Quality assurance in health care : the official journal of the International Society for Quality Assurance in Health Care最新文献

The importance of post-mortem examinations of abortions and perinatal deaths. 对堕胎和围产期死亡进行尸检的重要性。

Quality assurance in health care : the official journal of the International Society for Quality Assurance in Health Care Pub Date : 1993-12-01 DOI: 10.1093/intqhc/5.4.295

I Hägerstrand, L M Lundberg

引用次数: 10

Decreasing autopsy rate in Sweden reflects changing attitudes among clinicians. 瑞典尸体解剖率的下降反映了临床医生态度的改变。

Quality assurance in health care : the official journal of the International Society for Quality Assurance in Health Care Pub Date : 1993-12-01 DOI: 10.1093/intqhc/5.4.319

L Eriksson, C Sundström

{"title":"Decreasing autopsy rate in Sweden reflects changing attitudes among clinicians.","authors":"L Eriksson, C Sundström","doi":"10.1093/intqhc/5.4.319","DOIUrl":"https://doi.org/10.1093/intqhc/5.4.319","url":null,"abstract":"The autopsy rate has declined in the last 20 years in Sweden and is now approximately 30%. Clinical autopsies constitute about 18% and medico-legal autopsies somewhat more than 10%. There is an obvious geographical variation in clinical autopsy rate, whereas the variation in medico-legal autopsy rate is narrower. The difference in autopsy frequency between males and females seemed to be mainly dependent on the higher number of medico-legal autopsies among males. In order to explore the reasons behind the decline in autopsy rate we accomplished a study of the autopsy rate in 1986 and 1991 in three Swedish hospitals of various types and sizes. The hospitals studied were one university hospital and two community hospitals of different sizes. The autopsy rate varied between 0 and 100% among the different departments within these hospitals and also varied considerably between wards within the same department. The number of clinical autopsies declined between 1986 and 1991 in all three hospitals. The fall was greatest in the university hospital and in the larger of the two community hospitals. However, in these two hospitals departments with active research of clinico-pathological relevance maintained or even increased their autopsy rate during this period. The decline in autopsy rate in general and the difference in rate between hospitals, departments and wards could be explained neither by the Autopsy Act of 1976, or by the reluctance of relatives to give consent to the autopsy of a relative. A change in attitude toward and interest in the autopsy activity of clinicians seemed to be the major explanation for the decline of the autopsy.","PeriodicalId":77341,"journal":{"name":"Quality assurance in health care : the official journal of the International Society for Quality Assurance in Health Care","volume":"5 4","pages":"319-23"},"PeriodicalIF":0.0,"publicationDate":"1993-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1093/intqhc/5.4.319","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19012469","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 35

The impact of autopsies on the quality of care. Proceedings of a state of the art conference organized by the Swedish Medical Research Council. Sigtuna, Sweden, 16-17 November 1992. 尸检对护理质量的影响。瑞典医学研究理事会组织的最先进的会议记录。1992年11月16日至17日，瑞典西格图纳。

Quality assurance in health care : the official journal of the International Society for Quality Assurance in Health Care Pub Date : 1993-12-01

引用次数: 0

The current status of autopsies in medical care in the USA. 尸检在美国医疗保健中的现状。

Quality assurance in health care : the official journal of the International Society for Quality Assurance in Health Care Pub Date : 1993-12-01 DOI: 10.1093/intqhc/5.4.309

R B Hill

引用次数: 19

Decrease in the frequency of autopsies in Denmark after the introduction of a new autopsy act. 在丹麦实行新的尸体解剖法后，尸体解剖的频率有所下降。

Quality assurance in health care : the official journal of the International Society for Quality Assurance in Health Care Pub Date : 1993-12-01 DOI: 10.1093/intqhc/5.4.315

