Nivel de cumplimiento de metas internacionales de seguridad en un Sanatorio privado 2023 / Level of compliance with international safety goals in a private Sanatorium 2023

La presente investigación pretende evaluar el nivel de cumplimiento de las metas internacionales, que representan el foco principal para la mejora de calidad y seguridad de atención de los pacientes. La seguridad del paciente involucra a todos los estudios, prácticas y acciones promovidas por las instituciones sanitarias para disminuir y eliminar los riesgos de daños innecesarios relacionados con el cuidado de la salud. Metodología: Estudio descriptivo, observacional y transversal. De fuentes primaria y secundaria, Resultados: se abordaron las metas N° 1 la cual consiste en Identificar a los pacientes correctamente y la meta N° 6 la cual se refiere a Reducir el riesgo de lesiones en pacientes como resultado de caídas. En primer lugar, se destaca el cumplimiento en la identificación correcta del paciente y en segunda instancia la mejora del cumplimiento de medidas de prevención de caídas. Conclusión: Esta proximidad de los valores obtenidos genera un aspecto positivo para mejorar la seguridad de los pacientes y que, si bien el cumplimiento de las metas no es el deseado, es cercano al porcentaje planteado. Lo que en definitiva hace a este estudio un antecedente importante en la mejora continua con vista al futuro cercano[AU]

This research aims to evaluate the level of compliance with international goals, which represent the main focus for improving the quality and safety of patient care. Patient safety involves all studies, practices and actions promoted by health institutions to reduce and eliminate the risks of unnecessary harm related to health care. Methodology: Descriptive, observational and transversal study. From primary and secondary sources, Results: goals No. 1 were addressed, which consists of Identifying patients correctly and goal No. 6, which refers to Reducing the risk of injuries in patients as a result of falls. Firstly, compliance with correct patient identification stands out and secondly, improvement in compliance with fall prevention measures. Conclusion: This proximity of the values obtained generates a positive aspect to improve patient safety and that, although the fulfillment of the goals is not as desired, it is close to the proposed percentage. Which ultimately makes this study an important precedent in continuous improvement for the near future[AU]

Esta pesquisa tem como objetivo avaliar o nível de cumprimento das metas internacionais, que representam o foco principal para a melhoria da qualidade e segurança do atendimento ao paciente. A segurança do paciente envolve todos os estudos, e ações promovidas pelas instituições de saúde para reduzir e eliminar os riscos de danos desnecessários relacionados à assistência à saúde. Metodologia: Estudo descritivo, observacional e transversal. De fontes primárias e secundárias, dependendo do indicador e do objetivo para o qual a medição está sendo realizada. Resultados: Nesta pesquisa serão abordadas as metas nº1, que consiste em Identificar corretamente os pacientes e a meta nº 6, que es Reduzir o risco de lesões nos pacientes em decorrência de quedas. Foi realizado nos dois locais. Em primeiro lugar, destaca-se o cumprimento da correta identificação do paciente e, em segundo lugar, a melhoria no cumprimento das medidas de prevenção de quedas. Conclusão: Essa proximidade dos valores obtidos gera um aspecto positivo para melhorar a segurança do paciente e que, embora o cumprimento das metas não seja o desejado, está próximo do percentual proposto. O que acaba por tornar este estudo um precedente importante na melhoria contínua com vista ao futuro próximo.

Incidência de obstrução em cateteres periféricos intravenosos em adultos e fatores relacionados / Incidence of obstruction in peripheral intravenous catheters in adults and related factors / Incidencia de obstrucción en catéteres intravenosos periféricos en adultos y factores relacionados

Objetivo: analisar a incidência e os fatores relacionados à obstrução de cateter intravenoso periférico em adultos hospitalizados. Método: uma coorte prospectiva, realizada a partir da observação de 203 cateteres, entre fevereiro de 2019 e maio de 2020, em hospital público e de ensino brasileiro. Foram consideradas variáveis clínicas e do cateter. Os dados foram analisados descritivamente e por estatística inferencial. Resultados: o tempo de permanência variou entre um a 15 dias e a obstrução ocorreu em 7,5% das observações. Houve aumento do risco de obstrução em relação ao sexo (RR=0,49 / p=0,186), à idade (RR=1,20/ p=0,732), aos cateteres de maior calibre (RR=0,53/ p=0,250), à inserção no dorso da mão até antebraço (RR=2,33/ p=0,114) e ao tempo do cateter in situ (RR=033/ p=0,433). Conclusão: O cuidado diário e observação do cateter intravenoso periférico são importantes para minimizar o surgimento de complicações locais e sistêmicas e manter a patência do dispositivo.

