Citations

Objective: Design a protocol for conducting preoperative briefings within the context of cardiovascular surgery. Method: A combined questionnaire and semi-structured focus group approach involving four subspecialties of surgical staff (n = 47) was conducted to gather information concerning (1) attitudes towards preoperative briefings, (2) logistical issues related to the conduct and content of briefings and (3) potential barriers that might impede implementation. Results: Analyses revealed consensus among surgical staff concerning briefing benefits (majority were very positive), duration (< 10 min), location (in the OR), content (procedure, patient, and equipment issues) and potential barriers (staff availability, attitudes, case scheduling, and lack of resources). Differences in opinions arose concerning timing of the brief (e.g., before vs. after patient enters OR) and the role of key participants. Discussion: A prototype checklist for conducting preoperative briefings was developed based on these results. Additional research is needed to implement and validate its effectiveness.

Objectives: To determine if the METI laparoscopic surgical simulator can discriminate between novices and experts and to assess learning curves among novices. Methods: Twenty novices and 5 experts performed five repetitions on the following modules: place arrow, retract, dissect, and traverse tube. For each module, median baseline performance was calculated. Novices performed 35 additional repetitions to assess learning with practice. Results: Experts out-performed novices at baseline for completion time of the dissect, place arrow, and traverse tube modules, as well as for error frequency on the traverse tube and retract modules. Novices' performance times improved significantly with practice, approaching the experts' baseline in all modules. Conclusion: The METI simulator exhibits construct validity on three of four basic-skills modules when considering completion time and on two modules when considering error frequency. Among novices, learning occurred with additional repetitions. Whether acquired skills transfer to the actual surgical environment has yet to be determined.

Cardiopulmonary bypass machines (CBM's), first developed in 1953, are commonly used during heart surgery to oxygenate blood and circulate it throughout the body while the heart is stopped. Although several advances have occurred in the engineering of perfusion pumps, the interface design of CBM's has not changed appreciably for several decades. The growing awareness of human error in medicine has highlighted the role that poorly designed medical devices can play in producing errors that cause patient harm. The purpose of this study, therefore, was to identify issues related to CBM design that may predispose surgical teams to make errors. The study utilized multiple research methods including observations, heuristic evaluations, structured interviews and usability assessments. Results revealed several fundamental design problems associated CBM displays, controls, alarms, and component integration, as well as communication and procedural issues. These data provide valuable information for redesigning CBM's to reduce errors and improve patient safety.

Surgical flow disruptions can significantly increase the probability of surgical errors. However, little is known about the frequency and nature of surgical flow disruptions, making the development of evidence-based interventions extremely difficult. The goal of this project was to prospectively study surgical errors and their relationship to surgical flow disruptions within the context of cardiac surgery. A trained observer recorded surgical errors and flow disruptions during 31 cardiac operations over a three-week period. Flow disruptions were then reviewed and analyzed by an interdisciplinary team of surgical and human factors experts. Results revealed that flow disruptions consisted of teamwork/communication failures, equipment and technology problems, extraneous interruptions, training-related distractions, and resource accessibility issues. Errors increased significantly with increases in flow disruptions. Teamwork/communication failures were the strongest predictor of surgical errors. These findings provide preliminary data for developing evidenced-based error management and patient safety programs within cardiac surgery.

Errors with serious consequences continue to occur at a high rate in many surgical specialties. In this study, the Human Factors Analysis and Classification System (Wiegmann & Shappell, 2003) was used to develop a structured interviewing tool for prospectively assessing the systemic factors that may predispose operating room (OR) personnel to making errors. Approximately 50% (n = 68) of all staff involved in patient care within the cardiac surgery OR at our institution participated, with an equal proportion represented across staff specialties (Surgeons, Anesthesiologists, Nurses, Perfusionists and Technicians). Results identified a variety of potential error-producing factors present in the OR setting. While such factors were viewed by OR staff as occurring infrequently, significant relationships between the estimated frequency of systemic problems and specific error forms were identified. These findings can inform both the development of theoretical models of surgical error, as well as the practice of developing targeted intervention programs.

Assistive equipment has helped lower task demands and back stress for patient-handlers; however, limited research exists on the psychological benefits (i.e., safety and comfort) of self-transfer devices for patients in postoperative care. A study was conducted to determine the efficacy of a bed assistive device in a patient population; the objectives were to compare self-perceived recovery measures and usage of pain medication between patients in the Control ( n = 8; age, 34 ± 6.3years) and Device ( n = 7; 41 ± 12) groups. Fifteen female participants undergoing either abdominal hysterectomy ( n = 6) or Cesareansection ( n = 9) procedures were recruited for the study. Both groups completed a total of twelve questionnaires over a five-week recovery period. The Device Group reported higher levels of energy, less pain interference, lower perceived pain, less reliance on pain medication and returned to activities of daily living faster than the Control Group.

