Gestion de la qualité des soins au service d'acceuil des urgences (SAU) de l'hôpital du Mali: enjeux et perspectives / Management of the quality of care at the emergency reception service (SAU) of the hospital of Mali : challenges et perspectives

Introduction : La Neurochirurgie au Mali reste une discipline relativement jeune par rapport aux autres spécialités chirurgicales. Le but de ce travail est de décrire le parcours des urgences neurochirurgicales admises au SAU de l'hôpital du Mali.Patient et méthodes : C'est une étude prospective transversale analytique qui s'est déroulée au SAU de l'hôpital du Mali sur une durée de 02 mois. Sont inclus dans cette étude, tous les patients admis au SAU et dont on a eu recours à un avis neurochirurgical. Nous avons recensé et analysé les données épidémiologiques, cliniques, paracliniques et thérapeutiques chez 82 patients. Résultats : Sur un total de 152 patients admis au SAU, il y'avait 82 cas pour lesquels un avis neurochirurgical a été demandé soit 53, 95 % des admissions. Parmi ces 82 patients, il y avait 50 cas de traumatismes crâniens, 20 cas de traumatismes du rachis, 08 cas d'accident vasculaire cérébral hémorragique (AVCH), 03 cas de suppurations intracrâniennes et 01 cas de tumeur cérébrale. Nous avons opéré 41 patients (50%) et mis en observation 32 patients (39,02%). Malgré nos efforts, 09 patients sont sortis contre avis médical ou par faute de moyens. Nous avons noté 03 cas de décès. Conclusion : La qualité des soins et l'accès aux soins sont très souvent considérés par les patients comme les éléments essentiels de la performance d'un système de santé. En tant que Etablissement Public Hospitalier (EPH) de niveau 3, il doit bénéficier d'un plateau technique adéquat et d'un personnel médical et paramédical suffisant afin d'assurer une prise en charge correcte des patients

Introduction : Neurosurgery in Mali remains a relatively young discipline compared to other surgical specialties.The aim of this study is to describe the course of neurosurgical emergencies in "Hôpital du Mali". Patients and methods: This is a prospective cross-sectional analytical study that took place at the emergency department of "hôpital du Mali" over a period of 02 months. Are included in this study, all the patients admitted in emergency for whom neurosurgical advice was sought. We identified and analyzed epidemiological, clinical, paraclinical and therapeutic data in 82 patients.Results: Out of a total of 152 patients admitted to our emergency unit, there were 82 cases for which a neurosurgical opinion was requested, ie 53.95% of admissions. Among these 82 patients, there were 50 cases of head trauma, 20 cases of spinal trauma, 08 cases of brain stroke, 03 cases of intracranial suppurations and 01 case of brain tumor. We operated on 41 patients (50%) and observed 32 patients (39.02%). Despite our efforts, 09 patients were released against medical advice or for lack of funds. We noted 03 cases of death. Conclusion: The quality of care and access to care are very often seen by patients as essential elements of the performance of a health system. As a level 3 public hospital, it must have an adequate technical platform and sufficient medical and paramedical staff to ensure correct patient care

Complications des prothèses valvulaires mécaniques: à propos de cinq cas au service de cardiologie du Centre Hospitalier de Libreville / Complications of mechanical prothetic heart valves : about five cases in the cardiology Department of the Libreville University Hospital Center

Introduction : La présence de matériel prothétique intracardiaque expose au risque thromboembolique, infectieux et/ou hémorragique. L'objectif de ce travail était de décrire les particularités cliniques et étiologiques des complications de prothèses valvulaires mécaniques.Cas cliniques : Il s'agit d'une série de cinq observations de patients présentant une complication de prothèses valvulaires mécaniques colligées au service de cardiologie du Centre Hospitalier Universitaire de Libreville durant la période allant de Janvier 2017 à Décembre 2021. Les complications rapportées étaient deux cas de thrombose obstructive de prothèse, un accident vasculaire cérébral sur microthrombose, une endocardite infectieuse et un accident hémorragique sous antivitamines K. Ce dernier était responsable d'un décès. Conclusion : Ces cas cliniques mettent en exergue les difficultés liées au suivi de l'anticoagulation au long cours chez les patients porteurs de prothèse valvulaire mécanique dans notre contexte. La mise en place d'un programme d'éducation thérapeutique pourrait diminuer ces complications parfois létales