Objective: to analyze the incidence and factors related to peripheral intravenous catheter obstruction in hospitalized adults. Method: a prospective cohort, based on the observation of 203 catheters, between February 2019 and May 2020, in a Brazilian public teaching hospital. Clinical and catheter variables were taken into account. The data was analyzed descriptively and using inferential statistics. Results: the length of stay ranged from one to 15 days and obstruction occurred in 7.5% of the observations. There was an increased obstruction risk in relation to gender (RR=0.49 / p=0.186), age (RR=1.20/ p=0.732), larger catheters (RR=0.53/ p=0.250), insertion in the back of the hand up to the forearm (RR=2.33/ p=0.114) and the time length the catheter was in situ (RR=033/ p=0.433). Conclusion: Daily care and observation of the peripheral intravenous catheter is important to minimize the appearance of local and systemic complications and maintain the patency of the device.

Objetivo: analizar la incidencia y los factores relacionados con la obstrucción del catéter intravenoso periférico en adultos hospitalizados. Método: cohorte prospectiva, realizada mediante la observación de 203 catéteres, entre febrero de 2019 y mayo de 2020, en un hospital escuela público brasileño. Se consideraron variables clínicas y del catéter. Los datos se analizaron de forma descriptiva y mediante estadística inferencial. Resultados: el tiempo de permanencia varió entre uno y 15 días y la obstrucción ocurrió en el 7,5% de las observaciones. Hubo mayor riesgo de obstrucción en relación con el sexo (RR=0,49 / p=0,186), la edad (RR=1,20 / p=0,732), los catéteres de mayor calibre (RR=0,53 / p= 0,250), la inserción en el dorso de la mano hasta el antebrazo (RR=2,33/ p=0,114) y el tiempo del catéter in situ (RR=033/ p=0,433). Conclusión: el cuidado diario y la observación del catéter intravenoso periférico son importantes para minimizar la aparición de complicaciones locales y sistémicas y mantener la permeabilidad del dispositivo.

Age Is Just a Number? The Impact of Age on Abdominoplasty Outcomes: A Single Surgeon Experience.

BACKGROUND: Abdominoplasty is among the most popular aesthetic procedures in plastic surgery worldwide. Common indications include prior massive weight loss, surgical or not, with remaining skin excess and post-pregnancy women looking to restore their youthful abdominal contour. Aging of the worldwide population results in a greater number of older patients interested in aesthetic procedures. Identifying the impact of age on abdominoplasty outcomes is crucial in ensuring the safety of care and determining sub-optimal patients that might not benefit from the procedure. MATERIALS AND METHODS: Medical records of all abdominoplasty patients operated by the senior author were screened for appropriate patients. Patients were excluded from the study if the mandatory follow-up time was not met or in instances of incomplete medical records. Patients were further stratified into 5 age groups based on age and compared using pre-operative, intra-operative and post-operative characteristics. Further regression analysis was performed to estimate the risk of complications for each individual age group, in an unadjusted and adjusted model. RESULTS: Six hundred and seventy-three patients were included in the study. Statistically significant differences were noted between the groups in respect smokers, prior bariatric surgery, and hypertension, diabetes mellitus and dyslipidemia (p values <0.01). Seroma rates, were greatest in the oldest age group (P value = 0.039). Odds ratio of 3.3 was calculated for seroma development in patients aged greater than 60. In a multivariate analysis, the risk diminished and was found to be statistically insignificant. CONCLUSION: Abdominoplasty is a safe procedure in all age groups. Increased rates of specific complications must be assessed in relation to potential confounders that exist between different age groups. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Structural Requirements for the Outpatient Treatment of Benign Diseases of the Uterus.

