RESUMO
Tradicionalmente, el error ha servido para aprender lo que no había que hacer y lo que no era verdad. Luego se sumó la reacción de castigar al responsable del error suponiendo que éste era producto de la incapacidad o irresponsabilidad individual. La búsqueda, explícita o no, del "culpable" ha promovido mayor temor en los profesionales de la salud y generado una creciente tendencia a ocultar los errores. Desde 2001, la Academia Nacional de Medicina, a través de su Centro de Investigaciones Epidemiológicas, desarrolló e implementó un programa para el mejoramiento de la seguridad en la atención de los pacientes, en cuatro instituciones sanitarias de nuestro país de diferentes características. El propósito del programa es: "diseñar, validar y evaluar metodologías que permitieran identificar errores, casi errores y eventos adversos; analizar el mecanismo de su producción y contribuir a señalar los procesos correctivos". El mismo está organizado en cuatro componentes: a) cultura organizacional para la seguridad del paciente; b) sistemas de información para la vigilancia del error durante el proceso de atención, c) mejoramiento continuo de la seguridad del paciente y d) gestión de conocimiento.
Assuntos
Assistência ao Paciente/normas , Planos e Programas de Saúde , Saúde Ambiental , Medicina Baseada em Evidências , Erros Médicos/prevenção & controle , Erros Médicos/tendências , Notificação de Abuso , Guias de Prática Clínica como Assunto , Prontuários Médicos/normasRESUMO
BACKGROUND: Sclerotherapy is the most widely used method for treatment of acute variceal bleeding. Previous reports have suggested that octreotide infusion is as effective as sclerotherapy. Our aim was to investigate the efficacy and safety of octreotide in comparison with sclerotherapy in controlling variceal bleeding. METHODS: Seventy-six cirrhotic patients were randomized to receive either sclerotherapy (n = 37) or octreotide (n = 39) infusion of 50 microg/h intravenously for 48 h after a bolus of 100 microg, followed by subcutaneous injection of 100 microg/8 h for an additional 72 h. RESULTS: The two groups were similar in base-line data. A similar initial control of bleeding was obtained in 94.6% for sclerotherapy and 84.6% for octreotide (NS). No difference was observed between sclerotherapy and octreotide in rebleeding (23% versus 33%) and treatment failure (22% versus 36%, respectively). Furthermore, the overall success of treatment was 78% for sclerotherapy and 64% for octreotide. No significant difference in mortality was observed between treatments (eight patients for octreotide and three patients for sclerotherapy, NS). CONCLUSIONS: These results show that both treatments present a very high and similar initial and final control of bleeding. However, there is a trend that could be clinically important towards better results in the patients treated with sclerotherapy.