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Introduction: With an unknown scenario in the face of the pandemic and the uncertainties on the part of the population and health professionals, doubts have arisen, growing inside and outside health institutions, thus generating a need for systematic and effective action by the control committee of hospital infection (CCIH) in the search for strategies for the reorganization of the units, decision making, elaboration of protocols and training for the health team. Objective: To verify in national and international publications, the main measures and actions implemented by the hospital infection control commission in the face of the new SARS-CoV-2 Coronavirus. Methodology: This is an integrative literature review, produced from the analysis of articles in the Virtual Health Library (VHL), in the following databases: Latin American and Caribbean Literature on Health Sciences (LILACS), Library of Medicine of the United States of America (MEDLINE), Nursing Database (BDENF). Discussion: After carrying out an analytical reading, 08 articles were selected, as they had content that contributed to the development of the study, from the articles found in the databases. With this, it was possible to identify the actions carried out by the hospital infection control commission. Conclusion: The performance of the CCIH is extremely important in the face of the pandemic, and it was challenging for professionals due to the lack of preparation, providing a strategic look so that operational and managerial actions can be organized, prioritized and implemented in a unison. Introducción: Con un escenario desconocido ante la pandemia y las incertidumbres por parte de la población y los profesionales de la salud, han surgido dudas, creciendo dentro y fuera de las instituciones de salud, generando así la necesidad de una actuación sistemática y eficaz por parte del comité de control de infección hospitalaria (CCIH) en la búsqueda de estrategias para la reorganización de las unidades, toma de decisiones, elaboración de protocolos y capacitación del equipo de salud. Objetivo: Verificar en publicaciones nacionales e internacionales, las principales medidas y acciones implementadas por la comisión de control de infecciones hospitalarias frente al nuevo Coronavirus SARS-CoV-2. Metodología: Se trata de una revisión integrativa de la literatura, producida a partir del análisis de artículos de la Biblioteca Virtual en Salud (BVS), en las siguientes bases de datos: Literatura Latinoamericana y del Caribe en Ciencias de la Salud (LILACS), Biblioteca de Medicina de los Estados Unidos de América (MEDLINE), Base de datos de enfermería (BDENF). Discusión: Después de realizar una lectura analítica, de los artículos encontrados en las bases de datos, se seleccionaron 08 artículos, por tener contenido que contribuyera al desarrollo del estudio. Con ello, fue posible identificar las acciones realizadas por la comisión de control de infecciones hospitalarias. Conclusión: La actuación del CCIH es sumamente importante frente a la pandemia, y fue un desafío para los profesionales por la falta de preparación, brindando una mirada estratégica para que las acciones operativas y gerenciales puedan ser organizadas, priorizadas e implementadas al unísono. Com um cenário desconhecido frente à pandemia e as incertezas por parte da população e dos profissionais de saúde foram-se apresentando dúvidas, crescentes dentro e fora das instituições de saúde, gerando assim uma necessidade de atuação sistemática e eficaz da comissão de controle de infecção hospitalar (CCIH) na busca de estratégias para a reorganização das unidades, tomadas de decisões, elaboração de protocolos e treinamentos para equipe de saúde. Objetivo: Verificar nas publicações nacionais e internacionais, as principais medidas e ações implementadas pela comissão de controle de infecção hospitalar no enfrentamento do novo Coronavírus SARS-CoV-2. Metodologia: Trata-se de uma revisão integrativa da literatura, produzida a partir da análise de artigos na Biblioteca Virtual da Saúde (BVS), nas seguintes bases de dados: Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), Biblioteca Nacional de Medicina dos Estados Unidos da América (MEDLINE), Base de Dados de Enfermagem (BDENF). Discussão: Após a realização de uma leitura analítica, foram selecionados 08 artigos, por possuírem conteúdos contribuintes para o desenvolvimento do estudo, dos artigos encontrados nas bases de dados. Com isso foi possível identificar as ações realizadas pela comissão de controle de infecção hospitalar. Conclusão: A atuação da CCIH é de extrema importância diante da pandemia, e foi desafiadora para os profissionais devido à falta de preparo, proporcionando um olhar estratégico para que as ações operacionais e gerenciais possam ser organizadas, priorizadas e implantadas de forma uníssona.

