Quest to Improve Management of Prostate Cancer in West Africa Development of a Clinical Audit Tool

In 2010 and during the following decade, two guidelines werepublished for the management of prostate cancer in West Africa.A key recommendation of the guidelines was the need for thedevelopment of a Clinical Audit Tool which should helpsurgeons and institutions to identify the gaps between therecommended standards and current practice. In this paper, aClinical Audit Tool, WAPCAT, was developed to facilitate andimplement the audit process for the management of Prostatecancer in a West African healthcare institution

Elementos facilitadores no processo de doação de órgãos na perspectiva dos profissionais / Facilitating elements in the organ donation process from the perspective of professionals

Objetivou identificar os elementos facilitadores no processo de doação de órgãos e tecidos para transplante, na perspectiva dos profissionais das Comissões Hospitalares de Transplantes. Estudo descritivo, qualitativo, realizado com 20 profissionais que compõem as Comissões Intra-Hospitalares de Doação de Órgãos e Tecidos para Transplante. A coleta de dados ocorreu por meio de entrevista semiestruturada, analisados por meio da técnica do Discurso do Sujeito Coletivo. Emergiram três ideias centrais que versaram sobre os profissionais atuantes na Terapia Intensiva e Emergência como membros da Comissão Hospitalar de Transplantes; Suporte da Central Estadual de Transplante; Coordenação da Comissão Hospitalar de Transplantes. Identificou-se como elementos facilitadores no processo de doação de órgãos e tecidos os profissionais das comissões do quadro funcional das respectivas unidades envolvidas no processo. É necessário um serviço organizado e articulado, de profissionais capacitados e de liderança resolutiva para garantir sucesso no processo de doação de órgãos e tecidos para transplantes.

This work has aimed to identify the facilitating elements in the organ and tissue donation process for transplantation from the perspective of professionals from Brazilian Hospital Transplantation Commissions. This is a descriptive, qualitative study conducted with twenty professionals who make up the In-Hospital Commissions for Organ and Tissue Donation for Transplantation. Data collection took place through semi-structured interviews analyzed using the Collective Subject Discourse technique. Three central ideas have emerged, which address the professionals working in Intensive Care and Emergency as members of the Hospital Transplantation Commission (CHT), the Support from the State Transplant Center (CET), and the Coordination of the Hospital Transplantation Commission. The facilitating elements of the organ and tissue donation process were the professionals of the commissions from the respective units involved in the process. An organized and articulated service, with trained professionals and resolute leadership, is necessary to ensure the success in the organ and tissue donation process for transplantation.

Injury patterns of patients presenting to a non-governmental hospital in Western Uganda

Introduction: Injury is a leading cause of morbidity and mortality globally and disproportionately affects low-income countries. While most injury data comes from tertiary care centers in urban settings, the purpose of this study was to describe the characteristics and severity of injury in rural Uganda and the associated treatment patterns and delays in care. Methods: This is a retrospective cohort study of a trauma registry that was implemented at Masindi-Kitara Medical Center (MKMC), a rural hospital in Western Uganda. Demographic information, injury characteristics, modified Kampala Trauma Scores (M-KTS), and treatment modalities over a 12 month period were retrospectively collected from paper-based registry forms completed for all injury patients presenting to MKMC. Results: A total of 350 patients were entered into the trauma registry. Most patients were male (71.2%) with a median age of 26.5 years. Motorcycle crashes were the most prevalent mechanism of injury (42.3%) with the majority being unhelmeted (83.3%). Soft tissue injury was the most common diagnosis (44.9%). Patients were frequently treated in the outpatient department and then discharged (54.8%). Patients requiring admission or transfer (M-KTS = 11.57 or 11.67) tended to have a lower M-KTS than discharged patients (M-KTS = 12.75). Analgesics (74.6%) and antibiotics (52.9%) were the most common treatments administered. For those patients requiring admission (29.4%), only one in-hospital death was documented. Thirty-nine percent of patients reported a delay in seeking care, most frequently due to lack of transportation (31.5%) with a median time of delay of 11 h. Conclusion: Road traffic injuries were the leading cause of injury in Masindi, with a high proportion of injuries associated with unhelmeted motorcycle crashes. Future opportunities to prevent injury and improve care may be seen through improved prehospital care, enforcement of helmet laws, increased access to neurosurgical services, and enactment of hospital quality improvement measures

