity may be one of the most profitable activities for hospitals, but a cost-effective management requires a comprehension of its cost profile. Reallocation of unused operating room time according to CMH may represent a simple, reproducible and reliable tool for elective cases on a waiting list. In our experience, it helped improving the operating suite cost-effectiveness.

Estimación de la eficiencia del uso de pabellones electivos en el sistema de salud público chileno entre 2018 y 2021 / Efficiency estimation on the use of elective surgical theaters in the Chilean public health system from 2018 to 2021

Objective The efficient use of wards intended for elective surgeries is essential to resolve cases on the surgical waiting list. This study aims to estimate the efficiency of ward use in the Chilean public health system between 2018 and 2021. Methods The design was an ecological study. Section A.21 of the database constructed by the monthly statistical summaries that each public health network facility reported to the Ministry of Health between 2018 and 2021 was analyzed. Data from subsections A, E and F were extracted: ward staffing, total elective surgeries by specialty, number and causes of suspension of elective surgeries. Then, the surgical performance during working hours and the percentage of hourly occupancy for a working day was estimated. Additionally, an analysis was made by region with data from 2021. Results The percentage of elective wards in use ranged from 81.1% to 94.1%, while those enabled for those staffing ranged from 70.5% to 90.4% during 2018 and 2021. The total number of surgeries was highest in 2019 (n = 416 339), but for 2018, 2020, and 2021 it ranged from 259 000 to 297 000. Suspensions varied between 10.8% (2019) and 6.9% (2021), with the leading cause being patient-related. When analyzing the number of cases canceled monthly by facility, we saw that the leading cause was trade union-related. The maximum throughput of a ward intended for elective surgery was reached in 2019 and was 2.5 surgeries; in 2018, 2020 and 2021, the throughput borders on two surgeries per ward enabled for elective surgery. The percentage of ward time occupied during working hours by contract day varies between 80.7% (2018) and 56.8% (2020). Conclusions All the parameters found and estimated in this study show that there is an inefficient utilization of operating rooms in Chilean public healthcare facilities.

Objetivo El uso eficiente de pabellones destinados a cirugías electivas es fundamental para resolver patologías en lista de espera quirúrgica. El objetivo general de este estudio es estimar la eficiencia del uso de pabellones en el sistema de salud público de Chile entre los años 2018 y 2021. Métodos El diseño fue un estudio ecológico. Se analizó la Sección A.21 de la base de datos construida por los resúmenes estadísticos mensuales que cada establecimiento de la red de salud pública reportó al Ministerio de Salud de Chile entre 2018 y 2021. Se extrajeron los datos de la subsección A, E y F: dotación de pabellones, total de cirugías electivas por especialidad, número y causas de suspensión de cirugías electivas. Luego se estimó el rendimiento quirúrgico en horario hábil y el porcentaje de ocupación horaria respecto de una jornada laboral. Adicionalmente, se hizo un análisis por región con datos de 2021. Resultados El porcentaje de pabellones electivos respecto de los en dotación varió entre 81,1 y 94,1%; mientras que los habilitados respecto de los en dotación varió entre 70,5 y 90,4% durante 2018 y 2021. El número total de cirugías fue más alto en 2019 (n = 416 339), pero en 2018, 2020 y 2021 variaron entre 259 y 297 mil cirugías. Las suspensiones varían entre 10,8 (2019) y 6,9%w(2021), siendo la principal causa de suspensión atribuida al "paciente". Al analizar la cantidad de pacientes suspendidos mensualmente por institución, se observa que la principal causa es "gremial". El rendimiento máximo de un pabellón destinado a cirugía electiva se alcanzó en 2019 y fue de 2,5 cirugías; mientras que en 2018, 2020 y 2021 el rendimiento bordea las dos cirugías por pabellón habilitado para cirugía electiva. El porcentaje de tiempo de pabellón ocupado en horario hábil respecto a una jornada de contrato varía entre 80,7 (2018) y 56,8% (2020). Conclusiones Todos los parámetros encontrados y estimados en este estudio muestran que el uso de pabellones en el sistema público de Chile es ineficiente.

