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At least 271 records · Page 15Linked to original sources
PubMed2006

Surgical pathology--second reviews, institutional reviews, audits, and correlations: what's out there? Error or diagnostic variation?

CONTEXT: A variety of methodologies have been used to report error rates in surgical pathology within the peer-reviewed medical literature. The media has selectively and superficially reported these error rates creating a climate of disinformation between physicians and the public. OBJECTIVES: To review the medical literature on diagnostic error in surgical pathology and summarize and compare these data with selected reports in the print and broadcast media. DESIGN: A search of the medical literature from the National Library of Medicine database using the heading "Error and Pathology Diagnosis." RESULTS: Three thousand nine hundred ninety-two citations were found, of which 83 directly measured in some manner errors in surgical and cytopathology. Major error rates ranged from 1.5% to 5.7% globally for institutional consults. Error rates were less, 0.26% to 1.2% for global in-house prospective review and 4.0% for in-house and retrospective blinded review. Error rates also varied by anatomic site: skin, institutional consult, 1.4%; prostate, institutional consult, 0.5%; and thyroid, institutional consult, 7.0%. Error rates reported in citations used by the Wall Street Journal were as follows: prostate, Gleason score changed by 1 point, 44% and resultant change in treatment for prostate cancer, 10%; for breast, altered lumpectomy or mastectomy plan, 8%; and diagnosis changed for thyroid lesions, 18%. Errors in second opinion on breast lesions (single pathologist author for the study) fall within the range of global reviews. Errors for second opinions on prostate cancer were principally 81% upgrades in Gleason score for prostate core needle biopsies. However, this resulted in an upgrade of patient risk category in only 10.8% of patients. Data for the article on change in diagnosis of thyroid lesions were incomplete. There appeared to be 3 significant diagnostic errors (4.5%). CONCLUSIONS: Pathology is not immune to the power of the media to create concern about accuracy of diagnosis in surgical pathology and cytopathology. Detailed analysis of the medical literature cited by the media determines that painting the big picture and hitting the highlights can be profoundly misleading.

Databases, Bibliographic↗
PubMed2006

Comparing methods to measure error in gynecologic cytology and surgical pathology.

CONTEXT: Both gynecologic cytology and surgical pathology use similar methods to measure diagnostic error, but differences exist between how these methods have been applied in the 2 fields. OBJECTIVE: To compare the application of methods of error detection in gynecologic cytology and surgical pathology. DATA SOURCES: Review of the literature. CONCLUSIONS: There are several different approaches to measuring error, all of which have limitations. Measuring error using reproducibility as the gold standard is a common method to determine error. While error rates in gynecologic cytology are well characterized and methods for objectively assessing error in the legal setting have been developed, meaningful methods to measure error rates in clinical practice are not commonly used and little is known about the error rates in this setting. In contrast, in surgical pathology the error rates are not as well characterized and methods for assessing error in the legal setting are not as well defined, but methods to measure error in actual clinical practice have been characterized and preliminary data from these methods are now available concerning the error rates in this setting.

Diagnostic Errors↗
PubMed1995

Comparative cephalometric errors for orthodontic and surgical patients.

The aim of this study was to quantify and compare the reproducibility (intraexaminer method error) of cephalometric measurements in two groups of adult patients: one group with minor skeletal disharmonies and the other with severe skeletal disharmonies. It was hypothesized that errors were greater for subjects displaying severe morphologic deviations. The samples comprised two groups: 30 pretreatment cephalograms of patients planned for comprehensive orthodontic treatment and 30 cephalograms of patients additionally planned for orthognathic surgery. Two reference points and 28 cephalometric landmarks were defined and digitized by one examiner on two occasions 1 week apart. In total, 30 angles and 9 distances were studied. Reproducibility was expressed as the angular or linear differences between the two series of recordings. Two sample t tests were performed. In general, no significant differences in landmark location and measurement were found between the orthodontic and surgical patient groups. It was concluded that extreme variations in skeletal morphology do not effect the accuracy of cephalometric evaluation.

Adult↗
PubMed1994

Complications of the treatment of cubital tunnel syndrome.

Cubital tunnel syndrome is the most common entrapment of the ulnar nerve. Complications in the treatment of cubital tunnel syndrome may be caused by errors in diagnosis, errors in conservative management, and errors of surgical treatment. This article discusses each cause of complications separately, with a division in errors of surgical treatment into complications from decompression of the ulnar nerve, medial epicondylectomy, anterior transposition of the ulnar nerve, intramuscular transposition of the ulnar nerve, subcutaneous transposition of the ulnar nerve, submuscular transposition of the ulnar nerve, and failed surgical treatment.

