A survey on current practice of informed consent process in surgical specialties of a tertiary teaching hospital center: What is the state of play?

Background Informed consent is essential in current medical practice and should be a global standard to be sought at all instances when doctors interact with patients. The aim of this study was to evaluate compliance to the guidelines of the Portuguese health entity regarding the correct filling process of informed consent. Methods A prospective observational survey was conducted upon arrival of the patient at the operating room of a tertiary teaching hospital center in Portugal, in march 2021, to verify the presence of informed consent in the clinical process. A sample of 202 clinical files was randomly collected. Results Only 47% of the patients had the informed consent document in the clinic process and only 45% of the total clinical files had the informed consent signed by the patient. Merely 21.8% of the informed consents respected all the items recommended by the guidelines of the Portugal health entity. Most of the surgical informed consent (SIC) had only basic information and only a lower percentage had reports about the surgical procedure, information regarding the treatment, possible consequences of a missed treatment or complications and possible treatment alternatives. Those results didn’t conform to the standard regulations of the Portuguese health guidelines regarding SIC. Conclusion Even though improvements in SIC were attained in recent years, our study suggests that the implementation of SIC is still suboptimal in surgical practice. It is important to raise awareness for the obtention of SIC by the healthcare team, because complete information before an invasive procedure is an ethical requirement.

SEVERE COMBINED IMMUNODEFICIENCY SCREENING AND STEM CELL TRANSPLANT-AN ECONOMIC EVALUATION SCHEME

Background: Severe Combined Immunodeficiency (SCID) is a rare genetic disease that affects newborn immune system and costs healthcare system a substantial amount of money. Screening and stem cell transplant may offer a cost-effective alternative to the current medical practice. Objective: To determine the cost-effectiveness of screening newborn for SCID with subsequent stem cell transplant versus standard of care. Materials and Methods: An economic evaluation was proposed, using Treeage software on a set of evidence-based propabilities and variables. Outcomes: as shown on the tree, we count the death from SCID. Its given the payoff 1, while the survival is payoff 0. The outcome of interest is death averted by screening live birth and implementing subsequent stem cell transplant for those who tested +ve.

Particularities of quality and safety control in cancer care (literature review)

Introduction. Last decade significant progress was made in the development of cancer care algorithms. In this regard, new challenges are constantly being presented to the quality control of medical activities in actual practice. Aims. To summarize the outlines regarding the most relevant criteria for assessing the quality in oncology. Material and methods. The PubMed database (Medline) was used to identify the relevant and reliable sources of literature. The thematic methodology for obtaining information was used. Results. In total, over 80 most significant publications were identified, thoroughly studied and analyzed. International experience indicates the advantages for assessing the quality of cancer care by determining and measuring certain indicators. The model for quality assessment proposed by Donabedian A. (1966) is broadly applied in current medical practice. This model distinguishes the following: 1) structural indicators, 2) process indicators, 3) outcome indicators. Feedback is critically important in the organization of the audit of medical activities. It allows one to adapt the assessment methods by focusing on the tasks immediately during the control process. Because of cancer heterogeneity, there are apart requirements for developing quality indicators for each specific type of cancer because of cancer heterogeneity. Conclusions. Monitoring of medical activities is a crucial pillar for a robust healthcare system. The introduction of essential, practical and specialized audit techniques helps to improve the quality and safety of medical technologies used in cancer care. There is an increasing need to develop optimal indicators and standard operating procedures for the control of cancer care.

Retreatment with Hyaluronic Acid Viscosupplementation in Knee Osteoarthritis: Agreement between EUROVISCO Guidelines and Current Medical Practice

Objectives This work studied if and how current clinical practice agrees with European Viscosupplementation Consensus Group (EUROVISCO) recommendations and how this agreement might be different according to physician’s specialization. In addition, this work aimed to identify key decision factors that practitioners consider in their decision to retreat or not a patient with hyaluronic acid viscosupplementation. Methods Practitioners have been invited by e-mail to participate in an online exercise on viscosupplementation retreatment. They received a fictional patient case at random among a set of predefined fictional cases. The platform asked the practitioner if he/she would retreat the patient with viscosupplementation or not. To take a decision, the practitioner could select questions among a list of predefined questions. Among them, some were related to criteria used in the EUROVISCO decision tree and others served as confounding factors. Results A total of 506 practitioners participated to the exercise, of which 399 gave their decision about the case assigned to them by the platform. The observed agreement between practitioner decisions and EUROVISCO recommendations was 58.89 ± 4.95% (95% confidence interval [CI]). Overall, the decision to retreat was taken in 47.87% of the cases, while the EUROVISCO guidelines follow-up would have led to 55.89% retreatment for the same cases ( P = 0.03). Conclusions In current practice, physicians tended to reinject their patients less than recommended, although EUROVISCO guidelines for viscosupplementation retreatment consider decision criteria that clearly correspond to those of practitioners in real life. These include the patients’ willingness to be treated or the patients’ perception of the effectiveness of the treatment.

