Attitudes and practice of surgeons in reporting medical errors at a tertiary care hospital.

Medical error reporting is essential in creating a culture of accountability in our healthcare system. The aim of this study was to evaluate the frequency of reporting errors by surgeons in our setup and to analyse the factors resulting in under-reporting of medical errors. A total of 96 practicing surgeons at Mayo Hospital, Lahore were surveyed between the months of February, 2018 to June 2018 on their beliefs regarding the reporting of medical errors by means of a specifically designed questionnaire. This study revealed that 71 (74%) respondents had committed a medical error but only 16 (16.6%) of them reported those errors. Major factors in under-reporting of errors included work stress and fear of medico-legal consequences due to disclosure of error. Eighty-four (87.5%) believed that increase in reporting medical errors would contribute to a better system. Most surgeons had a positive view towards the process but believed that the reporting system was ineffective.

Root cause analysis of pre-microscopic errors in anatomical pathology using Eindhoven classification.

OBJECTIVE: To evaluate pre-microscopic errors in anatomical pathology. METHODS: The cross-sectional descriptive study was conducted at the Department of Pathology of a tertiary care hospital in Lahore, Pakistan, from September, 2016, to January, 2017, and comprised surgical pathology specimens. Errors were noted across the pre-microscopic process. Defects per million opportunities were calculated to determine sigma metric value in every step, from requisition to slide preparation. Root cause analysis was applied to the process of histology preparation to identify the root cause of each previously identified problem using Eindhoven classification. All errors were recorded on a pre-designed proforma. RESULTS: There were 2420 specimens. While errors were encountered in all phases of the pre-microscopic process, but the (G6: n=1085, 44.83%), followed by requisition (R3: n=893, 36.9%) and cover slipping (C1: n=776, 32.06%). CONCLUSIONS: Development of standard procedures and protocols with staff training is likely to help in controlling the errors.

Breaking bad news skill of postgraduate residents of tertiary care hospital of Lahore, Pakistan: A cross-sectional survey.

OBJECTIVE: To evaluate the skill of postgraduate residents in breaking bad news to the patients in a tertiary care hospital. METHODS: The cross-sectional study was conducted at King Edward Medical university, Lahore, Pakistan, from January to April 2016, and comprised postgraduate residents of different specialties at Mayo Hospital, Lahore. The subjects were examined in terms of their personal experience in breaking bad news to the patients by means of a specifically-designed questionnaire based on six-step protocol of Setting, Perception, Invitation, Knowledge, Empathy and Summarising model. Data was qualitatively and quantitatively analysed using SPSS 22. RESULTS: Of the 200 respondents, 141(70.5%) were males and 59(29.5%) were females. Overall mean age of the sample was 23 } 2.55years. Of the total, 94(47%) respondents were only fairly satisfied with their breaking bad news skill, while 130(65%) were eager to get training in this regard. The knowledge regarding breaking bad news protocols was lacking across all comparisons (p>0.05). CONCLUSIONS: Majority of the residents had little satisfaction regarding their breaking bad news skill. It is necessary to plan special training for the residents in this key area.

Immunohistochemical expression and correlation of mammaglobin with the grading system of breast carcinoma.

OBJECTIVES: In this study it was intended to study mammaglobin expression as a marker for the detection of breast cancer and correlate it with the Bloom-Richardson grading system of breast carcinoma. MATERIALS AND METHODS: The study was conducted from May 2007 to May 2008. Tissue samples were collected from 50 patients of breast cancer in the various stages of their disease and correlated histologically with the Bloom-Richardson grading system for breast carcinoma. The clinical data of the patients were obtained from their respective files. RESULTS: Positive immunostaining for mammaglobin was seen in 84% of breast carcinoma cases. This immunoreactivity did not correlate with histological and nuclear grades of the tumors, yet it varied according to the histological type of the tumor with ductal carcinoma showing stronger and diffuse staining than other varieties. CONCLUSION: These results elicit that mammaglobin is overexpressed in carcinoma breast as compared to the normal breast epithelium. This mammaglobin expression can act as a useful tool in the diagnosis of women with breast cancer.

Role of biopsy in pediatric lymphadenopathy.

OBJECTIVE: To determine the role of lymph node biopsy in the diagnosis of lymphadenopathy and to find out the pattern of different diseases in relation to age, gender, and the site of lymph nodes involved. METHODS: This retrospective study was carried out at the Histopathology Department of the Children's Hospital and The Institute of Child Health, Lahore, Pakistan, over a period of 9 years, from January 1999 to December 2007. Tissue samples were collected from 898 children presenting with lymphadenopathy, and the diagnosis was confirmed on histology and through various specific tests. The clinical data of the patients were collected from computerized hospital records. RESULTS: Among the total 898 consecutive lymph node biopsies, the most common pathology encountered was reactive hyperplasia in 356 children (39.6%), followed by tuberculosis in 262 (29.1%) and malignant lymphomas in 132 children (14.6%). The rest of the lesions include; 72 cases of granulomatous lymphadenitis (8%), 13 of histiocytosis X (1.4%), 44 (4.9%) of metastatic tumors, 16 of chronic inflammation (1.8%), and 3 cases of Kikuchi's disease (0.3%). The cause of lymphadenopathy was found to be significantly associated with age, gender, and site of the lymph nodes involved. CONCLUSION: Lymphadenopathy is a relatively common condition in the pediatric age group. Although 39.6% of children had reactive hyperplasia of unknown etiology, 60.3% children presented with a specific diagnosis.