Infants without apparent risk factors with aspiration as a cause of respiratory symptoms - a retrospective study.

BACKGROUND: Dysphagia is common in children born prematurely or those with neuromuscular conditions or airway malformations. Few studies have reported on children with isolated dysphagia and there is significant variation in the literature regarding clinical outcomes. AIMS: The aim of this study was to characterise the clinical presentation of children with isolated dysphagia as well as the diagnostic evaluation, treatment strategies and clinical outcomes. METHODS: A retrospective chart review was conducted of children with isolated dysphagia presenting to a tertiary paediatric centre over a 10-year period. RESULTS: We describe these patients' presentation, clinical feeding assessment findings, radiological findings, treatment strategies and outcomes. Seventeen children were identified. Recurrent respiratory tract infections were the most common presentation (82%). Oral feeds were continued in 9 (53%) with the remaining being NG fed. Gastrostomy tubes were required for long-term nutrition in 6/8 (75%) of these cases. At follow-up, 11/17 (65%) had resolution of symptoms and are on full oral feeds. The mean age at resolution is 3.45 years. Of those who required gastrostomy 50% have had them removed. CONCLUSION: Isolated dysphagia should be considered in children presenting with recurrent, otherwise unexplained respiratory symptoms. Resolution can take a number of years.

Medical Records: More Than the Health Insurance Portability and Accountability Act.

It is the responsibility of each organization, including private practice businesses, to maintain a comprehensive medical records retention policy. While registered dietitian nutritionists (RDNs) are qualified and competent business owners, navigating through the challenges of proper medical record management can be difficult without a sound policy. A comprehensive medical record retention policy consists of 4 major components: creation, utilization, maintenance, and destruction as well as a retention schedule. Successful implementation of a comprehensive medical record retention policy promotes positive clinician-patient interaction and avoidance of potential legal ramifications.

Essential Academy Resources Support Quality and Expand Practice.

The Academy of Nutrition and Dietetics (Academy) develops and maintains foundational documents that apply to all registered dietitian nutritionists (RDNs) and nutrition and dietetics technicians, registered (NDTRs): Scope of Practice for the RDN and NDTR; Standards of Practice in Nutrition Care and Standards of Professional Performance for RDNs and NDTRs; and the Academy and the Commission on Dietetic Registration Code of Ethics for the Nutrition and Dietetics Profession. The Quality Management Committee of the Academy has developed resources that assist RDNs and NDTRs in understanding how to work to the fullest extent of their individual scope of practice to increase professional satisfaction, achieve future employment and position goals, and provide safe and reliable services. These resources are the definition of terms list, practice tips and case studies, and scope of practice decision algorithm, which build on Academy foundational documents. They support quality practice by answering questions such as "how can I become more autonomous in my practice" and "how can I use telehealth technology in my practice?" The foundational Academy documents and practice application resources assist all RDNs and NDTRs in recognizing their individual competence and practicing within their scope of practice.

Calidad y seguridad de maternidades públicas argentinas de mayor complejidad. Resultados de evaluaciones externas / Quality and Safety of More Complex Argentine Public Maternity Hospitals. Results of External Evaluations

INTRODUCCIÓN: Para contribuir a reducir la mortalidad materno-infantil, el Ministerio de Salud de la Nación implementó la evaluación externa (EE) de maternidades públicas categorizadas como IIIB. OBJETIVOS: Evaluar la calidad y seguridad de las maternidades en Argentina. MÉTODOS: Se utilizó una herramienta con 254 estándares ponderados por riesgo, hubo 24 evaluadores capacitados, "trazamiento" de pacientes, entrevistas con personal y pacientes, revisión de documentos, recorridas, fotografías y observación. Se recurrió a fuentes de información primarias. RESULTADOS: Se evaluaron 16 maternidades (mediana: 4 125 partos anuales). Los procesos más riesgosos fueron: manejo de medicaciones, cirugías, reporte de errores, identificación del paciente, reanimación cardiopulmonar del adulto y emergencias obstétricas, comunicación, personal y servicios (atención continua, guardias, horarios de ecografías, anestesiólogos, camilleros, control de competencias, uso de guías), control de infecciones y seguridad del entorno. CONCLUSIONES: Las maternidades públicas de mayor complejidad tienen muchos procesos inseguros. Las EE son efectivas para obtener información sobre riesgos, priorizar procesos a mejorar y estimar la frecuencia de ocurrencia de problemas sistémicos. Deberían ser parte de una estrategia de calidad nacional que contemple apoyo, incentivos y obligatoriedades, a fin de que las instituciones logren las mejoras necesarias para disminuir riesgos.

INTRODUCTION: To contribute to reducing maternal and infant mortality, the National Ministry of Health implemented a project of external evaluation (EE) of public hospitals providing maternity care under category IIIB. OBJECTIVE: To evaluate the quality and safety in maternity hospitals in Argentina. METHODS: The study used a tool with 254 risk-weighted standards, including 24 trained evaluators, tracing of patient care, interviews with staff and patients, document review, visits to services, photos, and observation. Information was gathered from primary sources. RESULTS: A total of 16 hospitals were evaluated (median: 4125 births annually). The processes of highest-risk were: medication management, surgery, error reporting, patient identification, adult cardiopulmonary resuscitation and obstetric emergency preparedness, communication, staff and services (continuity of care, personnel on-duty, availability of ultrasound examinations, anesthesiologists, auxiliary personnel, control of competencies, use of guidelines), infection control, and safety of the environment. CONCLUSIONS: Many unsafe processes were identified in highcomplexity public maternity hospitals. EEs are effective for gathering information about risks, prioritizing processes for improvement, and estimating the frequency of occurrence of systemic problems. They should be part of a national quality strategy considering support, incentives, and mandatory requirements so that hospitals take action to reduce risk.

Manual de gerência da qualidade / Manual of quality management

Discute o estabelecimento de programa para melhorar a qualidade do desempenho de instituições de saúde, desde a programação de processos até a implantação de programas de garantia de qualidade (AMSB)