Inconsistent reporting of minimally invasive surgery errors

Introduction

Minimally invasive surgery (MIS) is a complex task requiring dexterity and high level cognitive function. Unlike surgical ‘never events’, potentially important (and frequent) manual or cognitive slips (‘technical errors’) are underresearched. Little is known about the occurrence of routine errors in MIS, their relationship to patient outcome, and whether they are reported accurately and/or consistently.

Methods

An electronic survey was sent to all members of the Association of Surgeons of Great Britain and Ireland, gathering demographic information, experience and reporting of MIS errors, and a rating of factors affecting error prevalence.

Results

Of 249 responses, 203 completed more than 80% of the questions regarding the surgery they had performed in the preceding 12 months. Of these, 47% reported a significant error in their own performance and 75% were aware of a colleague experiencing error. Technical skill, knowledge, situational awareness and decision making were all identified as particularly important for avoiding errors in MIS. Reporting of errors was variable: 15% did not necessarily report an intraoperative error to a patient while 50% did not consistently report at an institutional level. Critically, 12% of surgeons were unaware of the procedure for reporting a technical error and 59% felt guidance is needed. Overall, 40% believed a confidential reporting system would increase their likelihood of reporting an error.

Conclusion

These data indicate inconsistent reporting of operative errors, and highlight the need to better understand how and why technical errors occur in MIS. A confidential ‘no blame’ reporting system might help improve patient outcomes and avoid a closed culture that can undermine public confidence.     

Validated HIV Knowledge Scales for Use with Adults and Adolescents: A Systematic Review

AIDS and Behavior - HIV knowledge – the information a person possesses about HIV – is essential for the prevention and management of HIV. Therefore, the accurate measurement of HIV...     

<Emphasis Type="Italic">Kocuria kristinae</Emphasis> infection associated with acute cholecystitis

Background  

Kocuria, previously classified into the genus of Micrococcus, is commonly found on human skin. Two species, K. rosea and K. kristinae, are etiologically associated with catheter-related bacteremia.     

Involvement of the AML1 gene in the t(3;21) in therapy-related leukemia and in chronic myeloid leukemia in blast crisis

A nonrandom translocation between chromosomes 3 and 21, t(3;21)(q26.2;q22) has been detected in patients with a myelodysplastic syndrome or acute myeloid leukemia after treatment (t-MDS/t-AML) for a primary malignant disease and in chronic myelogenous leukemia in blast crisis (CML-BC). In these patients, the breakpoint on chromosome 21 is at band 21q22. This band is also involved in the t(8;21)(q22;q22) detected in 40% of the patients with acute myeloid leukemia subtype M2 (AML-M2) de novo who have an abnormal karyotype. In the t(8;21), the AML1 gene is the site of the breakpoint on chromosome 21. The AML1 gene is transcribed from telomere to centromere, and in the t(8;21) the 5' part of AML1 is fused to the ETO gene on chromosome 8 to produce the chimeric AML1/ETO on the der(8) chromosome. We found that AML1 is also rearranged in two t-AML patients and in one CML-BC patient with the t(3;21), but the breakpoints are approximately 40 to 60 kb downstream to those of AML-M2 patients. This region contains at least one additional exon of AML1, as determined by using an AML1 cDNA as a probe in Southern blot analysis. The t(3;21) breakpoints for the remaining patients could not be determined because, by fluorescence in situ hybridization analysis, the breaks are outside of the region covered by the available probes.     

Hypercalcemia and soft tissue calcification owing to sarcoidosis: The sunlight‐cola connection

Hypercalcemia occurs in sarcoidosis because of 1,25‐dihydroxyvitamin D production by pulmonary alveolar macrophages. Long‐standing hypercalcemia and hypercalciuria may cause such complications as nephrocalcinosis, nephrolithiasis, and soft tissue calcification, which can be at least partially reversible with treatment. Here we present a 43‐year‐old African‐American man with diffuse soft tissue calcifications and acute kidney injury owing to sarcoidosis‐induced hypercalcemia, probably exacerbated by sun exposure and phosphorus intake in the form of dietary cola drinks. Soft tissue calcifications resolved and kidney function improved significantly with hydration and glucocorticoid therapy. We discuss the pathophysiology of the hypercalcemia of sarcoidosis and current treatment options. © 2010 American Society for Bone and Mineral Research     

