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1.
Biochem Med (Zagreb) ; 30(3): 030403, 2020 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-33071554

RESUMO

To fight the virus SARS-CoV-2 spread to Europe from China and to give support to the collapsed public health system, the Spanish Health Authorities developed a field hospital located in the facilities of Madrid exhibition centre (IFEMA) to admit and treat patients diagnosed with SARS-CoV-2 infectious disease (COVID-19). The Department of Laboratory Medicine of La Paz University Hospital in Madrid (LMD-HULP) was designated to provide laboratory services. Due to the emergency, the IFEMA field hospital had to be prepared for patient admission in less than 1 week and the laboratory professionals had to collaborate in a multidisciplinary group to assure that resources were available to start on time. The LMD-HULP participated together with the managers in the design of the tests portfolio and the integration of the healthcare information systems (IS) (hospital IS, laboratory IS and POCT management system). Laboratorians developed a strategy to quickly train clinicians and nurses on test requests, sample collection procedures and management/handling of the POCT blood gas analyser both by written materials and training videos. The IFEMA´s preanalytical unit managed 3782 requests, and more than 11,000 samples from March 27th to April 30th. Furthermore, 1151 samples were measured by blood gas analysers. In conclusion, laboratory professionals must be resilient and have to respond timely in emergencies as this pandemic. The lab's personnel selection, design and monitoring indicators to maintain and further improve the quality and value of laboratory services is crucial to support medical decision making and provide better patient care.


Assuntos
Betacoronavirus , Infecções por Coronavirus , Unidades Móveis de Saúde/organização & administração , Pandemias , Pneumonia Viral , Cidades , Sistemas de Informação em Laboratório Clínico/organização & administração , Infecções por Coronavirus/epidemiologia , Assistência à Saúde , Necessidades e Demandas de Serviços de Saúde , Número de Leitos em Hospital , Sistemas de Informação Hospitalar/organização & administração , Hospitais Universitários/organização & administração , Humanos , Laboratórios Hospitalares/organização & administração , Recursos Humanos em Hospital/educação , Pneumonia Viral/epidemiologia , Testes Imediatos/organização & administração , Garantia da Qualidade dos Cuidados de Saúde/organização & administração , Espanha , Manejo de Espécimes
2.
Arch Pathol Lab Med ; 144(10): 1199-1203, 2020 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-33002152

RESUMO

CONTEXT.­: The burden of chronic kidney disease in Indigenous Australians is 7.3 times higher than that of non-Indigenous Australians. If chronic kidney disease is detected early and managed, deterioration in kidney function can be reduced. Urine albumin to creatinine ratio is a key marker of early renal damage. OBJECTIVE.­: To report on 16 years of analytic quality of urine albumin to creatinine ratio testing on Siemens DCA devices enrolled in the national Quality Assurance for Aboriginal and Torres Strait Islander Medical Services point-of-care testing program. DESIGN.­: Quality Assurance for Aboriginal and Torres Strait Islander Medical Services participants are required to test 2 quality assurance samples each month across two 6-monthly testing cycles per year. Participants also test 2 quality control samples monthly. RESULTS.­: The percentage of urine albumin, creatinine, and albumin to creatinine ratio results for quality assurance point-of-care testing that were within assigned allowable limits of performance averaged 96.9%, 95.9%, and 97.5%, respectively. The percentage acceptable quality control results for urine albumin and creatinine averaged 93.5% and 86.8%. The median imprecision for urine albumin, creatinine, and albumin to creatinine ratio quality assurance testing averaged 5.5%, 4.1%, and 3.3%, respectively, and the median within-site imprecision for quality control testing averaged 5.4%, 4.3%, and 5.7%, respectively, for the low sample and 4.0%, 4.1%, and 4.5%, respectively, for the high sample. CONCLUSIONS.­: For 16 years the DCA system has proven to be reliable and robust and operators at Aboriginal medical services have demonstrated they are able to conduct point-of-care testing for urine albumin to creatinine ratio that consistently meets analytic performance standards.


