Achieving flying colours in surgical safety: audit of World Health Organization 'Surgical Safety Checklist' compliance.

OBJECTIVE: The World Health Organization 'Surgical Safety Checklist' has been adopted by UK surgical units following National Patient Safety Agency guidance. Our aim was to assess compliance with our local version of this Checklist. METHODS: Otolaryngology trainee doctors prospectively assessed compliance with the local Checklist over a six-week period. A staff educational intervention was implemented and the audit was repeated 12 months later. RESULTS: A total of 72 cases were assessed. The initial audit found that: 44 per cent of procedures were undocumented at 'Sign in'; 'Time out' was inappropriately interrupted in 39 per cent of cases; the procedure started before Checklist completion in 33 per cent of cases; and the 'Sign out' was not read out in 94 per cent of cases and was not fully documented in 42 per cent of cases. Following education, re-audit indicated that overall compliance had improved from 63.7 per cent (± 8.9 per cent standard error of the mean) to 90.4 per cent (± 2.7 per cent standard error of the mean). CONCLUSION: Our completed audit cycle demonstrated a significant improvement in Checklist compliance following educational intervention. We discuss barriers to compliance, as well as strategies for quality improvement, and we call for other surgeons to similarly publish their Checklist experience and assess its impact on surgical outcomes.

A retropharyngeal multinodular goitre.

Thyroid goitre usually presents as a mid-line lump in the neck with or without compressive symptoms. More commonly, the goitre can extend inferiorly into the mediastinum resulting in a retrosternal goitre. We present an unusual case of goiterous enlargement of the thyroid gland into the retropharyngeal space presenting as a retropharyngeal mass.

Specialist Registrars in Otolaryngology: their training programme and career aspirations.

The Calman reforms were introduced to Otorhinolaryngology in July 1996 and we are half-way through its first cycle. Further changes may become necessary with expansion of our specialty and because of the need to incorporate super-specialization into current training programmes. We felt that it was an appropriate to evaluate these reforms through the eyes of the Specialist Registrars and at the same time to take the opportunity to investigate their career aspirations. In August 1999 a postal questionnaire was sent to all 184 Specialist Registrars in otorhinolaryngology in England and Wales, of which 123 (66.85%) responded. The results are presented in this paper.

Temporocele: CT findings and management.

The temporocele, a rare case of extra-mastoid pneumatization is discussed. It presented as a swelling over the mastoid in a 16-year-old female and the diagnosis was made by computed tomography (CT) scan. It was treated by obliteration by covering the sieve-like mastoid with bone dust and a large piece of temporalis fascia as well as ventilating the middle ear.

A clinic for the rapid processing of patients with neck masses.

Neck masses are common and may have serious underlying pathology. There is much anxiety and confusion in primary care as to which hospital department will provide the patient with the best service and the swiftest diagnosis. A clinic was set up at Wexham Park hospital to enable patients with neck masses to be seen early, and to undergo a one-stop specialist evaluation, ultrasound scan and fine needle aspiration biopsy. The clinic has yielded a wide variety of benign and malignant pathology. The first 100 patients are discussed and evaluated.

An assessment clinic for routine paediatric otolaryngological surgery.

In the current climate of medical practice clinicians are under constant pressure to come up with new ways of increasing efficiency and throughput whilst maintaining a high standard of patient care. Assessment clinics are not a new idea and are widely practised in the National Health Service. The novel feature of the clinic we are describing is that all relevant professionals are present: consultant otolaryngologist, audiologist, paediatric nurse, playleader and preassessment nurse. The Wexham Park Paediatric Otolaryngology Preassessment Clinic has now been running for six years, and in this time we have experienced a marked decrease in both the waiting times for surgery and the non-attendance rate.

Giant cell reparative granuloma of the cricoid cartilage.

Giant cell reparative granuloma (GCRG) is an uncommon benign lesion which has been reported at several sites in the head and neck. We present a case of a GCRG of the cricoid cartilage not previously described in the literature. It must be differentiated from the brown tumour of hyperparathyroidism and true giant cell tumours of bone. These were excluded on clinical, biochemical, radiological and histological grounds. The lesion responded well to surgical debulking and curettage and the patient remained disease-free 15 months after treatment.

