Search

Introduction: The evaluation of clinical trial (CT) safety is the main task of CT vigilance units. In addition to the management of adverse events, the units must review the literature to identify information that may impact the benefit-risk assessment of studies. In this survey, we investigated the literature monitoring (LM) activity of French Institutional Vigilance Units (IVU) from the working group "REflexion sur la VIgilance et la SEcurite des essais cliniques" (REVISE)., Material and Methods: We sent a questionnaire of 26 questions, divided into four themes, to the 60 IVU: (1) Presentation of the IVU and the LM activity; (2) Used sources, queries and criteria for selecting articles; (3) Valuation of the LM and (4) Practical organisation., Results: Of the 27 IVU that responded to the questionnaire, 85% of them carried out LM. This was mainly provided by medical staff to improve general knowledge (83%), to detect Adverse Reactions (AR) not listed in the reference documents (70%) and to detect new safety information (61%). Due to lack of time, staff, available recommendations and sources, only 21% of IVU conducted LM for all CT. On average, units reported four sources: ANSM information (96%), PubMed database (83%), EMA alerts (57%) and the subscription to APM international (48%). The LM had an impact on the CT of 57% of the IVU such as changing the conditions of a study (39%) or suspending a study (22%)., Discussion/conclusion: LM is an important but time-consuming activity with heterogeneous practices. According to the results of this survey, we proposed seven ways to improve this practice: (1) Target the highest risk CT; (2) Refine the PubMed queries; (3) Use other tools; (4) Create a decision flowchart for the selection of PubMed articles; (5) Improve training; (6) Value the activity and (7) Outsource the activity., (Copyright © 2023 Société française de pharmacologie et de thérapeutique. Published by Elsevier Masson SAS. All rights reserved.)

Context.—: One goal of the joint College of American Pathologists/American College of Medical Genetics and Genomics Cytogenetics Committee is to ensure the accurate detection and description of chromosomal abnormalities in both constitutional and neoplastic specimens, including hematologic neoplasms., Objective.—: To report a 20-year performance summary (1999-2018) of conventional chromosome challenges focusing on hematologic neoplasms., Design.—: A retrospective review was performed from 1999 through 2018 to identify karyotype challenges specifically addressing hematologic neoplasms. The overall performance of participants was examined to identify potential recurring errors of clinical significance., Results.—: Of 288 total conventional chromosome challenges from 1999-2018, 87 (30.2%) were presented in the context of a hematologic neoplasm, based on the provided clinical history, specimen type, and/or chromosomal abnormalities. For these 87 hematologic neoplasm challenges, 91 individual cases were provided and graded on the basis of abnormality recognition and karyotype nomenclature (ISCN, International System for Human Cytogenomic [previously Cytogenetic] Nomenclature). Of the 91 cases, 89 (97.8%) and 87 (95.6%) exceeded the required 80% consensus for grading of abnormality recognition and correct karyotype nomenclature, respectively. The 2 cases (2 of 91; 2.2%) that failed to meet the 80% consensus for abnormality recognition had complex karyotypes. The 4 cases (4 of 91; 4.4%) that failed to meet the 80% consensus for correct karyotype nomenclature were the result of incorrect abnormality recognition (2 cases), missing brackets in the karyotype (1 case), and incorrect breakpoint designation (1 case)., Conclusions.—: This 20-year review demonstrates clinical cytogenetics laboratories have been and continue to be highly proficient in the detection and description of chromosomal abnormalities associated with hematologic neoplasms., Competing Interests: Yuhas and Kearney coordinate the vendor series to the College of American Pathologists and receive royalties for this work. The other authors have no relevant financial interest in the products or companies described in this article.

