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To learn if treatment of recurrent nonmelanoma skin cancer (NMSC) varied in different practice settings.
Prospective cohort study of consecutive patients with recurrent NMSC.
A university-based dermatology practice and the dermatology clinic at the affiliated Veterans Affairs Medical Center (VAMC). Conventional therapies for NMSC were available at both sites.
All 191 patients diagnosed as having recurrent NMSC in 1999 and 2000 were included in the study. Data were collected from medical record review and surveys mailed to patients.
Performance of Mohs micrographic surgery (Mohs).
Patients at the VAMC were older, less educated, poorer, and had more comorbid illnesses, but their tumors were similar to those of patients at the university-based practice. Treatment choices differed at the 2 sites: the proportions of tumors treated in the VAMC and university sites were 60% and 14%, respectively, for excisional surgery; and 24% and 61%, respectively, for Mohs (P < .001). In multivariate analyses adjusting for patient, tumor, and physician features that may have affected treatment choice, tumors treated at the university-based site remained significantly more likely to be treated with Mohs (odds ratio, 8.68 [95% confidence interval, 3.66-20.55]; P < .001).
Substantial variation existed in the treatment of recurrent NMSC in different practice settings. This variation was not explained by measured clinical characteristics of the patients or the tumors.
To determine whether and how pediatricians would disclose serious medical errors to parents.
St Louis, Missouri, and Seattle, Washington.
University-affiliated hospital and community pediatricians and pediatric residents.
Anonymous 11-item survey administered between July 1, 2003, and March 31, 2004, containing 1 of 2 scenarios (less or more apparent to the child's parent) in which the respondent had caused a serious medical error.
Physician's intention to disclose the error to a parent and what information the physician would disclose to the parent about the error.
The response rate was 56% (205/369). Overall, 53% of all respondents (109) reported that they would definitely disclose the error, and 58% (108) would offer full details about how the error occurred. Twenty-six percent of all respondents (53) would offer an explicit apology, and 50% (103) would discuss detailed plans for preventing future recurrences of the error. Twice as many pediatricians who received the apparent error scenario would disclose the error to a parent (73%  vs 33% ; P < .001), and significantly more would offer an explicit apology (33%  vs 20% ; P = .04) compared with the less apparent error scenario.
This study found marked variation in how pediatricians would disclose a serious medical error and revealed that they may be more willing to do so when the error is more apparent to the family. Further research on the impact of professional guidelines and innovative educational interventions is warranted to help improve the quality of error disclosure communication in pediatric settings.
To compare effectiveness and costs of gauze-based vs occlusive, moist-environment dressing principles.
Randomized clinical trial.
Academic Medical Center, Amsterdam, the Netherlands.
Two hundred eighty-five hospitalized surgical patients with open wounds.
Patients received occlusive (ie, foams, alginates, hydrogels, hydrocolloids, hydrofibers, or films) or gauze-based dressings until their wounds were completely healed.
Primary end points were complete wound healing, pain during dressing changes, and costs. Secondary end point was length of hospital stay.
Time to complete wound healing did not differ significantly between occlusive (median, 66 days; interquartile range [IQR], 29-133 days) and gauze-based dressing groups (median, 45 days; IQR, 26-106 days; log-rank P = .31). Postoperative wounds (62% of the wounds included) healed significantly (P = .02) quicker using gauze dressings (median, 45 days; IQR, 22-93 days vs median, 72 days; IQR, 36-132 days). Median pain scores were low and similar in the occlusive (0.90; IQR, 0.29-2.34) and the gauze (0.64; IQR, 0.22-1.95) groups (P = .32). Daily costs of occlusive materials were significantly higher (occlusive, 6.34 [US $9.95] vs gauze, 1.85 [US $2.90]; P < .001), but nursing time costs per day were significantly higher when gauze was used (occlusive, 1.28 [US $2.01] vs gauze, 2.41 [US $3.78]; P < .001). Total cost for local wound care per patient per day during hospitalization was 7.48 (US $11.74) in the occlusive group and 3.98 (US $6.25) in the gauze-based group (P = .002).
The occlusive, moist-environment dressing principle in the clinical surgical setting does not lead to quicker wound healing or less pain than gauze dressings. The lower costs of less frequent dressing changes do not balance the higher costs of occlusive materials.
To evaluate the postoperative results of patients treated with and without the use of stents at the time of initial surgical treatment of choanal atresia (CA). Surgical treatment of CA in the neonatal period is complicated by postoperative stenosis, often necessitating multiple revision surgical procedures.
Retrospective medical record review.
Tertiary care academic center.
The medical records of 9 patients treated for bilateral CA during the neonatal period were reviewed. All patients were treated with an endoscopic approach. Outcomes were compared for patients with and without stent use at the initial operation. Main Outcome Measures Medical records were analyzed for diagnostic modality, clinical symptoms, age at surgery, sex, surgical repair, placement of stents, reoccurrence of atresia, follow-up time, and postoperative outcomes.
The mean age at initial surgery was 8 days (range, 5-15 days). Four patients had endotracheal tube stents placed at the time of initial surgery for a duration of 4 to 6 weeks. All patients required at least 1 additional surgery (mean, 2.6 procedures), and 3 (75%) had restenosis during infancy. The mean follow-up time for this group was 7.5 months. Five patients did not have stents placed at the time of initial surgery. None of these patients required additional surgical procedures during infancy, and none developed restenosis. The follow-up time for this group was 2.5 months.
This study suggests that the placement of stents for bilateral CA repair during the neonatal period results in a high rate of restenosis as well as the need for multiple subsequent procedures during infancy. The use of an endoscopic approach without stent placement appears to result in superior healing without the need for revision surgery.
Abstracts: In Other Archives Journals. Arch Facial Plast Surg. 2009;11(4):274–275. doi:https://doi.org/
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