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IntroductionProviding higher quality medical care to workers with occupationally associated carpal tunnel syndrome (CTS) may reduce disability, facilitate return to work, and lower the associated costs. Although many workers' compensation systems have adopted treatment guidelines to reduce the overuse of unnecessary care, limited attention has been paid to ensuring that the care workers do receive is high quality. Further, guidelines are not designed to enable objective assessments of quality of care. This study sought to develop quality measures for the diagnostic evaluation and non-operative management of CTS, including managing occupational activities and functional limitations.MethodsUsing a variation of the well-established RAND/UCLA Appropriateness Method, we developed draft quality measures using guidelines and literature reviews. Next, in a two-round modified-Delphi process, a multidisciplinary panel of 11 U.S. experts in CTS rated the measures on validity and feasibility.ResultsOf 40 draft measures, experts rated 31 (78%) valid and feasible. Nine measures pertained to diagnostic evaluation, such as assessing symptoms, signs, and risk factors. Eleven pertain to non-operative treatments, such as the use of splints, steroid injections, and medications. Eleven others address assessing the association between symptoms and work, managing occupational activities, and accommodating functional limitations.ConclusionsThese measures will complement existing treatment guidelines by enabling providers, payers, policymakers, and researchers to assess quality of care for CTS in an objective, structured manner. Given the characteristics of previous measures developed with these methods, greater adherence to these measures will probably lead to improved patient outcomes at a population level.

Copyright of Movimento (0104754X) is the property of Movimento, da Escola de Educacao, Fisica, Fisioterapia e Danca and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

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.)

Copyright of Journal of Nursing UFPE / Revista de Enfermagem UFPE is the property of Revista de Enfermagem UFPE and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

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.

São descritas atividades de extensão no Comitê de Prevenção da Mortalidade Infantil da 15ª Regional de Saúde do Paraná e a aproximação com estatísticas de saúde. O projeto articula parceria entre o Departamento de Enfermagem da Universidade Estadual de Maringá e Secretaria de Saúde do Estado com inserção de alunos de enfermagem. São apresentadas as atribuições do Comitê, avanços desde o inicio do projeto, como a compreensão dos sistemas de informação e importância da investigação do óbito infantil, mas existem desafios, como melhorar a qualidade do preenchimento da ficha de investigação. A parceria ensino/serviço aprimora a qualidade do trabalho, dos Sistemas de Informação, amplia a visão do aluno sobre desigualdades intraurbanas e acesso, incentivando seu comprometimento com a saúde coletiva.Son descriptas actividades desarrolladas al Comité Regional de Prevención de la Mortalidad Infantil de la 15ª Regional de Salud de Paraná (15ª RS) y los Sistemas de Información (SI). El proyecto articula sociedad del Departamento de Enfermería de la Universidad Estadual de Maringá y la 15ª RS. Son presentadas atribuciones del Comité, dificultades en la investigación del óbito infantil, manoseo y comprensión, por los participantes, de los SI. Son presentados avances, pero existen desafíos como la calidad de la ficha de investigación del óbito. La sociedad enseñanza/servicio perfecciona la calidad del trabajo del Comité, de los SI y amplia la visión del alumno sobre desigualdades intra urbanas y acceso a servicios incentivando su formación más comprometida con la salud colectiva.Extra classes' activities with the Committee of Infant Mortality Prevention of the 15th Paraná Health Office (15th HO) and some approaches to health statistics, are described. Those activities articulate a partnership between the Nursing Department of the State University of Maringá and the 15th HO. A description of the Committee's attributions, the advances since the partnership start, the importance of the infant mortality investigations as well as understanding the information systems are presented. There are still challenges such as to improve the quality of the inquiry form. The partnership University -15th HO improves the quality of the Information Systems, provides the students a wider perspective of the intra-urban inequalities to access to health services, stimulating their commitment with public health.

