Efficient Quality Assurance Research Articles

Análises de protocolos de braquiterapia, por alta taxa de dose, do controle de qualidade de alguns serviços locais, baseados no TG40, TG56 e ARCAL XXX

A braquiterapia por alta taxa de dose está recebendo atenção considerável na maioria dos países. Por isso, nos serviços que utilizam este equipamento exige-se que o desenvolvimento de um programa de controle de qualidade seja cada vez mais rigoroso, para garantir não apenas a segurança aos pacientes, mas também aos operadores e demais envolvidos. Este trabalho tem por objetivos fazer um levantamento dos tipos de testes para um equipamento de braquiterapia por alta taxa de dose, propostos pelos protocolos oficiais publicados (TG40, TG56 e ARCAL XXX) e avaliar os tipos de testes que atualmente são realizados por alguns serviços de radioterapia, comparando-os com aqueles apresentados nos protocolos citados. Das análises feitas, observou-se que: a) quanto aos protocolos oficiais, o TG56 é mais completo que o TG40 e o ARCAL XXX; b) quanto às instituições analisadas, estas em geral se basearam no TG56 para elaborar seus próprios protocolos, os quais demonstraram ter também concordância com os outros já citados. Nestes protocolos, a inexistência dos testes anuais foi notada, o que pode ser explicado por sua aparição nas freqüências trimestral e semestral. Do produto deste estudo são apresentadas tabelas dos tipos de testes com suas respectivas freqüências de utilização, das quais um protocolo pode ser inferido para auxiliar na implementação, pelo menos, dos tipos de testes de controle de qualidade básicos e indispensáveis para o equipamento, garantindo, assim, um tratamento adequado aos pacientes e uma melhor segurança ao pessoal envolvido e, conseqüentemente, assegurando a garantia de qualidade na braquiterapia por alta taxa de dose.

A Low-cost Alternative for More Efficient Quality Assurance

A Low-cost Alternative for More Efficient Quality Assurance

Patientenschulung in der Rheumatologie

A patient education program for patients with "rheumatoid arthritis" has been designed by the working team "Patient education" of the German Rheumatology Society (Deutsche Gesellschaft für Rheumatologie) as a model in cooperation with the German League for Rheumatoid Diseases (Deutsche Rheuma-Liga). This training course has three objects: to impart knowledge; to promote abilities and skills; to assist in coping with the disease. It comprises six basic elements: disease pattern, course of the disease, diagnostics; drug and surgical therapy; physiotherapy; psychological coping with pain; ergotherapy and joint protection; how to get along with the daily drudgery, that is to say, how to live with the disease. The course is held as a seminar and comprises six sessions of 90 minutes each, dealing with the six basic elements enumerated above. Not more than ten patients should attend each course, six to eight participants being ideal. Each course is conducted by an interdisciplinary team of physicians, psychologists/pedagogues, physiotherapists and ergotherapists. A group leader is in charge of the course; usually, this will be a psychologist or someone with comparable qualifications. The course is of an exploratory nature and aims at an initiation into the various topics while motivating the participants to go deeper into the problems that have been raised, with particular emphasis on stimulating the patients to practice self-help. The course can be held in hospitals, for outpatients, in self-help setups and within the framework of urban or communal health services. Of course, the necessary facilities must be arranged. These include classrooms that are suitable equipped for the courses, integration of the training into the treatment concept, well-qualified persons in charge, suitable trainers, and cooperation within the interdisciplinary team. Patients are referred to participate as with every other therapeutic measure in an individual treatment programme, taking indications and contraindications into due consideration. Efficient quality assurance in accordance with relevant quality criteria is imperative to ensure optimum effects and to avoid unfavourable side reactions.

Review of Negative Papanicolaou TestsIs the Retrospective 5-Year Review Necessary?

New federal regulations require review of all available negative gynecologic smears within the previous 5 years for each patient with a current high grade squamous intraepithelial lesion (HGSIL) or above. Two university hospitals retrospectively reviewed all patients who had HGSIL or above and who had prior negative smears. During 18 months, 35,807 Papanicolaou tests were reported, from which we identified 44 patients with 80 negative smears before presenting with HGSIL or above. These 80 negative smears were rescreened and, on review, there was agreement with the original diagnosis in 66 cases (82.5%). Fourteen (17.5%) smears were reclassified: 2 unsatisfactory, 6 atypical squamous/glandular cells of undetermined significance, 3 low grade SIL, and 3 HGSIL or above. Of the 12 cases satisfactory for reclassification, 9 (75%) occurred within 2 years before the HGSIL or above. Two cases of atypical squamous/glandular cells occurred within 4 years. One case of HGSIL occurred more than 4 years before, but a negative Pap smear had been reclassified within the year before the diagnosis of HGSIL. The authors conclude that a 2-year retrospective review, which identified 75% of our false-negative cases, is an effective and efficient quality control and assurance practice.

The integration of a QA/RM program in a rural healthcare obstetrical service.

Obstetrical services in a rural healthcare setting have special problems because the number of deliveries per month is below 100, with some facilities averaging fewer than 10 to 15 births per month. Medical resources may include obstetricians, pediatricians, or family practitioners, but not necessarily all three. Because it is not cost-effective to staff an obstetrical unit 24 hours a day when a low census is the norm, staffing patterns may be atypical and creative. The development of an effective credentialing system for both nursing and medical staffs is the first component of a QA/RM plan. Nursing staff play a vital role in modifying potential risk. When nurses do not routinely provide care on a unit, an efficient quality assurance plan is vital. Components of the plan must include staffing patterns and ratios, policies and procedures, and documentation. QA indicators should address both volume and outcome-oriented clinical indicators. Medical follow-up when indicated should also be part of the plan. Ongoing communication among team members and utilization of outside resources can assist in promoting an effective program. Although obstetrics is an area where the potential for risk exposure remains great, it is possible to create an efficient, practical risk management system.

Contrôle de qualité des groupages sanguins

Efficient quality assurance programs in blood group serology are optimally based on local, regional and national organizations. At the level of individual blood bank laboratories the control system should include reagents, equipments, procedures and performance evaluation of the technical staff together with an appropriate educational program. These are reviewed in some detail. Proficiency testings organized by regional transfusion centers among local blood banks are necessary parts of the control system. Examples are suggested regarding the actual content of these testings. National reference organizations should play an important role in the maintenance of high standards and uniformity throughout the country. The French National Blood Group Reference Laboratory, founded in 1975, has since been operating in this direction. An analysis of its activities is presented covering consultation service and training laboratory, elaboration of standards, checking and certification of reagents and distribution of reference red cells and sera.