Wrong Site Research Articles

Priority areas for mixed-species mangrove restoration: the suitable species in the right sites

The rapid mangrove loss and fragmentation observed in the past decades have catalyzed numerous efforts to restore mangroves globally, but nearly half of these efforts fail or underperform. Planting the wrong mangrove species on the wrong site, and overrelying on mangrove monocultures are the main mistakes. Here, we develop a methodological approach that combines a Geographic Information System-based suitability analysis and landscape connectivity analysis to identify suitable areas for species-specific and mixed-species mangrove restoration, and priority areas in terms of patch importance. We apply this approach to the Large Xiamen Bay in southeast China. Results from the case study emphasize the critical need of considering species-specific characteristics in mangrove restoration planning and the spatial heterogeneity of priority areas for mixed-species restoration. We find that mangrove restoration could indeed increase landscape connectivity of mangrove habitats. Larger patches would have more significant effects on habitat connectivity, and several small patches could be considered as stepping stones to promote landscape-level connectivity. The proposed approach has various implications for mangrove restoration efforts both at the study site and in other parts of the world.

Eliminating predictable DNA off-target effects of cytosine base editor by using dual guiders including sgRNA and TALE

Predictable DNA off-target effect is one of the major safety concerns for the application of cytosine base editors (CBEs). To eliminate Cas9-dependent DNA off-target effects, we designed a novel effective CBE system with dual guiders by combining CRISPR with transcription activator-like effector (TALE). In this system, Cas9 nickase (nCas9) and cytosine deaminase are guided to the same target site to conduct base editing by single-guide RNA (sgRNA) and TALE, respectively. However, if nCas9 is guided to a wrong site by sgRNA, it will not generate base editing due to the absence of deaminase. Similarly, when deaminase is guided to a wrong site by TALE, base editing will not occur due to the absence of single-stranded DNA. In this way, Cas9- and TALE-dependent DNA off-target effects could be completely eliminated. Furthermore, by fusing TALE with YE1, a cytidine deaminase with minimal Cas9-independent off-target effect, we established a novel CBE that could induce efficient C-to-T conversion without detectable Cas9- or TALE-dependent DNA off-target mutations.

Radiography as a sociotechnical system – Improving patient identification with a multi-level human factors approach

Irradiation of the wrong patient or wrong site is a reportable adverse event for hospitals. Improvement efforts to date have been narrowly targeted, often without consideration of wider contextual factors. This study applied a systems human factors/ergonomics (HFE) approach in an NHS trust to develop interventions across micro, unit and organisation levels.At the micro level, the workspace was adapted to reduce distractions during safety critical work. At the unit level a standard operating procedure for patient identification was designed with staff alongside the introduction of wristband barcode scanners. At the organisation level safety workshops were run for staff in the radiology directorate. These introduced a systems approach to managing risk, encouraged near miss reporting and employed scenario-based exercises to raise discussion of risk-efficiency trade-offs.Following implementation interruptions in the control rooms decreased by 34% (from a mean of 4.91/10 min). Interrupted time series analysis showed that the interventions were associated with a decrease in patient identification incidents (rate ratio = 0.37), and an increase in near miss reporting (rate ratio = 2.5), representing an additional 4.7 reports/month. The workshops raised a wide range of system components that influenced the imaging task and provided examples of situated and structural resilience attributes. The safe provision of imaging across different modalities and physical locations is a challenge for many radiology departments; this study indicates that a multi-level systems approach can reduce risk.

First Report of Testicular Replantation Following Wrong-Site Surgery

Testicular replantation represents a unique circumstance. There are very few reports documenting their experience with testicle replantation and to the best of the authors’ knowledge, this is the first case that has been reported in the peer-reviewed literature following a wrong site surgery. Therefore, we detail our technique and outcome when faced with such a rare event. In addition we review the literature, in order to compare and report the experience of others. This case highlights the value of applied microsurgical knowledge and the importance of cross-disciplinary efforts to improve patient outcomes.

Trends and Contributing Factors in Medicolegal Cases Involving Spine Surgery.