Objectives: To reveal the causes of blindness in patients who applied to the medical board of a hospital serving the Southeastern Anatolian region of Turkey. Materials and Methods: We retrospectively reviewed the records of 340 bilaterally blind patients who were among 3,234 patients referred to our hospital’s medical board between March 2016 and November 2018 for disability evaluation and rating report. Results: One-hundred sixty (48.8%) were female, 174 (51.2%) were male, and the mean patient age was 64.3±25.4 years. The most common cause of blindness was cataract in 158 eyes (23.2%), followed by corneal opacities in 114 eyes (16.8%), retinal dystrophy in 92 eyes (13.5%), optic atrophy in 73 eyes (10.7%), glaucoma in 65 eyes (9.6%), and phthisis bulbi in 59 eyes (8.7%). Conclusion: Avoidable causes of blindness such as cataract and corneal opacity (secondary to trachoma) were detected at high rates. Therefore, we believe that more awareness and effort might be required in our region to reduce avoidable blindness due to these causes.

Coronavirus disease 2019 (COVID-19) has rapidly become a ubiquitous health concern and a global pandemic. In an effort to slow disease spread and protect valuable healthcare resources, cessation of non-essential surgery including many orthopaedic procedures, has recently become commonplace in areas affected by the novel coronavirus. 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 at a tertiary care and academic center has taken an active role in enacting protocol changes in anticipation of COVID-19. In the past four weeks, since these changes were enacted, the Spine division has performed ten surgeries compared to an average of 60.4 spine cases performed annually over the same time period between 2015-2019. Furthermore, the number of clinic visits decreased from an average of 417.4 over this time period, to 322 with the percentage of new patient visits decreasing from 28% to 20%. During COVID-19, 318 of the 322 spine clinic visits were performed remotely via telehealth.The response to COVID-19 has been variable among surgical subspecialties and geographic regions. We present the changes that have been made regarding the care of spine patients at a busy academic center. 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.

The Political Action Committee (PAC) of the American Association of Orthopaedic Surgeons, also known as the OrthoPAC, is one of the most powerful and well-respected healthcare PACs in Washington, DC. Since its inception in 1999, the OrthoPAC has advocated at the federal level for orthopaedic patients and orthopaedic surgery as a profession. This manuscript will familiarize the reader with PACs, the history and structure of the OrthoPAC, important accomplishments of the OrthoPAC, current legislative positions, and leadership/organization. We also review the various ways that orthopaedic surgeons can engage in advocacy for musculoskeletal care.

International audience; The first wave of the SARS-CoV-2 pandemic required an unprecedented and historic increase in critical care capacity on a global scale in France. Authors and members from the ACUTE and REANIMATION committees of the French Society of Anaesthesia and Intensive Care (SFAR) wished to share experience and insights gained during the first weeks of this pandemic. These were summarised following the World Health Organization Response Checklist and detailed according to the subsequent subheadings: 1. Command and Control, 2. Communication, 3. Safety and Security, 4. Triage, 5. Surge Capacity, 6. Continuity of essential services, 7. Human resources, 8. Logistics and supply management, 9. Training/Preparation, 10. Psychological comfort for patients and next of kin, 11. Learning and 12. Post disaster recovery. These experience-based recommendations, consensual across all members from both committees of our national society, establish a practical framework for medical teams, either spared by the first wave of severe COVID patients or preparing for the second one.

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.

Résumé Ce travail étudie l’impact de l’épidémie de SARS-CoV2 et des recommandations qui ont été diffusées depuis le 16 mars sur l’activité des réunions de concertations pluridisciplinaires (RCP). L’activité des RCP d’Occitanie a été mesurée à partir des fiches RCP extraites du dossier communicant de cancérologie qui regroupe toutes les RCP. L’activité précédant le confinement a été comparée à celles des périodes de confinement (jusqu’au 24 avril) et des périodes équivalentes en 2019. Les critères de jugement étaient le nombre de réunions tenues, le nombre moyen de dossiers examinés par réunion, dont les premières présentations, et le nombre moyen de médecins présents. Les 191 RCP ont organisé 3943 réunions et étudié 72 070 dossiers (dont 30 127 premières soumissions). Nous avons observé une baisse de 8 % du nombre de réunions après le confinement. Le nombre de dossiers examinés a diminué de 23 % dans le mois suivant et jusqu’à 33 % dans la troisième quinzaine. Le nombre de médecins participant aux réunions a diminué initialement de 25 %. L’impact a été plus important dans la partie méditerranéenne de la région. Cette première étude à l’échelle d’une région montre que si l’impact de l’épidémie sur le nombre de RCP qui se sont réunies a été modeste, et que les RCP ont suivi les recommandations d’optimisation du quorum, la diminution du nombre de premières présentations laisse présager un retard au diagnostic et à la prise en charge des patients. Elle devra être complétée par des travaux qualitatifs et quantitatifs afin d’estimer l’impact réel de l’épidémie sur la prise en charge globale oncologique.

