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Abstract
BACKGROUND After their attempts to have patient safety concerns addressed internally were ignored by wilfully blind managers, nurses from Bundaberg Base Hospital and Macarthur Health Service felt compelled to 'blow the whistle'. Wilful blindness is the human desire to prefer ignorance to knowledge; the responsibility to be informed is shirked. OBJECTIVE To provide an account of instances of wilful blindness identified in two high-profile cases of nurse whistleblowing in Australia. RESEARCH DESIGN Critical case study methodology using Fay's Critical Social Theory to examine, analyse and interpret existing data generated by the Commissions of Inquiry held into Bundaberg Base Hospital and Macarthur Health Service patient safety breaches. All data was publicly available and assessed according to the requirements of unobtrusive research methods and secondary data analysis. ETHICAL CONSIDERATIONS Data collection for the case studies relied entirely on publicly available documentary sources recounting and detailing past events. FINDINGS Data from both cases reveal managers demonstrating wilful blindness towards patient safety concerns. Concerns were unaddressed; nurses, instead, experienced retaliatory responses leading to a 'social crisis' in the organisation and to whistleblowing. CONCLUSION Managers tasked with clinical governance must be aware of mechanisms with the potential to blind them. The human tendency to favour positive news and avoid conflict is powerful. Understanding wilful blindness can assist managers' awareness of the competing emotions occurring in response to ethical challenges, such as whistleblowing.
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Grondell J, Holleran C, Mintz E, Wiesel O. Postoperative Bedside Critical Care of Thoracic Surgery Patients. Am J Crit Care 2018; 27:328-333. [PMID: 29961669 DOI: 10.4037/ajcc2018107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- Jennifer Grondell
- Jennifer Grondell is nurse in charge and Charlotte Holleran is a staff nurse in the thoracic surgical intensive care unit, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts. Esther Mintz is a nurse practitioner and first assistant and Ory Wiesel is a thoracic surgeon, Division of Thoracic Surgery, Maimonides Medical Center, Brooklyn, New York
| | - Charlotte Holleran
- Jennifer Grondell is nurse in charge and Charlotte Holleran is a staff nurse in the thoracic surgical intensive care unit, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts. Esther Mintz is a nurse practitioner and first assistant and Ory Wiesel is a thoracic surgeon, Division of Thoracic Surgery, Maimonides Medical Center, Brooklyn, New York
| | - Esther Mintz
- Jennifer Grondell is nurse in charge and Charlotte Holleran is a staff nurse in the thoracic surgical intensive care unit, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts. Esther Mintz is a nurse practitioner and first assistant and Ory Wiesel is a thoracic surgeon, Division of Thoracic Surgery, Maimonides Medical Center, Brooklyn, New York
| | - Ory Wiesel
- Jennifer Grondell is nurse in charge and Charlotte Holleran is a staff nurse in the thoracic surgical intensive care unit, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts. Esther Mintz is a nurse practitioner and first assistant and Ory Wiesel is a thoracic surgeon, Division of Thoracic Surgery, Maimonides Medical Center, Brooklyn, New York
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Wang J, Zhang B, Meng J, Xiao G, Li X, Li G, Qin S, Du N, Zhang J, Zhang J, Xu C, Tang SC, Liang R, Ren H, Sun X. Analysis of risk factors for post-operative complications and prognostic predictors of disease recurrence following definitive treatment of patients with esophageal cancer from two medical centers in Northwest China. Exp Ther Med 2017; 14:2584-2594. [PMID: 28962198 PMCID: PMC5609247 DOI: 10.3892/etm.2017.4835] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 06/02/2017] [Indexed: 02/06/2023] Open
Abstract
Evaluating the clinicopathological features of patients receiving definitive treatment for esophageal cancer may facilitate the identification of patterns and factors associated with post-operative complications, and enable the development of a surveillance strategy for surviving patients at a higher risk of disease recurrence. In the present study, clinical data from 579 patients with esophageal cancer that underwent radical resection of esophagus were collected. These patients were admitted to two medical centers in Northwest China, and information regarding the presence or absence of basic chronic diseases and post-operative results were retrospectively analyzed. The level of selected stem cell markers, including aldehyde dehydrogenase 1, CD133, integrin subunit α 6, integrin subunit β 4 and T-cell factor-4, were determined in esophageal cancer tissue samples in order to determine whether these markers may be useful predictors of disease prognosis and recurrence. Post-operative complications in patients receiving radical resection of the esophagus included respiratory system complications, cardiovascular abnormalities and esophageal anastomotic fistulae. Diabetes, basic respiratory disease and lower pre-surgical serum albumin levels were observed to be individual risk factors associated with post-operative complications, including respiratory system complications of acute respiratory failure and pulmonary infection, cardiovascular abnormalities of atrial fibrillation and arrhythmia, as well as the development of esophageal anastomotic fistulae. Diagnosis of esophageal cancer at later stage was significantly correlated with anastomotic fistula. Molecular