Causes of Blindness in Adults in Southern Turkey According to Health Committee Reports

Objectives: To reveal the causes of blindness in patients who applied to the medical board of a hospital serving the Southeastern Anatolian region of Turkey. Materials and Methods: We retrospectively reviewed the records of 340 bilaterally blind patients who were among 3,234 patients referred to our hospital's medical board between March 2016 and November 2018 for disability evaluation and rating report. Results: One-hundred sixty (48.8%) were female, 174 (51.2%) were male, and the mean patient age was 64.3±25.4 years. The most common cause of blindness was cataract in 158 eyes (23.2%), followed by corneal opacities in 114 eyes (16.8%), retinal dystrophy in 92 eyes (13.5%), optic atrophy in 73 eyes (10.7%), glaucoma in 65 eyes (9.6%), and phthisis bulbi in 59 eyes (8.7%). Conclusion: Avoidable causes of blindness such as cataract and corneal opacity (secondary to trachoma) were detected at high rates. Therefore, we believe that more awareness and effort might be required in our region to reduce avoidable blindness due to these causes.

[COVID-19 impact on the cancer care structuration: Example of the multidisciplinary team meeting dedicated to oncology in Occitanie]. / Impact du SARS-CoV2 sur la structuration de la prise en charge du cancer : exemple de la tenue des RCP de cancérologie en Occitanie.

This work examines the impact of the SARS-CoV2 epidemic and the organizational recommendations that have been issued since March 16 on tumor boards (TB) activity. The tumor board activity was measured from tumor board sheets extracted from the oncologic electronic file between January 7, 2019 and April 24, 2020. The pre-containment activity was compared to the activity of the containment periods but also to the equivalent periods in 2019. The number of meetings held, the average number of files reviewed per meeting including first presentations and the average number of physicians' attendance were the evaluation criteria. The study covered 191 TB that held 3943 multidisciplinary team meetings (MTM) and reviewed 72,070 files (including 30,127 first submissions). There was a moderate decrease of 8 % in the number of meetings after March 16, 2020. The number of files examined decreased by 23 % in the following month and even more by 33 % in the third period. The physicians' number who attended MTM also decreased by 25 %. The negative impact was higher in the Mediterranean part of the region. This first study of tumor board activity, covering a large region but little affected by the pandemic, shows that its impact on the participation to the MTM has been moderate. In addition, tumor boards have followed the recommendations for optimizing quorum. However, the decrease in average MTM activity, particularly for first submissions, suggests a potential delay in patient management. Complementary qualitative and quantitative works are warranted to estimate the real impact on carcinologic outcomes.

[Implementation of blood sparing programs in Spain: results of a survey of departments of anesthesiology and resuscitation]. / Implementación de los programas de ahorro de sangre en España: resultados de la encuesta a los servicios de anestesiología y reanimación.

The objective of this article is to determine the availability of a perioperative transfusion management program (Patient Blood Management [PBM]) in various hospitals through a survey that included a description of the preanesthesia visit, the availability and use of the various blood-sparing techniques and the factors limiting their implementation in elective surgery. The survey included 42 questions, directed at the representative departments of anesthesiology of hospitals in Spain (n=91). The survey was conducted from September to November 2012. We analyzed the 82 surveys in which all the questions were answered (90%). Preoperative consultations are routinely performed (>70%) in 87% of the hospitals. The time from the consultation to surgery varied between 1 week and 2 months for 74% of the patients scheduled for orthopedic or trauma surgery, 78% of those scheduled for oncologic surgery and 77% of those scheduled for cardiac surgery. Almost all hospitals (77, 94%) had a transfusion committee, and 90% of them had an anesthesiologist on the committee. Seventy-nine percent of the hospitals had a blood-sparing program, and the most widely used technique was the use of antifibrinolytic agents (75% of hospitals), followed by intraoperative and postoperative blood recovery in equal proportions (67%). Optimization of preoperative hemoglobin was routinely performed with intravenous iron in 39% of the hospitals and with recombinant erythropoietin in 28% of the hospitals. The absence of a well-established circuit and the lack of involvement and collaboration with the surgical team were the main limiting factors in implementing PBM. Currently, the implementation of PBM in Spain could be considered acceptable, but it could also be improved, especially in the treatment of preoperative anemia. The implementation of PBM requires multidisciplinary collaboration among all personnel responsible for perioperative care, including the health authorities.

