bluuebunny/crossref_metadata_2025 huggingface dataset:
Critical Care for the Surgical Patient
Authors: Aps Chris
Published: December 2017

Dr Chris Aps has been involved, since the early 1980s, with the impact of the surgical patient on critical care provision. At that time, he established clinical techniques to lower patient dependency after cardiac surgery. This allowed for the postoperative management of such patients in a general recovery facility rather than in the formal Intensive Care Unit (ICU). This became known as cardiac fast-tracking and led to the development of the Overnight Intensive Recovery (OIR) concept.
Becoming An Ilizarov Nurse
Authors: Pearson Anita
Published: December 2017

In May 2002, I attended the Ilizarov nurse and physiotherapist course at the Russian Ilizarov Scientific Centre for Restorative Traumatology and Orthopaedics in Kurgan, Russia. The course was set up in conjunction with Smith & Nephew. I was able to attend due to the generous support of the NATN Education Research Fellowship Fund (ERFF) and the Children's Appeal Nursing Scholarship Fund at Sheffield Children's Hospital.
Adventures in Perioperative Africa
Authors: Woodhead Kate
Published: December 2017

Over the past two years, two well known members of NATN have been making their own personal contribution to the dissemination of perioperative knowledge in less privileged parts of the world. In this article, Kate Woodhead, past chairman of NATN, describes the experiences of herself and Lesley Fudge, past secretary of the Association in Uganda and Zambia, and how their project will continue in 2003.
Recovery Nursing Services An Evolution
Authors: Radford Mark
Published: December 2017

This article examines and charts the development of recovery services in the context of the social and scientific matrix of historical development. Such a reflection is important to gain an understanding of our future challenges and the direction that the perianaesthesia profession may take.
Managing a National Pilot Site Project the Derby Theatre Project Experience
Authors: Ainsworth David
Published: December 2017

The National Theatre Project was set up in March 2001 by the Modernisation Agency to improve the patient and carer experience, improve employee satisfaction, optimise theatre utilisation and reduce cancelled operations. This is the first in a series of four articles, looking at issues involved in managing a national project, improving operating theatre performance and how to engage the organisation in innovation and change.
Student Nurse Theatre Placements the New Curriculum
Authors: Hughes Suzanne J
Published: December 2017

Following the implementation of the Fitness for Practice (FFP) nurse education curriculum, opportunities are available for student nurses to return to the operating theatre environment during their surgical module. This follows a ten-year absence in most parts of Wales. This article investigates what realistic placement objectives are available for student nurses in Wales and how close mentor supervision can enhance the learning process and promote the clinical experience of theatre nursing.
The First Assistant the Perspective from a District General Hospital
Authors: Bazeley Linda , Chambers Stuart
Published: December 2017

In September 2003 the Perioperative Care Collaborative published a position statement on the role of the first assistant which aimed to inform practitioners undertaking the role of the associated risks. In this article Linda Bazeley and Stuart Chambers explain how their Trust took a positive approach to highlighting these risks and taking steps to deal with the problem.
Advanced Practitioners within the Operating Theatre
Authors: Tanner Judith
Published: December 2017

While the role of the nurse within theatre is yet to be defined (NATN has set up a working party to define this), some theatre practitioners are being described as advanced practitioners and certain types of theatre practice are being labelled as advanced or extended. What constitutes advanced practice has implications for theatre practitioners, their professional development, their competency-based salaries and how they are viewed by other nurses outside their specialism.
All Things Being Equal …
Authors: Pirie Susan
Published: December 2017

As most of us are aware, Agenda for Change is the new terms and conditions package for all NHS staff. Although it is currently being trialled at designated early implementer (EI) sites in England and Scotland, the agreement has been accepted by the Health departments of all four home countries of the UK. It is to be introduced to all NHS staff in October 2004.
Management of a Cjd Case: Part 1 Preoperative Organisation of the Case
Authors: McNeil Beverley
Published: December 2017

Recent years have seen the rise of variant Creutzfeldt-Jacob Disease (vCJD), causing great concern amongst the public at large and healthcare professionals, and the implications of the disease are still to be properly determined. In this, the first of two articles, Beverley McNeil outlines the various risk categories of CJD patients, the planning of the case and the handling of associated instrumentation postoperatively. Next month's article will deal with the practicalities surrounding management of the case.
Bladder Spasm following Transurethral Surgery
Authors: Yates Vicki , Tanner Judith , Crossley Angus
Published: December 2017

This article describes a study carried out to determine the incidence of bladder spasm and any common factors among patients presenting with bladder spasm in the recovery unit following transurethral surgery. Data was collected retrospectively from 200 sets of patient notes. The findings suggest that bladder spasm is common following transurethral surgery and that certain surgical procedures are more likely to result in bladder spasm.
Dressings in the Management of Open Surgical Wounds
Authors: Pulman Kath , Johnson Melody
Published: December 2017

