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At least 325 records · Page 18Linked to original sources
PubMed1978

Preventable anesthesia mishaps: a study of human factors.

A modified critical-incident analysis technique was used in a retrospective examination of the characteristics of human error and equipment failure in anesthetic practice. The objective was to uncover patterns of frequently occurring incidents that are in need of careful prospective investigation. Forty-seven interviews were conducted with staff and resident anesthesiologists at one urban teaching institution, and descriptions of 359 preventable incidents were obtained. Twenty-three categories of details from these descriptions were subjected to computer-aided analysis for trends and patterns. Most of the preventable incidents involved human error (82 per cent), with breathing-circuit disconnections, inadvertent changes in gas flow, and drug-syringe errors being frequent problems. Overt equipment failures constituted only 14 per cent of the total number of preventable incidents, but equipment design was indictable in many categories of human error, as were inadequate experience and insufficient familiarity with equipment or with the specific surgical procedure. Other factors frequently associated with incidents were inadequate communication among personnel, haste or lack of precaution, and distraction. Results from multi-hospital studies based on the methodology developed could be used for more objective determination of priorities and planning of specific investments for decreasing the risk associated with anesthesia.

Accident Prevention↗
PubMed1997

[The treatment concept in severe hand injuries].

Treatment of complex injuries of the hand aims at best possible reconstruction of function and quick social and professional rehabilitation. This objective is hardly to achieve in most cases due to the severity of injury. Outcome depends on patients' age and injury pattern and essentially on the strategy of surgical treatment. Errors in prehospital emergency treatment can hardly be corrected, no matter how excellent the surgical technique may be. Traumatic multiple finger or thumb amputations are clear indications for replantation. Beginning with osteosynthesis, suture of tendons and ligaments the restoration of blood supply is the most important step. Nerve reconstruction should be performed immediately, but if tension free repair is impossible, secondary nerve grafting is preferred. Primary skin closure should be carried out if possible, in case of defects skin grafts, local or free flaps have to be used.

Amputation, Traumatic↗
PubMed2003

Interpretation of skin biopsies by general pathologists: diagnostic discrepancy rate measured by blinded review.

CONTEXT: Slide review has been advocated as a means to reduce diagnostic error in surgical pathology and is considered an important component of a total quality assurance program. Blinded review is an unbiased method of error detection, and this approach may be used to determine the diagnostic discrepancy rates in surgical pathology. OBJECTIVE: To determine the diagnostic discrepancy rate for skin biopsies reported by general pathologists. DESIGN: Five hundred eighty-nine biopsies from 500 consecutive cases submitted by primary care physicians and reported by general pathologists were examined by rapid-screen, blinded review by 2 dermatopathologists, and the original diagnosis was compared with the review interpretation. RESULTS: Agreement was observed in 551 (93.5%) of 589 biopsies. Blinded review of these skin biopsies by experienced dermatopathologists had a sensitivity of 100% (all lesions originally reported were detected during review). False-negative errors were the most common discrepancy, but false positives, threshold discrepancies, and differences in type or grade were also observed. Only 1.4% of biopsies had discrepancies that were of potential clinical importance. CONCLUSIONS: Blinded review demonstrates that general pathologists reporting skin biopsies submitted by primary care physicians have a low diagnostic error rate. The method detects both false-negative and false-positive cases and identifies problematic areas that may be targeted in continuing education activities. Blinded review is a useful component of a dermatopathology quality improvement program.

Biopsy↗
PubMedDate not supplied

[Errors and difficulties in the surgical treatment of injuries of the cervical portion of the spine and spinal cord].

On the basis of clinical observations, the authors distinguish organizational, tactical, and technical errors. Problems of transportation and hospitalization of the injured persons in clinics not specializing in this branch of surgery underlie the organizational errors. The authors relate improper choice of the operative method (laminectomy, reduction of dislocations, or anterior decompression with corporodesis) to the tactical errors; they recommend a strictly differential approach to this problem and suggest definite indications for each of them. The technical errors include resection of the articular processes in reduction of dislocations and excessive skeletization which leads to destabilization of the spinal segments.

Cervical Vertebrae↗
PubMed1985

Potential errors in the diagnosis and surgical management of neonatal jaundice.