Safety culture among operating room healthcare workers: still a long way to go. An analytical cross-sectional study from Turkey

Introduction: safety culture attitudes of health workers are still not at the desired level. Although the creation of patient safety culture is important for all health care environments, it is more vital for critical units. Objective: to determine the patient safety culture levels of those working in the operating room environment and compare them with the 2008 results of the same hospitals. Materials and Methods: an analytical cross-sectional study was conducted in 2017-2018. The Turkish version of the Hospital Survey on Patient Safety Culture was administered to nurses, anesthesia technicians, assistant physicians, and specialist physicians working in the Operating Rooms (n=258) of two university hospitals in Konya, a large city in Anatolian region of Turkey. Results: average percent positive response to the 42 items was low (41%, n=258). While there was no change in one dimension of the questionnaire compared to 2008; there was a positive change in 8 dimensions and a negative change in 3 dimensions. All 12 dimensions were lower than the Agency for Healthcare Research and Quality score. Discussion: Despite many studies, policy developments and interventions on patient safety, the improvement of a patient safety culture is very slowly in Turkey as in other countries. Conclusion: non-reporting of errors and a punitive approach in case of errors are still considered the most important problems.

Introducción: las actitudes del personal de salud frente a la cultura de la seguridad siguen sin alcanzar su nivel deseado. Aunque la creación de una cultura de seguridad del paciente es importante en todos los entornos de cuidado, es vital en las unidades de cuidado crítico. Objetivo: determinar los niveles de cultura de seguridad del paciente de quienes trabajan en quirófanos y compararlos con los 2008 resultados de los mismos hospitales. Materiales y métodos: se realizó un estudio transversal analítico entre 2017 y 2018. La versión en turco de la Encuesta Hospitalaria sobre Cultura de Seguridad del Paciente se administró a profesionales de enfermería, anestesistas, médicos auxiliares y médicos especialistas que trabajaban en los quirófanos (n=258) de dos hospitales universitarios de Konya, una ciudad de la región de Anatolia en Turquía. Resultados: El porcentaje medio de respuestas positivas a los 42 ítems fue bajo (41%, n=258). Si bien no hubo cambios en una dimensión del cuestionario en comparación con los 2008 resultados, hubo un cambio positivo en 8 dimensiones y un cambio negativo en 3 dimensiones. Las 12 dimensiones presentaron una puntuación inferior a la de la Agencia para la Investigación y la Calidad del Cuidado de la Salud. Discusión: A pesar de los numerosos estudios, desarrollos en política e intervenciones en materia de seguridad del paciente, la mejora de la cultura de seguridad del paciente es muy lenta en Turquía, al igual que en otros países. Conclusión: No notificar errores y un enfoque punitivo en caso de error siguen considerándose los problemas más importantes.

Introdução: as atitudes de cultura de segurança dos profissionais de saúde ainda não estão no nível desejado. Embora a criação da cultura de segurança do paciente seja importante para todos os ambientes de assistência médica, ela é mais vital para as unidades críticas. Objetivo: determinar os níveis de cultura de segurança do paciente daqueles que trabalham no ambiente da sala de cirurgia e compará-los com os resultados de 2008 dos mesmos hospitais. Materiais e Métodos: um estudo analítico de corte transversal foi realizado em 2017-2018. A versão turca da Pesquisa Hospitalar sobre Cultura de Segurança do Paciente foi aplicada a enfermeiros, técnicos de anestesia, médicos assistentes e médicos especialistas que trabalham nas salas de cirurgia (n=258) de dois hospitais universitários em Konya, uma grande cidade na região da Anatólia, Turquia. Resultados: a porcentagem média de respostas positivas aos 42 itens foi baixa (41%, n=258). Embora não tenha havido alteração em uma dimensão do questionário em comparação com 2008, houve uma alteração positiva em 8 dimensões e uma alteração negativa em 3 dimensões. Todas as 12 dimensões foram inferiores à pontuação da Agency for Healthcare Research and Quality. Discussão: Apesar de muitos estudos, desenvolvimentos de políticas e intervenções sobre a segurança do paciente, o aprimoramento de uma cultura de segurança do paciente é muito lento na Turquia, assim como em outros países. Conclusão: a não notificação de erros e uma abordagem punitiva em caso de erros ainda são considerados os problemas mais importantes.

