Sepsis et choc septique en réanimation à Brazzaville (Congo) / Sepsis and septic shock in polyvalent intensive care at Brazzaville (Congo)

Objectifs. Décrire les aspects cliniques, bactériologiques et évolutifs du sepsis et du choc septique dans le service de réanimation polyvalente du CHUB. Patients et méthodes. Il s'agit d'une étude transversale, monocentrique et descriptive, durant 12 mois, incluant les patients âgés d'au moins 18 ans admis en réanimation polyvalente pour un sepsis ou choc septique. Les variables épidémiologiques, cliniques, bactériologiques et évolutives ont été analysées avec Excel 2019. Résultats. 56 patients ont été retenus (20,7%). Leur âge moyen était de 43,1 ± 17,9 ans (extrêmes de 18 et 84 ans), avec 66,1% des hommes. Le foyer infectieux initial était péritonéal (64,3 %). À l'admission, le nombre médian de défaillances d'organes par patient était de trois (maximum 5). Les défaillances rénale (71,4%), hépatique (69,6%) et hémodynamique (62,5%) étaient les plus représentées. Le taux de réalisation du bilan bactériologique était de 35,7% : hémoculture (10,7%), uroculture (14,3%), porte d'entrée infectieuse (7,1%). La durée d'hospitalisation des patients sortis vivants était de 8,1 ± 6,3 jours (extrêmes de 2 et 31 jours). Le taux de mortalité était de 57,1%. Les décès survenaient au-delà de 24 h d'hospitalisation (75%), chez des patients avec comorbidités (65,6%), porte d'entrée péritonéale (59,4%), et défaillances hémodynamique (81,2%) et rénale (75%). Conclusion. Les prévalences du sepsis et du choc septique dans notre série sont superposables à celles de la littérature. Le taux de réalisation des bilans bactériologiques reste faible. La mortalité du sepsis demeure très élevée.

Introduction. No accurate data on sepsis and septic shock in intensive care unit (ICU) in the Republic of Congo are available. The aim of the study was to describe the course of patients with sepsis and/or septic shock in the polyvalent ICU of the University Teaching Hospital of Brazzaville. Patients and methods. This was a cross-sectional, monocentric and descriptive study, lasting 12 months, including patients aged at least 18 years admitted to ICU for sepsis or septic shock. The clinical presentation, the bacteriological findings and the outcome were analyzed with Excel 2019. Results. 56 patients were selected (20.7%). The average age was 43.1 ± 17.9 years (extremes 18 and 84 years), with 66.1% of men. The initial infection was peritoneal (64.3%). At admission, the median number of organ failures per patient was three (maximum 5). Renal (71.4%), hepatic (69.6%) and hemodynamic (62.5%) failures were the most common. Bacteriological assessment rate was 35.7%: blood culture (10.7%), urine culture (14.3%). The duration of hospitalization of alive patients was 8.1 ± 6.3 days (extremes 2 and 31 days). The mortality rate was 57.1%. Deaths occurred beyond 24 hours of hospitalization (75%), in patients with comorbidities (65.6%), peritonitis (59.4%), hemodynamic (81.2%) and renal (75%) failures. Conclusion. The prevalence of sepsis and septic shock in our study is comparable to other published series. The bacteriological assessments rate is still low. The mortality is very high.

Anesthesia Management at Fuwai Hospital:Practice, Evidence and Outcomes / 中国医学科学杂志(英文版)

Fuwai Hospital was established in 1956 and the Anesthesia Department of Fuwai Hospital was one of the earliest anesthesia departments then in China. Under the leadership of several department directors and with the concerted efforts of all generations of colleagues, the Anesthesia Department of Fuwai Hospital has dramatically transformed, upgraded and modernized. For more than six decades, the Anesthesia Department has been providing high-quality peri-operative anesthesia care for cardiovascular surgeries, conducting innovative experimental and clinical researches, and offering comprehensive training on cardiovascular anesthesiology for professionals across China. Currently, Fuwai Hospital is the National Center for Cardiovascular Diseases of China and one of the largest cardiovascular centers in the world. The present review introduces the Anesthesia Department of Fuwai Hospital, summarizes its current practice of anesthesia management, the outcomes of cardiovascular surgeries at Fuwai Hospital, accumulates relevant evidence, and provides prospects for future development of cardiovascular anesthesiology.

