Labour ward negligence.

No amount of symposia and clinical meetings and formal management will make a clinical difference unless obstetric units regularly and ruthlessly self-assess to curb medical negligence. Court case, which represent a small portion of substandard outcomes, not infrequently reveal a serious lack of obstetric judgment as well as paucity of knowledge which are compatible with unsupervised responsibility of labour ward duties. One UK court case ACF 32(2): 09/2019 presents a factual picture of obstetric practice which is difficult to reconcile with modern UK practice. This article limits itself to a number of facts as presented to court by the claimant, and the comments are directed purely at the resulting implications. These facts as stated are seriously worrying in themselves as they reflect practice well below the minimum care to be expected in a modern country and are far from what is recommended by the Royal College of Obstetricians and Gynaecologists and indeed every day standards. The article recommends the shifting of focus from individual to collective or unit responsibility to achieve better care. In any case where gross mismanagement is found, there should be a wider check on practices within the whole obstetric unit.

Accreditation of endocrine surgery units.

BACKGROUND/PURPOSE: A key measure to maintain and improve the quality of healthcare is the formal accreditation of provider units. The European Society of Endocrine Surgeons (ESES) therefore proposes a system of accreditation for endocrine surgical centers in Europe to supplement existing measures that promote high standards in the practice in endocrine surgery. METHODS: A working group analyzed the current healthcare situation in the field of endocrine surgery in Europe. Two surveys were distributed to ESES members to acquire information about the structure, staffing, caseload, specifications, and technology available to endocrine surgery units. Further data were sought on tracer diagnoses for quality standards, training provision, and research activity. Existing accreditation models related to endocrine surgery were included in the analysis. RESULTS: The analysis of existing accreditation models, available evidence, and survey results suggests that a majority of ESES members aspire to a two-level model (termed competence and reference centers), sub-divided into those providing neck endocrine surgery and those providing endocrine surgery. Criteria for minimum caseload, number and certification of staff, unit structure, on-site collaborating disciplines, research activities, and training capacity for competence center accreditation are proposed. Lastly, quality indicators for distinct tracer diagnoses are defined. CONCLUSIONS: Differing healthcare structures, existing accreditation models, training models, and varied case volumes across Europe are barriers to the conception and implementation of a pan-European accreditation model. However, there is consensus on accepted standards required for accrediting an ESES competence center. These will serve as a basis for first-stage accreditation of endocrine surgery units.

¿Para qué sirven los jefes de servicio y los jefes de sección en un servicio de oftalmología de la sanidad pública? / What are the duties of Opthalmology Dept. heads in the public health system?

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Acceptance of the Chest Pain Unit Certification Process: Current Status in Germany.

The nationwide German certification process of specialized chest pain units is unique in Europe. By February 2018, 269 units had already been successfully certified. With that number, more than half of all catheter laboratories across the country offering service on a 24/7 basis for interventional treatment in myocardial infarction take part in that certified chest pain program - with still increasing tendency. Currently, those units provide a mean of one chest pain unit bed per 65,000 inhabitants. Thereby, a high percentage of recertification of about 95% reflects a high acceptance of the concept by the health care providers. Structured in-hospital procedures, increasing awareness within the community and among the emergency medical services as well as increasing numbers of self-referrals guarantee higher work-flow, improving performance and an even increasing demand for those units. Complimentary patient awareness campaigns focusing on early symptom recognition might further improve, expand and redirect patient flow, shorten patient-related delay and have to become the next level in chest pain patient care in Germany. Transferring the idea of early heart attack care to the community as a new way of thinking might be able to more significantly decrease future symptoms-to-therapy times as the current chest pain unit program can solely achieve.

Consensus statement for use and technical requirements of thyroid ultrasound in endocrinology units. / Criterios sobre la utilización y requerimientos técnicos de la ecografía tiroidea en los servicios de endocrinología y nutrición.

Thyroid nodule detection has increased with widespread use of ultrasound, which is currently the main tool for detection, monitoring, diagnosis and, in some instances, treatment of thyroid nodules. Knowledge of ultrasound and adequate instruction on its use require a position statement by the scientific societies concerned. The working groups on thyroid cancer and ultrasound techniques of the Spanish Society of Endocrinology and Nutrition have promoted this document, based on a thorough analysis of the current literature, the results of multicenter studies and expert consensus, in order to set the requirements for the best use of ultrasound in clinical practice. The objectives include the adequate framework for use of thyroid ultrasound, the technical and legal requirements, the clinical situations in which it is recommended, the levels of knowledge and learning processes, the associated responsibility, and the establishment of a standardized reporting of results and integration into hospital information systems and endocrinology units.

Problems associated with the microbiological control of the breast milk from hospital milk bank units.

The microbiological tests on breast milk performed when samples of pasteurized breast milk are added to hospital milk banks are covered by French regulations dating from December 3rd 2007. They involve counts of the aerobic total flora and of Staphylococcus aureus in a sample of milk before pasteurization, and culture after pasteurization to check that the treated milk is sterile. The regulations specify the nature of the agar plates to be used, together with the conditions for plating and incubation, but they lack detail in other areas. We developed a quality assurance system, modified our process to meet the statutory requirements, prepared for COFRAC certification of the laboratory for this parameter, and proposed solutions to overcome the inadequacies of the regulations. The modifications of the process associated with the quality approach led to a successful initial certification visit. However, the preparation for this certification highlighted other inadequacies of the regulations that might affect the final results obtained for total flora and S. aureus counts. We think that the text should be modified to overcome these problems and to ensure high-quality counting such that those running hospital milk banks can have confidence in the laboratory results they receive.

Mental health professionals' perspectives on the implementation of smoke-free policies in psychiatric units across England.

