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1.
Khirurgiia (Mosk) ; (2): 48-52, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32105255

RESUMO

OBJECTIVE: To analyze the influence of surgical sanation of patients with destructive tuberculosis on the prevalence of tuberculosis and mortality. MATERIAL AND METHODS: The strategy of treatment for new cases of destructive pulmonary tuberculosis was developed in the Perelman Department of Phthisiopulmonology and Thoracic Surgery of the Sechenov First Moscow State Medical University. This strategy was applied in the tuberculosis surgical department of the Tambov Regional Dispensary in 2013-2017. A register of patients with pulmonary destruction and bacterial excretion was developed and personal treatment plans were applied. Patients were divided into 3 groups depending on the treatment mode. The main group A consisted of patients who underwent surgical treatment. Surgery was not performed due to failure or discontinuation of treatment in the comparison group B. Group C included patients without indications or with contraindications for surgical treatment. RESULTS: Treatment efficacy considering destruction cavities closure and abacillation was 97.2% in group A, 41.4% in group B and 39.8% in group C. Surgical approach for patients with destructive tuberculosis reduced the number of patients in the register by 3.3 times (from 516 to 158) within 4 years. A significant reduction of the bacillary core allows breaking the infection chain, that affects the main epidemiological indicators. Reduced incidence of tuberculosis is observed in short-term period, but even greater impact of this factor should be expected in long-term follow-up. CONCLUSION: Surgical approach in complex treatment of destructive pulmonary tuberculosis is valuable to improve efficacy of management of these patients and reduce mortality rate.


Assuntos
Procedimentos Cirúrgicos Operatórios , Tuberculose Pulmonar , Humanos , Moscou/epidemiologia , Prevalência , Procedimentos Cirúrgicos Operatórios/normas , Resultado do Tratamento , Tuberculose Pulmonar/mortalidade , Tuberculose Pulmonar/cirurgia
2.
Rev Col Bras Cir ; 46(5): e20192311, 2019.
Artigo em Português, Inglês | MEDLINE | ID: mdl-31859726

RESUMO

OBJECTIVE: to identify adherence to the safe surgery checklist from its filling out in a general referral hospital in the interior of Minas Gerais state, as well as to verify factors associated with its use. METHODS: this is a retrospective, documentary, cross-sectional study with a quantitative approach. Data collection was performed through a retrospective review of medical records of patients undergoing surgery within one year. Patients of all specialties, aged 18 years or older, and with hospitalization period equal to or greater than 24 hours were included. The probabilistic sample was composed of 423 cases. RESULTS: the checklist was present in 95% of the medical records. However, only 67.4% of them were completely filled out. The presence of the checklist in the medical record was significantly associated with the anesthetic risk of the patient. There was no difference in the filling out percentage among the three checklist moments: before anesthetic induction (sign in), before surgical incision (time out or surgical pause), and before the patient leaves the operating room (sign out). There were also no significant differences regarding the filling out percentage of the surgeon's responsibility items. Considering the surgical procedure performed, inconsistencies were found in the laterality item. CONCLUSION: despite the high percentage of medical records with checklist, the presence of incompleteness and inconsistency may compromise the expected results in the safety of the surgical patient.


Assuntos
Lista de Checagem/normas , Salas Cirúrgicas/normas , Assistência Perioperatória/normas , Gestão da Segurança/métodos , Procedimentos Cirúrgicos Operatórios/normas , Adolescente , Adulto , Lista de Checagem/estatística & dados numéricos , Feminino , Fidelidade a Diretrizes , Hospitais Gerais , Humanos , Masculino , Pessoa de Meia-Idade , Segurança do Paciente , Estudos Retrospectivos , Adulto Jovem
4.
Rev Lat Am Enfermagem ; 27: e2939, 2019.
Artigo em Português, Inglês, Espanhol | MEDLINE | ID: mdl-31596404

RESUMO

OBJECTIVE: to estimate the prevalence and avoidability of surgical adverse events in a teaching hospital and to classify the events according to the type of incident and degree of damage. METHOD: cross-sectional retrospective study carried out in two phases. In phase I, nurses performed a retrospective review on a simple randomized sample of 192 records of adult patients using the Canadian Adverse Events Study form for case tracking. Phase II aimed at confirming the adverse event by an expert committee composed of physicians and nurses. Data were analyzed by univariate descriptive statistics. RESULTS: the prevalence of surgical adverse events was 21.8%. In 52.4% of the cases, detection occurred on outpatient return. Of the 60 cases analyzed, 90% (n = 54) were preventable and more than two thirds resulted in mild to moderate damage. Surgical technical failures contributed in approximately 40% of the cases. There was a prevalence of the infection category associated with health care (50%, n = 30). Adverse events were mostly related to surgical site infection (30%, n = 18), suture dehiscence (16.7%, n = 10) and hematoma/seroma (15%, n = 9). CONCLUSION: the prevalence and avoidability of surgical adverse events are challenges faced by hospital management.