Coronavirus disease 2019 (COVID-19) is a ubiquitous health concern and a global pandemic. In an effort to slow the disease spread and protect valuable healthcare resources, cessation of nonessential surgery, including many orthopaedic procedures, has become commonplace. This crisis has created a unique situation in the care of spine patients as we must balance the urgency of patient evaluation, surgical intervention, and continued training against the risk of disease exposure and resource management. The spine division of an orthopaedic surgery department has taken an active role in enacting protocol changes in anticipation of COVID-19. In the initial 4 weeks of the COVID-19 pandemic the spine division went from an average of 60.4 cases to 10 cases during the same timeframe. Clinic visits decreased from 417.4 to 322 with new patient visits decreasing from 28% to 20%. Three hundred eighteen of the 322 (98.7%) clinic visits were performed via telehealth. Although these changes have been forced upon us by necessity, we feel that our division and department will emerge in a more responsive, agile, and stronger state. As we look to the coming months and beyond, it will be important to continue to adapt to the changing landscape during unprecedented times.

Objectives: The world is currently facing an unprecedented healthcare crisis caused by the COVID-19 pandemic. The objective of these guidelines is to produce a framework to facilitate the partial and gradual resumption of intervention activity in the context of the COVID-19 pandemic., Methods: The group has endeavoured to produce a minimum number of recommendations to highlight the strengths to be retained in the 7 predefined areas: (1) protection of staff and patients; (2) benefit/risk and patient information; (3) preoperative assessment and decision on intervention; (4) modalities of the preanaesthesia consultation; (5) specificity of anaesthesia and analgesia; (6) dedicated circuits and (7) containment exit type of interventions., Results: The SFAR Guideline panel provides 51 statements on anaesthesia management in the context of COVID-19 pandemic. After one round of discussion and various amendments, a strong agreement was reached for 100% of the recommendations and algorithms., Conclusion: We present suggestions for how the risk of transmission by and to anaesthetists can be minimised and how personal protective equipment policies relate to COVID-19 pandemic context., (Copyright © 2020 The Author(s). Published by Elsevier Masson SAS.. All rights reserved.)

Ten years after the beginning of CREX in radiotherapy departments we wanted to know about users' feeling. We sent a survey to 168 centers in the whole country and a hundred of them answer. The time, top management's involvement and professionals' training seem to be the key success factors. Systemic analysis methods and mainly the Orion © one are not identified as an issue. The main challenge for the next years will be the effectiveness check of actions., (Copyright © 2019 Société française de radiothérapie oncologique (SFRO). Published by Elsevier Masson SAS. All rights reserved.)

Objective: To investigate the use of fall-risk-increasing drugs among patients with falls reported to the Patient Safety Office of a hospital, and to identify the factors associated with high risk for fall., Methods: A cross-sectional study, carried out in a teaching hospital. The study population was the universe of fall reports received by the Patient Safety Office. The dependent variable was a high risk for falls. The Medication Fall Risk Score was used to measure fall risk. Descriptive, univariate and multivariate analyses were performed., Results: Of the 125 fall reports in the study, 38 (30.4%) were in 2014, 26 (20.8%) in 2015, and 61 (48.8%) in 2016. Half of the patients (63; 50.4%) were classified as high fall risk and 74 (59.2%) had two or more risk factors for the event. The most frequently used drug classes were opioids (25%), anxiolytics (19.7%), beta-blockers (9.9%), angiotensin II antagonists (7%) and vascular-selective calcium channel blockers (7%). After the adjusted analysis, the factors associated with falls were amputation (odds ratio: 14.17), female sex (odds ratio: 2.98) and severe pain (odds ratio: 5.47)., Conclusion: Medications are an important contributor to in-hospital falls, and the Medication Fall Risk Score can help identify patients at a high risk for falls.

Regulatory and accrediting standards require hospitals to have a medical staff responsible for quality of care, patient safety, and clinician self-governance. PAs are on about 20% of hospital medical staffs in the United States and the number is growing.

Onco, the Regional oncology network of Northern France, in partnership with Cronor, is piloting a project to harmonize radiotherapy practice. In 2016, a working party "Quality in Radiotherapy" was set up to encourage all centres in the network to participate in regional experience feedback committees. These committee meetings allow for analysis and handling of adverse events in radiotherapy within predefined areas of expertise. The purpose is to formalize and issue recommendations based on good practice by the use of regional bulletins. This article details how such experiential feedback committees are implemented, what they can contribute and the barriers to such work at each stage of the project., (Copyright © 2018 Société française de radiothérapie oncologique (SFRO). Published by Elsevier Masson SAS. All rights reserved.)