BACKGROUND: The original audit on which this 2013 secondary analysis is based, was conducted in 2010. It explored implementation of smoke-free policies from the perspective of unit managers in 147 psychiatric units across England comprising a randomly selected sample of nine different unit types. MATERIAL: Two main themes are presented: positive perspectives of smoke-free policy implementation, and barriers and problems with smoke-free policy implementation. Analysis of unit managers' experiences and perspectives found that 96% of participants thought smoke-free policy had achieved positive outcomes for staff, patients, services and care. DISCUSSION: Consistency of response was the most prominent factor associated with policy success. Quality of the physical environment and care delivery were clear positive outcomes which enabled the environment to be more conducive to supporting staffs' and patients' quit attempts. Lack of consistency and a prevailing culture of acceptance of smoking were identified as some of the most reported perceived continuing problems. Solutions included the need to acknowledge that this type of complex systems change takes time and ongoing staff education and training. CONCLUSION: Our results demonstrate the importance of taking into account the experiences and attitudes of staff responsible for enacting smoke-free policy.

[Psychosocial rehabilitation and care under constraint]. / Réhabilitation psychosociale et soins sous contrainte.

Psychosocial rehabilitation is a theoretical tools used in psychiatry to fight against the marginalization of chronic patients. In Geneva, the "Tilleuls", a rehabilitation unit located in the psychiatric hospital, provides a range of group and individual interventionsfocusing on recovery for patients with criminal or civil constraints but also patient with severe and debilitating forms of psychotic illness. This article addresses the various types of constraints (medical, civil or criminal) and their impact on for the recovery process. In agreement with other studies, subjective perception of constraints in our clinical setting does not correspond to the legal status of admission. Similarly, the outcome of care is only marginally related to the presence of criminal or civil constraints.

The medical-legal responsibilities of a dialysis unit medical director.

The specialty of Nephrology, by virtue of its relationship with the dialysis procedure, is highly vulnerable to litigation. As is the case with all nephrologists, a dialysis unit medical director is not immune to medical malpractice suits, and can be held liable for any act of perceived or potential harm to any dialysis patient, regardless of the director's level of involvement. The medical director, per the Centers for Medicare and Medicaid Services (CMS) Conditions of Participation, accepts the responsibilities, accountability, and consequent legal liabilities of the quality of the medical care provided to every dialysis patient in the unit. This review is a synopsis of lawsuits filed against medical directors of dialysis units in the past forty years. Six categories of legal actions were noted; medical malpractice, fraudulent claims, self-referral and Stark Law, discrimination, negligence, and violation of patient autonomy and dignity.

Guia separ para la acreditación de unidades especializadas en tabaquismo / SEPAR’s Guideline to accreditation of Smoking Cessation Services

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[The reform in the Central Psychiatric Unit]. / A propósito de la reforma en el Servicio Psiquiátrico Central de Varones (Unidad 20).

The previous situation of the Central Psychiatric Unit is described, together with all the reforms taken place after the commentaries held by the commission of psychiatrists that carried out several visits to psychiatric unit. Case histories were audited and interviews were held with in-patients.

Stem cell and cellular therapy developments.

Recent discoveries on human and non-human stem cells have prompted the development of several studies aimed at the translation of laboratory evidences into novel clinical procedures collectively known as 'cellular therapy'. In this regard, a number of features specifically related to the clinical setting require stringent evaluation, including, but not limited to: ethical appropriateness; donor and recipient informed consent; autologous versus allogeneic use; media and devices for cell collection, processing, characterization, storage and distribution; donor and recipient adverse events registration and management; risk-to-benefit and cost analysis; outcome analysis; production sites accreditation and management; regulatory oversight. This article describes recent national and international developments related to the distribution of cells and tissues for clinical use. Moreover, an example is reported of the implementation of a cellular therapy production site compliant with good manufacturing practices (GMPs) in a large European University hospital.

Second hand smoke exposure and excess heart disease and lung cancer mortality among hospital staff in Crete, Greece: a case study.

Exposure to secondhand smoke (SHS) is a serious threat to public health, and a significant cause of lung cancer and heart disease among non-smokers. Even though Greek hospitals have been declared smoke free since 2002, smoking is still evident. Keeping the above into account, the aim of this study was to quantify the levels of exposure to environmental tobacco smoke and to estimate the attributed lifetime excess heart disease and lung cancer deaths per 1000 of the hospital staff, in a large Greek public hospital. Environmental airborne respirable suspended particles (RSP) of PM2.5 were performed and the personnel's excess mortality risk was estimated using risk prediction formulas. Excluding the intensive care unit and the operating theatres, all wards and clinics were polluted with environmental tobacco smoke. Mean SHS-RSP measurements ranged from 11 to 1461 microg/m3 depending on the area. Open wards averaged 84 microg/m3 and the managing wards averaged 164 microg/m3 thus giving an excess lung cancer and heart disease of 1.12 (range 0.23-1.88) and 11.2 (range 2.3-18.8) personnel in wards and 2.35 (range 0.55-12.2) and 23.5 (range 5.5-122) of the managing staff per 1000 over a 40-year lifespan, respectively. Conclusively, SHS exposure in hospitals in Greece is prevalent and taking into account the excess heart disease and lung cancer mortality risk as also the immediate adverse health effects of SHS exposure, it is clear that proper implementation and enforcement of the legislation that bans smoking in hospitals is imperative to protect the health of patients and staff alike.

Use of right lighting levels essential.

Hospital lighting must conform to a wide range of international standards. The purchaser of lights, ranging from bedside lamps to operating theatre units, is responsible for ensuring that a hospital's luminaires comply with relevant legislation. James Verrinder reports.