Adverse events in anesthesia: Analysis of claims against anesthesiologists affiliated to an insurance fund in Colombia. Cross-sectional study / Eventos adversos en anestesia: Análisis de las reclamaciones contra anestesiólogos afiliados a un fondo de aseguramiento en Colombia. Estudio de corte transversal

Abstract Introduction: Prevention, identification, analysis and reduction of adverse events (AEs) are all activities designed to increase safety of care in the clinical setting. Closed claims reviews are a strategy that allows to identify patient safety issues. This study analyzes adverse events resulting in malpractice lawsuits against anesthesiologists affiliated to an insurance fund in Colombia between 2013-2019. Objective: To analyze adverse events in closed medicolegal lawsuits against anesthesiologists affiliated to an insurance fund between 2013-2019. Methods: Cross-sectional observational study. Convenience sampling was used, including all closed claims in which anesthesiologists affiliated to an insurance fund in Colombia were sued during the observation period. Variables associated with the occurrence of AEs were analyzed. Results: Overall, 71 claims were analyzed, of which 33.5% were due to anesthesia-related AEs. Adverse events were found more frequently among ASA I-II patients (78.9%), and in surgical procedures (95.8%). The highest number of adverse events occurred in plastic surgery (29.6%); the event with the highest proportion was patient death (43.7%). Flaws in clinical records and failure to comply with the standards were found in a substantial number of cases. Conclusions: When compared with a previously published study in the same population, an increase in ethical, disciplinary and administrative claims was found, driven by events not directly related to anesthesia. Most of the anesthesia-related events occurred in the operating room during surgical procedures in patients and procedures categorized as low risk, and most of them were preventable.

Resumen Introducción: La prevención, identificación, análisis y reducción de los eventos adversos (EA), son actividades direccionadas a incrementar la seguridad de la atención en el entorno clínico. El estudio de los casos cerrados es una estrategia que permite identificar problemas relacionados con la seguridad del paciente. En este estudio se analizan eventos adversos conducentes a procesos medicolegales cerrados contra anestesiólogos afiliados a un fondo de aseguramiento en Colombia entre 2013-2019. Objetivo: Analizar los eventos adversos en procesos medicolegales cerrados de anestesiólogos afiliados a un fondo de aseguramiento entre 2013-2019. Métodos: Estudio observacional de corte transversal. Se analizó una muestra a conveniencia en la que se incluyeron todos los casos cerrados en los que anestesiólogos afiliados a un fondo de aseguramiento en Colombia fueron objeto de reclamaciones en el período de observación. Se analizaron variables relacionadas con la presentación del EA. Resultados: Se analizaron 71 reclamaciones, de las cuales el 33,5 % fueron por EA relacionado con anestesia. Los eventos adversos se encontraron con mayor frecuencia en pacientes ASA I-II (78,9 %), y en procedimientos quirúrgicos (95,8 %). El mayor número de eventos adversos se presentó en cirugía plástica (29,6 %); el evento de mayor proporción fue el fallecimiento del paciente (43,7 %). En un importante número de casos se demostró fallos en el registro de la historia clínica e incumplimiento de normas. Conclusiones: En relación con un estudio publicado previamente en la misma población, se encuentra un incremento en los procesos éticos, disciplinarios y administrativos, motivados por eventos sin una relación directa con el acto anestésico. La mayoría de eventos adversos relacionados con anestesia se presentan en procedimientos quirúrgicos, en salas de cirugía, en pacientes y procedimientos catalogados como de bajo riesgo, y son en su mayoría prevenibles.

Relevance of Project Evaluation and Review Technique (PERT) for Procurement of Equipments in a Government Medical College and Hospital in North-East India

Introduction: Continuous procurement of various equipments in the hospitals is essential to keep up with global progress of healthcare services. In public sectors, procurement process largely depends on budget sanctions and also by a number of formal procedures and rules which leads to delayed procurement. With this prevalent scenario, the present study was carried out to evaluate the procurement of two major equipments in an apex tertiary care institute using Project Evaluation and Review Technique (PERT). Objective: This study was done to evaluate the procurement of two major equipments using PERT in a tertiary care institute. Method: This study was conducted using Operational Research technique in an apex tertiary care institute i.e., medical college and hospital, in one of the North Eastern states of India. All the procurements related to equipments in that teaching hospital initiated in the financial year 2021 were listed. Out of them, two procurement files were selected by simple random sampling; procurement of Operating Table and Bio Safety cabinet Level – III. Project Evaluation and Review Technique (PERT) was applied to calculate the possible reduction in time in the whole procurement process. Results: The present study showed that procurement of Operating table took 185 days where minimum 8 days could have been saved and procurement of Bio-Safety cabinet Level-III was completed by 702 days where minimum 196 days could have been saved. Conclusion: Application of PERT in this procurement evaluation process can play significant role by calculating critical path and predicting the possible delay.