Mortalidad perioperatoria / Perioperative mortality

Introducción: La tasa de mortalidad perioperatoria representa un indicador global del acceso seguro a la atención quirúrgica y anestesiológica. Objetivo: Caracterizar los pacientes fallecidos durante el perioperatorio en intervenciones quirúrgicas. Métodos: Se realizó un estudio descriptivo transversal en el servicio de Anestesiología del Hospital Clínico Quirúrgico Arnaldo Milián Castro, provincia Villa Clara, en el periodo período de enero de 2015 a diciembre de 2018. La población estuvo constituida por los pacientes intervenidos quirúrgicamente en dicho hospital (N: 133 724). La muestra fueron los pacientes fallecidos durante el período intraoperatorio y primeras 24 h tras la intervención quirúrgica (n: 77). Resultados: La tasa de mortalidad perioperatoria general fue de 5,76/10 000. Incidencia de mortalidad mayor en hombres (59,7 por ciento), ancianos (75,3 por ciento), con varias comorbilidades asociadas (51,9 por ciento), clase 4 de la ASA (41,5 por ciento), riesgo quirúrgico grupo II (62,3 por ciento), cirugía abdominal (63,6 por ciento), intervenciones de urgencia (88,3 por ciento), bajo una técnica anestésica general (84,4 por ciento) y en el período postoperatorio 24 h (68,8 por ciento). El shock séptico constituyó la principal causa de mortalidad (48,1 por ciento). Conclusiones: Predominaron las defunciones en ancianos con comorbilidades asociadas, alto riesgo anestésico y quirúrgico, intervenidos de urgencia bajo anestesia general, con el shock séptico como principal causa de muerte. La tasa de mortalidad perioperatoria fue similar a naciones de desarrollo socioeconómico equivalente(AU)

Introduction: Perioperative mortality rate represents a global indicator for safe access to surgical and anesthesiological care. Objective: To characterize patients who deceased during the perioperative period in surgical interventions. Methods: A cross-sectional and descriptive study was carried out in the anesthesiology service of Arnaldo Milián Castro Clinical-Surgical Hospital, in Villa Clara Province, in the period from January 2015 to December 2018. The study population consisted of patients who received surgery within that hospital (N: 133 724). The sample consisted of patients who died during the intraoperative period and within the first 24 hours after surgery (n: 77). Results: The general perioperative mortality rate was 5.76/10 000. There was incidence of higher mortality among men (59.7 percent), elderlies (75.3 percent), patients with several associated comorbidities (51.9 percent), those classified as ASA-IV (41.5 percent), those belonging to group II for surgical risk (62.3 percent), cases of abdominal surgery (63.6 percent), emergency interventions (88.3 percent), patients under general anesthetic technique (84.4 percent), and at 24 hours after the postoperative period (68.8 percent). Septic shock was the main cause of mortality (48.1 percent). Conclusions: There was a predominance of deaths among elderlies with associated comorbidities, high anesthetic, as well as surgical risk, who received emergency surgery under general anesthesia, being septic shock the main cause of death. The perioperative mortality rate was similar to that in nations of equivalent socioeconomic development(AU)

Desafíos para el anestesiólogo en pacientes con Covid-19 / Challenges for the anesthesiologist regarding patients with COVID-19