Este estudo teve como objetivo analisar óbitos infantis na 15ª Regional de Saúde do Paraná utilizando o resultado das investigações do Comitê de Prevenção da Mortalidade Infantil. Trata-se de um estudo descritivo exploratório, a partir do Sistema de Investigação de Mortalidade Infantil e Sistema de Informações sobre Nascidos Vivos no período de 2000 a 2006. O coeficiente de mortalidade infantil diminuiu de 13,2% para 11,6%. Dos 799 óbitos, o Comitê investigou 74,5%; destes, 56,5% no período neonatal precoce. As afecções originadas no período perinatal e as malformações congênitas foram causas principais de óbito. Foram considerados reduzíveis 70,1% dos óbitos. A redutibilidade foi maior para óbitos de mães adolescentes, recém-nascidos ≥ 2500g, parto normal, raça/cor preta, parda e indígena e mães sem consulta de pré-natal. As análises dos óbitos devem ser efetuadas mais próximas das equipes de saúde da família, que conhecem as gestantes para aprimoramento do trabalho e qualidade nas análises do Comitê.Estudio que tuvo como objetivo analizar las muertes infantiles en la 15ª Región de Salud de Paraná basadas en los resultados de investigaciones del Comité de Prevención en Mortalidad Infantil. Se trata de un estudio descriptivo exploratorio utilizando para ello el Sistema de Investigación de Mortalidad Infantil y el Sistema de Informaciones sobre los Nacidos Vivos durante el período de 2000 a 2006. El coeficiente de mortalidad infantil disminuyó de 13,2% para 11,6%. Del total de muertes encontradas (799), el comité investigó 74,5%, de las cuales 56,5% fueron durante el período neonatal precoz. Las afecciones durante el período perinatal y las malformaciones congénitas fueron las principales causas de muerte. El 70,1% de las muertes fueron consideradas como deducibles. De la misma forma, se dedujo que la mayor proporción de muertes fueron las de niños de madres adolescentes, recién nacidos ≥2500g de peso, parto normal, raza/color negra, parda e indígena, así como aquellas madres que no tuvieron consulta prenatal. Análisis como estos, deben ser realizados de forma más visible para los equipos de salud de la familia, quienes conocen a las gestantes, de esta forma será posible mejorar la forma del trabajo y la calidad en las discusiones dentro del Comité.This study had the purpose to analyze infant deaths in the 15th Regional Health Center of Paraná State, using the result of the investigations of the Committee for the Prevention of Infant Mortality. It is a descriptive exploratory study based on the System of Investigation of Infant Mortality and on the Information System of Live Births in the period of 2000-2006. The infant mortality coefficient decreased from 13.2% to 11.6%. Of the 799 deaths, the Committee investigated 74.5%; 56.5% of which were in the early neonatal period. The diseases originated in the perinatal period and the congenital malformations were the main causes of death. Among them, 70.1% were considered reducible. The reducibility of death was greater among adolescent mothers' babies, newborns of ≥ 2500g, normal childbirth, black, mulatto and indigenous races, and on mothers without prenatal care. The analyses of the deaths should be performed together with the family health teams, who know the pregnant women best, in order to improve the work and the quality of the analyses from the Committee.

Este artigo tem por objetivo relatar a experiência de implantação e funcionamento dos Comitês de Prevenção da Mortalidade Infantil no Estado do Paraná, Brasil, apresentando as estratégias de operacionalização, composição e fluxo dos três níveis: estadual, regional e municipal. Para a efetiva implantação dessa proposta, foi necessário preparar profissionais para investigar o óbito infantil e, portanto, foram realizados treinamentos de Multiplicadores para Investigação dos Óbitos Infantis. Em dois anos, os comitês analisaram 50% dos óbitos do Estado. Pretende-se ampliar gradativamente o número de óbitos analisados, bem como dar continuidade ao acompanhamento e à reestruturação dos comitês, visando a obter melhor desempenho, mais agilidade e melhor qualidade dos dados.This article reports on the implementation and operation of committees for the prevention of infant mortality in the State of Paraná, Brazil, with the operational strategies, formation, and relations at three levels: State, regional, and municipal. To implement the committees it was necessary to train professionals to investigate infant deaths. In two years the committees analyzed 50% of the infant deaths occurring in the State. The goal is to increase the number of cases analyzed and to continue to monitor the committees' work, seeking improved performance, agility, and data quality.

A precariedade das informações disponíveis e as dificuldades para a obtenção de dados consistentes sobre a morte materna, em nosso país, põem em questão a confiabilidade das estatísticas oficiais. Os Comitês de estudos da morte materna se constituem uma das estratégias para a superação dessas dificuldades. Este artigo propõe algumas reflexões sobre aspectos da atuação dos Comitês com base na análise do percurso do Comitê do Estado de São Paulo que revelou, entre outras coisas, sua dimensão enquanto instrumento político e de controle social, situando-o, assim, para além de uma estratégia de vigilância epidemiológica. Tal posição tem trazido impasses ao trabalho de investigação da morte materna, e as adversidades decorrentes, como uma frágil inserção e pequena autoridade institucional, têm prejudicado enormemente o cumprimento das suas funções, tanto no âmbito técnico como no plano político. É necessário um reposicionamento que conduza ao seu fortalecimento como mecanismo de investigação e instância de proposição das medidas para a prevenção e redução da morte materna.The precarious available information and difficulties in obtaining consistent data on maternal deaths in Brazil raise doubts as to the reliability of official statistics. The Committees on Maternal Mortality are considered an important strategy for overcoming these difficulties. This article discusses certain aspects of the Committees' performance, based on the case of the State of São Paulo, demonstrating the Committee's role as a policy and advocacy instrument, thus going beyond merely an epidemiological surveillance strategy. This position has produced impasses in the work involving investigation of maternal deaths, and the resulting adversities, including limited institutional authority and power to intervene, have greatly jeopardized its functions both in the technical and political arenas. The Committee should be repositioned in order to strengthen itself as both a mechanism for investigation and a collective stakeholder to propose measures for the prevention and reduction of maternal mortality.

