a systematic review by characteristics of Hospital Survey on Patient Safety Culture dimensions

Purpose: To learn the weaknesses and strengths of safety culture as expressed by the dimensions measured by the Hospital Survey on Patient Safety Culture (HSOPSC) at hospitals in the various cultural contexts. The aim of this study was to identify studies that have used the HSOPSC to collect data on safety culture at hospitals; to survey their findings in the safety culture dimensions and possible contributions to improving the quality and safety of hospital care. Data sources: Medline (via PubMed), Web of Science and Scopus were searched from 2005 to July 2016 in English, Portuguese and Spanish. Study selection: Studies were identified using specific search terms and inclusion criteria. A total of 33 articles, reporting on 21 countries, was included. Data extraction: Scores were extracted by patient safety culture dimensions assessed by the HSOPSC. The quality of the studies was evaluated by the STROBE Statement. Results: The dimensions that proved strongest were 'Teamwork within units' and 'Organisational learning-continuous improvement'. Particularly weak dimensions were 'Non-punitive response to error', 'Staffing', 'Handoffs and transitions' and 'Teamwork across units'. Conclusion: The studies revealed a predominance of hospital organisational cultures that were underdeveloped or weak as regards patient safety. For them to be effective, safety culture evaluation should be tied to strategies designed to develop safety culture hospital-wide.publishersversionpublishe

a protocol for a scoping review

Funding Information: This work was supported by Fundação para a Ciência e Tecnologia, I.P. through Comprehensive Health Research Centre (CHRC), National School of Public Health from NOVA University of Lisbon and under the grant UI/BD/150875/2021. Publisher Copyright: © 2022 BMJ Publishing Group. All rights reserved.Introduction Health organisations should support healthcare workers who are physically and psychologically affected by patient safety incidents (second victims). There is a growing body of evidence which focuses on second victim support interventions. However, there is still limited research on the elements necessary to effectively implement and ensure the sustainability of these types of interventions. In this study, we propose to map and frame the key factors which underlie an effective implementation of healthcare worker support interventions in healthcare organisations when healthcare workers are physically and/or emotionally affected by patient safety incidents. Methods and analysis This scoping review will be guided by the established methodological Arksey and O'Malley framework, Levac and Joanna Briggs Institute (JBI) recommendations. We will follow the JBI three-step process: (1) a preliminary search conducted on two databases; (2) the definition of clear inclusion criteria and the creation of a list of search terms to be used in the subsequent running of the search on a larger number of databases; and (3) additional searches (cross-checking/cross-referencing of reference lists of eligible studies, hand-searching in target journals relevant to the topic, conference proceedings, institutional/organisational websites and networks repositories). We will undertake a comprehensive search strategy in relevant bibliographic databases (PubMed/MEDLINE, Embase, CINHAL, Web of Science, Scopus, PsycInfo, Epistemonikos, Scielo, Cochrane Library and Open Grey). We will use the Mixed Methods Appraisal Tool V.2018 for quality assessment of the eligible studies. Our scoping review will be guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Extension for Scoping Reviews. Ethics and dissemination This study will not require ethical approval. Results of the scoping review will be published in a peer-review journal, and findings will be presented in scientific conferences as well as in international forums and other relevant dissemination channels. Trial registration number 10.17605/OSF.IO/RQAT6. Preprint from medRxiv available: doi: https://doi.org/10.1101/2022.01.25.22269846.publishersversionpublishe

408 Cases of Genital Ambiguity Followed by Single Multidisciplinary Team during 23 Years: Etiologic Diagnosis and Sex of Rearing

Objective. To evaluate diagnosis, age of referral, karyotype, and sex of rearing of cases with disorders of sex development (DSD) with ambiguous genitalia. Methods. Retrospective study during 23 years at outpatient clinic of a referral center. Results. There were 408 cases; 250 (61.3%) were 46,XY and 124 (30.4%) 46,XX and 34 (8.3%) had sex chromosomes abnormalities. 189 (46.3%) had 46,XY testicular DSD, 105 (25.7%) 46,XX ovarian DSD, 95 (23.3%) disorders of gonadal development (DGD), and 19 (4.7%) complex malformations. The main etiology of 46,XX ovarian DSD was salt-wasting 21-hydroxylase deficiency. In 46,XX and 46,XY groups, other malformations were observed. In the DGD group, 46,XY partial gonadal dysgenesis, mixed gonadal dysgenesis, and ovotesticular DSD were more frequent. Low birth weight was observed in 42 cases of idiopathic 46,XY testicular DSD. The average age at diagnosis was 31.7 months. The final sex of rearing was male in 238 cases and female in 170. Only 6.6% (27 cases) needed sex reassignment. Conclusions. In this large DSD sample with ambiguous genitalia, the 46,XY karyotype was the most frequent; in turn, congenital adrenal hyperplasia was the most frequent etiology. Malformations associated with DSD were common in all groups and low birth weight was associated with idiopathic 46,XY testicular DSD

