Identify and categorize drug-related problems in hospitalized surgical patients in China.

Background Data is lacking on types and severities of drug-related problems (DRPs) in hospitalized surgical patients in China. Objective To identify and categorize types and causes of DRPs, and to assess severities of these DRPs. Setting An academic teaching hospital in Chongqing, China. Method We retrospectively reviewed all medication orders for patients in six surgical departments during a six-month period. DRPs were classified using the Pharmaceutical Care Network Europe (PCNE) classification, and the severity ratings of these DRPs were based on the National Coordinating Council for Medication Error Reporting and Prevention (NCCMERP) classification. Main outcome measure The number, types, causes and severities of the DRPs. Results A total of 291,944 medication orders in 10,643 patients were reviewed, and 3548 DRPs were identified. The average DRP number per patient was 0.3. The most common problem was treatment effectiveness (39.9%) and the major cause of the problems was dose selection (47.0%). Total 80.1% of the DRPs were rated at severity categories B to D (causing no or potential harm), whereas 19.9% were rated as categories E to H (causing actual harm). Conclusion DRPs are common in surgical patients, and prospective pharmacist medication order review services are needed to improve patients' pharmaceutical care.

El CIE-10 y el protocolo quirúrgico / CIE-10 and the surgical protocol

No disponible

Descriptive analysis of 30-day readmission after inpatient surgery discharge in the Veterans Health Administration.

IMPORTANCE: For the first time to our knowledge, this study analyzes and reports the 30-day all-cause readmission rates for surgical procedures performed in the Veterans Health Administration (VHA). OBJECTIVE: To analyze and report 30-day all-cause readmission rates following discharge from 9 surgical specialties in the VHA for a 10-year period. DESIGN, SETTING, AND PARTICIPANTS: In a retrospective observational study, Veterans Affairs Surgical Quality Improvement Program data for surgery records and VHA administrative discharge data were linked to evaluate all-cause readmission within 30 days of discharge from the surgical inpatient stay. The study population represents 9 surgical specialty groups: general, urology, neurosurgery, orthopedic, otolaryngology, plastic, thoracic, peripheral vascular, and cardiac. Trends of postoperative hospital admission rates for each surgery were investigated using 10 years (fiscal years 2001-2010; N = 894,943) of linked data. MAIN OUTCOMES AND MEASURES: All-cause 30-day readmission after surgery for each specialty. RESULTS: During the 10-year period, the overall 30-day all-cause readmission rate following inpatient surgery discharge significantly decreased from 12.9% to 12.2% (P < .001). Unadjusted readmission rates varied by surgical specialty: general, 12.5%; urology, 9.0%; neurosurgery, 10.5%; orthopedic, 9.6%; otolaryngology, 9.5%; plastic, 12.2%; thoracic, 14.4%; peripheral vascular, 16.0%; and cardiac, 16.6%. The following specialties were found to have a significant decline in readmission rates: orthopedic (P = .004), otolaryngology (P = .005), plastic (P = .02), thoracic (P = .04), peripheral vascular (P < .001), and cardiac (P = .003). Postoperative hospital length of stay in individual specialties decreased during this period (each P < .05) except for thoracic and cardiac surgery, which remained unchanged. Readmission diagnoses varied by specialty; postoperative infection was the most common readmission diagnosis in 7 specialties and the second most common in the other 2 specialties (urology and thoracic). Urinary tract infection and digestive system complications were also common readmission diagnoses. CONCLUSIONS AND RELEVANCE: This retrospective observational study showed decreasing 30-day readmission rates associated with a decline in postoperative hospital length of stay for 9 surgical specialties in the VHA during a 10-year period. Further study will be required to capture data from patients who had surgery at a VHA facility but were readmitted in the private sector.

[Even more critical medicine: a retrospective analysis of casualties admitted to the intensive care unit in the Spanish Military Hospital in Herat (Afghanistan)]. / Medicina aún más crítica: análisis retrospectivo de las bajas atendidas en la UCI del Hospital Militar español de Herat (Afganistán).

