Cystoscopic removal of an intravesical gossypiboma mimicking a bladder mass: a case report

<p>Abstract</p> <p>Background</p> <p>Intravesical retained surgical sponges are very rare and only a few cases have been removed by minimally invasive techniques.</p> <p>Case presentation</p> <p>We report a case of an intravesical gossypiboma in a 71-year-old man from western Nepal, who presented with urinary retention and persistent lower urinary tract symptoms one year after open cystolithotomy. He was diagnosed with an intravesical mass using ultrasonography. The retained surgical sponge was found during cystoscopy and removed through endoscopy.</p> <p>Conclusion</p> <p>Intravesical gossypibomas are rare and can mimic a bladder mass. This is one of the few reported cases of cystoscopic removal.</p

Trans-visceral migration of retained surgical gauze as a cause of intestinal obstruction: a case report

<p>Abstract</p> <p>Introduction</p> <p>A retained surgical sponge in the abdomen is uncommon although it is likely that this finding is underreported in the medical literature. The intravisceral migration of retained surgical gauze is even rarer, as demonstrated by the very few cases reported.</p> <p>Case presentation</p> <p>Three years after undergoing anterior resection of the rectum, a 75-year-old man presented with symptoms of small bowel obstruction. Plain abdominal radiography and CT showed a radio-opaque marker; a foreign body was suspected, probably a piece of retained surgical gauze. An ileotomy of about 5 cm. was performed to confirm this diagnosis and remove the gauze.</p> <p>Conclusion</p> <p>Although rare, retained gauze in the abdomen is a complication of surgery. The authors consider that this event may be more frequent than it appears from reports in the literature, probably because of its medico-legal implications. If all such cases were reported, it would be possible to estimate their exact number, classify the occurrence as a possible surgical complication and thus modify its medico-forensic consequences.</p

Prospective monitoring improves outcomes of primary total hip replacement: a cohort study

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Professionalism and Evolving Concepts of Quality

For much of the twentieth century, quality of care was defined specifically in terms of physician characteristics and behaviors. High-quality physicians were well trained, knowledgeable, skillful, and compassionate. More recently, quality of care has been defined in terms of systems of care. High-quality organizations develop and adopt practices to reduce adverse events and optimize outcomes. This essay discusses this transformation from physician-based to organization-based concepts of quality and the consequences for patient care and medical professionalism

Deepening Understanding of Certification Adoption and Non-Adoption of International-Supplier Ethical Standards

This study presents a theory of causally complex configurations of antecedent conditions influencing the adoption versus non-adoption of international supplier ethical certification-standards. Using objective measures of antecedents and outcomes, a large-scale study of exporting firms in the cut-flower industry in two South American countries (Colombia and Ecuador) supports the theory. The theory includes the following and additional propositions. No single (simple)-antecedent condition is sufficient for accurately predicting a high membership score in outcome conditions; the outcome conditions include a firm’s adoption or rejection of a product certification. No single (simple)-antecedent condition is necessary for accurately predicting high scores in the outcome condition. A few complex antecedent conditions (configurations) are sufficient but the occurrence of each is not necessary for accurately predicting high scores (e.g., adoption) in an outcome condition. Causal asymmetry of antecedent conditions indicating adoption versus non-adoption of specific ethical standards occurs—that is, causal conditions leading to rejection are not the mirror opposites of causal conditions leading to adoption

Assessing the level of healthcare information technology adoption in the United States: a snapshot

BACKGROUND: Comprehensive knowledge about the level of healthcare information technology (HIT) adoption in the United States remains limited. We therefore performed a baseline assessment to address this knowledge gap. METHODS: We segmented HIT into eight major stakeholder groups and identified major functionalities that should ideally exist for each, focusing on applications most likely to improve patient safety, quality of care and organizational efficiency. We then conducted a multi-site qualitative study in Boston and Denver by interviewing key informants from each stakeholder group. Interview transcripts were analyzed to assess the level of adoption and to document the major barriers to further adoption. Findings for Boston and Denver were then presented to an expert panel, which was then asked to estimate the national level of adoption using the modified Delphi approach. We measured adoption level in Boston and Denver was graded on Rogers' technology adoption curve by co-investigators. National estimates from our expert panel were expressed as percentages. RESULTS: Adoption of functionalities with financial benefits far exceeds adoption of those with safety and quality benefits. Despite growing interest to adopt HIT to improve safety and quality, adoption remains limited, especially in the area of ambulatory electronic health records and physician-patient communication. Organizations, particularly physicians' practices, face enormous financial challenges in adopting HIT, and concerns remain about its impact on productivity. CONCLUSION: Adoption of HIT is limited and will likely remain slow unless significant financial resources are made available. Policy changes, such as financial incentivesto clinicians to use HIT or pay-for-performance reimbursement, may help health care providers defray upfront investment costs and initial productivity loss

Effects on incident reporting after educating residents in patient safety: a controlled study

<p>Abstract</p> <p>Background</p> <p>Medical residents are key figures in delivering health care and an important target group for patient safety education. Reporting incidents is an important patient safety domain, as awareness of vulnerabilities could be a starting point for improvements. This study examined effects of patient safety education for residents on knowledge, skills, attitudes, intentions and behavior concerning incident reporting.</p> <p>Methods</p> <p>A controlled study with follow-up measurements was conducted. In 2007 and 2008 two patient safety courses for residents were organized. Residents from a comparable hospital acted as external controls. Data were collected in three ways: 1] questionnaires distributed before, immediately after and three months after the course, 2] incident reporting cards filled out by course participants during the course, and 3] residents' reporting data gathered from hospital incident reporting systems.</p> <p>Results</p> <p>Forty-four residents attended the course and 32 were external controls. Positive changes in knowledge, skills and attitudes were found after the course. Residents' intentions to report incidents were positive at all measurements. Participants filled out 165 incident reporting cards, demonstrating the skills to notice incidents. Residents who had reported incidents before, reported more incidents after the course. However, the number of residents reporting incidents did not increase. An increase in reported incidents was registered by the reporting system of the intervention hospital.</p> <p>Conclusions</p> <p>Patient safety education can have immediate and long-term positive effects on knowledge, skills and attitudes, and modestly influence the reporting behavior of residents.</p