Introduction: The presence of intracardiac prosthetic material exposes to thromboembolic, infectious and/or hemorrhagic risk. The objective of this study was to describe the clinical and etiological particularities of mechanical valve prostheses complications. Clinical cases: five observations of patients presenting with a complication of mechanical valve prostheses collected in the cardiology department of the Libreville University Hospital Center during the period from January 2017 to December 2021, were reported. Complications observed were two cases of obstructive prosthesis thrombosis, a cerebrovascular stroke coming from microthrombosis, an infective endocarditis and a hemorrhagic accident under vitamin K antagonists. This last was responsible for the one death. Conclusion: These clinical cases highlight the difficulties related to the monitoring of long-term anticoagulation in patients with mechanical valve prosthesis in our context. The development of a therapeutic education program could reduce these potentially lethal complications

Manual para otimização da aquisição de medicamentos no âmbito hospitalar / Manual for optimizing the acquisition of medicines in the hospital environment

Introdução: a falta de um medicamento durante a internação hospitalar, põe em risco o correto cumprimento dos planos terapêuticos traçados para os pacientes, o que pode vir a gerar a recidiva de um quadro clínico, o prolongamento do tempo de internação e o consequente aumento de custos para a instituição, seja ela pública ou privada. Dentro da cadeia logística do medicamento, diversas são as etapas que podem contribuir para o desabastecimento. No âmbito hospitalar essa logística se dá por meio do ciclo da assistência farmacêutica que compreende as etapas de seleção, programação, aquisição, armazenamento, distribuição e dispensação de medicamentos. Os estoques da farmácia hospitalar são caracterizados por ciclos de demandas e de ressuprimentos, com flutuações significativas, o que dificulta a disponibilidade na mesma proporção da utilização do medicamento. Tendo em vista esta complexidade torna-se necessário o uso de indicadores, que avaliem os processos de trabalho. Objetivos: o objetivo deste estudo foi identificar as principais causas de desabastecimento de medicamentos em uma unidade de saúde e desenvolver um manual para otimização da aquisição de medicamentos. Materiais e método: Inicialmente foi realizado um mapeamento do fluxo de valor a fim de compreender a movimentação de materiais e informações envolvidos no processo de aquisição de medicamentos. Posteriormente, confeccionou-se uma planilha para registrar o fluxo logístico dos produtos, que resultou na obtenção dos pontos críticos do processo. A coleta dos dados de aquisição de medicamentos foi realizada durante o ano de 2019. Os critérios avaliados foram definidos com base nas ocorrências que mais contribuíram para o desabastecimento, seja pela relevância, ou pela frequência. Por fim foi elaborado um manual contendo critérios, normas, e procedimentos, a serem seguidos a fim de se evitar o desabastecimento. Resultados: Elaboração de um manual para otimização da aquisição de medicamentos composto por: mapa do fluxo de valor logístico de medicamentos, planilha para registro da logística de aquisição de medicamentos, procedimentos operacionais padrão para a gestão da aquisição de medicamentos. Conclusão: com o manual espera-se otimizar a gestão logística de medicamentos e reduzir a incidência de problemas com desabastecimento, gerando um impacto positivo na assistência ao paciente

Introduction: the lack of a drug during hospitalization puts at risk the correct compliance with the therapeutic plans outlined for the patients, which can lead to the recurrence of a clinical condition, the extension of the hospital stay and the consequent increase in costs for the institution, whether public or private. Within the drug's logistics chain, there are several steps that can contribute to shortages. In the hospital context, this logistics takes place through the pharmaceutical care cycle, which comprises the stages of selection, programming, acquisition, storage, distribution and dispensing of medicines. Hospital pharmacy stocks are characterized by cycles of demand and resupply, with significant fluctuations, which makes availability in the same proportion as the use of the medication difficult. Due to this complexity, it is necessary to use indicators that assess work processes. Objectives: The aim of this study was to identify the main causes of drug shortages in a health unit and to develop a manual for optimizing drug acquisition. Materials and method: Initially, a mapping of the value stream was carried out in order to understand the flow of materials and information involved in the drug procurement process. Subsequently, a spreadsheet was made to record the logistical flow of the products, which resulted in the critical points of the process being obtained. Logistic data for drug acquisition during 2019 were collected and the criteria evaluated were defined based on the occurrences that most contributed to the shortage, either by relevance or by the frequency with which they occurred. Finally, a manual was created containing criteria, norms, and procedures to be followed in order to avoid shortages. Results: Preparation of a manual for optimizing drug procurement, comprising: a map of the logistical value flow of drugs, a spreadsheet for recording the logistics of drug procurement, standard operating procedures for managing drug procurement. Conclusion: the manual is expected to optimize the logistical management of medicines and reduce the incidence of problems with shortages, generating a positive impact on patient care

