Medication errors, critical incidents, adverse drug events, and more: a review examining patient safety-related terminology in anaesthesia.

Literature focused on quantifying or reducing patient harm in anaesthesia uses a variety of labels and definitions to represent patient safety-related events, such as 'medication errors', 'adverse events', and 'critical incidents'. This review extracts and compares definitions of patient safety-related terminology in anaesthesia to examine the scope of this variability and inconsistencies. A structured review was performed in which 36 of the 769 articles reviewed met the inclusion criteria. Similar terms were grouped into six categories by similarities in keyword choice (Adverse Event, Critical Incident, Medication Error, Error, Near Miss, and Harm) and their definitions were broken down into three base components to allow for comparison. Our analysis found that the Medication Error category, which encompasses the greatest number of terms, had widely variant definitions which represent fundamentally different concepts. Definitions of terms within the other categories consistently represented relatively similar concepts, though key variations in wording remain. This inconsistency in terminology can lead to problems with synthesising, interpreting, and overall sensemaking in relation to anaesthesia medication safety. Guidance towards how 'medication errors' should be defined is provided, yet a definition will have little impact on the future of patient safety without organisations and journals taking the lead to promote, publish, and standardise definitions.

Going Short: The Effects of Short-Travel Key Switches on Typing Performance, Typing Force, Forearm Muscle Activity, and User Experience.

This study examined the effects of 4 micro-travel keyboards on forearm muscle activity, typing force, typing performance, and self-reported discomfort and difficulty. A total of 20 participants completed typing tasks on 4 commercially available devices with different key switch characteristics (dome, scissors, and butterfly) and key travels (0.55, 1.3, and 1.6 mm). The device with short-travel (0.55 mm) and a dome-type key switch mechanism was associated with higher muscle activities (6%-8%, P < .01), higher typing force (12%, P < .01), slower typing speeds (8%, P < .01), and twice as much discomfort (P < .05), compared with the other 3 devices: short-travel (0.55 mm) and butterfly switch design and long travel (1.3 and 1.6 mm) with scissor key switches. Participants rated the devices with larger travels (1.3 and 1.6 mm) with least discomfort (P = .02) and difficulty (P < .01). When stratified by sex/gender, these observed associations were larger and more significant in the female participants compared with male participants. The devices with similar travel but different key switch designs had difference in outcomes and devices with different travel were sometimes not different. The results suggest that key travel alone does not predict typing force or muscle activity.

Epithelioid sarcoma: need for a multimodal approach to maximize the chances of curative conservative treatment.

OBJECTIVE: This study was designed to evaluate the impact of multimodal management on a series of epithelioid sarcoma (ES) patients treated with curative intent. METHODS: Data were collected on 69 consecutive patients treated from 1982 to 2012. Univariate and multivariate analyses were performed for tumor control and overall survival (OS). RESULTS: In total, 54 (78 %) patients had localized ES (M0 group). In the M0 group, 85 % of patients received multimodal management (surgery n = 50, radiotherapy n = 37, chemotherapy n = 30). Among 42 patients with limb ES, 9 (21 %) underwent amputation, and isolated limb perfusion (ILP) was required in 17 (40.5 %) to allow conservative management. Among the 45 patients who underwent conservative surgery, flap reconstructions were required in 13 (28.8 %). The median follow-up was 5.7 years. The 5-year actuarial OS rates were 54, 62, and 24 % in the entire group and the M0 and M1 groups, respectively. In the M0 group, the 5-year actuarial distant control, local control (LC), and locoregional control rates were 67, 75, and 66 %, respectively. Prognostic factors for poor OS in the multivariate analysis were tumors that were deep to the fascia (p = 0.04) and grade 3 (p = 0.005). In the univariate analysis, age <30 years (p = 0.04), the T2 stage (p = 0.04), and mass presentation (p = 0.03) correlated with decreased LC, whereas patients who underwent ILP had a significantly higher LC rate (hazard ratio 3; 95 % confidence interval 0.9-9.4; p = 0.05). CONCLUSIONS: Multimodal management including ILP and flap reconstruction is necessary to achieve optimal conservative LC. High rates of metastasis and lymphatic spread require innovative systemic treatments.