Despite advances and refinements in diagnostic techniques, distinguishing between cholestatic syndromes and extrahepatic biliary atresia is not always possible. Because there are inherent errors in all diagnostic studies including nuclear scanning, ultrasonography, and liver biopsy some infants presumed to have biliary atresia will come to surgery when, in fact, the bile ducts are partially or completely patent. The decision to proceed with a portoenterostomy or to terminate the procedure depends upon the appearance of the liver and histology of the biopsy.

Biopsy, Needle↗
PubMed1977

[Recurrence factors in the surgical treatment of prognathism of the mandible].

With regard to recurrences following surgery for prognathia of the mandible, the authors draw the distinction between immediate and secondary recurrences caused by errors in surgical indication or technique. They then review late recurrences, which they classify as being alveolar, basal or by forward sliding. They then study the role played in recurrences by growth of the condyle, neuromuscular balance and the hyoid suspensor system. Finally they stress the action of the tongue and the age factor (over 17 years being, in their view, desirable).

Adolescent↗
PubMed2000

Outcome of sulcus fixation of dislocated posterior chamber intraocular lenses using temporary externalization of the haptics.

OBJECTIVE: This study evaluated the visual outcome and complications of repositioning and sulcus fixation of a dislocated posterior chamber intraocular lens (PC IOL) using a technique in which the haptics of the IOL are temporarily externalized for suture placement. DESIGN: Retrospective, noncomparative case series. PARTICIPANTS: Seventy-eight patients with a dislocated PC IOL. INTERVENTION: All patients underwent surgery to fixate the PC IOL using this technique. MAIN OUTCOME MEASURES: Patients were evaluated for visual acuity, refractive error, and surgical complications associated with the procedure. RESULTS: The average visual acuity before surgery was 20/205 (range, 20/20 to light perception), with a median refractive error of -1.00 diopters (D; range, -7.25-+15.00 D). After surgery, the average visual acuity improved to 20/72 (range, 20/20 to no light perception), with a median refractive error of -0.75 D (range, -5.50-+3.50 D). Patients were observed for a median of 15.5 months (range, 6-57 months). Twenty patients had postoperative cystoid macular edema (26%), 7 patients had an epiretinal membrane (ERM) (9%), and 5 patients had a retinal detachment (6%). Eight patients (10%) experienced iris capture of the sutured IOL, and in three patients (4%) the PC IOL dislocated again after surgery. CONCLUSIONS: This technique is an effective method for securing a dislocated PC IOL.

Adult↗
PubMed1977

[Quality control of surgical care (author's transl)].

Based on studies carried on for more than ten years, various methods for voluntary quality control of surgical care are proposed. Besides short-term measures (e.g., "strategy of therapy"), a long-term pilot study would permit detection of defects and errors in surgical care through the recording of comparable data. An organization (similar to the Dutch "Concilium chirurgicum") should sponser visitations to various surgical centers. These two, strictly voluntary measures should form the basis for quality control that boots self-esteem of surgeons and does away with the need for state-sponsored measures.

Education, Medical, Continuing↗
PubMedDate not supplied

Accidents in the surgical treatment of varicose veins.

Serious accidents in the surgical treatment of varices are quite exceptional and it is impossible to say with any accuracy how often they occur. Generally they result from major errors of surgical technique, and arise mainly from: haemorrhaging after the tearing of the femoral vein or because of the loosening of the stump of the saphenofemoral junction, traumatism of the femoral artery, damage of the nervus peronaeus in crossectomy of the saphena parva. Minor accidents are more frequent but here too it is impossible to state a precise percentage. There are four fairly common types of accident: serious haematoma following a stripping, which can be avoided by ligation of the accessible collaterals. Trendelenburg's peroperative position, aspiration drainage, and elastic compression; phlebitis, usually superficial and at the level of appendage clusters on the trunk of the saphenal vein, but sometimes deep: much rarer, this has not been observed once in 2335 cases of surgery of the long saphenous vein, and only three times in 583 cases of surgery performed either on the short saphenous vein alone, or on both saphenae; oedema of lymphatic origin to be observed particularly after operations on recurrent cases but sometimes after initial surgery too: in the case of pre-existing lymphatic abnormality or in the case of multiple incisions, especially internal crural incisions; painful paresthesia of saphenal nerves which, as a general rule, regress spontaneously.

Femoral Artery↗