Since 2002, all healthcare facilities must have a food and nutrition liaison committee. The aim is to improve the management of food and nutrition related issues in hospital. The players concerned undertake a global and cross-disciplinary approach to ensure better food, notably for elderly patients at risk of protein-energy malnutrition., (Copyright © 2018 Elsevier Masson SAS. All rights reserved.)

Background: The experience feedback committee (EFC) is a tool designed to involve medical teams in patient safety management, through root cause analysis (RCA) within the team., Objectives: To investigate the functioning of EFCs in the departments of a large university-affiliated hospital in France and to consider its potential contribution to the management of patient safety., Methods: Cross-sectional, observational study, based on an analysis of the documents produced by the EFCs for 1 year. Data were collected independently by two investigators in meeting minutes, adverse event reports and event analysis reports., Results: The study included all 20 EFCs operating in the hospital's medical departments. During the study year, committees held 164 meetings, reviewed 1707 adverse events, conducted 91 event analyses and decided on 206 corrective actions. The median number of corrective actions adopted by each EFC was five actions (range, 0-62). A root cause analysis (RCA) was present in 76% of the analysis reports, and these analyses were complete in only 23% of the reports. There was also a lack of planning corrective actions: an implementation deadline was only defined in 26% of the actions., Conclusions: Healthcare professionals adhered to the system-based approach to patient safety, but we observed difficulties in holding regular meetings and deviations from the theoretical framework. These findings confirm the difficulties of practicing RCA in the healthcare setting. Nevertheless, EFCs can be vectors of safety culture and teamwork., Competing Interests: The authors have declared that no competing interests exist.

The American Medical Association-Specialty Society Relative Value Scale Update Committee, also known as the RUC, plays a critical role in assessing the relative value of physician services and procedures. This committee provides access for all physicians, including dermatologists, to the reimbursement process. Since the introduction of the Resource-Based Relative Value Scale by Medicare, the RUC has done important work to evaluate and refine reimbursement for physician services. The RUC recommendations have also led the Current Procedural Terminology (CPT) Editorial Panel to develop additional reimbursement codes as new procedures and services are developed. In this article (from the series Future Considerations for Clinical Dermatology in the Setting of 21st Century American Policy Reform), we will review the RUC, including its history and membership, the RUC update process, and a brief discussion of a few issues of particular importance to dermatologists., (Copyright © 2017 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.)

This research examines the institutional features of Brazil's National Commission for the Implementation of the Framework Convention on Tobacco Control (CONICQ) and how these institutional features have facilitated and hindered its ability to foster intersectoral tobacco control. In particular, we evaluate the key institutional features of CONICQ starting from when it was one of the key drivers of change and improvements in early tobacco control policies, which helped to make Brazil a world leader in this area. We also examine how the committee has evolved, as tobacco control has improved and particularly elucidate some of the major challenges that it faces to bring together often disparate government sectors to generate public health policies.

Objective: To systematize knowledge on the activities developed by the committees involved in the prevention of infant and fetal deaths., Method: Integrated literature review conducted in November 2015 at PubMed, CINAHL, Scopus, LILACS, BDEnf and SciELO databases using keywords and descriptors of infant mortality, infant death, infant deaths, fetal death, fetal deaths, fetal mortality, neonatal mortality, professional committee, committee, committees, advisory committees. The 34 selected studies were organized and analyzed using Microsoft Excel®., Results: International, national, regional, state and local committees analyze the deaths and conduct activities aimed to qualify maternal and childcare and feed the health information systems., Conclusion: The committees for the prevention of infant and fetal mortality collect, produce, analyze and disseminate information related to these deaths in order to reduce infant and fetal mortality rates.