Retrospective descriptive study. The aim of this study was to describe closed medicolegal cases involving physicians and spine surgery in Canada from a trend and patient safety perspective. Spine surgery is a source of medicolegal complaints against surgeons partly owing to the potential severity of associated complications. In previous medicolegal studies, researchers applied a medicolegal lens to their analyses without applying a quality improvement or patient safety lens. The study comprised a 15-year medicolegal trend analysis and a 5-year contributing factors analysis of cases (civil legal and regulatory authority matters) from the Canadian Medical Protective Association (CMPA), representing an estimated 95% of physicians in Canada. Included cases were closed by the CMPA between 2004 and 2018 (trends) or 2014 and 2018 (contributing factors). We fit a linear trend line to the annual rates of spine surgery cases per 1000 physician-years of CMPA membership for physicians in a neurosurgery or orthopedic surgery specialty. We then applied an ANOVA type III sum of squares test to determine the statistical significance of the annualized change rate over time. For the contributing factors analysis, we reported descriptive statistics for patient and physician characteristics, patient harm, and peer expert criticisms in each case. Our trend analysis included 340 cases. Case rates decreased significantly at an annualized change rate of -4.7% (P = 0.0017). Our contributing factors analysis included 81 civil legal and 19 regulatory authority cases. Most patients experienced health care-related harm (89/100, 89.0%). Peer experts identified intraoperative injuries (29/89, 32.6%), diagnostic errors (14/89, 15.7%), and wrong site surgeries (16/89, 18.0%) as the top patient safety indicators. The top factor contributing to medicolegal risk was physician clinical decision-making. Although case rates decreased, patient harm was attributable to health care in the majority of recently closed cases. Therefore, crucial opportunities remain to enhance patient safety in spine surgery.Level of Evidence: 4.

Dorsogluteal intramuscular injection depth needed to reach muscle tissue according to body mass index and gender: A systematic review.

The objective of this systematic review was to determine the needle length required to reach the dorsogluteal muscle based on body mass index and sex. Our aim was to provide evidence-based recommendations to current intramuscular injection guidelines from the result(s) of this review. Studies worldwide are documenting reduced medication effectiveness due to improperly placed dorsogluteal intramuscular injections because of incorrect needle length, wrong site selection and/or obesity. Current intramuscular injection guidelines lack specific instructions according to weight or sex. While there are similar concerns with other injectable sites, this review focuses solely on adult dorsogluteal intramuscular injections. A systematic review of relevant literature of dorsogluteal intramuscular injections based on body mass index and sex. This systematic review was reported using the PRISMA checklist 2020. The review protocol was registered with Center for Open Science (OSF). We analysed 1,412 articles from nine databases. We compared twelve studies that utilised computerised tomography or ultrasonography using The Johns Hopkins Evidence-Based Practice Model and Guidelines. A significant number of dorsogluteal intramuscular injections are administered into subcutaneous tissue rather than muscle because needles are too short for populations with body mass indexes over 25, especially women. Poor landmarking often results in improperly placed injections. To prevent administering a dorsogluteal intramuscular injection into subcutaneous tissue, women with a BMI of 25 and over require needles longer than 38mm (1.5 inches). Men have less subcutaneous tissue in the dorsogluteal area and only require longer needles if BMI is 35 and over. If skin-to-muscle depth is questionable in either sex, an ultrasound-guided intramuscular injection is warranted for accurate dorsogluteal placement. Landmarking and needle length are key to appropriately placed IM injections. Dorsogluteal injections are often injected into subcutaneous tissue rather than muscle because needles are not long enough to reach muscle, especially in women. Critical elements that determine placement of intramuscular injections into muscle versus subcutaneous tissue are sex, BMI, needle length and landmarking. Medications delivered into subcutaneous tissue may have reduced bioavailability.

The RNA-editing race intensifies

For small biotech companies hoping to strike a deal with larger drug developers, there’s no greater destination than the J.P. Morgan Healthcare Conference . In early January 2020, leaders from the start-up Shape Therapeutics made the annual pilgrimage to this mecca of biotechnology networking in San Francisco to make a pitch: What if you could edit someone’s genetic code without ever touching their DNA? The biotech industry is awash in companies using tools like CRISPR gene editing to fix or turn off problematic DNA. If gene editing works, it could provide a one-and-done cure. But some researchers are worried that if CRISPR slips up and cuts DNA at the wrong site , the damage could also be permanent. “Targeting DNA has a lot of all-or-nothing consequences,” says David Huss, head of research at Shape. At the conference, Huss explained to potential partners that Shape’s solution was to edit RNA instead

Prospects for n-type conductivity in cubic boron nitride

Cubic boron nitride is an ultrawide-bandgap semiconductor with potential applications in high-power electronics, ultraviolet optoelectronics, and quantum information science. Many of those applications are predicated on the ability to control doping. Using hybrid-functional first-principles calculations, we systematically explore potential donors including group-IV (C, Si, and Ge) and group-VI (O, S, and Se) elements, as well as Li and F. We also address the role of compensation either by substitution on the wrong site or due to native point defects. We identify SiB and ON as promising dopants, as they have the lowest formation energies and do not suffer from self-compensation. However, compensation by boron vacancies, which act as deep acceptors, poses a challenge. We discuss strategies to mitigate these effects.

