Asunto(s)
Cardiología/normas , Enfermedades Cardiovasculares/terapia , Prestación Integrada de Atención de Salud/normas , Medicina Basada en la Evidencia/normas , Evaluación de Procesos, Atención de Salud/normas , Indicadores de Calidad de la Atención de Salud/normas , Sistema de Registros/normas , Cardiología/ética , Enfermedades Cardiovasculares/diagnóstico , Conflicto de Intereses , Prestación Integrada de Atención de Salud/ética , Medicina Basada en la Evidencia/ética , Sector de Atención de Salud/ética , Sector de Atención de Salud/normas , Humanos , Relaciones Interinstitucionales , Evaluación de Procesos, Atención de Salud/ética , Mejoramiento de la Calidad , Indicadores de Calidad de la Atención de Salud/ética , Sistema de Registros/ética , Resultado del TratamientoRESUMEN
Since its establishment in 2008, the National Kidney Registry has facilitated 213 kidney transplants between unrelated living donors and recipients at 28 transplant centers. Rapid innovations in matching strategies, advanced computer technologies, good communication and an evolving understanding of the processes at participating transplant centers and histocompatibility laboratories are among the factors driving the success of the NKR. Virtual cross match accuracy has improved from 43% to 91% as a result of changes to the HLA typing requirements for potential donors and improved mechanisms to list unacceptable HLA antigens for sensitized patients. A uniform financial agreement among participating centers eliminated a major roadblock to facilitate unbalanced donor kidney exchanges among centers. The NKR transplanted 64% of the patients registered since 2008 and the average waiting time for those transplanted in 2010 was 11 months.
Asunto(s)
Sistemas de Administración de Bases de Datos , Fallo Renal Crónico/cirugía , Trasplante de Riñón , Donadores Vivos/provisión & distribución , Sistema de Registros , Obtención de Tejidos y Órganos , Agencias Voluntarias de Salud , Autoanticuerpos/inmunología , Conducta Cooperativa , Prestación Integrada de Atención de Salud , Difusión de Innovaciones , Antígenos HLA/inmunología , Accesibilidad a los Servicios de Salud , Histocompatibilidad , Humanos , Relaciones Interinstitucionales , Trasplante de Riñón/economía , Trasplante de Riñón/ética , Trasplante de Riñón/inmunología , Sistema de Registros/ética , Programas Informáticos , Obtención de Tejidos y Órganos/economía , Obtención de Tejidos y Órganos/ética , Estados Unidos , Agencias Voluntarias de Salud/economía , Agencias Voluntarias de Salud/éticaRESUMEN
Revalidation is the new method by which doctors in the UK will stay on the medical register. Most doctors will take the appraisal route to revalidation--that is, they will undergo annual appraisals and five successful appraisals will result in revalidation. So there is a lot riding on appraisal. But it relies almost completely on trust. And in a situation that is based on absolute trust there are endless opportunities for that trust to be broken. Doctors will be encouraged to look at how they are doing as a doctor in terms of the General Medical Council's characteristics of a good doctor-such as providing good clinical care and maintaining good relationships with patients. But doctors can fabricate evidence to show that they work to these standards. There is anecdotal evidence that this happens and also published evidence that medical students cheat and that such cheating may predict dishonesty later on. One study from outside medicine showed that some learners doing a postgraduate diploma in education admitted to cheating. The current system of appraisal and revalidation is currently under review in light of the Shipman inquiry and many doctors are scared that appraisal may be a stepping stone towards assessment. A guaranteed way of speeding up the drive towards introducing assessment is not taking appraisal seriously.