Patient-specific predictors of failure to rescue after pancreaticoduodenectomy.

Background: Failure to rescue (FTR) is a recently described outcome metric for quality of care. However, predictors of FTR have not been adequately investigated, particularly after pancreaticoduodenectomy. We aim to identify predictors of FTR after pancreaticoduodenectomy.

Performance of life support breathing apparatus for under-ice diving operations.

Introduction: Single-hose scuba regulators dived in very cold water may suffer first- or second-stage malfunction, yielding complete occlusion of air flow or massive freeflow that rapidly expends a diver's air supply.

Purpose: This study, conducted in Antarctica, evaluated the under-ice performance of a sampling of commercially available regulators.

Methods: Seventeen science divers logged a total of 305 dives in -1.

WHipple-ABACUS, a simple, validated risk score for 30-day mortality after pancreaticoduodenectomy developed using the ACS-NSQIP database.

Background: Pancreaticoduodenectomy needs simple, validated risk models to better identify 30-day mortality. The goal of this study is to develop a simple risk score to predict 30-day mortality after pancreaticoduodenectomy.

Methods: We reviewed cases of pancreaticoduodenectomy from 2005-2012 in the American College of Surgeons-National Surgical Quality Improvement Program databases.

The use of collaboration to implement evidence-based safe practices.

The Pennsylvania Patient Safety Authority receives over 235,000 reports of medical error per year. Near miss and serious event reports of common and interesting problems are analysed to identify best practices for preventing harmful errors. Dissemination of this evidence-based information in the peer-reviewed Pennsylvania Patient Safety Advisory and presentations to medical staffs are not sufficient for adoption of best practices.

Establishing a global learning community for incident-reporting systems.

Background: Incident-reporting systems (IRS) collect snapshots of hazards, mistakes and system failures occurring in healthcare. These data repositories are a cornerstone of patient safety improvement. Compared with systems in other high-risk industries, healthcare IRS are fragmented and isolated, and have not established best practices for implementation and utilisation.

Wrong site surgery near misses and actual occurrences.

Under coordination by the Patient Safety Authority, staff members in facilities across Pennsylvania analyzed 97 wrong site surgery near misses and 44 actual occurrences using a common analysis form from August 2007 to August 2008. These assessments were aggregated and compared by the Patient Safety Authority. Assessments in which near misses were identified that did not advance to actual wrong site occurrences were significantly more likely to report compliance with patient identification and preoperative reconciliation protocols, accurate scheduling, notation of the surgical site on the consent form, participation of the surgeon in preoperative verification, participation of all surgical team members in the time out, time outs performed with the site marking visible after draping, and the surgeon explicitly empowering team members to speak up if concerned and acknowledging concerns when expressed.

Wrong-site surgery: can we prevent it?

Wrong-site surgery happens frequently enough that it is a significant risk for many surgeons during their professional careers. But it is an event that should never happen. Most wrong-site surgery is wrong-side surgery, followed by wrong-digit and wrong-vertebral-level surgery.

A comparison of methods for assessing penetrating trauma on retrospective multi-center data.

Objective: TraumaSCAN-Web (TSW) is a computerized decision support system for assessing chest and abdominal penetrating trauma which utilizes 3D geometric reasoning and a Bayesian network with subjective probabilities obtained from an expert. The goal of the present study is to determine whether a trauma risk prediction approach using a Bayesian network with a predefined structure and probabilities learned from penetrating trauma data is comparable in diagnostic accuracy to TSW.

Methods: Parameters for two Bayesian networks with expert-defined structures were learned from 637 gunshot and stab wound cases from three hospitals, and diagnostic accuracy was assessed using 10-fold cross-validation.

Designing safety into the minimally invasive surgical revolution: a commentary based on the Jacques Perissat Lecture of the International Congress of the European Association for Endoscopic Surgery.

Surgical errors with minimally invasive surgery differ from those in open surgery. Perforations are typically the result of trocar introduction or electrosurgery. Infections include bioburdens, notably enteric viruses, on complex instruments.

A roadmap to safe surgical care: a view from Pennsylvania.

An effort to make operations safe is realistic if surgeons are committed. Such an effort involves educating surgeons about safe practices based on current knowledge of best practices, including team training and talking to patients. It involves identifying leaders and developing appropriate infrastructure for academic activities.

