bluuebunny/crossref_metadata_2025_split huggingface dataset:
Exploring situational awareness in diagnostic errors in primary care
Authors: Singh Hardeep , Giardina Traber Davis , Petersen Laura A , Smith Michael W , Paul Lindsey Wilson , Dismukes Key , Bhagwath Gayathri , Thomas Eric J 
Published: September 2011

ObjectiveDiagnostic errors in primary care are harmful but poorly studied. To facilitate the understanding of diagnostic errors in real-world primary care settings that use electronic health records (EHRs), this study explored the use of the situational awareness (SA) framework from aviation human factors research.MethodsA mixed-methods study was conducted involving reviews of EHR data followed by semi-structured interviews of selected providers from two institutions in the USA. The study population included 380 consecutive patients with colorectal and lung cancers diagnosed between February 2008 and January 2009. Using a pre-tested data collection instrument, trained physicians identified diagnostic errors, defined as lack of timely action on one or more established indications for diagnostic work-up for lung and colorectal cancers. Twenty-six providers involved in cases with and without errors were interviewed. Interviews probed for providers' lack of SA and how this may have influenced the diagnostic process.ResultsOf 254 cases meeting inclusion criteria, errors were found in 30 of 92 (32.6%) lung cancer cases and 56 of 167 (33.5%) colorectal cancer cases. Analysis of interviews related to error cases revealed evidence of lack of one of four levels of SA applicable to primary care practice: information perception, information comprehension, forecasting future events, and choosing appropriate action based on the first three levels. In cases without error, application of the SA framework provided insight into processes involved in attention management.ConclusionsA framework of SA can help analyse and understand diagnostic errors in primary care settings that use EHRs.
How practical are transmucosal fentanyl products for breakthrough cancer pain? novel use of placebo formulations to survey user opinion: Table 1
Authors: England Ruth , Maddocks Matthew , Manderson Cathann , Zadora-Chrzastowska Sonja , Wilcock Andrew 
Published: September 2011

BackgroundThree transmucosal fentanyl products have recently been licensed for cancer-related breakthrough pain: a sublingual tablet, a buccal/sublingual tablet and a nasal spray. Limited comparative data hinder identifying the most appropriate to use and adopt onto a service formulary. However, the availability of placebo formulations provides a unique opportunity to compare the practical aspects of their use.Methods30 patients with cancer accessed and administered a placebo of each product and were asked to rate them using 1–7 Likert agree–disagree scales and free-text responses, with regard to ease of access and administration, palatability and overall impression. Participants rated their usual rescue analgesic similarly, based on recall. They also indicated whether they would be prepared to use the fentanyl product, and their most preferred.ResultsFor accessibility, the usual rescue analgesic was rated best (median score 3), significantly better than the buccal/sublingual tablet (p=0.01) and nasal spray (p<0.01), but not the sublingual tablet. Conversely, the nasal spray was rated significantly worse (median score 7) than the others (p<0.01). For ease of administration, the usual rescue analgesic and sublingual tablet were rated equally best (median score 1), with only the latter being significantly different to the buccal/sublingual tablet (p=0.04) and nasal spray (p=0.05). For palatability, the sublingual tablet was rated the best (median score 2), but was significantly different only to the buccal/sublingual tablet (p<0.01). For overall impression, the sublingual tablet was rated significantly better (median score 3) than the others, with more patients prepared to use it and selecting it as their most preferred (27 and 18, respectively).ConclusionThis survey provides valuable insight into the practical aspects of these three transmucosal fentanyl products for practitioners considering their use.
Patients who leave emergency departments without being seen: literature review and English data analysis
Authors: Clarey A J , Cooke M W 
Published: September 2011

ObjectivesThe purpose of this review was to determine the rate of those that leave the emergency department (ED) without being seen and their reasons, to clarify if such behaviour poses a health risk, to analyse the impact initiatives have made on the leave without being seen (LWBS) rate, and to discuss the implications of using it as a national performance indicator within the NHS.MethodsA combination of data sources was reviewed: a ‘realistic’ literature review, analysis of hospital episode statistics data from England and a local NHS trust audit.Major FindingsLWBS rates vary across the world, from 15% to 0.36%. Also initiatives to reduce LWBS rates demonstrated mixed outcomes, with reductions in the rate by as much as 96%, while others were ineffective. The most common reason quoted for LWBS was long waiting times and there were few data to suggest LWBS posed a risk to patient health.ConclusionsLWBS is an issue experienced in many countries that has responded in a varying manner to many initiatives in attempts to reduce it; however, it is clearly associated with the waiting times experienced in ED and therefore working within a packet of performance measures it would assess the effect of waiting times from another perspective.
Large Prospective Study of Ovarian Cancer Screening in High-Risk Women: CA125 Cut-Point Defined by Menopausal Status
Authors: Skates Steven J. , Mai Phuong , Horick Nora K. , Piedmonte Marion , Drescher Charles W. , Isaacs Claudine , Armstrong Deborah K. , Buys Saundra S. , Rodriguez Gustavo C. , Horowitz Ira R. , Berchuck Andrew , Daly Mary B. , Domchek Susan , Cohn David E. , Van Le Linda , Schorge John O. , Newland William , Davidson Susan A. , Barnes Mack , Brewster Wendy , Azodi Masoud , Nerenstone Stacy , Kauff Noah D. , Fabian Carol J. , Sluss Patrick M. , Nayfield Susan G. , Kasten Carol H. , Finkelstein Dianne M. , Greene Mark H. , Lu Karen 
Published: September 2011

