Recomendaciones generales apra mejorar la calidad de la atención obstétrica

INTRODUCTION. Maternal care means roughly a half of medical interventions, hospital discharges and surgery realized in Mexico. Obstetrics reached the second place (14.5%) in malpractice complaints in National Commission of Medical Arbitration (CONAMED). OBJECTIVE: To analize the CONAMED�s experience about obstetric care claims, and profit recommendations for medical practice. METHOD: The authors revised 1431 complaints ob/gin-related, placed in CONAMED between june 1996 to june 2001, and selected a sampling of 121 cases of ruling reports. We describe sociodemographic, institutional, clinical, communication and lawattach indicators. RESULTS. Complaints were originated in third quarter of pregnancy (82.8%), in social-security services (72.1%), in second level hospitals (62.3%). Fifty seven percent were high risk pregnancies, with previous cesarean section as frequent medical historial (21.5%). The complications were predictable in almost half of cases. First medical error was a deficient labor surveillance (22.3%). Malpractice was identified in 54.5%, ethical mistakes in 30%, institutional insufficiencies in 40.5%, inaccurate medical records in 45% and inadequate communication in 76%. CONCLUSIONS. An accurate obstetric care is composed by proffesional sense of duty and ethics, conscientious patient care, identify high risk pregnancies, recognize personal and institutional skill restrictions, to know health laws, and effective physician - patient communication. We declare 9 recommendations for medical and paramedical who care obstetric patients.ANTECEDENTES. La atención materna representa aproximadamente la mitad de las intervenciones médicas, egresos hospitalarios y las cirugías que se realizan en México. Las demandas por mala práctica relacionadas con atención obstétrica alcanzaron el segundo lugar (14.5%) de los asuntos atendidos por CONAMED. OBJETIVO. Analizar la experiencia de CONAMED sobre conflictos por atención obstétrica y expresar recomendaciones para la atención de estas pacientes. METODOLOGÍA. Se revisaron 1431 inconformidades relacionadas con atención ginecoobstétrica, radicadas en CONAMED entre junio de 1996 hasta junio de 2001. Se seleccionó una muestra dirigida de 121 casos concluidos por dictamen pericial. Se describen indicadores sociodemográficos, institucionales, clínicos, de comunicación y apego a reglamentación vigente. RESULTADOS. Las inconformidades se originaron en el tercer trimestre de gestación (82.8%), en la seguridad social en 72.1%, en hospitales de 2º nivel (62.3%). La calificación de riesgo fue elevado en 57%, con cesárea previa como antecedente más frecuente (21.5%). Las complicaciones eran previsibles en casi la mitad de los casos. La principal desviación fue vigilancia deficiente del trabajo de parto (22.3%). Se identificó mala práctica en 54.5%, desviaciones éticas en 30%, deficiencias institucionales en 40.5%, expedientes mal integrados en 45% y mala comunicación en 76%. CONCLUSIONES. Una atención obstétrica adecuada requiere: compromiso y ética profesional, atención minuciosa, identificar los casos de riesgo, reconocer limitaciones personales e institucionales, conocer la normatividad y una comunicación médico-paciente efectiva. Se presentan 9 recomendaciones, dirigidas al personal médico y paramédico que atiende pacientes obstétricas

Association between convalescent plasma treatment and mortality in COVID-19: a collaborative systematic review and meta-analysis of randomized clinical trials

Abstract Background Convalescent plasma has been widely used to treat COVID-19 and is under investigation in numerous randomized clinical trials, but results are publicly available only for a small number of trials. The objective of this study was to assess the benefits of convalescent plasma treatment compared to placebo or no treatment and all-cause mortality in patients with COVID-19, using data from all available randomized clinical trials, including unpublished and ongoing trials (Open Science Framework, https://doi.org/10.17605/OSF.IO/GEHFX ). Methods In this collaborative systematic review and meta-analysis, clinical trial registries (ClinicalTrials.gov, WHO International Clinical Trials Registry Platform), the Cochrane COVID-19 register, the LOVE database, and PubMed were searched until April 8, 2021. Investigators of trials registered by March 1, 2021, without published results were contacted via email. Eligible were ongoing, discontinued and completed randomized clinical trials that compared convalescent plasma with placebo or no treatment in COVID-19 patients, regardless of setting or treatment schedule. Aggregated mortality data were extracted from publications or provided by investigators of unpublished trials and combined using the Hartung–Knapp–Sidik–Jonkman random effects model. We investigated the contribution of unpublished trials to the overall evidence. Results A total of 16,477 patients were included in 33 trials (20 unpublished with 3190 patients, 13 published with 13,287 patients). 32 trials enrolled only hospitalized patients (including 3 with only intensive care unit patients). Risk of bias was low for 29/33 trials. Of 8495 patients who received convalescent plasma, 1997 died (23%), and of 7982 control patients, 1952 died (24%). The combined risk ratio for all-cause mortality was 0.97 (95% confidence interval: 0.92; 1.02) with between-study heterogeneity not beyond chance (I2 = 0%). The RECOVERY trial had 69.8% and the unpublished evidence 25.3% of the weight in the meta-analysis. Conclusions Convalescent plasma treatment of patients with COVID-19 did not reduce all-cause mortality. These results provide strong evidence that convalescent plasma treatment for patients with COVID-19 should not be used outside of randomized trials. Evidence synthesis from collaborations among trial investigators can inform both evidence generation and evidence application in patient care

Association between convalescent plasma treatment and mortality in COVID-19: a collaborative systematic review and meta-analysis of randomized clinical trials

Abstract Background Convalescent plasma has been widely used to treat COVID-19 and is under investigation in numerous randomized clinical trials, but results are publicly available only for a small number of trials. The objective of this study was to assess the benefits of convalescent plasma treatment compared to placebo or no treatment and all-cause mortality in patients with COVID-19, using data from all available randomized clinical trials, including unpublished and ongoing trials (Open Science Framework, https://doi.org/10.17605/OSF.IO/GEHFX ). Methods In this collaborative systematic review and meta-analysis, clinical trial registries (ClinicalTrials.gov, WHO International Clinical Trials Registry Platform), the Cochrane COVID-19 register, the LOVE database, and PubMed were searched until April 8, 2021. Investigators of trials registered by March 1, 2021, without published results were contacted via email. Eligible were ongoing, discontinued and completed randomized clinical trials that compared convalescent plasma with placebo or no treatment in COVID-19 patients, regardless of setting or treatment schedule. Aggregated mortality data were extracted from publications or provided by investigators of unpublished trials and combined using the Hartung–Knapp–Sidik–Jonkman random effects model. We investigated the contribution of unpublished trials to the overall evidence. Results A total of 16,477 patients were included in 33 trials (20 unpublished with 3190 patients, 13 published with 13,287 patients). 32 trials enrolled only hospitalized patients (including 3 with only intensive care unit patients). Risk of bias was low for 29/33 trials. Of 8495 patients who received convalescent plasma, 1997 died (23%), and of 7982 control patients, 1952 died (24%). The combined risk ratio for all-cause mortality was 0.97 (95% confidence interval: 0.92; 1.02) with between-study heterogeneity not beyond chance (I2 = 0%). The RECOVERY trial had 69.8% and the unpublished evidence 25.3% of the weight in the meta-analysis. Conclusions Convalescent plasma treatment of patients with COVID-19 did not reduce all-cause mortality. These results provide strong evidence that convalescent plasma treatment for patients with COVID-19 should not be used outside of randomized trials. Evidence synthesis from collaborations among trial investigators can inform both evidence generation and evidence application in patient care