Wrong site tooth extraction: no longer a never event

Wrong site tooth extraction was removed from NHS England’s list of ‘never events’ in February 2021 as the systemic barriers put in place to prevent these events were not considered strong enough. This opinion article discusses the risk factors leading to wrong site tooth extractions, including the effects of human factors, the implications for dental professionals and the different methods dental professionals can implement to minimise risk.

Faulty external fixation

External fixation a common method for treatment of open fractures with different degrees caused by many mechanisms. It is very vital in case of stabilization of fractures of poly-traumatized patients. Perfection in the fixation and good stability of the fixator will affect the outcome of treatment and induce early fracture healing. Faulty external fixation is a common problem in our locality. The aim of our study is to discover and categorize the faulty fixation and try to know the reasons behind these faults and what is best way to overcome it. We randomly studied (212) external fixators, 168 (79%) patients and 44 (21%) x-rays. These (168) patients were, 163 (97%) males and 5 (3%) females aged from (5-56) years and have been treated in many hospitals during the period from the 5th of October 2014 till the 10th of November 2015. (85%) of the patients that were treated by external fixation were due to military and mass casualties' injuries. (1145) pins distributed on (212) fixators were studied. X-rays of the fracture and the external fixation site have been taken and carefully examined. We found that 350 pins (35%) were over penetrated to the far cortex, 112 pins (9.7%) in the fracture, 45 pins (3.9%) just anchored in near cortex, 16 (1.3%) broken pins and 9 pins (0.7%) in the joint. Regarding the faults of the fixator as whole, we found that 33 fixators (15.6%) with pins far away from the fracture line, 88 fixators (41.5%) with pins not ideally separated on each segment of the fracture, 15 fixators (7.1%) with insufficient number of pins, 4 fixators (1.9%) with wrong decision for fixation, 7 fixators (3.3%) with wrong site for pin insertion. We discovered that 131 fixators (61.8%) were applied without accepted anatomical reduction to the fractured bone. As a final result of the (212) fixators we studied, there were (199) faulty external fixators which accounted for (94%). We concluded that the faulty external fixation in our locality is much more than what we expect. Lack of full awareness about the AO principles of external fixation is the main reason beyond this high rate of faulty fixation.

A multistep approach to preventing wrong site surgery in skin lesion excision.

A multistep approach to preventing wrong site surgery in skin lesion excision.

Understanding the role of social media in caring for patients with gynecologic cancers

Understanding the role of social media in caring for patients with gynecologic cancers

Adverse Vaccination Reactions in Animals and Man

It was only possible because of vaccination that we were able to create a safe environment for us and animals/ pets. If it was not for rabies vaccination, we never would have kept dogs and cats as our companion animals as we do now, and we never would have been able to protect our domestic animals from diseases that not only reduce the productivity but may even be deadly. But the vaccines comes with their own adverse effects such as hypersensitivity reactions which occur due to some component of the infectious agent or one of its products; due to stabilizers like gelatin; due to adjuvants like aluminium hydroxide; due to preservatives like thiomersal; due to antibiotics like neomycin; and due to a biological culture medium like chicken embryo cells. Other adverse effects include autoimmune disorders like immune mediated hemolytic anemia, thrombocytopenia and neoplastic diseases like fibrosarcomas. Lack of efficacy, interference with diagnostic testing and other occasional suspected product-related issues have also been reported as adverse vaccination reactions. An absence of adverse reaction indicates that the immune system has not been stimulated but due to variability in the vaccines immune system, environmental conditions and the nature of the vaccine, sometimes there may be excessive stimulation of immune system thus causing serious reactions. The common reasons for occurrence of vaccine reactions are contamination of vaccines with extraneous chemical agents, failure to inactivate the vaccine organism in a killed vaccine, adverse vaccine reactions due to vaccine-induced immune suppression, adverse vaccine reactions due to excessive induction of cytokine release. Also other adverse reactions are due to human errors like administration at the wrong site or improper dilution of the vaccines, or improper storage or transportation of vaccines and thus can be minimized. Also some vaccine reactions occur due to simultaneous administration of different vaccines so is preventable. Due to a marked degree of underreporting and a bias toward more severe adverse reactions, proper data for the vaccine reactions is not available from field conditions, also due to limited number of animals used during vaccine trials, there is no accurate data even in controlled settings as to how much adverse reactions can be expected while administering a vaccine. To solve this problem post marketing surveillance for all the vaccines should be done which should involve four interrelated components, namely, data collection, analysis, interpretation, and timely dissemination. To tackle this problem of adverse vaccination reaction we can also go for double blind placebo trails as are done for drug testing in which comparison is done between vaccinated and unvaccinated group and not just one vaccinated group with other vaccinated group.