Processo de trabalho da comissão de doação de órgãos e tecidos: percepção da equipe / Work process of the organ and tissue donation committee: team perception

Objective: to know the team's perception of the work process of an Intra-Hospital Transplant Organ and Tissue Donation Commission (CIHDOTT). Method: descriptive research of qualitative nature. Held with ten CIHDOTT members from a public hospital in northwestern Paraná. Single interviews were recorded, transcribed and subjected to thematic content analysis. Results:Three thematic categories emerged, which relate the daily work activities of the service, the challenges experienced in the work of CIHDOTT and themotivational factors of acting on the committee. Final Considerations: To the ceaseless work towards greater organ and tissue uptake in line with the need to comply with current legislation, workers face major challenges related to the hospital's physicalstructure and the understanding of aspects that surround their roles by professionals outside the committee. However, the humanization of the peculiar care provided and the teamwork of the current CIHDOTT motivate them.

Objetivo: conhecer a percepção da equipe sobre o processo de trabalho de uma Comissão Intra-Hospitalar de Doação de Órgãos e Tecidos para Transplante (CIHDOTT). Método: pesquisa descritiva, de natureza qualitativa. Realizada com dez membros de uma CIHDOTT de um hospital público do Noroeste do Paraná. As entrevistas individuais foram gravadas, transcritas e submetidas à análise de conteúdo temática. Resultados: Emergiram três categorias temáticas, as quais relacionam as atividades laborais cotidianas do serviço, os desafios vivenciados no trabalho da CIHDOTT e os fatores motivacionais de atuar na comissão. Considerações Finais: Ao trabalho incessante rumo à maior captação de órgãos e tecidos alinhada à necessidade de cumprir a legislação vigente, os trabalhadores enfrentam grandes desafios relacionados à estrutura física hospitalar e o entendimento de aspectos que entornam sua função por profissionais externos à comissão. Porém, a humanização do cuidado peculiar prestado e o trabalho em equipe da atual CIHDOTT os motivam.

Gestión por procesos y costos basados en actividades en una empresa de salud / Activity-based management in a healthcare business processes and costs

Introducción: El Instituto de Nutrición (IN) está dedicado al tratamiento de obesidad. Existen herramientas de gestión tales como, el enfoque basado en procesos (PR), y el costeo basado en actividades (ABC). Los objetivos del trabajo son confeccionar los PR operativos del IN; y realizar un modelo de ABC de éstos. Materiales y Métodos: para la confección de los procesos PR se siguió la sistemática de trabajo de Narbarte y Col. Para la realización del ABC se siguió la propuesta de trabajo de Quesada. Resultados: Se confeccionaron los procesos operativos, se les aplicó las herramientas de costeo. Se describieron los PR y se Confeccionaron las herramientas de control. Con la información de costos y la descripción de las actividades de los PR se realizó el modelo de ABC, obteniendo el costeo de los PR y del plan de tratamiento. Conclusiones: con la aplicación de la GP ha mejorado la forma de trabajo del IN hacia una burocracia profesional, mejorando la percepción de los clinetes desde la organización. El ABC ha permitido comprender con más profundidade los costos y trazar politicas de incentivo hacia los empleados y participantes

Summary: Introduction: The Institute of Nutrition (IN) is dedicated to the treatment of obesity. There are management tools like the process approach (PR) and activity-based costing (ABC). The objectives of this work are to make IN operative PR, and to model their ABC. Materials and Methods: to build the PR followed the systematic of Narbarte et al. and to carry out the ABC methodology, is used the work of Quesada. Results: operative PR was built, and tools were applied. PR was described and monitoring tools were constructed. With cost information and description of the activities of PR was performed ABC model, obtaining the costing of the PR and the treatment plan. Conclusions: the implementation fo the PR has imporved the way to work to a professional bureaucracy in the IN, improving customer perception from the organization. The ABC has enabled more fully understand the costs and draw incentive policies to employees and participants

Modo de actuación profesional a través del proceso de atención de enfermería en el Policlínico Universitario Julián Grimau García / Professional performance through the nursing care process in Julián Grimau García University Polyclinic