The purpose of this paper is to summarise the methodology for the 5th International Consensus Conference on Concussion in Sport. The 18 months of preparation included engagement of a scientific committee, an expert panel of 33 individuals in the field of concussion and a modified Delphi technique to determine the primary questions to be answered. The methodology also involved the writing of 12 systematic reviews to inform the consensus conference and submission and review of scientific abstracts. The meeting itself followed a 2-day open format, a 1-day closed expert panel meeting and two additional half day meetings to develop the Concussion Recognition Tool 5 (Pocket CRT5), Sport Concussion Assessment Tool 5 (SCAT5) and Child SCAT5., Competing Interests: Competing interests: WHM is the medical director of the National Hockey League. He has received research grant support through the University of Calgary from the Canadian Institutes of Health Research, Alberta Innovates Health Solutions, the FIFA, Alberta Children’s Hospital Research Institute and the Hotchkiss Brain Institute. He is the founding chair of the Sport Injury Prevention Research Centre, which is one of the International Research Centres for Prevention of Injury and Protection of Athlete Health supported by the IOC. He has a clinical consulting practice in sport medicine at the University of Calgary Sport Medicine Centre. He is an expert group member of the IOC Medical Commission and has received travel funding in that capacity. KJS is a physiotherapy consultant at Evidence Sport and Spinal Therapy in Calgary, Alberta, Canada. She has received honoraria for speaking at various conferences. She has received research grant support through the University of Calgary from the Alberta Children’s Hospital Research Institute, Hotchkiss Brain Institute and the Canada Foundation for Innovation (including matching funds through the Province of Alberta). She is a faculty member at the Sport Injury Prevention Research Centre, within is one of the International Research Centres for Prevention of Injury and Protection of Athlete Health supported by the IOC. CFF is a member of World Rugby’s Independent Expert Panel on Concussion. She was not involved in any other aspects of the International Consensus Conference on Concussion in Sport except for the planning for the Delphi study and review and editing of the manuscript. PM is a coinvestigator, collaborator, or consultant on grants relating to mild TBI funded by several governmental organisations. He is directly employed by the National Health and Medical Research Council of Australia and is based at the Florey Institute of Neuroscience and Mental Health. He is co-chair of the Australian Centre for Research into Sports Injury and its Prevention (ACRISP), which is one of the International University Research Centres for Prevention of Injury and Protection of Athlete Health supported by the IOC. He is co-chair of the International Concussion in Sport Group. He has a clinical and consulting practise in general and sports neurology. He receives book royalties from McGraw-Hill and was employed in an editorial capacity by the British Medical Journal Publishing Group from 2001 to 2008. He has been reimbursed by the government, professional scientific bodies and sporting bodies for travel costs related to presenting research on mild TBI and sport-related concussion at meetings, scientific conferences and symposiums. He received consultancy fees in 2010 from Axon Sports (US) for the development of educational material (which was not renewed) and has received research funding since 2001 from Cogstate Inc. He has not received any research funding, salary or other monies from the Australian Football League, FIFA or the NFL. The Australian Football League funds research at the Florey Institute under a legal memorandum and PM does not receive any money from this industry-funded research. PM is a cofounder and shareholder in two biomedical companies (involved in eHealth and Compression garment technologies) but does not hold any individual shares in any company related to concussion or brain injury assessment or technology., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

This population-based study included all the late maternal deaths from the case series of the Maternal Mortality Committees in the city of São Paulo and the state of Paraná, Brazil. The study compared 134 deaths identified by the São Paulo committee and 124 from the Paraná committee in 2004-2013, aimed at demonstrating the magnitude and causes of late maternal mortality. Late maternal deaths accounted for 13.4% of all maternal deaths in the case series of the São Paulo committee and 12.1% in the cases series of the Paraná committee. Direct obstetric causes accounted for 32.1% of the late maternal deaths in São Paulo and 42.1% in Paraná, with postpartum cardiomyopathy as the principal cause in both case series. Death occurred between 43 and 69 days postpartum in 44% of the cases in São Paulo and 39.5% in Paraná. The correction factor for late maternal death was 3.3 in São Paulo and 4.3 in Paraná. Late maternal death had a relevant impact on overall maternal mortality, and postpartum cardiomyopathy was the principal cause of late direct obstetric death.

