Errores médicos / Medical errors

Enero 6, 2017. No. 2561

Definiendo la excelencia: los próximos pasos para los clínicos que tratan de prevenir el error de diagnóstico. Defining excellence: next steps for practicing clinicians seeking to prevent diagnostic error. Foster PN1, Klein JR2. J Community Hosp Intern Med Perspect. 2016 Sep 7;6(4):31994. doi: 10.3402/jchimp.v6.31994. eCollection 2016. Abstract The Institute of Medicine (IOM) released its report on diagnostic errors in September, 2015. The report highlights the urgency of reducing errors and calls for system-level intervention and changes in our basic clinical interactions. Using the report's controversial definition of diagnostic error as a starting point, we introduce the issues and the potential impact on practicing physicians. We report a case used to illustrate this in an academic conference. Finally, we turn to the challenge of integrating these ideas into the traditional peer-review process. We argue that the medical community must evolve from understanding diagnostic failures to redesigning the diagnostic process. We should see errors as steps toward diagnostic excellence and reliable processes that minimize the risk of mislabeling and harm. KEYWORDS: Institute of Medicine; diagnostic error; graduate medical education; patient safety; peer review PDF Efecto adverso y error de eventos inesperados que amenazan la vida dentro de las 24 horas del ingreso al servicio de urgencias. Adverse event and error of unexpected life-threatening events within 24h of emergency department admission. Zhang E1, Hung SC1, Wu CH1, Chen LL2, Tsai MT1, Lee WH3. Am J Emerg Med. 2016 Nov 30. pii: S0735-6757(16)30897-X. doi: 10.1016/j.ajem.2016.11.062. Abstract OBJECTIVES: Errors and adverse events associated with unexpected life-threatening events including unplanned transfer to the intensive care unit (ICU) and unexpected death after emergency department (ED) hospitalization are not well characterized. We performed this study to investigate the role of unexpected life-threatening events as a trigger to capture errors and adverse events for ED patient safety. METHODS: This prospective observational study enrolled adult non-trauma patients with unexpected life-threatening events within 24h of general ward admission from the ED of a medical center in Taiwan. The period of study was one year (in 2013); the medical records of enrolled patients were reviewed to identify adverse events and errors. We measured the incidence rate of adverse events or errors. Preventability, type, and physical injury severity of adverse events were investigated. RESULTS: Of 33,224 adult non-trauma ward admissions from the ED, 100 admissions (0.3%) met the study criteria. Incidence rate was 2% and 15% for errors and adverse events, respectively. In admissions involving error, all were preventable and the error type was overlooked of severity. In admissions that involved adverse events, 93.3% were preventable. There were 20% of admissions that resulted in death and 60% developed with severe physical injury. The adverse event types were diagnosis issues (53.3%), management issues (40%), and medication adverse events (6.7%). CONCLUSIONS: Unexpected life-threatening events within 24h of admission from the ED could be a useful trigger tool to identify preventable adverse events with serious physical injury in ED. PDF Análisis descriptivo de once años de veredictos de corte cerrado sobre errores médicos en España y Massachusetts. Eleven-year descriptive analysis of closed court verdicts on medical errors in Spain and Massachusetts. Giraldo P1, Sato L2, Martínez-Sánchez JM3, Comas M4, Dwyer K5, Sala M6, Castells X6. BMJ Open. 2016 Aug 30;6(8):e011644. doi: 10.1136/bmjopen-2016-011644. Abstract OBJECTIVES:To evaluate and compare the characteristics of court verdicts on medical errors allegedly harming patients in Spain and Massachusetts from 2002 to 2012. DESIGN, SETTING AND PARTICIPANTS: We reviewed 1041 closed court verdicts obtained from data on litigation in the Thomson Reuters Aranzadi Westlaw databases in Spain (Europe), and 370 closed court verdicts obtained from the Controlled Risk and Risk Management Foundation of Harvard Medical Institutions (CRICO/RMF) in Massachusetts (USA). We included closed court verdicts on medical errors. The definition of medical errors was based on that of the Institute of Medicine (USA). We excluded any agreements between parties before a judgement. RESULTS: Medical errors were involved in 25.9% of court verdicts in Spain and in 74% of those in Massachusetts. The most frequent cause of medical errors was a diagnosis-related problem (25.1%; 95% CI 20.7% to 31.1% in Spain; 35%; 95% CI 29.4% to 40.7% in Massachusetts). The proportion of medical errors classified as high severity was 34% higher in Spain than in Massachusetts (p=0.001). The most frequent factors contributing to medical errors in Spain were surgical and medical treatment (p=0.001). In Spain, 98.5% of medical errors resulted in compensation awards compared with only 6.9% in Massachusetts. CONCLUSIONS: This study reveals wide differences in litigation rates and the award of indemnity payments in Spain and Massachusetts; however, common features of both locations are the high rates of diagnosis-related problems and the long time interval until resolution. KEYWORDS: ACCIDENT & EMERGENCY MEDICINE; EPIDEMIOLOGY; FORENSIC MEDICIN PDF 5to Curso Internacional de Anestesiología cardiotorácica, vascular, ecocardiografía y circulación extracorpórea. SMACT Mayo 4-6, 2017, Mexicali, México Informes Dr. Hugo Martínez Espinoza bajamed@hotmail.com  Regional Anesthesiology and Acute Pain Medicine Meeting April 6-8, 2017, San Francisco, California, USA ASRA American Society of Regional Anesthesia and Pain Medicine Información / Information California Society of Anesthesiologists Annual Meeting April 27-30, 2017 San Francisco California Información / Information

