Evaluación de la gestión de calidad de los servicios de Enfermería en un Centro de Restauración Neurológica / Evaluation of quality management of Nursing services at the International Center for Neurological Restoration

Introducción: La evaluación de la gestión de calidad de los servicios de Enfermería se perfila como una herramienta útil para trazar estrategias de mejora de los procesos organizacionales y satisfacer las necesidades del cliente. Objetivo: Evaluar la gestión de calidad de los servicios de Enfermería. Métodos: Estudio cuantitativo, descriptivo, de corte transversal, en el Centro Internacional de Restauración Neurológica, La Habana, en el año 2022. Participaron 60 enfermeras con 5 o más años de servicio, pertenecientes a los servicios lesiones estáticas, restauración biológica cerebral, atención a cubanos, lesiones raquimedulares, trastornos del movimiento y neurocirugía. Se aplicó una encuesta adaptada al contexto hospitalario basada en el Modelo Europeo de excelencia European Foundation for Quality Management. Se utilizó la media como medida de resumen. Se consideró la evaluación punto fuerte (aceptable) cuando el valor real alcanzado fue igual o superior al deseado y área de mejora (no aceptable) cuando el valor real no alcanzó el deseado. Resultados: La puntuación global fue de 977,88 de 1000 puntos que exige el Modelo. Se detectaron dos áreas de mejora a expensas de los criterios 3 (implicar los grupos de interés) y 5 (gestionar el funcionamiento y la transformación). Se evidenciaron puntos fuertes con énfasis en una cultura de calidad y elevada capacitación en los profesionales. Conclusión: La evaluación de gestión de la calidad en los servicios de Enfermería se considera aceptable. Los hallazgos obtenidos permiten plantearse acciones de mejora para fortalecer la calidad de la atención que se brinda a los clientes. La evaluación de la gestión de calidad en los servicios de enfermería es una estrategia metodológica útil para identificar errores y ayudar a identificar el camino hacia la excelencia(AU)

Introduction: The evaluation of quality management of Nursing services is emerging as a useful tool to outline strategies to improve organizational processes and meet customer needs, Objective: To evaluate the quality management of nursing services. Methods: Quantitative, descriptive, cross-sectional, cross-sectional study at the International Center for Neurological Restoration, Havana, Cuba, in the year 2022. Sixty nurses with 5 or more years of service, belonging to the services Static Injuries, Biological Brain Restoration, Care for Cubans, Rachimedullary Injuries, Movement Disorders and Neurosurgery participated. A survey was applied, adapted to the hospital context based on the European Model of Excellence EFQM. The mean was used as a summary measure. The evaluation was considered a strong point (acceptable) when the actual value achieved was equal to or higher than the desired value, and an area for improvement (not acceptable) when the actual value did not reach the desired value. Results: The overall score was 977.88 out of 1000 points required by the Model. Two areas for improvement were detected at the expense of criteria 3 (involve stakeholders) and 5 (manage operation and transformation). Strengths were evidenced with emphasis on a culture of quality and high qualification of professionals. Conclusion: The evaluation of quality management in nursing services is considered acceptable(AU)

Las normas técnicas para la formación en ingeniería biomédica, tecnología y administración en salud / Technical standards for the training in biomedical engineering, health technology and health management

Introducción: Los documentos normativos establecen el estado del arte relacionado con determinado campo del conocimiento. Existe una gran cantidad de normas relacionadas con los servicios de salud y su gestión, cuya aplicación es relevante en este sector. Objetivo: Exponer la importancia de las normas técnicas en la formación de los profesionales en ingeniería biomédica, tecnología y administración en salud. Desarrollo: Diferentes aspectos relacionados con el desempeño y las funciones de los profesionales en ingeniería biomédica, tecnología de la salud y administración en salud están recogidos en normas técnicas internacionales y en otras de carácter nacional, que resultan pertinentes y de gran utilidad para su formación en el nivel de grado y el posgrado. Conclusiones: Las profesiones abordadas requieren emplear los documentos normativos relacionados con sus funciones para contribuir con la calidad de los servicios de salud; de ahí la pertinencia de su incorporación en los planes de estudio de estas carreras(AU)

Introduction: Normative documents establish the state of the art related to a certain field of knowledge. There is a large number of standards related to health services and their management, whose application is relevant in this sector. Objective: To show the importance of technical standards in the training of professionals from the fields of biomedical engineering, health technology and health management. Development: Different aspects related to the performance and functions of professionals from the fields of biomedical engineering, health technology and health management are gathered in international and other national technical standards, relevant and useful for their training at the undergraduate and postgraduate levels. Conclusions: The addressed professions require the use of normative documents related to their functions in order to contribute to the quality of health services, hence the relevance of their incorporation into the curriculums of these major(AU)

Patient and family experience of telehealth care delivery as part of the CF chronic care model early in the COVID-19 pandemic.

