ABSTRACT
BACKGROUND: Patient safety is a fundamental principle of health care but is one of the biggest challenges currently faced and a serious public health problem, since the occurrence of adverse events is probably one of the main causes of morbidity and mortality worldwide. The vulnerability of the paediatric population, combined with the potentially dangerous context of intensive care, makes Paediatric Intensive Care Units services of particular complexity in matters of safety, where there is a greater likelihood of incidents with serious consequences. It is agreed that research on the topic of PS should start with the measuring of different types of harm that exist in the contexts, to identify high-risk areas and define priorities. For this, it is necessary to resort to a multiplicity of valid, reliable and specific measurement instruments and to learn their advantages and limitations. The objective of this review will be to identify and map in scientific literature the instruments for measuring incidents related to patient safety applicable in the context of paediatric intensive care. METHODS: This review will cover studies and documents that refer to all measurement instruments used in the field of patient safety in a context of paediatric intensive care. Quantitative, qualitative, or mixed nature published studies, as well as grey literature, produced in the last 5 years and relevant to the topic will be included, in Portuguese, English or Spanish languages. The sources of information include several databases (such as MEDLINE, CINAHL, Cochrane Library, JBI Databases) and sources relevant to grey literature. Two reviewers will independently screen all citations, full-text articles and abstract data. The extracted data, after being organised in the extraction table, will be mapped in a descriptive and logical way, taking into account the defined review questions. DISCUSSION: The mapping of the tools in these protocols will allow to summarise the most widely used instruments, to know their specificities and to guide researchers to use the most appropriate measurement tools for their context, specifically, in paediatric intensive care. SYSTEMATIC REVIEW REGISTRATION: Open Science Framework ( osf.io/b5m7j ).
Subject(s)
Delivery of Health Care , Patient Safety , Child , Critical Care , Health Facilities , Humans , Review Literature as TopicABSTRACT
BACKGROUND: Locally advanced colon cancer with direct abdominal wall and skin invasion is an extremely rare finding with most data being derived from case reports, historical autopsy-based or single-center retrospective studies. We present a unique case of a colon cancer with direct cutaneous invasion and colocutaneous fistulization. CASE PRESENTATION: Eighty-six year old Caucasian female with multiple comorbidities, referred to Surgical Consultation due to ulcerated skin lesion in the abdomen. She had a long-standing large umbilical hernia but with no previous episodes of incarceration or occlusive symptoms. She denied any digestive or constitutional symptoms. Physical examination showed a large non-reducible umbilical hernia, with an associated painless firm mass within the hernia sac and cutaneous ulcerated growth. Colonoscopy revealed transverse colon cancer (endoscopic biopsy of the tumor and skin punch biopsy confirmed adenocarcinoma of the colon). Computed tomography showed a tumoral mass within the umbilical hernia, with cutaneous infiltration and enlarged regional lymph nodes. Rapid local progression led to colocutaneous fistula with total fecal diversion. We performed an extended right hemicolectomy with en bloc excision of the hernia sac and infiltrating cutaneous mass. CONCLUSIONS: In the current era of widespread use of screening colonoscopies, initial diagnosis of locally advanced colon cancer is decreasing. However, this unique case presented an opportunity to recall the advantages of multivisceral resections.