This article looks at wound dressings, comparing traditional ribbon gauze dressing with occlusive dressings, focusing on the use of calcium alginates. The author looks at the nursing responsibilities concerning the choice of wound products from a professional and ethical perspective. She makes important recommendations about how this knowledge can be integrated into nursing practice in the operating theatre.
The Hazards of Diathermy Plume Part 1 the Literature Search
Authors: Scott Eve , Beswick Alan , Wakefield Kathy
Published: December 2017

Laser and electrocautery devices used during surgery produce smoky emissions that may contain vapours and particulate aerosols, which can have a chemical and biological impact on those exposed. A group of theatre staff and specialist nurses at Rotherham District General Hospital got together to draw up a risk assessment into the possible occupational exposure of theatre staff, with a view to eliminating or controlling these hazards as far as possible.
Consent and Confusion who Decides?
Authors: Kavanagh Ruth
Published: December 2017

Current trends in the NHS promote patient rights including the right to accept or refuse surgery. Valid consent when the patient appears to have fluctuating competence can place theatre nurses in a difficult position. This article explores the legal framework in which the Department of Health consent forms work and looks at the NMC's Code of Professional Conduct for standards of practice.
Managing Modern Perioperative Education
Authors: Mehigan Sinead
Published: December 2017

This article focuses on the kinds of issues that practice educators in the perioperative setting may face. It looks specifically at current educational programmes for nurses, and has been written in light of key changes to the way such programmes are set up, as a result of recommendations and changes made to the nursing regulatory body.
An In-House Course for First Assistants (Advanced Scrub Practitioners) in Theatres
Authors: Turner Sarah , McLaughlan Sarah
Published: December 2017

It has become commonplace to see theatre practitioners undertaking the role of the first assistant to the surgeon in the absence of medical staff in the operating room (Martin 2004). At Kettering General Hospital we have devised, implemented and are in the process of evaluating a first assistant training package to facilitate a solution to the increasing problems arising from the challenges of the European Working Time Directive.
Eye Surgery on the Thai Burma Border
Authors: Bolster Mary
Published: December 2017

Civil war and ethnic conflict are two of the intractable problems facing the world today, and they are followed by refugees and displaced people almost as inevitably as night follows day. This article looks at what has been achieved by two British ophthalmologists working with the local people in just one of these situations.
New Ways of Working in Theatres: Three Session Working Days
Authors: Collins Gill
Published: December 2017

Innovative ideas will be required to meet government targets for the health service in the future. Increasing the number of hours available to surgical teams from two to three sessions could be one solution. Efficient and effective utilisation of a huge capital resource would appear to be further justification for increased hours, although the Audit Commission suggests that improving existing utilisation rather than extending hours should be the priority. However if operating sessions could be increased from two to three there is a potential to reduce waiting lists.
Safer Surgical Gloves: Evaluation and Implementation
Authors: Bowler Gill
Published: December 2017

In 2003 the Scottish Health Service Central Legal Office was consulted on the requirement to supply an alternative to natural rubber latex gloves for healthcare professionals within NHS Lothian University Hospitals Trust. Counsel stated that as latex is now accepted as being hazardous to health, employers must prove the statutory defence in Regulation 7(1) of the Control of Substances Hazardous to Health Regulations (HSE 2002). Counsel also stated that, as there are now adequate alternatives to latex gloves, NHS employers would have an indefensible position if no attempt was made to supply alternatives.
The Orbis Flying Eye Hospital
Authors: Munsell Megan , Frank Tine
Published: December 2017

In the mid 1970s, Dr David Paton, a Houston ophthalmologist, conceived the idea of an airborne ophthalmic teaching hospital. He wanted to share eye care skills and expertise with health personnel in developing countries. With the help of benefactors, the charity ORBIS was formed 24 years ago with the aim of eliminating avoidable blindness worldwide by taking medical and surgical skills, readily available in the Western world, to areas of greatest need.
Facilitating Benefit, Minimising Risk: Responsibilities of the Surgical Practitioner during Electrosurgery
Authors: Cunnington Jannice
Published: December 2017

This article will explore the role of the surgical practitioner in providing best care for the patient, by discussing electrosurgical intervention (ESI). It will exemplify the technological aspect of the role. Management of ESI equipment, and its inherent risks, will be shown to relate directly to the practitioner's role. Some safety claims for ESI equipment will be analysed, demonstrating the need for a theatre practitioner to establish the validity of sources that inform practice. The roles of circulating practitioner and scrubbed practitioner will be elucidated, with exploration of professional and ethical responsibilities to the patient, themselves and colleagues.
What is the ‘Nurse’ in Nurse Anaesthetist? a Policy and Literature Review
Authors: Kennedy Wendy
Published: December 2017

External forces have had a direct and indirect impact on the role of the nurse. Key policy initiatives have been central to changes in administration. With management reorganisation and technical developments at the forefront of successive governments’ economic and social policy, the nursing role has become diversified and increasingly specialised with perioperative practice developing as a consequence.
Sickle Cell Disease in the Perioperative Setting
Authors: Mason Philippa
Published: December 2017

This article explores Sickle Cell Disease and Sickle Cell Trait. These are hereditary conditions that affect thousands of people in the UK and abroad. The disease tends to occur in people of Afro-Caribbean or Mediterranean descent. The specific Pre-, Peri- and postoperative care of affected patients is examined.
Kocher's Gland Dissector, Thyroid Retractor and Artery Forceps
Authors: Ellis Harold
Published: December 2017

