BACKGROUND. Neonatal cholestatic jaundice is a common paediatric condition with a paucity of recent local data and a notable absence of locally influenced diagnostic algorithms. OBJECTIVES. To describe the causes of cholestatic jaundice, investigations conducted and patient outcomes. METHODS. This was a retrospective file review of 96 patients presenting to the Specialist Clinic at Rahima Moosa Mother and Child Hospital in Johannesburg between 1 January 2014 and 31 December 2020. Clinical features, serum biochemistry at presentation, diagnostic investigations (haematological, radiological and histological), diagnosis and outcome were analysed during data collection. RESULTS. Ninety-six patients were included in the study. The median age of jaundice onset was at 2 months, while the median age of presentation was 3.3 months. Causes of jaundice fell into three main categories: 38 had biliary atresia (BA); 24 had another specific diagnosis; and 34 remained without an underlying diagnosis (idiopathic neonatal hepatitis). An overall mortality rate of 26% was noted at a median (interquartile range) age of 13 (5 - 24) months and it was highest in the BA group (n= 14; 56%). CONCLUSION. The evaluation of neonatal jaundice requires a wide differential and expeditious referral to optimise outcomes and avoid complications. Many patients remained undiagnosed, and the overall prognosis was poor. The authors recommend the development of a locally relevant diagnostic protocol to minimise delays in the identification, diagnosis and treatment of neonatal jaundice.

Resumen Objetivo: comprobar si el seguimiento telefónico agrega efecto a la aplicación de Intervenciones Breves para el uso de alcohol entre las mujeres embarazadas. Metodología: se trata de un ensayo clínico controlado y aleatorizado, abierto, paralelo, de dos brazos. Los datos fueron recolectados en la atención primaria de salud en São Carlos y el Centro de Referencia para la Salud de la Mujer en Ibaté (São Paulo, Brasil). Se realizó un seguimiento de las mujeres embarazadas que consumieron cualquier cantidad de alcohol durante el embarazo. Posteriormente, fueron distribuidos aleatoriamente en dos grupos. El grupo de control recibió solo una breve intervención; el grupo experimental recibió una intervención breve y fue monitoreado semanalmente por teléfono durante dos semanas después de la intervención. Se utilizó un programa estadístico para realizar estadísticas descriptivas e inferenciales (Test de Wilcoxon). Resultados: Hubo una reducción en el consumo en ambos grupos. Sin embargo, solo en el grupo experimental en el que se implementó la intervención con seguimiento, hubo abstinencia en todo el grupo (AUDIT-C: p-valor=0,011; T-ACE: p-valor=0,010). Conclusiones: Las intervenciones breves asociadas al seguimiento telefónico durante el embarazo demostraron ser efectivas para detener el consumo de alcohol. El seguimiento continuo después de intervenciones breves mejora las tasas de abstinencia de alcohol. Registro Brasileño de Ensayos Clínicos: RBR-4y4k7w.

Abstract Objective: to test whether telephone monitoring adds effect to the application of Brief Interventions for alcohol use among pregnant women. Methodology: this is a controlled and randomized clinical trial, open, parallel, with two arms. Data were collected in primary health care in São Carlos and Reference Center for Women's Health in Ibaté (São Paulo, Brazil). Pregnant women who consumed any amount of alcohol during pregnancy were tracked. Afterwards, they were randomly allocated into two groups. The control group received only a brief intervention; the experimental group received a brief intervention and were monitored weekly by telephone for two weeks after the intervention. A statistical program was used to perform descriptive and inferential statistics (Wilcoxon Test). Results: There was a reduction in consumption in both groups. However, only in the experimental group in which the intervention with monitoring was implemented, there was abstinence in the entire group (AUDIT-C: p-value=0.011; T-ACE: p-value=0.010). Conclusions: Brief interventions associated with telephone monitoring during pregnancy proved to be effective in stopping alcohol consumption. Continuous monitoring after brief interventions improves alcohol abstinence rates. Brazilian Registry of Clinical Trials: RBR-4y4k7w.