In many cases, outpatient surgical treatment of benign diseases of the uterus has advantages over inpatient care. This has been demonstrated by the healthcare situation in other countries. However, the prerequisite for the provision of outpatient services is that this does not lead to any impairment in the quality of care or of patient safety. The ultimate goal should not be to reduce costs but rather to maintain and, ideally, improve the quality of care. This requires that services are not just defined by the surgical procedure but also by the entire treatment chain, including, for example, psychosocial support, and are remunerated accordingly. It is particularly worrying that the final decision as to whether an outpatient operation is possible is not the responsibility of the operating unit, but of the "Medizinischer Dienst," with the corresponding options and threats of sanctions. This situation is unique internationally and requires a paradigm shift. Furthermore, structural prerequisites must be maintained which currently only exist inadequately in Germany. Since a substantial proportion of planned outpatient operations require immediate or secondary inpatient treatment, there must be a barrier-free transition between the outpatient and inpatient sectors. This will require the creation of networks between outpatient service providers and one or more hospitals that are equipped and competent to manage even complex complications. It is important to create structures that, with intensive involvement of the operating unit, include adequate preoperative evaluation and patient education as well as needs-oriented postoperative care at home. The current separation of sectors is a significant hinderance. Moreover, when expanding and promoting outpatient surgery, the aspect of training and further education of specialist staff must be taken into account, as well as cross-sectoral quality assurance. Based on a review of the international literature, this article presents 13 recommendations for adequate structures when providing outpatient services which should serve as a prerequisite for the greatest possible guarantee of patient safety.

Application of a digital quality measure for cancer diagnosis in Epic Cosmos.

OBJECTIVES: Missed and delayed cancer diagnoses are common, harmful, and often preventable. We previously validated a digital quality measure (dQM) of emergency presentation (EP) of lung cancer in 2 US health systems. This study aimed to apply the dQM to a new national electronic health record (EHR) database and examine demographic associations. MATERIALS AND METHODS: We applied the dQM (emergency encounter followed by new lung cancer diagnosis within 30 days) to Epic Cosmos, a deidentified database covering 184 million US patients. We examined dQM associations with sociodemographic factors. RESULTS: The overall EP rate was 19.6%. EP rate was higher in Black vs White patients (24% vs 19%, P < .001) and patients with younger age, higher social vulnerability, lower-income ZIP code, and self-reported transport difficulties. DISCUSSION: We successfully applied a dQM based on cancer EP to the largest US EHR database. CONCLUSION: This dQM could be a marker for sociodemographic vulnerabilities in cancer diagnosis.

Racial disparities in the utilization and outcomes of robotic bariatric surgery: an 8-year analysis of Metabolic and Bariatric Surgery Accreditation Quality Improvement Program data.

BACKGROUND: Robotic surgery utilization has been increasing across surgical specialties; however, racial disparities in patient access to care and outcomes have been reported. OBJECTIVES: In this study, we examined racial disparities in the utilization and outcomes of robotic bariatric surgery over an 8-year period. SETTING: Metabolic and Bariatric Surgery Accreditation Quality Improvement Program (MBSAQIP) centers of excellence across the United States. METHODS: The MBSAQIP database was used to identify adult patients who underwent robotic bariatric surgery between 2015 and 2022. Patients were stratified according to race and ethnicity into non-Hispanic White, non-Hispanic Black or African American (AA), Indigenous, Asian, and Hispanic patients. Multivariable analyses were used to assess predictors of robotic surgery use, odds of minor and major complications, prolonged length of stay (prolonged length of stay (pLOS): ≥3 days), readmissions, reoperations, and mortality within 30 days. RESULTS: Out of 1,288,359 patients included, robotic surgery was utilized in 196,314 patients (15.2%), with a mean age of 44 ± 12 years and 80.6% females. Rates of robotic surgery increased to 30% by 2022. Compared to White patients, Black/AA patients were more likely to undergo robotic surgery (adjusted odds ratio (aOR) = 1.22, 95% confidence interval (CI) = 1.21-1.24, P < .001). The safety of robotic bariatric surgery improved for both White and Black patients with decreased odds of major complications, readmissions, reoperations, and pLOS over the study period. However, Black/AA patients were more likely to experience minor and major complications, readmissions and have pLOS compared with White patients in 2022 (aOR:1.26, 95% CI:1.19-1.34, P < .001; aOR:1.22, 95% CI:1.06-1.41, P = .006; aOR:1.44, 95% CI:1.28-1.62, P < .001; aOR:2.26, 95% CI:2.06-2.47, P < .001, respectively). CONCLUSION: The utilization of robotic bariatric surgery has increased significantly over the past 8 years with continued improvements in its safety profile. While Black/AA patients have improved access to robotic surgery, their clinical outcomes continue to be worse than those of White patients. Efforts to address racial disparities in bariatric surgery outcomes must remain a priority to achieve health equity.

