Surg J R Coll Surg E
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Whilst the steps for reacting to and communicating following a surgical error should be clear to all, actual practice is punctuated by a range of failures which lead to the harm done by the error being compounded by inadequacies in the disclosure and subsequent processes. This article outlines best practice at the current time within the United Kingdom when responding to a surgical error and it also reports the type of behaviours which result in poor levels of satisfaction from the patients' perspective - often resulting in litigation being invoked.
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Surg J R Coll Surg E · Dec 2013
ReviewImproving disclosure and management of medical error - an opportunity to transform the surgeons of tomorrow.
Human error is the major causal factor of industrial and transportation accidents and healthcare is not immune to the effects of human error. Medical error can be defined as the failure of the planned action to be completed as intended or the use of a wrong plan to achieve an aim. ⋯ Junior doctors are a unique population, with a higher propensity to medical error. A transition from the current culture of 'name, blame and shame' is required. We need to ensure that the 'learning moment' is seized and that mistakes are learned from and not simply forgotten. Surgery has an opportunity to learn from high risk-industries and incorporate human factors training, into surgical training programs in order to better manage and prevent medical error.
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Surg J R Coll Surg E · Dec 2013
ReviewPelvic fractures presenting with haemodynamic instability: treatment options and outcomes.
The management of trauma patients with haemodynamic instability and an unstable pelvic fracture is an issue of vivid debate in "trauma community". A multidisciplinary approach needs to be instituted regarding the required diagnostic and therapeutic measures. Control of haemorrhage is the first priority. ⋯ It needs to be determined on an institutional basis based on the available local resources such as angiography suite and whole-body CT scan and the expertise of the treating surgical team. Despite the fact that recent advances in diagnostic modalities and trauma care systems have improved the overall outcome of patients with pelvic fractures, the early mortality associated with high-energy pelvic injuries presenting with haemodynamic instability remains high. Any suspected injured person with pelvic ring injury should automatically be taken to a level one-trauma centre where all the facilities required are in place for these patients to survive.
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Fournier's gangrene (FG) is a synergistic polymicrobial gangrenous infection of the perineum, scrotum and penis which is characterised by obliterative endarteritis of the subcutaneous arteries, resulting in gangrene of the subcutaneous tissue and the overlying skin. FG affects all ages and both genders, with a male preponderance. It is a rare but life-threatening disease, and despite therapeutic advances in recent years, the mortality rate is 3%-67%, with an incidence of 1:7500-1:750,000. ⋯ Treatment of FG is based on a multimodal approach which includes intensive fluid resuscitation to stabilise the patient and correction of electrolyte imbalance, if any. This is followed by extensive debridements and resections in order to remove all necrotic and infected tissue, wide spectrum antibiotics and reconstructive surgery, whenever required. However, despite all the advances in treatment today, FG remains a surgical emergency, hence, early recognition with aggressive haemodynamic stabilisation, parenteral broad spectrum antibiotics and urgent surgical debridement are the mainstay of treatment.
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Surg J R Coll Surg E · Aug 2013
ReviewThe surgical management of Spitz naevi and atypical spitzoid neoplasms: A review of the literature.
Melanocytic lesions with spitzoid differentiation represent a difficult management paradigm. Spitzoid lesions form a spectrum of distinct entities encompassing Spitz naevi, atypical Spitz naevi and spitzoid melanoma which range from benign to malignant. ⋯ We review the literature in terms of the newer histological tools available to more explicitly classify these lesions which may have an impact on the clinical care that these patients receive. The article also examines the controversy which surrounds the role of sentinel lymph node biopsy (SLNB) and completion lymph node dissection in the management of melanocytic proliferations with Spitz differentiation.