Assuntos
Albuminúria/urina , Creatinina/urina , Testes Imediatos , Insuficiência Renal Crônica/diagnóstico , Austrália , Humanos , Grupo com Ancestrais Oceânicos , Garantia da Qualidade dos Cuidados de Saúde , Controle de Qualidade , Insuficiência Renal Crônica/urina , Urinálise
3.
J Orthop Surg Res ; 15(1): 474, 2020 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-33059739

RESUMO

BACKGROUND: Coronavirus disease 2019 (COVID-19) has broken out and spread rapidly nationwide at the beginning of 2020, which has brought huge impacts to people and work. The current situation of prevention and control is severe and urges guidance for clinicians, especially for medical systems. In the hope of providing a reference and recommendation for the prevention and control of the COVID-19, we carried out research to improve the quality of patient care and prevention during this epidemic. METHODS: All of the staff were trained rapidly to master personal protection in our department. We reviewed the patients' discharged records who underwent surgery in our department during January 1 to March 1, 2019, and January 1 to March 1, 2020. The management of the surgery patients and flow charts were described and analyzed. Post-operation outcomes of the patients include duration, complications, surgical site infection (SSI), system infection, re-operation, and mortality. Both chi-squared test and Student's t test were performed to determine the relationship between the two periods in terms of post-operation outcomes. RESULTS: Descriptive statistics analysis revealed that demographic of the patients between the two periods is similar. We had benefited from the strict flowcharts, smart robot, and protection equipment during the perioperative managements for orthopedic patients. With the help of the strict flow charts and smart equipment, post-operation outcomes of the patients revealed that the rates of the complications and re-operation had been reduced significantly (p < 0.05), while duration of operation, SSI, and system infection had no significant difference between two periods (p > 0.05). No patient and staff caught COVID-19 infection or mortality during the epidemic. CONCLUSIONS: Our study indicated that medical quality and efficiency were affected little with the help of strategies described above during the epidemic, which could be a reference tool for medical staff in routine clinical practice for admission of patients around the world. What is more, the provided strategies, which may evolve over time, could be used as empirical guidance and reference for orthopedic peers to get through the pandemic and ensure the normal operation of the hospital.


Assuntos
Infecções por Coronavirus/epidemiologia , Eficiência Organizacional , Procedimentos Ortopédicos , Assistência Perioperatória , Pneumonia Viral/epidemiologia , Garantia da Qualidade dos Cuidados de Saúde , Betacoronavirus , China/epidemiologia , Feminino , Unidades Hospitalares , Humanos , Controle de Infecções , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Pandemias , Equipamento de Proteção Individual , Complicações Pós-Operatórias , Reoperação , Estudos Retrospectivos , Robótica , Fluxo de Trabalho
5.
Medicine (Baltimore) ; 99(43): e22876, 2020 Oct 23.
Artigo em Inglês | MEDLINE | ID: mdl-33120829

RESUMO

BACKGROUND: Spontaneous intracerebral hemorrhage (sICH) is a serious stroke subtype. The effective therapies for patients with sICH are still unclear, and the role of hemostatic agents in sICH is still unclear. Although some studies have shown that hemostatic agents could benefit patients with sICH, different hemostatic drugs have different effects on patients with sICH, and which hemostatic drug has the best effect on the prevention of hematoma expansion and neurological deterioration in sICH patients remains unclear. To better understand the effects of hemostatic agents in patients with sICH, it is necessary to carry out a network meta-analysis to comprehensively compare the effects of different hemostatic agents. METHODS: This protocol has been designed following the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols statement. Related studies in the following databases will be searched until September 2020: PubMed, Embase, Scopus, Web of Science, the Cochrane Library, China National Knowledge Infrastructure, VIP and Wanfang. Randomized controlled trials and nonrandomized controlled studies comparing at least 2 different hemostatic agents in sICH patients will be included. A quality assessment will be conducted with the Cochrane Collaboration tool or the Newcastle-Ottawa Scale based on the study design. The primary outcome will be the incidence of hematoma expansion, and the secondary outcome will be the functional outcome. Pairwise and network meta-analyses will be conducted using STATA V.14 (StataCorp, College Station, Texas, USA). Mean ranks and the surface under the cumulative ranking curve will be used to evaluate every agent. Statistical inconsistency assessment, subgroup analysis, sensitivity analysis and publication bias assessment will be performed. RESULTS: According to disseminate through academic conferences, the results of this network meta-analysis are expected to publish in a peer-reviewed journal. CONCLUSION: This study will provide high quality evidence about effects of different hemostatic agents in patients with sICH. REGISTRATION NUMBER: CRD42020196039.