Resumo Objetivo: testar se o monitoramento por telefone acrescenta efeito à aplicação de Intervenções Breves para o uso de álcool entre gestantes. Metodologia: trata-se de ensaio clínico controlado e randomizado, aberto, paralelo, com dois braços. Os dados foram coletados na atenção primária à saúde de São Carlos e Centro de Referência de Saúde da Mulher em Ibaté (São Paulo, Brasil). Foram rastreadas gestantes que consumiram qualquer quantidade de álcool na gestação. Após, foram alocadas aleatoriamente em dois grupos. O grupo controle recebeu apenas uma intervenção breve; o grupo experimental recebeu uma intervenção breve e foi monitorado semanalmente por telefone nas duas semanas posteriores à intervenção. Utilizou-se programa estatístico para realização de estatísticas descritivas e inferencial (Teste de Wilcoxon). Resultados: Houve redução do consumo nos dois grupos. Porém, apenas no grupo experimental em que foi implementado intervenção com monitoramento, houve abstinência de todo o grupo (AUDIT-C: p-valor=0,011; T-ACE: p-valor=0,010). Conclusões: Intervenções breves associadas a monitoramento telefônico durante a gestação se mostraram efetivas para a cessação do consumo de álcool. O monitoramento contínuo após intervenções breves melhora as taxas de abstinência de álcool. Registro Brasileiro de Ensaios Clínicos: RBR-4y4k7w.

Abstract Objective: To audit our experience with Choanal Atresia (CA). Study design: Observational retrospective study. Material/Methods: Clinical data of all CA patients followed from 2003 to 2020 at Hospital Central do Funchal were analysed. Results: Eleven patients were included and 63,64% were females. They were divided into two groups: Unilateral (63,64%) and bilateral atresia (36,36%). In both groups, mixed type atresia was the most common. Regarding unilateral group, endoscopic repair was performed in 85,71% of cases (71,4% with stents) at a median age of 15 years old. Median number of surgeries was 1,29. Bilateral group had more congenital malformations (50%) and had more reinterventions. All patients underwent an endoscopic approach at a median age of 8 days old. Conclusions: Associated malformations, younger age at first surgery and higher number of surgeries were more associated to bilateral CA.

Resumo Objetivo : Descrever a experiência do Serviço de Otorrinolarinogologia do Hospital Dr. Nélio Mendonça com Atrésia das Coanas (AC). Desenho do estudo: Observacional retrospectivo. Material/Métodos: Analisaram-se os dados clínicos de todos os doentes com AC de 2003-2020 do Hospital Central do Funchal. Resultados: Dos onze doentes incluídos, 63,64% eram do sexo feminino e 36,36% eram do sexo masculino. As onze crianças estudadas foram divididas em dois grupos: AC unilateral (63,64%) e bilateral (36,36%). Nos dois grupos, o tipo misto foi o mais comum. Na AC unilateral, a correção endoscópica foi realizada em 85,71% dos casos (71,4% com stents) com idade média de 15 anos. Foi realizada uma média de 1,29 cirurgias. O grupo bilateral apresentou mais malformações congénitas (50%) e apresentou mais reintervenções. Todos foram submetidos a cirurgia endoscópica (idade média: 8 dias). Conclusões: Malformações associadas, idade mais jovem na primeira cirurgia e maior número de cirurgias estiveram mais associadas à AC bilateral.