As efforts to address unmet need for family planning and contraception (FP/C) accelerate, voluntary use, informed choice and quality must remain at the fore. Active involvement of affected populations has been recognized as one of the key principles in ensuring human rights in the provision of FP/C and in improving quality of care. However, community participation continues to be inadequately addressed in large-scale FP/C programmes. Community and healthcare providers' unequal relationship can be a barrier to successful participation. This scoping review identifies participatory approaches involving both community and healthcare providers for FP/C services and analyzes relevant evidence. The detailed analysis of 25 articles provided information on 28 specific programmes and identified three types of approaches for community and healthcare provider participation in FP/C programmes. The three approaches were: (i) establishment of new groups either health committees to link the health service providers and users or implementation teams to conduct specific activities to improve or extend available health services, (ii) identification of and collaboration with existing community structures to optimise use of health services and (iii) operationalization of tools to facilitate community and healthcare provider collaboration for quality improvement. Integration of community and healthcare provider participation in FP/C provision were conducted through FP/C-only programmes, FP/C-focused programmes and/or as part of a health service package. The rationales behind the interventions varied and may be multiple. Examples include researcher-, NGO- or health service-initiated programmes with clear objectives of improving FP/C service provision or increasing demand for services; facilitating the involvement of community members or service users and, in some cases, may combine socio-economic development and increasing self-reliance or control over sexual and reproductive health. Although a number of studies reported increase in FP/C knowledge and uptake, the lack of robust monitoring and evaluation mechanisms and quantitative and comparable data resulted in difficulties in generating clear recommendations. It is imperative that programmes are systematically designed, evaluated and reported.

Compassionate care is based on an individual and collective dynamic process. Otherness, recognition, the meaning given to actions are fundamental preliminary considerations of any approach in this direction. A group of engaged professionals can initiate and support a project for promoting compassionate care in an institution., (Copyright © 2016 Elsevier Masson SAS. All rights reserved.)

By performing a systemic analysis of medication errors which occur in practice, the multidisciplinary teams can avoid a reoccurrence with the aid of an improvement action plan. The methods must take into account all the factors which might have contributed to or favoured the occurrence of a medication incident or accident., (Copyright © 2016 Elsevier Masson SAS. All rights reserved.)

This column shares the best evidence-based strategies and innovative ideas on how to facilitate the learning of EBP principles and processes by clinicians as well as nursing and interprofessional students. Guidelines for submission are available at http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1741-6787., (© 2015 Sigma Theta Tau International.)

Since the late 2,000 years, under the incentive of the French agencies ANAP (previously MEAH) and HAS and following the decision DC-0103 of the ASN, experience feedback committees (known as 'Comité de retour d'expérience or Crex' in French) have widely been implemented within radiation oncology departments in France. Based on the declaration of error/near misses (precursor events) occurring during medical care to patients, an intuitive method of systematic analysis of these events is basically the aim of such committees (such as the Orion method(©) derived from the air transportation industry). Our article aims at summarizing the paths and pitfalls attached to this methodology, emphasizing what could be the next step, beyond the 'Crex' committees, in the long march to know how to secure care to patients within a radiotherapy medical team., (Copyright © 2015 Société française de radiothérapie oncologique (SFRO). Published by Elsevier SAS. All rights reserved.)

Productivity is the main concern of hospitals as organizations providing health services. As the role of hospital committees is increasing and their productivity and performance improvement is very important, the present study was performed to identify weaknesses and strengths of committee sessions. This analytical-descriptive study was conducted cross- sectional from January to April in 2012. Summary of 405 committee session's agendas related to 11 kinds of committees in 8 hospitals (out of 23 hospitals) of capital cities in 3 provinces of Sistan and Balouchestan, South Khorasan and Khorasan Razavi in Iran were extracted. Data was collected through a form and was analyzed by SPSS16 software using descriptive statistics and variance analysis and content analysis technique. This study showed that the number of hospital committee's sessions holding in 2012 was more than 2011.The differences between public and private hospitals in terms of the following subjects were significant (P-Value < 0.001). In terms of the number of selected policies, participants of the committees, and the duration of the sessions the public hospitals had better conditions. And regarding documentation process, feedback of decisions to personnel and the implementation of the formulated policies in the committees, private hospitals performed better. According to the results of this study, to improve the productivity of hospital committees, it is suggested to motivate senior, tactical and operational managers to appropriately participate in the committees and necessary planning for the committees in advance is mandatory.