BACKGROUND: During the COVID-19 pandemic, CF centers shifted to a telehealth delivery model. Our study aimed to determine how people with CF (PwCF) and their families experienced telehealth and assessed its quality and acceptability for future CF care. METHODS: The CF Patient and Family State of Care Survey (PFSoC) was fielded from August 31-October 30, 2020. The PFSoC explored themes of overall telehealth quality, ease of use, desirability, and preference for a future mix of in-person and telehealth care. Demographic covariates considered included: gender, age, CFTR modulator status, and region of residence. RESULTS: 424 PwCF and parents of PwCF responded (47% parents). Most (81%) reported a telehealth visit which included a MD/APP and nurse team members. 91% found telehealth easy to use, and 66% reported similar/higher quality than in-person care. One-third (34%) reported the highest desire for future telehealth care, with 45% (n =212) desiring 50% or more of visits conducted via telehealth. Adults were more likely than parents to report highest desire for future telehealth (64% vs. 36%). Respondents who perceived telehealth as similar/higher quality were more likely to desire future telehealth compared to those who perceived telehealth as lower quality (96% vs. 50%). Mixed methods analysis revealed themes affecting perceptions of telehealth. CONCLUSIONS: PwCF desire for future telehealth was influenced by perception of quality and age. Several themes emerged that need to be explored as telehealth is adapted into the CF chronic care model, especially when thinking about integration into pediatric care.

Nivel de adherencia al protocolo asistencial para la prevención de lesiones por presión en servicios de atención al grave / Level of Adherence to the Care Protocol for the Prevention of Pressure Injuries in Services of Care for Seriously Ill Patients

Introducción: La implementación de protocolos asistenciales como proyección estratégica en la prestación de servicios de salud permite contribuir a mejorar la calidad de la atención. Objetivo: Identificar el nivel de adherencia al protocolo asistencial para la prevención de lesiones por presión en servicios de atención al grave. Métodos: Estudio descriptivo y transversal en cinco servicios de atención al grave del Hospital Hermanos Ameijeiras, desde octubre a diciembre de 2019. Según criterios, la muestra quedó constituida por 31 personal de enfermería, de ellos, 16 licenciados en enfermería (51,61 por ciento) y 15 enfermeros técnicos (48,39 por ciento). Fueron evaluadas 21 historias clínicas. La recolección de la información se realizó mediante un test de conocimientos y una lista de chequeo, validados a través de criterios de expertos. Se realizó prueba piloto con el test, que permitió evaluar su validez y confiabilidad. Resultados: El 92,09 por ciento del total de los evaluados presentaron conocimientos medianamente suficientes (64,51 por ciento) y suficientes (27,58 por ciento). En cuatro servicios evaluados (80 por ciento) tenían disponible los recursos materiales. En 21 historias clínicas (100 por ciento) se valoraron los factores de riesgo. La identificación del riesgo, así como la planificación y ejecución de intervenciones de enfermería, solamente se reflejaron en 10 historias (47,61 por ciento). Se obtuvieron 4,33 puntos en la sumatoria total. Conclusiones: Se determinó como de nivel medio la adherencia al protocolo asistencial para la prevención de lesiones por presión en servicios de atención al grave(AU)

Introduction: The implementation of care protocols as a strategic projection in the provision of health services allows to contribute to improving the quality of care. Objective: To identify the level of adherence to the care protocol for the prevention of pressure injuries in care services for severely ill patients. Methods: Descriptive and cross-sectional study carried out in five care services for severely ill patients at Hermanos Ameijeiras Hospital, from October to December 2019. Based on to criteria, the sample consisted of 31 nursing staff members, of which sixteen were diploma nurses (51.61 percent) and fifteen were associate nurses (48.39 percent). Twenty-one medical records were assessed. The information was collected using a knowledge test and a checklist, validated through expert criteria. A pilot test was carried out with the test, which made it possible to evaluate its validity and reliability. Results: 92.09 percent of those evaluated had moderately sufficient (64.51 percent) and sufficient (27.58 percent) knowledge. In four assessed services (80 percent), the material resources were available. Risk factors were assessed in 21 medical records (100 percent). The identification of risk, as well as the planning and execution of nursing interventions, were only reflected in ten medical records (47.61 percent). In the total sum, 4.33 points were obtained. Conclusions: Adherence to the care protocol for the prevention of pressure injuries in serious care services was determined as medium level(AU)

Consulting with young people: informing guidelines for children's palliative care.

