Evaluation of healthcare quality: a tale of three giants.

Although the concept of quality of care goes as far back as King Hammurabi in 1700 bc, and many have worked on improving the quality of care in medicine since, 3 individuals receive credit for laying down the foundation for the evaluation and measurement of quality of care in modern surgery: Ernest Amory Codman, Avedis Donabedian, and Shukri Khuri. Donabedian was not a surgeon, but his concepts in systems of care provided the basis for the modern engineering design of surgical care delivery. Without crossing paths, each of those giants built on the contributions of their predecessors.

Preoperative irradiation for tethered rectal carcinoma.

Twenty-eight patients with resectable but tethered rectal carcinomas were treated with preoperative irradiation (EBRT) and surgical resection. The 5-year actuarial disease-free survival and local control rates of these 28 patients were 66 and 76%, respectively. Two patients have developed local failure only, 2 patients concurrent local failures and distant metastases, and 4 patients distant metastases only.