BACKGROUND: Rape has a high prevalence in South Africa. The collection of credible and valid forensic evidence is a key legal factor that impacts case trial outcomes. Victim behaviour around the time of the rape can impact the collection and the integrity of forensic evidence, and can have a direct effect on case progression and conviction. Despite the importance of victim behaviour, few studies have been done on the role of victims in preserving forensic evidence. This article discusses how common personal hygiene practices undertaken by rape victims after being raped can impact the quality and validity of forensic evidence. This investigation was done with the aim of elucidating the role of victims in preserving forensic evidence post rape METHODS: This was a descriptive, retrospective clinical audit of all rape victims managed at Robert Mangaliso Sobukwe Hospital forensic unit in South Africa from 01 January 2020 to 31 March 2022 RESULTS: A total of 192 rape cases over the study period were included in this review. The median age of rape victims was 20 years (minimum 2 years; maximum 76 years). The majority (n = 178; 92.7%) of the victims were female. About 44.8% (n = 86) of the victims reported that they had urinated post-rape and prior to forensic examination, 20.8% (n = 40) had changed their clothing, 8.3% (n = 16) had showered, 6.8% (n = 13) had bathed, 4.2% (n = 8) had douched, and only 1.0% (n = 2) had defecated. Only 44 (22.9%) of the victims reported to have ingested alcohol or spiked drinks before the rape CONCLUSION: These findings suggest that some rape victims engaged in personal hygiene practices that could militate against forensic evidence preservation. This finding, therefore, indicates the need for public awareness about ways to preserve evidence to the greatest extent possible after an incident of rape CONTRIBUTION: We provide simple guidelines for victims on the preservation of forensic evidence following rape and before detailed forensic medical examination and evidence collection

BACKGROUND: Stillbirths are a global public health challenge, predominantly affecting low- and middle-income countries. The causes of most stillbirths are preventable. OBJECTIVES: this study reviewed perinatal clinical audit data from Kgapane Hospital over a 4-year period with a special focus on the factors associated with stillbirths. METHODS: File audits were done for all stillbirths occurring at Kgapane Hospital and its catchment area from 2018 to 2021. The data from these audits were analysed to identify factors associated with stillbirths. RESULTS: A total of 392 stillbirths occurred during the study period at Kgapane Hospital and its surrounding clinics, resulting in a stillborn rate of 19.06/1000 births. Of the 392 stillbirths recorded, audits were conducted on 354 of the maternal case records. The five most common causes of stillbirths identified were: hypertensive disorders in pregnancy (HDP) (29.7%), intrauterine growth restriction without HDP (11.6%), birth asphyxia (7.1%), premature labour (< 1000 g) (6.5%) and maternal infections (5.9%) including HIV with unsuppressed VL, intrauterine infection, coronavirus disease (COVID) and syphilis. Modifiable factors that can form the basis of improvement strategies should include training, timeous referral, plus improved resources and staffing. CONCLUSION: Understanding the causes of stillbirths can guide improvement strategies to reduce this heart-breaking complication of pregnancy. CONTRIBUTION: Family physicians working in rural hospitals are also responsible for perinatal care. Understanding the factors associated with stillbirths will guide them to develop improvement strategies to reduce these preventable deaths.

BACKGROUND: South Africa has one of the highest incidences of rape globally. Understanding the epidemiological pattern of rape is needed to inform the design of effective intervention programmes for rape prevention and management of alleged rape cases. AIMS: To investigate important epidemiological patterns associated with rape in Kimberly, Northern Cape Province, South Africa. SETTING: The Robert Mangaliso Sobukwe Hospital (RMSH) forensic unit. METHODS: A descriptive, retrospective cross-sectional clinical audit of rape cases. RESULTS: The majority (93.3%) of the alleged rape victims were women, with a mean age (SD) of 21.6 years (11.3); the male population made up 6.7% of the cases, with a mean age (SD) of 10.5 years (6.9). The highest incidence of alleged rape in the male population was seen in the age group ≤ 16 years (81.8%) and for women 17-30 years (50.3%). Most of the incidents occurred at the perpetrators' homes (42.7%); on the days Fridays (14.6%), Saturdays (29.9%) and Sundays (23.2%); at night up to midnight 20:00-23:59 (32.9%) (p = 0.01) and involved threats of violence (55.5%). The majority (56.0%) of the perpetrators were known to the victims. CONCLUSION: Important information about the victims and circumstances in which rape occurs as reported herein can be used to inform the design of effective intervention programmes for sexual crime prevention and management in Kimberly, South Africa. CONTRIBUTION: This study helped to advance knowledge and understanding of the epidemiological pattern associated with rape in Kimberley, Northern Cape Province of South Africa.