Assuntos
Hemorragia Cerebral/tratamento farmacológico , Hematoma/prevenção & controle , Hemostáticos/uso terapêutico , Doenças do Sistema Nervoso/prevenção & controle , China/epidemiologia , Gerenciamento de Dados , Feminino , Hematoma/epidemiologia , Hemostáticos/administração & dosagem , Humanos , Incidência , Masculino , Metanálise em Rede , Ensaios Clínicos Controlados não Aleatórios como Assunto , Avaliação de Resultados da Assistência ao Paciente , Garantia da Qualidade dos Cuidados de Saúde/métodos , Ensaios Clínicos Controlados Aleatórios como Assunto
6.
Igaku Butsuri ; 40(3): 88-96, 2020.
Artigo em Japonês | MEDLINE | ID: mdl-32999255

RESUMO

The quality assurance (QA) of the output constancy of linear accelerators (linacs) is one of the most basic items for radiation therapy. The necessity and demand of the dosimetric audit is on the rise. We aimed at establishing an on-site dosimetric audit program with a plastic phantom in order to enrich the availability of dosimetric audit in Japan. By this, we developed and evaluated an on-site audit program in multiple institutions in 120 cases for photon and electron standard dosimetry and intensity modulated radiation therapy (IMRT) condition. For photon standard dosimetry, we evaluated the accuracies of institutional measured absorbed dose in 50 cases by this on-site audit program. For the electron standard dosimetry, we evaluated the accuracies of institutional measured absorbed dose in 25 cases. For IMRT condition, we evaluated the accuracies of the institutional calculated dose in radiation treatment planning systems in 45 cases. The agreements of the measured absorbed dose between our audit and the institutions were within±1.1% for photon standard dosimetry. The agreements of the measured absorbed dose between our audit and the institutions were within±2.1% for electron standard dosimetry. The agreements between the measured absorbed dose of our audit and the institutional calculated dose were within±2.1% for IMRT condition. We established an on-site dosimetric audit program with a plastic phantom and this program is suitable with tight criteria similar to criteria required for clinical QA.


Assuntos
Auditoria Médica/métodos , Garantia da Qualidade dos Cuidados de Saúde , Radiometria/métodos , Radioterapia de Intensidade Modulada/métodos , Radioterapia de Intensidade Modulada/normas , Humanos , Japão , Auditoria Médica/normas , Órgãos em Risco , Imagens de Fantasmas , Plásticos , Radiometria/normas , Dosagem Radioterapêutica , Risco , Sensibilidade e Especificidade
8.
Medicentro (Villa Clara) ; 24(3): 505-530, jul.-set. 2020. graf
Artigo em Espanhol | LILACS | ID: biblio-1125013