Insuficientes políticas universitarias sobre integridad científica y su relación con la denegación de licenciamiento institucional

El objetivo del estudio fue analizar la relación existente entre las políticas institucionales sobre integridad científica y la obtención de licenciamiento en universidades peruanas. Se trata de un estudio descriptivo de observación documental y análisis de la normativa peruana sobre evaluación de la calidad universitaria, licenciamiento de universidades, normativa de integridad científica y resoluciones de denegación de licencias de funcionamiento de universidades. Se encontró que, de las 48 universidades y 2 escuelas de postgrado que no demostraron en su evaluación el cumplimiento de las Condiciones Básicas de Calidad, bajo el Modelo de Licenciamiento Institucional, 32 universidades y 1 escuela de postgrado (66%) han sido observadas por presentar deficiencias en aspectos relacionados con políticas de integridad científica requisitas. El estudio concluye en que la política universitaria de integridad científica es un criterio importante para recibir el Licenciamiento Institucional en el sistema universitario peruano.

The aim of this study was to analyze the relation between institutional policies on scientific integrity and licensing of Peruvian universities. It is a descriptive study analyzing Peruvian regulations on university quality assessment, university licensing (accreditation), scientific integrity regulations and the denial of university operating licenses. It was found that, of the 48 universities and 2 graduate schools that did not meet the Basic Quality Conditions under the Peruvian Institutional Licensing Model, 32 universities and 1 graduate school (66%) had deficiencies related to required scientific integrity policies. The study concludes that universities' scientific integrity policies are an important criterion for receiving Institutional Licensing in the Peruvian university system.

Visual analysis of occupational health and safety research among medical staff / 中国职业医学

Objective: To study the current status, hotspots and frontiers in the field of occupational health and safety (OHS) research among medical staff. Methods: A comprehensive search on OHS of domestic and international literature on medical staff was conducted using the China National Knowledge Infrastructure and Web of Science databases from 2002 to 2022. The collected literature was subjected to bibliometric analysis and visualized using CiteSpace 6.1.R6 software. Results: A total of 5 858 articles related to medical personnel OHS comprising 2 144 Chinese articles and 3 714 English articles, were included. The publication of Chinese articles showed an initial increase followed by a decline, while English articles exhibited a sustained increase followed by a sudden decline. Domestic research mainly focused on hospitals and academic institutions, with few collaboration between institutions and regions in China. Research abroad demonstrated strong collaboration and exchange between countries and institutions. The OHS related research hotspots were occupational exposure, occupational health, and occupational safety of medical personnel at home and abroad. The key department of interest was operating rooms, and the key group personnel was nurses. Advanced research in foreign countries has extended to fields such as personal protective equipment and medical personnel sleep issues. Conclusion: There is still a gap on OHS research among medical staff between China and foreign countries. Domestic scholars need to grasp the academic frontiers, strengthen collaboration and exchange among domestic institutions, regions, and international counterparts, enlarge the research scope and content to ensure the OHS of medical personnel.

One-stop intravitreal injection model: expert consensus on establishment and management / 中华眼底病杂志

Intravitreal drug injection is a treatment for common chronic fundus diseases such as age-related macular degeneration and diabetic retinopathy. The "14th Five-Year" National Eye Health Plan (2021-2025) recommends focusing on fundus diseases and improve the management mode of patients with chronic eye diseases. Therefore, it is imperative to explore how to further optimize the service process of intravitreal injection under the premise of guaranteeing patients' medical safety, to promote medical service efficiency and standardized management level and improve the medical experience of patients. Based on the quality control standard of vitreous cavity injection for retinopathy in China, Chinese fundus disease and related field experts developed the present expert consensus on the establishment of a one-stop intravitreal injection model and the management of its organization after a serious, comprehensive, and complete discussion, focusing on a standardized operation process, quality control, and safety management, providing more references for establishing a suitable intravitreal injection management model for ophthalmology and promoting the development of diagnostic and treatment models for fundus disease in China.

