ABSTRACT
OBJECTIVES: Prolonged alveolar air leak is the most common complication after pulmonary surgery. We conducted an investigator-led randomized trial to evaluate the effectiveness of CoSeal® surgical sealant (Cohesion Technologies Inc.; manufactured and distributed by Baxter Healthcare) for the closure of alveolar air leak after anatomical pulmonary resection. METHODS: Patients undergoing primary open lobectomy, bilobectomy, or sublobar resection with a demonstrable air leak on intra-operative testing were randomized to either standard care or standard care plus application of CoSeal® surgical sealant to areas of air leak. A second application of CoSeal® was used in the treatment group if air leak persisted. Patients were allocated at the point of entry to the trial by unbiased allocation with minimization to ensure balance between the two arms with respect to age, sex, surgeon, number of segments resected, preoperative forced expiratory volume in 1s (FEV1), and grade of air leak. Kaplan-Meier analysis of air-leak duration and a log rank test were performed on an intention-to-treat basis, with observations censored at death, transfer to the intensive care unit, or discharge. RESULTS: Of the 200 patients, who entered the trial over a 24-month period, 121 with demonstrable intra-operative air leak were randomly allocated to the two groups. Data were missing for one patient in the CoSeal® group. In 57%, the air leak was stopped at the first application; a quarter continued to leak after the second. At 24h, there was no difference in air leak and fewer patients in the control group were leaking at 48 h postoperatively. By log rank test, the difference was not significant (p=0.09). CONCLUSIONS: Patients treated with CoSeal® in this study had, as a group, a longer duration of air leak and hence we cannot recommend its routine use.
Subject(s)
Pneumonectomy/adverse effects , Pneumothorax/etiology , Pneumothorax/therapy , Polyethylene Glycols/therapeutic use , Tissue Adhesives/therapeutic use , Aged , Drainage , Female , Humans , Intraoperative Care/methods , Length of Stay/statistics & numerical data , Male , Middle Aged , Pneumonectomy/methods , Polyethylene Glycols/adverse effects , Postoperative Period , Prospective Studies , Tissue Adhesives/adverse effects , Treatment OutcomeABSTRACT
OBJECTIVE: To assess the feasibility and acceptability of obtaining data on prescribing error rates in routine practice, and presenting feedback on such errors to medical staff. SETTING: One clinical directorate of a London teaching trust. METHODS: Ward pharmacists recorded all prescribing errors identified in newly written medication orders on one day each fortnight between February and May 2005. We examined prescribing errors reported on the trust's medication incident database for the same period. MAIN OUTCOME MEASURES: Prescribing errors identified and recorded by ward pharmacists, prescribing errors reported as incident reports; prescribing error rates per clinical specialty; lead consultants' views on receiving feedback on errors for their specialty. RESULTS: During eight data collection days, 4,995 new medication orders were examined. Of these, 462 (9.2%; 95% confidence interval 8.5 -10.1%) contained at least one prescribing error. There were 474 errors in total. Pharmacists indicated that they would have reported 19 (4%) of the prescribing errors as medication incidents. Eight prescribing errors were reported for the entire four-month study period on non-data collection days. Feedback was presented to lead clinicians of 10 clinical specialties. This included graphical summaries showing how the specialty compared with others, and a list of errors identified. This information was well-received by clinicians. CONCLUSION: Prescribing errors identified by ward pharmacists can be systematically fed back at the level of the clinical specialty; this is acceptable to the consultants involved. Incident report data is subject to gross under-reporting. Routinely providing feedback for each consultant team or for individual prescribers will require more focussed data collection.
Subject(s)
Data Collection/methods , Feedback , Medication Errors , Physicians , Practice Patterns, Physicians'/standards , Documentation , Hospitals, Teaching/statistics & numerical data , Humans , London , Pharmacists , Pilot ProjectsABSTRACT
We sought to establish the extent to which tumour uptake of [18F]-fluoro2-deoxy-glucose is associated with survival in patients with primary lung cancer. From our analysis of data concerning 498 lung cancer patients, including surgical and non-surgical cases, we conclude that there is a clear association between higher tumour uptake of glucose and worse survival.
Subject(s)
Fluorodeoxyglucose F18 , Lung Neoplasms/diagnostic imaging , Lung Neoplasms/mortality , Radiopharmaceuticals , Aged , Female , Fluorodeoxyglucose F18/pharmacokinetics , Humans , Lung Neoplasms/metabolism , Male , Middle Aged , Radionuclide Imaging , Radiopharmaceuticals/pharmacokinetics , Survival Analysis , Time FactorsABSTRACT
Faced with the problem of giving individualised advice about adjuvant chemotherapy to patients who have had an apparently curative lung cancer resection, we propose a model to help clarify the choices being made. This would inform the clinician, help the patient and be an explicit basis on which to initiate the discussion.
