Medical mistakes and their absence in medical schools

Medical mistakes are any unintentional acts which are detrimental to patients' health, most of which have multiple causes or arise from the complexity of modern healthcare systems. Since no medical specialty is free of mistakes, training is needed beginning in undergraduate school to learn how to deal with them. (Acta Med Colomb 2022; 48. DOI:https://doi.org/10.36104/amc.2023.2522).

Accuracy of sequential organ failure assessment score in emergency department physicians in Beijing:a multicenter investigation study / 中华危重病急救医学

Objective To investigate the accuracy of sequential organ failure assessment (SOFA) scoring in emergency physicians in Beijing. Methods Emergency physicians from 8 hospitals in Beijing in January 2018 were demanded to complete a SOFA questionnaire which was developed on ''wenjuanxing'' website and submit via cell phone. All participants were divided into urban center group (UC group) and no-urban center group (NUC group) based on the hospital's location. The accuracy rate of components and total score of SOFA along with the mistakes were evaluated, and the results of the two groups were compared. Results ① The questionnaire was sent to 217 emergency physicians of the 8 hospitals, and 197 qualified questionnaires were received with 109 of NUC group and 88 of UC group, respectively, the total response rate was 90.8%. Compared with those from NUC group, UC physicians had older ages [years:37 (32, 42) vs. 34 (29, 40), Z = -2.554, P = 0.011] and higher education level [postgraduate degree 76.1% (67/88) vs. 40.4% (44/109), χ2= 25.327, P < 0.001], and more of them experienced SOFA scoring [62.5% (55/88) vs. 45.9% (50/109), χ2= 5.409, P = 0.020]. Other baseline characteristics such as gender, working years, professional title and training experience were not different between the two groups. ② The accuracy rate of total SOFA score was 62.4% (123/197) in the whole cohort, and UC group was lower than that of NUC group, but the difference was not significant [56.8% (50/88) vs. 67.0% (73/109), χ2= 2.141, P = 0.143]. While comparing the accuracy of individual variable/system of SOFA, the accuracy rate of norepinephrine of UC group was much higher than NUC group [80.7% (71/88) vs. 66.1% (72/109), χ2= 5.235, P = 0.022], but the accuracy of Glasgow coma scale (GCS) was much lower in NUC group [38.6% (27/70) vs. 81.6% (71/87), χ2= 30.629, P < 0.001]. Other variables of SOFA were not different between the two groups. ③Based upon the results of all submitted questionnaires, 566 mistakes were identified. It was indicated that the mistakes per capital was 2.9 in the whole cohort and in the two groups. The first type mistakes which caused by carelessness (including calculating error, filling error, choosing error) were 233 times. The calculating error in norepinephrine from NUC physicians was higher than the UC group [33.9% (37/109) vs. 19.3% (17/88), χ2= 5.235, P =0.022], there was no significant difference in any other first type mistakes between the two groups. The total second type mistakes caused by misunderstanding of SOFA (including using wrong variables, not using the worst value within 24 hours, and incorrect GCS score) were 333 times in the whole cohort. GCS error [61.8% (42/88) vs. 16.9% (14/109), χ2=32.292, P<0.001], and using urine output per hour instead of urine output per 24 hours [15.9% (14/88) vs. 4.6% (5/109), χ2= 7.162, P = 0.007] were much higher in UC group than NUC group. Conclusions The total accuracy of SOFA scoring in the investigated emergency physicians of 8 hospitals in Beijing was not good. Mistakes causing by carelessness or misunderstanding of score rules were similar. It is necessary to apply strict training in SOFA scoring.

Estrés emocional en estudiantes de Medicina de la Universidad Nacional Autónoma de México / Emotional stress in medical students from the National Autonomous University of Mexico

El presente estudio se realizó con el objetivo de evaluar el impacto del estrés emocional en la adecuada toma de decisiones y práctica médica oportuna y de calidad de los estudiantes que cursan el quinto año de la carrera en la Facultad de Medicina de la Universidad Nacional Autónoma de México (UNAM). Se utilizó una lista de valoración para las competencias de la simulación de reanimación cardiopulmonar avanzada, y un Cuestionario de Maslach Burnout Inventory (MBI) para valorar los sentimientos, actitudes y de desgaste profesional. Los resultados muestran que aquellos que estaban expuestos a mayor cantidad de labores recientes y estrés fueron más propensos de incidir en errores médicos durante la toma de decisiones y su aprendizaje.