The role for leaders of health care organizations in patient safety.

We review what leaders of health care systems, including chief executive officers and board members, need to know to have "patient safety literacy" and do to make their systems safe. High reliability organizations produce reliable results that are not dependent on providers being perfect. Their characteristics include the commitment of leadership to safety as a system responsibility, with a culture of safety that decreases variability with standardized care and does not condone "at-risk behavior.

Getting surgery right.

Objective: We sought to identify factors contributing to wrong-site surgery (wrong patient, procedure, side, or part).

Methods: We examined all reports from all hospitals and ambulatory surgical centers--in a state that requires reporting of wrong-site surgery--from the initiation of the reporting requirement in June 2004 through December 2006.

Results: Over 30 months, there were 427 reports of near misses (253) or surgical interventions started (174) involving the wrong patient (34), wrong procedure (39), wrong side (298), and/or wrong part (60); 83 patients had incorrect procedures done to completion.

Translating patient safety legislation into health care practice.

Background: An independent state agency, the Authority is charged with taking steps to reduce and eliminate medical errors by identifying problems and recommending solutions that promote patient safety. PENNSYLVANIA PATIENT SAFETY REPORTING SYSTEM (PA-PSRS): The Authority implemented PA-PSRS, a mandatory reporting and analysis system for both adverse events and near-misses, among 450 hospitals, birthing centers, and ambulatory surgical facilities. Pennsylvania is the only state to require the reporting of both adverse events and near-misses.

How a system for reporting medical errors can and cannot improve patient safety.

The Institute of Medicine has recommended systems for reporting medical errors. This article discusses the necessary components of patient safety databases, steps for implementing patient safety reporting systems, what systems can do, what they cannot do, and motivations for physician participation. An ideal system captures adverse events, when care harms patients, and near misses, when errors occur without any harm.

Evaluating the discriminatory power of a computer-based system for assessing penetrating trauma on retrospective multi-center data.

Objective: To evaluate the discriminatory power of TraumaSCAN-Web, a system for assessing penetrating trauma, using retrospective multi-center case data for gunshot and stab wounds to the thorax and abdomen.

Methods: 80 gunshot and 114 stab cases were evaluated using TraumaSCAN-Web. Areas under the Receiver Operator Characteristic Curves (AUC) were calculated for each condition modeled in TraumaSCAN-Web.

Comparisons of survival predictions using survival risk ratios based on International Classification of Diseases, Ninth Revision and Abbreviated Injury Scale trauma diagnosis codes.

Background: We conducted a comparison of methods for predicting survival using survival risk ratios (SRRs), including new comparisons based on International Classification of Diseases, Ninth Revision (ICD-9) versus Abbreviated Injury Scale (AIS) six-digit codes.

Methods: From the Pennsylvania trauma center's registry, all direct trauma admissions were collected through June 22, 1999. Patients with no comorbid medical diagnoses and both ICD-9 and AIS injury codes were used for comparisons based on a single set of data.

Representations of the cinaedus in Roman art: Evidence of "gay" subculture?

Whereas analysis of ancient Roman texts reveals signs of a possible homosexual subculture, their interpretation is difficult. This article analyzes the content and context of visual representations of male-male intercourse, including wall paintings at Pompeii, a silver cup, and an engraved agate gemstone. Whether presenting negative stereotypes (Tavern of Salvius, Pompeii; Suburban Baths, Pompeii), or positive ones (Warren Cup, British Museum; Leiden gemstone), these representations reveal the presence of well-developed social attitudes toward the practice ofmale-male sex and the practitioners themselves.

A surgeon who CARES can be safer.

The characteristics of a high-reliability organization are reviewed. Examples of how these characteristics relate to patient safety in surgical practice are illustrated by vignettes. The characteristics discussed include commitment to safety demonstrated to others by the conduct of one's practice; attention focused on one's own performance and the performance of others to the task at hand; rehearsal and proper preparation and contingency planning for procedures; effective communication so that information is accurate, adequate, unambiguous, and confirmed; and sense-making, or an understanding and verification of consistency between what is observed and expected and between what is planned and the premises for those plans.