The rise and fall(acy) of clinical directorates in Italy.

Clinical Directorates (CDs), in the sense of "intermediate organizational arrangements through which defined parts of larger hospitals health services are managed", were introduced in the Italian National Health Service (INHS) by law after the major reform of 1992. By means of such reform, accountability chains within INHS hospitals were streamlined. Changes looked at strengthening the role of management in hospitals as a strategy to improve efficiency in the provision of services. From this stream of managerialism emerged the attempts to re-organize hospital activities along the lines of clinical directorates. The aim of this paper is to outline the context in which CDs initially developed in Italy as the "one best way" to address current hospital problems and the reasons why they are now challenged due to not coming up to expectations. To do so we run through the last 10 years of history of CDs in Italy and propose an interpretative framework to understand the grounds for their partial failure and success.

Informe de la actividad del comité de tumores de partes blandas del hospital de Basurto / Report of the activity of the soft tissue tumors committee of the hospital of Basurto

La captación, registro y seguimiento de los pacientes que padecen un tumor de partes blandas es un proceso necesario para asegurar que el paciente es tratado, para coordinar, de una forma completa y sin demoras las fases diagnóstica y terapéutica, y para valorar los resultados de los protocolos aplicados. Entre febrero de 2001 y julio de 2002 fueron presentados 106 pacientes en el Comité de Tumores de Partes Blandas (CTPB) del Hospital de Basurto (Bilbao, España). En esta publicación hacemos un informe descriptivo de la actividad de nuestro Comité y de su funcionamiento (AU)

The reception, registration and follow-up of patients that suffer from a soft tissue tumour are a necessary process to assure adecuate treatment of those patients, to coordinate, in a comprehensive way and without delays, the diagnostic and therapeutic steps and to evaluate the results of the applied protocols. Between February 2001 and July 2002, 106 patients were visited at the Soft Tissue Tumours Committee of the Hospital de Basurto (Bilbao, Espa- ña). In this publication we make a description of the patients included in our protocol and a comment on the way of working of the Committee (AU)

Equipes multiprofissionais em unidades de diálise: contribuiçäo ao estudo da realidade brasileira / Muiltiprofessional teams working in dialyses units: role in the study of the Brasilian situation

A visäo integral do ser humano e a aplicaçäo de açöes conjuntas por diversops especialistas que atuam na área de saúde transformaram-se em realidade que inclui resultados positivos para pacientes e profissionais. Verifica-se, atualmente, que a saúde näo é competência de um único especialista, mas tarefa multiprofissional e interdisciplinar. Baseados nessa proposta, diversos especialistas reunidos no X Congresso Brasileiro de Nefrologia Pediátrica constituíram um comitê para colaborar com a ampliaçäo de equipes multiprofissionais em nefrologia pediátrica e no exercício da interdisciplinariedade. Posteriormente, esse comitê oficializou-se na Sociedade Brasileira de Nefrologia e iniciou seus trabalhos por esse estudo.(au)

Referrals to a hospital-based child abuse committee: a comparison of the 1960s and 1990s.

