Undetected Cortrak tube misplacements in the United Kingdom 2010-17: An audit of trace interpretation.

OBJECTIVES: Determine why Cortrak-guided, undetected tube misplacement may occur in relation to the system of trace interpretation used. METHODOLOGY: From 2010 to 2017 we obtained seven of the eight Cortrak traces from the United Kingdom where misplacement was undetected and the patient received feed. Seven suffered serious harm. Each misplacement was interpreted by three systems: screen position, manufacturer guidance and gastrointestinal (GI) flexures. SETTING: National and local records. MAIN OUTCOME MEASURES: Ability to identify misplacement. RESULTS: Traces that were later identified as misplacements, could not be differentiated from GI position when they wholly or partially: a) overlapped with the GI screen area plotted from historical records (57-71%) or b) met both manufacturer guidance criteria or were confused with receiver misplacement or unusual anatomy and reached the lower left quadrant (14-71%). Conversely, all lung misplacements were identified as unsafe using the GI flexure system. All three systems failed to detect the intra-peritoneal trace. Traces were inconsistently stored by healthcare centres. CONCLUSION: Trace file storage should be mandated by and accessible to relevant health authorisation bodies to improve safety research. Screen position alone and manufacturer guidance fail to consistently differentiate the shape of safe from unsafe traces. GI flexure interpretation appears safer but requires testing in larger studies.

Management of postpartum hemorrhage in a rural hospital in Kenya: a best practice implementation project.

INTRODUCTION: Postpartum hemorrhage accounts for 34% of maternal deaths in Kenya. The World Health Organization guidelines on postpartum hemorrhage are not always followed despite being prominently promoted in hospitals. OBJECTIVES: The objectives of this study were to assess the current practice of health workers in the prevention and management of postpartum hemorrhage and to implement strategies to promote best practice. METHODS: A baseline audit with five evidence-based audit criteria was conducted using the Joanna Briggs Institute Practical Application of Clinical Evidence System. Strategies to improve compliance were implemented and a follow-up audit was carried out using the same data collection methods. Results of both audits were compared. RESULTS: The baseline audit showed that 90% of health workers were aware of the existence and location of the national guidelines. Almost two thirds (65%) of staff had received education on postpartum hemorrhage within the last two years. Only 30% had received specific training on the use of the guidelines and compliance with the guidelines was 0%. At the follow-up audit, the proportion of health workers who had received recent education on postpartum hemorrhage and specific training on the use of a protocol increased to 90%. The use and documentation of a protocol for postpartum hemorrhage increased to 100%. Compliance in prenatal risk assessment for postpartum hemorrhage decreased from 65% to 35%. CONCLUSIONS: Knowledge of the guidelines did not translate into their use during management of patients with postpartum hemorrhage. The introduction of a tool and staff education and training improved compliance.

Development of pharmacy resident leadership skills through creation of a regional ambulatory care forum.

BACKGROUND AND PURPOSE: Action-based leadership activities help refine leadership skills. This paper describes an experiential, longitudinal leadership experience for post-graduate year two (PGY2) pharmacy residents in ambulatory care. EDUCATIONAL ACTIVITY AND SETTING: As part of a leadership and advocacy rotation, two PGY2 ambulatory care pharmacy residents collaborated with a state association, North Carolina Association of Pharmacists, to co-chair a newly formed regional ambulatory care forum in the western part of the state. The residents developed charges for the group, directed and organized the leadership team meetings, moderated the member events of approximately 30 participants, and served as liaisons to the state association and its members. Two residency preceptors who supervised the academic and leadership experiences for the residency program provided oversight for the residents with the forum. Residents completed written and oral self-reflections, received formative feedback from the forum's leadership team and leadership preceptor, participated in a 360-degree leadership evaluation, and received quarterly summative evaluations. FINDINGS: Skills developed included leading a group, event planning, advocacy, networking, communication, professional writing, creating a shared vision, teamwork, and collaboration. SUMMARY: Serving in leadership roles within professional organizations can provide PGY2 pharmacy residents with practical hands-on leadership opportunities to help prepare them for positional and non-positional leadership roles in the future.

Presente y futuro de la especialidad desde la perspectiva de la Comisión Nacional / Present and future of the specialty from the perspective of the National Committee

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Implementing entrustable professional activities: the yellow brick road towards competency-based training?