Theodor Kocher (1841–1917) was Switzerland's greatest surgeon. Indeed, his name ranks high in the surgical world's hall of fame. In the latest of his ongoing series of articles, Harold Ellis explores Kocher's contribution to the field.
National Survey of Hand Antisepsis Practices
Authors: Tanner Judith , Blunsden Chris , Fakis Apostolos
Published: December 2017

Surgical hand antisepsis is routinely carried out prior to undertaking invasive procedures in an attempt to reduce surgical site infection. There are a number of components within hand antisepsis which include the choice of antiseptic agent, the method of application and the duration of the process. This article presents the findings of a postal survey of 1,471 (out of 8,000) perioperative practitioners identifying their surgical hand antisepsis practices. While a traditional scrub using chlorhexidine gluconate remains the preferred method of antisepsis, 20% of practitioners use alcohol rubs for repeated cases. Compliance with recommended guidelines is patchy (for example, only 3% of practitioners scrub for the recommended time of two minutes) and guidelines need to address more issues.
Cushing's Clips
Authors: Ellis Harold
Published: December 2017

Together with Sir William Macewen (1848–1924) and Sir Victor Horsley (1857–1916), Harvey Cushing (1869–1939) is recognised as one of the triumvirate of founders of the speciality of neuosurgery.
A Vision of Mentorship in Practice
Authors: McNair Wendy , Smith Brian , Ellis Jeannette
Published: December 2017

This article explores the emotional and reflective journey of registered nurse Wendy McNair in her role as a mentor. This personal account illuminates her awareness of what makes a good mentor and how the role influences the student's perioperative experience. The information shared in this article has been extracted from her reflective portfolio created during a recent mentorship course at Edge Hill University (Manchester).
A Comparison of Methods of Local Anaesthesia used for Cataract Extraction
Authors: Studholme Suki
Published: December 2017

This paper will discuss the various techniques used for the instillation of local anaesthetics (LA) during intraocular (IO) cataract extraction. It will be limited to a comparison of peribulbar block, sub-Tenons block and topical plus intracameral anaesthesia alone, as these are those most frequently used at the author's place of work. It will focus on both the surgeons’ preferences and the patients’ perceptions and comfort pre-, peri- and postoperatively. A description of each technique and the drugs available will be followed with a discussion of the patients’ perceptions and pain levels. Included will be a summary of the patients’ anxiety levels and the benefits of any sedation. Throughout, general and specific complications will be debated. All will be supported by current, relevant literature.
Care of the Intubated Patient in the Pacu: The ‘Abcde’ Approach
Authors: Younker Jackie
Published: December 2017

This paper discusses airway management in the post anaesthetic care unit (PACU). Many patients will be extubated on arrival to the PACU, however a small number will need further support with tracheal intubation. Patient assessment is a key role for the PACU staff and using the ABCDE approach will provide a systematic method for assessing the patient and determining suitability for extubation. Care of the patient following extubation is also described.
The First Pneumonectomies for Lung Cancer
Authors: Ellis Harold
Published: December 2017

The year 1933 was remarkable in the history of lung surgery in that five surgeons, in five separate medical centres in the USA and Canada, performed the first, and successful, pneumonectomies for tumours of the lung.
Preoperative Consent: How to Make Sure Your Practice is Legal – Part One
Authors: Corfield Lorraine , Pomeroy Anne
Published: December 2017

Perioperative practitioners encounter consent issues constantly in their practice, both in terms of the main procedure listed and procedures they will undertake personally to enable the main procedure to be carried out safely. The law on consent has previously been governed by case (common) law but is now also partly governed by the Mental Capacity Act 2005 (MCA) (HMSO 2005). The onus is on practitioners to ensure that their practice is legal. This article and the subsequent companion article aim to emphasise the key legal points.
Varicose Veins
Authors: Bhutia Sherab G , Balakrishnan Arun , Lees Timothy
Published: December 2017

Varicose veins are common and often asymptomatic. A variety of treatment methods are available for those who develop symptoms or complications. The traditional open surgical treatment still forms the mainstay of treatment. Endovenous treatment methods offer a new alternative but have their own limitations. Foam sclerotherapy holds much promise as it can be done in an outpatient setting under local anesthesia, but it needs to be tested over a longer time period.
Abortion: Implications for Theatre Staff
Authors: Lipp Allyson
Published: December 2017

Abortion is controversial and often sparks polemic debate. Nevertheless, theatre staff need to know the different methods of abortion, to be aware of the current UK legal position and possible future directions. Theatre staff must be mindful of their own ethical and emotional position in order to play a vital role in making women attending for this surgery feel at ease during such an emotionally charged event.
Education, Training and Competency Assessment for Intraoperative Cell Salvage
Authors: Grainger Hannah , Jones Joan , Mcgee Danny
Published: December 2017