Patient positioning in minimally invasive gynecologic surgery: strategies to prevent injuries and improve outcomes.

Effective patient positioning is a critical factor influencing surgical outcomes, mainly in minimally invasive gynecologic surgery (MIGS) where precise positioning facilitates optimal access to the surgical field. This paper provides a comprehensive exploration of the significance of strategic patient placement in MIGS, emphasizing its role in preventing intraoperative injuries and enhancing overall surgical success. The manuscript addresses potential complications arising from suboptimal positioning and highlights the essential key points for appropriate patient positioning during MIGS, encompassing what the surgical team should or shouldn't do. In this perspective, the risk factors associated with nerve injuries, sliding, compartment syndrome, and pressure ulcers are outlined to guide clinical practice. Overall, this paper underscores the critical role of precise patient positioning in achieving successful MIGS procedures and highlights key principles for the gynecological team to ensure optimal patient outcomes.

Designing an Intervention to Improve Medication Safety for Nursing Home Residents Based on Experiential Knowledge Related to Patient Safety Culture at the Nursing Home Front Line: Cocreative Process Study.

BACKGROUND: Despite years of attention, avoiding medication-related harm remains a global challenge. Nursing homes provide essential health care for frail older individuals, who often experience multiple chronic diseases and polypharmacy, increasing their risk of medication errors. Evidence of effective interventions to improve medication safety in these settings is inconclusive. Focusing on patient safety culture is a potential key to intervention development as it forms the foundation for overall patient safety and is associated with medication errors. OBJECTIVE: This study aims to develop an intervention to improve medication safety for nursing home residents through a cocreative process guided by integrated knowledge translation and experience-based codesign. METHODS: This study used a cocreative process guided by integrated knowledge translation and experience-based co-design principles. Evidence on patient safety culture was used as an inspirational source for exploration of medication safety. Data collection involved semistructured focus groups to generate experiential knowledge (stage 1) to inform intervention design in a multidisciplinary workshop (stage 2). Research validation engaging different types of research expertise and municipal managerial representatives in finalizing the intervention design was essential. Acceptance of the final intervention for evaluation was aimed for through contextualization focused on partnership with a municipal advisory board. An abductive, rapid qualitative analytical approach to data analysis was chosen using elements from analyzing in the present, addressing the time-dependent, context-bound aspects of the cocreative process. RESULTS: Experiential knowledge was represented by three main themes: (1) closed systems and gaps between functions, (2) resource interpretation and untapped potential, and (3) community of medication safety and surveillance. The main themes informed the design of preliminary intervention components in a multidisciplinary workshop. An intervention design process focused on research validation in addition to contextualization resulted in the Safe Medication in Nursing Home Residents (SAME) intervention covering (1) campaign material visualizing key roles and responsibilities regarding medication for nursing home residents and (2) "Medication safety reflexive spaces" focused on social and health care assistants. CONCLUSIONS: The cocreative process successfully resulted in the multifaceted SAME intervention, grounded in lived experiences shared by some of the most important (but often underrepresented in research) stakeholders: frontline health care professionals and representatives of nursing home residents. This study brought attention toward closed systems related to functions in medication management and surveillance, not only informing the SAME intervention design but as opportunities for further exploration in future research. Evaluation of the intervention is an important next step. Overall, this study represents an important contribution to the complex field of medication safety. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/43538.