This study was conducted with the aim of assessing the impact of emotional stress in the appropriate decision-making and quality medical practice of fifth year medical students from the Faculty of Medicine of the National Autonomous University of Mexico (UNAM). It was used an assessment list for cardiopulmonary resuscitation simulation competence and a Maslach Burnout Inventory (MBI) Questionnaire was used to assess feelings, attitudes and professional wear and tear. Results show those who were exposed to a greater number of recent tasks and to greater stress were more likely to make medical mistakes while making decisions and learning.

A escrita do sinthoma segundo a lógica não toda fálica / The sinthome writings according to the not all phallic logic / La escritura del sínthoma de acuerdo con la lógica no toda fálica

As questões que pautam o presente texto surgem da experiência de trabalho como psicóloga em diferentes serviços da rede pública de saúde mental e são desdobradas em uma pesquisa acadêmica vinculada ao Programa de Pós-graduação em Psicanálise: Clínica e Pesquisa, da Universidade do Estado do Rio de Janeiro (UERJ). O texto objetiva desenvolver pontos da teoria psicanalítica para pensar a operação de sexuação como modo singular de tratamento de gozo para cada ser falante. Para tanto, a distância entre o real da coisa e suas representações é abordada. Explora-se o erro comum que acopla distintos modos de gozo à existência de dois sexos. Em seguida são investigados os limites implicados nas tentativas de compartilhar questões indizíveis acerca do que se passa no corpo a partir do gozo sexual. Depois de passar pelos efeitos de uma sexuação sintomática ligada ao erro comum, a discussão toca outras possibilidades de tratamento do gozo, principalmente com base nas elaborações lacanianas acerca de James Joyce. Como conclusão, são apresentadas questões que destacam a lógica do não todo fálico como via que aponta para uma singularidade radical na escrita do sinthoma.

The issues that guide this text arise from work experience as a psychologist in different public mental health services and are further developed in the academic production of research linked to the Postgraduate Program Psicanálise: Clínica ePesquisa, at Universidade do Estado do Rio do Janeiro (UERJ - Rio de Janeiro State University). The text aims to expand points in psychoanalysis theory in order to consider the sexuation operation as a unique mode of the treatment of jouissance for every speaking being. The distance between the real in itself, and it's symbolic representations is broached. The common misconception that pairs up distinct modalities of jouissance with cultural established sex difference is also explored.Then, the limits in sharing unspeakable issues about what happens in the body, concerning to sexual jouissance, are investigated. Next, considering the effects of a symptomatic sexuation connected to that common mistake, the discussion reaches other possibilities of treatment of jouissance, based mainly on the Lacanian elaborations regarding James Joyce. In conclusion, issues are presented that emphasize the not all phallic logic as a pathway that goes beyond the barriers of what is possible to shareand points to a radical uniqueness in the writing of the sinthome.

Las preguntas que guían este texto surgen de la experiencia de trabajo como psicóloga en diferentes servicios de la red públicos de salud mental y se despliegan en una investigación académica vinculada al posgrado en Psicoanálisis: Clínica e Investigación, de la Universidad del Estado de Rio de Janeiro (UERJ). El texto tiene como objetivo desarrollar puntos de la teoría psicoanalítica para pensar la operación de sexuación como forma singular de tratar el goce para cada ser hablante. Para eso, fue abordada la distancia entre lo real de la cosa y sus representaciones. Se explora el error común que hace un emparejamiento entre distintos modos de goce y la existencia de dos sexos. Seguidamente son investigados los límites implicados en los intentos de compartir cuestiones indecibles acerca de lo que pasa en el cuerpo a partir del goce sexual. Después de pasar por los efectos de una sexuación sintomática relacionada con el error común, la discusión toca otras posibilidades de tratamiento del goce, basados principalmente en las elaboraciones de Lacan sobre James Joyce. En conclusión, se presentan cuestiones que resaltanla lógica del no todo fálico como vía a la escritura del sínthoma.

