| 1. |
- Acosta, Stefan, et al.
(författare)
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Trends in prevalence of fatal surgical diseases at forensic autopsy
- 2007
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Ingår i: ANZ Journal of Surgery. - : Wiley. - 1445-2197 .- 1445-1433. ; 77:9, s. 718-721
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Tidskriftsartikel (refereegranskat)abstract
- Background: In 1992, there were major changes in Swedish law of the deceased, which had led to a dramatic decrease in autopsy rates. The aim of this study was to investigate the prevalence of fatal or potential fatal surgical diseases within a Swedish forensic autopsy cohort, before and after this change in legislation. Methods: Deaths referred for forensic autopsy at the Institution of Forensic Medicine, Lund University Hospital, Sweden, between 1970-1982 and 2000-2004, were studied regarding the prevalence of aorto-iliac diseases, acute abdomen and abdominal cancer. Results: The forensic autopsy rates in the population during the two time periods were 14.0% (29 399 patients) and 5.3% (4487 patients), respectively. The total prevalence of surgical diseases has increased significantly from 67.3 (95% confidence interval 64.3-70.2) to 83.4 (74.9-91.8) per 1000 autopsies, respectively. The cause-specific mortality ratios in patients with fatal acute abdomen increased significantly from 16.5 (15.1-18.0) to 39.0 (33.2-44.8) per 1000 autopsies, respectively, and there was almost a three-time increase in patients with fatal gastrointestinal haemorrhage and acute alcohol-related pancreatitis. Conclusions: Forensic autopsy data continues to be invaluable, despite changes in legislation in Sweden, for epidemiological studies on fatal or potential fatal surgical diseases.
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| 3. |
- Dekker, Sidney
(författare)
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Criminalization of medical error: Who draws the line?
- 2007
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Ingår i: ANZ Journal of Surgery. - : Wiley. - 1445-2197 .- 1445-1433. ; 77:10, s. 831-837
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Tidskriftsartikel (refereegranskat)abstract
- As stakeholders struggle to reconcile calls for accountability and pressures for increased patient safety, criminal prosecution of surgeons and other health-care workers for medical error seems to be on the rise. This paper examines whether legal systems can meaningfully draw a line between acceptable performance and negligence. By questioning essentialist assumptions behind 'crime' or 'negligence', this paper suggests that multiple overlapping and partially contradictory descriptions of the same act are always possible, and even necessary, to approximate the complexity of reality. Although none of these descriptions is inherently right or wrong, each description of the act (as negligence, or system failure, or pedagogical issue) has a fixed repertoire of responses and countermeasures appended to it, which enables certain courses of action while excluding others. Simply holding practitioners accountable (e.g. by putting them on trial) excludes any beneficial effects as it produces defensive posturing, obfuscation and excessive stress and leads to defensive medicine, silent reporting systems and interference with professional oversight. Calls for accountability are important, but accountability should be seen as bringing information about needed improvements to levels or groups that can do something about it, rather than deflecting resources into legal protection and limiting liability. We must avoid a future in which we have to turn increasingly to legal systems to wring accountability out of practitioners because legal systems themselves have increasingly created a climate in which telling each other accounts openly is less and less possible.
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| 4. |
- Dekker, Sidney, et al.
(författare)
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Laparoscopic bile duct injury: understanding the psychology and heuristics of the error.
- 2008
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Ingår i: ANZ Journal of Surgery. - : Wiley. - 1445-2197 .- 1445-1433. ; 78:12, s. 1109-1114
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Tidskriftsartikel (refereegranskat)abstract
- Bile duct injury is an important unsolved problem of laparoscopic cholecystectomy, occurring with unacceptable frequency even in the hands of experienced surgeons. This suggests that a systemic predisposition to the injury is intrinsic to cholecystectomy and indicates that an analysis of the psychology and heuristics of surgical decision-making in relation to duct identification may be a guide to prevention. Review of published reports on laparoscopic bile duct injury from 1997 to 2007 was carried out. An analysis was also carried out of the circumstances of the injuries in 49 patients who had transection of an extrahepatic bile duct and who were referred for reconstruction or were assessed in a medicolegal context. Special emphasis was placed on identifying the possible psychological aspects of duct misidentification. Review of published work showed an emphasis on the technical aspects of correct identification of the cystic duct, with few papers addressing the heuristics and psychology of surgical decision-making during cholecystectomy. Duct misidentification was the cause of injury in 42 out of the 49 reviewed patients (86%). The injury was not recognized at operation in 70% and delay in recognition persisted into the postoperative period in 57%. Underestimation of risk, cue ambiguity and visual misperception ('seeing what you believe') were important factors in misidentification. Delay in recognition of the injury is a feature consistent with cognitive fixation and plan continuation, which help construct and sustain the duct misidentification during the operation and beyond. Changing the 'culture' of cholecystectomy is probably the most effective strategy for preventing laparoscopic bile duct injury, especially if combined with new technical approaches and an understanding of the heuristics and psychology of the duct misidentification error. Training of surgeons for laparoscopic cholecystectomy should emphasize the need to be alert for cues that the incorrect duct is being dissected or that a bile duct injury might have occurred. Surgeons may also be trained to accept the need for plan modification, to seek cues that refute a given hypothesis and to apply 'stopping rules' for modifying or converting the operation.
