Monitoring the changing pattern of delivery of paediatric epilepsy surgery in England--an audit of a regional service and examination of national trends.

PURPOSE: The demand for paediatric epilepsy surgery in the UK greatly exceeds the number of operations performed. Hence, Children's Epilepsy Surgery Service (CESS) was commenced in 2012. This study is aimed to characterise the changes in service delivery in the North East of England Paediatric Neuroscience Network and nationally. METHODS: A retrospective cohort study of paediatric epilepsy surgery in Leeds between 2005 and 2012 is presented followed by analysis of British Paediatric Neurosurgical Group (BPNG) data before and after CESS commissioning. RESULTS: During the study period, 42 children underwent epilepsy surgery in Leeds. The commonest aetiologies were neoplasm (33%), focal cortical dysplasia (19%) and mesial temporal sclerosis (19%). Seizure outcome was 71 % EngelI and 83% EngelI+II. Complications included one infection (2%), two temporary (5%) and one permanent (2%) motor deficits, three new/worsened visual field deficits (7%). There were six re-craniotomies (14%). The BPNG data show a 48% increase in paediatric epilepsy surgery in England between 2009 (90 cases) and 2012 (133 cases), and a 20% fall in 2013 (106 cases)--the first calendar year for CESS. On average, 64% of all operations were performed in London. CONCLUSIONS: The number of children receiving surgery for epilepsy in England had increased annually up to, and declined after, the establishment of CESS centres. The yearly caseload in neurosurgical units outside of London is small. The outcomes from Leeds are comparable to those published elsewhere. Other UK units are encouraged to publish outcomes to facilitate patient, commissioner and provider decision making.

Development and implementation of the internal audit mechanisms to be used in the health care facilities.

Issues concerning the quality of care service improvement have become of national importance in the health-care system for both developed and developing countries. Internal audit is effective and efficient method to improve the quality of care in various health care facilities. Data from 452 outpatient cards of the case patients with arterial hypertension were analyzed, the level of awareness and patient compliance were defined. The stages of internal audit mechanisms implementation in the health care facilities were developed. As a result of medical records audit and awareness monitoring of patients with arterial hypertension ways to improve quality of medical care were defined.

Auditoria: uma abordagem histórica e atual / Audit: a historical and contemporary approach

O objetivo foi levantar na literatura aspectos sobre a auditoria, os tipos exercidos por profissionais de saúde, o trabalho do auditor em saúde e a auditoria em Enfermagem. Pesquisa bibliográfica realizada entre fevereiro a maio de 2010 nas bases de dados SCIELO, LILACS, além do Google Acadêmico, entidades de classe e documentos legais. Abordou o início e marcos importantes da auditoria; definição e classificações; modalidades de trabalho para os auditores; características e habilidade para um bom trabalho de auditoria; auditoria em Enfermagem. Percebeu-se a importância da auditoria, a diversidade de profissionais que a realizam, como é específica e complexa e quanto colabora na gestão de serviços de saúde.

Auditoria participativa na gestão em saúde do município de Piraí ­ Rio de Janeiro / Participatory audit in the health management of the municipality of Piraí - Rio de Janeiro

O presente estudo tem por temática a participação do controle social na gestão em saúde. O objetivo geral deste estudo consiste em Analisar a experiência de acompanhamento e controle das contas públicas pelo Conselho de Saúde do município de Piraí, Estado do Rio de Janeiro. Com base nos objetivos específicos: Descrever o funcionamento do Conselho Municipal de Saúde e as percepções dos conselheiros sobre participação, responsabilidade e direito; Identificar nas práticas dos conselheiros possibilidades e limites do controle social para assegurar governança na gestão municipal em saúde e compartilhar lições aprendidas com a experiência de participação política do Conselho Municipal de Saúde do SUS de Pirai com outras secretarias setoriais. Como fundamentação teórica desta pesquisa, apresenta-se: Auditoria, gestão em saúde e controle social relacionando a garantia da integralidade da atenção ao individuo e coletividade. A proposta metodológica utilizada foi constituída de abordagem qualitativa. Os dados foram obtidos por meio de entrevista semi - estruturada e analisados com base na análise de conteúdo proposta por Bardin (2004). Ao analisarmos a totalidade do material empírico observamos que o CMS de Piraí tem atuação para além do controle em si, pois tem representado em seu cotidiano ações que demonstram o idealizado pela inscrição do usuário enquanto membro do conselho e assim sujeito ativo na construção de sua própria saúde. O que tornou possível concluir que a gestão em saúde tem sua legitimidade assegurada quanto à funcionalidade e organização nos moldes legais com atenção as necessidades da população a que serve e representa. Assim podemos inferir que a auditoria participativa constitui-se em inovação na gestão do SUS