AbstractBackgroundThis study evaluated the impact of tumor regression grading (TRG) and other pathologic variates in a cohort of rectal carcinoma patients treated with neoadjuvant chemoradiotherapy (CRT). The value of a grading less than pCR for predicting survival is unknown. Tumor budding has not been systematically studied in rectal cancer after neoadjuvant therapy.MethodsPathologic risk factors for survival were evaluated on surgical specimens of 237 patients with stages I, II, and III rectal cancer treated between 1996 and 2006. All patients underwent preoperative CRT followed by surgical resection 6–8 weeks later. TRG, tumor grade, budding, venous invasion, radial margin, and nodal status were evaluated. The prognostic value of TRG categories was calculated with Cox regression models and validated with resampling methods.ResultsTRG of <25% occurred in 61 (25.7%) and a complete response in 39 (16.4%) of the resected specimens. TRG of <25% was shown to be a statistically significant predictor for cancer‐specific survival (CSS) and recurrence‐free survival (RFS) compared to TRG ≥25% (P = 0.013). Tumor budding was present in 24 (10.1%) of the patients and was negatively associated with CSS (P = 0.013). Lymph node involvement was observed in 83 (35.0%) patients. TRG and nodal status (P < 0.001) were the most significant predictors associated with outcome.ConclusionPartial pathologic response ≥25% was a superior predictor compared to pCR for improved survival after preoperative CRT. CSS and RFS were adversely affected by the presence of lymph node metastases.

ABSTRACTPurposeTo identify studies that have validated administrative and claims database algorithms for identifying patients with orthopedic device revision or removal.MethodsAs a part of the Food and Drug Administration's Mini‐Sentinel pilot program, we performed a systematic review to identify algorithms for orthopedic implant removal/revision in administrative and claims databases in the USA or Canada.ResultsFive studies examined the validity of database algorithms against a gold standard of documentation in medical records (n = 3) or codes/documentation in another database (n = 2). The positive predictive values (PPV) of the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD‐9‐CM) and/or the Current Procedural Terminology codes for revision total hip arthroplasty (THA) in the US Medicare population compared with medical record review were 92%and 91%, respectively. In another study of the US Medicare population, multiple ICD‐9 codes for revision total knee arthroplasty were compared with newly available single ICD‐9‐CM codes for revision knee arthroplasty; sensitivity was 87% and specificity was 99% (PPV not provided). The fourth study validated the ICD‐9‐CM codes for revision total knee arthroplasty against Ontario health insurance physician fee service claims as the gold standard and found a PPV of 32%. In the last study in Medicare population, the accuracy of the attribution of revision THA to the same side as the earlier index primary THA was examined; PPV for same laterality of revision THA was 71% (using ICD‐9‐CM codes).ConclusionsValidation data, with regard to the ICD‐9‐CM or the Current Procedural Terminology code algorithms for revision THA in the Medicare population, exist. More validation studies are needed to confirm these findings and examine other large databases. Copyright © 2012 John Wiley & Sons, Ltd.

Abstract A consensus panel from the United States and Europe was convened recently to update and revise the 1997 consensus guidelines for the neuropathologic evaluation of Alzheimer's disease (AD) and other diseases of brain that are common in the elderly. The new guidelines recognize the pre‐clinical stage of AD, enhance the assessment of AD to include amyloid accumulation as well as neurofibrillary change and neuritic plaques, establish protocols for the neuropathologic assessment of Lewy body disease, vascular brain injury, hippocampal sclerosis, and TDP‐43 inclusions, and recommend standard approaches for the workup of cases and their clinico‐pathologic correlation.

Inferior vena cava (IVC) filters are widely used to decrease the risk of pulmonary embolism in patients with contraindications to anticoagulation. Complications include local hematoma, access site deep venous thrombosis (DVT), filter migration and embolization, leg penetration through the IVC wall, IVC occlusion, and filter fracture with embolization. Other rare complications include leg penetration into adjacent organs including duodenum and ureter. Lumbar artery pseudoaneurysms are rare and may be spontaneous, iatrogenic, or traumatic. To date, there have been 3 case reports of lumbar artery pseudoaneurysms caused by IVC filters. We present an additional case of a lumbar artery pseudoaneurysm caused by a Gunther Tulip IVC filter treated successfully with selective embolization.