Litigation costs of wrong-site surgery and other non-technical errors in orthopaedic operating theatres.

INTRODUCTION: This study reviews the litigation costs of avoidable errors in orthopaedic operating theatres (OOTs) in England and Wales from 1995 to 2010 using the National Health Service Litigation Authority Database. MATERIALS AND METHODS: Litigation specifically against non-technical errors (NTEs) in OOTs and issues regarding obtaining adequate consent was identified and analysed for the year of incident, compensation fee, cost of legal defence, and likelihood of compensation. RESULTS: There were 550 claims relating to consent and NTEs in OOTs. Negligence was related to consent (n=126), wrong-site surgery (104), injuries in the OOT (54), foreign body left in situ (54), diathermy and skin-preparation burns (54), operator error (40), incorrect equipment (25), medication errors (15) and tourniquet injuries (10). Mean cost per claim was £40,322. Cumulative cost for all cases was £20 million. Wrong-site surgery was error that elicited the most successful litigation (89% of cases). Litigation relating to implantation of an incorrect prosthesis (eg right-sided prosthesis in a left knee) cost £2.9 million. Prevalence of litigation against NTEs has declined since 2007. CONCLUSIONS: Improved patient-safety strategies such as the World Health Organization Surgical Checklist may be responsible for the recent reduction in prevalence of litigation for NTEs. However, addition of a specific feature in orthopaedic surgery, an 'implant time-out' could translate into a cost benefit for National Health Service hospital trusts and improve patient safety.

The effect of annealing on the variation of glass refractive index.

The variation of refractive index (RI) over a non-toughened, float pane of glass and a toughened, float pane of glass was investigated. The two panes of colourless, float glass were cut into 150 5 cm × 5 cm squares. The pre- and post-annealing RI values from three random areas from each square were measured. Bayesian statistical hierarchical modelling of the results showed that for the non-toughened, float glass pane annealing increased the variability in RI by a factor of 1.29-1.58, with a mean of 1.43 (with 95% probability); and for the toughened, float pane of glass annealing decreased the variability in RI by a factor of 0.63-0.76, with a mean of 0.69 (with 95% probability). In addition it was found that although there were no systematic differences in ΔRI across either pane of glass, there were observable differences across both panes of glass. These results provide information regarding the expected RI variation over entire panes of both non-toughened and toughened float window glass for both pre- and post-annealing RI measurements.

An investigation into the variability of the refractive index of glass: part II- the effect of debris contamination.

The effect of debris contamination on the measurement of the refractive index of glass fragments was investigated. Results are presented that suggest that the variability of refractive index measurements is increased when debris contamination is present on glass fragments.

An investigation into the relationship between edge counts and the variability of the refractive index of glass. Part I: Edge morphology.

The effect of glass fragment morphology on the variability of refractive index values in five different glass objects was investigated. Data are presented that suggest that the variability of refractive index values is increased when fragment edge morphology becomes unsuitable for phase contrast microscopy.

A study of the performance and utility of annealing in forensic glass analysis.

The use of annealing in forensic glass casework is reviewed. New data is presented that suggests a continuous approach to the interpretation of such data may be superior to the classification approach. Data are presented supporting the previously observed relationship between change in refractive index (RI) and the thickness of the glass pane. An examination of the possible assumption of independence between RI and change in RI is undertaken.

Spatial variation of refractive index in a pane of float glass.

In the statistical interpretation of forensic glass evidence it is standard practice to make the assumption of homogeneity of the refractive index (RI) of the source glass, or of localized homogeneity. However, the work of Locke and Hayes showed that, for toughened windscreen glass, this assumption might not be true. This work is well cited, but there appears to have been little follow-on published research. Furthermore, the toughening process is something known to affect the refractive index, and is a process that float glass does not undergo. Float glass is a major component of casework in New Zealand and for that reason it would be interesting to know whether the findings of Locke and Hayes apply when dealing with float glass. In this paper we describe an experiment similar to that of Locke and Hayes, systematically examining the variation of RI in a pane of float window glass. It was found that, although there were no systematic differences in refractive index, there were observable differences across the pane.

Estrogen receptor functional status in human breast cancer.

Estrogen receptors (ER) are detected in 50-85% of all breast tumors, and are clinically important because they tend to identify patients with a higher probability of responding to hormonal or endocrine manipulations. However, approximately 30-40% of all ER+ patients do not respond to hormonal manipulations. The lack of response to hormonal manipulations in ER+ patients could be the result of nonfunctional ER, as determined by its inability to recognize and bind to specific DNA-responsive elements and/or its inability to recruit other transcriptional activation factors. The functional status of ER in 34 human breast tumors was assessed determining the structural integrity of the ER DNA-binding domain using site-directed monoclonal anti-estrogen receptor antibody and sucrose density gradient analysis. Based on the fraction of ER containing an intact DNA-binding domain, the tumors were classified into three groups: group I with > 65% of intact ER, group II with > 30% of intact ER, group III with < 30% of intact ER. Clinical and pathologic data were obtained only for patients who were treated with the anti-estrogen tamoxifen and correlated with ER functional status. In group I, 11 of 13 (84.6%) patients were responsive to hormonal therapy with favorable clinical outcome; two patients had unfavorable clinical outcome. In group II, 13 of 15 patients (86.7%) had favourable clinical outcome, and two patients 13.3% had unfavorable outcome. In group III, three of six patients appeared to be hormone responsive with favorable clinical outcome, and three of the patients in this group had unfavorable response to therapy.(ABSTRACT TRUNCATED AT 250 WORDS)

The synthesis and role of integrin in corneal epithelial cells in culture.

Cell-substratum interaction and recognition is essential for cellular adherence and protein synthesis. To understand the mechanisms underlying diseases related to corneal erosion, it is necessary to examine the role integral proteins play in cellular adherence and spreading. In the current study, we used antibodies to evaluate the accumulation of integrin by corneal epithelial cells in tissue culture. We demonstrated that while the protein was incorporated into the cell layer at 6, 24, 48, and 72 hr, a far greater amount was secreted into the media. The total amount of integrin did not change with time, and the level of mRNA did not increase from 24 to 48 hr. During this time period, fibronectin was not detected. Antibodies to the fibronectin-binding receptor inhibited cellular spreading over a period of 18 hr. These results indicate that rabbit corneal epithelial cells do synthesize integrin and that integrin plays a critical role in cellular spreading.

Carbohydrate moieties of the basal lamina: their role in attachment and spreading of basal corneal epithelial cells.

Three lectins, Wheat germ agglutinin, succinyl Concanavalin A and Ricinus communis agglutinin were used to block specific sugar moieties in the basal lamina. Corneal epithelial basal cells were plated onto freshly denuded basal lamina. Attachment was studied by quantifying the adherence of prelabeled cells and by examining attachment sites using transmission electron microscopy. Spreading was examined using scanning electron microscopy. Attachment of the cells occurred within 15 min and spreading was apparent after 45 min. Both Wheat germ agglutinin and beta-N-acetylglucosaminidase inhibited cellular attachment. Succinyl Concanavalin A and Ricinus Communis agglutinin permitted attachment, but inhibited extensive cellular spreading. The results indicate that the attachment of basal cells is dependent on N-acetylglucosamine residues, and spreading is mediated by alpha methylmannoside, glucose, and galactose residues.