Research on the Risk Prevention and Quality Control of Public Hospital Procurement / 中国医疗器械杂志

Through the functional combination of relevant departments involved in hospital procurement, to simplify and unify the work process, we establish a standardized procurement system, to realize the pre-procurement budget and approval, power balance, strengthen the fairness and openness of procurement process. By introducing the closed-loop process of in-process supervision to ensure the impartiality of review and post-evaluation control, it comprehensively strengthens the internal control of procurement management, and finally realizes the purpose of strengthening procurement risk prevention and procurement quality management.

Gestão de compras em um hospital de ensino terciário:um estudo de caso um estudo de caso / Purchasing Management in a Tertiary Teaching Hospital: a case study

Modelo do Estudo: Estudo de Caso. Objetivo do Estudo: O presente trabalho visou estudar o processo de compras e programação de materiais de um hospital público de ensino de nível terciário e analisar os perfis de itens de materiais de consumo faltantes em determinado período, com a finalidade de identificar como ferramentas de gestão de materiais podem ajudar na definição de políticas de compras e estoque. Metodologia: O estudo foi elaborado com base em análises qualitativas e quantitativas. As primeiras foram feitas por meio de coleta de dados relativos ao entendimento dos processos e estrutura interna da Divisão de Materiais do Hospital através de observação e entrevistas semi estruturadas entre o período de setembro a novembro de 2013. A relação dos itens faltantes em 2012 e 2013 foi obtida através do sistema de informação da instituição e a partir destes dados foram feitas as análises quantitativas dos perfis destes itens segundo as classificações ABC e VEN (ou XYZ). Resultado: Os resultados apontam que dos 8.595 itens de materiais de consumo do Hospital apenas 5% em quantidade são classificados como A na curva ABC, no entanto tais itens correspondem a 42% em valores. Já os itens vitais representam 49% do valor e 46% em termos de quantidade. Quando analisadas em conjunto, as duas curvas apontam que a maioria das quantidades de materiais de consumo do Hospital são classificados como vitais da curva C (36,35%) e os itens não essenciais da curva A representam tanto em valor como em quantidade a menor parcela de materiais. O perfil dos itens faltantes em 2012 e 2013 são semelhantes,o maior índice de faltas está nos itens vitais da curva C e a menor nos itens não essenciais da curva...

Model Study: Case Study. Purpose of the Study: This study aims to explore the purchasing materials process in a tertiary teaching hospital and analyze the missing items profiles in a given period in order to identify how materials management tools can help optimizing purchasing and inventory policies. Methodology: The study was based on qualitative and quantitative analyses. The first was made by means of collecting data to understand both processes and internal structure of the Materials Division through observation and semi-structured interviews between September-November 2013. A list of missing items in 2012 and 2013 was obtained from system information in order to analyze the profiles of these items according to the ABC and VEN (or XYZ) ratings. Results: The results show that out of 8,595 items of consumable materials, only 5 % in volume are classified as A in ABC curve, however such items correspond to 42 % in value. On the other hand, vital items represent 49 % on value and 46 % in terms of quantity. When analyzed together, the two curves show that most quantities of consumables materials are classified as vital from the C curve (36.35%) where as non-essential items from the A curve represent both in value and in volume the smallest amount portion of materials. The missing items profile in 2012 and 2013 were similar, the highest rate of faults is from vital and C curve materials and the smaller, of nonessentials of the A curve...

