Experience from a Singapore tertiary hospital with restructuring of a vascular surgery practice in response to national and institutional policies during the COVID-19 pandemic.

Singapore was one of the first countries to be affected by COVID-19, with the index patient diagnosed on January 23, 2020. For 2 weeks in February, we had the highest number of COVID-19 cases behind China. In this article, we summarize the key national and institutional policies that were implemented in response to COVID-19. We also describe in detail, with relevant data, how our vascular surgery practice has changed because of these policies and COVID-19. We show that with a segregated team model, the vascular surgery unit can still function while reducing risk of cross-contamination. We explain the various strategies adopted to reduce outpatient and inpatient volume. We provide a detailed breakdown of the type of vascular surgical cases that were performed during the COVID-19 pandemic and compare it with preceding months. We discuss our operating room and personal protective equipment protocols in managing a COVID-19 patient and share how we continue surgical training amid the pandemic. We also discuss the challenges we might face in the future as COVID-19 regresses.

[Knowledge, attitude and opinion of patients regarding the new German legislation on advance care planning : Results of a survey in a department of general internal medicine]. / Wissen, Haltung und Meinung von Patienten zum neuen Patientenverfügungsgesetz : Ergebnisse einer Umfrage in einer allgemeininternistischen Abteilung.

BACKGROUND: In September 2009 a new legislation for advance care planning was introduced in Germany with the important characteristics of bindingness and unlimited validity for individual directives. Knowledge regarding this act and the attitude towards its characteristics among patients is unclear. AIM OF THIS STUDY: Analysis of knowledge, attitude and opinion of patients in a general internal medical department regarding advance care planning in general and the recent German legislation. METHODS: A total of 200 consecutive patients in an internal medicine ward were interviewed with the help of a questionnaire regarding their attitude to and knowledge on advance care planning in general and the current legislation. RESULTS: Approximately 40 % of the patients had issued some form of directive (either advance care directive or health care proxy) and only 7.5 % were advised by their physicians to make an advance directive. Patients with no directive were not willing to deal with dying and death, were not well-informed about directives or assumed that relatives or physicians would make an appropriate decision. Characteristics of the new legislation were controversially assessed; only 21 % of the patients wished to have a literal implementation of their directive. Regarding the content of an advance directive, more than 80 % of the patients voted for pain control in the palliative setting. CONCLUSION: The proportion of patients with a directive regarding advance care planning is only slowly increasing. Many patients are not well-informed, do not want to deal with dying or would like to delegate decisions to relatives and physicians. The present characteristics of the German legislation are controversially assessed and often do not represent the wishes of the patients.

[Legal aspects of the supervision of nosocomial infection]. / Aspekty prawne nadzoru nad zakazeniami szpitalnymi.

Hospital infections are a serious epidemiological problem since hospital departments have been established. Through many years the problem of hospital infections was unsatisfactorily recognized and not until 1970 appeared in Poland publications concerning hospital infections and suggesting systems of control as well as inspection. In the same time acts and instructions were issued defining principles and procedures in case of nosocomial infections. The aim of this paper was to show changes in legislation concerning the incidence, registration and action against hospital infections.

[Restraining measures in the hospital and nursing home]. / Bettgitter, Fixiergurte oder Sedativa: Wo endet der Schutz und wo beginnt die Freiheitsberaubung?

Time and time again, physicians and nursing staff are confronted with a need to apply compulsory fixation measures to hospital patients or nursing home residents. This may be necessary to protect the physical integrity either of the patient himself or of others. When applying coercive measures, careful consideration must be given to the respective hazard potential. The care-providing physician must exercise great care with regard to the selection, implementation and documentation of the measures to be employed.

Errors in compliance with federal rules and regulations relating to healthcare benefits programs: the University of Washington Department of Neurological Surgery experience.

This article details the errors in compliance with federal rules and regulations relating to the healthcare benefits programs at the University of Washington Department of Neurological Surgery from 1996 through 2002. University faculty members, regardless of the organization to which they belong, will be identified by the federal government as the individual responsible in healthcare finance inquiries. A full understanding of all regulations and an active compliance program are necessary to avoid problems, including criminal prosecution.

[Indicators for quality evaluation of inpatient patient care in an ENT clinic]. / Qualitätsbewertende Indikatoren in der stationären Versorgung einer HNO-Klinik.

According to the law (Section 137 SGBV) in Germany, hospitals have to implement quality-assurance (QA) programs, which are now of particular importance in times of ongoing structural change in health care. External as well as internal methods of QA are well established and can serve as parameters for single processes and outcomes in most cases. However, there is still an urgent need for methods measuring the quality of total hospital performance. Indicators are powerful instruments for this purpose. They reliably reflect clinical outcome, physicians' and nurses' activities, administration and can be regarded as instruments for general hospital performance in otorhinolaryngology. We describe the process of definition, development and application of quality indicators for measuring quality in health care. Furthermore, we present a critical overview of selected indicators in otorhinolaryngology, general medical indicators and indicators concerning administrative problems. Because of current developments in German health care the application of quality assurance methods similar to the system of indicators presented is strongly recommended.

Effect of regulations and guidelines on gastroenterology programs.

This paper reviews the standards of practice, regulations, and guidelines that govern gastrointestinal endoscopy and their effect on space and equipment, staff and physician quality of care, and educational programs. It also examines how all these considerations have affected the growth of an endoscopy center and describes the processes that have been instituted to ensure compliance with all relevant standards, regulations, and guidelines.

Reglamento interno: hospital gineco-obstetrico "Dr. Jaime Sanchez Porcel" / Intern regulations: gynecologic and obstetric Hospital Dr. Jaime Sánchez Porcel

El reglamento establece y regula las relaciones existentes entre el hospital gineco-obstétrico con las personas que prestan sus servicios en ella, a cambio de una remuneración, determinando derechos y obligaciones de ambas partes. Sus preceptos tienes carácter general y serán aplicables a las relaciones entre la entidad con las personas a su servicio

Reglamento interno Hospital Obrero / Intern regulations: Hospital Obrero

El presente reglamento establece las normas y lineamientos para organizar e impartir permanentemente cursos y actividades de capacitación, adiestramiento y actualización. Para la interpretación y aplicación del presente reglamento

Ramifications of the Family and Medical Leave Act of 1993.

Six months ago, the Family and Medical Leave Act of 1993 was signed into law, and key provisions of the act became effective on August 5, 1993. This article examines the main provisions of the act, explains how employee leaves will be granted in compliance with the act, outlines the consequences of noncompliance with the act, analyzes the operational ramifications of the act, quantifies the financial implications of the act, and discusses the role of the healthcare financial manager in assisting with the formulation of a hospital policy to comply with the act.

Review exclusive contracts in light of recent challenges.

Many hospitals hold exclusive physician contracts, primarily with hospital-based specialists such as pathologists, radiologists, emergency physicians and anesthesiologists. But some physicians are beginning to view exclusive contracting as a form of economic credentialing, and have begun challenging such contracts in the courts in a number of states.

Safety in health care facilities.

Safety plays an important role in the daily operation of any health care facility. Effective safety management not only assures employees that they have a safe working environment, but also allows patients to enjoy an atmosphere that is free from unnecessary risks and hazards. Having an effective safety program that addresses pertinent safety issues within the facility, as well as within the community will give the administration confidence that the facility is delivering the highest quality of patient care.