RESUMO

RESUMEN Introducción: la evaluación de la calidad de un producto constituye una herramienta importante para la toma de futuras decisiones y para aspirar a un servicio de excelencia. Objetivo: diseñar un instrumento evaluativo para indicadores de proceso en un Servicio de prótesis estomatológica en correspondencia con las carencias identificadas. Métodos: se realizó un estudio en la Facultad de Estomatología de Villa Clara, en el período comprendido entre septiembre 2017 y marzo 2018. Para evaluar los indicadores de proceso se utilizó un universo constituido por los pacientes ingresados en el período previsto; se seleccionó una muestra no probabilística de 200 pacientes. Se utilizaron instrumentos y métodos cualitativos y cuantitativos. Resultados: se diagnosticaron dificultades en el control y evaluación de los procesos asistenciales en el Servicio de prótesis. El grupo nominal aportó los elementos finales para diseñar el instrumento; se seleccionaron aquellos aspectos en los que más del 50 % de los especialistas coincidieron a favor de incluirlos. Los resultados de la aplicación y evaluación se expresaron en recuadros y tablas. La mayoría de estos resultados apuntaron hacia el cumplimiento de los indicadores de proceso en cuanto al proceso clínico de atención y la calidad técnica de los aparatos. Conclusiones: los especialistas aceptaron el producto, se obtuvieron resultados positivos en su implementación, y se demostró su utilidad.


ABSTRACT Introduction: the quality evaluation of a product is an important tool to make future decisions and to aspire to an excellent service. Objective: to design an evaluative instrument for process indicators in a Dental Prosthetic Service in correspondence with the identified deficiencies. Methods: a study was carried out in the Dentistry Faculty of Villa Clara between September 2017 and March 2018. A universe consisting of patients admitted in the planned period was used to evaluate the process indicators; a non-probability sample of 200 patients was selected. Qualitative and quantitative methods and instruments were used. Results: difficulties in the control and evaluation of the care processes were diagnosed in the Prosthetic Service. The nominal group contributed the final elements to design the instrument; those aspects in which more than 50% of the specialists agreed in favor of including them were selected. The results of the application and evaluation were expressed in boxes and tables. Most of these results pointed towards compliance with the process indicators in terms of the clinical care process and the technical quality of the devices. Conclusions: the specialists accepted the product; positive results were obtained with its implementation, as well as its usefulness was demonstrated.


Assuntos
Avaliação de Processos e Resultados em Cuidados de Saúde , Garantia da Qualidade dos Cuidados de Saúde , Prótese Dentária
9.
Medicine (Baltimore) ; 99(36): e22071, 2020 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-32899075

RESUMO

BACKGROUND: Whether prophylactic hyperthermic intraperitoneal chemotherapy (HIPEC) offers long-term survival benefit to patients with low-grade appendiceal mucinous neoplasms (LAMNs) after resection surgery is still under heated debate. The aim of the present meta-analysis is to investigate the comparative effectiveness and safety of prophylactic HIPEC regimens in LAMNs METHODS:: A systematic search of MEDLINE, EMBASE, PubMed, Web of Science, the Cochrane Central Register of Controlled Trials, International Clinical Trials Registry Platform (ICTRP), clinicaltrials.gov and controlledtrials.com will be performed. All published RCTs and quasi-RCTs through July 20, 2020 with language restricted in English will be included in this review study. Two reviewers will independently conduct the procedures of study identification, data collection, and methodological quality assessment. The primary outcomes are overall survival (OS) and disease-free survival (DFS). The secondary outcomes consist of peritonitis and sepsis, colonic fistula, chemotherapy-associated adverse events, and adhesive intestinal obstruction. The pooled odds ratios (ORs) or hazard ratios (HRs) and relative 95% confident intervals (CIs) of each outcome measurement will be calculated. EndNote X9 software will be applied to manage all citations. The Stata software version 14.0 and R x64 software version 3.5.1 will be employed for main statistical analyses. DISCUSSION: This study will employ a network meta-analysis to summarize direct and indirect evidence in the specific area to provide detailed individualized guidance on surgical management for LAMNs. REGISTRATION: This protocol was registered with the International Platform of Registered Systematic Review and Meta-Analysis Protocols (INPLASY) on 25 July 2020 (registration number INPLASY202070112).