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| 5. |
- Loch-Wilkinson, Thorbjorn J., et al.
(författare)
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Nerve stimulation in thyroid surgery : is it really useful?
- 2007
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Ingår i: ANZ journal of surgery. - : Wiley. - 1445-1433 .- 1445-2197. ; 77:5, s. 377-380
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Monitoring of the recurrent laryngeal nerve (RLN) has been claimed in some studies to reduce rates of nerve injury during thyroid surgery compared with anatomical dissection and visual identification of the RLN alone, whereas other studies have found no benefit. Continuous monitoring with endotracheal electrodes is expensive whereas discontinuous monitoring by laryngeal palpation with nerve stimulation is a simple and inexpensive technique. This study aimed to assess the value of nerve stimulation with laryngeal palpation as a means of identifying and assessing the function of the RLN and external branch of the superior laryngeal nerve (EBSLN) during thyroid surgery. METHODS: This was a prospective case series comprising 50 consecutive patients undergoing total thyroidectomy providing 100 RLN and 100 EBSLN for examination. All patients underwent preoperative and postoperative vocal cord and voice assessment by an independent ear, nose and throat surgeon, laryngeal examination at extubation and all were asked to complete a postoperative dysphagia score sheet. Dysphagia scores in the study group were compared with a control group (n = 20) undergoing total thyroidectomy without nerve stimulation. RESULTS: One hundred of 100 (100%) RLN were located without the use of the nerve stimulator. A negative twitch response occurred in seven (7%) RLN stimulated (two bilateral, three unilateral). Postoperative testing, however, only showed one true unilateral RLN palsy postoperatively (1%), which recovered in 7 weeks giving six false-positive and one true-positive results. Eighty-six of 100 (86%) EBSLN were located without the nerve stimulator. Thirteen of 100 (13%) EBSLN could not be identified and 1 of 100 (1%) was located with the use of the nerve stimulator. Fourteen per cent of EBSLN showed no cricothyroid twitch on EBSLN stimulation. Postoperative vocal function in these patients was normal. There were no instances of equipment malfunction. Dysphagia scores did not differ significantly between the study and control groups. CONCLUSION: Use of a nerve stimulator did not aid in anatomical dissection of the RLN and was useful in identifying only one EBSLN. Discontinuous nerve monitoring by stimulation during total thyroidectomy confers no obvious benefit for the experienced surgeon in nerve identification, functional testing or injury prevention.
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| 6. |
- Musiello, Toni, et al.
(författare)
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Breast surgeons perceptions and attitudes towards contralateral prophylactic mastectomy
- 2013
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Ingår i: ANZ journal of surgery. - : Wiley-Blackwell. - 1445-1433 .- 1445-2197. ; 83:7-8, s. 527-532
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Tidskriftsartikel (refereegranskat)abstract
- Background: The rates of contralateral prophylactic mastectomy (CPM) are increasing worldwide. This study investigated Australian and New Zealands breast surgeons perceptions, knowledge and attitudes towards CPM, and explored if demographic characteristics of surgeons were associated with an increased tendency to recommend or perform CPM. less thanbrgreater than less thanbrgreater thanMethods: A cross sectional research design was employed, with breast surgeons completing a self-report questionnaire. The questionnaire collected information including surgeons perceptions on CPM in their clinical practice, their attitudes and knowledge of CPM and surgeons demographic information. less thanbrgreater than less thanbrgreater thanResults: Eighty-one of 220 (37%) breast surgeons contacted via BreastSurgANZ participated in this study. Forty-four per cent of surgeons perceived that the rates of CPMs they performed had increased over the last year. CPM rates were found to be unrelated to surgeons age (P = 0.773) or gender (P = 0.941). The main reasons a surgeon recommended a CPM to patients included known BRCA+ mutation, family history of breast cancer and patient factors including fear and anxiety and a desire to avoid further breast cancer treatment. less thanbrgreater than less thanbrgreater thanConclusions: Breast surgeons perceived that rates of CPM were increasing in their own clinical practice. CPM rates were unrelated to surgeon demographics including age and gender. While surgeons are aware of the objective risk factors that make performing a CPM advisable, they also report taking into account subjective factors, including patient fear and anxiety and a desire for breast symmetry when recommending a CPM.
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| 10. |
- Campanello, Magnus, et al.
(författare)
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Image of an adrenal mesenchymoma.
- 2023
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Ingår i: ANZ journal of surgery. - 1445-1433 .- 1445-2197. ; 93:10, s. 2533-2534
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Tidskriftsartikel (refereegranskat)
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