Introducción: En diciembre del año 2019, una serie de casos de neumonía surgieron en Wuhan, Hubei, China; el 11 de marzo de 2020 se identifica el primer caso en Cuba. El SARS-CoV-2 se transmite rápidamente con consecuencias nefastas para la población y constituye actualmente una pandemia. Las técnicas avanzadas para manejo de vía aérea son propias de anestesiólogos e intensivistas, estas complejas y requieren de elementos y dispositivos que no se encuentran generalmente fuera del ámbito de quirófano. Objetivo: Describir la conducta anestesiológica ante pacientes anunciados para procedimientos quirúrgicos de urgencias o emergencia, con sospecha o confirmación de estar infectado por la COVID-19, durante el perioperatorio. Métodos: Se realizó una revisión de artículos referentes a conductas y estrategias a seguir en pacientes con sospecha/confirmación de la enfermedad COVID-19, tales como: preparación y limpieza del quirófano, consideraciones anestésicas, manejo de la vía aérea y las medidas y equipos de protección necesarias para el personal anestésico-quirúrgico. Desarrollo: La Organización Mundial de la Salud y organizaciones sanitarias recomiendan adoptar en todos estos enfermos de forma rutinaria, una serie de indicaciones descritas en el presente artículo. Conclusiones: Se requiere de entrenamiento y actualización continua por parte del personal médico y paramédico. Los especialistas involucrados en el manejo de la vía área deben disponer de algoritmos locales y del material necesario para garantizar una atención perioperatoria de calidad(AU)

Introduction: In December 2019, a series of pneumonia cases appeared in Wuhan, Hubei, China. On March 11, 2020, the first case in Cuba was identified. SARS-CoV-2 spreads rapidly, with fatal consequences for the population, and is currently a pandemic. The advanced techniques for the management of the airways are typical of anesthesiologists and intensivists. These are complex and require elements and devices not generally found outside the operating room. Objective: To describe the anesthesiological behavior in patients announced for emergency surgical procedures and with suspicion or confirmation of being affected by COVID-19, during the perioperative period. Methods: A review of articles referring to behaviors and strategies to follow in patients with suspicion/confirmation of COVID-19 disease was carried out; for example, preparation and cleaning of the operating room, anesthetic considerations, management of the airway, as well as the safety measures and the equipment necessary for the anesthetic-surgical personnel. Development: The World Health Organization and other health organizations recommend that a series of indications described in this article be adopted routinely in all these patients. Conclusions: Continuous training and updating is required by medical and paramedical personnel. The specialists involved in the management of the airways must have local algorithms and the materials necessary to guarantee quality perioperative care(AU)

Anémie post-opératoire au service de chirurgie générale de l'Hôpital National d'Ignace Deen

Introduction : L'objectif de l'étude était de déterminer la prévalence de l'anémie post-opératoire au service de chirurgie générale de l'hôpital national Ignace. Méthodologie : Il s'agissait d'une étude transversale de type descriptif d'une durée de six mois allant 1er Mai au 30 Octobre 2016. Elle a été réalisée au service de chirurgie générale de l'hôpital national IGNACE DEEN. Résultats : Sur un total de 451 patients opérés, 100 patients ont développé une anémie post-opératoire soit une prévalence de 22 %. Le sex-ratio était de 1,08. L'âge moyen des patients était de 39 ans avec des extrêmes de 13 et de 66 ans. Le taux moyen d'hémoglobine en post-opératoire était 10g/dl, avec des extrêmes de 7g/dl et de 11g/dl. La durée moyenne des interventions était 1h36min avec des extrêmes de 28min et de 2h25min. La pathologie initiale dominante était la péritonite soit 18% des cas. Conclusion : L'amélioration des conditions de travail du bloc opératoire avec la diminution importante de l'hémorragie serait nécessaire pour minimiser la prévalence de cette anémie

Síndrome de Ehlers-Danlos hipermóvel: um relato de caso / Hypermobile Ehlers-Danlos syndrome: a case report

A síndrome de Ehlers-Danlos é estabelecida por distúrbios hereditários do tecido conjuntivo que tem como manifestações principais a hipermobilidade articular, a hiperextensibilidade da pele e a fragilidade de tecidos, como articulações, ligamentos, pele, vasos sanguíneos e órgãos internos. São reconhecidos 13 subtipos, de acordo com Classificação Internacional de 2017. Dentre estes, abordamos o hipermóvel, cujo diagnóstico é eminentemente clínico, com manifestações sistêmicas distintas. Esse artigo refere-se ao caso de uma paciente diagnosticada com síndrome de Ehlers-Danlos hipermóvel, tendo como intuito a atualização acerca dos novos critérios diagnósticos, assim como o diagnóstico precoce de tal raropatia.

