La formación en seguridad del paciente y una docencia segura en atención primaria

Este artículo de revisión y actualización tiene como objetivo plantear las dificultades y oportunidades para la formación en seguridad del paciente del personal de ciencias de la salud (grado, posgrado, formación especializada y continua), y algunas propuestas para llevarla a cabo. Muy brevemente trata esta formación específica y la situación actual en atención primaria, destacando que la seguridad del paciente es una necesidad, un área competencial y una oportunidad formativa para los residentes. Establece el marco general de la seguridad del paciente en atención primaria, teniendo como referencia el documento «Siete Pasos para la Seguridad del Paciente en Atención Primaria», planteando la necesidad de un abordaje sistémico. Destaca la elaboración y presentación de casos sobre errores clínicos como la estrategia formativa más frecuente. Los escenarios clínicos reales se relacionan con los pacientes de trato difícil, los incidentes críticos y la bioética en el ejercicio profesional. Estos escenarios presentan como característica común el hecho de producir dificultades y sufrimiento a todos los actores participantes. Se incluyen varios instrumentos para la formación en seguridad del paciente (SP). La meta, a medio plazo, es la consolidación de la seguridad clínica en la formación sanitaria especializada. Finalmente, se analiza la repercusión de la pandemia en la formación en seguridad del paciente, especialmente sobre la formación sanitaria especializada, haciendo propuestas de cómo llevar a cabo una docencia segura en tiempos de pandemia de COVID-19

Investigating the impact of extraneous distractions on consultations in general practice: Lessons learned

<p>Abstract</p> <p>Background</p> <p>Extraneous distractions may influence the flow of general practice consultations. This study piloted a methodology to examine the impact of interrupting general practitioners (GPs) while consulting actor-patients.</p> <p>Methods</p> <p>Six GPs were video recorded consulting six actor-patients each presenting a different clinical scenario in a simulated surgery. Five cases presented red flag cancer symptoms. Half the consultations were interrupted. Two independent assessors, blinded to the occurrence of interruptions, assessed consultation performance using the Leicester Assessment Package (LAP) for clinical competence.</p> <p>Results</p> <p>24 of 36 consultations were video recorded with sufficient audio-visual clarity to allow scoring. The association between LAP score and three variables could be studied: a variety of interruptions, different GPs and various scenarios. Agreement between assessors on GP performance was poor and showed an increased bias with increasing LAP score. Despite this, the interruption did not significantly impact on assessor LAP scores (Mean difference: 0.22, P = 0.83) even after controlling for assessor, different GPs and scenarios.</p> <p>Conclusion</p> <p>Extraneous distractions had no impact on GP performance in this underpowered pilot study, a conclusion which needs to be confirmed in a larger study. However several important lessons were learned. Recorded actor-patient clinical sessions are logistically challenging. GPs whose skills were not previously assessed were working in unfamiliar surroundings dealing with relatively straight forward diagnostic challenges and may have anticipated the interruptions. In a redesign of this experiment it may be possible to eliminate some of these limitations.</p

A New Catalyst for the Epimerization of Secondary Alcohols: Carbon-Hydrogen Bond Activation in the Rhenium Alkoxide Complexes (η\u3csup\u3e5\u3c/sup\u3e-C5R5)Re(NO)(PPh3)(OCHRR’)

The methoxide complexes (η5-C5R5)Re(NO)-(PPh3KOCH3) (R = H, Me) catalyze the title reaction (65-90 °C, C6H5R solvent); intermediate secondary alkoxide complexes undergo PPh3 dissociation and sequential epimerization at rhenium and carbon. © 1991, American Chemical Society. All rights reserved

Insertion of Internal Acetylenes into Orthopalladated a- Methyl benzylami ne. Crystal Structure of [ Pd{C( Ph)=C( Ph)C( Ph)=C( Ph)C,H,CH( Me)NH,}Br]

The complex [Pd{C,H,CH (Me)NH,}( Me,CO),]CIO, reacted with diphenylacetylene to give [ Pd2(q5- C,Ph,),(p-q2-PhC=CPh)]. A pathway for this reaction is suggested. Species related with the postulated intermediates can be isolated starting from [{Pd[C,H,CH( Me) NH,] (p-Br)},] which reacts with disubstituted alkynes (RCECR, R = C0,Me or Ph) to afford [Pd{C(R)=C(R)C(R)=C(R)C,H,CH- (Me)NH,}Br) (R = C0,Me l a or Ph 1 b) through a double insertion of the alkyne into the Pd-C bond. Complex la reacted with 1 equivalent of MeO,CC=CCO,Me to give the tri-insertion reaction product 2. These are the first products of alkyne insertion into a cyclopalladated primary amine. Neutral ligands, such as pyridine (py) or CO, can break the Pd-n-olefinic bond in la to give the corresponding adducts [Pd{C(R)=C(R)C(R)=C(R)C,H,CH(Me)NH,}Br(L)] (R = C0,Me; L = py 3 or CO 4). Complexes l a and 1 b reacted with AgCIO, (1 : 1) in acetone to afford AgBr and [Pd{C(R)=C(R)C(R)=C(R)C,H,CH(Me)NH2}(solv)]CI0, (R = CO,Me, solv = H,O 5a; R = Ph, solv = Me,CO 5b). The reaction of complex la with AgCIO, (1 :1) and excess of pyridine gave the cationic complex [Pd{C(R)=C(R)C(R)=C(R)C,H,CH(Me)NH,}(py),]CIO, 6 (R = C0,Me). The crystal structure of complex l b has been determined by X-ray diffraction. The palladium atom is bonded to Br, N, C(l) and to the midpoint of the C(3)-C(4) double bond in a distorted square-planar geometry