Current situation and effect evaluation of mobile applications for physical activity management in China / 中华健康管理学杂志

Objective:To analyze the current situation and effect of mobile applications for physical activity management in China.Methods:In this systematic review, search terms such as “exercise”, “sports”, “exercise”, “physical activity” and “mobile health” were used to retrieve the applications for physical activity management in the IOS Application Store developed in mainland of China. Then the Mobile Application Rating Scale (MARS) and the Behavior Change Technology (BCT) were used to evaluate the quality of the applications and analyze the behavior change technologies that applications adopted. Moreover, a systematic review of relevant experimental studies was applied to summarize the effectiveness of the applications in promoting physical activity.Results:Total of 141 applications were included in this analysis, and 58 behavior change techniques in 16 categories were applied. The most frequently used 4 categories of BCT were behavior comparison (67.4%), repetition and substitution (67.4%), knowledge construction (67.4%), feedback and monitoring (58.2%). The overall objective quality score of MARS was 3.17±0.42, of which, the score of engagements, functionality, aesthetic design and information quality was 2.67±0.73, 3.75±0.54, 3.44±0.59 and 2.83±0.55, respectively. The number of BCT adopted in each application had a linear relationship with the application′s objective quality score in MARS ( B=0.023, 95% CI: 0.018-0.029) and user rating ( B=0.040, 95% CI: 0.019-0.060) (both P<0.001). A total of 4 articles were included to test the effects of techniques (i.e., physical activity behavior monitoring, physical activity planning and physical activity guidance) in 4 applications. The overall quality of the literatures was good. The main outcomes were physical activity duration (3 articles) and step count (1 article). Compared with those who did not use the application or only used the accelerometer to monitor physical activity, subjects who used the application to monitor physical activity had significant longer physical activity durations and step count (both P<0.05). Conclusions:The number, function and technology of physical activity management applications in China are abundant, but the quality of the applications is moderate. The number of BCT is an important factor in evaluating application′s quality, but its effect on behavior change is still not clear.

Efficacy evaluation of cluster nursing in robot-assisted surgery for the treatment of reducible atlantoaxial dislocation / 中华创伤杂志

Objective:To explore the effect of cluster nursing in robot-assisted surgery for the treatment of reducible atlantoaxial dislocation.Methods:A retrospective cohort study was conducted to analyze the clinical data of 41 patients with reducible atlantoaxial dislocation treated by robot-assisted surgery in Honghui Hospital affiliated to Xi′an Jiaotong University from January 2019 to December 2021, including 28 males and 13 females; aged 18-79 years [(45.2±10.3)years]. Ninteen patients received cluster nursing (cluster nursing group), with operating room nursing team set up on the basis of routine nursing and performed cluster nursing in line with evidence-based medicine. Twenty-two patients received routine nursing (routine nursing group). The operation time, intraoperative blood loss, frequency of intraoperative C-arm fluoroscopy, time of drainage tube placement and chief surgeon′s satisfaction for nursing were compared between the two groups. The degree of pain was evaluated by pain numerical score (NRS) at 12 hours, 24 hours, 48 hours, 72 hours, 1 month and 3 months after operation and at the last follow-up. The neck disability index (NDI) was assessed at 1 day before operation, 1 month after operation, 3 months after operation and at the last follow-up. The complications were observed.Results:All patients were followed up for 12-18 months [(16.7±3.7)months]. The operation time, intraoperative blood loss, frequency of C-arm fluoroscopy and time of drainage tube placement in cluster nursing group were (82.9±10.4)minutes, (105.9±11.8)ml, (3.8±0.6)times and (1.5±0.4)days, while those in routine nursing group were (125.7±12.8)minutes, (208.4±13.8)ml, (9.7±2.3)times and (3.6±0.6)days, respectively (all P<0.01). The chief surgeon′s satisfaction for nursing was 94.7% (18/19) in cluster nursing group and was 68.2% (15/22) in routine nursing group ( P<0.05). The NRS in cluster nursing group was (6.2±0.4)points, (6.0±0.7)points, (4.9±1.1)points, (2.7±0.5)points, (1.9±0.4)points, (1.8±0.4)points and (1.5±0.3)points at 12 hours, 24 hours, 48 hours, 72 hours, 1 month and 3 months after operation and at the last follow-up, while it was (7.6±0.6)points, (6.8±1.2)points, (5.8±1.5)points, (4.2±0.8)points, (3.4±0.7)points, (2.6±0.5)points and (2.2±0.5)points in routine nursing group ( P<0.05 or 0.01). There was no significant difference in the NDI between the two groups at 1 day before operation, but the NDI in cluster nursing group was 20.6±4.5, 14.6±2.8 and 10.7±2.5 at 1 month and 3 months after operation and at the last follow-up, while it was 26.9±4.1, 18.7±3.3 and 13.7±1.7 in routine nursing group (all P<0.01). There was no hematoma, infection or implant-related complications in both groups .Conclusion:For robot-assisted surgery in the treatment of reducible atlantoaxial dislocation, cluster nursing is associated with shortened operation time and time of drainage tube placement, decreased intraoperative blood loss and frequency of intraoperative fluoroscopy, increased chief surgeon′s satisfaction for nursing, reduced pain and accelerated functional recovery.