AbstractPrevious screening trials for early detection of ovarian cancer in postmenopausal women have used the standard CA125 cut-point of 35 U/mL, the 98th percentile in this population yielding a 2% false positive rate, whereas the same cut-point in trials of premenopausal women results in substantially higher false positive rates. We investigated demographic and clinical factors predicting CA125 distributions, including 98th percentiles, in a large population of high-risk women participating in two ovarian cancer screening studies with common eligibility criteria and screening protocols. Baseline CA125 values and clinical and demographic data from 3,692 women participating in screening studies conducted by the National Cancer Institute–sponsored Cancer Genetics Network and Gynecologic Oncology Group were combined for this preplanned analysis. Because of the large effect of menopausal status on CA125 levels, statistical analyses were conducted separately in pre- and postmenopausal subjects to determine the impact of other baseline factors on predicted CA125 cut-points on the basis of 98th percentile. The primary clinical factor affecting CA125 cut-points was menopausal status, with premenopausal women having a significantly higher cut-point of 50 U/mL, while in postmenopausal subjects the standard cut-point of 35 U/mL was recapitulated. In premenopausal women, current oral contraceptive (OC) users had a cut-point of 40 U/mL. To achieve a 2% false positive rate in ovarian cancer screening trials and in high-risk women choosing to be screened, the cut-point for initial CA125 testing should be personalized primarily for menopausal status (50 for premenopausal women, 40 for premenopausal on OC, and 35 for postmenopausal women). Cancer Prev Res; 4(9); 1401–8. ©2011 AACR.
Green Tea Gets Molecular
Authors: Rouzer Carol A. , Marnett Lawrence J. 
Published: September 2011

Abstract
Green tea and its major polyphenolic flavonoid, epigallocatechin gallate (EGCG), have been credited with cancer chemopreventive activity for many years; the mechanism for this activity, however, has remained obscure. Now, as reported in this issue of the journal (beginning on page 1366), Urusova and colleagues showed direct binding of EGCG to the peptidyl prolyl cis/trans isomerase Pin1, which inhibited Pin1 enzymatic activity. They showed that Pin1 expression is required for EGCG effects on cell growth, c-Jun activation, and transcription regulation mediated by NF-κB and activator protein-1. The data provide a glimpse of the mechanism of action of EGCG and set a new bar for the future study of natural products with chemopreventive activity. Cancer Prev Res; 4(9); 1343–5. ©2011 AACR.
Business of Medicine
Authors: Waguespack Richard W. , Koch Wayne M. , Marple Bradley F. , Dillon Jane T. , Moran Willard B. , Koopmann Charles F. , Setzen Michael , Eisenberg Lee D. 
Published: September 2011

Program DescriptionDeclining reimbursement over many years now threatens the viability of physician practices across specialties and practice settings. This miniseminar will outline the efforts of our Academy, specifically the Physician Payment Policy Work Group (3P), to advocate for fair reimbursement for our members in increasingly challenging public and private payer environments. Topics include updates on government health care reform, the Current Procedural Terminology (CPT) and Relative Value Update Committee (RUC) processes, coding and reimbursement for new technology, and new public and private payment models including the Accountable Care Organization concept. Strategies will be described as to how members can become actively involved to make a difference for our specialty.Educational Objectives1) Learn current healthcare reform initiatives, new payment models, and Academy efforts on Capitol Hill. 2) Understand Academy interaction with the AMA’s CPT Editorial Panel and Relative Value Update Committee. 3) Know Academy strategies for interaction with public and private payers, and effective membership involvement.
Apology and Disclosure
Authors: Roberson David W. , Hanscom Robert , Kenney Linda K. , Wojcieszak Douglas B. , Troxel David 
Published: September 2011