¿Cuántas son las emociones básicas? Estudio preliminar en una muestra de adultos mayores sanos / How many are the basic emotions? Preliminary study in a sample of healthy old adults

Hay dos posturas sobre cuáles son las emociones básicas. La clásica plantea que las mismas son asco, tristeza, alegría, enojo, miedo y sorpresa; y la postura actual concluye que las emociones básicas son tristeza, alegría y la combinación de miedo/sorpresa por un lado y enojo/asco por otro. El objetivo será estudiar las fallas en el reconocimiento de asco, enojo, miedo y sorpresa, y la relación en el tipo de error producido en una muestra de sujetos mayores sanos. Se evaluaron 18 sujetos con la batería de Reconocimiento Facial de Emociones Básicas considerando las respuestas correctas y las elecciones incorrectas. Los resultados obtenidos muestran que hay diferencias significativas entre los pares "miedo correcta-miedo por sorpresa"," sorpresa correcta-sorpresa por miedo","enojo correcta-enojo por asco" y "asco correcta-asco por enojo". Estos hallazgos apoyan la postura clásica sobre la existencia de las seis emociones básicas.

There are two main positions about what the basic emotions are. The standard posture establishes that the basic emotions are disgust, sadness, joy, anger, fear and surprise; however, the current position concludes that these basic emotions are sadness, joy and the combination of fear and surprise on one hand, and on the other, anger and disgust. The purpose will be to study the flaws on the recognition of the expressions of disgust, anger, fear and surprise, and the connection in the type of error produced in a cohort of healthy old subjects. 18 subjects were evaluated with the battery of Facial Recognition of Basic Emotions considering the correct answers and the incorrect selections. The results obtained show that there are significant differences between the pairs of ¨correct fear and fear by surprise¨, ¨correct surprise and surprise by fear¨, ¨correct anger and anger by disgust¨ and ¨correct disgust and disgust by anger¨. These findings support the standard posture about the existence of the 6 basic emotions.

Patterns of medical accidents and disputes in the orthodontic field in Korea / 대한치과교정학회지

The committee of admitted doctors developed a questionnaire regarding medical dispute and distributed it to 1,600 members of Korean Academy of Orthodontics. The questionnaire consisted of three categories and 56 items covering basic information about the doctors and patients who had experienced medical disputes, the cause and workaround of medical accidents, and methods for taking precautions. The present survey showed a similar proportion of responders who had experienced a medical accident compared to the study in 1997. The primary reason for medical disputes was dissatisfaction with appearance. Many doctors felt that they would likely experience a medical dispute at some point. Most disputes were settled by doctors themselves, usually for an amount of less than 5 million Korean won. For some doctors, medical accidents lead to ongoing psychological problems. Responders felt that continuing education for medical dispute is very necessary. These results reveal a need for the association of orthodontists to lead advancements in education and countermeasures for preventing and managing medical accidents and disputes.

ndicios de atención insegura, errores y eventos adversos ocurridos en el proceso de atención en salud y enfermería en una IPS de Bogotá en el periodo junio 2009-junio 2010 / signs of unsafe care, errors and adverse events that occurred in the process of health and nursing care in an IPS in Bogotá in the period June 2009-June 2010

La seguridad del paciente es una preocupación mundial, en Colombia es liderada por el Sistema Obligatorio de Garantía de calidad en salud con el objetivo de prevenir la presencia de situaciones que afecten la seguridad del paciente durante la atención, reducir y de ser posible eliminar la ocurrencia de Eventos adversos para garantizar instituciones seguras y competitivas. Lo que se obtiene a través de los componentes obligatorios del sistema de garantía de la calidad, uno de ellos Auditoria para el Mejoramiento Continuo, cuyo objetivo es realizar seguimiento y control a todos los procesos, como una estrategia que garantice atenciones más seguras. Los informes de auditoría reflejan datos que son el resultado de la revisión y análisis integral de todas las atenciones realizadas, basan sus análisis en los atributos de calidad de la atención en salud, asume los lineamientos contractualmente definidos y acoge las normas vigentes frente a las atenciones en salud brindadas a las personas que las requieren. El Programa creado como una estrategia por el ministerio de la protección social involucra a todos los profesionales de salud y los compromete a asegurar la calidad del servicio en todos los ámbito; enfermería tiene a cargo la responsabilidad de brindar la atención directa, por lo tanto debe contribuir a la detección oportuna de atenciones inseguras y brindar cuidados oportunos, de calidad en lo posible libres de riesgo. Esta investigación se abordó como un estudio cuantitativo, retrospectivo de tipo descriptivo, para determinar la presencia de indicios de atención insegura, errores y eventos adversos que ocurrieron durante las atenciones realizadas en una IPS de II nivel de complejidad y que fueron presentados como atenciones no conformes en general en los informes de auditoría, para luego especificar cuáles de ellos son atribuidos específicamente a las acciones de enfermería. Los resultados obtenidos muestran un comportamiento similar a los estudios realizados por la Organización Mundial y permiten a los directivos de las instituciones, definir estrategias de mejoramiento continuo y establecer una estrategia permanente de evaluación y control, que permita a los profesionales de enfermería implementarla como herramienta que garantice la calidad del cuidado durante la atención.