Se efectuó un estudio descriptivo y transversal de 32 enfermeras pertenecientes al Policlínico Universitario "Julián Grimau García" de Santiago de Cuba, desde agosto de 2009 hasta enero de 2010, a fin de evaluar su modo de actuación profesional mediante el Proceso de Atención de Enfermería, para lo cual se aplicó la metodología desarrollada por la Facultad de Medicina de La Habana en la evaluación de la Atención Primaria de Salud. Se conformó un grupo de especialistas, quienes procesaron los criterios, indicadores y estándares aplicados a los efectos, de donde se derivó que el nivel de competencia y desempeño profesional del grupo no eran los adecuados, así como también que los prestadores de salud estaban insatisfechos con la insuficiente preparación recibida sobre el proceso, la falta de capacitación y los resultados del trabajo respecto al programa. Se concluyó que la calidad de la atención brindada a través del Proceso de Atención de Enfermería era inadecuada.

A descriptive and cross-sectional study with 32 nurses belonging to Julián Grimau García University Polyclinic in Santiago de Cuba was carried out from August, 2009 to January, 2010, in order to evaluate their professional performance through the Nursing care Process. For this reason, a methodology devised by the Medicine Faculty in Havana taking into account the Primary Health Care assessment was applied. A group of specialists, who processed criteria, indicators, and standards applied to these effects, was created, in which case the competition level and the professional performance of the group were inadequate. Furthermore, health workers showed dissatisfaction with the insufficient training received about that process, the need of more training, and the work results related to that program. It was concluded that the health care quality offered through the Nursing Care Process was not appropriate.

Medical audit and death audit.

A good death is not a single event; a good death is a series of events, relationships and preparation that takes place over time (Evans and Walsh, 2002). [1] There is no gold standard for what constitutes a good death, the definition varies between individuals and therefore quality care must be negotiated to incorporate the individual patient values and preferences (Steinhauser et al, 2000).[2] Death audit meetings are infrequent in Government hospitals in India to analyse the circumstances which led to death of patients and what are the possible steps if taken might have prevented the death(Times of India 2004).[3] Medical audit determines the quality of medical care provided to patients from analyzing the clinical records and hospital services. In the present article we have given Idea about history, purpose, and maintenance record and analysis process. Government is planning to make infant and maternal death audit by clinical team compulsory as a part of efforts to ensure that no women and child will died in state (Andhra Pradesh) in want of medical attention (The Hindu 2010).[4]

Quality Assurance of Ultrasonic Diagnosis in Breast

Sonography is a subjective diagnostic method which is highly dependent on the experience of the operator and the equipment quality which requires real-time adjustments. Breast screening examination currently consists of clinical examination and mammography. Breast sonography, either supplementary to mammography or independently, is indicated for the dense breast, especially in younger women. Breast sonography is especially applicable for Korean women because of the denser breast parenchyma and the approximately 10-year younger incidence rate of breast cancer of Korean women compared to western women. To avoid unnecessary breast biopsy because of the high rate of false positive lesions in breast parenchyma, which is different from other body organs such as the liver or the kidney, a quality assurance program for breast sonography is essential. The quality assurance of breast ultrasound involves quality assurance of the equipment, imaging display and acquisition of clinical images, personnel qualifications and other aspects such as unification of lexicon, guideline of diagnostic examination and reporting system; US BI-RAD reporting system, assessment items and organization, education program, medical audit, certification issues, and medicolegal issues. A breast sonographic quality assurance system should be established before a scheme to initiate governmental medical insurance for breast sonography.

Recomendaciones para mejorar la atención en enfermería / Recommendations to improve attention in nursing

El personal de enfermería desempeña una actividad fundamental en los servicios de salud, con fuerte apego a principios científicos y éticos; sus intervenciones permiten fortalecer la calidad en los servicios de salud, através de acciones interdisciplinarias. Se analizaron las inconformidades relacionadas con atención de enfermería que recibió la Comisión Nacional de Arbitraje Médico (CONAMED) de junio de 1996 a diciembre de 2001. Con base en el análisis se elaboraron recomendaciones dirigidas a prevenir el conflicto, mejorar la práctica de enfermería y propiciar la adecuada comunicación con el paciente, familiares y equipo interprofesional de salud. Se integró un grupo representativo de las instituciones educativas y gremiales de enfermería más prestigiadas y reconocidas, para su validación externa. De esta manera, la CONAMED y el grupo de validación externa, proponen al personal de enfermería atender las siguientes recomendaciones: 1) Mantener una comunicación efectiva con las personas a las que proporciona atención; 2) Reconocer en la persona su concepción holística; 3) Proporcionar cuidados que garanticen la atención libre de riesgos y daños innecesarios; 4) Establecer una coordinación efectiva con el equipo interprofesional de salud; 5) Actuar con base en los principios éticos que rigen la práctica profesional de enfermería.

