RESUMEN
This article maps current approaches to public reporting on waiting times, patient experience and aggregate measures of quality and safety in 11 high-income countries (Australia, Canada, England, France, Germany, Netherlands, New Zealand, Norway, Sweden, Switzerland and the United States). Using a questionnaire-based survey of key national informants, we found that the data most commonly made available to the public are on waiting times for hospital treatment, being reported for major hospitals in seven countries. Information on patient experience at hospital level is also made available in many countries, but it is not generally available in respect of primary care services. Only one of the 11 countries (England) publishes composite measures of overall quality and safety of care that allow the ranking of providers of hospital care. Similarly, the publication of information on outcomes of individual physicians remains rare. We conclude that public reporting of aggregate measures of quality and safety, as well as of outcomes of individual physicians, remain relatively uncommon. This is likely to be due to both unresolved methodological and ethical problems and concerns that public reporting may lead to unintended consequences.
Asunto(s)
Benchmarking/métodos , Accesibilidad a los Servicios de Salud , Satisfacción del Paciente , Calidad de la Atención de Salud/organización & administración , Benchmarking/normas , Países Desarrollados , Salud Global , Hospitales/normas , Humanos , Atención Primaria de Salud , Encuestas y Cuestionarios , Listas de EsperaRESUMEN
OBJECTIVES: To present a new guidance technique using transtomography in the operating room and to test the accuracy of this surgical protocol. MATERIAL: A new concept of operating room, integrating when necessary this imagery to secure flapless procedures by intraoperative control, is described. This operating room concept, including X ray protection of the operators, is explained in addition to the transport system of the panoramic machine for its transfer to the patient who remains seated on his surgical chair. METHODS: Twenty-five single-tooth edentulous patients were treated by implant placement with a flapless or a minimally invasive procedure using transtomographic navigation. The surgical protocol is explained: after the first limited drill through mucosa and bone, intraoperative transtomography is performed with a custom-made titanium guide inserted into the bone. Images show the drilling axis in three dimensions. This form of navigation allows rectifying the drill axis. We explain how this protocol respects asepsis. RESULTS: The mean angular deviation was 2.04 degrees in the mesiodistal direction (range: 0 degrees -4.8 degrees, variance: 2.88) and 2.71 degrees in the buccal or the palatolingual direction (range: 0 degrees -5.4 degrees; variance: 2.63). Implant tip deviation was calculated: the mean mesiodistal tip deviation was 0.42 mm, and the mean buccal or palatolingual tip deviation was 0.5 mm. The maximum tip mesiodistal deviation was 1.08 mm and the maximum vestibular or palatolingual tip deviation was 1.22 mm. CONCLUSION: This protocol appears to be as accurate as other guided or navigation systems. The advantages and limitations of this technique are explained, followed by future prospects with the new 3D cone beam computed tomography developed with the same panoramic machine.