Patient safety is a global concern, in Colombia is led by the Mandatory System of Quality Assurance in Health with the goal of preventing the occurrence of situations that affect patient safety during care, reduce and possibly eliminate the occurrence Adverse Event to ensure safe and competitive institutions. What we get through the mandatory components of system quality assurance, one auditing for continuous improvement, which aims to track and control all processes, as a strategy to ensure safer care. Audit reports show data that is the result of the comprehensive review and analysis of all patients attended, based their analysis on the quality attributes of health care, assumed contractually defined guidelines and welcomes the current rules about the attentions extended to health than those required. The program was created by the ministry of social protection, and involves all health professionals and make them promise to ensuring the quality of service in all aspects ; nursing has in its shoulders the responsibility of providing direct care, therefore must contribute to the timely detection of unsafe care and provide timely care, with quality and free of any risk. The research was approached as a quantitative, descriptive, retrospective study, to determine the presence of signs of unsafe care, mistakes and adverse events that occurred during care attention in an IPS on level II of complexity that were presented as "nonconforming attentions" generally in the audit reports, and then specify which of them are specifically attributed to nursing actions. The results show a behavior similar to studies by the World Health Organization and allow managers of institutions, defining continuous improvement strategies and establish a permanent strategy evaluation and control, enabling nurses to implement it as a tool ensure the quality of care for attention.

Indicios de atención insegura, errores y eventos adversos ocurridos en el proceso de atención en salud y enfermería en una IPS de Bogotá en el periodo junio 2009-junio 2010 / Signs of unsafe care, errors and adverse events occurred in the process of health and nursing care in an IPS in Bogotá in the period June 2009-June 2010

La seguridad del paciente es una preocupación mundial, en Colombia es liderada por el Sistema Obligatorio de Garantía de calidad en salud con el objetivo de prevenir la presencia de situaciones que afecten la seguridad del paciente durante la atención, reducir y de ser posible eliminar la ocurrencia de Eventos adversos para garantizar instituciones seguras y competitivas. Lo que se obtiene a través de los componentes obligatorios del sistema de garantía de la calidad, uno de ellos Auditoria para el Mejoramiento Continuo, cuyo objetivo es realizar seguimiento y control a todos los procesos, como una estrategia que garantice atenciones más seguras. Los informes de auditoría reflejan datos que son el resultado de la revisión y análisis integral de todas las atenciones realizadas, basan sus análisis en los atributos de calidad de la atención en salud, asume los lineamientos contractualmente definidos y acoge las normas vigentes frente a las atenciones en salud brindadas a las personas que las requieren. El Programa creado como una estrategia por el ministerio de la protección social involucra a todos los profesionales de salud y los compromete a asegurar la calidad del servicio en todos los ámbito; enfermería tiene a cargo la responsabilidad de brindar la atención directa, por lo tanto debe contribuir a la detección oportuna de atenciones inseguras y brindar cuidados oportunos, de calidad en lo posible libres de riesgo. Esta investigación se abordó como un estudio cuantitativo, retrospectivo de tipo descriptivo, para determinar la presencia de indicios de atención insegura, errores y eventos adversos que ocurrieron durante las atenciones realizadas en una IPS de II nivel de complejidad y que fueron presentados como atenciones no conformes en general en los informes de auditoría, para luego especificar cuáles de ellos son atribuidos específicamente a las acciones de enfermería. Los resultados obtenidos muestran un comportamiento similar a los estudios realizados por la Organización Mundial y permiten a los directivos de las instituciones, definir estrategias de mejoramiento continuo y establecer una estrategia permanente de evaluación y control, que permita a los profesionales de enfermería implementarla como herramienta que garantice la calidad del cuidado durante la atención.