C N Petri

{"title":"Decrease in the frequency of autopsies in Denmark after the introduction of a new autopsy act.","authors":"C N Petri","doi":"10.1093/intqhc/5.4.315","DOIUrl":"https://doi.org/10.1093/intqhc/5.4.315","url":null,"abstract":"Unlabelled: New techniques have influenced the attitude to the autopsy and contribute to a de-emphasis on the importance of post-mortem examination. Since 1990, new Danish legislation has provoked a dramatic fall in the autopsy rate, which had already declined from 45% in 1970 to 35% in 1980. In the first half of 1990 the rate was 24% in the second half of that same year it had fallen to 16% (Source: The Danish National Institute of Health, 1992). The clinicians now seem to manage without the autopsy to confirm or correct their daily diagnostics. They also seem to be of the opinion that they do well without this \"final checklist\". The autopsy, however, is still an important tool in understanding, correcting and improving future diagnosis. Therefore, post-mortems should again be carried out as a matter of course and common practice. The following proposals are all aimed at obtaining a higher autopsy rate: The 1990 legislation on autopsy should be changed so that permission to perform a post-mortem can be given in due time, before the supposed death, preferably by the patient himself and obviously with the right to a subsequent change of mind. It is of great importance that the Public Health Service informs both the public and health workers in general about the nature and importance of the autopsy. Likewise, doctors and health workers in general should be educated in how best to give information to patients. Pathologists should, through a more uniform and exact practice, encourage the clinicians to a renewal of the close collaboration concerning the facts revealed by the autopsy, both in their everyday practice and in scientific projects in general.","PeriodicalId":77341,"journal":{"name":"Quality assurance in health care : the official journal of the International Society for Quality Assurance in Health Care","volume":"5 4","pages":"315-8"},"PeriodicalIF":0.0,"publicationDate":"1993-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1093/intqhc/5.4.315","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19012468","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 42

The meta-autopsy: changing techniques and attitudes towards the autopsy. 元尸检:改变尸检技术和态度。

Quality assurance in health care : the official journal of the International Society for Quality Assurance in Health Care Pub Date : 1993-12-01 DOI: 10.1093/intqhc/5.4.325

R D Start, D W Cotton

引用次数: 7

An autopsy-based quality assessment program for improvement of diagnostic accuracy. 一个基于尸体解剖的质量评估程序，以提高诊断的准确性。

Quality assurance in health care : the official journal of the International Society for Quality Assurance in Health Care Pub Date : 1993-12-01 DOI: 10.1093/intqhc/5.4.351

R B Hill, R E Anderson

{"title":"An autopsy-based quality assessment program for improvement of diagnostic accuracy.","authors":"R B Hill, R E Anderson","doi":"10.1093/intqhc/5.4.351","DOIUrl":"https://doi.org/10.1093/intqhc/5.4.351","url":null,"abstract":"A program for quality assessment of medical diagnostics is proposed, based on detailed, ongoing comparison of clinical diagnoses with autopsy diagnoses. The model requires that the autopsy service itself be subjected to quality control to assure the reliability of the autopsy findings, including the quality of diagnoses made postmortem, and the quality of autopsy reports. Discrepancies between premortem and postmortem diagnoses are classified as to cause and magnitude; for each disease, the total diagnostic experience is collected, and sensitivity and specificity of clinical diagnostics are computed. These are compared with control ranges of sensitivity and specificity, prospectively arrived at through analysis of thousands of cases. Statistically acceptable sampling for autopsy, and review of findings by an independent body are also discussed. The findings generated by this program would be of great value in programs for quality improvement of medical care. The model has the following advantages: (1) it recognises that there is an unavoidable baseline of diagnostic errors; (2) the control levels, based on current medical practice, are prospectively established; (3) it avoids placing blame in a single case; and (4) it provides a fairly high power scrutiny that can focus on diagnostics for single diseases rather than the entire spectrum of medical practice.","PeriodicalId":77341,"journal":{"name":"Quality assurance in health care : the official journal of the International Society for Quality Assurance in Health Care","volume":"5 4","pages":"351-9"},"PeriodicalIF":0.0,"publicationDate":"1993-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1093/intqhc/5.4.351","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19012474","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 17

