An unusual case of recurrent pneumonia.

A gentleman, aged 54, with shunted hydrocephalus presented with recurrent chest infections. He had a ventriculoperitoneal (VP) shunt inserted when he was 38 years old for obstructive hydrocephalus due to a cerebellar tumour, with no subsequent shunt revisions since. Over a 2-year period, he presented with three episodes of pneumonia, which, on each occasion, responded well to antibiotics but then subsequently recurred. A chest x-ray identified the distal end of the VP shunt above the level of the diaphragm. CT scan found the distal end of the shunt tubing to be within a pulmonary bronchus. The VP shunt was revised and the patient had no subsequent recurrences of his chest infections. The authors review the complications of VP shunt placement including the more common sites of shunt tubing migration.

The World Health Organization's 'Surgical Safety Checklist': should evidence-based initiatives be enforced in hospital policy?

OBJECTIVES: To assess the awareness and voluntary usage of the World Health Organization's Surgical Safety Checklist (WHO SSC), just prior to its mandatory implementation. DESIGN: Questionnaire-based, prospective, telephone survey. SETTING: Patients are exposed to systematic risks and principles of surgical safety are inconsistently applied even in sophisticated settings. The evidence-based WHO SSC addresses shortfalls to promote patient safety. It was formally introduced in the United Kingdom in January 2009 and became a mandatory preoperative requirement in all hospitals from February 2010. PARTICIPANTS: Two hundred and thirty-eight hospitals, both private and government-run, in the UK. MAIN OUTCOME MEASURES: Appreciation among senior theatre personnel as to the existence, implementation and usage of the WHO SSC concept. RESULTS: Almost all had heard of the SSC, but in only two-thirds of hospitals was its use mandatory. Where the SSC was not compulsory, 80% were using it informally or sporadically. One-quarter of senior theatre personnel in hospitals without compulsory use indicated they did not know or that their department did not plan on using the checklist in the next six months, despite the deadline for implementation. CONCLUSIONS: If the SSC is to optimize safety, then greater education and awareness is required.