Assuntos
Hospitais de Ensino/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Procedimentos Cirúrgicos Operatórios/efeitos adversos , Adulto , Brasil/epidemiologia , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Segurança do Paciente , Complicações Pós-Operatórias/prevenção & controle , Período Pós-Operatório , Estudos Retrospectivos , Procedimentos Cirúrgicos Operatórios/normas , Deiscência da Ferida Operatória/epidemiologia , Infecção da Ferida Cirúrgica/epidemiologia
6.
J Trauma Acute Care Surg ; 87(2): 289-296, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31349347

RESUMO

BACKGROUND: There is a longstanding interest in the field of management science to study high performance organizations. Applied to medicine, research on hospital performance indicates that some hospitals are high performing, while others are not. The objective of this study was to identify a cluster of high-performing emergency general surgery (EGS) hospitals and assess whether high performance at one EGS operation was associated with high performance on all EGS operations. METHODS: Adult patients who underwent one of eight EGS operations were identified in the California State Inpatient Database (2010-2011), which we linked to the American Hospital Association database. Beta regression was used to estimate a hospital's risk-adjusted mortality, accounting for patient- and hospital-level factors. Centroid cluster analysis grouped hospitals by patterns of mortality rates across the eight EGS operations using z scores. Multinomial logistic regression compared hospital characteristics by cluster. RESULTS: A total of 220 acute care hospitals were included. Three distinct clusters of hospitals were defined based on assessment of mortality for each operation type: high-performing hospitals (n = 66), average performing (n = 99), and low performing (n = 55). The mortality by individual operation type at the high-performing cluster was consistently at least 1.5 standard deviations better than the low-performing cluster (p < 0.001). Within-cluster variation was minimal at high-performing hospitals compared with wide variation at low-performing hospitals. A hospital's high performance in one EGS operation type predicted high performance on all EGS operation types. CONCLUSION: High-performing EGS hospitals attain excellence across all types of EGS operations, with minimal variability in mortality. Poor-performing hospitals are persistently below average, even for low-risk operations. These findings suggest that top-performing EGS hospitals are highly reliable, with systems of care in place to achieve consistently superior results. Further investigation and collaboration are needed to identify the factors associated with high performance. LEVEL OF EVIDENCE: Prognostic, level III.


Assuntos
Hospitais Gerais/normas , Procedimentos Cirúrgicos Operatórios/normas , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , California , Análise por Conglomerados , Emergências , Feminino , Mortalidade Hospitalar , Hospitais Gerais/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Garantia da Qualidade dos Cuidados de Saúde , Procedimentos Cirúrgicos Operatórios/estatística & dados numéricos , Adulto Jovem
7.
J Trauma Acute Care Surg ; 87(1): 140-146, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31259872

RESUMO

BACKGROUND: As the geriatric population grows, the need for hospitals performing high quality emergency general surgery (EGS) on older patients will increase. Identifying clusters of high-performing geriatric emergency general surgery hospitals would substantiate the need for in-depth analyses of hospital-specific structures and practices that benefit older EGS patients. The objectives of this study were therefore to identify clusters of hospitals based on mortality performance for geriatric patients undergoing common EGS operations and to determine if hospital performance was similar for all operation types. METHODS: Hospitals in the California State Inpatient Database were included if they performed a range of eight common EGS operations in patients 65 years or older, with a minimum requirement of three of each operation performed over 2 years. Multivariable beta regression models were created to define hospital-level risk-adjusted mortality. Centroid cluster analysis was used to identify groups of hospitals based on mortality and to determine if mortality-performance differed by operation. RESULTS: One hundred seven hospitals were included, performing a total of 24,279 operations in older patients. Hospitals separated into three distinct clusters: high, average, and low performers. The high-performing hospitals had survival rates 1 to 2 standard deviations better than the low-performers (p < 0.001). For each cluster, high performance in any one EGS operation consistently translated into high performance across all EGS operations. CONCLUSION: Hospitals conducting EGS operations in the geriatric patient population cluster into three distinct groups based on their survival performance. High-performing hospitals significantly outperform the average and low performers across every operation. The high-performers achieve reliable, high-quality results regardless of operation type. Further qualitative research is needed to investigate the perioperative drivers of hospital performance in the geriatric EGS population. LEVEL OF EVIDENCE: Study Type Prognostic, level III.