Assuntos
Adenocarcinoma Mucinoso/terapia , Neoplasias do Apêndice/patologia , Hipertermia Induzida/métodos , Metanálise em Rede , Adenocarcinoma Mucinoso/mortalidade , Neoplasias do Apêndice/cirurgia , Ensaios Clínicos como Assunto , Intervalo Livre de Doença , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/epidemiologia , Feminino , Humanos , Hipertermia Induzida/efeitos adversos , Fístula Intestinal/epidemiologia , Obstrução Intestinal/epidemiologia , Obstrução Intestinal/etiologia , Masculino , Avaliação de Resultados em Cuidados de Saúde , Peritonite/epidemiologia , Garantia da Qualidade dos Cuidados de Saúde , Ensaios Clínicos Controlados Aleatórios como Assunto , Segurança , Sepse/epidemiologia , Aderências Teciduais/complicações , Aderências Teciduais/epidemiologia , Resultado do Tratamento
11.
Medicine (Baltimore) ; 99(39): e22284, 2020 Sep 25.
Artigo em Inglês | MEDLINE | ID: mdl-32991430

RESUMO

BACKGROUND: Plate fixation and intramedullary nail/Knowles pin fixation methods are commonly used to treat displaced midshaft clavicle fractures. However, the differences between these 2 methods are unclear. OBJECTIVE: This meta-analysis aimed to compare plate fixation and intramedullary nail/Knowles pin fixation for displaced midshaft clavicle fractures. METHODS: We searched PubMed, EBM reviews, and Ovid Medline online for studies related to comparison of plate fixation versus intramedullary nail/Knowles pin fixation for displaced midshaft clavicle fracture from inception to June 30, 2019. Relevant literature search, data extraction, and quality assessment will be performed by 2 researchers independently. The methodological quality of all included studies was appraised using the Cochrane system for randomized trials. The RevMan 5.2 software was used for heterogeneity assessment, generating funnel-plots, data synthesis, sensitivity analysis, and determining publication bias. The fixed-effects or random-effects model was used to calculate mean difference (MD)/relative risks (RRs) and 95% confidence intervals (CIs). RESULTS: This meta-analysis included 839 patients from 12 randomized controlled trials. We found that compared to plate fixation, intramedullary nail/Knowles pin fixation yielded a higher shoulder constant score [MD = -2.43, 95% CI (-3.46 to -1.41), P < .00001] and lower disabilities of the arm, shoulder and hand (DASH) score [MD = 2.98, 95% CI (0.16-5.81), P = .04], and lower infection rates [RR = 2.05, 95% CI (1.36-3.09), P = .003], operation time [MD = 20.20, 95% CI (10.80-29.60), P < .0001], incision size [MD = 6.09, 95% CI (4.54-7.65), P < .00001], and hospital stay [MD = 1.10, 95% CI (0.56-1.64), P < .00001] but with a higher removal rate [RR = 0.52, 95% CI (0.41-0.65), P < .00001] compared to plate fixation. There were no significant differences in nonunion, reintervention, or revision and refracture between these two methods. The limitation is that many studies did not demonstrate the random generated details, and only English articles were enrolled in this meta-analysis. CONCLUSIONS: Intramedullary nail/Knowles pin fixation might be an optimum choice for treating displaced midshaft clavicle fractures, with similar performance in terms of the nonunion, reintervention, or revision and refracture, and better shoulder constant and DASH scores, infection rates, and operative parameters.


Assuntos
Placas Ósseas/efeitos adversos , Clavícula/patologia , Fixação Intramedular de Fraturas/efeitos adversos , Fraturas Ósseas/cirurgia , Adulto , Pinos Ortopédicos/efeitos adversos , Avaliação da Deficiência , Feminino , Fixação Intramedular de Fraturas/instrumentação , Fraturas Ósseas/classificação , Fraturas não Consolidadas/epidemiologia , Humanos , Infecções/epidemiologia , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Avaliação de Resultados em Cuidados de Saúde , Garantia da Qualidade dos Cuidados de Saúde/métodos , Ensaios Clínicos Controlados Aleatórios como Assunto , Reoperação/estatística & dados numéricos , Risco , Sensibilidade e Especificidade , Ferida Cirúrgica/classificação , Ferida Cirúrgica/epidemiologia
13.
Arch. argent. pediatr ; 118(4): 234-239, agosto 2020. tab, ilus
Artigo em Inglês, Espanhol | LILACS, BINACIS | ID: biblio-1118171