Situación actual del control interno de la unidad de adquisición del Hospital Militar Escuela Dr. Alejandro Dávila Bolaños año 2014

Estudio Transversal, cualitativa y descriptiva. Se recomienda emitir y controlar la aplicación de normas que regulen el proceso de adquisiciones de bienes en el hospital. Se propone realizar la evaluación y sanción de los contratos suscritos sin vigencias con el fin de apegarlos a las exigencias contenidas en la Ley de Contrataciones del Estado y sus reformas.

Discussion on the Right of Medical Equipment Purchasing Operation Method and Effect / 中国医疗器械杂志

Medical equipment procurement authority provides sunshine supervisory channel for hospital staff by power operation monitoring software, which could operate in the open. The exercise of purchase rights should upload the content in accordance with the provisions of "internal control point". It could strengthen the procurement process control and ensure the orderly supervision links to further regulate bidding and purchasing behavior, which can prevent the exercise of uncontrolled power.

Análisis de tiempos y movimientos en el proceso de contratación administrativa de medicamentos, en el Hospital México durante el año 2009 / Time and motion analysis for the process of public procurement of drugs in Mexico Hospital during 2009

Justificación y objetivo: Dentro de la población que atiende la Caja Costarricense del Seguro Social existe un grupo minoritario que posee necesidades excepcionales de determinados medicamentos debido a su condición clínica diferencial. Ante esta situación de importancia, a pesar que solo constituye la menor parte de los casos, la CCSS ofrece un sistema para adquirir los medicamentos tránsito y los que se encuentran fuera de la Lista Oficial de Medicamentos, LOM. Este proceso de adquisición conlleva una variedad de trámites de Contratación Administrativa, establecidos en la Ley, los cuales afectan la prescripción del medicamento al paciente. El presente estudio tiene como objetivo analizar la duración del proceso de contratación administrativa en las compras directas y licitaciones de medicamentos no LOM en el Hospital México durante el año 2009. Métodos: En esta investigación se revisó un 47.26 por ciento de la población total de expedientes de compra, que corresponden a 112 de las 237 compras directas y de licitación que aparecen registradas en el año 2009, según el Histórico de Compras 2009. Resultados y Conclusión: Se determinó que existe una alta variabilidad entre las diferentes compras, carteles de medicamentos, y entre los diferentes procesos que se llevan a cabo en cada uno de estos carteles. No existe una uniformidad en relación a los procesos de adquisición de medicamentos, lo cual dificulta el poder determinar los factores que obstaculizan este proceso.

Revelation of purchase system of developed nation to large medical equipment group purchase in our country / 中国医疗器械杂志

There were some features of purchase system in developed nation, such as clear purchase objectives flexible methods, standard programming, emphasis on competition and open process. The measures suggested include playing the role of competition purchasing; establishing the e-business modern purchasing information system; establishing legislation system; and completing business purchasing.

The research of organization behavior model in planning medical equipments purchasing / 中国医疗器械杂志

The law named The Safety Management Standardization of Medical Apparatus and Instruments in Clinic issued by the government recently, has classified the technical evaluation as one of the aspects of controlling medical risks in demonstration of medical equipments purchasing. This article has researched the organization behavior model, put forward the inevitability of the role in clinical engineering subjection, provided the idea and method of medical equipment purchasing plan, corresponding with the new standardization in now period.

The generation characteristics and purchasing points of Gamma Knife / 中国医疗器械杂志

With the rapid development of the computer technology and the constant updating of the radiotherapy equipment, a huge improvement has been manifested by the new generation of the Gamma Knife radiotherapy system. Not only its functions are being improved, but also the treatment indications are expanding. These advances have been widely recognized by the clinical medical experts, breaking off the forbbiden zone of surgical operations, saving a lot of tumor patients with both malignant and benign lesions, who are not suitable for surgical operations due to local anatomical limitations. However, there are still a lot of clinicians being not clear about the funcitons and generations of Gamma Knife radiotherapy system. Moreover, variant guidances by different manufacturerers have given rise to confusions, especially on the equipment purchasing. Therefore, in this report we summarize the features of Gamma radiotherapy systems produced by different manufacturers in recent years, to supply reference data for the organization and expert buyers.

