ABSTRACT
Solitary fibrous tumors (SFTs) are spindle-cell tumors that rarely arise within extrathoracic area. Massive SFTs involving the pterygopalatine fossa are extremely rare and surgical excision represents a multidisciplinary surgical challenge. We present a case of 64-year-old female with a huge mass originating from the pterygopalatine fossa invading the skull base. Distinct microscopic findings and a positive nuclear staining of signal transducer and activator of transcription 6 (STAT-6) pathologically confirmed SFT. The right internal maxillary artery branch was embolized preoperatively and a surgical excision was performed through a combined technique of transpalatal, mid-facial degloving and endoscopic approach. Postoperative radiotherapy successfully removed the remnant tumor adjacent to the carvenous sinus. Follow- up MR images showed no evidence of recurrence for two years. To our knowledge, there has been no previous report of the successful treatment of this vast extent of SFT in the pterygopalatine region via endoscopic-external-combined approach and radiotherapy.
ABSTRACT
PURPOSE: The aim of this study was to examine degrees of nurse-nurse collaboration and nurse-physician collaboration, and investigate their relationships to the occurrence of medical errors. METHODS: A cross-sectional questionnaire survey was conducted with 264 nurses in a university hospital. The questionnaire included fivecomponent nurse-nurse collaboration and three-component nurse-physician collaboration scales. Data were analyzed using independent t-tests, ANOVA, χ2 tests, and multiple logistic regression. RESULTS: Mean score for nurse-nurse collaboration was 2.8 out of 4.0, and for nurse-physician collaboration, 3.4 out of 5.0. There were significant differences in the nurse-nurse and nurse-physician collaboration scores by nurses' preference to workplace and work unit. A significant difference was found in the nurse-nurse collaboration scores by job position. Fifty-seven (21.60%) nurses responded that they had experienced a medical error in the last six months. Logistic regression analysis revealed that nurse-physician collaboration was a significant factor associated with nurses' error experience. Nurses with higher scores for the nurse-physician relationship component were less likely to experience medical errors. CONCLUSION: Findings from this study show that nurse-nurse and nurse-physician collaboration were moderate. Negative relationship between nurse-physician collaboration and the occurrence of medical error indicates that enhancing nurse-physician collaboration would contribute to improving patient safety.
Subject(s)
Cooperative Behavior , Interprofessional Relations , Logistic Models , Medical Errors , Patient Safety , Physician-Nurse Relations , Weights and MeasuresABSTRACT
BACKGROUND: Since 2009, database construction of anesthesia-related adverse events has been initiated through the legislation committee of the Korean Society of Anesthesiologists (KSA), based on expert consultation referrals provided by police departments, civil courts, and criminal courts. METHODS: This study was a retrospective descriptive analysis of expert consultation referrals on surgical anesthesia-related cases between December 2008 and July 2010. RESULTS: During the given period, 46 surgical anesthesia-related cases were referred to the KSA legislation committee for expert consultation. Because six cases were excluded due to insufficient data, 40 cases were included in the final analysis. Of 40 cases, 29 (72.5%) resulted in death. Respiratory events were most common in both surviving/disabled and dead patients (36.4 vs. 51.7%, respectively; P > 0.05). Overall, respiratory depression due to the drugs used for monitored anesthesia care (MAC) was the most common specific mechanism (25%), in which all but one case (profound brain damage) resulted in death. In all of these cases, surgeons or physicians provided MAC without the help of anesthesiologists. CONCLUSIONS: Overall, the most common damaging mechanism was related to respiratory depression due to sedatives or anesthetics used for MAC. Almost all MAC injury cases are believed to be preventable with the use of additional or better monitoring and an effective response to initial physiological derangement. Thus, it is essential to establish practical MAC guidelines and adhere to these guidelines strictly to reduce the occurrence of severe anesthesia-related adverse outcomes.