PubMed · 11191342
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J S Benson. Reducing medical errors through reporting, development and training.. https://pubmed.ncbi.nlm.nih.gov/11191342/
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PURPOSE: This study was conducted to evaluate the decrease in risk from misadministration of the new Leksell Gamma Knife Model C with Automatic Positioning System compared with previous models. METHODS AND MATERIALS: Elekta Instruments, A.B. of Stockholm has introduced a new computer-controlled Leksell Gamma Knife Model C which uses motor-driven trunnions to reposition the patient between isocenters (shots) without human intervention. Previous models required the operators to manually set coordinates from a printed list, permitting opportunities for coordinate transposition, incorrect helmet size, incorrect treatment times, missing shots, or repeated shots. RESULTS: A risk analysis was conducted between craniotomy involving hospital admission and outpatient Gamma Knife radiosurgery. A report of the Institute of Medicine of the National Academies dated November 29, 1999 estimated that medical errors kill between 44,000 and 98,000 people each year in the United States. Another report from the National Nosocomial Infections Surveillance System estimates that 2.1 million nosocomial infections occur annually in the United States in acute care hospitals alone, with 31 million total admissions. CONCLUSIONS: All medical procedures have attendant risks of morbidity and possibly mortality. Each patient should be counseled as to the risk of adverse effects as well as the likelihood of good results for alternative treatment strategies. This paper seeks to fill a gap in the existing medical literature, which has a paucity of data involving risk estimates for stereotactic radiosurgery.
Analytical instrumentation for Raman spectroscopy has advanced rapidly in recent years to the point where commercial field-portable instruments are available. Raman analysis with portable instrumentation is a new capability that can provide emergency response teams with on-site evaluation of hazardous materials. Before Raman analysis is accepted and implemented in the field, realistic studies applied to unknown samples need to be performed to define the reliability of this technique. Studies described herein provide a rigorous blind field test that utilizes two instruments and two operators to analyze a matrix that consists of 58 unknown samples. Samples were searched against a custom hazardous materials reference library (Hazardous Material Response Unit (HMRU) Spectral Library Database). Experimental design included a number of intentionally difficult situations including binary solvent mixtures and a variety of compounds that yield medium-quality spectra that were not contained in the HMRU library. Results showed that over 97% of the samples were correctly identified with no occurrences of false positive identifications (compounds that were not in the library were never identified as library constituents). Statistical analysis indicated equivalent performance for both the operators and instruments. These results indicate a high level of performance that should extrapolate to actual field situations. Implementation of Raman techniques to emergency field situations should proceed with a corresponding level of confidence.
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