A perspective on wrong level, wrong side, and wrong site spine surgery.

Background: Four of the most common “errors” in spine surgery include: operating on the wrong patient, doing the wrong procedure, performing wrong-level surgery (WLS), and/or performing wrong-sided surgery (WSS). Although preoperative verification protocols (i.e. Universal Protocol, routine Time-Outs, and using the 3 R’s (i.e. right patient, right procedure, right level/side)) have largely limited the first two “errors,” WLS and WSS still occur with an unacceptably high frequency.Methods: In 20 studies, we identified the predominant factors contributing to WLS/WSS; unusual/anatomical anomalies/variants (i.e. sacralized lumbar vertebrae. lumbarized sacral vertebra, Klippel-Feil vertebrae, block vertebrae, butterfly vertebrae, obesity/morbid obesity), inadequate/poor interpretation of X-rays/fluoroscopic intraoperative images, and failure to follow different verification protocols.Results: “Human error” was another major risk factor contributing to the failure to operate at the correct level/side (WLS/WSS). Factors comprising “human error” included; surgeon/staff fatigue, rushing, emergency circumstances, lack of communication, hierarchical behavior in the operating room, and failure to “speak up”.Conclusion: Utilizing the Universal Protocol, routine Time Outs, and the 3 R’s largelly avoid operating on the wrong spine patient, and performing the wrong procedure. However, these guidelines have not yet sufficiently reduced the frequently of WLS and WSS. Greater recognition of the potential pitfalls contributing to WLS/WSS as reviewed in this perspective should better equip spine surgeons to avert/limit such “errors” in the future.

Analysis and outcomes of wrong site thyroid surgery

BackgroundIn thyroid surgery, wrong-site surgery (WSS) is considered a rare event and seldom reported in the literature.Case presentation This report presents 5 WSS cases following thyroid surgery in a 20-year period. We stratified the subtypes of WSS in wrong target, wrong side, wrong procedure and wrong patient. Only planned and elective thyroid surgeries present WSS cases. The interventions were performed in low-volume hospitals, and subsequently, the patients were referred to our centres. Four cases of wrong-target procedures (thymectomies [n = 3] and lymph node excision [n = 1] performed instead of thyroidectomies) and one case of wrong-side procedure were observed in this study. Two wrong target cases resulting additionally in wrong procedure were noted. Wrong patient cases were not detected in the review. Patients experienced benign, malignant, or suspicious pathology and underwent traditional surgery (no endoscopic or robotic surgery). 40% of WSS led to legal action against the surgeon or a monetary settlement.ConclusionWSS is also observed in thyroid surgery. Considering that reports regarding the serious complications of WSS are not yet available, these complications should be discussed with the surgical community. Etiologic causes, outcomes, preventive strategies of WSS and expert opinion are presented.

Neurosurgical Wrong Surgical Site in Lower-Middle- or Low-Income Countries (LMICs): A Survey Study

One of the most preventable errors of a surgeon's career is operating on the incorrect surgical site (ICSS). No study in any specialty has ever investigated the incidence of ICSS events in lower-income countries. This study focuses on identifying the occurrence of these events along with an analysis of potential causes leading to these unfortunate events. The authors distributed a survey to neurosurgical colleagues from around the world. These surgeons were first asked to identify details about their practice and incidence and personal experience with ICSS in their own careers. At the end of the survey, they responded to questions about their knowledge of safety checklists. In this study there was a 63.4% response rate. When combined with those who participated through various social media platforms, there were 178 responses. The incidence rate for every 10,000 cases performed was found to be 22.8 in the cranial group, 88.6 in the cervical group, and 158.8 in the lumbar procedural group. This study identified that 40% of participants had never learned or experienced the ABCD time-out strategy and that 60% of surgeons did not use intraoperative navigation or imaging in their practices. The error has never been disclosed to the patient in 48% of the ICSS cases. Due to a lack of application of safety checklist protocol, there is an increased occurrence of ICSS events in lower-income countries. The results of this study demonstrate the necessity of investing time and resources dedicated to avoiding preventable errors.

