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Concept: Medical error


The way hemodynamic therapies are delivered today in anesthesia and critical care is suboptimal. Hemodynamic variables are not always understood correctly and used properly. The adoption of hemodynamic goal-directed strategies, known to be clinically useful, is poor. Ensuring therapies are delivered effectively is the goal of decision support tools and closed loop systems. Graphical displays (metaphor screens) may help clinicians to better capture and integrate the multivariable hemodynamic information. This may result in faster and more accurate diagnosis and therapeutic decisions. Graphical displays (target screens) have the potential to increase adherence to goal-directed strategies and ultimately improve patients' outcomes, but this remains to be confirmed by prospective studies. Closed loop systems are the ultimate solution to ensure therapies are delivered. However, most therapeutic decisions cannot be based on a limited number of output variables. Therefore, one should focus on the development of systems designed to relieve clinicians from very simple and repetitive tasks. Whether intraoperative goal-directed fluid therapy may be one of these tasks remains to be evaluated.

Concepts: Medicine, Therapy, Classification of Pharmaco-Therapeutic Referrals, Decision theory, Control theory, Decision support system, Graphic design, Medical error


In the Southwestern United States, the venom of the scorpion Centruroides sculpturatus (common name bark scorpion) can cause serious and potentially fatal neurotoxicity, with young children most vulnerable to its effects. Historically, advances in the quality of supportive care have made significant improvements in morbidity and mortality. In recent years, the development of effective antivenom therapies has changed the landscape of caring for these patients. This article reviews the background, pathophysiology, diagnosis, and treatment options for C. sculpturatus envenomation. Recent advances in immunotherapy and subsequent implications for pediatric emergency care providers are discussed.

Concepts: Medicine, United States, Venom, Scorpion, Medical error, Buthidae, Centruroides exilicauda, Mac Gargan


Aspirin sensitivity syndrome is an underdiagnosed entity in pediatric otolaryngology. The diagnosis must be considered in a pediatric non-cystic fibrosis patient with florid nasal polyposis. In this small case series, we will describe 2 patient’s presentation, work up, allergic and surgical therapies and their postoperative course. In doing so, we hope to increase awareness and to illustrate the details that are involved in its diagnosis and treatment.

Concepts: Medicine, Asthma, Physician, Salicylic acid, Medical error, Samter's triad, Salicylate sensitivity


Female pattern hair loss (FPHL) is a common cause of hair loss in women characterized by diffuse reduction in hair density over the crown and frontal scalp with retention of the frontal hairline. Its prevalence increases with advancing age and is associated with significant psychological morbidity. The pathophysiology of FPHL is still not completely understood and seems to be multifactorial. Although androgens have been implicated, the involvement of androgen-independent mechanisms is evident from frequent lack of clinical or biochemical markers of hyperandrogenism in affected women. The role of genetic polymorphisms involving the androgen and estrogen receptors is being increasingly recognized in its causation and predicting treatment response to anti-androgens. There are different clinical patterns and classifications of FPHL, knowledge of which facilitates patient management and research. Chronic telogen effluvium remains as the most important differential diagnosis. Thorough history, clinical examination, and evaluation are essential to confirm diagnosis. Patients with clinical signs of androgen excess require assessment of biochemical parameters and imaging studies. It is prudent to screen the patients for metabolic syndrome and cardiovascular risk factors. The treatment comprises medical and/or surgical modalities. Medical treatment should be initiated early as it effectively arrests hair loss progression rather than stimulating regrowth. Minoxidil continues to be the first line therapy whereas anti-androgens form the second line of treatment. The progressive nature of FPHL mandates long-term treatment for sustained effect. Medical therapy may be supplemented with cosmetic concealment in those desirous of greater hair density. Surgery may be worthwhile in some carefully selected patients.