Application of TRIZ theory in clinical teaching in orthopedic operating room / 中华医学教育探索杂志

Objective:To investigate the role of TRIZ theory in clinical teaching in orthopedic operating room.Methods:A total of 43 interns in the orthopedic operating room of our hospital from October 2019 to July 2020 were selected as control group, and 46 interns in the orthopedic operating room of our hospital from August 2020 to May 2021 were selected as observation group. The interns in the control group received traditional teaching, and those in the observation group received teaching based on TRIZ theory. The two groups were compared in terms of professional assessment results, self-evaluation, satisfaction score, and qualification of aseptic operation in orthopedic operating room. SPSS 22.0 was used to perform the t-test and the chi-square test. Results:Compared with the control group, the observation group had significantly higher theoretical knowledge score, practical skill score, and weighted total score ( t=14.90, 11.82, and 13.23, all P?0.001). Compared with the control group, the observation group also had significantly higher scores of analysis and problem-solving ability, clinical thinking, doctor-patient communication, psychological quality, clinical case analysis, self-study ability, and teaching satisfaction ( t=7.88, 11.78, 15.26, 7.94, 12.93, 9.83, and 13.22, all P?0.001). Compared with the control group, the observation group had significantly higher qualified rates of surgical hand-washing, wearing sterile surgical gowns, non-contact glove wearing; and bacteriological testing ( χ 2=4.22, 6.02, 4.92, and 7.59, P=0.040, 0.014, 0.027, and 0.006). Conclusion:TRIZ theory has a certain value in clinical teaching in orthopedic operating room and can significantly improve the scores of theoretical knowledge and practical skills, strengthen aseptic operation abilities in orthopedic operating room, and enhance the satisfaction with teaching among interns.

Value of virtual operating system for visual behavioral assessment in mice models of visual disease / 中华实验眼科杂志

Visual behaviorally operant method is one of the main detections for identifying animal models of visual diseases, which is mainly through the optomotor response (OMR) and optokinetic reflex (OKR) stimulated by the virtual operating system (VOS). The automated VOS was commonly used as a powerful tool to control the contrast sensitivity and measure the spatial frequency of the monitoring device by adjusting parameters such as grating fringe width, rotation velocity and light intensity, and also to track the OKR, OMR, and the combined movement of OKR and OMR.Both the optimized measuring methods and evaluation indicators including the search coils, the corneal labeling, OMR-arena system, the OMR index, the staircase protocol tests and the improved stimuli from two-dimensional to three-dimensional helped to ensure the validity of test data.Moreover, the introduction of image recognition technology benefited in extracting the body and head contours of mice.Computer algorithms such as deep learning were also applied to analyze and process the visual behavior of diseased mice, which promoted sensitivity, shortened testing time, reduced detection errors and improved data accuracy.For all the factors mentioned, the VOS could be used as an effective research tool for glaucoma, cataract, retinopathy, hereditary eye disease, optic nerve degeneration and others.This article reviewed the value of VOS for visual behavioral assessment in mice models of visual disease from the visual detection methods and assessment indicators.