Ehlers-Danlos syndrome is established through hereditary disorders of connective tissue, and has as its manifestations: joint hypermobility, skin hyperextensibility, and fragility of tissues such as joints, ligaments, skin, blood vessels, and internal organs. Thirteen subtypes have been recognized according to the 2017 International Classification. Among these, the hypermobile type, the diagnosis of which is eminently clinical, with distinct systemic manifestations, will be addressed. This article refers to the case of a patient diagnosed with hypermobile Ehlers-Danlos syndrome, with the objective of updating the new diagnostic criteria, as well as the early diagnosis of such a rare disease.

An Analytic Framework to Assess Organizational Resilience

BACKGROUND: Resilience engineering is a paradigm for safety management that focuses on coping with complexity to achieve success, even considering several conflicting goals. Modern sociotechnical systems have to be resilient to comply with the variability of everyday activities, the tight-coupled and underspecified nature of work, and the nonlinear interactions among agents. At organizational level, resilience can be described as a combination of four cornerstones: monitoring, responding, learning, and anticipating. METHODS: Starting from these four categories, this article aims at defining a semiquantitative analytic framework to measure organizational resilience in complex sociotechnical systems, combining the resilience analysis gridand the analytic hierarchy process. RESULTS: This article presents an approach for defining resilience abilities of an organization, creating a structured domain-dependent framework to define a resilience profile at different levels of abstraction, and identifying weaknesses and strengths of the systemand potential actions to increase system's adaptive capacity. An illustrative example in an anesthesia department clarifies the outcomes of the approach. CONCLUSION: The outcome of the resilience analysis grid, i.e., a weighed set of probing questions, can be used in different domains, as a support tool in a wider Safety-II oriented managerial action to bring safety management into the core business of the organization.

Detección de contaminación en el equipo anestésico de sala de operaciones del Hospital México, junio 2014 / Detection of contamination in the anesthetic equipment of the operating room of Hospital México, June 2014

Resumen:Justificación: Las infecciones nosocomiales producen un impacto negativo para los profesionales de la salud y los pacientes. Se ha reconocido la influencia de múltiples factores hospitalarios en el desarrollo de las mismas, sin embargo, el papel del ambiente anestésico no ha sido claramente descrito. En Costa Rica, al igual que en muchos países del Mundo, no se cuenta con políticas y guías de limpieza del equipo anestésico.Métodos: El propósito del presente estudio fue evaluar la presencia de contaminación en los equipos anestésicos de sala de operaciones del Hospital México. Se analizaron nueve superficies de la máquina de anestesia, equipo de monitoreo y laringoscopios, durante la mañana y la tarde. Cada superficie fue sometida a cuatro pruebas, detección de contaminación visible, detección de contaminación sanguínea, conteo de adenosina trifosfato (ATP) y cultivo por Staphylococcus spp.Resultados: Las pruebas evidenciaron poca correlación entre la contaminación visible y por sangre con los cultivos por Staphylococcus sppy el conteo de unidades relativas de luz (URL). Se obtuvieron altos porcentajes de cultivos positivos por Staphylococcus spptanto en la mañana como en la tarde, 52% versus 67% respectivamente. Las mediciones de URL presentaron un valor promedio en la mañana de 5208,3 y en la tarde de 5514,8, 14 veces mayores a los considerados limpios, el estándar es 350 URL. Conclusión: El equipo anestésico no está siendo correctamente manipulado, es necesario crear políticas de limpieza del mismo ya que se expone a los pacientes a riesgos de salud innecesarios. Es pertinente más que el desarrollo de una herramienta de prevención, la sensibilización sobre el tema, la modificación de conductas y la educación.

