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Surgical Processes (surgical + process)
Selected AbstractsCUMULATIVE SUM TECHNIQUES FOR SURGEONS: A BRIEF REVIEWANZ JOURNAL OF SURGERY, Issue 7 2007Cheng-Hon Yap There has been increasing awareness of the need for monitoring the quality of health care, particularly in the area of surgery. The Cumulative Summation (Cusum) techniques have emerged as a popular tool for performance monitoring in surgery. They allow one to judge whether a given variation in performance is probably due to chance or greater than could be expected from random variation and thus a cause for concern. The Cusum techniques are simple to carry out and can be applied to any surgical process with a binary outcome. Four parameters need to be set in advance: acceptable outcome rate, unacceptable outcome rate, Type I and Type II error rates. In this article, we review the history, statistical methods and potential applications for the Cusum techniques in the field of surgery and illustrate the two common forms of charting (cumulative failure and Cusum charting) by using unadjusted outcome data from the Geelong Hospital and St Vincent's Hospital cardiac surgery databases. [source] The Fivefold Root of an Ethics of SurgeryBIOETHICS, Issue 3 2002Miles Little Surgical ethics have generally been framed as general medical ethics applied to surgical contexts. This model is helpful, but may miss some of the special features of the surgical process and relationship. It is suggested in this paper that there are five categories of experience and relationship which are especially important in surgery ,rescue, proximity, ordeal, aftermath and presence. The sense of rescue, the feeling of relational proximity, the ordeal and the aftermath of surgery are things which the patient experiences. Understanding these experiences allow surgeons to understand what may be asked of them in an ethical sense. Recognition of the reality and validity of each category in the surgical process highlights the importance of presence, the acts by which the surgeon demonstrates that he is present to the patient throughout the surgical process and its aftermath. While the teaching of communication skills may never compensate for insensitivity, the ideal of presence as virtue and duty can be taught by precept and example. [source] The Relationship between Patients' Perception of Care and Measures of Hospital Quality and SafetyHEALTH SERVICES RESEARCH, Issue 4 2010Thomas Isaac Background. The extent to which patient experiences with hospital care are related to other measures of hospital quality and safety is unknown. Methods. We examined the relationship between Hospital Consumer Assessment of Healthcare Providers and Systems scores and technical measures of quality and safety using service-line specific data in 927 hospitals. We used data from the Hospital Quality Alliance to assess technical performance in medical and surgical processes of care and calculated Patient Safety Indicators to measure medical and surgical complication rates. Results. The overall rating of the hospital and willingness to recommend the hospital had strong relationships with technical performance in all medical conditions and surgical care (correlation coefficients ranging from 0.15 to 0.63; p<.05 for all). Better patient experiences for each measure domain were associated with lower decubitus ulcer rates (correlations ,0.17 to ,0.35; p<.05 for all), and for at least some domains with each of the other assessed complications, such as infections due to medical care. Conclusions. Patient experiences of care were related to measures of technical quality of care, supporting their validity as summary measures of hospital quality. Further study may elucidate implications of these relationships for improving hospital care. [source] Quantitative evaluation of prostatectomy for benign prostatic hypertrophy under a national health insurance law: a multi-centre studyJOURNAL OF EVALUATION IN CLINICAL PRACTICE, Issue 1 2002D. Pilpel PhD Abstract Assessing regional variation between various medical centres in diagnostic and surgical processes is an approach aimed at evaluating the quality of care. This study analyses the differences between eight medical centres in Israel, where all citizens are covered by medical insurance, through the National Health Insurance Law (NHIL). The analysis refers to the diagnostic process, type of surgery and immediate post-surgical complications associated with prostatectomy for benign prostatic hypertrophy (BPH), which is the most frequent surgical procedure performed on men aged 50+. The study sample was comprized of 261 consecutive prostatectomy patients operated on in eight Israeli medical centres (MC), located in various parts of the country, between November 1996 and April 1997. Co-operation with participating directors of surgical wards was obtained after confidentiality of information had been assured. Surgeons in selected departments abstracted data routinely recorded in the patient's file and filled-out a standard one-page questionnaire. The following items were included: age, the presence of accompanying chronic diseases, preoperative tests, type of operation, and post-surgical complications. In the various MCs 32.6% of the patients underwent more than five preoperative tests ranging from 8.9% to 88.9% (<0.01). Assessment of kidney and bladder normality ranged from 75% to 100% (P < 0.01). The rate of patients whose prostatic symptoms (I-PSS) were assessed ranged from 0% to 79% (P < 0.01). There were also differences in severity of prostatism between the MCs, with severe symptoms ranging from 54.0% to 89.3% (P < 0.05), for type of operation performed (for ,open' prostatectomies, 35.4% to 68.0%, P < 0.01) and post-operative complications (19.0% to 41.6%, P = 0.07). After controlling for case-mix, type of operation was the most important predictor for post-surgical complications. MCs with low volume of surgeries had a higher rate of postoperative complications. We conclude that diagnostic and type of operation and post-surgical complications differed between various MCs. Participating surgeons were willing to fill out a one-page standard questionnaire from data routinely recorded in patients' files. [source] Opening the black box of cancer surgery quality: WebSMR and the Alberta experienceJOURNAL OF SURGICAL ONCOLOGY, Issue 8 2009L.A. Mack MD Abstract A web-based synoptic operative report, the WebSMR (Surgical Medical Record), was developed to define and improve the quality of cancer surgery. Surgeons accurately record the essential steps of an operation including important decision-making in an analyzable format. Outcomes can be reviewed with provincial aggregates for quality improvement and maintenance of certification. Future synoptic pathology and follow-up templates will open the "black box" of surgical processes to define quality indicators for the improvement of cancer outcomes. J. Surg. Oncol. 2009;99:525,530. © 2009 Wiley-Liss, Inc. [source] Thyrocyte integration, and thyroid folliculogenesis and tissue regeneration: Perspective for thyroid tissue engineeringPATHOLOGY INTERNATIONAL, Issue 6 2001Shuji Toda The thyroid gland is composed of many ball-like structures called thyroid follicles, which are supported by the interfollicular extracellular matrix (ECM) and a capillary network. The component thyrocytes are highly integrated in their specific structural and functional polarization. In conventional monolayer and floating culture systems, thyrocytes cannot organize themselves into follicles with normal polarity. In contrast, in 3-D collagen gel culture, thyrocytes easily form stable follicles with physiological polarity. Integration of thyrocyte growth and differentiation results ultimately in thyroid folliculogenesis. This culture method and subacute thyroiditis are two promising models for addressing mechanisms of folliculogenesis, because thyroid-follicle formation actively occurs both in the culture system and at the regenerative phase of the disorder. The understanding of the mechanistic basis of folliculogenesis is prerequisite for generation of artificial thyroid tissue, which would enable a more physiological strategy to the treatment of hypothyroidism caused by various diseases and surgical processes than conventional hormone replacement therapy. We review here thyrocyte integration, and thyroid folliculogenesis and tissue regeneration. We also briefly discuss a perspective for thyroid tissue regeneration and engineering. [source] | ||||||||||