The use of Intraoperative Cell Salvage (ICS) is an important facet in establishing the recommendations of Better Blood Transfusion (DH 2007). Training in ICS often varies and has been identified as a challenge in the establishment of the routine use of ICS (UKCSAG 2007a). To help address this, the UK Cell Salvage Action Group, has developed a number of tools to assist in the delivery of both theory and practical elements of ICS training. The aim of this work is to provide standardised educational materials to support ICS training in hospitals throughout the UK.
Insertion Techniques of the Laryngeal Mask Airway: A Literature Review
Authors: Middleton Patrick
Published: December 2017

This article is based on a literature review comparing insertion techniques of the laryngeal mask airway (LMA). I will be looking at the manufacturer's recommended technique and identifying alternative methods, adapted for ease of use, patient comfort or individual circumstances. Risks associated with LMA use will be identified and examples given of research carried out to limit these risks.
Preventing DVT: A Perioperative Perspective
Authors: Ryan Karena , Johnson Sue
Published: December 2017

In the absence of thromboprophylaxis, deep vein thrombosis (DVT) is a significant risk for surgical patients especially those undergoing orthopaedic surgery and lengthy procedures (ICS 2002, SIGN 2002, Geerts et al 2004, ICS 2006, NICE 2007). Venous thromboembolism (VTE) is preventable; however it kills 25,000 patients each year in the UK.

This article reviews relevant literature regarding thromboprophylaxis, and focuses particularly on the use of intermittent pneumatic devices (IPC) within the perioperative environment.
Stem Cell Applications and Tissue Engineering Approaches in Surgical Practice
Authors: Khan Wasim S , Malik Atif A , Hardingham Timothy E
Published: December 2017

There has been an increasing interest in stem cell applications and tissue engineering approaches in surgical practice to deal with damaged or lost tissue. Although there have been developments in almost all surgical disciplines, the greatest advances are being made in orthopaedics, especially in bone repair. Significant hurdles however remain to be overcome before tissue engineering becomes more routinely used in surgical practice.
Commissioning the Ideal Perioperative Suite: Is Going it Alone Your Best Option?
Authors: Bielby Ray
Published: December 2017

Commissioning the ideal perioperative suite, what does it really mean to the perioperative manager?

Negotiating through the maze of design, furniture and equipment needs in healthcare building projects requires a great deal of time and input and there will be many questions the perioperative manager will need to ask if they are to undertake this role effectively. What do they need to know and how do they ensure that their department is represented fairly in the building and procurement selection process?

What do they really know about project management and how to be a successful and valuable member of a project team? What are the fundamentals that every perioperative manager who is seconded onto a project team needs to be aware of when asked to assist with the fit out and design of a new perioperative suite?

If going it alone isn't the best option where can they go to find the right professional help? Is engaging a medical equipment planner the answer?
Non-steroidal Anti-inflammatory Drugs in Orthopaedic and Perioperative Practice
Authors: Khan Wasim , Al-Rashid Mamun , Marsh David R
Published: December 2017

Non-steroidal anti-inflammatory drugs are powerful and effective anti-inflammatory, analgesic and anti-pyretic drugs. They are routinely used in orthopaedic conditions and in the perioperative setting. They are however associated with potentially life-threatening side-effects and it is important to appreciate these before these medicines are administered. There is evidence suggesting that these drugs adversely affect bone formation, and this has implications for their use in patients with fractures and other pathologies that involve bone remodelling.
Postoperative Fluid and Electrolyte Balance: Alarming Audit Results
Authors: Johnson Rebecca , Monkhouse Simon
Published: December 2017

Perioperative fluid and electrolyte management requires an understanding of physiology and fluid losses. Consequences of poor management in postoperative patients can be fatal. This audit assesses the latest consensus guidelines and applies them to a district general hospital setting. Results are concerning and demonstrate a global lack of application of knowledge and understanding. Recommendations are suggested in order to control this potentially devastating situation.
The WHO Surgical Safety Checklist: The Evidence
Authors: Wilson Iain , Walker Isabeau
Published: December 2017

Of the more than 230 million patients who undergo surgery each year, 7 million suffer a disabling complication, and one million die (Weiser 2008). These numbers are substantial, and through the WHO Surgical Safety Checklist, the issues surrounding safe surgery are at last receiving attention on the international stage.
Incidents in Anaesthesia: Past Occurrence and Future Avoidance
Authors: Catchpole Ken , McCulloch Peter
Published: December 2017

This article is a revised version of an analysis of reported incidents related to anaesthesia, originally published in the journal Anaesthesia (Catchpole et al 2008a) and undertaken on behalf of the National Patient Safety Agency. The purpose was to examine the range, types, frequencies and causes of reported patient safety incidents associated with anaesthesia. First we examined anaesthetic incidents as a sub-set of the total number of reported incidents; then we examined pre-surgery assessment, epidural anaesthesia, and anaesthetic awareness incidents, as they were identified as being frequent and of potential concern. To our knowledge it was the first paper to analyse and present results of the NPSA's database in a clinical academic journal. Here, we take the opportunity to re-present and review the findings in light of subsequent progress in understanding and improving patient safety and quality of care.
Dame Josephine Barnes: Distinguished Gynaecologist and First Woman President of the British Medical Association
Authors: Ellis Harold
Published: December 2017