OBJECTIVE: Increasingly the views of young people are sought when improving healthcare; however, it is unclear how they shape policy or practice. This paper presents a consultation with young people commissioned by the National Institute for Health and Care Excellence (NICE) to inform clinical guidelines for paediatric palliative care (end-of-life care for infants, children and young people). METHODS: The consultation involved qualitative thematic analysis of data from 14 young people (aged 12-18 years) with a life-limiting or life-threatening condition who took part in focus groups or interviews. The topics explored were predefined by NICE: information and communication; care planning; place of care; and psychological care. Data collection consisted of discussion points and activities using visual cues and was informed by a pilot consultation group with five young adults (aged 19-24 years). Findings were shared with participants, and feedback helped to interpret the findings. RESULTS: Four overarching themes were identified, cutting across the predetermined topic areas: being treated as individuals with individual needs and preferences; quality of care more important than place; emotional well-being; and living as a young person. Importantly, care planning was viewed as a tool to support living well and facilitate good care, and the young people were concerned less about where care happens but who provides this. CONCLUSION: Young people's priorities differ from those of parents and other involved adults. Incorporating their priorities within policy and practice can help to ensure their needs and preferences are met and relevant research topics identified.

Evaluación de la gestión del conocimiento en el Centro Nacional de Cirugía de Mínimo Acceso / Evaluation of knowledge management at the National Center for Limited Access Surgery

RESUMEN Introducción: La gestión del conocimiento es vital para las organizaciones de salud con vistas a garantizar la calidad de sus servicios. Objetivo: Evaluar la gestión del conocimiento en el Centro Nacional de Cirugía de Mínimo Acceso. Métodos: Se realizó una investigación descriptiva de tipo transversal. Se elaboró, validó y aplicó una encuesta a 20 trabajadores del Centro en los meses de noviembre y diciembre de 2018. Se estudió la variable gestión del conocimiento, a través de sus elementos caracterizadores, los cuales fueron evaluados en dos dimensiones: importancia y frecuencia. Los datos se procesaron mediante los métodos de estadística descriptiva con el uso del programa SPSS v.21. Resultados: Se identificaron el compromiso de la alta dirección del centro con la gestión del conocimiento, la existencia de una infraestructura tecnológica suficiente para apoyar sus actividades, así como la necesidad de fortalecer los intercambios entre especialistas para compartir los resultados de investigación y aprovechar las lecciones aprendidas de los errores médicos y las no conformidades, para lo cual se requirió destinar tiempo y recursos. Conclusiones: El Centro Nacional de Cirugía de Mínimo Acceso es una institución con una destacada actividad en gestión del conocimiento. La aplicación de la encuesta para evaluar la gestión del conocimiento en el centro permitió identificar las oportunidades de mejora necesarias en apoyo a la innovación y la calidad del servicio de salud que se presta, lo que potencia aún más actividades como la formación profesional y el intercambio de las lecciones aprendidas entre los especialistas para el aprendizaje organizacional.

ABSTRACT Introduction: Knowledge management is vital for health organizations in order to guarantee the quality of their services. Objective: To evaluate knowledge management at the National Center for Limited Access Surgery. Methods: A descriptive cross-sectional investigation was carried out. A survey was prepared, validated and applied to 20 employees at this institution from November to December 2018. The knowledge management variable was studied, through its characterizing elements, which were evaluated in two dimensions: importance and frequency. The data were processed through descriptive statistics methods with the use of SPSS v.21 program. Results: The investigation identified the institution top management commitment with knowledge management, the existence of a sufficient technological infrastructure to support its activities, as well as the need to strengthen exchanges between specialists to share research results and take advantage of lessons learned from medical errors and non-conformities, for which time and resources were required. Conclusions: The National Center for Limited Access Surgery is an institution with outstanding activity in knowledge management. The application of the survey to evaluate knowledge management in the institution allowed identifying the necessary improvement opportunities in support of innovation and the quality of the health service provided, which further enhances professional training and exchange of lessons learned among specialists for organizational learning.

Percepción de usuarios sobre calidad de atención y educación durante la captación de sintomáticos respiratorios / Perception of users of quality of care and education during the respiratory symptomatic recruitment