Concepts: Medicine, The Canon of Medicine, Estrogen, Therapy, Medical diagnosis, Differential diagnosis, Medical error, Telogen effluvium


Empty nose syndrome (ENS) is a rare, late complication of turbinate surgery. The most common clinical symptoms are paradoxical nasal obstruction, nasal dryness and crusting, and a persistent feeling of dyspnea. Little is known about the pathogenesis of ENS, though it is speculated that anatomical changes leading to alterations in local environment, disruption of mucosal cooling, and disruption of neurosensory mechanisms are strongly implicated. The diagnosis is clinical, though often difficult to make due to the poor correlation between subjective and objective findings. Medical therapies include mucosal humidification, irrigations, and emollients. Surgical therapy should be reserved for refractory cases and may involve turbinate reconstruction, most commonly using implantable biomaterials. Ultimately, prevention of this feared complication through turbinate-sparing techniques is essential.

Concepts: Medicine, Therapy, Physician, Mucus, Nose, Nasal cavity, Medical error, Empty nose syndrome


Abstract Introduction: Errors in medicine and patient safety are topics with growing scientific and public attention. In undergraduate medical education, these issues are little investigated so far. The aim of this study was to collect data regarding attitudes and needs of medical students. Methods: In a sample of 269 German medical students, data were collected using an anonymous online questionnaire. It consisted of three parts: (1) international validated questionnaire, (2) questions about the German medical education system and (3) demographic data. Data were analysed quantitatively and qualitatively. Results: One-hundred sixty-seven data sets were analysed (completion rate 62%). Twenty-five percent of the respondents stated that they already had committed a medical error. Almost half of the participants reported that they had been assigned tasks they had not been qualified for (47%), or where medical errors could have happened easily (50%). Final year students showed less confidence in error disclosure compared to younger students (p < 0.001). The majority of respondents (64%) wished for more education on the issues. Discussion: With regard to future curricular developments, a consideration of attitudes and needs of medical students regarding the topics of medical errors and patient safety seems necessary. A goal-directed undergraduate education can promote an open culture and can lead to safety and satisfaction for both patients and medical professionals.

Concepts: Psychology, Education, Physician, Higher education, Iatrogenesis, Patient safety, Medical error, Patient Safety and Quality Improvement Act


Medication error is a frequent, harmful and costly patient safety incident. Research to date has mostly focused on medication errors in hospitals. In this study, we aimed to identify the main causes of, and solutions to, medication error in primary care.

Concepts: Error, Identification, Iatrogenesis, Hospital accreditation, Patient safety, Medical error, Patient Safety and Quality Improvement Act


In the past decade, the addition of molecular diagnosis of mutations and use of tyrosine kinase inhibitors (TKIs), either as neoadjuvant/adjuvant therapy with surgery or as primary therapy in nonresectable gastrointestinal stromal tumors (GIST), has improved patient outcomes markedly. Additional therapeutics also are on the horizon. The goal of this review is to identify the current incidence, diagnostic modalities, and trends in personalizing the medical and operative management for patients with GIST. Medline, PubMed, and Google scholar were queried for recently published literature regarding new molecular mechanisms, targeted therapies, and clinical trials investigating the treatment of GIST. The objective of this review is to highlight the biomarkers under development, newly discovered mutations, and newer therapies targeting specific mutational phenotypes which are continually improving the outlook for patients with this disease.

Concepts: Medicine, Cancer, Cure, Therapy, Physician, Protein kinase, Gastrointestinal stromal tumor, Medical error


A new approach to hospital handoffs has shown it can significantly reduce medical errors as well as preventable adverse events. The approach, dubbed the I-PASS bundle, uses a mnemonic to alert providers to all the issues that need to be covered during a handoff, but also includes a written handoff tool, communication training, a sustainability campaign, and a process for feedback. In a study of the I-PASS bundle conducted at nine pediatric hospitals, investigators found that the approach reduced medical errors by 23%, and the rate of preventable adverse events by 30%. Investigators say I-PASS did not increase the amount of time required to conduct a handoff. On average, handoffs in the study took 2.5 minutes per patient. Several medical centers are now implementing the approach hospital-wide, and additional studies into the approach are planned. Developers advise hospitals interested in the approach to first gather data and survey providers to make a case for the intervention.

Concepts: Medicine, Patient, Hospital, Physician, Implementation, Conducting, Medical error, Handoff


 To examine the relative risks of iatrogenic and non-iatrogenic injuries during the period shortly before and after a diagnosis of cancer.

Concepts: Relative risk, Medical error