RESUMO
INTRODUCTION: The effort to increase patient safety has become one of the main focal points of all health care professions, despite the fact that, in the field of dentistry, initiatives have come late and been less ambitious. The main objective of patient safety is to avoid preventable adverse events to the greatest extent possible and to limit the negative consequences of those which are unpreventable. Therefore, it is essential to ascertain what adverse events occur in each dental care activity in order to study them in-depth and propose measures for prevention. OBJECTIVES: To ascertain the characteristics of the adverse events which originate from dental care, to classify them in accordance with type and origin, to determine their causes and consequences, and to detect the factors which facilitated their occurrence. MATERIAL AND METHOD: This study includes the general data from the series of adverse dental vents of the Spanish Observatory for Dental Patient Safety (OESPO) after the study and analysis of 4,149 legal claims (both in and out of court) based on dental malpractice from the years of 2000 to 2010 in Spain. RESULTS: Implant treatments, endodontics and oral surgery display the highest frequencies of adverse events in this series (25.5%, 20.7% and 20.4% respectively). Likewise, according to the results, up to 44.3% of the adverse events which took place were due to predictable and preventable errors and complications. CONCLUSION: A very significant percentage were due to foreseeable and preventable errors and complications that should not have occurred.
Assuntos
Assistência Odontológica/efeitos adversos , Humanos , Erros Médicos/estatística & dados numéricos , Segurança do Paciente , Espanha , Fatores de TempoRESUMO
The clinical risks associated with health care have been a known factor since ancient times, and their prevention has constituted one of the foundations of health care. However, concern for the risks involved in health care treatments has risen very significantly in recent years, becoming a modern current of concern for clinical health care risks which is referred to by the name of "patient safety" in the scientific literature. Unfortunately, there are no studies on patient safety in dental practice or case studies of adverse events in this practice. In addition to the lack of studies on adverse events in regular dental practice, there are even fewer references to treatment for disabled patients. In this article, we provide a "proposal for analysis" of the clinical risks associated with treating disabled patients, which will make it possible to evaluate the health care risks associated with the treatment of patients who have a specific disability, at one determined moment and in one specific environment.
Assuntos
Assistência Odontológica para a Pessoa com Deficiência , Segurança do Paciente , Gestão da Segurança , HumanosRESUMO
OBJECTIVE: To evaluate the stability achieved in isolated reconstruction of each ACL bundles (minimum 2-year follow-up). STUDY GROUP: 39 consecutive patients (28.1 years of mean age) underwent anteromedial (AM) and posterolateral (PL) bundle reconstruction surgery (31.71 months of mean follow-up). CONTROL GROUP: 36 non-concurrent patients using single-bundle (SB) technique (more than 2-year follow-up). Evaluation based on IKDC scores, taking anterior-posterior translation and rotational stability as primary endpoints, and epidemiological data, ischaemia time, waiting time for surgery and complications as secondary endpoints. RESULTS: SB, AM and PL groups showed an anteroposterior translation (APT) at 2 years of 2.3, 1.8 and 1.8 mm, respectively, with an APT reduction of 5.4, 2.9 and 2.3 mm, respectively, but with no difference between both types of partial reconstruction (p = 0.552). IKDC scores in the AM group were as follows: preoperative (11 cases in group A, 12 B, 3 C), postoperative (24 A, 2 B); IKDC in the PL group: preoperative (7 B, 6 C), postoperative (10 A, 3 B). Mobility restored in all cases, while in group B, 2 AM patients and 3 PL had a slight Pivot Shift. There were no differences in complications as compared to conventional techniques. DISCUSSION: All techniques showed global significant enhancement in rotational stability (p < 0.0005). Improvement in anterior-posterior translation in AM group and in rotational stability in PL group was achieved; both showed no relevant statistical significance. Residual translation shows directly proportional relationship with preoperative status, surgical ischaemia time and patient weight. CONCLUSION: Reconstruction of one ACL bundle or the other can restore knee stability and function. Care should be taken to detect where the PL bundle reaches maximum tension and in improving patient preoperative status and ischaemia time.
Assuntos
Reconstrução do Ligamento Cruzado Anterior , Ligamento Cruzado Anterior , Instabilidade Articular , Complicações Pós-Operatórias , Adulto , Ligamento Cruzado Anterior/fisiopatologia , Ligamento Cruzado Anterior/cirurgia , Lesões do Ligamento Cruzado Anterior , Reconstrução do Ligamento Cruzado Anterior/efeitos adversos , Reconstrução do Ligamento Cruzado Anterior/métodos , Artroscopia , Pesquisa Comparativa da Efetividade , Feminino , Humanos , Instabilidade Articular/diagnóstico , Instabilidade Articular/etiologia , Instabilidade Articular/fisiopatologia , Instabilidade Articular/prevenção & controle , Articulação do Joelho/fisiopatologia , Masculino , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/fisiopatologia , Complicações Pós-Operatórias/prevenção & controle , Estudos Prospectivos , Radiografia , Amplitude de Movimento Articular , Recuperação de Função Fisiológica , Ruptura/diagnóstico por imagem , Ruptura/etiologia , Ruptura/fisiopatologia , Ruptura/cirurgia , Espanha , Fatores de Tempo , Transplante Autólogo , Resultado do TratamentoRESUMO
OBJECTIVES: Although the safety of patients has been one of the inherent concerns of dental practice, but because the proposals made in the field of dentistry are few and improperly structured, this paper constitutes an attempt to present a proposal titled "Plan for Dental Health Care Risk Management, " promoted by the General Council of Dentists of Spain, including a description of the proposed work methodology. DESIGN: The "risk management plan " proposed in this paper is based on applying the basic concepts dealt with in patient safety to the field of dentistry, due to the fact that the available bibliography contains no specific "health care risk management plan " for dentistry specifically. RESULTS AND CONCLUSIONS: In order to implement health care risk management in the field of dental care provided at any level throughout Spain, a seven-step plan which covers the main objectives in Patient Safety is provided.