Aim: The aim of this study was to reduce crossmatch to transfusion ratio through development of a new Blood Utilization Committee., Background: Blood utilization hinges on the cooperation between transfusion services, medical staff, nursing and administration. Transfusion committees have attempted to bring about better oversight and bridge the gap between departments but in our institution this did not work until we had a catalyst to drive the effort. The unabashed desire and enthusiasm of one of our cardiac surgeons for self-improvement led to the formation of a new Blood Utilization Committee in October of 2012., Study Design and Methods: Crossmatch and transfusion data were gathered from our blood bank information system starting with the 4th quarter of 2011 through the 1st quarter of 2013. The crossmatch to transfusion ratio (C:T) was calculated and comparisons were made between the results from before and after the initiation of the committee., Results: At the commencement of the committee the initial C:T for the cardiac team was 2.48. We calculated a decrease of the C:T to 1.5 four months after the November 2012 formation of the new committee. The P-value calculated (P<0.0005) proved that the decrease was statistically significant., Conclusion: The initial impulse generated by the cardiothoracic surgery team is now spreading to other DRG groups in our hospital and we are seeing a drop in their C:T as well. Better blood utilization is attainable when the physicians who perform most transfusions lead the charge., (Copyright © 2015. Published by Elsevier SAS.)

Organizational culture underlies every improvement strategy; without a strong culture, a change, even if initially successful, is short lived. Changing culture and improving quality require commitment of leadership, and leaders must play an active and visible role to articulate the vision and create the proper environment. Quality-improvement projects require a consistent framework for outlining a process, identifying problems, and testing, evaluating, and implementing changes. Wake Up Safe is a patient safety organization that strives to use quality improvement to make anesthesia care safer. Root cause analysis is a methodology in safety analytics based on a sequence of events model of safety., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Introduction: International research indicates that internal health and safety organizations (HSO) and health and safety committees (HSC) do not have the intended impact on companies' safety performance. The aim of this case study at an industrial plant was to test whether the HSO can improve company safety culture by creating more and better safety-related interactions both within the HSO and between HSO members and the shop-floor., Methods: A quasi-experimental single case study design based on action research with both quantitative and qualitative measures was used., Intervention: Based on baseline mapping of safety culture and the efficiency of the HSO three developmental processes were started aimed at the HSC, the whole HSO, and the safety representatives, respectively., Results: Results at follow-up indicated a marked improvement in HSO performance, interaction patterns concerning safety, safety culture indicators, and a changed trend in injury rates. These improvements are interpreted as cultural change because an organizational double-loop learning process leading to modification of the basic assumptions could be identified., Practical Applications: The study provides evidence that the HSO can improve company safety culture by focusing on safety-related interactions., (© 2013. Published by Elsevier Ltd and National Safety Council.)

Objective: This study was aimed at analyzing the participation of a committee formed by representatives of the community in tuberculosis control based on a participatory management model., Method: This is a Case Study involving a tuberculosis committee with data collected through semi-structured interviews conducted with nine individuals. The data, organized through the Association of Ideas Map technique, were analyzed based on the Social Constructionism perspective., Results: The participation of the Tuberculosis Committee studied was shown to be effective and associated with aspects articulated according to the measures taken by the social parties involved in the committee, culminating with assistances inserted into certain parts of the town's co-management., Conclusion: It was concluded that the reality of this case study shows that relationships among civil society can guide the management model in the search for effective processes of tuberculosis control.

Academic review committees would benefit from more details about the contributions made by individual researchers to papers with multiple authors, and also from more information about other types of scholarly communication.

The American College of Obstetricians and Gynecologists (the College) has a long history of leadership in ensuring that its educational mission is evidence based and unbiased. A predecessor to this Committee Opinion was published in 1985, making the College one of the first professional associations to provide guidance on this issue. The College has continued to update the ethical guidance on physician interactions with industry periodically. Obstetrician-gynecologists' relationships with industry should be structured in a manner that will enhance, rather than detract from, their obligations to their patients. The ideal behaviors set forth in this Committee Opinion will contribute toward maintaining patient trust in the specialty and avoiding conflicts of interest by College members.