In previous articles in this series, we have written about the great women pioneers who broke down the barriers which prohibited or limited their entry into the various branches of the healthcare professions and who then proved that they could compete, on equal terms, with their male counterparts. Included in the first among these, of course, was Florence Nightingale, who, in the Crimean war (1854–6) and afterwards introduced the ‘modern’ era of nursing training and put an end to the dirty, ignorant and often drunk women who had been delegated to look after the sick and injured in the hospital wards before her time.
Needlestick and Sharps Injuries among Theatre Care Professionals
Authors: Al-Benna Sammy
Published: December 2017

Health care professionals are exposed to blood and other body fluids in the course of their work (Al-Benna et al 2008). The World Health Organisation (2003) estimates that 9% of the 35 million healthcare professionals worldwide will experience percutaneous exposure to bloodborne pathogens each year (WHO 2003). In the UK about 100,000 sharps injuries occur in NHS hospitals each year (Trim & Elliott 2003). This is 17% of all accidents involving NHS staff (NAO 2003). Four percent of NHS staff sustain from 1 to 6.2 sharps injuries each year. These injuries occur mainly in clinical areas such as wards and theatres, but also in non-clinical areas due to accidental handling of inappropriately discarded sharps (Trim & Elliott 2003, Waterson 2004). Percutaneous injuries involving hollowbore needles remain the most commonly reported occupational exposures in the healthcare setting (HPA 2010). Consequently, workers are at risk of infection with bloodborne viruses including human immunodeficiency virus, hepatitis B virus, hepatitis C virus and bacterial infections (Al-Benna et al 2008).
Advanced Trauma Life Support Radiographic Trauma Series: Part 3 - the Pelvis Radiograph
Authors: Chimutengwende-Gordon Mukai , Khan Wasim , Sidhu Jasmeet , Maruthainar Nimalan
Published: December 2017

Pelvic fractures are often high energy injuries and are associated with a high morbidity and mortality. The plain antero-posterior pelvis radiograph is part of the advanced trauma life support radiographic trauma series and is used as a screening test. The main limitation of plain antero-posterior pelvic radiographs is the difficulty in identification of some fractures, in particular posterior fractures, therefore radiographic findings should be considered in conjunction with clinical assessment.
A Student Perspective: Navigating through the Complexities of Perioperative Practice (Part 1)
Authors: Crowley Aidan J
Published: December 2017

This article is one of many written by a student operating department practitioner (ODP) telling their story from the day they entered the operating theatre. Their intention is to share reflections and tips on how they coped with the overwhelming, complex and diverse aspects of perioperative practice.

Qui non est hodie cras minus aptus erit …He who is not prepared today will be less so tomorrow - Ovid
Reducing the Risk of Surgical Site Infection: A Case Controlled Study of Contamination of Theatre Clothing
Authors: Sivanandan Indu , Bowker Karen E , Bannister Gordon C , Soar Jasmeet
Published: December 2017

Surgical site infections are one of the most important causes of healthcare associated infections (HCAI), accounting for 20% of all HCAIs. Surgical site infections affect 1% of joint replacement operations.

This study was designed to assess whether theatre clothing is contaminated more inside or outside the theatre suite. Petri dishes filled with horse blood agar were pressed on theatre clothes at 0, 2, 4, 6 and 8 hours to sample bacterial contamination in 20 doctors whilst working in and outside the theatre suite. The results showed that there was greater bacterial contamination when outside the theatre suite at 2 hours. There were no differences in the amount of contamination at 4, 6 and 8 hours. This study suggests that the level of contamination of theatre clothes is similar both inside and outside the theatre setting.
The Early Days of Nasal Reconstruction
Authors: Ellis Harold
Published: December 2017

Most healthcare professionals, if asked, would say that plastic and reconstructive surgery is a recent phenomenon. So most of it is, but, rather surprisingly, the story of replacing the absent nose goes back for many centuries.
The Impact of Discussing Preoperative Fasting with Patients
Authors: Khoyratty Saleem , Din Ah , Spendlove Rachel , Teehan Melissa , Arhi Chanpreet , Modi Bhavik N , Brown Katherine , Twigley Alison , Ravichandran D
Published: December 2017

Patients awaiting surgery are often fasted preoperatively well in excess of the recommended fasting times. Educated perioperative practitioners were asked to discuss preoperative starvation with patients. Preoperative starvation period for clear fluids was significantly reduced from a mean of 8 hours 30 minutes in the original audit, to 6 hours 10 minutes in this study of 113 patients (p < 0.001). Improving patient understanding of preoperative fasting can increase compliance with fasting recommendations.
The Early Days of Heart Valve Surgery
Authors: Ellis Harold
Published: December 2017