BACKGROUND: Red blood cell (RBC) transfusion is one of the most critical and expensive lifesaving treatment modalities. A clinical audit is a valuable instrument to determine whether transfusion practices align with the guidelines and identify knowledge deficiencies. The study aimed to evaluate the RBC transfusion practices and patient outcomes at the National District Hospital in Bloemfontein, South Africa, and to determine adherence to transfusion guidelines. METHODS: A retrospective descriptive study was conducted. All blood transfusion registers in the hospital were used to identify transfusion episodes during the study period. Files were retrieved from the admissions office and information captured on a paper-based datasheet. The appropriateness of the transfusion and adherence to the South African transfusion guidelines were evaluated using specific criteria. RESULTS: Of the 118 transfusion episodes during the study period, 78 files were retrieved and 76 included in the study. The patients' median age was 47 years (interquartile range [IQR]: 32-66 years), with human immunodeficiency viruses (HIV) (n = 34; 44.7%) being the most common comorbid condition. Pre-transfusion haemoglobin was documented for all patients with a median of 4.6 g/dL (IQR: 3.95 g/dL - 5.5 g/dL). The audit revealed that in 68.4% (n = 52) of the cases, the guidelines were applied appropriately. CONCLUSION: The study described the blood transfusion practices and identified shortcomings when compared with the standard clinical guidelines. CONTRIBUTION: The study highlights the importance of applying rationale, caution and consideration of the specific patient profile when performing transfusions.

BACKGROUND: Our study focuses on vasectomies, an underutilised contraception method worldwide. Little is known about post-vasectomy semen analysis (PVSA) adherence in our setting, which is an essential step in confirming the procedure's success. We aimed to describe patient adherence to post-vasectomy follow-up and the success of procedures performed by different surgeon categories at three Cape Town district health facilities METHODS: We conducted a retrospective descriptive audit. We extracted sociodemographic and procedural information from theatre records and patient folders. The PVSA results were retrieved from Groote Schuur Hospital's Reproductive Medicine Unit RESULTS: The records of 270 patients who underwent vasectomies in local district-level facilities from September 2016 to July 2021 were included. Only 122 (45.2%) semen analysis results were retrievable, of which 115 (94.2%) showed that the procedure was successful. Incomplete patient records significantly impacted the study. A data-collection instrument and implementing standardised stationery were developed, which some sites already use. These measures are designed to ensure more comprehensive datasets for future audits CONCLUSION: The study's findings have identified flaws in record-keeping practices at the three study sites, a crucial step towards improving post-vasectomy care. Tracking procedural success and patient adherence to post-vasectomy semen analyses using the implemented stationery may assist future research and help drive quality improvement projects CONTRIBUTION: This audit strengthens our understanding of improving this underutilised family planning option in the district health services. In partnership with the local teams, a revised clinical care pathway was developed to inform the delivery of an evidence-informed vasectomy service

BACKGROUND: This project is part of a broader effort to develop a new electronic registry for ophthalmology in the KwaZulu-Natal (KZN) province in South Africa. The registry should include a clinical decision support system that reduces the potential for human error and should be applicable for our diversity of hospitals, whether electronic health record (EHR) or paper-based. METHODS: Post-operative prescriptions of consecutive cataract surgery discharges were included for 2019 and 2020. Comparisons were facilitated by the four chosen state hospitals in KZN each having a different system for prescribing medications: Electronic, tick sheet, ink stamp and handwritten health records. Error types were compared to hospital systems to identify easily-correctable errors. Potential error remedies were sought by a four-step process. RESULTS: There were 1307 individual errors in 1661 prescriptions, categorised into 20 error types. Increasing levels of technology did not decrease error rates but did decrease the variety of error types. High technology scripts had the most errors but when easily correctable errors were removed, EHRs had the lowest error rates and handwritten the highest. CONCLUSION: Increasing technology, by itself, does not seem to reduce prescription error. Technology does, however, seem to decrease the variability of potential error types, which make many of the errors simpler to correct. CONTRIBUTION: Regular audits are an effective tool to greatly reduce prescription errors, and the higher the technology level, the more effective these audit interventions become. This advantage can be transferred to paper-based notes by utilising a hybrid electronic registry to print the formal medical record.