BACKGROUND: We describe implementation of competency-based postgraduate surgical training, using an entrustable professional activities (EPAs) programme. The programme aims to improve patient outcomes by optimizing supervision of surgical trainees, creating opportunities for additional teaching and feedback. The curriculum was designed to maximize feasibility for implementation within a colorectal surgical department. METHODS: The curriculum was developed using previously described methods by consensus between two consultants within the department. Seven EPAs were identified and described for each grade of trainee. A consultant within the teaching faculty or a delegate is required to assess each EPA and provide formal feedback until the trainee is given permission to act autonomously. RESULTS: It is hoped the programme can progress with minimal disruption to key stakeholders. We will record trainee assessment data anticipating that performance of trainees on other tasks in the future may provide some evidence of validity for the EPA assessments. CONCLUSIONS: There are perceived benefits and problems evident in the EPA model at this early stage of implementation. The programme should result in an increase in the number of formative assessments and feedback opportunities for trainees. The assessment process is familiar to supervisors, which should facilitate implementation of the curriculum. There is concern that supervisors may require further training to ensure the assessment process is objective and reproducible. The EPA programme could make the process of delegating patient care to trainees more transparent, but we have not identified a method of widely disseminating trainee assessment data without the potential to prejudice trainees unfairly.

«MENTOR». Un programa innovador de reclutamiento de residentes / «MENTOR»: A novel program for recruiting residents

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Percepción de los profesionales sobre la utilización y la utilidad del listado de verificación quirúrgica / The healthcare professional's perceptions on the implementation and usefulness of the surgical safety checklist

Objetivo. Conocer la percepción de los profesionales sobre el grado de utilización y la utilidad del listado de verificación quirúrgica (LVQ) tras su implantación en un hospital terciario. Material y métodos. Estudio descriptivo transversal. Cuestionario autocumplimentado con 5 preguntas sobre utilidad, 5 sobre utilización, 1 pregunta abierta y 4 preguntas de control. La población objetivo: cirujanos, anestesiólogos, enfermeras de planta y de quirófano del hospital. Resultados. La tasa de respuesta fue del 73% (entre el 51 y el 88%, según perfil profesional). El 95,7% de los profesionales manifestó utilizar siempre o casi siempre el LVQ cuando se interviene a un paciente quirúrgicamente. Los profesionales otorgaron al LVQ una utilidad media de 6,6 puntos (escala, 0-10), el 11,6% manifestó que gracias al LVQ se habían evitado errores, el 32,5% consideró que es una herramienta que mejora la comunicación entre los profesionales, y al 68% le gustaría que se cumplimentase el LVQ si ellos mismos fuesen a ser intervenidos. Los profesionales que contestaron que gracias al LVQ se consiguió evitar errores otorgaron valores de utilidad 1,4 puntos por encima de la media, en este mismo grupo, al 100% de los profesionales les gustaría que se utilizase el LVQ en ellos mismos y el 63,2% consideró que mejoraba la comunicación. No hubo diferencias en la utilidad en función de la experiencia profesional o el sexo. Conclusiones. Los profesionales utilizan casi siempre el LVQ y le otorgan una utilidad moderada. Los profesionales que experimentaron que gracias al LVQ se había conseguido evitar errores confirieron al LVQ una utilidad mayor que los que no lo experimentaron(AU)

Objective. To find out the perception of the health care professionals on the level of implementation and the usefulness of the surgical safety checklist (LVQ) after its introduction in a tertiary care hospital. Material and method. A descriptive cross-sectional study was conducted using a specially designed self-completion questionnaire. This consisted of 5 questions on the usefulness, 5 questions on the use of the LVQ, one open question and 4 control questions. The target population was hospital surgeons, anaesthetists, ward nurses, and surgical nurses. Results. The response rate was 73%, ranking from 51% to 88% depending on the respondent profile. Almost all (95.7%) of the respondents declared they always or almost always used the LVQ when performing a surgical operation. The health care professionals rated the usefulness of the LVQ with a mean of 6.6 (scale, 1-10); 11.6% mentioned that actual errors had been avoided through the use of the LVQ; 32.5% considered the LVQ as a tool that improves communication between professionals; and 68% of the respondents declared they would like the LVQ to be used if they were surgical patients. Those respondents who answered that the LVQ had prevented errors gave higher usefulness scores, 1.4 above the mean. In this same group, 100% of the respondents would like the LVQ to be used on themselves and 63.2% considered that communication had improved. There were no differences in usefulness scores as regards professional experience or gender. Conclusions. The health care professionals use the LVQ very frequently, and consider that it has a moderate usefulness. Those professionals with experience of the LVQ preventing errors considered it to be more useful than those who did not experience an error being prevented(AU)