OBJECTIVE: Although reports of child maltreatment have increased yearly since national data were first collected in 1976, little information is available about changes in the characteristics of children reported. Therefore, to examine changes over time in recognition and reporting in a medical setting, we compared referrals to a hospital-based child abuse committee in the late 1960s and early 1990s. DESIGN: Retrospective, cross-sectional review of medical records and logs of the hospital's child abuse committee. SETTINGS: Ambulatory, emergency, and inpatient services at Yale-New Haven Hospital. PATIENTS: Medical records were reviewed for 101 of the 165 children referred to the child abuse committee in 1968-1969 (early group) and 107 of the 843 children referred in 1990-1991 (late group). Cases of sexual abuse were excluded. RESULTS: Referrals for nonsexual abuse cases increased from 80 children per year in the early group to 181.5 per year in the late group; the late group was characterized by a larger number of newborn referrals (1% vs. 52%, p < .001). When non-newborns were compared, the two groups were similar with respect to gender and race, but the late group had fewer patients with private insurance (31% vs. 12%, p < .05). The late group also had more female-headed households (32% vs. 67%, p < .05) and more parents with a history of substance abuse (4% vs. 49%, p < .001). Excluding newborns, who were all classified as "at-risk," the types of problems were classified as abuse (41% early vs. 29% late), neglect (41% vs. 35%), and "at-risk" (16% vs. 35%). Although the types of injuries were similar: superficial injuries (20% vs. 16%), burns (9% vs. 8%), and fractures (6% vs. 4%), fewer maltreated children suffered physical injuries in the late group (71% vs. 49%, p < .05). CONCLUSIONS: A substantial change has occurred in referrals to the hospital's child abuse committee for abuse or neglect. Most referrals have become socially high-risk newborns and children or children with minimal injuries. This shift is likely due to broader definitions of maltreatment and earlier recognition of troubled families.

Why are patients discharged by review boards?

OBJECTIVE: To identify why Review Boards revoked certificates for involuntary hospitalization. METHOD: The outcome of all applications for a Review Board hearing at 2 psychiatric hospitals in Ontario were recorded from the beginning of 1987 to the end of 1996. All cases where a certificate of involuntary hospitalization was revoked were identified. For each of these cases, the clinical record, including the Review Board's written reasons for its decision, was reviewed. RESULTS: During the study period, 2644 patients applied for a review of their involuntary hospitalization. Only 42% of applications reached a hearing. Of these, 9% were revoked. Several recurring reasons for overturning certificates were identified. These included the physician relying too much on hearsay evidence, relatives supporting discharge at the hearings, and the patient clearly having recovered by the time the hearing took place. CONCLUSIONS: Relatives or staff who observe dangerous behaviour should be encouraged to give evidence at hearings. The treatment team should take careful note of the views of patients' families and friends and review the patients' progress before hearings.

Medical staff leadership: a national panel survey.

Dramatic change in health care has challenged traditional medical staff governance and leadership. The role of medical staff leaders, particularly the chief of staff, and of the medical executive committee is explored through a national panel survey.

Las comisiones institucionales de bioética y su función consultiva / The institutional Bioethics Commisions and the their consultative function

La extrema juventud de los Comités Institucionales de Bioética que funcionan en nuestro país ha hecho que las áreas docentes y de investigación de los mismos se hayan desarrollado en desmedro del área consultiva orientada al asesoramiento a los poderes políticos. En este trabajo se destacan los aportes derivados de tal función y se consignan dos casos pioneros en la República Argentina en los que la aplicación de justicia se vio auxiliada por sendos informes elaborados al efecto por comisiones bioéticas marplatenses

Product standards committees today and tomorrow.

The results of a survey of product standards committees conducted by the JOURNAL OF HEALTHCARE MATERIEL MANAGEMENT show that most hospitals have such a committee, chaired by the materiel manager. Despite the fact that respondents named 49 different disciplines as possible members of the committees and 100% attendance is experienced less than a quarter of the time, most respondents said they had the right number of people on their committee and that the committee was effective or very effective. With more facility affiliations in the offing, purchasing decisions will be made at a corporate level. To be viable in the future, the products committee will have to transform itself into a utilization review and cost oversight committee, and drastically reduce its membership.