Introduction: Mortality rate for childhood acute leukemia is an indicator of access to and efficacy of health services. Analysis of this indicator allows the identification of factors contributing to the development of the illness and the final condition of affected children., Objective: The operative experience results were described from data obtained by committee of analysis of institutional mortality by childhood acute leukaemia., Materials and Methods: Formal reports of deaths in children under 15 due to acute lymphoblastic or myeloid leukemia were provided to the National Cancer Institute of Colombia. A descriptive analysis of these reports from the period 2008-2010 was undertaken by the National Cancer Institute. Avoidability analysis was performed using the 1994 "three delays" model of Thaddeus and Maine., Results: Of 24 deaths analyzed, 21 were caused by acute lymphoblastic leukemia. The median age was 10.5 years. The delay 3 (get adequate and timely treatment) was identified in 83% of the cases and transfers during treatment were the most common limitation (66.7%). 83.3% of deaths were deemed unavoidable given the clinical conditions of the patients., Conclusions: Even though the delays identified did not affect mortality in a direct way, they did nonetheless constitute the basis for improvements to the quality of attention to children with cancer.

There has been a growing interest in the use of portfolios to assess nursing student progress in areas such as critical thinking, problem solving, and communication. The data obtained from student portfolios can be used to improve undergraduate nursing curricula; however in order for change to occur, closing the assessment feedback loop is essential. The portfolio program of one Midwestern school of nursing has successfully used portfolio evidence to effect undergraduate curricular change. This portfolio program, under the direction of the school's Portfolio Subcommittee, involves active participation by students, faculty and administration. Examples of curricular improvements based on portfolio findings included increasing rigor in course assignments, improving student self reflection, promoting students' ability to write in the discipline, and maintaining writing assignments in larger classes.

This article describes how a community hospital engaged nurses through the nursing shared governance model to select a PPM that aligned nursing values and priorities with the organization's vision and mission.

The residents and relatives committee is an area for exchange and expression concerning the running of the facility or unit caring for a resident. It is an important body which places the user at its centre but which can however reveal disparities in the way it operates.

The increasing complexity of cancer care makes organisation of clinical decision-making one of the key elements in high-quality cancer care. The great number of professionals involved in this disease means that communication and co-ordination among such professionals is of pivotal importance. The prospect of an organised multidisciplinary care is highlighted for its ability to move from a sequential model of care to progress towards an inclusive process led by a multidisciplinary team. Scientific evidence shows that such a perspective contributes to improved survival and quality of life of cancer patients. In the context of highly frequent, costly and clinically complex cancer diseases, the priority is to develop a different approach to its management, based on the expertise of professionals and teams by tumour location. The organisation and management of many hospitals, however, does not generally reflect this dimension. The process of care is based on very rigid hospital services which restrict cross-communication. This hinders a redistribution of responsibilities of the professionals with the greatest potential to improve clinical effectiveness. The present paper shows the difficulty in developing a model of integrated professional cooperation and identifies the different models of implementation of multidisciplinary care, using cancer as an example, in the context of the Spanish National Health System., (Copyright © 2011 SECA. Published by Elsevier Espana. All rights reserved.)

Objective: This study aimed to verify the performance of blood transfusion committees in transfusion services linked to the public blood bank network of the state of Minas Gerais., Methods: A cross-sectional observational study was conducted between 2007 and 2008 using questionnaires and proficiency tests to evaluate the reporting and investigation of transfusion reactions comparing transfusion services with and without transfusion committees in the public transfusion services of the state of Minas Gerais., Results: Nineteen of Hemominas own transfusion services and 207 that contracted the services of the foundation located in 178 municipalities were visited between 2007 and 2008. Established transfusion committees were present in 63.4% of the services visited. Transfusion incidents were reported by 53 (36.8%) transfusion services with transfusion committees and by eight (9.6%) without transfusion committees (p < 0.001) with 543 (97.5%) and 14 (2.5%) notifications, respectively. Of the reported transfusion incidents, 40 (75.5%) transfusion services with transfusion committees and only two (25%) of those without transfusion committees investigated the causes., Conclusion: The incidence of notification and investigation of the causes of transfusion reactions was higher in transfusion services where a transfusion committee was present. Despite these results, the performance of these committees was found to be incipient and a better organization and more effective operation are required.