Comisión Nacional de la especialidad de Radiodiagnóstico. ¿Qué es y para qué sirve? / What is the National Commission for the Specialty of Diagnostic Imaging and what is its purpose?

La Comisión Nacional de Radiodiagnóstico es un órgano asesor del Ministerio de Sanidad y Consumo y del Ministerio de Educación en temas de formación sanitaria especializada. Dentro del capítulo de Formación de Residentes en Radiología se explican las competencias y funciones de la Comisión Nacional de la especialidad de Radiodiagnóstico, como son: elaboración del programa formativo, elaboración del libro del residente, establecimiento de criterios de evaluación, propuesta de áreas de capacitación específica, establecimiento de criterios de evaluación de unidades docentes y formativas y participación en el diseño de planes integrales dentro de la especialidad. También se detallan otras funciones meramente administrativas, pero que repercuten en toda la comunidad radiológica (AU)

The National Commission for the Specialty of Diagnostic Imaging is an organ of the Ministry of Health and Consumer Affairs and of the Ministry of Education that is responsible for the evaluation of thet raining of specialists in diagnostic imaging. With in the chapter on the training of radiology residents, the jurisdiction and function of the Nation Commission for the Specialty of Diagnostic Imaging are described as including the elaboration of a training program, the elaboration of the resident’s log book, the establishment of criteria for evaluation, the proposal of areas of specific competence, the establishment of criteria for the evaluation of teaching and training units, and the participation in the design of integrated plans with in the specialty. Other, merely administrative, functions that have repercussions in the radiological community are also detailed (AU)

Recomendaciones de la Comisión para la Detección Precoz de la Hipoacusia (CODEPEH) para 2010 / Early hearing detection and intervention: 2010 CODEPEH recommendation

Actualmente, el cribado auditivo neonatal se lleva a cabo de forma rutinaria en muchos de los sistemas de salud autonómicos en España. A pesar de la importante expansión del cribado de la hipoacusia desde 2000, su viabilidad y los beneficios de la identificación e intervención tempranas, aún existen importantes retos. En este artículo, la CODEPEH actualiza las recomendaciones que se consideran importantes para el futuro desarrollo de los sistemas de detección e intervención precoz en los siguientes puntos: 1. Protocolos de cribado: se recomienda seguir distintos protocolos para los niños ingresados en cuidados intensivos neonatales y los procedentes de maternidad. 2. Evaluación audiológica: se precisa contar con profesionales con experiencia en evaluación de recién nacidos y niños pequeños para completar tanto el diagnóstico como para la selección y adaptación de audioprótesis. 3. Evaluación médica: los factores de riesgo para la hipoacusia neonatal y adquirida se recogen en una única lista en lugar de estar agrupados por el momento de su aparición. Un protocolo de diagnóstico paso a paso es más eficiente y de coste efectivo que efectuar todas las pruebas simultáneamente. 4. Intervención temprana y seguimiento: todos los profesionales que atienden a niños con hipoacusia deberían contar con un entrenamiento especializado y experiencia en la audición, el habla y el lenguaje. Debe realizarse un control periódico del desarrollo de las habilidades auditivas, si existen sospechas paternas y del estado del oído medio. 5. Control de calidad: la gestión de la información como parte integral del sistema es importante para monitorizar y mejorar la calidad del servicio (AU)