Assuntos
Hospitais/normas , Procedimentos Cirúrgicos Operatórios/normas , Idoso , California , Análise por Conglomerados , Emergências , Mortalidade Hospitalar , Hospitais/estatística & dados numéricos , Humanos , Procedimentos Cirúrgicos Operatórios/mortalidade , Procedimentos Cirúrgicos Operatórios/estatística & dados numéricos
8.
Int J Surg ; 69: 19-22, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31310820

RESUMO

It is human nature to make mistakes, all people in all works make errors, but an amputation of the wrong leg or an inadvertently retained needle in the abdominal cavity are unanticipated incidents, that no physician in the world wants to experience. Such catastrophic events, except for the consequences on the patient's health and the physician's career, have severe financial implications on the healthcare system. Human nature, apart from making mistakes, is also able to find solutions to minimize adverse incidents. A systematic time-out in the operating room just before incision has been introduced the last two decades to help prevent wrong site surgeries and other surgical never events. Despite its effectiveness in increasing patient safety, compliance issues remain a major problem in its implementation and gaps in its daily use still occur. The current review presents patterns of wrong time-out procedures, emphasizes the problem of poor compliance and reviews the suggested strategies to increase compliance for safer operating rooms.


Assuntos
Lista de Checagem , Erros Médicos/prevenção & controle , Segurança do Paciente , Procedimentos Cirúrgicos Operatórios/normas , Humanos , Guias de Prática Clínica como Assunto , Organização Mundial da Saúde
9.
Surgery ; 166(3): 380-385, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31208864

RESUMO

BACKGROUND: Surgical futility is poorly defined. However, there are patients with extremely high preoperative risk who still undergo surgery and ultimately die, suggesting futile care. To further explore surgical futility, we examined the incidence and factors associated with extreme-risk patients undergoing major emergency general surgery with early death. METHODS: The American College of Surgeons National Surgical Quality Improvement Program database was reviewed for all adults undergoing colectomy, small bowel resection, control of bleeding ulcer, lysis of adhesion, and exploratory laparotomy between 2007 and 2015. Extreme-risk was defined as having an estimated mortality risk ≥75% using the National Surgical Quality Improvement Program mortality-risk calculator. Futile care was defined as extreme-risk patients who died within 48 hours of an operation. The incidence of, and clinical factors associated with, futile surgery were identified. RESULTS: Of 94,350 emergency general surgery patients, 1.9% were extreme-risk. Among extreme-risk patients, 30-day mortality was 71.2%; 31.6% of extreme-risk patients died within 48 hours, representing futile care. Only 5.5% of extreme-risk patients were discharged home. Patients who were >80 years (odds ratio [OR] 6.25 vs 40-64; 95% confidence interval [CI], 4.51-8.66), septic (OR 4.63; 95% CI, 3.38-6.34), or had a dependent functional status (OR 2.50 vs independent; 95% CI, 1.83-3.43]) had higher odds of having a futile operation. CONCLUSION: A significant number of emergency general surgery operations were on extreme-risk patients who suffered early death, which may indicate futile care. Surgeons face numerous conflicting pressures when asked to perform potentially futile surgery. Additional research in the decision-making process in these cases is needed to understand why surgeons operate in such dire circumstances and whether they should.


Assuntos
Futilidade Médica , Complicações Pós-Operatórias/mortalidade , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Bases de Dados Factuais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados da Assistência ao Paciente , Complicações Pós-Operatórias/epidemiologia , Melhoria de Qualidade , Medição de Risco , Fatores de Risco , Procedimentos Cirúrgicos Operatórios/normas , Estados Unidos/epidemiologia , Adulto Jovem
10.
Unfallchirurg ; 122(6): 452-463, 2019 Jun.
Artigo em Alemão | MEDLINE | ID: mdl-31165213

RESUMO

Surgical providers must maintain currency and competency for low-volume high-risk procedures for optimal outcomes. There are currently a number of methods available to train for these rare but vital skills, ranging from simple to complex and inexpensive to expensive. Traditionally, these skills have been taught using human cadaveric and animal models, which are limited by availability (cadavers) and social acceptability (animals). As such, there is a need to utilize advances in educational and simulation technologies to refine and develop consensus-based, validated, tissue-realistic, anatomically correct and cost-effective training tools to teach these vital skills. Partially perfused human cadavers have recently been shown to be an important adjunct to established trauma training. Human patient simulators (HPS) and the associated technology is rapidly expanding, but currently lack consistent realism to be used for competence training, when compared to traditional models and are currently cost-prohibitive. It will be important for surgical trainers and trainees to remain engaged and facilitate the development of realistic cost-effective training tools.