Sensorineural hearing loss caused by metastatic prostatic carcinoma: a case report.

Metastases to the temporal bone are a recognized, if rare, cause of otological symptoms including sudden sensorineural hearing loss. Carcinoma of the prostate is a common cancer which frequently metastasizes to bone but is only rarely reported in the temporal bone. We report a case of sudden sensorineural hearing loss due to metastatic prostatic carcinoma in the temporal bone.

Primary radiotherapy for treating all laryngeal cancer: a district hospital experience.

We report our experience of long-term follow-up of all patients treated during a ten-year period with primary radiotherapy irrespective of the disease stage of their laryngeal carcinoma. This policy was adopted in order to allow all patients the opportunity to save their larynx and to preserve their voice. In the present literature, surgery is favoured for treating advanced disease.

Muscle damage and recovery in the rabbit tongue following photodynamic therapy with haematoporphyrin derivative.

To study the effects of photodynamic therapy on the tissues of the tongue, 20 New Zealand White rabbits were injected intravenously with haematoporphyrin derivative. Their tongues and those of 2 controls were illuminated with 100 J/cm2 of red light from a copper vapour-pumped dye laser emitting light at 625 nm. The rabbits were sacrificed at intervals between 2 days and 12 weeks following treatment. Their tongues were examined histologically. Initially there was marked damage to mucosa, muscle and blood vessels. However, this healed by a mixture of regeneration and scarring.

Decision making in advanced cancer of the head and neck: variation in the views of medical specialists.

Forty specialists were asked about their management of three theoretical patients with advanced cancer of the head and neck. Reasons for variation were explored by considering the influence of perceived aims of treatment (radical or palliative), together with a number of factors relating to the tumour, the lymph nodes, and the patients' personal circumstances. The perceived aim of treatment was the most important determinant as to treatment modality but, when chances of influencing survival were small, there was disagreement as to the appropriate aim and subjective value judgements became influential. More careful analysis of the initial decision-making process is needed if new clinical trials are to significantly affect clinical practices.

The rabbit VX2 tumour as a model for carcinomas of the tongue and larynx.

Animal models of carcinomas can provide useful information for the evaluation of new treatments. In the rabbit, the VX2 tumour is a fast growing, transplantable squamous cell carcinoma. By implanting a cell suspension of the tumour into the tongue and/or the larynx, a useful new model for studying or treating tumours in this region has been developed. The tumours were evaluated histologically and showed features consistent with human carcinomas, including surface ulceration, lymphatic spread and encroachment of the airway. The VX2 tumours in these sites have features which offer advantages over existing models. These include the ability to study several sites of tumour growth in the same animal, to follow rapidly growing tumours, storage of the tumour in liquid nitrogen allowing experiments to be started when convenient, and the large size of the rabbit larynx which permits considerable tumour growth before airway embarrassment.

Squamous cell carcinoma and liposarcoma of the larynx occurring metachronously.

A case of liposarcoma arising in a larynx previously irradiated for carcinoma is reported. Treatment was by wide local excision. The previous radiotherapy was probably incidental in this case.

Pseudotumoral mycobacterial infection in the head and neck: a clinical study.

The clinical aspects of mycobacterial infection of the head and neck are considered as presenting in patients at a cancer hospital over the last 15 years. Some difficulties in diagnosis with respect to the evolution of tuberculosis in this region are discussed. A total of 32 patients with evidence of infection were identified. Twenty-six of these with cervical lymphadenopathy are considered as a group; their clinical features and diagnosis are summarized and a note made of the recent change in the macroscopic quality of the nodes removed. Six cases are given particular attention: two with laryngeal tuberculosis, two with nasal or adenoidal infection and two with atypical mycobacterial infection diagnosed on clinical grounds.

Quinsy following tonsillectomy (five case reports).

Five cases of post-tonsillectomy quinsy are presented, usually associated with tonsillar remnants. Four of these had no pus and one did, but the clinical picture was the same. Hence, if tonsillectomy is performed to prevent further quinsies, it must be careful and complete.