Clinical diagnostic accuracy audited by autopsy in a university hospital in two eras. 两个时代的大学医院尸检对临床诊断准确性的审计。

Quality assurance in health care : the official journal of the International Society for Quality Assurance in Health Care Pub Date : 1993-12-01 DOI: 10.1093/intqhc/5.4.281

B Veress, I Alafuzoff

引用次数: 35

Problems with the use of autopsy results as a yardstick in medical audit and epidemiology. 在医学审计和流行病学中使用尸检结果作为衡量标准的问题。

Quality assurance in health care : the official journal of the International Society for Quality Assurance in Health Care Pub Date : 1993-12-01 DOI: 10.1093/intqhc/5.4.339

R Saracci

{"title":"Problems with the use of autopsy results as a yardstick in medical audit and epidemiology.","authors":"R Saracci","doi":"10.1093/intqhc/5.4.339","DOIUrl":"https://doi.org/10.1093/intqhc/5.4.339","url":null,"abstract":"Autopsy can represent a key instrument in auditing clinical diagnosis performance, on which in turn the accuracy of diagnoses, as used in a variety of epidemiological investigations, depend. This audit can be implemented through clinico-pathological surveys which require both accurate pathological examinations and validity of study design and analysis. To this end, estimates of sensitivity and specificity of the clinical diagnosis, using the autopsy diagnosis as a yardstick, should be obtained, which can however be severely distorted by factors such as nonrandom selection of cases for autopsy or by unrecognized errors in post-mortem diagnosis. Such distortion may be minimized by (a) estimating the likely magnitude of errors in postmortem diagnosis, (b) specifying standard conditions for performing autopsies and (c) ensuring an unbiased sample of moderate size rather than a large biased sample. Considerable improvement in the validity of clinico-pathological surveys as carried out up until now is possible, and there is room for research to provide the necessary information (e.g. on necropsy diagnosis variability and feasible sampling schemes).","PeriodicalId":77341,"journal":{"name":"Quality assurance in health care : the official journal of the International Society for Quality Assurance in Health Care","volume":"5 4","pages":"339-44"},"PeriodicalIF":0.0,"publicationDate":"1993-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1093/intqhc/5.4.339","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19012472","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 10

The selection for post-mortem examination: a retrospective analysis of 74 deceased surgical cases. 尸检选择:回顾性分析74例手术死亡病例。

Quality assurance in health care : the official journal of the International Society for Quality Assurance in Health Care Pub Date : 1993-12-01 DOI: 10.1093/intqhc/5.4.345

I Alafuzoff, B Veress

{"title":"The selection for post-mortem examination: a retrospective analysis of 74 deceased surgical cases.","authors":"I Alafuzoff, B Veress","doi":"10.1093/intqhc/5.4.345","DOIUrl":"https://doi.org/10.1093/intqhc/5.4.345","url":null,"abstract":"The factors which could influence the selection of cases for post-mortem examination were analysed during a 6-month period. The variables studied included the age and sex of the patients, the length of terminal hospitalization, the principal disease, the certainty of the clinical diagnostics and the extent of the clinical investigation. Both clinical and autopsy records were reviewed. Seventy-four patients died at the Department of Surgery during this period of whom 50 (68% autopsy rate) were autopsied. The autopsy rate was influenced by (a) the length of the terminal hospitalization, (b) the diagnosis of the principal disease and, to a certain degree, (c) the extent of the clinical investigation. Thus, patients who were hospitalized for a shorter period, had no clinically diagnosed malignant tumours and were not investigated with more sophisticated methods were more frequently autopsied. The discrepancy rate between principal clinical and post-mortem diagnoses was 28% and was not influenced by the use of modern investigative methods.","PeriodicalId":77341,"journal":{"name":"Quality assurance in health care : the official journal of the International Society for Quality Assurance in Health Care","volume":"5 4","pages":"345-9"},"PeriodicalIF":0.0,"publicationDate":"1993-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1093/intqhc/5.4.345","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19012473","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 12