Variable trajectory: a systematic review, analytic synthesis and construct domain consolidation of international measures of competence in doctors and medical students

BackgroundCompetence is assessed throughout a doctor’s career. Failure to identify and manage impaired competence can have critical consequences. Consistent conceptualisation and accurate measurement of this construct is imperative. Therefore, the objective of this review was to identify and evaluate measures used to assess competence in doctors and medical students.MethodsA systematic search of the published literature was undertaken between December 2019 and February 2020 for articles reporting on the measurement of competence in doctors and/or medical students. Searches were conducted in the PsychSOURCE, US National Library of Medicine National Institutes of Health, MEDLINE (PubMed), The Cochrane Central Register of Controlled Trials and Web of Science electronic databases. Citation screening and forward citation tracking of included studies were carried out to identify any further relevant papers for inclusion. One thousand one hundred and thirty-six potentially relevant articles were screened. An analytic synthesis approach was implemented to the identification, organisation and interpretation of homogenous study and measure characteristics.ResultsTwelve competence domains were identified from the 153 identified measures. Knowledge and procedural competence domains were the dominant focus of publications reporting current medical practice, but less so in research-based studies which more frequently assessed interpersonal, psychological, physiological and ethical competencies. In the 105 included articles, the reporting of measurement instrument quality was varied, with comprehensive reporting only present in 53.6% of measures; validation for some of the measures was particularly limited.DiscussionWhile this review included a considerable number of publications reporting the measurement of competence in doctors and medical students, the heterogeneity of the measures and variation of findings limit the ability to evaluate their validity and generalisability. However, this review presents a resource for researchers and medical educators which may inform operational practice and future research.PROSPERO registration numberCRD42020162156.

Ocular Ischemic Syndrome as a Clue for Carotid Artery Stenosis

In current medical practice, all symptoms of a patient could reveal a systemic involvement of an inflammatory condition which primary presentation might not be vivid enough for diagnosis of the original disease. In this case report, a painful eye of a patient lead us to diagnose stenosis of carotid artery and endovascular therapy consequently subsided patient visual acuity and prevented future devastating results.

Patient-specific meta-analysis of 3 validation studies of the 12-gene colon cancer recurrence score assay for recurrence risk assessment after surgery with or without 5FU and oxaliplatin.

3599 Background: The 12-gene Oncotype DX Colon Recurrence Score assay is a clinically validated genomic assay that evaluates recurrence risks in stage II and stage III colon cancer patients independent of clinical-pathologic features. Improved colon cancer care has reduced recurrence rates since the late 1990’s. Methods: Pre-specified patient-specific meta-analysis methods were used to estimate 1-, 3- and 5-year recurrence risk combining the 12-gene colon recurrence score (RS) validation studies CALGB 9581, NSABP C-07 and SUNRISE. Cox models had effects for RS result, number of nodes examined (<12 or ≥ 12), T-stage, MMR status, and stage (II, IIIAB or IIIC). Baseline cumulative hazard estimates used the latest two studies to reflect current medical practice. Estimates for surgery, surgery+5FU and surgery+5FU+oxaliplatin treatment were provided by integrating stage-specific 5FU hazard ratios from a meta-analysis of the QUASAR study (2007) and a pooled analysis of NSABP studies (Wilkinson 2010), and oxaliplatin treatment effect estimates from NSABP C-07. Recurrence risk with 5FU alone was not estimated for MMR-deficient patients due to expected lack of 5FU efficacy in these patients (Sargent 2010). Results: In the overall population of 2,179 patients, 55%, 32% and 13% were Stage II, IIIA/B and IIIC, 63% had ≥12 nodes examined, 90% were T3, and 88% were MMR proficient. Median RS result was 31 (IQR 23–39). RS result and each clinical-pathologic factor contributed independent prognostic information (meta-analysis Wald tests, all p<.001). Risk estimates are generally lower than previous RS report risk estimates. For patients with pathological stage II, T3, MMR-proficient tumors with ≥12 nodes examined, approximately 40% are expected to have 5-year recurrence risk ≤10% with surgery alone based on the distribution of RS results. The table shows example 5-year recurrence risk estimates for specific RS results and clinical-pathologic characteristics. Conclusions: The new recurrence risk estimates provide more patient-specific information reflecting more current medical practice than previous reports using RS result, allowing better, more individualized treatment decisions.[Table: see text]

Tobramycin: efficacy of intensive therapy

One of the leading cause of the decrease of treatment efficacy in patient with community-acquired infections in the intensive care department is a spread of antibiotic resistance in main causative agents. Among Gram-negative microorganisms Pseudomonas aeruginosa is one of the leading causative agents, that is related to health service. A review of foreign and domestic literature concerning tobramycin – systemic form use in the current medical practice in the conditions of increasing resistance of microorganisms to the most broad-spectrum antibiotics is presented in the article. Pharmacokinetic and pharmacodynamic characteristics of tobramycin are described, results of clinical trials, that demonstrate an efficacy of its use in the combination with other antibiotics in the life-threatening infections caused by Gram-negative microorganisms are presented in the article.