10 research outputs found
Validação de indicadores de qualidade do cuidado cirĂșrgico no Sistema Ănico de SaĂșde
OBJETIVO: Validar um conjunto de indicadores para monitoramento da qualidade dos procedimentos cirĂșrgicos no Sistema Ănico de SaĂșde (SUS). MĂTODOS: Estudo de validação desenvolvido em 5 etapas: 1) revisĂŁo de literatura; 2) priorização de indicadores; 3) validação de conteĂșdo dos indicadores por mĂ©todo de consenso RAND/UCLA; 4) estudo piloto para anĂĄlise da confiabilidade; e 5) desenvolvimento de instrutivo para tabulação dos indicadores de resultado para monitoramento via sistemas de informaçÔes oficiais. RESULTADOS: A partir da revisĂŁo de literatura, foram identificados 217 indicadores de qualidade cirĂșrgica. Os indicadores excluĂdos foram: indicadores baseados em evidĂȘncias cientĂficas inferiores a 1A, similares, especĂficos, que correspondiam a eventos sentinelas; e aqueles que nĂŁo se aplicavam ao contexto do SUS. Foram submetidos ao consenso de especialistas 26 indicadores com alto nĂvel de evidĂȘncia cientĂfica. Foram validados 22 indicadores, dos quais 14 indicadores de processo e 8 indicadores de resultado com Ăndice de validação de conteĂșdo â„80%. Dos indicadores de processo validados, 6 foram considerados confiĂĄveis substancialmente (Coeficiente de Kappa entre 0,6 e 0,8; p < 0,05) e 2 tiveram confiabilidade quase perfeita (coeficiente de Kappa > 0,8, p < 0,05), quando analisada a concordĂąncia interavaliador. Foi possĂvel mensurar e estabelecer mecanismo de tabulação para TabWin para 7 indicadores de resultado. CONCLUSĂO: O estudo contribui com o desenvolvimento de um conjunto de indicadores cirĂșrgicos potencialmente eficazes para o monitoramento da qualidade do cuidado e segurança do paciente nos serviços hospitalares do SUS.OBJECTIVE: To validate a set of indicators for monitoring the quality of surgical procedures in the Unified Health System (SUS). METHODS: Validation study developed in 5 stages: 1) literature review; 2) prioritization of indicators; 3) content validation of indicators by RAND/UCLA consensus method; 4) pilot study for reliability analysis; and 5) development of instruction for tabulation of outcome indicators for monitoring via official information systems. RESULTS: From the literature review, 217 indicators of surgical quality were identified. The excluded indicators were: those based on scientific evidence lower than 1A, similar, specific, which corresponded to sentinel events; and those that did not apply to the SUS context. Twenty-six indicators with a high level of scientific evidence were submitted to expert consensus. Twenty-two indicators were validated, of which 14 process indicators and 8 outcome indicators with content validation index â„80%. Of the validated process indicators, 6 were considered substantially reliable (Kappa coefficient between 0.6 and 0.8; p < 0.05) and 2 had almost perfect reliability (Kappa coefficient > 0.8, p < 0.05), when the inter-rater agreement was analyzed. One could measure and establish tabulation mechanism for TabWin for 7 outcome indicators. CONCLUSION: The study contributes to the development of a set of potentially effective surgical indicators for monitoring the quality of care and patient safety in SUS hospital services
Utilidad de la laparoscopia en el tratamiento de la apendicitis aguda / Victor Soria Aledo; directores Pascual Parrilla Paricio, Juan Antonio LujĂĄn MompeĂĄn, Ricardo Robles Campos.
Tesis-Universidad de Murcia.MEDICINA ESPINARDO. DEPOSITO. MU-Tesis 358.Consulte la tesis en: BCA. GENERAL. ARCHIVO UNIVERSITARIO. T.M.-1051
Comunicaciones PĂłster.-ElaboraciĂłn de protocolo para revisiĂłn bibliogrĂĄfica y desarrollo de formulario web mediante la aplicaciĂłn âencuestas.um.esâ para anĂĄlisis bibliogrĂĄfico.
Intestinal obstruction secondary to endoscopic capsule retention ObstrucciĂłn intestinal secundaria a retenciĂłn de cĂĄpsula endoscĂłpica
Comunicaciones Orales.-Factores nutricionales relacionados con las complicaciones quirĂșrgicas en cirugĂa mayor abdomino-pĂ©lvica
Malignant degeneration of rectal endometriosis
Background: Endometriosis is a relatively common disease among women with child-bearing potential, and rare before puberty or following menopause. It consists of the presence of hormone-responsive endometrium outside the endometrial cavity. Case report: We report the case of a patient with a rectal lesion, initially approached as a primary rectal malignancy, where histopathology eventually revealed an adenocarcinoma arising from endometrial tissue in the colonic wall. Discussion: Endometriosis has an estimated rated of 10-20%. Sites may be split up into two larger categories - gonadal and extragonadal. The frequency of extragonadal endometriosis in the bowel is estimated to involve 3%-37% of women with pelvic endometriosis, and most lesions are found in the sigmoid colon and rectum. The malignant transformation of endometriotic lesions is estimated between 0.3% and 1% of cases. The gold standard in the diagnosis of intestinal endometriosis is exploratory laparotomy and the pathological study of specimens. Adjuvant radiotherapy and chemotherapy, although used for some patients, have not proven effective
Type II intrapancreatic choledochal malignant cyst in adults: duodenopancreatectomy
A 62-year-old female patient was admitted for abdominal pain and vomiting. Imaging tests revealed a solid-cystic lesion at the head of the pancreas communicating with the distal bile duct. A Todani type II choledochal cyst was diagnosed with neoplastic degeneration after cytological diagnosis with endoscopic ultrasound-guided puncture. The patient was treated with a cephalic duodenopancreatectomy with curative intention
La biopsia intraoperatoria no reduce la tasa de reintervenciones por cĂĄncer tras hemitiroidectomĂa
Manejo quirĂșrgico de pacientes con infecciĂłn por COVID-19. Recomendaciones de la AsociaciĂłn Española de Cirujanos.
Due to the current pandemic of respiratory disease known as coronavirus disease 2019 (COVID-19) caused by the SARS-CoV-2 virus, many patients with confirmed or suspected COVID-19 infection will require elective surgery, surgery that cannot be postponed, or emergency surgical treatment. In these situations, special measures need to be adopted in order to minimize the possibility of transmission between patients, exposure of healthcare personnel and the development of postoperative complications. This document explains the main principles to consider when managing confirmed or suspected COVID-19 patients during evaluation as well as when surgical treatment is required
Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries
Background
Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks.
Methods
The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned.
Results
A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P < 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31).
Conclusion
Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)