To the lay public, the very idea of an operation on that vital structure, the heart, seems to be out of the question. (In fact, the heart muscle is an incredibly tough machine that can go on pumping, without a single service, for 90 or more years!) Even to the surgeons of the end of the 19th century, who, thanks to the twin discoveries of anaesthesia and antiseptic surgery, were beginning to operate on all the other major organs of the body, heart surgery seemed to remain an impossible dream. Even that great pioneer of modern scientific surgery, Theodor Billroth, Professor of Surgery in Vienna, who had himself already performed the first successful partial gastrectomy for a stomach cancer and the first laryngectomy, wrote, in 1893, ‘Any surgeon who would attempt an operation on the heart should lose the respect of his colleagues'.
The Case for Human Factors Training
Authors: Hirst Guy
Published: December 2017

The Association for Perioperative Practice has taken a leading role in raising awareness of the importance of human factors in healthcare. We at Atrainability (2011) have been privileged to run training courses on human factors to association members at the last two annual conferences and also at venues throughout the UK. The funding has been provided by the Hilda Mears trust.
Students Experiences of Theatre Allocations
Authors: Lydon Christina , Burke Eimear
Published: December 2017

The aim of this literature review was to explore Irish student nurses' experiences of theatre allocations as limited research has been conducted in this area.
The Early Days of Surgery for Cancer of the Rectum
Authors: Ellis Harold
Published: December 2017

Long before being aware of tumours elsewhere along the alimentary canal, surgeons from the earliest days of the profession were all too familiar with cancer of the rectum. The vivid local symptoms of rectal bleeding and mucous discharge, bowel disturbance and then intractable local pain, and the ready detection of the growth by a finger inserted into the fundament made diagnosis all too easy and with it, of course, a hopeless outlook for the poor sufferer. Until quite recent times, treatment was entirely palliative, with the use of hot baths, emollient enemas and dilatations of the constricting growth with bougies. Opium and laudanum, (opium dissolved in alcohol), would be prescribed in advanced cases. Some bold surgeons would use the cautery -an iron heated to red heat - to burn down a fungating growth presenting at the anal margin.
Minimising the Spread of Infection in the Operating Department
Authors: Wilson Rachel
Published: December 2017

We live in a world of continuing advances in technology, surgical techniques and rapidly improving medicine. Despite these advances, diseases are continuing to thrive and cause infection both in the community and, more disturbingly, in hospitals. Damani (2003) states that medical care is more complex than ever before, and this has resulted in hospital acquired infections (HAIs) increasing due to organisms which are resistant to antibiotics such as: methicillin resistant staphylococcus aureus (MRSA) and vancomyan resistant enterococci (VRE). Wilson (2006) explains that hospitals provide a particularly fertile breeding ground for resistant micro-organisms, due to the widespread exposure to antibiotics and the many opportunities that hospitals provide to transfer MRSA between vulnerable patients and into sites which are susceptible to infection, such as wounds and invasive devices. Damani (2003) emphasises again that the key to successful control of antimicrobial resistant pathogens in hospitals is good isolation techniques, and especially rigorous attention to hand hygiene by all members of staff who are in contact with patients affected or colonised with resistant pathogens. The aim should be to eliminate the infection as quickly as possible and to ensure that the patient's period of isolation is kept to a minimum. Advice and knowledge about the control of infection is therefore imperative.
Targeted Distribution of the National Patient Safety Agency Safer Practice Notice on Throat Packs
Authors: Durand Marcus , Coates Tracy , Flood Chris , Norris Beverley , Curran John
Published: December 2017

Using an electronic questionnaire, we tested the effectiveness of professional networks for distributing a National Patient Safety Agency Safer Practice Notice, ‘Reducing the risk of retained throat packs after surgery’, issued in April 2009. Using professional networks for the targeted distribution of guidance to specific professional groups was found to be effective.
Contemporary Issues in Operating Room Care: A Critical Incident
Authors: Ford Linda
Published: December 2017

During my training to become an Operating Department Practitioner (ODP) I experienced a situation which could have endangered a patient. I have reflected upon this incident using the Gibbs reflective cycle (see Jasper 2003) to help me analyse how the situation arose, how it could have been prevented and what I can learn from it. During the incident I was undertaking the circulating role in an orthopaedics case.
Anaesthesia Type, Gender and Anxiety
Authors: Mitchell Mark
Published: December 2017

The number of patients treated by elective day-case surgery in the UK is growing. Patient preoperative anxiety can be considerable, although the opportunity to help to reduce fears is minimal. Day surgery patients (n=674) were surveyed and 82% were found to be anxious. General anaesthesia patients were more anxious than local anaesthesia patients and females more anxious than males. The results indicate that general anaesthesia patients may require more preoperative information, and gender differences associated with waiting may need to be given greater consideration.
Interprofessional Collaborative Teamwork Facilitates Patient Centred Care: A Student Practitioner's Perspective
Authors: Osbiston Mark
Published: December 2017

Interprofessional teamwork and collaboration are essential for facilitating perioperative patient centred care. Operating department practitioners (ODPs) and nurses are registered professional ‘practitioner’ members of the perioperative team. Standards of conduct, communication skills, ethical principles and confidentiality legislation associated with documented patient information underpin and guide perioperative practitioner practice. This article will discuss, from a student's theoretical and practice experience perspective, the registered professional ‘practitioner’ role in the context of the interprofessional team.
A Waking Nightmare: How can we Avoid Accidental Awareness during General Anaesthesia?
Authors: Macgregor Kerry
Published: December 2017