Photographic Confirmation of Biopsy Sites Saves Lives.

Quality photographic documentation of lesions prior to biopsy can decrease the risk of wrong site surgery, improve patient care, and save lives.

Rates of Serious Surgical Errors in California and Plans to Prevent Recurrence

Despite widespread recognition and known harms, serious surgical errors, known as surgical never events, endure. The California Department of Public Health (CDPH) has developed an oversight system to capture never events and a platform for process improvement that has not yet been critically appraised. To examine surgical never events occurring in hospitals in California and summarize recommendations to prevent future events. This cross-sectional study identified 386 CDPH hospital administrative penalty reports, of which 142 were ascribable to never events occurring during surgery. These never events were identified and summarized from January 1, 2007, to December 31, 2017. A directed qualitative approach was used to analyze CDPH-mandated corrective steps to reduce future errors in this multicenter study of all accredited hospitals in California. Inclusion of surgical never event records was based on definitions established by the US Department of Health and Human Services National Quality Forum. Data analysis was performed from January 1, 2019, to November 30, 2020. Never events include death or disability of an American Society of Anesthesiologists class I patient, wrong site or wrong surgery, retained foreign objects, burns, equipment failure leading to intraoperative injury, nonapproved experimental procedures, insufficient surgeon presence or privileges, or fall from the operating room table. Incident rates, consequences, and improvement plans to prevent additional never events were outcomes of interest. A total of 142 never events were reported to the CDPH (1 per 200 000 operations). Annual surgical volume for hospitals with events was 9203 vs 3251 cases for hospitals without events (P < .001). A total of 94 of 142 events (66.2%) were retained foreign objects ranging from Kocher clamps to drain sponges. Wrong site or patient surgery accounted for 22 events (15.5%), surgical burns for 11 (7.7%), and other for 15 (10.6%). Other included insufficient surgeon presence, equipment failure, or falls in the operating room. Improvement plans included 18 unique categories of recommendations from regulators, many focusing on proper use of checklists. Regulators mandated a mean (SD) of 13 (7) corrective actions in the improvement plans. Policy adherence monitoring (119 [90.2%]), revision of existing policy (84 [63.6%]), and education regarding policy (83 [62.9%]) were common action items, whereas disciplinary action toward staff was rare (11 [8.3%]). Surgical never events are a rare issue in California. Numerous strategies have evolved to reduce errors, many involving the thorough and proper use of intraoperative checklists.

Revisiting Understanding of Electrochemical CO2 Reduction on Cu(111): Competing Proton-Coupled Electron Transfer Reaction Mechanisms Revealed by Embedded Correlated Wavefunction Theory.

Copper (Cu) electrodes, as the most efficacious of CO2 reduction reaction (CO2RR) electrocatalysts, serve as prototypes for determining and validating reaction mechanisms associated with electrochemical CO2 reduction to hydrocarbons. As in situ electrochemical mechanism determination by experiments is still out of reach, such mechanistic analysis typically is conducted using density functional theory (DFT). The semilocal exchange-correlation (XC) approximations most often used to model such catalysis unfortunately engender a basic error: predicting the wrong adsorption site for CO (a key CO2RR intermediate) on the most ubiquitous facet of Cu, namely, Cu(111). This longstanding inconsistency casts lingering doubt on previous DFT predictions of the attendant CO2RR kinetics. Here, we apply embedded correlated wavefunction (ECW) theory, which corrects XC functional error, to study the CO2RR on Cu(111) via both surface hydride (*H) transfer and proton-coupled electron transfer (PCET). We predict that adsorbed CO (*CO) reduces almost equally to two intermediates, namely, hydroxymethylidyne (*COH) and formyl (*CHO) at -0.9 V vs the RHE. In contrast, semilocal DFT approximations predict a strong preference for *COH. With increasing applied potential, the dominance of *COH (formed via potential-independent surface *H transfer) diminishes, switching to the competitive formation of both *CHO and *COH (both formed via potential-dependent PCET). Our results also demonstrate the importance of including explicitly modeled solvent molecules in predicting electron-transfer barriers and reveal the pitfalls of overreliance on simple surface *H transfer models of reduction reactions.

Timeout procedure in paediatric surgery: effective tool or lip service? A randomised prospective observational study

BackgroundFor over a decade, the preoperative timeout procedure has been implemented in most paediatric surgery units. However, the impact of this intervention has not been systematically studied. This study evaluates...