Safety assessment of drug impurities for patient safety: A comprehensive review.

Drug impurities are undesirable but unavoidable chemicals which can occur throughout the drug life cycle. The safety implications of drug impurities can be significant given that they can impact safety, quality, and efficacy of drug products and that certain drug impurities are mutagenic, carcinogenic, or teratogenic. The characteristics of drug impurities could be specific to drug modalities (e.g., small molecules vs. biologics). The commonly encountered drug impurities include elemental impurity, residual solvent, organic impurity, host cell protein and DNA, residual viral vector, extractable and leachable, and particle. They can cause various adverse effects such as immunogenicity, infection, genotoxicity, and carcinogenicity upon significant exposure. Therefore, the effective control of these drug impurities is central for patient safety. Regulations and guidelines are available for drug developers to manage them. Their qualification is obtained based on authoritative qualification thresholds or safety assessment following the classic toxicological risk assessment. The current review focuses on the safety assessment science and methodology used for diverse types of drug impurities. Due to the different nature of diverse drug impurities, their safety assessment represents a significant challenge for drug developers.

Medical Error: Using Storytelling and Reflection to Impact Resident Error Response Factors.

Introduction: Medical error is common and has a significant impact on physicians, learners, and patients' perception of the medical system; however, residents receive little formal training on this topic. This curriculum aims to foster sharing of personal medical error stories, review and practice error management and coping strategies, and impact error response factors. Methods: Faculty identified factors related to effective physician error management and recovery in order to develop a targeted curriculum for family medicine residents. The curriculum consisted of three 1-hour didactic sessions in a medium-sized, urban program. Instructional methods included guided reflection after mentor storytelling, small-group discussion, role-play, and self-reflection. Results: Twenty-two out of 30 (73%) residents completed the premodule survey, and 15 out of 30 (50%) residents completed the post module survey. Fewer than half of residents reported they knew what to do when faced with medical error, but this increased to 93% after curriculum delivery, as did rates of reported error story sharing. Resident reported self-efficacy (I can be honest about the errors I make as a doctor.) and self-awareness (I acknowledge when I am at increased risk for making errors) also increased following the curriculum. Discussion: Family medicine residents are receptive to learning from peers and mentors about error management and recovery. A brief curriculum can impact the culture around disclosure and support. Future iterations should focus on the impact of targeted curricular interventions on patient-oriented outcomes related to medical error.

Artificial intelligence-powered chatbots in search engines: a cross-sectional study on the quality and risks of drug information for patients.

BACKGROUND: Search engines often serve as a primary resource for patients to obtain drug information. However, the search engine market is rapidly changing due to the introduction of artificial intelligence (AI)-powered chatbots. The consequences for medication safety when patients interact with chatbots remain largely unexplored. OBJECTIVE: To explore the quality and potential safety concerns of answers provided by an AI-powered chatbot integrated within a search engine. METHODOLOGY: Bing copilot was queried on 10 frequently asked patient questions regarding the 50 most prescribed drugs in the US outpatient market. Patient questions covered drug indications, mechanisms of action, instructions for use, adverse drug reactions and contraindications. Readability of chatbot answers was assessed using the Flesch Reading Ease Score. Completeness and accuracy were evaluated based on corresponding patient drug information in the pharmaceutical encyclopaedia drugs.com. On a preselected subset of inaccurate chatbot answers, healthcare professionals evaluated likelihood and extent of possible harm if patients follow the chatbot's given recommendations. RESULTS: Of 500 generated chatbot answers, overall readability implied that responses were difficult to read according to the Flesch Reading Ease Score. Overall median completeness and accuracy of chatbot answers were 100.0% (IQR 50.0-100.0%) and 100.0% (IQR 88.1-100.0%), respectively. Of the subset of 20 chatbot answers, experts found 66% (95% CI 50% to 85%) to be potentially harmful. 42% (95% CI 25% to 60%) of these 20 chatbot answers were found to potentially cause moderate to mild harm, and 22% (95% CI 10% to 40%) to cause severe harm or even death if patients follow the chatbot's advice. CONCLUSIONS: AI-powered chatbots are capable of providing overall complete and accurate patient drug information. Yet, experts deemed a considerable number of answers incorrect or potentially harmful. Furthermore, complexity of chatbot answers may limit patient understanding. Hence, healthcare professionals should be cautious in recommending AI-powered search engines until more precise and reliable alternatives are available.