Anaesthesia awareness is a terrifying prospect for any patient undergoing a surgical procedure and can cause considerable physical and psychological distress. Recommendations to reduce the risk of anaesthesia awareness include: undertaking a thorough preoperative assessment, ensuring that equipment has been checked, reducing drug error, consistent monitoring, and investment in safer technology. By implementing these recommendations it is hoped that patient safety and care can be improved during clinical anaesthesia.
Safety in the Emergency Situation: The Airway – A Theatre Team Approach
Authors: Mellanby E , Podmore Bm , McNarry Af
Published: December 2017

Managing an expected or unanticipated difficult airway can result in morbidity and even mortality (Cook et al 2011). These scenarios place considerable demands on the anaesthetic team and require the wider support of theatre staff. It is crucial that the perioperative team is adequately prepared for these time-critical emergencies in order to prevent avoidable patient harm. This article introduces the topic and discusses the core knowledge and skills required of the perioperative team.
We Need An Educated Voice! Access to Specific Theatre Based Higher Education and the Professional Advancement of Theatre Nurses
Authors: Miller G
Published: December 2017

Newly qualified theatre nurses could benefit from a wider national availability of university based education specifically for theatre practice from which to develop both the technical and nontechnical skills of their role to enhance the delivery of optimum, safe and sensitive patient care. They would be better prepared for challenging situations and develop resilience, thereby reducing stress. The professional role of the theatre nurse would be advanced through engagement in recognised education with academic accreditation.
Extracorporeal Membrane Oxygenation: Look Out for a Retrieval Team Coming to a Hospital near You!
Authors: Jones N , Yusuff H , Fowles J , Nichols A , Webb St
Published: December 2017

In 2011 the Department of Health commissioned five hospitals in England to provide extracorporeal membrane oxygenation (ECMO) to adults with severe respiratory failure. This review will explain the principles underlying ECMO, describe the circuitry used and discuss the care of a patient receiving support. We hope that it will be of use should a patient at your hospital be considered a candidate for ECMO.
The Osteotome: A Design by Sir William Macewen
Authors: Huntley Js , Osman Mkk
Published: December 2017

The osteotome is ostensibly a simple surgical instrument. In fact it was carefully designed to allow accurate aseptic osteotomy for deformities around the knee. Here we outline William Macewen's classic work on the design of this tool and set this work in the context of his life.
The Challenge of Change: Not Everyone's Cup of Tea
Authors: Booth K , Hall S
Published: December 2017

This article explains how the authors adapted The Productive Operating Theatre (TPOT) programme for a large theatre department. The multidisciplinary theatre teams identified barriers at each launch. At subsequent programme workshops they learned to collate information and to work together to challenge and change practices.
Patient Evaluation of Outpatient Venous Thromboembolism Prophylaxis Service following Lower Limb Injuries Using a Developed Validated Questionnaire
Authors: Menakaya Cu , Khan As , Nunn T , Pennington N , Ward M , Malhotra R , Muthukumar N , Mohsen A
Published: December 2017

This paper explores patients' perceptions of a new service and protocol for managing outpatient venous thromboembolism (VTE) prophylaxis, using either subcutaneous Dalteparin or oral off-license Dabigatran in patients with lower limb injury requiring immobilisation. Establishing a patient's perspective is part of good practice as, when this is positive, it aids patient compliance and protocol dissemination. A questionnaire consisting of fifty questions was given at random to one hundred patients over a six month period when they attended the trauma clinic. Each question was scored on a five point Likert scale (1=poor, 5=excellent) by the patient. The internal consistency of the questionnaire (Cronbach's alpha reliability coefficient) was more than 0.9 in all domains. Qualitative analysis was done for open-ended questions. One hundred respondents completed the questionnaire, two were void due to significant amounts of incomplete data. The gender split was 54 females, 43 males, and one did not answer the question. The average age was 43 (range 18–72). Sixty seven respondents were first-time attenders, 22 were follow-up patients and nine did not complete this section. The overall average score was 4.26 (range 1–5), with 90% of the patients recommending the service. The overall patient satisfaction for a VTE prophylaxis service is high although there is room for improvement as demonstrated by the range of the scores.
Non-Technical Skills for Scrub Practitioners
Authors: Mcclelland Guy
Published: December 2017

The non-technical skills of situational awareness and the formation of effective interpersonal relationships are essential to enhance surgical outcomes. However, most scrub practitioners demonstrate only tacit awareness of these skills and develop such qualities on an informal basis. Application of non-technical skills may be assessed formally, using a structured framework, to transform normative behaviour and to strengthen barriers against the latent threats that may result from fallible humans working in inadequate organisational systems.
Development and Efficiency of Dedicated Upper Limb Trauma Lists in a District General Hospital
Authors: Makki D , Alnajjar Hm , Saw N
Published: December 2017