OBJECTIVE: To analyze casualties from firearm and explosives injuries who were admitted to the Intensive Care Unit in the Spanish ROLE-2E from December 2005 to December 2008 and to evaluate which damaging agent had produced the highest morbidity-mortality in our series using score indices with anatomical base (ISS and NISS). DESIGN: Observational and retrospective study performed between 2005 and 2008. SETTING: Polyvalent Intensive Care Unit in the Spanish Military Hospital of those deployed in Afghanistan. PATIENTS OR PARTICIPANTS: The inclusion criteria were all patients who had been wounded by firearm or by explosive devices and who had been admitted in ICU in Spanish Military Hospital in Herat (Afghanistan). INTERVENTION: The anatomic scores Injury Severity Score and the New Injury Severity Score (NISS) were applied to all the selected patients to estimate the grade of severity of their injuries. VARIABLES OF INTEREST: Independent: damaging agent, injured anatomical area, protection measures and dependent: mortality, surgical procedure applied, score severity and socio-demographics and control variables. RESULTS: Eighty-six casualties, 30 by firearm and 56 by explosive devices. Applying the NISS, 38% of the casualties had suffered severe injuries. Mean stay in the ICU was 2.8 days and mortality was 10%. Significant differences in admission to the ICU for the damaging agent were not observed (P=.142). CONCLUSIONS: No significant differences were observed in the need for admission and stay in the ICU according to the damaging agent. The importance of the strategy, care and logistics of the intensive care military physician in Intensive Medicine in the Operating Room in Afghanistan is stressed.

Quality assessment in surgical care departments: proposal for a scoring system in terms of structure and process.

OBJECTIVE: To build a score able to reflect and rank surgical departments according to a definition of "quality" in terms of structure and process. METHODS: Collaborative design of a quality score in the framework of the French clinical research project NosoQual. Feasibility and observational study in 46 surgical departments visited between November 2002 and March 2003 according to standardised procedures. A bibliographic review followed by expert consultations, a field test, analysis and a final reconsideration leading to the definition of a consensual score. RESULTS: 138 variables comprised the score. They were classified into seven dimensions, each representing a different aspect of quality of care in surgery. According to the threshold and weight attributed to every variable, scores were calculated for each department. The average level of achievement of the scores varied from 42% to 71% of theoretical maxima. The variability of the scores related to the seven dimensions was larger and more significant than the one expressed by the overall score (coefficient of variation=0.1). CONCLUSION: This analytical work contributed to the design of a quality score for surgery. However, the progress of the score should continue to take into account all the obstacles that were observed and to meet the high requirements of the actual patient safety issue.

[Prognosis for cutaneous melanoma according to surgical department: comparative study at a tertiary care hospital]. / Pronóstico del melanoma cutáneo según el servicio quirúrgico: estudio comparativo en un hospital de tercer nivel.

INTRODUCTION: Surgical treatment of melanoma is performed by dermatologists and general or plastic surgeons. It is not known whether the type of specialist treating the melanoma results in a different prognosis for these patients. MATERIAL AND METHODS: A retrospective study was carried out on the epidemiological, clinical/histological and evolutional characteristics of all patients diagnosed with melanoma at Hospital Gregorio Marañón over a 10-year period (1994-2003). The differences by hospital department where the patients were treated (dermatology, general surgery and plastic surgery) were noted. RESULTS: Over 90 % of the patients with melanoma were treated by the Dermatology Department. The thickness of the tumors and the presence of histologic ulceration were significantly higher in the melanomas treated by general and plastic surgeons (p <0.05). The differences in overall average survival (105, 55 and 77 months) and disease-free time (88, 24 and 51.3 months) in the melanomas operated on by dermatologists, general surgeons and plastic surgeons, respectively, were significant (p <0.001). CONCLUSIONS: This study confirms that there are significant differences in the clinical and histological characteristics and the life prognosis of patients with cutaneous melanoma treated by different specialists. The melanomas treated by general or plastic surgeons have usually been developing for a longer time, and therefore are thicker and more often ulcerated than those treated by dermatologists, resulting in a lower survival period. With appropriate medical and surgical training, dermatologists are the most suitable specialists for early diagnosis and treatment.