Patient safety is a global concern, in Colombia is led by the Mandatory System of Quality Assurance in Health with the goal of preventing the occurrence of situations that affect patient safety during care, reduce and possibly eliminate the occurrence Adverse Event to ensure safe and competitive institutions. What we get through the mandatory components of system quality assurance, one auditing for continuous improvement, which aims to track and control all processes, as a strategy to ensure safer care. Audit reports show data that is the result of the comprehensive review and analysis of all patients attended, based their analysis on the quality attributes of health care, assumed contractually defined guidelines and welcomes the current rules about the attentions extended to health than those required. The program was created by the ministry of social protection, and involves all health professionals and make them promise to ensuring the quality of service in all aspects ; nursing has in its shoulders the responsibility of providing direct care, therefore must contribute to the timely detection of unsafe care and provide timely care, with quality and free of any risk. The research was approached as a quantitative, descriptive, retrospective study, to determine the presence of signs of unsafe care, mistakes and adverse events that occurred during care attention in an IPS on level II of complexity that were presented as "nonconforming attentions" generally in the audit reports, and then specify which of them are specifically attributed to nursing actions. The results show a behavior similar to studies by the World Health Organization and allow managers of institutions, defining continuous improvement strategies and establish a permanent strategy evaluation and control, enabling nurses to implement it as a tool ensure the quality of care for attention.

Discussion on tax of scientific research work reward / 中华医学科研管理杂志

Along with the perfection of taxation system,the country enhances the supervision of individual income tax constantly.It is easy for managers of the scientific research funds to ignore the tax management of scientific research work reward.Combined with the actual work,this article pointed out the tax misunderstanding of the scientific research work reward that exists in scientific research funds management,and analyzed some examples that explain the difierence and methods of calculating the individuaI income tax by the scientific research work reward in the difierent situations.Moreover,it clarified that it is verv ireportant for the management of scientific research funds to tax the individual income according to law.

Discussing the present mistakes about teaching of operational research of hygienic management / 中华医学教育探索杂志

This paperd probed four mistakes about teaching of Operational Research of Hygienic Management from different angles such as nature of courses,content of courses,academic goal and multimedia.By teaching example analysis,it put forward corresponding measures and suggestions on how to avoid these mistakes.

Application Research of Using Wireless Technology to Avoid Medical Mistake / 医疗卫生装备

Objective To avoid medical mistake,improve service quality of medical care,insure the security of patients. Methods The wireless Lan was deployed in ward to implement the scheme of using wireless Lan and avoid medical mistake,and then use wireless nursing system to prove it. Results This scheme can reduce the work intensity of medical staff,decrease the probability of medical mistake,and improve the service quality of medical care. Conclusion The wireless technology can avoid medical mistake effectively.

Application of mistake-demonstration method in experiment teaching of operative dentistry and Endodontics / 中华医学教育探索杂志

Students are often apt to make mistakes in operative dentistry and endodontics experiments because of the complex experiment procedures and various instruments.Practice shows that it can effectively prevent and correct many mistakes by reasonably using mistake-demonstration method in experiment teaching of operative dentistry and endodontics.

Removing mistake on application of centralized oxygen supply / 医疗卫生装备

In order to enable centralized oxygen supply a healthy development,this paper introduces five kinds of mistakes in the application of centralized oxygen supply technique.

Mistakes about Oracle performance tuning / 医疗卫生装备

At present,the database of Oracle is widely used in military hospitals.As the core of hospital information system,the performance of current database is closely related to the stability of whole system.This article describes some mistakes and experience in oracle performance tuning.

Misunderstandings to Be Avoided in Licensed Pharmacist Legislation / 中国药房

OBJECTIVE:To provide references for the legislation of Licensed Pharmacist Legislation. METHODS:Several misunderstandings appearing during the complementation of licensed pharmacist regulation were analyzed, as well as the reasons for these misunderstandings. RESULTS&CONCLUSION: The misunderstandings in the respect of legislative subjects, licensed posts, licensed treatment, talent market demand and further education should be avoided in the process of Licensed Pharmacist Legislation.