Outcomes from elective colorectal cancer surgery during the SARS-CoV-2 pandemic

This study aimed to describe the change in surgical practice and the impact of SARS-CoV-2 on mortality after surgical resection of colorectal cancer during the initial phases of the SARS-CoV-2 pandemic

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Eventos adversos nos hospitais portugueses : avaliação da potencial associação com os diagnósticos de admissão e procedimentos realizados

RESUMO - O EA pode resultar em incapacidade permanente, temporária ou morte, associado o prolongamento de dias de internamento e custos adicionais. A ocorrência de EA’s tem sido relacionada com a idade, tempo de internamento, tipo de procedimentos realizados e a condição clínica dos doentes. Pretendemos caracterizar os EA’s num grupo de hospitais do SNS e analisar a potencial associação destes com os diagnósticos de admissão e com os procedimentos realizados. Este é um estudo caso-controlo, desenvolvido a partir de uma coorte retrospetiva. Dos 4225 doentes da coorte resultaram duas subamostras, formadas com base na organização da ICD-9-CM: 4133 doentes admitidos com diagnóstico identificado e 4187 doentes sujeitos a procedimentos. Calculamos a associação utilizando a regressão logística bivariada. Realizamos o ajustamento à idade, sexo e comorbilidades. Os homens (51,7%, n=271) apresentam maior número de EA’s do que as mulheres (48,3%,n=253) (p˂0,001). A ocorrência de EA’s aumenta ao longo da idade, sendo mais frequentes nos doentes com ≥ 85 anos (28,4%, n=149) (p˂0,001). Os grupos de doentes admitidos por “Doenças do sistema respiratório” (OR =1,545; IC 95%:1,182, 2,019; p=0,001), nomeadamente por “Pneumonia derivada de um organismo inespecífico” (OR= 2,269, IC 95% : 1,509, 3,412; p˂0,000), e por “Envenenamento e lesão” (OR= 0,028; IC 95%: 1,569, 2,621; p<0,000), mais especificamente nas “Complicações devido a cuidados cirúrgicos e médicos ainda não classificados” (OR = 6,351; IC 95% 4,123, 9,783; p<0,000) e categorias correspondentes foram aqueles em que se encontrou associação com a ocorrência de EA’s. Relativamente aos doentes sujeitos a procedimentos, foi também encontrada associação entre a ocorrência de EA’s e o grupo “Diversos procedimentos de diagnóstico e terapêutica” (OR=0,819; IC 95%: 682;983; p <0,05). no entanto não foi encontrada associação significativa (p<0,05), nos subgrupos deste capítulo. Estes resultados apenas provam a associação, não demonstram a causalidade.ABSTRACT- Adverse events (AE’s) can result in permanent or temporary disability or death, associated with extra hospital staying days and additional costs. AE’s occurrence has been related with age, length of stay in hospital, healthcare procedures and the clinical condition of the patient. The aim of this study is to describe the demographic distribution of AE’s in a group of National Health System (NHS) hospitals and analyse the potential association of these with the admission diagnosis and the procedures. A nested case-control study was developed. Two subsamples resulted from a cohort sample of 4225 cases, based on ICD-9-CM organization: 4133 patients were identified and admitted in hospital and 4187 were involved in healthcare procedures. The association was calculated using logistic regression, also adjusted to patient’s age, sex and morbidity. Male patients (51,7%, n=271) have more AE than female patients (48,3%,n=253) (p˂0,001). AE occurrence increases with age and the group with ≥ 85 years old have the highest percentage of AE (28,4%, n=149; p˂0,001). In respiratory diseases group (OR =1,545; IC 95%:1,182, 2,019; p=0,001) it was found a strong association between AE and “Pneumonia, organism unspecified” group (OR= 2,269, IC 95%: 1,509, 3,412; p˂0,000). It was also found an association with “Injury and Poisoning” group (OR= 0,028; IC 95%: 1,569, 2,621; p<0,000), namely with patients admitted by “Complications of surgical and medical care, not elsewhere classified” (OR = 6,351; IC 95% 4,123, 9,783; p<0,000) and corresponding categories. In procedures group, it was found an association between AE’s and “Miscellaneous diagnostic and therapeutic procedures” (OR=0,819; IC 95%: 682; 983; p <0,05), however we didn’t find any significant association (p<0,05) in correspondent sub-categories of this group. This study only proves the association, do not demonstrate the causalit

Social Skills In Women With Turner Syndrome.