RESUMO

Introducción. El abordaje de las emergencias pediátricas requiere recursos especializados y son frecuentes los errores relacionados con la medicación.Objetivos. Describir el contenido de los carros de emergencia (CE) en un hospital pediátrico y compararlo luego de una intervención educativa.Métodos. Se incluyeron CE de 9 salas de internación. Se elaboró una lista de cotejo con 30 drogas. Se relevaron los CE determinando presencia o ausencia de drogas y si las cantidades eran suficientes. Luego se realizó una intervención educativa y relevamientos 30 y 90 días posintervención.Resultados. La medición basal arrojó una proporción global de drogas adecuadas del 43,9 % (intervalo de confianza ­IC­ del 95 %: 38,4-49,4) con una variación entre CE del 29 % al 54,8 % y del 15 % al 85 % en los grupos de drogas. A los 30 días, la proporción correcta alcanzó el 70,3 % (IC 95 %: 65,2-75,4), con amplia variación entre los diferentes CE y grupos de drogas (del 51,6 % al 93,5 % y del 50 % al 95 %, respectivamente). A los 90 días, los porcentajes fueron similares. La comparación entre la primera y segunda medición mostró mejoría en todos los CE (rango: del 3,2 % al 45,1 %), odds ratio 3,73 (IC 95 %: 2,5-5,6), p < 0,001. Los resultados fueron similares entre la segunda y tercera medición.Conclusiones. En la medición inicial, se evidenció bajo nivel de adecuación de drogas de los CE. Luego de la intervención, mejoró significativamente y se mantuvo durante el período evaluado.


Introduction. The approach to pediatric emergencies requires specialized resources, and medication errors are common.Objectives. To describe the contents of emergency trolleys (ETs) in a children's hospital and compare them after an educational intervention.Methods. The ETs from 9 hospitalization wards were included. A checklist of 30 drugs was developed. ETs were assessed by determining whether drugs were present or absent and their amount. An educational intervention was conducted and assessments were repeated 30 and 90 days after the intervention.Results. The baseline measurement indicated an overall ratio of adequate drugs of 43.9 % (95 % confidence interval [CI]: 38.4-49.4) with a variation among ETs from 29 % to 54.8 %, and from 15 % to 85 % among drug groups. At 30 days, the adequate ratio reached 70.3 % (95 % CI: 65.2-75.4), with a wide variation among the different ETs and drug groups (from 51.6 % to 93.5 % and from 50 % to 95 %, respectively). At 90 days, the percentages were similar. The comparison between the first and second measurementshowed an improvement in all ETs (range: 3.2 %-45.1 %), odds ratio: 3.73 (95 % CI: 2.5-5.6), p < 0.001. Results were similar between the second and third measurement.Conclusions. The baseline measurement showed a low level of adequate ET drugs. After the intervention, this improved significantly and was maintained during the studied period


Assuntos
Humanos , Preparações Farmacêuticas , Reanimação Cardiopulmonar/instrumentação , Serviços Médicos de Emergência/normas , Garantia da Qualidade dos Cuidados de Saúde , Emergências , Serviços Médicos de Emergência/organização & administração , Equipamentos e Provisões , Lista de Checagem , Ensaios Clínicos Controlados não Aleatórios como Assunto
14.
Ann Biol Clin (Paris) ; 78(4): 363-382, 2020 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-32753365