Assuntos
Necessidades e Demandas de Serviços de Saúde , Simulação de Paciente , Procedimentos Cirúrgicos Operatórios/educação , Animais , Competência Clínica , Simulação por Computador , Emergências , Humanos , Procedimentos Cirúrgicos Operatórios/normas , Inquéritos e Questionários
12.
Ann R Coll Surg Engl ; 101(7): 463-471, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31155919

RESUMO

INTRODUCTION: Surgical site infections are associated with increased morbidity and mortality in patients. The Getting It Right First Time surgical site infection programme set up a national survey to review surgical site infection rates in surgical units in England. The objectives were for frontline clinicians to assess the rates of infection following selected procedures, to examine the risk of significant complications and to review current practice in the prevention of surgical site infection. METHODS: A national survey was launched in April 2017 to assess surgical site infections within 13 specialties: breast surgery, cardiothoracic surgery, cranial neurosurgery, ear, nose and throat surgery, general surgery, obstetrics and gynaecology, ophthalmology, oral and maxillofacial surgery, orthopaedic surgery, paediatric surgery, spinal surgery, urology and vascular surgery. All participating trusts prospectively identified and collected supporting information on surgical site infections diagnosed within the six-month study period. RESULTS: Data were received from 95 NHS trusts. A total of 1807 surgical site infection cases were reported. There were variations in rates reported by trusts across specialties and procedures. Reoperations were reported in 36.2% of all identified cases, and surgical site infections are associated with a delayed discharge rate of 34.1% in our survey. CONCLUSION: The Getting It Right First Time surgical site infection programme has introduced a different approach to infection surveillance in England. Results of the survey has demonstrated variation in surgical site infection rates among surgical units, raised the importance in addressing these issues for better patient outcomes and to reduce the financial burden on the NHS. Much work remains to be done to improve surgical site infection surveillance across surgical units and trusts in England.


Assuntos
Hospitais Estaduais/estatística & dados numéricos , Medicina Estatal/estatística & dados numéricos , Procedimentos Cirúrgicos Operatórios/efeitos adversos , Infecção da Ferida Cirúrgica/epidemiologia , Antibioticoprofilaxia/normas , Efeitos Psicossociais da Doença , Inglaterra/epidemiologia , Feminino , Hospitais Estaduais/normas , Humanos , Masculino , Guias de Prática Clínica como Assunto , Avaliação de Programas e Projetos de Saúde , Estudos Prospectivos , Medicina Estatal/economia , Medicina Estatal/normas , Procedimentos Cirúrgicos Operatórios/normas , Infecção da Ferida Cirúrgica/economia , Infecção da Ferida Cirúrgica/etiologia , Infecção da Ferida Cirúrgica/prevenção & controle
13.
Semin Pediatr Surg ; 28(3): 124-130, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31171145

RESUMO

The importance of defining and implementing a culture of safety in pediatric surgery is being increasingly seen as essential to decreasing complications and improving outcomes. The concept of a safety culture is a universal one, but the elements of such a culture are different for every disease and anomaly treated. In this paper, I will review these elements as they pertain to the treatment of abdominal wall defects starting from fetal evaluation to post-discharge care.


Assuntos
Parede Abdominal/cirurgia , Assistência ao Convalescente/normas , Gastrosquise/cirurgia , Hérnia Umbilical/cirurgia , Erros Médicos , Segurança do Paciente/normas , Pediatria/normas , Diagnóstico Pré-Natal/normas , Procedimentos Cirúrgicos Operatórios/normas , Parede Abdominal/anormalidades , Assistência ao Convalescente/métodos , Gastrosquise/diagnóstico , Hérnia Umbilical/diagnóstico , Humanos , Recém-Nascido , Pediatria/métodos , Diagnóstico Pré-Natal/métodos , Procedimentos Cirúrgicos Operatórios/métodos
14.
Semin Pediatr Surg ; 28(3): 139-142, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31171148

RESUMO

Esophageal atresia (EA) repair has always been a source of immense professional gratification for the pediatric surgeon. In many ways, this anomaly defines the entire profession. Due to its rarity, there is an increased risk of inadvertent events occurring during correction. This article describes some of the error traps that may occur in attempting esophageal reconstruction and how they may be avoided.