BACKGROUND: Pancreatic ductal adenocarcinoma (PDAC) is an aggressive malignancy with poor survival rates. Timeously introduced palliative care (PC) improves the quality of life (QoL) for patients with terminal diseases. In 2020, an in-patient PC-quality improvement (QI) programme was implemented for PDAC patients. This study compared PC outcomes before and after the introduction of the PC-QI programme. METHODS: A focus group identified five critical intervention areas that could improve care. These were in-patient PC referral, pain and symptom control, shared decision-making, interdisciplinary collaborative care, and continuity of care. A hospital record audit of PDAC patients was conducted in pre- and post-implementation cohorts, and the results were compared. RESULTS: A total of 68 (2017 pre-PC-QI) and 39 (2022 post-PC-QI) patient records were audited. Demography, symptom duration, referral delay, and clinical findings were similar in both cohorts. In-patient PC referrals improved significantly from 54.4% in 2017 to 82.1% in 2022 (p = 0.0059). Significant improvements were also recorded in shared decision-making, collaboration, and continuity of care, while the reassessment of pain and symptoms after treatment improved. Fewer invasive procedures were done in the 2022 cohort (p = 0.0056). The delay from admission to an invasive diagnostic procedure decreased from a mean of 8.7 to 1.5 days (p = 0.0001). The duration of hospital admission, overall survival (OS), and readmissions during the final 30 days of life were similar. CONCLUSION: The QI programme resulted in improved use of the in-hospital PC service and made better use of scarce resources. Increasing patient and family participation and feedback will further inform the development of the quality of PC services.

BACKGROUND: Critical laboratory results are test results suggesting a patient is in immediate danger unless treatment is administered promptly. There is a paucity of studies in sub-Saharan Africa on clinicians' utility of these results and affected patients' outcomes. In our resource-limited setting in South Africa, we rely on telephonic communication to convey critical results OBJECTIVE: The aim of this study was to determine the average time for clinicians to acknowledge these results on the laboratory information system and to determine the outcome of affected patients METHODS: A retrospective descriptive audit at Tygerberg Academic Hospital was conducted between 01 October 2021 and 31 March 2022. Critical results and the time of acknowledgement by clinicians on the laboratory information system were obtained from inpatients and outpatients. One hundred and twenty inpatient critical results were randomly selected for a folder review to determine patient outcome RESULTS: Overall, 2514 critical results were reported, and 63 results were excluded. The remaining 2451 results were obtained from 1346 patients. The majority (94.5%) of results were obtained from inpatients, where 1681 (68.6%) were acknowledged within 24 h. The folder audit of 120 patients determined that 40 (33.3%) patients demised. In 82 (68.3%) patients, communication of a critical result did not alter clinical management CONCLUSION: Critical laboratory results are crucial to patient care. This study found that approximately one-third of critical laboratory results were not used within 24 h. Engaging clinicians in current practice and implementing a means of improved communication of critical results is required WHAT THIS STUDY ADDS: The study adds to the evidence of challenges experienced with communicating critical results to clinicians which could impact patient care. This is especially true in resource-limited settings; clinicians need to be made aware of the importance of these results, and communication modes need to be improved.