Gestión clínica de la lista de espera en un servicio de cirugía general / Management of the hospital waiting list in a general surgery department

Introducción. Presentamos nuestra experiencia en la gestión clínica de la lista de espera del Servicio de Cirugía General del Hospital de Viladecans (hospital público del Institut Català de la Salut).Objetivos. Diseño de una base de datos para la gestión clínica de la lista de espera del servicio de cirugía general, y evaluación de los resultados tras su diseño y aplicación.Material y método. Base de datos creada a tal fin, y que recoge todos los pacientes incluidos en lista de espera para intervención quirúrgica electiva durante un período de 5 años (desde el 1 de enero de 1996 al 31 de diciembre de 2000).Resultados. El número de intervenciones quirúrgicas electivas año tras año se ha mantenido por debajo de la demanda, creando un déficit que equivaldría a incrementar nuestra actividad en un 23,8 por ciento para adecuarla a la demanda. La lista de espera para la cirugía electiva ha estado condicionada a la presión de urgencias, que ha ido progresivamente en aumento. El criterio establecido de prioridad se ha demostrado útil, habiendo operado el 60,8 por ciento de los pacientes preferentes antes de 3 meses, y el 65,2 por ciento de los pacientes no preferentes entre 3 y 9 meses.Conclusiones. 1) Existe un progresivo incremento de la demanda de servicios quirúrgicos en nuestra área de influencia. 2) Se ha logrado una mejor gestión clínica, con un progresivo descenso en el número de anulaciones y un incremento en la actividad quirúrgica. 3) Se ha reducido el número de reprogramaciones de un 32 a un 14,3 por ciento. 4). Calculamos un déficit de recursos (horas de quirófano) que equivaldría a un 23,8 por ciento de nuestra actividad quirúrgica actual para poder adecuarnos a la demanda. 5) La base de datos diseñada por nosotros ha demostrado ser un instrumento útil de gestión de nuestra lista de espera (AU)

Multivariate matching and bias reduction in the surgical outcomes study.

BACKGROUND: Outcomes studies often need a level of detail that is not present in administrative data, therefore requiring abstraction of medical charts. Case-control methods may be used to improve statistical power and reduce abstraction costs, but limitations of exact matching often preclude the use of many covariates. Unlike exact matching, multivariate matching may allow cases to be matched simultaneously on hundreds of covariates. OBJECTIVES: To develop multivariate matched case-control pairs in a study of death after surgery in the Medicare population. RESEARCH DESIGN: Using 830 randomly selected index cases of patients who died within 60 days from admission, controls were found who did not die within that time period, matching on risk for death and other patient characteristics with up to 173 variables used simultaneously in the matching algorithms. SUBJECTS: General and orthopedic Medicare surgical cases in Pennsylvania from 1995 to 1996. Controls were either selected from across the entire state (108,765 possible subjects), or from within the same hospital as the case. MEASURES: Percent bias reduction and the average difference between cases and controls in units of standard deviations. RESULTS: Matched controls were far more similar to cases (deaths) upon admission to the hospital than typical patients, both in statewide and within hospital matches. Bias reduction was usually greater than 50% and often approached 100%. The difference between cases and matched controls for most variables was usually below 0.2 SD. CONCLUSIONS: Multivariate matching methods may aid in conducting studies with Medicare claims records by improving the quality of matches, thereby achieving a better understanding of the etiology of outcomes.

Evaluacion de la calidad de la información clínica: validez en la asignación de los grupos de diagnosticos relacionados (GRD) / Quality assessment of clinical information: validity of the diagnosis related groups (DRGs)