Introducción: La tuberculosis es la novena causa mundial de mortalidad en adultos y la primera por enfermedades infecciosas. Mortalidad evitable con diagnóstico precoz y tratamiento oportuno. Estudio motivado por baja captación de sintomáticos respiratorios. Objetivo: Valorar la percepción de los usuarios de una institución de salud sobre la calidad de la atención y de la educación para el autocuidado, durante la captación de sintomáticos respiratorios en el programa de tuberculosis. Métodos: Estudio cualitativo, de abordaje con elementos de teoría fundamentada. Realizado en una institución estatal de salud de primer nivel. Participaron 96 adultos, quienes firmaron el consentimiento informado: 70 sintomáticos respiratorios y 26 familiares acompañantes. Se realizaron seis grupos focales, con dos categorías apriorísticas: calidad de atención y educación durante el proceso de captación. Información grabada y transcrita. Con Atlas Ti se realizó codificación abierta, axial y selectiva, utilizando comparación constante y memos. El análisis se apoyó en postulados de Dorothea Orem. Resultados: Sobre calidad de atención: hubo desconocimiento de la ruta integral de atención y deficiente identificación e información sobre riesgo. Sobre educación para el autocuidado: hubo desconocimiento de aspectos relacionados con tuberculosis y déficit en educación recibida. Los participantes no relacionaron sintomáticos respiratorios con tuberculosis; esta fue estigmatizada como enfermedad contagiosa y mortal, consideraron difícil recoger muestra para baciloscopia. Se evidenciaron limitaciones de cuidado favorecidas por insuficiente apoyo educativo. Conclusiones: La percepción de los usuarios orienta hacia la necesidad de fomentar servicios seguros, accesibles y humanizados para detección temprana y cuidado del sintomático respiratorio. La educación para el autocuidado y una mayor interacción con usuarios pueden mejorar resultados institucionales(AU)

Introduction: Tuberculosis, the world ninth leading cause of death in adults, first due to infectious diseases. Avoidable mortality with early diagnosis and timely treatment. Study motivated by limited awareness of respiratory symptomatics. Objective: To assess the perception of users of a healthcare institution in regards to the quality of care and self-care education during the Tuberculosis program. Methods: A Qualitative study approach with elements from proven theory. Conducted at state-class healthcare institution. Participants: 96 consenting adults (70 respiratory symptoms, 26 accompanying relatives). Six focus groups were carried out during the recruitment process with two aprioristic categories: quality of care and self-care education. Information was recorded and transcribed. Utilizing Atlas Ti, open, axial and selective coding was performed and using constant comparisons and memos. The analysis was based on Dorothea Orem postulates. Results: Quality of care: lack of comprehensive route of care and poor identification and risk information. Self-care education: ignorance of TB-related aspects and shortfalls of received education. Participants did not link respiratory symptoms to tuberculosis; this was stigmatized as a contagious and fatal disease. They considered it difficult to collect sample(s) for baciloscopy. Care limitations are evident by insufficient educational support. Conclusions: User perception should be oriented towards promoting safe, accessible and humanized services for early detection and care of respiratory symptoms. Self-care education and greater interaction with users can improve institutional outcomes(AU)

Práctica asistencial segura de los profesionales de enfermería con pacientes geriátricos / Safe care practice of nursing professionals with geriatric patients

Introducción: La seguridad del paciente geriátrico está ligada a la dimensión de la calidad de la práctica asistencial, que busca reducir y prevenir los riesgos asociados a la atención sanitaria, la misma se conoce como seguridad del paciente o seguridad clínica. Objetivo: Exponer el alcance y naturaleza disponible sobre la práctica asistencial segura de los profesionales de enfermería con pacientes geriátricos. Métodos: Revisión bibliográfica integrativa. Se efectuó análisis reflexivo del contenido de estudios originales y de revisión, de acceso abierto, en español, inglés o portugués, publicados entre 1996-2020. Se excluyeron publicaciones duplicadas y literatura gris que no respondieran al objetivo del estudio. La búsqueda se realizó en SciELO, Dialnet, Elsevier, Google Académico, la estrategia se estructuró a partir de palabras clave reconocidas en (DeCS), "seguridad del paciente", "enfermería geriátrica", "anciano", "asistencia a los ancianos", y los operadores booleanos AND y OR. Se identificaron 60 artículos de los que fueron útiles 32. Conclusiones: Es posible minimizar los riesgos en la práctica asistencial y reducir el daño asociado a la asistencia sanitaria. Estas evidencias pueden servir de referencia para la seguridad y la calidad de la asistencia brindada, lo que constituye un desafió para la enfermería gerontológica, dadas las características del paciente geriátrico que lo sitúan como grupo etáreo vulnerable y frágil(AU)

Introduction: Geriatric patient safety is linked to the quality dimension of healthcare practice, which seeks to reduce and prevent the risks associated with health care, which is known as patient safety or clinical safety. Objective: To expose the scope and nature available on the safe care practice of nursing professionals with geriatric patients. Methods: Integrative bibliographic review where reflective analysis of the content of original and open access review studies was carried out, in Spanish, English or Portuguese, published between 1996-2020. Duplicate publications, gray literature, that did not respond to the study objective were excluded. The search was carried out in SciELO, Dialnet, Elsevier, Google Scholar, the strategy was structured based on recognized keywords in (DeCS), "patient safety", "geriatric nursing", "elderly", "assistance to the elderly", and the Boolean operators AND and OR. 60 articles were identified, of which 32 were useful. Conclusions: It is possible to minimize the risks in healthcare practice, and reduce the harm associated with healthcare. These evidences can serve as a reference for the safety and quality of the care provided, which constitutes a challenge for gerontological nursing, given the characteristics of the geriatric patient that place them as a vulnerable and fragile age group(AU)

Prevalence, trend and disparities of palliative care utilization among hospitalized metastatic breast cancer patients who received critical care therapies.