This study is subject to participation of social control in healthcare management. The aim of this study is to analyze the experience of monitoring and control of public accounts by the Board of Health Pirai, State of Rio de Janeiro. Based on specific objectives: Describe the operation of the Municipal Health Council and the perceptions of counselors on participation, accountability and law; Identify the practices of counselors possibilities and limits of social control to ensure governance in municipal management in health and share lessons learned experience of political participation of the Municipal Health Council of SUS Pirai with other sectoral departments. As theoretical basis of this research, we present: Audit management in health and social control relating to guarantee comprehensive health care to the individual and collectivity. The methodology used consisted of qualitative approach. Data were collected through semi - structured interviews and analyzed using content analysis proposed by Bardin (2004). By analyzing the empirical totalities noted that CMS has Piraí performance beyond the control itself, as it has shown in their daily actions that demonstrate the application designed by the user as a member of the board and so active subject in the construction of their own health. What made it possible to conclude that the health management has ensured its legitimacy as the functionality and organization modeled carefully the legal needs of the population it serves and represents. Thus we may infer that audit is participatory in innovation in NHS management

La auditoría de comunicación. Una herramienta para las organizaciones sanitarias / Communication audit. A tool for health organizations

La función comunicativa se ha incorporado como un elemento de desarrollo de la gestión y dirección de las organizaciones sanitarias. Los objetivos, la misión, la visión y los valores deben estar adecuadamente definidos en cualquier organización. A pesar de que en el ámbito de la salud suelen estar definidos estos parámetros, se constata una desviación entre la formulación de la finalidad institucional y los valores intrínsecos de los profesionales que trabajan en la organización. Lo que se comunica institucionalmente no suele corresponder con el proceso de aculturación de la práctica asistencial de las organizaciones sanitarias. En este sentido, es necesario que las organizaciones de la salud empleen la auditoría de la comunicación como una herramienta que les permita establecer una estrategia organizativa coherente, adecuada y proclive a proceder a los cambios y a las transformaciones pertinentes para adaptarse continuamente al entorno interno y externo. La auditoría de la comunicación, a través de unas fases determinadas (preparación, encuesta preliminar, observación evaluativa e interpretación de resultados) y con la debida participación de los profesionales, contribuye a disminuir la incoherencia y la desviación existente entre lo que se comunica oficialmente y lo que se percibe en el desarrollo cotidiano de la asistencia

The communicative function has been incorporated as an element of the development of management of health organizations. Purposes, mission, views and values must be well-defined in all organizations. Despite this, there is a deviation between the formal expressions of main purpose of health organizations and the intrinsic values of health professionals. Official communication from institutions does not generally correlate with the socialization process in the everyday health care practice. In this sense, health organizations must make use of audit communication as a tool for a coherent, adequate and proclive organizational strategy. Communication audit contributes to the achievement of changes and appropriate transformations in order to continuously adapt to the internal and external environment. Audit communication, through different phases (preparation, preliminary survey, evaluative observation and results interpretation) and adequate participation of health professionals, contributes to decrease incoherence and deviation between official communication and everyday health care perception

Auditoria de la democracia: Bolivia, 2002 / Democracy audit: Bolivia 2002

El presente documento se constituye en el tercer estudio realizado en el 2002. En varios sentidos el periodo 2000-2002 refleja las fortalezas y debilidades del sistema politico boliviano. Por una parte, la continuidad electoral y el respeto a requisitos básicos de la democracia han contribuido a una estabilidad continuada durante los ultimos 17 años. Desde inicios de los ochenta se han realizado cinco elecciones presidenciales y seis elecciones municipales. Por otra parte, repetidas acusaciones de corrupcion, estallidos de violentas protestas populares y declaraciones de estado de sitio han sacudido a la democracia en diferentes formas. Ademas estos problemas han ocurrido en el contexto de continuos problemas económicos. Por ejemplo, el censo nacional del 2001 determinó que el 58.6 por ciento de la población se hallaba bajo la linea de pobreza, una notable mejora si se compara con el 79.9 por ciento registrado en el censo de 1992. No obstante, incluso con esta tasa disminuida de pobreza, Bolivia registra una de las tasas mas altas cuando se la compara a otros paises latinoamericanos.