RESUMO

The point-of-care tests (POCT) are subject to accreditation. A national inventory survey provides a synthesis of knowledge. The survey distributed 31 questions in 2019. 147 responses were received (75% biologists, 49% CHU, 42% CHG). Only 20.41% are accredited ISO22870, the majority for <50% of the medical departments; 70% say they are going there at the end of 2019 or in 2020. The maps are unknown for 32% (EBMD) and 82% (TROD). Visibility is poor with: medical establishment committee (40%), IT department (31%). Connection is necessary for 87-95% depending on the criterion (QC, authorizations, etc.) and 66% of answers highlight that less than 50% of connexion is effective. The major advantage is the delay of the result (62.5%), then the relationship with the health teams (33.3%). The disadvantages: difficulty of the quality approach (45%), cost of tests (34.3%). Human resource requirements are identified for technicians (82%) and biologists (76%). The multiplicity of sites, devices and operators means that it is difficult to set up and maintain. Biology outside the laboratories, under biological responsibility, must meet a rigorous imperative quality approach.


Assuntos
Técnicas de Laboratório Clínico , Saúde Global , Laboratórios/estatística & dados numéricos , Laboratórios/normas , Testes Imediatos , Acreditação , Serviços de Laboratório Clínico/normas , Serviços de Laboratório Clínico/estatística & dados numéricos , Técnicas de Laboratório Clínico/normas , Técnicas de Laboratório Clínico/estatística & dados numéricos , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , França/epidemiologia , Saúde Global/normas , Saúde Global/estatística & dados numéricos , História do Século XXI , Humanos , Internacionalidade , Ensaio de Proficiência Laboratorial/normas , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Sistemas Automatizados de Assistência Junto ao Leito/normas , Sistemas Automatizados de Assistência Junto ao Leito/estatística & dados numéricos , Testes Imediatos/organização & administração , Testes Imediatos/normas , Testes Imediatos/estatística & dados numéricos , Garantia da Qualidade dos Cuidados de Saúde/organização & administração , Inquéritos e Questionários
16.
J Occup Environ Med ; 62(10): 781-782, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32769798

RESUMO

OBJECTIVE: The proliferation of improvised masks during the COVID-19 pandemic has raised questions regarding filter effectiveness and safety. We sought to compare the effectiveness of commonly used improvised filter materials against N95 industry standards. METHODS: Six different filter materials commonly used in the community were tested using both single- and multi-layer configurations with the TSI 8130 automated filter tester in accordance with National Institute for Occupational Safety and Health (NIOSH) standards for N95 respirators. RESULTS: Only three of the tested filter material configurations met N95 parameters with regard to filtration efficiency and pressure drop across the filter material-the: True-high-efficiency particulate air (HEPA) filter, four-layer MERV 13 and 14 HVAC filters. CONCLUSIONS: Many proposed filter materials for improvised masks do not meet current industry standards and may pose safety and efficacy concerns. Care should be taken when selecting materials for this critical respirator component, particularly for health care workers or others at high risk for pathogen exposure.


Assuntos
Infecções por Coronavirus/prevenção & controle , Exposição por Inalação/prevenção & controle , Máscaras/normas , Exposição Ocupacional/prevenção & controle , Saúde do Trabalhador , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Poluentes Ocupacionais do Ar/análise , Infecções por Coronavirus/epidemiologia , Desenho de Equipamento , Segurança de Equipamentos , Feminino , Saúde Global , Pessoal de Saúde/estatística & dados numéricos , Humanos , Masculino , Teste de Materiais , National Institute for Occupational Safety and Health, U.S./normas , Pandemias/estatística & dados numéricos , Tamanho da Partícula , Pneumonia Viral/epidemiologia , Garantia da Qualidade dos Cuidados de Saúde/normas , Estados Unidos
17.
Plast Reconstr Surg ; 146(2): 127e-136e, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32740569