BACKGROUND: Early integration of palliative care (PC) for patients with advanced cancer has been recommended to improve quality of care. This study aims to describe prevalence, temporal trend and predictors of PC use in metastatic breast cancer (mBCa) patients receiving critical care therapies (CCT; included invasive mechanic ventilation, percutaneous endoscopic gastrostomy tube, total parenteral nutrition, tracheostomy and dialysis). METHODS: The National Inpatient Sample was queried for mBCa patients receiving CCT between 2005 and 2014. Annual percent changes (APC) were calculated for PC prevalence in the overall cohort and subgroups. Multivariable logistic analysis was used to explore predictors of PC use. RESULTS: Of 5833 mBCa patients receiving CCT, 880 (15.09%) received PC. Rate of PC use increased significantly from 2.53% in 2005 to 25.96% in 2014 (APC: 35.75%; p < 0.0001). Higher increase in PC use was observed in South (from 0.65% to 27.11%; APC: 59.42%; p < 0.0001), medium bedsize hospitals (from 3.75% to 26.05%; APC: 38.16%; p = 0.0006) and urban teaching hospitals (from 4.13% to 29.86%; APC: 37.33%; p = 0.0005). Multivariable analysis revealed that year interval, urban teaching hospitals, and invasive mechanical ventilation were associated with increased PC use, while primary diagnosis of gastrointestinal disorders, fractures, metastatic sites from lymph nodes and tracheostomy were associated with lower PC use. CONCLUSIONS: PC use in mBCa patients receiving CCT increases significantly over the period. However, it still remains low. Efforts to illustrate disparities in PC use are needed to improve quality of care for mBCa patients receiving CCT, especially for those hospitalized in rural and nonteaching hospitals.

Complications, Costs, and Quality Outcomes of Patients Undergoing Cervical Deformity Surgery With Intraoperative BMP Use.

STUDY DESIGN: An epidemiological study using national administrative data from the MarketScan database. OBJECTIVE: The aim of this study was to identify the impact of bone morphogenetic protein (BMP) on postoperative outcomes in patients undergoing adult cervical deformity (ACD) surgery. SUMMARY OF BACKGROUND DATA: BMP has been shown to stimulate bone growth and improve fusion rates in spine surgery. However, the impact of BMP on reoperation rates and postoperative complication rate is controversial. METHODS: We queried the MarketScan database to identify patients who underwent ACD surgery from 2007 to 2015. Patients were stratified by BMP use in the index operation. Patients <18 years and those with any history of tumor or trauma were excluded. Baseline demographics and comorbidities, postoperative complication rates, and reoperation rates were analyzed. RESULTS: A total of 13,549 patients underwent primary ACD surgery, of which 1155 (8.5%) had intraoperative BMP use. The overall 90-day complication rate was 27.6% in the non-BMP cohort and 31.1% in the BMP cohort (P < 0.05). Patients in the BMP cohort had longer average length of stay (4.0 days vs. 3.7 days, P < 0.05) but lower revision surgery rates at 90 days (14.5% vs. 28.3%, P < 0.05), 6 months (14.9% vs. 28.6%, P < 0.05), 1 year (15.7% vs. 29.2%, P < 0.05), and 2 years (16.5% vs. 29.9%, P < 0.05) postoperatively. BMP use was associated with higher payments throughout the 2-year follow-up period ($107,975 vs. $97,620, P < 0.05). When controlling for baseline group differences, BMP use independently increased the odds of postoperative complication (odds ratio [OR] 1.22, 95% confidence interval [CI] 1.1-1.4) and reduced the odds of reoperation throughout 2 years of follow-up (OR 0.49, 95% CI 0.4-0.6). CONCLUSION: Intraoperative BMP use has benefits for fusion integrity in ACD surgery but is associated with increased postoperative complication rate. Spine surgeons should weigh these benefits and drawbacks to identify optimal candidates for BMP use in ACD surgery. LEVEL OF EVIDENCE: 3.

Do neurosurgeons receive more patient complaints than other physicians? Describing who is most at risk and how we can improve.