Bioinformatics advances in saliva diagnostics

There is a need recognized by the National Institute of Dental & Craniofacial Research and the National Cancer Institute to advance basic,translational and clinical saliva research. The goal of the Salivaomics Knowledge Base (SKB) is to create a data management system and web resource constructed to support human salivaomics research. To maximize the utility of the SKB for retrieval,integration and analysis of data,we have developed the Saliva Ontology and SDxMart. This article reviews the informatics advances in saliva diagnostics made possible by the Saliva Ontology and SDxMart.     

Lobular capillary hemangioma of the liver

BACKGROUND:Lobular capillary hemangioma(LCH) is a benign vascular tumor that is rare in adults and has never been reported in the liver.This vascular lesion usually presents on the skin or mucous membranes,and predominantly affects children. METHODS:LCH as a large asymptomatic hepatic mass was seen in a 35-year-old female.Imaging and pathologic characteristics of the mass are reviewed,and the relevant literature is also reviewed. RESULTS:A large vascular hepatic lesion was observed in an asymptomatic 35-yea...     

Youth working alliance: a core clinical construct in need of empirical maturity

The therapeutic alliance has long been recognized as an important component of successful psychotherapy for adults; research has established robust links to outcome. Until recently, however, research on the alliance between youth and their therapists has been sparse. The present review synthesizes the existing findings regarding the youth alliance and utilizes the adult alliance literature and the child and adolescent developmental literatures to suggest future avenues of research. Weak alliance was found to predict premature termination, and strong alliance predicted symptom reduction, with some support for differential effects of the youth-therapist and parent-therapist alliances. In addition, the youth alliance is moderated by several patient and therapist characteristics, including the particular problems of patients and the interpersonal skills of therapists. The field has yet to coalesce around a single definition of the youth alliance, however, making it difficult to assess research results. Adult models of the alliance continue to be used heuristically despite some evidence that the alliance operates differently for youth. Tightening the operational definition of the youth alliance and addressing methodological issues will be essential in future efforts to understand how the alliance develops and what role it may play in the treatment process for youth.     

Salbutamol for hyperkalaemia in children

Hyperkalaemia is a potentially fatal disorder that demands direct treatment. The efficacy of traditional medical treatment is unpredictable, limited, of short duration or carries the risk of serious adverse events. The administration of salbutamol for hyperkalaemia in children is described in several clinical trials and case reports.

Conclusion: Salbutamol, inhaled or infused, is safe and efficacious and results in a predictable and long-lasting reduction in serum potassium. Salbutamol merits a place as the preferred medication for hyperkalaemia in children without arrhythmias. If follow-up with haemodialysis is required, the administration of salbutamol gives time to make the necessary preparations.     

Healthy Characters? An Investigation of Marketing Practices in Children's Food Advertising

ObjectiveTo determine the nutritional quality of foods advertised with familiar children's characters and health-related messages.DesignChildren's programming aired on the most popular broadcast and cable channels during 2011 was sampled to form a composite weekday and weekend day. All food advertisements (ads) included in this programming were content analyzed.ParticipantsFive hundred seventy-seven food ads.Variables MeasuredFamiliar characters promoting products were either trade or licensed characters. A product's nutritional quality was determined using the United States Department of Health and Human Services' categorizations, based on the frequency foods should be consumed. Health cues were present when a food was claimed to be healthy, physical activity was depicted, or the product was associated with fruit.AnalysisFrequencies and chi square analyses were conducted; P < .05.ResultsNearly three quarters (73%) of food ads targeting children use a familiar character. The majority of these ads (72%) promote foods of low nutritional quality, yet 53% employ a health-related message.Conclusions and ImplicationsFamiliar characters proliferate in food advertising to children, yet marketers do not adhere to recommendations that characters promote strictly healthy foods. Future research is needed to investigate effects and inform policy decisions in this realm.