Abstract:Background: nosocomial infections have a negative impact on healthcare professionals and patients. The influence of multiple hospital-related factors has been recognized as playing a role in these infections' development, nevertheless, the part of the anesthetic environment has not been clearly stated. In Costa Rica, like in many other countries in the world, there are no policies or guidelines related to the cleaning of anaesthetic equipment.Methods: The purpose of this study was to evaluate the presence of contamination on the anaesthetic equipment in the operating theatre of Hospital México. Analysis was carried out on nine surfaces of the anaesthesia machine, monitoring equipment and laryngoscopes, in both the morning and the afternoon of one day. Each surface had four tests: detection of visible contamination, detection of blood contamination, adenosine triphosphate (ATP) count and a bacterial culture test for Staphylococcus spp.Results: The tests showed a poor correlation between the visible and blood contamination and Staphylococcus sppcultures along with the count for relative units of light (RUL). High positive percentage of Staphylococcus sppcultures were recorded during both the morning and the afternoon, with respective values of 52% and 67%. The RUL measurements presented an average value during the morning of 5208.3 and during the afternoon of 5514.18, which is 14 times greater than the value considered clean, the permitted limit is of 350 RUL.Conclusion: Anesthetic equipment is not being correctly handled, and that it is necessary to create cleaning policies.

Anestesia peridural: vantagens e desvantagens na prática anestésica atual / Epidural anesthesia: advantages and disadvantages in the current anesthesia practice

Estudos recentes foram realizados com o intuito de evidenciar vantagens no uso da anestesia peridural em diversas especialidades. Na cirurgia cardíaca, ela reduziu o risco de arritmias supraventriculares e complicações pulmonares sem influenciar diretamente na mortalidade, na incidência de infarto agudo do miocárdio e de acidente cerebrovascular. Em procedimentos ortopédicos promoveu bom controle da dor pós-operatória, principalmente em cirurgias de correção de escoliose. Todavia, não teve impacto significativo em desfechos pós-operatórios. Nas cirurgias urológicas oncológicas não foi encontrada associação entre o uso do bloqueio peridural e a diminuição da recorrência tumoral. Houve redução do sangramento perioperatório e controle adequado da dor sem ocorrer, no entanto, alteração no tempo de internação hospitalar. Nas cirurgias torácicas, atualmente tem perdido espaço para o bloqueio paravertebral, que se mostrou igualmente eficaz e com melhor perfil de efeitos colaterais. Na população pediátrica, o bloqueio peridural se destaca frente às outras modalidades analgésicas, sobretudo em cirurgias de grande porte. O risco de complicações associadas diminui progressivamente com o aumento da idade e a execução da técnica sob anestesia geral ou sedação profunda é aparentemente segura. Em gestantes, a analgesia peridural permite alívio da dor e não há evidência de que aumenta a incidência de cesáreas, porém em situações de urgência o bloqueio subaracnóideo é preferido. Estudos que avaliaram a anestesia peridural em cirurgias abdominais verificaram retorno precoce do trânsito gastrintestinal, sem aumento na incidência de deiscência anastomótica. O uso do bloqueio em cirurgias laparoscópicas ainda é controverso.

Recent studies have been conducted to elucidate the advantages of using epidural anesthesia in several specialties. In cardiac surgery, it was shown to reduce supraventricular arrhythmias and pulmonary complications risk, without having a direct effect on mortality,myocardial infarction and cerebrovascular events. Epidural anesthesia produced better pain control after orthopedic procedures, especially after scoliosis correction, however it has no significant impact in postoperative outcomes. No correlation between the use of epidural block and tumor recurrence could be found in urological oncological surgeries. Reduced bleeding and good pain control has been achieved without reduction on hospitalization duration. In thoracic surgeries, recently, it is being replaced by paravertebral block, which can be equally effective and with better collateral profile. Epidural anesthesia is preferable over the other analgesic modalities, in the pediatric population, especially for major procedures. The complications risk with its use reduces progressively with increasing age and the execution of the technique under general anesthesia or deep sedation is apparently safe. Epidural analgesia in parturients relief pain and there is no evidence on increasing cesarean rate, but in the emergency scenarios subarachnoid spinal anesthesia is still preferred. Studies have evaluated the epidural blockade in abdominal surgeries, it was shown to allow fast return of bowel movements without increasing the incidence of anastomotic leakage. Its use in laparoscopic surgery is still controversial.