Factors affecting treatment outcomes of hospital injury patients in Korea.

Objectives: To analyze the characteristics of hospital injured patients and the factors that affect treatment results. Methods: We used the data from the Korea National Hospital Discharge In-depth Injury Survey from 2019 to 2021 of the Korea Disease Control and Prevention Agency (KDCA), 18,037 people who experienced hospital injury accidents were analyzed. In a retrospective cross-sectional study, general characteristics and injury-related characteristics of patients with hospital-acquired injuries were collected. The data were analyzed using chi-square test and logistic regression analysis of complex sampling design. The significance of all statistical analyses was verified at the p-value (<0.05) level. Results: Variables that significantly affected the death of patients with hospital injuries were gender, age, route of admission, type of hospital injury, principal diagnosis, and length of stay (p < 0.05). The risk of death was 3.174 times (95% confidence interval: 2.376-4.238) higher when neoplasm was the principal diagnosis compared to cases with principal diagnosis of other systems. Conclusions: It is necessary to do patient safety education to help medical personnel be more aware of groups of patients who had a high risk of death from hospital damage, such as male and elderly patients, patients who admitted through the emergency room, and patients whose principal diagnosis was neoplasm, circulatory system, or respiratory system disease.

The Challenges of Implementing a Safety Culture.

This article provides an update on patient safety data recently reviewed by and recommendations of the President's Council of Advisors on Science and Tech - nology. This article attempts to capture the impact of the eroding ability of the nursing workforce to perform its traditional role of blocking errors before they harm patients. Some strategies, tactics, and practice examples to assist in renewing this protective capacity in today's challenging environment are presented. Finally, acknowledging the variability of substantive support for maintaining a safety culture provided by individual health care organizations, this article encourages and applauds the personal courage of nephrology nurses and other health care providers as they engage and assist their clinical and quality improvement teams in addressing the persistence of what Hughes (2008) termed the "everydayness of errors" (p. 1-7).

Treatment expectations of patients and clinicians: a cross-sectional study.

Importance: Understanding treatment expectations of patients and their clinicians is of great importance in improving personalized medical services and enhancing patient safety systems. Objective: To investigate treatment expectations of patients and their clinicians and compare differences between both, by using a pair of validated structured assessment tools covering three key aspects/dimensions of clinical interests. Design setting and participants: This single-center cross-sectional study was conducted at Peking Union Medical College Hospital in China. The study enrolled patients aged 16 years and older receiving inpatient care and their clinicians. Patient recruitment was conducted from March 2023 to November 2023. Assessments: In addition to demographic and clinical characteristics, this study employed two validated structured assessment tools to evaluate treatment expectations among patients and their clinicians: the Hospitalized Patients' Expectations for Treatment Scale-Patient version (HOPE-P) and its counterpart, the Hospitalized Patients' Expectations for Treatment Scale-Clinician version (HOPE-C). Results: A total of 233 patients (mean [SD] age, 52.3 [15.1] years; 108 [46.4%] female) along with their clinicians, who numbered 75 in total were enrolled in this study. The distribution of total scores for HOPE-P and HOPE-C displayed similar patterns, with most scores concentrated in the higher range (above 50% of the full score). The mean HOPE-P total score was higher than that of HOPE-C (mean [SD] score, 38.78 [4.86] vs 37.49 [4.32]; t = 3.12, P = 0.002). In Dimension 2, the HOPE-P score was higher than HOPE-C (23.67 [3.20] vs 21.72 [3.03]; t = 6.98, P < 0.001). However, in Dimensions 1 and 3, HOPE-P scored lower than HOPE-C (13.37 [2.44] vs 13.84 [1.73]; t = -2.384, P < 0.018; 1.74 [1.14] vs 1.94 [1.00]; t = -2.00, P = 0.047). Certain demographic and clinical characteristics led to variations in patients' treatment expectations, including marital status, monthly family income, and smoking history. Conclusions and relevance: This cross-sectional study revealed significant differences between patients' and doctors' treatment expectations. Notably, it highlighted the need for clinicians to focus on rationalizing patients' expectations concerning treatment outcomes. Trial Registration Chinese Clinical Trial Registry Identifier: ChiCTR2300075262.