Program DescriptionFollowing errors and adverse events, the traditional legal and risk management advice to physicians has been to refrain from any disclosure or apology which might be used against the physician legally. Other factors which may inhibit disclosure and apology include a medical culture of perfection and a lack of experience with effective communication techniques. An increasing body of work has shown that the traditional technique of stonewalling is naturally infuriating to patients and is much more likely to lead to lawsuits. In addition, it places physicians in an intolerable position, since the natural human impulse of the caregiver is to apologize for mistakes and then to do everything possible to make things right. A number of non‐profit organizations and a few forward‐thinking malpractice carriers and institutions are now encouraging prompt, honest disclosure of adverse events, and apology when a genuine error has occurred. Experience to date has been that this more honest process is tremendously relieving to patients and physicians, and that malpractice suits and losses are substantially less when patients are treated honestly. In this miniseminar, three national experts on errors, disclosure, and apology, will discuss the ethical imperative for disclosure and the data that support this approach, both from a patient/provider satisfaction standpoint and a risk reduction standpoint. Doug Wojcieszak, the founder of Sorry Works! will speak about the advantages of disclosure and (when appropriate) apology from a patient perspective. Linda Kenney of Medically Induced Trauma Support Services will speak to how a culture of secrecy around errors harms both patients who are kept in the dark and physicians who aren’t able to be honest with their patients. Rob Hanscom, Vice President of Loss Prevention of Risk Management Foundation (a branch of Harvard’s medical malpractice carrier), will explain why insurance carriers may support thoughtful disclosure and apology policies. A discussion period will cover the issues of what and when to disclose to patients about adverse events, and the difficult question of when an apology is and is not appropriate. We will also present effective techniques for both disclosure and (when appropriate) apology.Educational Objectives1) Understand the literature supporting disclosure and apology as the ethically appropriate response to adverse events. 2) Understand the evidence that disclosure and apology reduce the likelihood of litigation. 3) Know strategies to facilitate disclosure and apology after errors and adverse events.
Practice Considerations and Contracts for New Employment
Authors: Sturm‐O’Brien Angela K. , Glazer Robert A. , Fried Marvin P. , Zacharia Daniel , Ghossaini Soha N. 
Published: September 2011

Program DescriptionThe AAO‐HNS Section for Residents and Fellows and Women in Otolaryngology are sponsoring a miniseminar to assist physicians in embarking on or changing a career in otolaryngology. Important decisions regarding the right type of practice, finding practice opportunities, and interviewing insights will be explored. Discussion will include appropriate questions that physicians should ask themselves and their potential employers. Tips for successful interviewing and placement will be provided by an experienced and highly successful private practice employer. Considerations for those seeking an academic position will also be explored. An attorney will provide insight into negotiation of a fair contract and benefits package from both the employer and employee standpoint. Avoidance of common pitfalls will also be discussed. Issues specific to women in otolaryngology contract negotiation will be addressed, as well. This miniseminar will conclude with an interactive question and answer session.Educational Objectives1) Appreciate factors crucial in evaluating a practice opportunity specific to women and young physicians. 2) Be prepared for a successful interview. 3) Understand the basics of and avoid common pitfalls in negotiating medical employment contracts.
Surgical CAHPS for Measuring Patient Experience: A Pilot for Future MOC Requirements
Authors: Rhee John S. , Witsell David L. 
Published: September 2011

Program DescriptionThe Surgical Consumer Assessment of Healthcare Providers and Systems (SCAHPS®) is a standardized tool sponsored by the American College of Surgeons and the Surgical Quality Alliance that asks consumers and patients to report on and evaluate their experiences and satisfaction with their surgical care. The survey covers topics such as communication skills of providers (surgeon, anesthesiologist) and front office staff, and assesses all phases of the surgery (pre‐, intra‐, postoperative) for inpatient and outpatient settings.Through presentation of both aggregate data and outlier case analysis from the AAO‐HNS pilot, this interactive miniseminar aims to give attendees a practical understanding of the utility of a survey like SCAHPS for assessing patient experience given the upcoming requirements under Part IV of MOC.Health plans, insurers, and specialty boards may use the data from the SCAHPS for quality improvement activities and other financial incentive programs. Specifically, beginning in 2011, the American Board of Otolaryngology Part IV (Evaluation of Performance in Practice) Maintenance of Certification will require assessment of the interpersonal and communication skills of the surgeon using the SCAHPS or an equivalent survey.Given this MOC requirement, the AAO‐HNSF BOD mandated the undertaking of this pilot in December 2009 to better understand the challenges and utility of assessing physician communication and the patient experience.Educational Objectives1) Describe the tool itself and the utility of the scores that assess surgeon‐physician communication. 2) Describe the feasibility and challenges of implementing a patient experience survey in busy academic and private otolaryngology–head and neck surgery practices. 3) Share lessons learned from outlier case analysis.
The Future of Our Specialty: Selecting and Training Residents in 2011
Authors: Tsue Terance , Stewart Michael G. , Goebel Joel A. , Levenberg Patricia , Franzese Christine B. 
Published: September 2011