Anestesia peridural em paciente portadora de esclerose lateral amiotrófica - relato de caso / Epidural anesthesia in patient with amyotrophic lateral sclerosis - case report

Justificativa e objetivos: a esclerose lateral amiotrófica (ELA) é uma doença degenerativa progressiva do neurônio motor, de causa desconhecida, com padrão genético frequente. Quando os músculos responsáveis pela ventilação são acometidos, o paciente evolui para o óbito em alguns anos em decorrência da insuficiência respiratória. O objetivo deste trabalho é relatar o caso de uma paciente com ELA que foi submetida à gastrostomia e colostomia no Hospital Belo Horizonte sob anestesia peridural contínua e sedação consciente. Conclusão: as evidências têm demonstrado que a administração do bloqueio no neuroeixo associado à dexamedetomidina parece ser segura em pacientes com ELA, pois evita a manipulação das vias aéreas e as complicações respiratórias.

Justification and objectives: Amyotrophic Lateral Sclerosis (ALS) is a progressive degenerative disease of the motor neuron, of unknown cause, with a frequent genetic pattern. When the muscles responsible for ventilation are affected, the patient progresses to death in a few years as a result of respiratory failure. The aim of this study is to report the case of a patient with ALS who underwent gastrostomy and colostomy in Belo Horizonte Hospital under continuous epidural anesthesia and conscious sedation. Conclusion: Evidence has shown that the neuraxial block administration associated with dexmedetomidine seems to be safe in patients with ALS, since it avoids manipulation of the respiratory airways and complications

Evaluación de la calidad de atención del medico anestesiólogo en el Hospital Nacional Ramiro Prialé Prialé-2013 / Evaluation of the anesthesiologist quality of health care at the Hospital Nacional Ramiro Prialé Prialé-2013

Objetivo: Determinar la calidad de atención del médico anestesiólogo a través de la medición del grado de satisfacción del paciente quirúrgico del Hospital Nacional Ramiro Prialé Prialé durante el primer trimestre del 2013, a quines se aplicó un cuestionario, validado por un juicio de expertos, para detrminar la satisfacción del paciente en tres periodos, preanestesia, anestesia y postanestesia. Resultados: Se encontraron grados de satisfacción ubicados en los niveles medio y alto tanto a nivel general asi como en los diferentes periodos. Los pacientes adultos comprendidos entre 51 y 65 años presentaron los mayores niveles de satisfacción. Las mujeres expresaron mayor satisfacción que los varones. Conclusión: La atención que ofrece el médico anestesiólogo del Hospital Nacional Ramiro Prialé Prialé es de calidad, según se deduce del alto grado de satisfacción del paciente quirúrgico.

Objective: To assess the anesthesiologist's quality of health care through the measure of the satisfaction level from surgical patients of the Hospital Nacional Ramiro Prialé Prialé. Material and methods: Descriptive, prospective and transversal study performed in 71 surgical patients of the Hospital Nacional Ramiro Prialé Prialé during the first trimester of 2013. To collect data a questionnaire validated by an expert judgment was constructed to determine satisfaction patients in three periods, preanethesia, anesthesia and postanesthesia. Results: Median and high levels of satisfaction were found both in global satisfaction and in each of the different periods. Adult patients between 51 and 65 years had the highest leevls of satisfaction. The women expressed greater satisfaction than men. Conclusion: The care provided by the anesthesiologist of the Hospital Nacional Ramiro Prialé Prialé is of high quality, as deduced from the high degree of satisfaction of the surgical patient.