detection of stem cell markers for prognosis prediction was achieved by immunohistochemical and immunofluorescence staining assays. The results demonstrated that the presence of stem-like cells in cancer tissues was associated with poor disease prognosis and a high recurrence ratio. In conclusion, the results of the current study suggested that post-operative complications were more likely to occur in patients with diabetes, basic respiratory disease or lower serum albumin levels prior to surgery. Therefore, sufficient intensive peri-operative care, rigorous operative risk assessments, and the selection of the patients with early or mid-stage esophageal cancer, may decrease the risk of post-surgical complications in patients receiving radical resection of the esophagus. In addition, a high ratio of esophageal cancer stem-like cells was associated with cancer recurrence. These results suggest that an intensive surveillance strategy should be implemented in order to facilitate early detection of disease recurrence and improve the clinical management of these patients post-surgery.
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Affiliation(s)
- Jichang Wang
- Department of Vascular and Endovascular Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China
| | - Boxiang Zhang
- Department of Thoracic Surgery and Oncology, The Second Department of Thoracic Surgery, Cancer Center, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China
| | - Jinying Meng
- Department of Surgery Oncology, The First People's Hospital of Xianyang, Xianyang, Shaanxi 712000, P.R. China
| | - Guodong Xiao
- Department of Thoracic Surgery and Oncology, The Second Department of Thoracic Surgery, Cancer Center, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China
| | - Xiang Li
- Department of Thoracic Surgery and Oncology, The Second Department of Thoracic Surgery, Cancer Center, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China
| | - Gang Li
- Department of Thoracic Surgery and Oncology, The Second Department of Thoracic Surgery, Cancer Center, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China
| | - Sida Qin
- Department of Thoracic Surgery and Oncology, The Second Department of Thoracic Surgery, Cancer Center, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China
| | - Ning Du
- Department of Thoracic Surgery and Oncology, The Second Department of Thoracic Surgery, Cancer Center, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China
| | - Jia Zhang
- Department of Thoracic Surgery and Oncology, The Second Department of Thoracic Surgery, Cancer Center, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China
| | - Jing Zhang
- Department of Thoracic Surgery and Oncology, The Second Department of Thoracic Surgery, Cancer Center, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China
| | - Chongwen Xu
- Department of Otorhinolaryngology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China
| | - Shou-Ching Tang
- Solid Tumor Clinical Trials, Georgia Cancer Center, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA.,Department of Cancer Biology, Cancer Institute and Hospial, Tianjin Medical University, Tianjin, Hebei 300060, P.R. China
| | - Rui Liang
- Department of Hepatobiliary Chest Surgery, Shaanxi Provincial Corps Hospital of Chinese People's Armed Police Force, Xi'an, Shaanxi 710066, P.R. China
| | - Hong Ren
- Department of Thoracic Surgery and Oncology, The Second Department of Thoracic Surgery, Cancer Center, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China
| | - Xin Sun
- Department of Thoracic Surgery and Oncology, The Second Department of Thoracic Surgery, Cancer Center, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China
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Ono H, Taguchi T, Kido Y, Fujino Y, Doki Y. The usefulness of bright light therapy for patients after oesophagectomy. Intensive Crit Care Nurs 2011; 27:158-66. [PMID: 21511473 DOI: 10.1016/j.iccn.2011.03.003] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2010] [Revised: 03/11/2011] [Accepted: 03/15/2011] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The prevention of delirium is an important issue in the field of perioperative nursing. The objective of this study was to verify the usefulness of acute-stage bright light exposure on patients following oesophagectomy. METHODS The participants were oesophagectomy patients that were removed from their ventilators the day after surgery. After extubation, we assigned the participants to either the exposure group or control group. At Day 2 after surgery, the exposure group underwent two hours of bright light exposure for four days. In both groups, we monitored physical activity and autonomic activity. In addition, we scored the participants on the NEECHAM Scale and evaluated their postoperative delirium and postoperative arrhythmia. RESULTS On the nights of Days 4 and 5, the amount of activity of the exposure group was significantly lower and The sympathetic nervous index was significantly lower on the night of Day 5. The level of arrhythmia was lower in the exposure group and we observed a significant difference on the night of Day 4 and the daytime of Day 5 after surgery. The occurrence rate of postoperative delirium tended to be lower in the exposure group, but there was no significant difference. None of the participants in the exposure group had NEECHAM Scale scores below the cut-off value from the night of Day 4 onwards. CONCLUSION We conclude that postoperative bright light exposure adjusted the sleep-wakefulness cycle and improved the bed rest of patients. It was also indicated that bright light therapy is useful for reducing postoperative delirium.