Objective: To report the experience of the Nursing Committee for Coping with COVID-19 in Bahia. Methods: The experience report describes motivation, objectives, representatives, organization, working groups, activities and impact of the Committee actions. Results: The Committee consists of educational institutions and class representation. It accepts demands, questions and complaints from nursing workers, acts in favor of safe care and inspection of health and safety conditions at work. Five working groups and six technical support groups were formed. These groups address Communication, Review of Health Services Contingency Plans, Assistance to Long-Term Institutions, Epidemiology and External Activities. An Instagram account was created for quick and reliable access to information, and also an email to meet demands and monitor COVID-19 cases. Conclusion: The results of the Committee work contribute to guide, support, value and defend nursing workers in coping with COVID-19

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

Introduction Neurostimulation involves the implantation of devices to stimulate the brain, spinal cord, or peripheral or cranial nerves for the purpose of modulating the neural activity of the targeted structures to achieve specific therapeutic effects. Surgical placement of neurostimulation devices is associated with risks of neurologic injury, as well as possible sequelae from the local or systemic effects of the intervention. The goal of the Neurostimulation Appropriateness Consensus Committee (NACC) is to improve the safety of neurostimulation. Methods The International Neuromodulation Society (INS) is dedicated to improving neurostimulation efficacy and patient safety. Over the past two decades the INS has established a process to use best evidence to improve care. This article updates work published by the NACC in 2014. NACC authors were chosen based on nomination to the INS executive board and were selected based on publications, academic acumen, international impact, and diversity. In areas in which evidence was lacking, the NACC used expert opinion to reach consensus. Results The INS has developed recommendations that when properly utilized should improve patient safety and reduce the risk of injury and associated complications with implantable devices. Conclusions On behalf of INS, the NACC has published recommendations intended to reduce the risk of neurological injuries and complications while implanting stimulators.

Introduction The Neurostimulation Appropriateness Consensus Committee (NACC) was formed by the International Neuromodulation Society (INS) in 2012 to evaluate the evidence to reduce the risk of complications and improve the efficacy of neurostimulation. The first series of papers, published in 2014, focused on the general principles of appropriate practice in the surgical implantation of neurostimulation devices. The NACC was reconvened in 2014 to address specific patient care issues, including bleeding and coagulation. Methods The INS strives to improve patient care in an evidence-based fashion. The NACC members were appointed or recruited by the INS leadership for diverse expertise, including international clinical expertise in many areas of neurostimulation, evidence evaluation, and publication. The group developed best practices based on peer-reviewed evidence and, in the absence of specific evidence, on expert opinion. Recommendations were based on international evidence in accordance with guideline creation. Conclusions The NACC has recommended specific measures to reduce the risk of bleeding and neurological injury secondary to impairment of coagulation in the setting of implantable neurostimulation devices in the spine, brain, and periphery.

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.

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.

The European Board of Medical Genetics: development of a professional registration system in Europe

Despite the fact that incident review committees have been a key component of quality improvement in behavioral health settings for decades, specific models of how these committees are structured and operate are not well described. We present a model for an incident review committee that has been implemented in 2 large, academic acute care psychiatric hospitals. We believe the model not only permitted us to efficiently and effectively review untoward incidents, but that it also provided an approach to calibrating standards of care for the institution, engaging physicians in an interdisciplinary effort, promulgating a culture of quality review and improvement throughout the organization, promoting continuity and sustainability of the incident review process, and, most importantly, driving beneficial change in clinical practice. Demonstration of the effectiveness of this model requires formal investigation.

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.

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 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.

Diagnostics are a cornerstone of the practice of infectious diseases. However, various limitations frequently lead to unmet clinical needs. In most other domains, diagnostics focus on narrowly defined questions, provide readily interpretable answers, and use true gold standards for development. In contrast, infectious diseases diagnostics must contend with scores of potential pathogens, dozens of clinical syndromes, emerging pathogens, rapid evolution of existing pathogens and their associated resistance mechanisms, and the absence of gold standards in many situations. In spite of these challenges, the importance and value of diagnostics cannot be underestimated. Therefore, the Antibacterial Resistance Leadership Group has identified diagnostics as 1 of 4 major areas of emphasis. Herein, we provide an overview of that development, highlighting several examples where innovation in study design, content, and execution is advancing the field of infectious diseases diagnostics.

In this issue of JAMA, Zapata and colleagues discuss framing the provision of unnecessary medical care as a patient safety problem and managing this problem using the hospital patient safety committee.1 The case presented highlights the lack of clarity about who is accountable for addressing overuse issues. All hospitals are concerned with the safety of their patients, and the authors provide a thoughtful discussion of the merits and challenges of using patient safety infrastructure to target overuse. To retain focus on safety issues while facilitating greater attention to overuse requires defining the relationship between overuse and patient safety.