OBJECTIVE: The number of unsolicited patient complaints (UPCs) about surgeons correlates with surgical complications and malpractice claims. Using a large, national patient complaint database, the authors sought to do the following: 1) compare the rates of UPCs for neurosurgeons to those for other physicians, 2) analyze the risk of UPCs with individual neurosurgeon characteristics, and 3) describe the types of UPCs made about neurosurgeons. METHODS: Patient and family complaint reports among 36,265 physicians, including 423 neurosurgeons, 8292 other surgeons, and 27,550 nonsurgeons who practiced at 33 medical centers (22 academic and 11 regional) from January 1, 2014, to December 31, 2017, were coded with a previously validated Patient Advocacy Reporting System (PARS) algorithm. RESULTS: Among 423 neurosurgeons, 93% were male, and most (71%) practiced in academic medical centers. Neurosurgical subspecialties included general practice (25%), spine (25%), tumor (16%), vascular (13%), functional (10%), and pediatrics (10%). Neurosurgeons had more average total UPCs per physician (8.68; 95% CI 7.68-9.67) than nonsurgeons (3.40; 95% CI 3.33-3.47) and other surgeons (5.01; 95% CI 4.85-5.17; p < 0.001). In addition, a significantly higher percentage of neurosurgeons received at least one UPC (71.6%; 95% CI 67.3%-75.9%) than did nonsurgeons (50.2%; 95% CI 49.6%-50.8%) and other surgeons (58.2%; 95% CI 57.1%-59.3%; p < 0.001). Factors most associated with increased average UPCs were younger age, measured as median medical school graduation year (1990.5 in the 0-UPC group vs 1993 in the 14+-UPC group, p = 0.009) and spine subspecialty (13.4 mean UPCs in spine vs 7.9 mean UPCs in other specialties, 95% CI 2.3-8.5, p < 0.001). No difference in complaints was seen in those who graduated from non-US versus US medical schools (p = 0.605). The most common complaint types were related to issues surrounding care and treatment, communication, and accessibility, each of which was significantly more common for neurosurgeons than other surgical specialties (p < 0.001). CONCLUSIONS: Neurosurgeons were more likely to generate UPCs than other surgical specialties, and almost 3 out of 4 neurosurgeons (71.6%) had at least one UPC during the study period. Prior studies have shown that feedback to physicians about behavior can result in fewer UPCs. These results suggest that neurosurgeons have opportunities to reduce complaints and potentially improve the overall quality of care delivered.

Characterization of Burnout Among Spanish Family Physicians Treating Fibromyalgia Patients: The EPIFFAC Study.

OBJECTIVE: Burnout among physicians has increased, affecting not only doctors but also the quality of patient care. Treating challenging disorders, such as fibromyalgia, may increase the risk of feeling burned out. Health care of fibromyalgia patients is increasingly being assigned to family physicians. Therefore, we described the demographic characteristics, work contexts, component burnout scores (exhaustion, depersonalization, and personal accomplishment), and perceptions of fibromyalgia care of Spanish family medicine physicians with high and low levels of burnout. We then evaluated which of these variables were associated with having high or low levels of burnout. METHOD: This cross-sectional study assessed 506 family physicians recruited from the Spanish Society of Family Physicians and randomly selected from Primary Health Care Centers. The subgrouping of family physicians based on their burnout scores was assessed by cluster analysis. Variables showing statistically significant differences between clusters and significance below 0.25 in univariate logistic regressions were assessed by multivariate logistic regression analysis. RESULTS: Family physicians reporting higher burnout scores (25%) felt that fibromyalgia patients on sick leave increased their workload, reported no support from nurses in the treatment of fibromyalgia patients, and had a more negative impression of fibromyalgia patients. CONCLUSIONS: One-quarter of family physicians reported feeling exhausted, detached from fibromyalgia patients, or less professionally accomplished. Several personal characteristics and contextual variables increased burnout. Several interventions to modify these variables and, thus, protect family physicians treating fibromyalgia from burnout are suggested.

Enhanced Recovery after Lumbar Spine Fusion: A Randomized Controlled Trial to Assess the Quality of Patient Recovery.