Se presenta un análisis de la evolución del Comité de evaluación de intervenciones quirúrgicas en el Hospital Universitario «Comandante Manuel Fajardo», en el trienio 1995-1997 en cirugía mayor. Se comprueba que el 99,1 % de las operaciones tuvo evaluación A-1 y B-1, y no fue calificado sólo el 0,89 %. En la urgencia la evaluación de B-1, fue más frecuente que en el electivoThe evolution of the Committee of Evaluation of Surgical Procedures in relation to major surgery at the "Comandante Manuel Fajardo" Teaching Hospital was analyzed from 1995 to 1997. It was observed that 99.1%of the operations had evaluation A-1 and B-1 and that only 0.89% were not evaluated. The evaluation of B-1 was more frequent in emergency than in elective surgery

Copyright of Revista Brasileira em Promoção da Saúde is the property of Revista Brasileira em Promocao da Saude and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Revista Brasileira em Promoção da Saúde is the property of Revista Brasileira em Promocao da Saude and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background We sought to describe the components and processes in a violence risk assessment and management system, including electronic record requirements in the Veterans Health Administration (VA). We present information on system-level variation among program elements and their association with perceived and measured effectiveness. Methods We conducted a cross-sectional survey of Chiefs of Staff (COS) at 140 VA hospitals across the United States about specific disruptive behavior program elements, such as committee processes, patient referrals, and outcome patterns. We assessed COS perceived effectiveness of the processes. We compared COS perceptions with employee-reported assault-related incident rates and workers compensation lost time claim rates for assault-related injuries for 2009 and 2010. Results We found the violence risk assessment and management system is heavily used, often with guidance to provide police protection for providers. COS respondents were generally satisfied with design and performance of the system. Committee processes and perceptions of effectiveness were associated with reduction in assault-related incident rates. Conclusions VA's system was considered effective by system owners and users may be effective at reducing assaulted-related injuries. Am. J. Ind. Med. 55:1009-1017, 2012. © 2012 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

Objectives: To describe the administrative functioning of all current Canadian psychiatry residency training programs (RTPs) and to suggest available improvements to existing systems.Method: We obtained data about the 2004 RTPs by distributing 2 questionnaires to all Canadian psychiatry RTPs.Results: Residency program committees (RPCs) are mainly consultative and carry only a small amount of the workload of managing a residency program. Program directors (PDs) manage more than 80% of the work and report that the time allowance to perform their duties is suboptimal. PDs remain in office for about 5 years, departing during or at the end of a predetermined second term.Conclusion: RPCs bear only a small amount of the workload generated by the RTP. We piloted administrative changes that led to more equitable work distribution. [ABSTRACT FROM AUTHOR]

Background. Consent forms are required in most bio medical research involving, human subjects. In recent years, a number of studies from different disciplines ha\e reported problems related to consent form readability. Methods. We analyzed 284 consent forms submitted to and approved by five institutional review boards (IRBs) (schools of Medicine, Nursing, Academic Affairs, Dentistry, and Public Health) at one university and one IRB at another. We examined consent form readability scores and factors that might relate to readability. Results. The average reading level of all consent forms was high: 12.2., which corresponds roughly to a 12th-grade reading level. Less than 10% of all consent forms were written at a 10th grade reading level or below. Thirty-two percent of all consent forms had no evidence of revisions, and less than 2% of consent forms were revised more than once. Readability scores were not related to consent form revisions, the type of IRB, the year of study, or the university where the research was conducted. Conclusions. Poor readability- of consent forms probably occurs in all university related research. We recommend that IRRs require readability checks for research consent forms before researchers submit their proposals to an IRB. [ABSTRACT FROM AUTHOR]

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.)

Este artigo tem por objetivo relatar a experiência de implantação e funcionamento dos Comitês de Prevenção da Mortalidade Infantil no Estado do Paraná, Brasil, apresentando as estratégias de operacionalização, composição e fluxo dos três níveis: estadual, regional e municipal. Para a efetiva implantação dessa proposta, foi necessário preparar profissionais para investigar o óbito infantil e, portanto, foram realizados treinamentos de Multiplicadores para Investigação dos Óbitos Infantis. Em dois anos, os comitês analisaram 50% dos óbitos do Estado. Pretende-se ampliar gradativamente o número de óbitos analisados, bem como dar continuidade ao acompanhamento e à reestruturação dos comitês, visando a obter melhor desempenho, mais agilidade e melhor qualidade dos dados.

A precariedade das informações disponíveis e as dificuldades para a obtenção de dados consistentes sobre a morte materna, em nosso país, põem em questão a confiabilidade das estatísticas oficiais. Os Comitês de estudos da morte materna se constituem uma das estratégias para a superação dessas dificuldades. Este artigo propõe algumas reflexões sobre aspectos da atuação dos Comitês com base na análise do percurso do Comitê do Estado de São Paulo que revelou, entre outras coisas, sua dimensão enquanto instrumento político e de controle social, situando-o, assim, para além de uma estratégia de vigilância epidemiológica. Tal posição tem trazido impasses ao trabalho de investigação da morte materna, e as adversidades decorrentes, como uma frágil inserção e pequena autoridade institucional, têm prejudicado enormemente o cumprimento das suas funções, tanto no âmbito técnico como no plano político. É necessário um reposicionamento que conduza ao seu fortalecimento como mecanismo de investigação e instância de proposição das medidas para a prevenção e redução da morte materna.

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.