[Effect of verbal and audio methods of training on pre-surgery anxiety of patients]

Regarding the undesirable effects of anxiety on physiologic indexes of human body and development of post-surgery intensified symptoms, attempt to reduce the degree of anxiety is of prime necessity. The goal of this study was to study the effect of two verbal and audio methods of training on patient's anxiety before surgery. This was an empirical study carried out at Imam Khomeini Medical Center in Sari [Iran] during 2009-2010. Three groups of patients, each group consisting of 35 individuals were included in the study. Samples were taken through accessibility while grouping was made completely at random. The research tools were demographic questionnaires, checklist for vital signs as well as characteristics anxiety questionnaires. The results showed significant differences between the two test groups and also the control group in terms of anxiety levels and their conditions two hours before operation [P=0.03]. The mean systolic and diastolic blood pressure in the group under verbal education two hours before operation was 17.2 +/- 2 and 8.6 +/- 1 cmHg, and in group trained with handout 18.9 +/- 1 and 8.9 +/- 1 cmHg, respectively. There was a significant difference between two test and control groups. Based on results found through this study, it is suggested that at the time a patient is admitted to anesthesia clinic, in addition to routine examinations, some verbal education should be given to lower the unwanted and harmful physiological effects of anxiety which provides a better ground for risk free post-operation recovery for patient

Description of Surgical and Anaesthetic Services Provided at Two District Hospitals in KwaZulu-Natal in Relation to the Surgical Norms and Standards Outlined in the Service Package for District Hospitals

Background: Provision of surgical services at district hospitals (DHS) is cost effective and important. The District Hospital Service Package for South Africa (package of services) specifies the services that a district hospital should provide. The aim of this study was to document the surgical services provided at two DHS in KwaZulu-Natal and to compare this with the recommendations in the package of services. Methods: In a retrospective quantitative study; data from 2008 were collected from the theatre register at two DHS. Data were analysed and results compared with the norms and standards in the package of services. Results were presented to staff at the hospitals; who then commented on the challenges of providing surgical services at DHS. Results: Only 60and 30respectively of procedures listed in the package of services were being carried out at the two hospitals. In total; 3 900 procedures were carried out over the year. Dundee Hospital offered a broader range of surgical procedures and anaesthetics than the Church of Scotland Hospital (COSH). COSH has a large obstetric burden; with 3 666 deliveries each year. A large number of procedures were being carried out by a single operator. Conclusions: Many surgical procedures are being carried out even though neither hospital provides the full complement of surgical services as specified in the package of services. The wide variation between the surgical services offered reflects the surgical and anaesthetic skills at the respective hospitals. Potential medico-legal hazards that require urgent attention were identified. A review of the package of services is essential to identify core procedures that must be provided at DHS

An Association among Verbal Abuse, Social Support and Turnover Intention for Special Unit Nurses in a Hospital / 대한산업의학회지

OBJECTIVES: Nurses' turnover has a negative influence on the nursing staff, as well as on the hospital organization as a whole. In an effort to reduce the turnover of nurses, the conditions causing turnover intentions can be identified and managed. The research is conducted to identify the association among verbal abuse, social support, and turnover intentions for special unit nurses. METHODS: A survey was conducted in 105 registered nurses who worked in the following areas at Kyonggi province hospital: operating room, intensive care unit, and anesthesia department. The questionnaires included questions in the following areas: verbal abuse by doctors, supervisors, and colleagues social supports by supervisors and colleagues and turnover intention. The survey was distributed and analyzed based on nurses' responses. RESULTS: Operating room nurses had the highest turn over intentions. The verbal abuse by doctors and supervisors were highest in the operating room. Verbal abuse by supervisors had a significantly positive association with turnover intentions. Verbal abuse by doctors and by colleagues was not associated with the intention to leave. Finally, the social support by supervisors had a significant negative association with turnover intentions. Social supports by colleagues did not affect turnover intentions. CONCLUSIONS: For nurses working at special units, verbal abuse and social support by supervisors had a significant association with turnover intentions. It is important for supervisors to make an effort to reduce nurses' turnover intentions by reducing verbal abuse and by increasing social support.