The aim of this audit was to assess the impact of dedicated upper limb trauma lists on the hospital stay and satisfaction of patients treated operatively for upper limb injuries. In first audit, we reviewed the data of 52 consecutive patients with upper limb injuries treated on the routine trauma lists. Accordingly, a new pathway of dedicated upper limb trauma lists was introduced whereby patients presenting with injuries were safely discharged home with written instructions regarding arrangements for surgery. The audit loop was then closed by collecting data of 78 consecutive patients treated using the new scheme. Dedicated upper limb trauma lists have reduced our in-patient stay without affecting the care and outcomes for our patients. The lists also improved patient satisfaction as arrangements for surgery were more convenient.
Consenting Patients with Femoral Neck Fractures – How well are we Involving the Patient's Relatives?
Authors: Qasim SA , Oyekan A , Boyd RPR , Kieffer WKM , Panose P
Published: December 2017

The consent process is a vital part of the in-patient journey for patients admitted with a fractured neck of femur. However, an aspect that is frequently over-looked is the involvement of a patient's next of kin. We organised a pilot study in our institution to see what steps we could take to make improvements in the way that next of kin involvement was managed, in line with widespread national guidelines.
Simple Mastectomy under Hypnosis: A Case Study Approach
Authors: Fiddaman J
Published: December 2017

There is a clear inverse relationship between preoperative anxiety and effective anaesthesia and recovery. Studies have shown that perioperative anxiety can be detrimental to the efficacy of recovery. In order to mitigate the perioperative anaesthetic risk to the patient, perioperative care must be inclusive of psychological as well as physiological elements. Therefore, when planning and implementing care for the surgical patient alternative interventions, such as hypnosis, should be considered when presented with difficult patient factors, such as crippling anxiety. This article takes on a case study approach to critically analyse and appraise the holistic care of a patient undergoing a simple mastectomy with hypnosis as the primary anaesthesia.
Sharing and Learning
Authors: Coates Tracy
Published: December 2017

The NHS Litigation Authority (NHS LA) is a not-for-profit NHS organisation that manages negligence and other claims against the NHS in England on behalf of their member organisations. Their overarching vision is to resolve claims in a timely and fair manner while sharing the lessons of why things go wrong and improving safety.
Culture, Silence and Voice: The Implications for Patient Safety in the Operating Theatre
Authors: Jones C , Durbridge M
Published: December 2017

Team culture is an important antecedent to safety behaviours such as speaking up. A positive safety culture in the operating theatre has been linked to fewer adverse events. Psychological safety, a component of safety culture, is the belief that the team is safe to take risks such as raising concerns. Power dynamics can influence active speaking up behaviour or ‘voice’. When theatre team members chose to remain silent rather than voice concerns this can be a protective or defensive strategy rather than passive inactivity.
Case Report of a Patient with Myasthenia Gravis Requiring a Caesarean Section
Authors: De Silva S
Published: December 2017

RS is a 28-year old lady who presented in her first pregnancy to the High-Risk Obstetric Clinic for review in view of her medical history of myasthenia gravis. She was diagnosed with myasthenia gravis (MG) as a teenager, and underwent thymectomy soon after diagnosis. At the time of presentation to the clinic, RS was taking pyridostigmine and azathioprine for her MG.
Airway Safety in a Patient with Submandibular Swelling
Authors: De Silva S
Published: December 2017

A fifty-eight year old gentleman (CH) with a five-day history of toothache presented to the emergency department (ED) with increasing pain with associated submandibular swelling over the last 24-hours. He was an unkempt gentleman who had not consulted his general practitioner or dentist in many years, was unaware of any significant past medical history and was not on any regular medication. He was an obese gentleman with a BMI of 56.
Critical Incident Analysis: Equip to Avoid Failure
Authors: Potts N , Martin DSE , Hoy L
Published: December 2017

This work is set in the context of perioperative practice in difficult airway management. It integrates a root cause analysis and fish bone technique to investigate a critical incident in temporary yet crucial equipment failure. Risk management and incident reporting is analysed alongside human factors in the operating theatre environment. Finally, recommendations for risk reduction, vigilance and checking vital airway equipment are made in anaesthetic practice.
eAppendicitis: Diagnostic Uncertainty in Appendicitis and the Role of Ehealth –does it Help?
Authors: Batt J , Kynaston J , Olivier J
Published: December 2017

The availability of medical information on the World Wide Web has grown as information technology has become more accessible. Patients seeking online information may be able to self-select conditions having been adequately informed. This study evaluates the effect of eHealth information on those presenting to hospital with a suspected appendicitis and its effect on their management and clinical outcome. Patients who had performed online reading were more likely to go to theatre but were less likely to have a confirmed histological diagnosis of appendicitis.
Does a Dedicated Orthopaedic Day Surgery List Improve Delivery of Trauma Services?
Authors: Bhamra JS , Dhinsa BS , Patel S , Davies C , Oliver M
Published: December 2017

Our aim was to implement a 23-hour pathway for uncomplicated trauma to overcome delays and improve efficiency. A retrospective review of a single surgeon series of 105 consecutive patients operated on between July 2010 and July 2011 was performed. With recently revised trauma tariffs, we believe an efficient day surgery trauma list improves theatre utilisation, reduces inpatient bed demands, prioritises major and sub-specialist trauma and delivers patient satisfaction.