Newborn hearing screening is currently performed routinely in many regional health-care systems in Spain. Despite the remarkable expansion in newborn hearing screening since 2000, its feasibility and the benefits of early identification and intervention, many major challenges still remain. In this article, the Committee for the Early Detection of Hearing Loss (Comisión para la Detección Precoz de la Hipoacusia, CODEPEH) updates the recommendations that are considered important for the future development of early hearing detection and intervention (EDHI) systems in the following points: 1. Screening protocols: Separate protocols are recommended for NICU (Neonatal Intensive Care Units) and well-infant nurseries. 2. Diagnostic audiology evaluation. Professionals with skills and expertise in evaluating newborn and young infants should provide diagnosis, selection and fitting of amplification devices. 3. Medical evaluation. Risk factors for congenital and acquired hearing loss have been combined in a single list rather than grouped by time of onset. A stepwise diagnostic paradigm is diagnostically more efficient and cost-effective than a simultaneous testing approach. 4. Early intervention and surveillance. All individuals providing services to infants with hearing loss should have specialized training and expertise in the development of audition, speech and language. Regular surveillance should be performed on developmental milestones, auditory skills, parental concerns, and middle ear status. 5. Quality control. Data management as part of an integrated system is important to monitor and improve the quality of EDHI services (AU)

Improving GP diabetes management - A PDSA audit cycle in Western Australia.

BACKGROUND: Tight glucose, blood pressure and lipid control in patients with diabetes can reduce morbidity and mortality from macro- and micro-vascular complications. However, treatment targets are not being met in a large proportion of patients. Clinical audit involves cycles of evaluation of current activity against standards. It allows problems to be identified and action to be taken to address them. METHODS: Annual retrospective audits over 3 years of random samples of up to 20 patient medical records from 13 general practitioners in the midwest region of Western Australia (n=807). Statistical tests compared the second and third audits with the first in regard to completeness of screening, health indicators, and the proportion of patients within The Royal Australian College of General Practitioners and Diabetes Australia guidelines targets. RESULTS: While there was a significant improvement in lipid monitoring over the study period (p<0.001), monitoring of HbA1c and blood pressure (BP) remained unchanged. Between the first and third audits, a reduction in mean HbA1c (p<0.001), mean total cholesterol (p=0.017), mean LDL cholesterol (p=0.014) and mean systolic BP (p=0.002) was seen. There was an improvement in the proportion of patients achieving cholesterol goals (measured by LDL and reaching a target of HbA1c <7%) between the first and third audits; however the proportion with BP within target declined. In the third audit, 11% of patients on diet alone, 36% on an oral hypoglycaemic agent, 90% on three oral hypoglycaemic agents and 84% of those on insulin were outside the target HbA1c. In the same audit, of those outside target BP, 53% were on no treatment and 65% were only on one type of medication. Eighty-seven percent of patients outside target cholesterol levels had not been prescribed a statin. DISCUSSION: Many of the audited GPs in our study undertreated BP, HbA1c and cholesterol. Improvement in some areas was seen over the study period, which may have been due to the quality assurance activities undertaken. These results reveal a therapeutic opportunity for reducing cardiovascular events in patients with diabetes. More aggressive management of BP and lipids by GPs may see rewards in terms of reducing cardiovascular events in patients with diabetes.

Fracture prevention strategies in patients presenting to Australian hospitals with minimal-trauma fractures: a major treatment gap.

BACKGROUND: The aim of this study was to examine current fracture prevention strategies through the recognition, investigation and treatment of osteoporosis in patients presenting to acute hospitals with minimal-trauma fracture. METHODS: A retrospective audit using a standardized database was conducted in 16 Australian hospitals. This involved 1829 cases of minimal-trauma fracture initially presenting to hospital emergency departments during 2003-2005. Cases of minimal-trauma fracture were retrospectively identified using diagnosis-related group fracture codes and case record review at each site. Relevant data were entered into a standardized database and analysed centrally and independently. Risk factors for osteoporosis, investigations, interventions and discharge follow up were recorded. RESULTS: The percentage of minimal-trauma fracture patients who underwent investigation or initiated therapy designed to prevent subsequent minimal-trauma fracture was obtained. Less than 13% of patients presenting to hospital with minimal-trauma fractures had risk factors for fracture identified. Ten per cent were appropriately investigated, 12% were commenced on calcium and 12% on vitamin D. Eight per cent started bisphosphonates and 1% selective oestrogens receptor modulators in the acute setting. CONCLUSION: Most patients presenting to Australian hospitals with minimal-trauma fracture are neither investigated nor treated for osteoporosis. As this group is at high risk of subsequent fracture, this is a missed opportunity to reduce fracture burden.

Audit of pneumocystis pneumonia in patients seen by the Christchurch Hospital rheumatology service over a 5-year period.