Conservative en bloc surgery for aggressive angiomyxoma achieves good local control: analysis of 14 patients from a single institution.

BACKGROUND: The purpose of this study was to assess the value of conservative surgery in aggressive angiomyxoma (AA) in our institutional series. METHOD: This was a retrospective review of patients with AA treated at our institution between 1999 and 2010. RESULTS: Fourteen consecutive patients were analyzed: 8 primary tumors and 6 recurrences. Female/male ratio was 13:1; median female age was 36 years. Median size of primary lesions was 12 cm (range, 7-17 cm). Median size of recurrences was 20.5 cm (range, 3-44 cm). Twelve patients were operated on. Two asymptomatic patients whose surgery would have been mutilating were placed under wait and see. Four patients had concomitant visceral resections because of massive infiltration. No tumor rupture was recorded on pathological examination. Margins were R0 (n = 2), R1 (n = 10), and R2 (n = 0). Seven patients (50%) received radiotherapy. Median postoperative follow-up was 69 months, and no patient was lost at follow-up. All patients operated on (primaries and recurrences) had no evidence of recurrence. CONCLUSION: Conservative and planned en bloc surgery achieves good local control with low morbidity. Radiotherapy could enhance local control in advanced disease. Wait and see is an exploratory option for asymptomatic, stable, and nonprogressing AA in which surgery would be mutilating.

A database of human gait performance on irregular and uneven surfaces collected by wearable sensors.

Gait analysis has traditionally relied on laborious and lab-based methods. Data from wearable sensors, such as Inertial Measurement Units (IMU), can be analyzed with machine learning to perform gait analysis in real-world environments. This database provides data from thirty participants (fifteen males and fifteen females, 23.5 ± 4.2 years, 169.3 ± 21.5 cm, 70.9 ± 13.9 kg) who wore six IMUs while walking on nine outdoor surfaces with self-selected speed (16.4 ± 4.2 seconds per trial). This is the first publicly available database focused on capturing gait patterns of typical real-world environments, such as grade (up-, down-, and cross-slopes), regularity (paved, uneven stone, grass), and stair negotiation (up and down). As such, the database contains data with only subtle differences between conditions, allowing for the development of robust analysis techniques capable of detecting small, but significant changes in gait mechanics. With analysis code provided, we anticipate that this database will provide a foundation for research that explores machine learning applications for mobile sensing and real-time recognition of subtle gait adaptations.

Tablet form factors and swipe gesture designs affect thumb biomechanics and performance during two-handed use.

Tablet computers' hardware and software designs may affect upper extremity muscle activity and postures. This study investigated the hypothesis that forearm muscle activity as well as wrist and thumb postures differ during simple gestures across different tablet form factors and touchscreen locations. Sixteen adult (8 female, 8 male) participants completed 320 tablet gestures across four swipe locations, with various tablet sizes (8″ and 10"), tablet orientations (portrait and landscape), swipe orientations (vertical and horizontal), and swipe directions (medial and radial). Three-dimensional motion analysis and surface electromyography measured wrist and thumb postures and forearm muscle activity, respectively. Postures and muscle activity varied significantly across the four swipe locations (p < .0001). Overall, swipe location closest to the palm allowed users to swipe with a more neutral thumb and wrist posture and required less forearm muscle activity. Greater thumb extension and abduction along with greater wrist extension and ulnar deviation was required to reach the target as the target moved farther from the palm. Extensor Carpi Radialis, Extensor Carpi Ulnaris, Flexor Carpi Ulnaris, Extensor Policis Brevis, and Abductor Pollicis Longus muscle activity also increased significantly with greater thumb reach (p < 001). Larger tablet size induced greater Extensor Carpi Radialis, Extensor Carpi Ulnaris, Flexor Carpi Ulnaris, Flexor Carpi Radialis, and Abductor Pollicis Longus muscle activity (p < .0001). The study results demonstrate the importance of swipe locations and suggest that the tablet interface design can be improved to induce more neutral thumb and wrist posture along with lower forearm muscle load.