RESUMO Objetivo: Avaliar a capacidade de identificar possíveis doadores de órgãos em um hospital universitário no estado do Maranhão (MA). Métodos: O estudo é uma coorte retrospectiva, quantitativa, baseada na análise documental de prontuários de pacientes falecidos nas unidades de terapia intensiva (UTIs) de adultos de um hospital universitário no MA, no período de 2018 a 2019. Utilizou-se o Instrumento de Triagem I da Organización Nacional de Trasplantes (ONT) da Espanha, fundamentado por Avedis Donabedian e validado no Brasil, para identificar possíveis doadores com indícios clínicos de morte encefálica (ME). A análise envolveu a revisão dos prontuários e a aplicação de critérios de diagnóstico de ME, conforme a Resolução nº 2.173 de 2017 do Conselho Federal de Medicina. Foram analisados 312 prontuários, resultando em 38 com sinais de ME, classificados como escapes por falhas na identificação e manutenção dos doadores. Resultados: Dos 312 prontuários avaliados, 21 de 2018 e 17 de 2019 (totalizando 38) apresentaram indícios clínicos de ME e foram selecionados para auditoria detalhada. Além disso, foi identificado que 31,1% dos escapes ou perdas de possíveis doadores ocorreram devido a óbitos não identificados como ME, gerando indicadores antes desconhecidos. A ferramenta revelou que pacientes submetidos a tratamento cirúrgico para tumores encefálicos e doenças cerebrovasculares têm maior probabilidade de evoluir para ME. Esses pacientes, geralmente internados na UTI geral, devem receber atenção especial nas avaliações diárias, pois têm alto potencial para se tornarem doadores de órgãos. Conclusão: A auditoria evidenciou a necessidade de melhorias na identificação e manutenção de possíveis doadores, bem como na redução de recusas familiares para aumentar o número de doações efetivas. Objetivo MA. MA . (MA) Métodos retrospectiva quantitativa UTIs (UTIs 201 Utilizouse Utilizou ONT (ONT Espanha Brasil (ME) 2173 2 173 2.17 Medicina 31 3 Resultados avaliados 1 totalizando detalhada disso 311 31,1 desconhecidos geral diárias Conclusão efetivas (MA 20 (ME 217 2.1 31, 2.

ABSTRACT Objective: To assess the capacity to identify potential organ donors in a university hospital in Maranhão (MA). Methods: The study is a retrospective, quantitative cohort based on the documentary analysis of medical records of deceased patients in the adult intensive care units (ICUs) of a university hospital in MA from 2018 to 2019. Screening Instrument I from the Organización Nacional de Trasplantes (ONT) of Spain, based on Avedis Donabedian and validated in Brazil, was used to identify potential donors with clinical signs of brain death (BD). The analysis involved reviewing medical records and applying BD diagnostic criteria, according to Conselho Federal de Medicina Resolution nº 2,173 of 2017. A total of 312 records were analyzed, resulting in 38 with signs of BD, classified as escapes due to identification and maintenance failures of potential donors. Results: Of the 312 evaluated records, 21 from 2018 and 17 from 2019 (totaling 38) presented clinical signs of BD and were selected for detailed auditing.Additionally, it was identified that 31.1% of the escapes or losses of potential donors resulted from deaths not identified as BD, generating previously unknown indicators. The tool revealed that patients undergoing surgical treatment for brain tumors and cerebrovascular diseases have a higher likelihood of evolving to BD. These patients, usually admitted to the general ICU, should receive special attention in daily assessments due to their high potential to become organ donors. Conclusion: The audit highlighted the need for improvements in the identification and maintenance of potential donors, as well as in reducing family refusals, to increase the number of effective donations. Objective MA. . (MA) Methods retrospective ICUs (ICUs 201 ONT (ONT Spain Brazil (BD) criteria 2173 2 173 2,17 2017 31 analyzed 3 Results 1 totaling auditingAdditionally auditing Additionally auditing.Additionally 311 31.1 indicators ICU Conclusion refusals donations (MA 20 (BD 217 2,1 31. 2,