Anti-Inflammatory Agents↗
PubMed2006

Accuracy of information on medicines in hospital discharge summaries.

BACKGROUND: At Auckland Hospital, patients have been given handwritten summaries on discharge from hospital with a copy posted to the general practitioner. A typed summary is often not completed so the list of medicines on the handwritten summary needs to be accurate and complete. METHODS: We selected 100 patient charts from the general medical service and 100 charts from the general surgical service and recorded the medicines on admission, on the inpatient medication chart and on the discharge summary. We noted errors in the recording of medicines on the discharge summary and rated the severity of errors. RESULTS: Surgical patients were discharged on 7.88 (95% confidence interval (CI) 7.40-8.64) medicines and medical patients on 8.58 (95% CI 7.87-9.29) medicines. During the admission there were 0.59 (95% CI 0.38-0.80) changes to the medicines for the surgical patients and 1.70 (95% CI 1.39-2.01) for the medical patients (P < 0.0001). There were 0.81 (95% CI 0.65-1.02) errors per surgical discharge summary and 1.42 (95% CI 1.20-1.67) errors per medical summary (P = 0.006). Four errors were graded as having the potential to cause readmission to hospital, 24 as potentially serious, 83 as potentially troublesome and 111 as minor. DISCUSSION: Error rates were high and although the majority were minor, a number of them had the potential to cause serious consequences. There were more medication changes in the medical patients and this may contribute to higher error rates in this group. There is a need to improve the accuracy of recording medicines on discharge summaries. Strategies to improve this problem are discussed.

Adolescent↗
PubMed2001

Negative results of randomized clinical trials published in the surgical literature: equivalency or error?

HYPOTHESIS: We hypothesized that review of randomized controlled clinical trials (RCTs) with nonstatistically significant or "negative" results published in the surgical literature do not have appropriate statistical power to demonstrate equivalency between treatment arms. DATA SOURCES AND STUDY SELECTION: The MEDLINE database was searched to obtain reports of all RCTs with negative results published in 3 surgical journals from 1988 to 1998. Manual review of one year (1997) of publications for each journal was performed to validate our search strategy. Equivalency was evaluated using the Two One-Sided Tests Procedure and post hoc power calculations. DATA SYNTHESIS: Ninety reports of RCTs with negative results were identified in the surgical literature between 1988 and 1998. The manual review of 1997 showed a 100% retrieval rate for our search strategy. After applying the Two One-Sided Tests Procedure, 35 reports (39%) met the criteria for demonstrating equivalency. The other 55 reports (61%) contained at least a 10% absolute difference in the 90% confidence interval of Delta. Using the power calculation method, only 22 (24%) articles had a power greater than.80 to detect a 50% difference in therapeutic effect. Only 29% of the reports included a formal sample size calculation and these studies were more likely to demonstrate equivalency than those without a sample size estimate (P<.01). CONCLUSIONS: Many reports from negative RCTs published in the surgical literature lack sufficient statistical power to establish that clinically important differences are not present. Surgeons should perform appropriate sample size calculations when designing RCTs and recognize the utility of confidence intervals when reporting negative results.

Confidence Intervals↗
PubMed2006

Pediatric surgical pathology: pitfalls and strategies for error prevention.

CONTEXT: Few data exist regarding quality measures for pediatric surgical pathology, types of errors, or how error-prone situations and diagnostic pitfalls can be minimized. OBJECTIVE: This review reports on survey findings regarding methodology for quality assurance and error detection measurement and classification in pediatric surgical pathology. It presents information regarding, and quality aspects of, intraoperative consultations in pediatric surgical pathology. General strategies for identifying diagnostic pitfalls in pediatric surgical pathology are briefly discussed. DATA SOURCES: A survey of children's hospitals based on a survey created by the Association of Directors of Anatomic and Surgical Pathology, literature review, and institutional quality assurance records provided information for this review. CONCLUSIONS: Approaches to quality assurance and error reduction in pediatric surgical pathology are similar to those used in general surgical pathology. The children's hospitals that were surveyed used a variety of standard quality assurance measures. Because of differences in data collection, classification, and reporting, it is not possible to provide a detailed analysis of the types of diagnostic error across institutions at this time. Intraoperative consultations are a potential source of error. Pediatric neoplasms and Hirschsprung disease account for the majority of intraoperative consultations in the pediatric setting. Further considerations include the unique aspects of pediatric medical and neoplastic disorders and special diagnostic criteria, classification, grading, and staging requirements.

Adolescent↗
PubMed1988

Intramedullary nailing of femoral shaft fractures. Part I: Decision-making errors with interlocking fixation.