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Feliz 2017 / Feliç 2017 /m Happy 2017 / lycklig 2017

Enero 1, 2017. No. 2556

Hoy iniciamos este año felices de estar cumpliendo nuestra meta educativa y a la vez enviar un afectuoso saludo a todos nuestros amigos y colegas deseándoles un 2017 lleno de Salud, Amor y Éxitos en compañía de sus seres queridos y de cada uno de sus pacientes. La información con acceso abierto ha crecido en forma logarítmica y ahora es gratuito actualizarse en cualquier tema del saber humano. Hoy cumplimos 7 años de haber iniciado nuestro Programa Alfa de Actualización Continua en Medicina haciendo llegar a la computadora de 4,646 colegas localizados en los 5 continentes información relevante de diversos temas. Esta información se selecciona y se envía diariamente de acuerdo al interés de cada colega inscrito en este programa. Desde enero 1, 2010 se han enviado 2,556 correos electrónicos con 1 o más artículos completos en PDF, HTLM, revistas, libros, imágenes o videoclips con información actualizada o temas clásicos. Se le invita a enviarnos sugerencias para mejorar este programa educativo y una vez más le agradecemos su valioso apoyo. Today we start this year happy to be fulfilling our educational goal and at the same time sending a warm greeting to all our friends and colleagues wishing them a 2017 full of Health, Love and Success in the company of their loved ones and each of their patients. Information with open access has grown logarithmic and is now free to update on any subject of the human knowledge. Today is our seventh year since we started our Alpha Program of Continuous Updating in Medicine, reaching the computer of 4,646 colleagues located in the 5 continents with relevant information on various topics. This information is selected and sent daily according to the interest of each colleague enrolled in this program. Since January 1, 2010 we have sent 2,556  e-mails with 1 or more complete articles in PDF, HTLM, journals, books, images or video clips with updated information or classic themes. You are invited to send us suggestions to improve this educational program and once again we thank you for your valuable support. Σήμερα θα ξεκινήσουμε αυτό το έτος να είναι ευτυχισμένο εκπλήρωση των εκπαιδευτικών μας στόχος και ταυτόχρονα να στείλει θερμούς χαιρετισμούς σε όλους τους φίλους και τους συνεργάτες μας να σας ευχηθώ μια γεμάτη υγεία, αγάπη και την επιτυχία το 2017 στην εταιρεία των αγαπημένων και κάθε ένα από τους ασθενείς τους. Οι πληροφορίες ανοικτή πρόσβαση έχει αυξηθεί λογαριθμικά και είναι πλέον δωρεάν αναβάθμιση για οποιοδήποτε θέμα της ανθρώπινης γνώσης. Σήμερα συναντηθήκαμε 7 έτη μετά την έναρξη Πρόγραμμα Συνεχούς μας Άλφα Ενημέρωση στην Ιατρική φτάνοντας 4.646 συναδέλφους υπολογιστή που βρίσκεται στις 5 ηπείρους σχετικές πληροφορίες για διάφορα θέματα. Αυτές οι πληροφορίες είναι επιλεγμένο και αποστέλλονται καθημερινά, σύμφωνα με το συμφέρον του κάθε συνάδελφο που εγγράφονται σε αυτό το πρόγραμμα. Από την 1η Ιανουαρίου 2010 έχουν σταλεί 2.556 emails με 1 ή περισσότερα πλήρη άρθρα σε μορφή PDF, Htlm, περιοδικά, βιβλία, φωτογραφίες ή βίντεο κλιπ με ενημερωμένες πληροφορίες ή κλασική θέματα. Μπορείτε καλούνται να αποστείλουν προτάσεις για τη βελτίωση αυτού του εκπαιδευτικού προγράμματος και για άλλη μια φορά να σας ευχαριστήσω για την πολύτιμη υποστήριξή σας. Avui iniciem aquest any feliços d'estar complint la nostra meta educativa i alhora enviar una afectuosa salutació a tots els nostres amics i col·legues desitjant-los 1 2017 ple de Salut, Amor i Èxits en companyia dels seus éssers estimats i de cadascun dels seus pacients. La informació amb accés obert ha crescut en forma logarítmica i ara és gratuït actualitzar-se en qualsevol tema del saber humà. Avui complim 7 anys d'haver iniciat el nostre Programa Alfa d'Actualització Contínua en Medicina fent arribar a l'ordinador de 4,646 col·legues localitzats en els 5 continents informació rellevant de diversos temes. Aquesta informació es selecciona i s'envia diàriament d'acord a l'interès de cada col·lega inscrit en aquest programa. Des de gener 1, 2010 s'han enviat 2,556 correus electrònics amb 1 o més articles complets en PDF, HTLM, revistes, llibres, imatges o clips de vídeo amb informació actualitzada o temes clàssics. Se li convida a enviar-nos suggeriments per millorar aquest programa educatiu i una vegada més li agraïm el seu valuós suport. Neuroplasticidad en la práctica clínica. Construyendo poder cerebral para la salud Neuroplasticity and Clinical Practice: Building Brain Power for Health. Shaffer J1. Front Psychol. 