OBJETIVOS: El objetivo del trabajo es el estudio de la validez de los GRD asignados a las altas del Servicio de Cirugía del Hospital General de Castellón durante el año 1998, mediante la estimación del porcentaje de errores producidos en la asignación de GRD, la determinación de la variación que ocasiona en el índice case-mix , y la descripción de las causas de los errores. MÉTODOS: Se ha obtenido una muestra de las altas del Servicio de Cirugía. Se ha elaborado un nuevo conjunto mínimo de datos básicos (CMBD) de la muestra mediante la revisión de las historias clínicas, sin conocer cómo fueron codificadas originalmente y se han comparado los resultados con el CMBD de las altas a estudio ya existente en la base de datos del hospital, se analizan las diferencias y las razones de las mismas. RESULTADOS: El análisis mostró un 27,4 por ciento (IC 95 por ciento: 19,3 por ciento a 35,4 por ciento) de GRD mal asignados que han ocasionado una disminución del 0,4 por ciento en el índice casemix del Servicio de Cirugía. CONCLUSIONES: Se describen los motivos responsables de los errores, distinguiendo los debidos al productor de información (clínico) de los ocasionados durante el procesamiento de la información (indización y codificación), al objeto de proponer medidas correctoras (AU)

[Cardiac surgery in France (supply, service and needs response): a national survey]. / La chirurgie cardiaque en France (offre, activité et réponse aux besoins): une enquête nationale.

This paper describes the results of a national study of the 70 french cardiac surgery units. This study was required by the ministry of health in order to prepare the planning process of cardiac surgery in France. Results concerning the year 1994 show important regional variations of resources among the country. The number of interventions has increased three fold in 15 years (from 13,000 to 38,000 a year). The share of the different indications are constant (coronaropathy: 53%; valvulopathy: 36%; congenital: 8%). Patient flows across french regions represent 15% of the interventions. Regional intervention rates per capita range from 45 to more than 80 for 100,000 inhabitants. French cardiac surgery is, in fact, organized at a multiregional level and the regional intervention rates are not correlated with mortality or demographic rates.

Rural hospital inpatient surgical volume: cutting-edge service or operating on the margin?

Surgical services are an important part of modern health care, but providing them to isolated rural citizens is especially difficult. Public policy initiatives could influence the supply, training, and distribution of surgeons, much as they have for rural primary care providers. However, so little is known about the proper distribution of surgeons, their contribution to rural health care, and the safety of rural surgery that policy cannot be shaped with confidence. This study examined the volume and complexity of inpatient surgery in rural Washington state as a first step toward a better understanding of the current status of rural surgical services. Information about rural surgical providers was obtained through telephone interviews with administrators at Washington's 42 rural hospitals. The Washington State Department of Health's Commission Hospital Abstract Recording System (CHARS) data provided a count of the annual surgical admissions at rural hospitals. Diagnosis-related group (DRG) weights were used to measure complexity of rural surgical cases. Surgical volume varied greatly among hospitals, even among those with a similar mix of surgical providers. Many hospitals provided a limited set of basic surgical services, while some performed more complex procedures. None of these rural hospitals could be considered high volume when compared to volumes at Seattle hospitals or to research reference criteria that have assessed volume-outcome relationships for surgical procedures. Several hospitals had very low volumes for some complex procedures, raising a question about the safety of performing them. The leaders of small rural hospitals must recognize not only the fiscal and service benefits of surgical services--and these are considerable--but also the potentially adverse effect of low surgical volume on patient outcomes. Policies that encourage the proper training and distribution of surgeons, the retention of basic rural surgical services, and the rational regionalization of complex surgery are likely to enhance the convenience and safety of surgery for rural citizens.

Servicio de cirugia general hospital Obrero / Service of surgery general hospital Obrero

Contiene:Personal del servicio de cirugia,residentes del servicio de cirugia,servicio de cirugia general, actividades semanales del servicio de cireugia, actividades de los estudiantes internos, evaluacion, ficha individual de evaluacion, resedencia, calendario de los cursos del servicio de cirugia, seminarios, programa de anatomia quirurgica corso de cirugia para residentes, programa general de fisioterapia para residentes de cirugia, programa general de patologia quirurgica para residentes de cirugia, cursos de cirugia anbulatoria, cursos de post-operatorio en cirugia para enfermera, patologia de la pared addominal, cursos de emergencias no traumaticas, cursos de actualizacion en pancreas, cursos de patologia vascular cursos de actualizacion en gastroenterologia para especialistas, cursos de liquidos y electroliticos en cirugia, cursos de patologia de colon, cursos de cirugia toracica, reunión de evaluacion de las actividades del servicio