RESUMO

BACKGROUND: Reduction mammaplasty is the standard of care for symptomatic macromastia. The process of requesting insurance coverage for reduction mammaplasty is cumbersome and potentially controversial, and insurance policies vary significantly. The goal of our analysis is to identify trends in insurance coverage rates, assess for the presence of disparities, and propose ways to increase chances of successful preauthorization. METHODS: The authors performed a retrospective review of preauthorizations for reduction mammaplasty at a single institution from 2012 to 2017. Insurance company names were deidentified. Preauthorization denial rates were assessed by year, insurance carrier, and reason for denial. Multiple regression analysis was performed to identify predictors for predetermination denial by insurance companies. RESULTS: Among 295 preauthorizations, 212 were approved (72 percent) and 83 were denied (28 percent), among which 18 were appealed, 13 successfully. Rates of insurance denials have been increasing steadily, from 18 percent to 41 percent. Medicaid had the lowest denial rates (9.3 percent), whereas private carriers denials ranged from 21.4 to 62.1 percent. In terms of reason for denial, 30 percent were because of contract exclusion, 39 percent were because of inadequate documentation or not meeting medical criteria, and 12 percent were because of inadequate predicted resection weight. Certain private insurance carriers were the only independent predictors of predetermination denial. CONCLUSIONS: Rate of preauthorization denials is high and has been increasing steadily. Insurance criteria remain arbitrary. A proper documentation and appeal process by the plastic surgeon may improve rates of insurance approval. Although resection weight does not correlate with symptom relief, predicted breast tissue resection weight continues to be critical for insurance approval.


Assuntos
Mama/anormalidades , Hipertrofia/cirurgia , Reembolso de Seguro de Saúde/economia , Mamoplastia/economia , Garantia da Qualidade dos Cuidados de Saúde/normas , Adulto , Mama/cirurgia , Feminino , Seguimentos , Humanos , Cobertura do Seguro/economia , Mamoplastia/métodos , Estudos Retrospectivos , Estados Unidos
19.
Acta Cytol ; 64(6): 597-606, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32829336

RESUMO

BACKGROUND: The Royal College of Pathologists of Australasia Quality Assurance Programs (RCPAQAP) offers a comprehensive range of External Quality Assurance programs for all disciplines of pathology and is committed to delivering programs to advance outcomes in patient care and promote excellence in laboratory diagnostic and technical proficiency. Proficiency testing in cytopreparatory techniques became available for formal enrolment in 2018. The 2019 technical program focused on the demonstration of a laboratory to troubleshoot problems encountered during staining and processing. The exercise provided a peer comparison of a laboratory's ability to (1) identify the problem viewed from a digital image and (2) describe the troubleshooting steps to rectify the problem using assessment guidelines. METHODS: Ten troubleshooting exercises including whole-slide z-stacked virtual images, a reference slide, and an online Result Entry questionnaire were provided. Common staining and processing problems were demonstrated in these exercises. Multiple-choice responses were made available to participants for each case with 1 response requiring submission. Participants were then allowed free text to describe how they would rectify the problem. RESULTS: Of the 72 participants who participated, 62 participants (86%) achieved a satisfactory assessment, 6 participants (8%) received a borderline assessment, and 4 participants (6%) received an unsatisfactory assessment. The average mark obtained was 32.7 out of a total of 45 marks, which equates to a satisfactory assessment. The highest mark obtained for this survey was 42.5. CONCLUSIONS: Quality cytopathology preparatory techniques are integral to mitigating the risk of diagnostic error. The digital pathology platform allowed homogeneity of samples for all participants and appeared to be a satisfactory mode for demonstrating the technical problems to participants. Laboratories participating in this survey showed good performance in identifying processing and staining problems on virtual images and working through the troubleshooting steps. The exercise also identified a method for troubleshooting formalin vapour-affected slides using citrate buffer which may be useful for laboratories following in-house validation.


Assuntos
Laboratórios/normas , Teste de Papanicolaou/normas , Patologia Clínica/normas , Garantia da Qualidade dos Cuidados de Saúde/normas , Testes Diagnósticos de Rotina , Feminino , Humanos , Controle de Qualidade , Coloração e Rotulagem/métodos , Esfregaço Vaginal/métodos
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