Thromboprophylaxis in lower limb amputation surgery.

Background: Lower limb amputation surgery is associated with a high risk of venous thromboembolism. There is evidence that pharmacological thromboprophylaxis is not widely prescribed to patients undergoing this type of procedure. Objectives: To investigate the profile of the thromboprophylaxis practices of angiologists and vascular surgeons in Brazil during the perioperative period of lower limb amputation surgery and conduct a descriptive analysis of the findings. Methods: This is a cross-sectional, descriptive study, with simple probabilistic sampling, carried out with angiologists and vascular surgeons working in Brazil. Data were collected through electronic questionnaires, from February to June 2023. Results: There were 237 respondents, 58.6% of whom conduct thrombotic risk stratification. Of these, 86.3% use the Caprini score. Only 27% of participants stratify patients' bleeding risk. Low molecular weight heparin is the medication of choice for 85.7% of study participants, 78.9% of whom use a dosage of 40 IU per day. Around 46.8% use direct oral anticoagulants in addition to low molecular weight heparin and rivaroxaban is the drug they most often prescribe (94.6%). A little more than half (51.15%) routinely recommend pharmacological thromboprophylaxis until hospital discharge. Conclusions: The study revealed the heterogeneous nature of conduct related to prescription of pharmacological thromboprophylaxis, highlighting the need for more studies to support prophylaxis decision-making in this patient population.

Obstacles to using the safe surgery checklist: Perspectives of first-line personnel.

Objectives: The safe surgery checklist, presented by the World Health Organization in 2008, is an aid to performing surgical interventions safely. Research indicates that the use of checklists in clinical activities leads to a reduced number of adverse events. However, research suggests that the use of checklists differs between different institutions and even between units in the same organisation. The intention of this study is to identify factors regarded by the health personnel in 'the sharp end' as obstacles to using the checklist. Methods: The study has a qualitative, case-based design. It is performed by the Hazard Identification method, which is a method for revealing safety hazards based on workers' experiences. Results: Obstacles were identified related to the content of the list, areas of use, distribution of responsibilities connected with the use of the list, and finally the organisation and management of safety efforts related to clinical activities. The use of checklists must be part of a system's perspective, and deviations from checklists must be discussed in the organisation. The informants also claimed that checklists should be implemented for interventions located outside the operating theatres and for emergency treatments. Conclusions: Even though the majority of employees believe that checklists are necessary, many surrounding factors are perceived as obstacles to their use. Not least, site-specific factors may be revealed by use of the Hazard Identification method.

Retrograde Umbilical Hernia Repair During Abdominoplasty: A Safe and Simple Technique.