The aim of this study was to evaluate the performance of a group of women with Turner Syndrome (TS) in interpersonal situations where several social skills were required, and to compare the results with unaffected sisters. Fifty-two TS females aged 15-35 years and 33 sisters aged 16-43 were evaluated using Del-Prette Social Skills Inventory (SSI) and individual interviews. Thirty mothers to subjects and sisters answered questionnaires. It was found that TS girls' performance in SSI was as good as their sisters' and even better in meeting new people and facing unknown situations (p = 0.020). Older TS women scored better than younger ones, differently from their sisters. There were no significant correlations between total score of TS women and their age at diagnosis, time of follow-up and height z-score. Mothers reported having more problems with TS girls than with sisters. Although TS girls demonstrated having social difficulties, just a few of them spontaneously complained about interpersonal problems in the interview. Results suggest that social difficulties may not cause TS girls major problems nor make them unhappy with their social lives, and/or TS girls may not be able to perceive their own difficulties. Good performance in SSI also suggests that TS girls can identify adequate skills in presented situations and answer in a way to obtain good scores, but they may not necessarily use their skills due to other factors like anxiety and shyness. They may also have a tendency to answer SSI in a way they consider socially desirable, masking their real difficulties.52440-

A percepção da doença em portadoras da síndrome de Turner Turner syndrome: the patients' view

OBJETIVO: Identificar a percepção das pacientes com síndrome de Turner a respeito de sua condição. CASUÍSTICA E MÉTODO: Entrevistas individuais com 36 pacientes com síndrome de Turner entre 15 e 25 anos e mais de 2 anos de acompanhamento, abordando temas referentes ao impacto no momento do diagnóstico, compreensão a respeito da síndrome de Turner, seu impacto sobre a vida atual e expectativas de futuro. RESULTADOS: Apenas 31% compreenderam o diagnóstico de síndrome de Turner imediatamente, e o sentimento associado a esse momento foi freqüentemente neutro (47%) ou de preocupação (33%). Cerca de 1/3 das pacientes não soube explicar a etiologia da síndrome de Turner (42%), não relacionou a ela os sintomas que apresenta (36%) e/ou acredita haver cura (44%). Atualmente, embora a grande maioria declare que a síndrome de Turner não interfere em sua vida (67%) e se considere feliz (78%), em mais da metade dos casos há evidências de dificuldades de interação social e de relacionamento amoroso, baixa auto-estima, insatisfação com a aparência física (em particular a baixa estatura) e sofrimento com a questão da esterilidade. Suas expectativas de futuro estão predominantemente ligadas a trabalho e estudo; e mesmo estando com 19 anos, em média, uma em cada duas ainda espera crescer (53%). CONCLUSÃO: Além da abordagem médica da síndrome de Turner, é fundamental que o conhecimento das pacientes a respeito dessa síndrome e as questões referentes à esterilidade, baixa estatura, auto-estima e interações sociais sejam alvo de atenção especial e contínua a partir do momento do diagnóstico; a situação ideal seria a de atuação de um psicólogo juntamente com a equipe médica.<br>OBJECTIVE: To identify how patients with Turner syndrome perceive their condition. METHODS: Thirty-six women with Turner syndrome, aged between 15 and 25 years and with over 2 years of medical follow-up, were individually interviewed about: the impact of Turner syndrome at the moment of the diagnosis, their understanding of the syndrome, its effect in their lives, and their expectations for the future. RESULTS: Only 31% of the patients immediately understood the diagnosis. Their feelings associated to that moment were neutral (47%) or concerned (33%). About one third of the interviewed women were unable to explain the etiology of Turner syndrome (42%), did not relate their symptoms with Turner syndrome (36%), and/or believe there might be a cure for it (44%). Although most of the interviewed women affirm that the syndrome has no interference in their lives (67%) and that they consider themselves happy persons (78%), in more than half of the interviews there are evidences of difficulties in social interaction and love relationship, low self-esteem, dissatisfaction with their physical appearances, especially the short stature and infertility. Their hopes for the future refer mainly to study and have a job. Although being, on average, 19 years old, one in two women (53%) still hopes to grow up. CONCLUSION: Besides medical treatment, it is important that the knowledge of the patients about the syndrome and some issues as infertility, short stature, self-esteem and social interactions receive proper and continuous attention from the moment of the diagnosis. The ideal situation should be a joint-action of a psychologist and the medical team