Nurse personnel performs a fundamental activity in t health services, with strong attach at scientific and ethical principles, whose interventions can fortify the services of health quality, through interdisciplinary actions. We analyzed the compliants related to nursing attention that were received in CONAMED since June 1996 to December 2001. Wedevised recommendations directed to prevent patient-health care professionals conflicts, improve the practice of nursing and favor adequate communication with the patient, family and interprofessional health care team. Those recommendations were presented to the more prestigious and recognized educational and professional groups of nursing, for their external validation. In this manner, CONAMED and the external group of validation, propose to nurses to attend the following recommendations: 1) Maintain an effective communication with the patients that provides attention; 2) Recognize the holistic concept in the person; 3) Provide cares that guarantee tree-risk attention and prevent unnecessary damages; 4) Establish an effective coordination with the health care interprofessional team and 5) Act based on ethical principles that govern the professional practice of nursing.

Odores e infecções em ambiente hospitalar: a negação do óbvio no registro das observações da enfermagem / Odores and infections in the hospital environment: denying the obvious in registering nursing observations

Este artigo aborda a percepção dos fenômenos odorantes com o objetivo de proporcionar reflexão acerca do significado destes fenômenos e sua relação com processos infecciosos no espaço hospitalar. Realizou-se uma análise documental dos conteúdos de 5303 Observações Complementares de Enfermagem, referentes à percepção da equipe de Enfermagem frente às situações odorantes, sua interpretação através de registros da taxonomia dos cheiros e procedimentos decisórios aos mesmos, de 160 clientes internados nas Clínicas de Internação Cirúrgica de um Hospital Universitário. Os dados mostram que das 5303 observações, 2557 eram relativas a fenômenos odorantes, e destas, apenas 91 caracterizam o fenômeno odorante qualificado, concentrando-se em secreções corporais. No espaço hospitalar evidencia-se a negação, ocultação ou silêncio olfativo, o que sem dúvida, impede a real evidência dos riscos de infecções. Recomenda-se avançar nos conhecimentos e práticas de higiene corporal, ambiental e dos materiais utilizados nos serviços de saúde para promover a saúde, bem como, desenvolver novas concepções e modalidades de abordagem sobre as percepções olfativas, suas sensações e implicações em prol do viver mais saudável...

This article lays out the perception of the odorous phenomenon, with the objective to inspire reflection concerning the significance of these phenomenon and their relationship with infectious processes in the hospital environment. A documental analysis was performed, searching the contents of 5503 Complementary Nursing Observations, referring to the perception of the Nursing Team before odorous situations, their interpretation through registration of the taxonomy of smells and decision-making procedures towards the 160 clients submitted to the Overnight Surgery Clinics in a University Hospital. The data show that of the 5503 observations, 2557 referred to odorous phenomenon, and of these, only 91 characterized the qualified odorous phenomenon, focusing on corporal secretions. In the hospital space, denial, occulting, and olfactory silence are evidenced. This, without a doubt, impedes the real evidence of the risk of infection. We recommend advancing the study and practice of bodily and environmental hygiene, as well as of the materials used in the health care services to promote health. We also recommend developing new conceptions and modalities of approaching olfactory perceptions, their sensations and implications in view of healthier living...