Assuntos
Broncoscopia/normas , Atresia Esofágica/cirurgia , Erros Médicos , Pediatria/normas , Procedimentos Cirúrgicos Operatórios/normas , Toracoscopia/normas , Broncoscopia/métodos , Atresia Esofágica/diagnóstico , Humanos , Recém-Nascido , Pediatria/métodos , Procedimentos Cirúrgicos Operatórios/métodos , Toracoscopia/métodos
15.
Semin Pediatr Surg ; 28(3): 143-150, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31171149

RESUMO

The growth of the field of fetal surgery over the last two decades driven by new indications and data from prospective randomized trials supporting prenatal intervention has resulted in techniques protocols and methodologies that have gained confidence by insuring good outcomes. Error traps are methods or techniques that usually work well in most of the cases, but which are apt to fail under certain specific circumstances. The very confidence the surgeon develops in these techniques or methodologies makes them a trap for the unwary surgeon. The purpose of this article is to discuss common error traps in fetal interventions, including ultrasound guided procedures, fetoscopic surgery, open fetal surgery and EXIT procedures. Awareness of these error traps and approaches to avoid them may enhance fetal surgical outcomes and reduce complications rates.


Assuntos
Doenças Fetais/cirurgia , Fetoscopia/normas , Fotocoagulação a Laser/normas , Erros Médicos , Ablação por Radiofrequência/normas , Procedimentos Cirúrgicos Operatórios/normas , Ultrassonografia Pré-Natal/normas , Feminino , Fetoscopia/métodos , Humanos , Fotocoagulação a Laser/métodos , Gravidez , Ablação por Radiofrequência/métodos , Procedimentos Cirúrgicos Operatórios/métodos , Ultrassonografia Pré-Natal/métodos
16.
Semin Pediatr Surg ; 28(3): 151-159, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31171150

RESUMO

Hirschsprung disease affects many children every year around the world. Currently, there is an extensive menu of diagnostic methods, and surgical treatments. This situation compels the physicians to follow the rationale of these interventions. The comprehensive diagnosis and treatment of Hirschsprung disease need singular procedures. The clear understanding of how to perform each of these techniques, as well as to read the results is mandatory. Otherwise, the medical team may perform unconscious errors and fall into traps. Many errors still happen in patients with Hirschsprung, resulting in a spectrum of problems; from delayed diagnosis to unnecessary colectomies. In other patients, the damage to the anal canal results in fecal incontinence. When this is established, it is an unreversed and devastating social problem. This article describes why these errors occur and how to prevent them.


Assuntos
Biópsia/normas , Técnicas de Diagnóstico do Sistema Digestório/normas , Incontinência Fecal/prevenção & controle , Doença de Hirschsprung/diagnóstico , Doença de Hirschsprung/cirurgia , Complicações Intraoperatórias/prevenção & controle , Erros Médicos , Segurança do Paciente/normas , Complicações Pós-Operatórias/prevenção & controle , Procedimentos Cirúrgicos Operatórios/normas , Biópsia/métodos , Incontinência Fecal/etiologia , Humanos , Lactente , Recém-Nascido , Complicações Intraoperatórias/etiologia , Complicações Pós-Operatórias/etiologia , Procedimentos Cirúrgicos Operatórios/efeitos adversos , Procedimentos Cirúrgicos Operatórios/métodos
17.
Semin Pediatr Surg ; 28(3): 164-171, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31171152

RESUMO

This article reviews technical issues to improve surgical safety and avoid surgical errors in pediatric surgical oncology, particularly in the three most common extracranial solid tumors: neuroblastoma, hepatoblastoma and Wilms tumor. The use of adjuvant chemotherapy - when indicated - the use of tumor specific classifications, adequate surgical planning, that may include the use of 3D printable models, improved surgical instruments and technology, and following surgical guidelines, would result in avoiding error, increased safety, and therefore in improved surgical outcomes.