Dynamic intramedullary fixation depends on the configuration of the fracture for postoperative stability. Unanticipated loss of reduction of the fracture after dynamic intramedullary nailing of the femur may result from errors in surgical decision-making, specifically the failure to insert both proximal and distal interlocking screws. Of 133 dynamic femoral intramedullary nailings that were performed after interlocking techniques became routinely available, fourteen (10.5 per cent) were complicated by loss of postoperative fixation and reduction. Thirteen of the fourteen femora shortened an average of 2.0 centimeters; the remaining femur shortened slightly, with clinical loss of rotational stability. Eight of fourteen patients elected some form of surgical revision, most commonly closed osteoclasis with restoration of femoral length, followed by the insertion of a statically locked nail. Errors in surgical judgment were attributed to inadequate preoperative analysis of the pattern of the fracture; undetected intraoperative comminution during reaming or insertion of the nail, or both; or postoperative failure to recognize an increase in comminution and instability of the fracture. We suggest using high-quality preoperative radiographs to detect non-displaced comminution of the major fracture fragments. Any increase in comminution of the fracture that occurs with reaming of the canal or insertion of the nail is an indication for static interlocking fixation. Radiographs that are made immediately postoperatively should be analyzed while the patient is under anesthesia, and any previously undetected instability of the fracture should be treated by static interlocking fixation. Dynamic intramedullary stabilization of the femur should be reserved for transverse or short oblique fractures at the femoral isthmus that have type-I or type-II comminution.

Adolescent↗
PubMed1996

[The most frequent errors during use of the surgical techniques of Cotrela-Dubousset (C-D) and Texas Scottish Rite Hospital (TSRH) for surgical treatment of idiopathic scoliosis].

Results of operative treatment of idiopathic scoliosis in 88 patients (77 girls and 11 boys) with an average follow-up of 18 months have been presented. Basic principles of surgical procedure and most commonly made errors are demonstrated on the basis of authors' experience and data from the literature. The method of strategic vertebrae selection for hook implantation depending on scoliosis type are discussed. Differences in surgical technique in respect to idiopathic lordoscoliosis or kyphoscoliosis have been highlighted.

Child↗
PubMed1995

Arthroscopic Bankart repair with the Suretac device. Part I: Clinical observations.

Although arthroscopic Bankart repair has become an accepted surgical stabilization technique for anterior shoulder instability, the failure rate remains unacceptably high. Little information is available concerning healing of the Bankart repair. The purpose of this article is to clarify this issue by analyzing a cohort of 15 patients who underwent a "second-look" arthroscopy to evaluate and treat pain or recurrent instability following arthroscopic Bankart repair with the Suretac device (Acufex Microsurgical, Mansfield, MA). "Second-look" arthroscopy was performed at an average of 9 months following the index surgical procedure. The reasons for this second surgery were recurrent instability in 7, pain in 6, and pain and stiffness in 2. In the 7 patients with recurrent instability, the Bankart repair was found to be completely healed in 3 (43%), partially healed in 1 (14%), and had recurred in 3 (43%); however, 6 of 7 were observed to have lax capsular tissue. In 4 of these cases, retrospective review of the index surgical procedure showed that a technical error had been made during the repair. Two cases had biopsy of the repair site on "second-look" at 6 to 8 months, and this showed residual polyglyconate polymer debris surrounded by a histiocytic infiltrate. In the remaining 8 cases with stable shoulders, the Bankart repair had completely healed in 5 cases (62.5%) and partially healed in 3 cases (37.5%). The higher failure rate with this approach compared with open approaches appears to result from improper patient selection and errors in surgical technique. There is some question concerning healing strength of the Bankart repair, although complete healing of the Bankart does not seem to be a prerequesite for shoulder stability. Success of the procedure might be expected to improve by selecting only patients with unidirectional, posttraumatic, anterior instability who are found to have a discrete Bankart lesion and well-developed ligamentous tissue.

Adult↗
PubMed1991

[Errors and hazards in the surgical treatment of hepatic echinococcosis].

The article analyses the results of operative treatment of 455 patients for hydatid disease of the abdominal organs, in particular the errors and hazards of surgical management of hydatid disease of the liver. Difficulties occur in the differential diagnosis in suppuration of hydatid cysts which had not been operated on, as well as in residual cavities in patients who had undergone surgery for this disease. The authors dwell on the diagnostic algorithm and the surgical tactics depending on the size and location of the hydatid cysts. Some problems of the operative techniques and intraoperative measures for the prevention of recurrences in complicated forms of hepatic hydatid disease are discussed. The suggested diagnostic algorithm and the surgical tactics allowed the authors to reduce diagnostic errors in this pathological condition to 3.5% and surgical mortality rates to 3.07%.

Algorithms↗