BACKGROUND: Prospective trials of enhanced recovery after spine surgery are lacking. We tested the hypothesis that an enhanced recovery pathway improves quality of recovery after one- to two-level lumbar fusion. METHODS: A patient- and assessor-blinded trial of 56 patients randomized to enhanced recovery (17 evidence-based pre-, intra-, and postoperative care elements) or usual care was performed. The primary outcome was Quality of Recovery-40 score (40 to 200 points) at postoperative day 3. Twelve points defined the clinically important difference. Secondary outcomes included Quality of Recovery-40 at days 0 to 2, 14, and 56; time to oral intake and discharge from physical therapy; length of stay; numeric pain scores (0 to 10); opioid consumption (morphine equivalents); duration of intravenous patient-controlled analgesia use; complications; and markers of surgical stress (interleukin 6, cortisol, and C-reactive protein). RESULTS: The analysis included 25 enhanced recovery patients and 26 usual care patients. Significantly higher Quality of Recovery-40 scores were found in the enhanced recovery group at postoperative day 3 (179 ± 14 vs. 170 ± 16; P = 0.041) without reaching the clinically important difference. There were no significant differences in recovery scores at days 0 (175 ± 16 vs. 162 ± 22; P = 0.059), 1 (174 ± 18 vs. 164 ± 15; P = 0.050), 2 (174 ± 18 vs. 167 ± 17; P = 0.289), 14 (184 ± 13 vs. 180 ± 12; P = 0.500), and 56 (187 ± 14 vs. 190 ± 8; P = 0.801). In the enhanced recovery group, subscores on the Quality of Recovery-40 comfort dimension were higher (longitudinal mean score difference, 4; 95% CI, 1, 7; P = 0.008); time to oral intake (-3 h; 95% CI, -6, -0.5; P = 0.010); and duration of intravenous patient-controlled analgesia (-11 h; 95% CI, -19, -6; P < 0.001) were shorter; opioid consumption was lower at day 1 (-57 mg; 95% CI, -130, -5; P = 0.030) without adversely affecting pain scores (-2; 95% CI, -3, 0; P = 0.005); and C-reactive protein was lower at day 3 (6.1; 95% CI, 3.8, 15.7 vs. 15.9; 95% CI, 6.6, 19.7; P = 0.037). CONCLUSIONS: Statistically significant gains in early recovery were achieved by an enhanced recovery pathway. However, significant clinical impact was not demonstrated.

Perceptions of Facilitators and Barriers to Measuring and Improving Quality in Palliative Care Programs.

OBJECTIVE: To examine perceptions of facilitators and barriers to quality measurement and improvement in palliative care programs and differences by professional and leadership roles. METHODS: We surveyed team members in diverse US and Canadian palliative care programs using a validated survey addressing teamwork and communication and constructs for educational support and training, leadership, infrastructure, and prioritization for quality measurement and improvement. We defined key facilitators as constructs rated ≥4 (agree) and key barriers as those ≤3 (disagree) on 1 to 5 scales. We conducted multivariable linear regressions for associations between key facilitators and barriers and (1) professional and (2) leadership roles, controlling for key program and respondent factors and clustering by program. RESULTS: We surveyed 103 respondents in 11 programs; 45.6% were physicians and 50% had leadership roles. Key facilitators across sites included teamwork, communication, the implementation climate (or environment), and program focus on quality improvement. Key barriers included educational support and incentives, particularly for quality measurement, and quality improvement infrastructure such as strategies, systems, and skilled staff. In multivariable analyses, perceptions did not differ by leadership role, but physicians and nurse practitioners/nurses/physician assistants rated most constructs statistically significantly more negatively than other team members, especially for quality improvement (6 of the 7 key constructs). CONCLUSIONS: Although participants rated quality improvement focus and environment highly, key barriers included lack of infrastructure, especially for quality measurement. Building on these facilitators and measuring and addressing these barriers might help programs enhance palliative care quality initiatives' acceptability, particularly for physicians and nurses.

The COVID-19 pandemic will have a long-lasting impact on the quality of cirrhosis care.

The coronavirus disease 2019 (COVID-19) pandemic has shattered the meticulously developed processes by which we delivered quality care for patients with cirrhosis. Care has been transformed by the crisis, but enduring lessons have been learned. In this article, we review how COVID-19 will impact cirrhosis care. We describe how this impact unfolds over 3 waves; i) an intense period with prioritized high-acuity care with delayed elective procedures and routine care during physical distancing, ii) a challenging 'return to normal' following the end of physical distancing, with increased emergent decompensations, morbidity, and systems of care overwhelmed by the backlog of deferred care, and iii) a protracted period of suboptimal outcomes characterized by missed diagnoses, progressive disease and loss to follow-up. We outline the concrete steps required to preserve the quality of care provided to patients with cirrhosis. This includes an intensification of the preventative care provided to patients with compensated cirrhosis, proactive chronic disease management, robust telehealth programs, and a reorganization of care delivery to provide a full service of care with flexible clinical staffing. Managing the pandemic of a serious chronic disease in the midst of a global infectious pandemic is challenging. It is incumbent upon the entire healthcare establishment to be strong enough to weather the storm. Change is needed.