Assuntos
Hepatoblastoma/cirurgia , Neoplasias Renais/cirurgia , Neoplasias Hepáticas/cirurgia , Erros Médicos , Neuroblastoma/cirurgia , Segurança do Paciente/normas , Pediatria/normas , Guias de Prática Clínica como Assunto/normas , Oncologia Cirúrgica/normas , Procedimentos Cirúrgicos Operatórios/normas , Tumor de Wilms/cirurgia , Humanos , Pediatria/métodos , Oncologia Cirúrgica/métodos , Procedimentos Cirúrgicos Operatórios/métodos
18.
JNMA J Nepal Med Assoc ; 57(215): 64-66, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31080250

RESUMO

Globally, millions of surgeries are performed each year to compliment and manage a diverse set of medical conditions. Adverse surgical outcomes constitute a major proportion of avoidable death and disabilities in the hospital, especially in low-income countries like Nepal. A comprehensive study on the standards of surgical procedures and its institutional regulations is missing. We discuss here the importance of surgical regulation based on it's financial as well as healthcare implications in the Nepalese healthcare system. Keywords: health care facilities; safety; surgery; surgical procedures; WHO.


Assuntos
Assistência à Saúde/normas , Instalações de Saúde/normas , Procedimentos Cirúrgicos Operatórios/normas , Assistência à Saúde/economia , Assistência à Saúde/legislação & jurisprudência , Instalações de Saúde/economia , Instalações de Saúde/legislação & jurisprudência , Humanos , Nepal , Procedimentos Cirúrgicos Operatórios/economia , Procedimentos Cirúrgicos Operatórios/legislação & jurisprudência
19.
Br J Hosp Med (Lond) ; 80(5): 258-262, 2019 May 02.
Artigo em Inglês | MEDLINE | ID: mdl-31059333

RESUMO

As a consequence of an ageing population greater numbers of elderly patients are presenting for both elective and emergency surgery. These older patients typically present with an increased burden of age-related problems and multimorbidity, which is associated with an increased risk of adverse postoperative outcomes. Traditional preoperative assessment models are adept at discerning patients' suitability for anaesthesia and surgery, but there is minimal focus on improving postoperative outcomes. Comprehensive geriatric assessment is a multidisciplinary approach used both to assess existing 'known' pathology and to screen for previously undiagnosed issues across medical, functional, social and/or psychological domains. This diagnostic phase then leads to the development and implementation of an individualized 'optimization' strategy across these domains. There is emerging evidence that comprehensive geriatric assessment and optimization in the surgical setting leads to improved outcomes, and it is reasonable to conclude that it would benefit the patient's long-term health.


Assuntos
Avaliação Geriátrica/métodos , Geriatria/métodos , Cuidados Pré-Operatórios/métodos , Procedimentos Cirúrgicos Operatórios/métodos , Acne Conglobata , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Fragilidade/epidemiologia , Geriatria/normas , Nível de Saúde , Humanos , Alta do Paciente , Desempenho Físico Funcional , Medição de Risco , Apoio Social , Procedimentos Cirúrgicos Operatórios/normas
20.
World J Surg ; 43(9): 2175-2185, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31049605

RESUMO

BACKGROUND: Proper documentation is an essential part of patient safety and quality of care in the surgical field. Surgical procedures are traditionally documented in narrative operative reports which are subjective by nature and often lack essential information. This systematic review will analyze the added value of the newly emerged synoptic reporting technique in the surgical setting. METHODS: A systematic review was conducted to compare the completeness and the user-friendliness of the synoptic operative report to the narrative operative report. A literature search was performed in EMBASE, Ovid MEDLINE, Web of Science, Cochrane CENTRAL, and Google Scholar for studies published up to April 6, 2018. The Newcastle-Ottawa Scale was utilized for the risk of bias assessment of the included articles. PROSPERO registration number was: CRD42018093770. RESULTS: Overall and subsection completion of the operative report was higher in the synoptic operative report. The time until completion of the operative report and the data extraction time were shorter in the synoptic report. One exception was the specific details section concerning the operative procedure, as this was generally reported more frequently in the narrative report. The use of mandatory fields in the synoptic report resulted in more completely reported operative outcomes with completion percentages close to 100%. CONCLUSIONS: The synoptic operative report generally demonstrated a higher completion rate and a much lower time until completion compared to the traditional narrative operative report. A hybrid approach to the synoptic operative report will potentially yield better completion rates and higher physician satisfaction.


Assuntos
Sistemas Computadorizados de Registros Médicos/normas , Procedimentos Cirúrgicos Operatórios/normas , Cirurgia Geral/organização & administração , Cirurgia Geral/normas , Humanos , Registros Médicos , Narração
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