Este artículo aborda la percepción de los fenómenos de mal olor con el objetivo de reflexionar sobre del significado de estos fenómenos y su relación con los procesos infecciosos en el espacio hospitalario. Se realizó un análisis documental de los contenidos de 5,303 observaciones complementarias de Enfermería, relacionados a la percepción del equipo de enfermería frente a las situaciones mal olientes, su interpretación a através de los registros de la taxonomía de los olores y procedimientos decisivos a los mismos, de 160 clientes internados en las clínicas de internamiento quirúrgico de un Hospital Universitario. Los datos muestran que de las 5303 observaciones, 2,557 eran con relación a fenómenos de mal olor, y de éstas, solo 91 caracterizan el fenómeno de mal olor, concentrado en secresiones corporales. En el espacio hospitalar se evidencia la negación, ocultamiento o silencio olfativo, lo que sin duda, impide la real evidencia de los riesgos de infecciones. Se recomienda avanzar en los conocimientos y prácticas de higiene corporal, ambiental y de los materiales utilizados en los servicios de salud para promover la salud, asi como, desarrollar nuevas concepciones y modalidades de abordaje sobre las percepciones olfativas, sus sensaciones e implicaciones en pro de un processo de vida más saludable...

Auditoria médica: herramienta de gestión moderna subvalorada / Medical audit: an undervalued management tool

Medical audit is defined as the critical and periodical assessment of the quality of medical care, through the revision on medical records and hospital statistics. This review defines the work of the medical auditor and shows the fields of action of medical audit, emphasizing its importance and usefulness as a management tool. The authors propose that every hospital should create an audit system, should provide the necessary tools to carry out medical audits and should form an audit committee

Memorias y publicaciones científicas: Instituto de Maternidad Dotor Percy Boland Rodríguez 2000 / Proceedings and scientific publications: Institute of Maternity Doctor Percy Boland Rodrígues 2000

El presente documento presenta investigaciones médicas que buscan la calidad de atención intrahospitalaria

Calidad del trabajo kinésico: bases conceptuales de la CPMCTK / Quality of kinesic work: conceptual basis of CPMCTK

Desde hace algo más de una década se vislumbra la urgente necesidad de disponer de elementos que verifiquen éxito terapéutico y satisfacción en la atención de pacientes a través instrumentos confiables y desarrollados para procesos específicos en kinesiología. Insistentemente se ha planteado la conveniencia del uso de escalas de medición que permitan cuantificar el estado actual de la salud y los logros derivados de la terapia. Si bien la kinesiología chilena está en vías de expansión, posicionamiento y diferenciación, hasta hoy su crecimiento se ha afirmado en indicadores arbitrarios, hecho que señala la urgencia de precisar la acción kinesiológica. La futura tarea de la kinesiología chilena se establece en precisar estándares de atención que tengan por finalidad delimitar en todas las áreas de la actividad kinésica la mejor manera de realizar kinesiología en Chile y definir en consenso cual es la práctica aceptable en términos de cantidad y calidad de servicio, quien es responsable y cuales son los resultados esperados. Para ello se incorpora el concepto de función, expresado en términos de independencia, autonomía y calidad de vida, como una estrategia central en la medición del impacto de las terapias. Se acoge el uso de guías clínicas ya en funcionamiento y la clasificación internacional de deterioro, discapacidad y handicap propuesta por Organización Mundial de la Salud como herramientas que permiten expresar de manera diferenciada y universal nuestros procesos y sus resultados

Perlas de bioética Nº1: publicación periódica de la Comisión de Bioética / Bioetic of pearls Nº1: periodic publications of the Bioetic Comission

La comisión de bioética del "Hospital de Niños J.M de los Ríos" inicia con este boletín una publicación periódica cuyo objetivo es mejorar la información de la comunidad hospitalaria sobre temas relacionados en la bioética. Comenzamos por presentar a los integrantes de la Comisión, Dres: Armando Sucre (coordinador), Alba Valero, Mery Castillo, Manuel Sánchez, Xavier Murraga, Luis Maldonado, Enriqueta Sileo, Gladys Velázquez y la Lic. en Enfermería Belkis Quintero de Monsalve. En la actualidad se conciben los comités de bioética hospitalarios como grupos interdisciplinarios, por lo que en el futuro este grupo inicial se ampliará con otro miembros del personal de salud y profesionales de otras áreas. Las funciones de la Comisión pueden resumirse en tres: educativa, consultiva (análisis ético de los casos remitidos y de los proyectos de investigación) normativa (elaboración de normas éticas para las conductas y procedimientos hospitalarios). Iniciamos nuestras publicaciones con el tema del consentimiento informado, por considerarlo una necesidad imperiosa de nuestra institución