State public health agencies face challenges when monitoring the efforts and effects of public health programs that use disparate strategies and address various diseases, locations, and populations. The external evaluators of a complex portfolio of grant funding sought a standardized reporting framework and tool that could be used for all grants in the portfolio, without having to redesign it for each disease or intervention approach. Evaluators iteratively reviewed grant-funded projects to identify common project delivery strategies, then developed and implemented a common reporting framework and spreadsheet-based data capture tool. Evaluators provided training, technical assistance, and ongoing data reviews. During 2 fiscal years, 103 public health programs throughout Colorado submitted quarterly reports; agencies funded to implement these programs ranged from small community-based organizations to university- and hospital-affiliated groups in urban and rural settings. Aggregated reports supported estimates of program reach by strategy and by disease area, and the system supported production of summary descriptions of program implementation. Standardized language and expectations for reporting helped to align grant applications and work plans with reporting tools. A common language and standardized reporting tool can be used for diverse projects in a comprehensive evaluation framework. Decentralized data collection using common spreadsheet software enabled the aggregation of common data elements across multiple programs and projects. Further refinements could enable wider dissemination of common reporting criteria and expectations.

Objective: To investigate the common syndromes, clinical symptoms and characteristics of chronic obstructive pulmonary disease at acute exacerbation stage (AECOPD)., Methods: Delphi method was used to organize the AECOPD expert questionnaire. This questionnaire was distributed to 30 selected experts of respiratory diseases. The resulting data were statistically analyzed by Chi-square test and statistical description such as mean, coefficient of variation and ratio of full marks. Common syndrome: mean≥3.00, coefficient of variation <30% and ratio of full marks≥10% and common clinical symptoms: for major symptoms present, the index mean≥4.00 and coefficient of variation <30% and for minor symptom, index mean≥3.00 and coefficient of variation <30% were used as criteria., Results: Twenty-nine valid expert questionnaires were received. The coefficient of positivity was 96.67%, of authority was 0.835 and of coordination equals 0.359 (χ(2)=463.15, P=0.001). The mean, coefficient of variation and ratio of full marks for AECOPD syndrome of wind and cold invasion of lung were 4.12, 21.50%, and 34.48%, respectively. Those for syndrome of exogenous cold-evil and fluid-retention were 4.39, 14.32%, 48.28%; those for syndrome of wind and heat invasion of lung were 3.54, 30.77%, 6.90%;those for syndrome of phlegm-heat obstruction of the lung were 4.85, 9.23%, 89.66%; those for syndrome of pulmonary stagnation of phlegm were 4.36, 15.57%, 48.28%; those for syndrome of external cold and internal heat were 4.59, 16.27%, 65.52%; those for syndrome of retention of phlegm and blood stasis in the lung were 4.54, 12.70%, 55.17%; those for syndrome of qi deficiency of the lung and spleen were 3.25, 27.30%, 13.79%; those for syndrome of qi deficiency of the lung and kidney were 3.32, 27.24%, 13.79%; those for syndrome of qi-yin deficiency of the lung and kidney were 3.29, 28.98%, 24.14%; those for syndrome of yin deficiency of the lung and kidney were 2.98, 32.71%, 3.45%; those for syndrome of blood stasis were 4.67, 10.29%, 62.07% and those for syndrome of fu shi were 3.07, 30.01%, 6.90%, all respectively. The blood stasis and fu shi were accompanying syndromes., Conclusion: Seven common syndromes of AECOPD are wind and cold invasion of lung, exogenous cold-evil and fluid-retention, phlegm-heat obstruction in the lung, pulmonary stagnation of phlegm qi deficiency of the lung and spleen, qi deficiency of the lung and kidney, as well as qi-yin deficiency of the lung and kidney. One additional syndrome that accompanies many of the afore-mentioned syndromes was blood stasis.