The British journal of oral & maxillofacial surgery
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Br J Oral Maxillofac Surg · Jan 2016
ReviewGood people who try their best can have problems: recognition of human factors and how to minimise error.
Human error is as old as humanity itself and is an appreciable cause of mistakes by both organisations and people. Much of the work related to human factors in causing error has originated from aviation where mistakes can be catastrophic not only for those who contribute to the error, but for passengers as well. The role of human error in medical and surgical incidents, which are often multifactorial, is becoming better understood, and includes both organisational issues (by the employer) and potential human factors (at a personal level). ⋯ However, this does not address limitations or other safety concerns that are related to performance, such as stress and fatigue, emotional state, hunger, awareness of what is going on situational awareness, and other factors that could potentially lead to error. Here we attempt to raise awareness of these human factors, and highlight how they can lead to error, and how they can be minimised in our day-to-day practice. Can hospitals move from being "high risk industries" to "high reliability organisations"?
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Br J Oral Maxillofac Surg · Nov 2015
Efficacy of sclerotherapy with radio-opaque foam guided by digital subtraction angiography for the treatment of complex venous malformations of the head and neck.
Our aim was to evaluate the efficacy of sclerotherapy using radio-opaque foam and guided by digital subtraction angiography (DSA) for complex venous malformations in the head and neck in 11 selected patients between 2011 and 2013. The sclerosing foam was manufactured by the classic Tessari method and consisted of air, 1% polidocanol, and radio-opaque media iopromide (Ultravist(®)300) in a ratio of 7:2:1. We recorded the site and size of the lesion, time and duration of treatment, and therapeutic response. ⋯ Only one lesion recurred. Early complications included immediate swelling in injected areas, snoring, and pain on swallowing, but there were no air emboli or signs of cutaneous necrosis, and the complications were self-limiting. DSA-guided sclerotherapy with radio-opaque foam was safe and effective for the treatment of complex vascular malformations of the head and neck.
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Br J Oral Maxillofac Surg · Nov 2015
Perspectives of the multidisciplinary team on the quality of life of patients with cancer of the head and neck at 2 years.
We aimed to assess the extent to which core members of the head and neck multidisciplinary team (MDT) use data on health-related quality of life (HRQoL), and their familiarity with specific HRQoL outcomes for different groups of patients with cancer of the head and neck. We surveyed members of the head and neck MDT in the Merseyside Regional Head and Neck Cancer Centre (consultants, clinical nurse specialists, and allied health professionals) about their views on patient-reported outcomes for 8 common clinical situations after treatment for cancer. A total of 17/27 responded (63%), and of them, 12 use the data. ⋯ Although HRQoL information is used by most clinicians, it is often used for research and not to inform them about the patient. Its use can enable discussions with patients and carers to be more relevant, but it is important to remember that individual HRQoL outcomes can differ. There is scope for further study to explore the decision-making process for different types of treatment that have equivalent survival from the perspective of both the MDT and the patient.
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Br J Oral Maxillofac Surg · Nov 2015
Publication rates in peer-reviewed journals of abstracts presented at the Oral and Maxillofacial Surgery Society of Turkey meetings 2007-2012.
The purpose of this study was to find out the rate of peer-reviewed publication of full papers of abstracts presented at the annual meeting of the Oral and Maxillofacial Surgery Society of Turkey, and to identify the time taken for publication, subspecialty, and study design. All abstracts accepted for presentation at the meetings in 2007-12 were identified from the books of abstracts, and evidence of publication was sought from PubMed and Google Scholar. The following variables were evaluated: publication rate, type of presentation (oral or poster), time to publication, subspecialty, study design, name of the journal in which the paper was published, impact factor of the journal, author affiliation, change in number of authors and origin of the study. ⋯ Anatomical presentations had the highest publication rate (8/11), whereas orthognathic surgery had the lowest (5/67, 7%). Technical notes (5/9) and animal studies (32/70, 46%) were the most common types of publication. Only 246 of the 1322 abstracts (19%) were subsequently published as full papers, which is lower than previously reported in oral and maxillofacial surgery.
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Br J Oral Maxillofac Surg · Sep 2015
Management and maintenance of the airway in cervical necrotising fasciitis: a retrospective analysis of 15 cases.
Cervical necrotising fasciitis is a progressive deep infection of the neck associated with high mortality, and skillful management of the airway is critical for operations under general anaesthesia. Tracheostomy under local anaesthesia has been considered the gold standard of airway management in patients with deep neck infections, but it may be difficult or impossible in advanced cases. We report here our experience over 6 years (January 2008 and December 2013) during which a total of 15 patients was diagnosed with cervical necrotising fasciitis. ⋯ Patients were intubated postoperatively from 3 to 14 days, and there were no problems with the airway. Advanced techniques for control of the airway have a high rate of success in patients with necrotising fasciitis and could be an appropriate alternative to a traditional airway. Postoperative sedation and analgesia should be considered as routine management of pain and anxiety.