BACKGROUND: Abdominoplasties are a very common procedure that is geared toward improving the abdominal contour and restoring quality of life. Main candidates for surgery are postpartum patients and patients after massive weight lost results in excess skin. The high incidence of umbilical hernias in the general population raises the question of whether combining its repair with cosmetic abdominoplasties is a safe and effective procedure. PURPOSE: Determine the safety of the "retrograde umbilical hernia" (RUH) technique, which utilizes a pre-peritoneal approach to the hernia, during abdominoplasty procedure and expand the literature on hernia repair during aesthetic abdominal surgery. METHODS: This is the retrospective cohort study of all patients that underwent abdominoplasty by the senior author. Eligible patients were divided into 2 groups: where one group included all patients who underwent abdominoplasty with RUH repair, and the second group underwent sole abdominoplasty. Baseline variables, surgical notes, and post-operative outcomes were obtained from the patients' medical records and analyzed for the purpose of this study. RESULTS: In total, 744 patients underwent abdominoplasties during the course of our study, 112 of which underwent concomitant umbilical hernia repair using the retrograde technique. The RUH technique was not found to result in a higher rate of complications compared to a similar population of traditional abdominoplasties. CONCLUSIONS: The retrograde umbilical hernia repair is a safe and efficient technique that can be easily implemented during abdominoplasty procedures in a heterogeneous population of patients. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

The Impact of Preoperative Flexible Fiberoptic Laryngoscopy on Anesthesia's Intubation Plans.

Purpose: To assess the value of conducting a preairway management review of flexible fiberoptic laryngoscopy examinations (FFL) by the anesthesia team for patients with head and neck cancer and to examine its impact on intubation strategies and overall patient safety. Methods: Prospective study at a single tertiary referral center including patients with stage T2 and greater cancers of the oropharynx, hypopharynx, or larynx who underwent intubation by the anesthesia team between May 2022 and April 2023. Pre- and postoperative surveys gathered data on the intubation plan, including details such as method, sedation, patient respiration, laryngoscope, tube size, and use of paralysis. Postoperative surveys gauged the FFL's subjective utility and documented intubation details and complications. Results: Thirty-four patients (49-87 years of age) were included in the study. Eleven intubation plans were changed after reviewing the FFL, while 23 were not. Although this was a pilot study, there was no significant correlation between location of the tumor and change in intubation plan. Of the 34 intubations, 9 were executed based on the plan after reviewing FFL. The majority of the attending anesthesiologists agreed or strongly agreed that seeing the FFL was more helpful than reading the findings in clinic notes and that reviewing the FFL was helpful in creating the intubation plan, 77% and 88%, respectively. Conclusion: Reviewing the FFL led to changes in the anesthesia team's intubation plan in 32% of the cases in our pilot study. While these findings are promising, they highlight the need for further research with larger sample sizes and across multiple centers to validate the impact of FFL on intubation strategies for patients with stage T2 and greater cancers of the oropharynx, hypopharynx, or larynx.

Factors influencing healthcare providers' behaviours in deprescribing: a cross-sectional study.

Introduction: Deprescribing serves as a pivotal measure to mitigate the drug-related problem due to polypharmacy. This study aimed to map the factors influencing healthcare providers' deprescribing decision using the Behaviour Change Wheel framework and develop an innovative conceptual model to support deprescribing practice. Methods: A cross-sectional online survey targeting doctors and pharmacists was conducted to assess the influence of various factors on healthcare providers' comfort in recommending deprescribing. The conceptual model was formulated, based on the existing deprescribing framework and the Behaviour Change Wheel. The model's robustness was scrutinised through Partial Least Squares Structural Equation Modeling (PLS-SEM), and model-fitting indices were employed to obtain the best-fit model. Results: A total of 736 responses were analysed with the final best-fit model consisting of 24 items in 5 constructs (R 2: 0.163; SRMR: 0.064; rho_c: 0.750-0.862; AVE: 0.509-0.627) and three independent factors. Based on the results, we proposed that deprescribing could be promoted through strategies aimed at enhancing healthcare providers internal capabilities such as knowledge levels, when patients' condition deteriorated and previous experiences with adverse events of drugs. Organisational support in providing such educational opportunities is important, with the empowerment of patient and healthcare providers through policy enhancements, guideline development, and effective communication. Conclusion: The deprescribing behaviours of healthcare professionals are influenced by an intricate interplay of patient, prescriber, and system factors. Enhancing deprescribing practices necessitates a comprehensive strategy that encompasses providers and patients' education, the development of structured deprescribing guidelines, the implementation of deprescribing support tools, and the enhancement of communication between healthcare providers.