AIM: The aim of the study was to review all cases of Pneumocystis carinii pneumonia (PCP) in patients seen by the Christchurch Hospital Rheumatology service over a 5-year period and to determine the annual incidence of PCP. METHODS: The Canterbury Health Laboratory database was searched for rheumatology patients testing positive for PCP from 31 December 2000 to 31 December 2005. The rheumatology database was then searched to identify patients receiving the same immunosuppressant medication as those who developed PCP to determine the annual incidence of PCP in this group. RESULTS: Four rheumatology patients were diagnosed with PCP during the 5-year period. Two were receiving oral methotrexate (MTX) for rheumatoid arthritis and two were receiving cyclophosphamide (CYC), one each for Wegener's granulomatosis and dermatomyositis. None of the four cases was receiving PCP chemoprophylaxis. Five hundred and forty-seven patients commenced MTX over the same 5-year period and 47 commenced CYC. Only 14 of 47 (29.7%) CYC-treated patients received PCP prophylaxis. The annual incidence of PCP was 0.17% (95% confidence interval (CI) 0.02-0.63) and 5.33% (95%CI 0.65-19.24) in patients prescribed MTX and CYC, respectively. For the 33 patients receiving CYC without concomitant PCP prophylaxis the annual incidence was 9.50% (95%CI 1.15-34.33). CONCLUSION: In our study the annual incidence of PCP in patients taking MTX was low and would not support the use of routine PCP chemoprophylaxis. In patients receiving CYC without concomitant PCP chemoprophylaxis the annual incidence of PCP was higher although the number of cases was small. Given the high morbidity and mortality in this group, PCP chemoprophylaxis should be considered.

Los itinerarios profesionales en Biología: un ejemplo de formación académica orientada a la inserción profesional / Professional pathways in Biology: an example of professionally-oriented teaching

Uno de los retos de la Universidad es formar los profesionales necesarios para la sociedad en que está inserta. Este ajuste no es fácil de obtener debido la rigidez de los planes de estudios oficiales y a las cambiantes necesidades sociales. Sin embargo, el próximo Espacio Europeo de Educación Superior tiene este empeño como uno de sus principales objetivos. En el presente artículo se preséntala experiencia de los itinerarios profesionales de la licenciatura en Biología de la Universito Pompeu Fabra durante dos cursos académicos. Situados en el quinto curso del plan de estudios, permiten aros estudiantes una formación específica en uno de los ámbitos profesionales en los que pueden insertarse laboralmente. La experiencia muestra que, tras un período de uno o dos años de su graduación, el 83% de los egresados se encuentran realizando un trabajo remunerado, en la mayoría de los casos relacionado con la biología, mientras que un9% realizan otros estudios (no doctorado).Sólo el 3% de los graduados están buscando trabajo de forma activa. En conclusión, los itinerarios profesionales pueden constituir una estrategia educativa adecuada para permitir que los licenciados en Biología se inserten con éxito en ocupaciones laborales acordes con su formación (AU)

One of the main challenges facing universities is to train professionals who possess the skills that society requires. This is difficult to achieve due to the rigidity of official curricula and the constantly changing needs of society. However, it remains one of the main goals of the Bologna process. This paper describes the experience of the professional pathways which form part of the biology degree offered by the Universitat Pompeu Fabre, over a period of two academic years. Professional pathways are an essential part of the fifth year syllabus and provide students with specific training in one of the professional settings in which they may eventually work. Our experience shows that 83% of graduates are currently working in biology-related posts, while an additional 9%are engaged in postgraduate studies (non-PhD programmes). Only 3% of graduates are actively seeking employment. In summary, professional pathways may constitute a valid educational strategy for preparing biology graduates for successful professional activity in biology-related environments (AU)

Geriatría, especialidad médica. 25 años de historia / The medical specialty of Geriatrics. 25 years of history

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Auditoria médica: herramienta de gestión moderna subvalorada / Medical audit: an undervalued management tool

Medical audit is defined as the critical and periodical assessment of the quality of medical care, through the revision on medical records and hospital statistics. This review defines the work of the medical auditor and shows the fields of action of medical audit, emphasizing its importance and usefulness as a management tool. The authors propose that every hospital should create an audit system, should provide the necessary tools to carry out medical audits and should form an audit committee