RESUMO Introdução: A captação de tecidos musculoesqueléticos é fundamental para garantir o fornecimento de produtos biológicos de origem humana com segurança e eficácia clínica. Para assegurar a qualidade desses tecidos, é essencial que a etapa de captação passe por um processo de validação. Objetivos: Este artigo descreve a experiência de um banco de multitecidos humanos (BMTHs) público na validação da captação de tecido musculoesquelético (cabeça femoral) de doador vivo. Métodos: Trata-se da avaliação e adequação de um protocolo de captação visando promover a excelência na qualidade dos tecidos distribuídos para fins terapêuticos e de pesquisa. Para isso, foram realizadas uma visita técnica em outro banco de tecidos e reuniões com a equipe do serviço de ortopedia para apresentação e discussão sobre o fluxo do processo. A triagem do doador foi conduzida por meio da aplicação de formulários, avaliando os critérios de seleção e exclusão. Após a aceitação, mediante termo de consentimento, foram solicitados os exames sorológicos do doador e, por fim, a captação. Validaram-se o kit de captação, o controle de temperatura da caixa térmica de transporte e a coleta de material microbiológico da peça no momento da retirada. Para considerar válido o processo, o tecido captado passou por avaliações macroscópicas, radiológicas e microbiológicas. Os formulários e demais documentos do prontuário foram auditados pelo Núcleo de Qualidade e Segurança em Saúde (NQSS) da instituição. Também foi realizado o mapeamento dos processos, visando os riscos e oportunidades de melhoria. Resultados: O protocolo de captação foi realizado e validado conforme previsto no plano de ação. A técnica de captação foi realizada de forma estéril no centro cirúrgico. As análises microbiológicas e sorológicas apresentaram resultados negativos e o tecido foi considerado macroscopicamente viável. Após auditoria, a documentação foi considerada adequada ao atender a legislação vigente (Resolução da Diretoria Colegiada – RDC Nº 707, de 1 de julho de 2022). Além disso, o mapeamento dos processos garantiu a segurança da captação e proporcionou oportunidades de melhoria. Conclusão: Apresenta-se um protocolo de captação de tecidos musculoesqueléticos no serviço de referência, sendo o processo de validação replicável, por meio de uma ferramenta fundamental para assegurar a inocuidade e segurança na captação de tecidos. Descritores: Doação de Tecidos; Transplante de Tecidos; Controle de Qualidade Biológica; Produtos Inócuos; Banco de Tecidos Humanos. Introdução clínica Objetivos BMTHs (BMTHs cabeça femoral vivo Métodos Tratase Trata se pesquisa isso exclusão aceitação consentimento fim Validaramse Validaram retirada macroscópicas NQSS (NQSS instituição melhoria Resultados ação cirúrgico viável auditoria Resolução 707 2022. 2022 . 2022) disso Conclusão Apresentase Apresenta referência replicável Descritores Biológica Inócuos Humanos 70 202 7 20 2

ABSTRACT Introduction: The harvesting of musculoskeletal tissues is essential to ensure the supply of biological products of human origin with safety and clinical efficacy. The harvesting stage must undergo a validation process to guarantee the quality of the tissues. Objectives: This article describes the experience of a public human multi-tissue bank (HMTB) in validating the harvesting of musculoskeletal tissue (femoral head) from a living donor. Methods: This involves evaluating and adapting a harvesting protocol to promote excellence in the quality of tissues distributed for therapeutic and research purposes. To this end, a technical visit was carried out at another tissue bank, and meetings were held with the orthopedic service team to present and discuss the process flow. Donor screening was done by applying forms evaluating the selection and exclusion criteria. After acceptance, through the consent form, the donor’s serological tests were requested and collected. The harvesting kit, control of the temperature thermal transport box, and collecting microbiological material from the piece at the time of removal were validated. The validated harvested tissue underwent macroscopic, radiological, and microbiological evaluations to consider the process valid. The forms and other documents in the medical record were audited by the institution’s health quality and safety center. Process mapping was also carried out, targeting risks and opportunities for improvement. Results: The harvesting protocol was validated as foreseen in the action plan. The harvesting technique was performed sterilely in the operating room. Microbiological and serological analyses showed negative results, and the tissue was considered macroscopically viable. After the audit, the documentation was deemed adequate to comply with current legislation (Resolução da Diretoria Colegiada – RDC Nº 707, of July 1, 2022), and the mapping of processes guaranteed the security of harvesting and provided opportunities for improvement. Conclusion: A protocol for capturing musculoskeletal tissues in the reference service is presented, with the validation process being replicable through a fundamental tool to ensure harmlessness and safety in tissue harvesting. Introduction efficacy Objectives multitissue multi HMTB (HMTB femoral head donor Methods purposes end flow criteria acceptance form donors s collected kit box macroscopic radiological valid institutions institution center improvement Results plan room results viable audit Resolução 707 1 2022, 2022 , 2022) Conclusion presented 70 202 7 20 2