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Affiliation(s)
- Hiroshi Ono
- Osaka University Hospital, Yamadaoka, Suita-shi, Japan.
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Devenney-Cakir B, Tkacz J, Soto J, Gupta A. Complications of esophageal surgery: role of imaging in diagnosis and treatments. Curr Probl Diagn Radiol 2011; 40:15-28. [PMID: 21081209 DOI: 10.1067/j.cpradiol.2009.08.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Esophageal surgery is a common and integral component in the management of hiatal hernias, esophageal carcinoma, and esophageal perforation. Understanding the expected postsurgical imaging features of these common esophageal surgeries and postoperative complications is essential. Image-guided intervention can be used to aid the surgeon in the management of many post esophageal surgical complications. We discuss the imaging features of the postoperative esophagus and the use of imaging, including fluoroscopy and computed tomography, in the diagnosis of post esophageal surgical complications and treatment.
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Abstract
OBJECTIVES To review the incidence, risk factors, staging, and diagnosis of esophageal, gastroesophageal junction, and stomach cancers, as well as nursing challenges associated with managing patients with these tumors. DATA SOURCES Published research reports, epidemiologic data, published patient management guidelines, and institution-based clinical tools. CONCLUSION While survival is slowly increasing, morbidity and mortality associated with upper gastrointestinal (UGI) cancers remain high. Research is needed to identify therapeutic approaches that will effectively decrease tumor burden and minimize physical consequences associated with disease and treatment. IMPLICATIONS FOR NURSING PRACTICE Nurses need to be familiar with risk factors, disease course, and future therapies of UGI cancers to provide education relevant to preventive approaches, assist patients with treatment decision-making, and manage disease and treatment-induced sequela. Early identification and management of postoperative complications and nutritional issues can avoid life-threatening effects.
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McLean TR, Haller CC. Stapled diverticulectomy and myotomy for symptomatic Zenker's diverticulum. Am J Surg 2006; 192:e28-31. [PMID: 17071177 DOI: 10.1016/j.amjsurg.2006.08.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2006] [Revised: 08/01/2006] [Accepted: 08/01/2006] [Indexed: 11/26/2022]
Abstract
BACKGROUND Few surgeons have extensive experience with the operative management of Zenker's diverticulum (ZD). METHODS Retrospective review of stapled diverticulectomy and cricopharyngeal myotomy (SDM) for ZD. All procedures were performed by midlevel surgery residents supervised by single board-certified surgeon. A drain was not used, and patients were liberally advanced to a regular diet postoperatively. RESULTS Three patients with ZD underwent this procedure during a 6-year period. The mean age of the patients was 81 years, and all had multiple comorbidities. Time to discharge was less than 48 hours in 2 patients and 5 days in 1 patient who developed new atrial fibrillation. There were no deaths or clinical leaks. At a mean follow-up of 33 (range 6-62) months, 1 patient died of an unrelated cause, and the other 2 are free of esophageal-related symptoms. CONCLUSIONS SDM for ZD is a safe and effective operation that is easily taught to surgical residents.
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Affiliation(s)
- Thomas R McLean
- Department of Surgery, EKVAHCS, 4104 S Fourth Street Trafficway, Leavenworth, KS 66048, USA.
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