Evidence-based management of medical disposable materials / 中国医疗器械杂志

Evidence-based management of medical disposable materials pays attention to collect evidence comprehensively and systematically, accumulate and create evidence through its own work and also evaluate evidence strictly. This can be used as a function to guide out job. Medical disposable materials evidence system contains product register qualification, product quality certification, supplier's behavior, internal and external communication evidence. Managers can find different ways in creating and using evidence referring to specific inside and outside condition. Evidence-based management can help accelerating the development of management of medical disposable materials from traditional experience pattern to a systematic and scientific pattern. It also has the very important meaning to improve medical quality, control the unreasonable growth of medical expense and make purchase and supply chain be more efficient.

Practice and discussion on classified coding management of medical disposable materials / 中国医疗器械杂志

This paper describes the heart of class supplies involved in bidding and purchasing code library classification principles and, in the hope of medical supplies through the establishment of bidding and purchasing code library to assist the health authorities and medical institutions for effective quality control. Clinical research oriented, CT, volume, operation cost, cost per capita, BEP.

Design of a medical equipment purchasing system / 中国医疗器械杂志

This paper introduces the network data dynamic exchange technology applied to the design of the medical equipment purchase system according to the process of the medical equipment purchasing. The new system adopts B/S structure based on .net technology, to realize the medical equipment purchasing information's dynamic management of network purchase application and verification, suppliers qualification examination and the contact file inquiry etc.

The SWOT analysis and strategic considerations for the present medical devices' procurement / 中国医疗器械杂志

In this paper, the SWOT analysis method is used to find out the internal strength, weakness, exterior opportunities and threats of the present medical devices' procurements in hospitals and some strategic considerations are suggested as "one direction, two expansions, three changes and four countermeasures".

Bacterial contamination of vegetables served in hospitals.

OBJECTIVES: To study bacterial contamination of fresh vegetables before cleaning and before serving to patients in 14 hospitals. MATERIAL AND METHOD: Aerobic plate count was performed and emphasized on total viable aerobic bacteria, fecal coliform, fecal Escherichia coli and enteric pathogens in fresh vegetables including romaine lettuce, onion, parsley, celery and tomato before cleaning and before serving. Hospital nutrition officers who were involved in food purchasing and processing were interviewed. RESULTS: One hundred and six of 403 of fresh vegetable samples (26.3%) before cleaning were contaminated with > 10(7) colony forming unit per gram (CFU/gram) of viable aerobic bacteria, 106 of 178 samples (59.6%) contained MPN/fecal coliform >1,100 /gram, 78 samples (43.8%) contained MPN fecal E. coli >10/gram. Enteric bacteria were isolated from 7.2% of the total 304 samples including non typhoid Salmonella (1 sample), Vibrio cholerae non O1/O139 (7 samples) and Aeromonas species (14 samples). Forty of 396 ready to serve vegetable samples (10.1%) contained > 10(7) CFU/gram of viable aerobic bacteria. Seventy five of 183 (40.9%) samples contained >1,100 MPN fecal coliform/gram and 43 (23.5%) contained >10 MPN fecal E. coli/gram. Enteric bacteria were also detected in 7.6% of the samples including V. cholerae non O1/O139 (6 samples) and Aeromonas species (17 samples). There were three different ways in obtaining fresh vegetables to the hospitals: by auction (50%), wholesalers (21.4%) and retailers (14.2%). There were also different standards of transportation, packaging, delivery and food processing, particularly cleaning methods. CONCLUSION: Ready-to-eat fresh vegetables were contaminated in high percentages with microorganisms in the number that exceeded the standard. Better management is required to safeguard patients.

El contenido del cartel y la aplicación de los principios en materia de contratación administrativa / The content of the poster and the application of the principles in the matter of administrative hiring

El respeto a los principos que rigen la materia de contratación administrativa y su aplicación práctica en la elaboración de los carteles licitarios, es indispensable para garantizar la eficacia del procedimiento llevado a cabo. De tal manera que, mientras los principios de contratación sean aplicados de manera correcta, los oferentes verán garantizadas sus expectativas bajo condiciones de participación igualitaria. Por otra parte, el cartel o pliego de condiciones se constituirá en adelante en ley tanto para la administración como para los oferentes participantes, de allí su importancia en la adquisición de los bienes y servicios requeridos por las diversas administraciones para satisfacer los intereses colectivos determinados constitucionalmente o bien mediante la legislación al respectiva.