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SUMMARY In the emergency care of cancer patients, in addition to cancer-related factors, two aspects influence the outcome: (1) where the patient is treated and (2) who will perform the surgery. In Brazil, a significant proportion of patients with surgical oncological emergencies will be operated on in general hospitals by surgeons without training in oncological surgery. OBJECTIVE: The objective was to discuss quality indicators and propose the creation of an urgent oncological surgery advanced life support course. METHODS: Review of articles on the topic. RESULTS: Generally, nonelective resections are associated with higher rates of morbidity and mortality, as well as lower rates of cancer-specific survival. In comparison to elective procedures, the reduced number of harvested lymph nodes and the higher rate of positive margins suggest a compromised degree of radicality in the emergency scenario. CONCLUSION: Among modifiable factors is the training of the emergency surgeon. Enhancing the practice of oncological surgery in emergency settings constitutes a formidable undertaking that entails collaboration across various medical specialties and warrants endorsement and support from medical societies and educational institutions. It is time to establish a national registry encompassing oncological emergencies, develop quality indicators tailored to the national context, and foster the establishment of specialized training programs aimed at enhancing the proficiency of physicians serving in emergency services catering to cancer patients.

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Public-private partnerships (PPP) represent an alternative model of health management focused on improving the quality of health services, particularly in emerging countries. To date, a systematic method to improve the perceived quality of health services by healthcare users in Peru has not been established. The purpose of this study was to evaluate the quality of health services in two PPP hospitals in Peru using the Kano model. A prospective cross-sectional descriptive observational study was carried out through a health service satisfaction survey using the Kano model methodology, measuring six categories of attributes. A total of 250 users of the health services were surveyed in the two PPP hospitals, located in Lima and Callao, using non-probability convenience sampling. Of the 31 attributes evaluated by the patients, 27 (81%) were classified as having a one-dimensional-type attribute, 3 (10%) were reported as mandatory, and 1 (3%) was considered as inverse. These results suggest that the presence of most of the attributes evaluated was relevant to maintaining the level of user satisfaction and that the absence of these attributes generated dissatisfaction in the users. The results showed that the users' evaluation of health services was multidimensional-namely, their evaluation was focused not only on the interaction space between the patient and medical personnel but also addressed other interaction services.

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ABSTRACT Objective: To investigate relationships among flexible and hierarchical organizational cultures, quality improvement domains, and authentic leadership competencies in Canadian healthcare facilities. Method: Observational cross-sectional study conducted in Alberta, Canada. Nurse managers (n=226) completed a survey including validated measures of organizational culture, quality improvement and authentic leadership. Data were analyzed using descriptive statistics, Spearman's correlation coefficient and Chi-squared test (p<0.05). Results: Quality improvement through accreditation is related to organizational culture and authentic leadership. We saw a propensity for participants who reported working in a more flexible culture also reported greater quality improvement implementation and authentic leadership practices. Conclusion: This study assessed and reported the relationships between flexible organizational cultures, quality improvement through the accreditation process, and authentic leadership practices of healthcare managers. Flexible organizational cultures influence the adoption of authentic leadership, participatory management model and also improves quality.

RESUMO Objetivo: Investigar as relações entre culturas organizacionais flexíveis e hierárquicas, domínios de melhoria da qualidade e competências da liderança autêntica em instituições de saúde canadenses. Método: Estudo observacional transversal realizado em Alberta, Canadá. Os gerentes de enfermagem (n=226) responderam a um questionário validado sobre cultura organizacional, melhoria da qualidade e liderança autêntica. Os dados foram analisados ​​por estatística descritiva, coeficiente de correlação de Spearman e teste Qui-quadrado (p<0,05). Resultados: A melhoria da qualidade alcançada por meio da acreditação está relacionada à cultura organizacional adotada e à liderança autêntica. Participantes que relataram trabalhar em uma cultura flexível, também relataram maior investimento na melhoria da qualidade e práticas de liderança autênticas. Conclusão: Este estudo avaliou as relações entre culturas organizacionais flexíveis, melhoria da qualidade por meio da acreditação e práticas autênticas de liderança dos gerentes de enfermagem. Culturas organizacionais flexíveis influenciam a adoção da liderança autêntica, modelo de gestão participativo e melhoria da qualidade.

RESUMEN Objetivo: investigar las relaciones entre culturas organizacionales flexibles y jerárquicas, los dominios de mejoría de calidad, y las competencias del liderazgo auténtico en las instituciones canadienses de cuidado a la salud. Método: estudio observacional trasversal conducido en Alberta, Canadá. Enfermeras administradoras (n=226) respondieron a una encuesta incluyendo medidas validadas de cultura organizacional, mejoría de calidad, y liderazgo auténtico. Se analizó a los datos por medio de estadística descriptiva, de la correlación de Spearman, y de la prueba de ji-cuadrado (p<0,05). Resultados: la mejoría de la calidad por medio de acreditación está relacionada a la cultura organizacional y al liderazgo auténtico. Hemos visto una tendencia según la cual los participantes que dijeron trabajar en una cultura más flexible también expresaron que hubo una implantación mayor de mejorías y de prácticas de liderazgo auténtico. Conclusión: ese estudio verificó y relató las relaciones entre culturas organizacionales flexibles, mejorías de calidad por medio de procesos de acreditación y prácticas de liderazgo auténtico de administradoras de atención a la salud. Culturas organizacionales flexibles influencian en la adopción de un liderazgo auténtico, de un modelo de administración participativo, además de mejoraren la calidad.

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OBJECTIVES: This study was designed to address the current relative void of valid measures by developing evidence-based quality indicators for pain management of chronic nonmalignant pain. METHODS: We performed a 10-year literature search to identify guidelines and review articles on chronic pain management to identify evidence-based recommendations for the different conditions associated to chronic pain. A complementary search of indicators and indicator-related articles was also performed. Then, we built new indicators or adapted existing ones to cover all the evidence-based recommendations we found. The resulting set was pilot tested for feasibility, reliability (kappa), and usefulness to identify quality problems, using the Lot Quality Acceptance method (α ≤ 0.05 and ß ≤ 0.01) for 75% (40% threshold) and 95% (70% threshold) compliance standards, and estimates with binomial exact 95% confidence intervals. We reviewed clinical records from a primary care center, a medium-size hospital (250 beds), and a large hospital (500 beds). RESULTS: Forty-six indicators were developed (6 general and 40 condition specific). Thirty-three were feasible in primary care and/or hospitals. Feasible indicators were also reliable (most kappa > 0.7). Regarding compliance, 4 quality indicators obtained compliance levels over 60%, addressing pharmacological treatment, multimodal approach, and appropriate use of neuro-image tests, while 16 obtained compliance scores under 15% (6 with 0% compliance). CONCLUSIONS: The created set has tested to be feasible, reliable, and useful, with the capacity to serve as the baseline for developing the necessary strategies to improve the management of chronic nonmalignant pain, by monitoring and evaluating quality of care.

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