2016 Jul 26;7:1118. doi: 10.3389/fpsyg.2016.01118. eCollection 2016. Abstract The focus of this review is on driving neuroplasticity in a positive direction using evidence-based interventions that also have the potential to improve general health. One goal is to provide an overview of the many ways new neuroscience can inform treatment protocols to empower and motivate clients to make the lifestyle choices that could help build brain power and could increase adherence to healthy lifestyle changes that have also been associated with simultaneously enhancing vigorous longevity, health, happiness, and wellness. Another goal is to explore the use of a focus in clinical practice on helping clients appreciate this new evidence and use evolving neuroscience in establishing individualized goals, designing strategies for achieving them and increasing treatment compliance. The timing is urgent for such interventions with goals of enhancing brain health across the lifespan and improving statistics on dementia worldwide. KEYWORDS: brain plasticity; cognition; cognitive; computerized cognitive training; health psychology; healthy aging; neurogenesis; neuroplasticity PDF La Felicidad y El Arte de Ser Bhagavan Sri Ramana PDF Trabajo y equilibrio de vida "Si no somos felices tanto en el trabajo como fuera del trabajo, no podemos proporcionar felicidad a los demás". Work and Life Balance "If We Are Not Happy Both in Work and out of Work, We Cannot Provide Happiness to Others". Kimura D1. Front Pediatr. 2016 Feb 17;4:9. doi: 10.3389/fped.2016.00009. eCollection 2016. KEYWORDS: burnout; happiness; other industries; pediatric critical care medicine; professional; work-life balance PDF Felicidad y salud: Los factores biológicos. Revisión sistemática Happiness & Health: The Biological Factors- Systematic Review Article. Dfarhud D1, Malmir M2, Khanahmadi M3. Iran J Public Health. 2014 Nov;43(11):1468-77. Abstract Happiness underlying factors are considerable from two dimensions: endogenic factors (biological, cognitive, personality and ethical sub-factors) and exogenic factors (behavioral, socialcultural, economical, geographical, life events and aesthetics sub-factors). Among all endogenic factors, biological sub-factors are the significant predictors of happiness. Existence of significant differences in temperament and happiness of infants is an indicator of biological influences. Therefore, this study aimed to consider biological factors that underlie happiness. At the first, all of the biological factors in relation with happiness were searched from following websites: PubMed, Wiley& Sons, Science direct (1990-2014). Then, the articles divided into five sub-groups (genetic, brain and neurotransmitters, endocrinology and hormones, physical health, morphology and physical attractiveness). Finally, a systematic review performed based on existing information. Results of studies on genetic factors indicated an average effectiveness of genetic about 35 -50 percent on happiness. In spite of difficulties in finding special genes, several genes distributed to emotion and mood. Neuroscience studies showed that some part of brain (e.g. amygdala, hipocamp and limbic system) and neurotransmitters (e.g. dopamine, serotonin, norepinefrine and endorphin) play a role in control of happiness. A few studies pointed to the role of cortisol and adrenaline (adrenal gland) and oxitocin (pituitary gland) in controlling happiness. Physical health and typology also concluded in most related studies to have a significant role in happiness. Therefore, according to previous research, it can be said that biological and health factors are critical in underlying happiness and its role in happiness is undeniable. KEYWORDS: Biological factors; Happiness; Health PDF 5to Curso Internacional de Anestesiología cardiotorácica, vascular, ecocardiografía y circulación extracorpórea. SMACT Mayo 4-6, 2017, Mexicali, México Informes Dr. Hugo Martínez Espinoza bajamed@hotmail.com

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