Program DescriptionOtolaryngology programs continue to attract some of the best medical student applicants, but there have been increasing challenges placed on residency training. ACGME, medico‐legal, public expectations, and financial pressures have changed the methods in which we train residents. This miniseminar will involve an expert panel discussion of the evolving aspects of otolaryngology residency training, which will expand into a town hall–type format using the audience response system and a roaming microphone for active audience contribution. The panel will include initiating perspectives from the ACGME RRC Executive Director, President of the Otolaryngology Program Directors Organization, members of the ABOto Education Council, an Associate Dean for GME and seasoned Program Directors. The discussion will focus on the important decision steps of both the residency applicant and program in the course of training: 1) How to select the right residency program applicant, including what is known and being studied with regard to resident performance and outcomes. 2) A review of match statistics including how we compare with other competing specialties that our applicants consider. 3) The here and now in terms of the new accreditation and duty hour rules, and what remains in the near future for program accreditation (milestones, etc). What does the average otolaryngology program look like (current program accreditation statistics), and what are some best practice solutions to adapt to the changing environment. 4) The use of the In‐training examination by programs and residents in preparation for the board certification and re‐certification.Educational Objectives1) Learn to improve a program’s resident applicant selection process to maximize resident performance and outcomes. 2) Understand how a program’s match and accreditation outcomes compare nationally. 3) Understand the current and future expectations for program accreditation and training.
What’s New in Quality Improvement: What to Prepare For
Authors: Nussenbaum Brian , Kienstra Matthew A. 
Published: September 2011

Program DescriptionOur duty as otolaryngologists to provide the best care possible depends on our ability to stay current with the literature. This important task is becoming more difficult in this era of long hours, more clinical demands, and an ever‐growing body of medical literature. Additionally, key research findings that influence policies at hospitals and surgical centers are frequently not published in the usual journals read by otolaryngologists. The educational objectives of this miniseminar are to discuss current original research findings, provide a forum for the exchange of scholarly ideas, and highlight examples of best practice as related to new findings in the literature of patient safety and quality improvement. The format will be through the use of PowerPoint presentations with critical appraisal of the articles using the criteria described by SQUIRE (Standards for Quality Improvement Reporting Excellence), and then considering the validity and usefulness of the results in a practical manner toward our clinical practices. Articles will be chosen that have direct relevance and impact on the practice of otolaryngology‐head and neck surgery. The articles will be chosen by the members of the Patient Safety and Quality Care Committee.Educational Objectives1) Describe important recent research findings in the fields of patient safety and quality improvement. 2) Understand the relevance of these new findings to the everyday clinical practice of otolaryngology‐head and neck surgery. 3) Learn about the SQUIRE guidelines for reporting quality improvement studies.
Facial Plastic and Reconstructive Surgery
Authors: Wax Mark K. , Rosenthal Eben L. , Fedok Fred G. , Wang Tom D. 
Published: September 2011

Program DescriptionPatients with facial nerve paralysis suffer significant cosmetic and functional morbidity due to lack of eye protection, ectropion, and lack of muscular control of the lower face. These effects can not only socially isolate the patient but may cause devastating complications to the affected organ including corneal ulceration and poor oral intake requiring nutritional supplementation. While the etiology of facial paralysis can be multifactorial, most of these patients eventually require the attention of the facial plastic reconstructive surgeon. Management of the eye involves not only loading the upper eyelid but tightening the lower eyelid. Many procedures are available for this rehabilitation, and these will be discussed. Gold weight versus platinum weight for the upper lid, shortening, tarsal strip, or wedge excision of the lower lid will be compared and contrasted. Mid‐face reconstruction can be addressed by mid‐face lifting or by nasal valve repair. The high incidence of nasal obstruction following facial nerve paralysis often is not recognized and should not be neglected. Rehabilitation of the nasal valve is straight forward and well received by patients. The lower face functions to allow for proper articulation and deglutition. Without oral competence, drooling and social isolation will occur. The reconstructive options for the lower face can be considered as either dynamic using a temporalis muscle sling or as dynamic with just some form of acellular suspension. The advantages and risks associated with the procedures and the operative results of these techniques will be discussed by the panel. Each panelist in this multidisciplinary presentation will present their preferred method of rehabilitation and then case scenarios will be used to explore subtleties of each surgical approach. This miniseminar will consist of a short presentation by each panelist with a focus on individual case management presentations. Audience participation will be encouraged.Educational Objectives1) Be able to manage the acute and chronic effects of paralysis of the upper eye. 2) Add tarsal strip to their management paradigm of the lower lid. 3) Discuss the benefits and disadvantages of lower face reanimation with dynamic vs adynamic reconstruction.