Abstract Objective: To implement the best scientific evidence in the clinical supervision of ICUs by applying the JBI clinical audit tool for the optimization of the practice of clinical supervision in intensive care units. Materials and methods: This project used the JBI evidence implementation framework, based on the audit and feedback process together with a structured approach to identify and manage barriers to compliance with recommended clinical practices. Results: Most supervisors have little time to supervise critical care areas. The baseline audit showed that, of the 8 criteria set by JBI to assess clinical supervision, only three achieved 80% compliance by supervisors. Conclusions: The JBI clinical audit model allowed the identification of a series of criteria that were affecting clinical supervision and the establishment of a work plan template to strengthen and standardize the work of nursing supervision.

Resumen Objetivo: Implementar la mejor evidencia científica en la supervisión clínica de las UCI mediante la aplicación de la herramienta del JBI de auditoría clínica para la optimización de la práctica de la supervisión clínica en las unidades de cuidados intensivos. Materiales y Métodos: Este proyecto utilizó el marco de implementación de evidencia de JBI basado en el proceso de auditoría y retroalimentación junto con un enfoque estructurado para identificar y gestionar las barreras al cumplimiento de las prácticas clínicas recomendadas. Resultados: La mayoría de los supervisores tienen poco tiempo de supervisar las áreas de cuidados críticos. La auditoría de línea de base mostró que, de los 8 criterios establecidos por el JBI para evaluar la supervisión clínica, solo tres lograron un 80% de cumplimiento por parte de los supervisores. Conclusiones: El modelo de auditoría clínica JBI permitió identificar una serie de criterios que estaban afectando la supervisión clínica y la instauración de una plantilla de plan de trabajo para fortalecer y estandarizar la labor de la supervisión de enfermería.

BACKGROUND: A discharge summary may be the only available health record for a patient, especially in resource-limited settings with suboptimal record-keeping. Considering the risk of adverse neurodevelopmental outcomes secondary to hypoxic ischaemic encephalopathy (HIE), as well as litigation, the quality of summaries for neonates with HIE is particularly important. OBJECTIVES: To audit electronic discharge summaries of neonates admitted with HIE to two tertiary hospitals in Bloemfontein, South Africa. METHODS: A retrospective, quantitative study was conducted. Electronic discharge summaries of late preterm and term neonates with HIE, admitted in 2018 and 2019, were audited for relevant information, including final diagnosis, birth history, clinical evaluation, management, investigations, plan at discharge, as well as counselling of parents. RESULTS: Of the 165 identified cases, 34 (20.6%) were excluded. Ten patients did not have electronic discharge summaries. Admission register details were incomplete for the other 24 cases. The final diagnosis of HIE appeared in 87 of 131 (66.4%) audited summaries. More than half (52.7%) had incorrect ICD-10 coding for HIE. Information on foetal distress and sentinel events was absent in 61.1% and 42.0%. Requirement for resuscitation was recorded in 90.8% of summaries. Performance of cardiac compressions and adrenaline administration were not specified in 46.6% and 54.2%. Admission blood gas results, particularly base deficit, lactate and glucose, were absent in 42.7%, 63.4% and 90.8% of summaries. Eligibility for therapeutic hypothermia was not captured in 41.2%. Cranial ultrasound, neuroimaging, exclusion of meningitis, or multisystem involvement was not mentioned in 80.9%, 99.2%, 80.2% and 96.2%, respectively. Notes on counselling of parents were lacking (83.2%). Final cause of death was unspecified in 85.7% (n=12/14) of patients who died. CONCLUSION: Discharge summaries of neonates at risk of adverse neurodevelopmental outcomes secondary to HIE lacked essential information. Quality improvement and regular auditing of patient records must be prioritised.