Evolución de las recomendaciones para la prevención de la infección quirúrgica en cirugía de colon / Evolution of the Recommendations for Preventing Surgical Site Infection After Colon Surgery

RESUMEN Las infecciones del sitio quirúrgico constituyen un problema de calidad de los cuidados a la salud, las cuales son potencialmente prevenibles mediante la aplicación de guías de prevención basadas en evidencias. Se pretendedescribir la evolución histórica de las prácticas de uso profiláctico de antibióticos en cirugía de colon desde el siglo pasado. Se analizó literatura publicada en las últimas cinco décadas en MEDLINE, Infomed y otras fuentes secundarias. Se destaca la evolución del uso combinado de antimicrobianos (aminoglucósidos, penicilina, cefalosporinas y nitroimidazoles) asociados a la preparación enérgica del colon en la década de los 70 del pasado siglo. Numerosos antimicrobianos y prácticas han sido ensayados para demostrar que el uso de antibióticos para el control de las bacterias aerobias y anaerobias, administrados por vía oral e intravenosa, logra la prevención de hasta el 75 por ciento de las infecciones del sitio quirúrgico en cirugía de colon. Las evidencias científicas orientan hacia la necesidad del uso de profilaxis antibióticos orales más intravenosas asociados a la preparación mecánica del colon(AU)

ABSTRACT Surgical site infections are a concern with respect to quality of health care. Surgical site infections are potentially preventable through the application of evidence-based prevention guidelines. The aim is to describe the historical evolution of practicing prophylactic use of antibiotics in colon surgery since the last century. We analyzed the literature published in the last five decades in MEDLINE, Infomed and other secondary sources. The evolution is highlighted of the combined use of antimicrobials (aminoglycosides, penicillin, cephalosporins, and nitroimidazoles) associated with the vigorous preparation of the colon in the 1970s of the last century. Numerous antimicrobials and practices have been tested to demonstrate that the use of antibiotics to control aerobic and anaerobic bacteria, administered orally and intravenously, achieves the prevention of up to 75 percent of surgical site infections in colon surgery. Scientific evidence points to the need for the use of more intravenous oral antibiotic prophylaxis associated with mechanical preparation of the colon(AU)

National TB program shortages as potential factor for poor-quality TB care cascade: Healthcare workers' perspective from Beira, Mozambique.

BACKGROUND: Mozambique is one of the countries with the deadly implementation gaps in the tuberculosis (TB) care and services delivery. In-hospital delays in TB diagnosis and treatment, transmission and mortality still persist, in part, due to poor-quality of TB care cascade. OBJECTIVE: We aimed to assess, from the healthcare workers' (HCW) perspective, factors associated with poor-quality TB care cascade and explore local sustainable suggestions to improve in-hospital TB management. METHODS: In-depth interviews and focus group discussions were conducted with different categories of HCW. Audio-recording and written notes were taken, and content analysis was performed through atlas.ti7. RESULTS: Bottlenecks within hospital TB care cascade, lack of TB staff and task shifting, centralized and limited time of TB laboratory services, and fear of healthcare workers getting infected by TB were mentioned to be the main factors associated with implementation gaps. Interviewees believe that task shifting from nurses to hospital auxiliary workers, and from higher and well-trained to lower HCW are accepted and feasible. The expansion and use of molecular TB diagnostic tools are seen by the interviewees as a proper way to fight effectively against both sensitive and MDR TB. Ensuring provision of N95 respiratory masks is believed to be an essential requirement for effective engagement of the HCW on high-quality in-hospital TB care. For monitoring and evaluation, TB quality improvement teams in each health facility are considered to be an added value. CONCLUSION: Shortage of resources within the national TB control programme is one of the potential factors for poor-quality of the TB care cascade. Task shifting of TB care and services delivery, decentralization of the molecular TB diagnostic tools, and regular provision of N95 respiratory masks should contribute not just to reduce the impact of resource scarceness, but also to ensure proper TB diagnosis and treatment to both sensitive and MDR TB.

Medicare Reimbursement for General Surgery Procedures: 2000 to 2018.

OBJECTIVE: The purpose of this study is to evaluate monetary trends from 2000 to 2018 in Medicare reimbursement rates for the most common general surgery procedures. SUMMARY BACKGROUND DATA: A complete understanding of financial trends in general surgery in the United States is lacking. As such, an evaluation of trends in reimbursement rates in general surgery is important for defining the specialty's current and future financial health. METHODS: The Physician Fee Schedule Look-Up Tool from the Centers for Medicare and Medicaid Services was queried for each of the 20 top codes top in general surgery. The total raw percent change in Medicare reimbursement rate for each procedure from 2000 to 2018 was calculated and averaged. All data was corrected for inflation. Both average annual and total percentage change were calculated based on these adjusted trends. Compound annual growth rate was calculated using the adjusted data. RESULTS: After adjusting all data for inflation, the reimbursement rate for all included procedures decreased by an average of 24.4% throughout the study period. During this time, the adjusted reimbursement rate decreased by an average of 1.4% each year with an average compound annual growth rate of -1.6%. CONCLUSION: After adjusting for inflation, Medicare reimbursement rates in general surgery have steadily decreased from 2000 to 2018. It is important that these trends are understood and considered by surgeons, healthcare administrators, and policy-makers in order to develop and implement agreeable models of reimbursement while ensuring access to quality general surgery care in the United States.