Auditoria de la democracia: Bolivia, 2002 / Democracy audit: Bolivia 2002

El presente documento se constituye en el tercer estudio realizado en el 2002. En varios sentidos el periodo 2000-2002 refleja las fortalezas y debilidades del sistema politico boliviano. Por una parte, la continuidad electoral y el respeto a requisitos básicos de la democracia han contribuido a una estabilidad continuada durante los ultimos 17 años. Desde inicios de los ochenta se han realizado cinco elecciones presidenciales y seis elecciones municipales. Por otra parte, repetidas acusaciones de corrupcion, estallidos de violentas protestas populares y declaraciones de estado de sitio han sacudido a la democracia en diferentes formas. Ademas estos problemas han ocurrido en el contexto de continuos problemas económicos. Por ejemplo, el censo nacional del 2001 determinó que el 58.6 por ciento de la población se hallaba bajo la linea de pobreza, una notable mejora si se compara con el 79.9 por ciento registrado en el censo de 1992. No obstante, incluso con esta tasa disminuida de pobreza, Bolivia registra una de las tasas mas altas cuando se la compara a otros paises latinoamericanos.

[Modern operations management in workflow operation. Spectrum of responsibilities and challenges for the future]. / Modernes Operationsmanagement im Workflow Operation. Aufgabenspektrum und Herausforderungen der Zukunft.

The operating unit is one of the cost-intensive facilities in a surgical clinic with a pacemaking function for most of the internal procedures. The power of performance of the operating unit is based on the co-operation of all disciplines and professions involved. The key to management of the operating unit is not only to co-ordinate the daily procedures, but also to interact with support personnel. To ensure successful OR management, the internal structure of the OR must fit the clinical tasks and the available quantity of personnel in each profession must be co-ordinated. Sufficient utilization of resources and equipment must be guaranteed without cost-intensive over-capacities and patient flow must be orientated to OR capacities. The development of such a business structure requires the management to clearly define the goal, to know the actual on-site data in detail with regard to the idiosyncratic workings of each speciality and to clearly assign the competence of each member of the team working in the OR. Co-ordination of the operating unit is the main task of OR management, which must ensure the following: transparent and co-ordinated schedule management in the various operative specialities, goal-directed changes of the schedule with incorporation of emergencies, as well as effective organization of staff. In order to realize these tasks, it is reasonable to implement interdisciplinary rules of procedures. In addition, the assignment of a neutral decision-making body within the OR and the creation of an information center for all OR personnel. The challenge of OR organization in the future is to implement more effective documentation systems and active controlling within the OR. One can ensure adequate utilization of resources in the OR with prospectively oriented planning. Better transparence of operations in the OR contributes to increased efficiency. Implementation of quality management is the foundation for a successfully operating surgical hospital. Not only the productivity of individual members of the staff, but also the precise documentation of the quality of results will become important parameters in a successful surgical hospital, whose nucleus is the OR.

[Contribution of anesthesia to workflow operation]. / Beitrag der Anästhesie zum Workflow Operation.

The changes in our health care system caused by the introduction of DRGs make it necessary for us to abandon departmental process structures in favour of total hospital orientated process structures. An interdisciplinary approach is crucial to enable the most effective use of personnel and material resources. Future orientated information technology and organisational structures will enable us to process our patients effectively and efficiently from pre-admission to discharge. Anaesthesia has to be integrated into a patient management system for in- and out-patients. The essential matters for consideration are anaesthesia consulting hours, the common establishment of process structures for preoperative care, operation room management and postoperative patient care. Routine controls and analysis of the required teamwork reveal improvement potential and enable us to use the necessary control elements effectively.

Did the CP audits promote the enterprises' CP? A case study in Beijing.

Seven enterprises that have had recent Cleaner Production (CP) audits in Beijing were interviewed to identify whether these enterprises implemented the audit recommendations. If enterprises did implement the recommendations, their reasons and the results were analyzed. Finally, some suggestions on how to promote enterprise-wide CP were given.