bluuebunny/crossref_metadata_2025 huggingface dataset:
The Smoke Factor: Things you Should Know
Authors: Marsh Steph
Published: December 2017

Surgical smoke is a regular hazard that the majority of perioperative personnel are exposed to. Many staff are unaware of the risks of surgical smoke and many more may take it for granted that a surgical facemask provides enough protection. This article provides detail on the composition of surgical smoke and highlights the potential dangers that theatre staff face and what could be done to protect them. It will demonstrate the potential harm for the patient with particular reference to laparoscopic procedures as these are becoming more favourable in general and gynaecological specialities and are of particular interest to the author.
Is the Commonly Told Story of Lister's Antisepsis a Whiggish One?
Authors: Smart Alexander , Khan Wasim S
Published: December 2017

Joseph Lister is often seen as a hero of surgery, but his famous method of antisepsis was not solely his work alone. The commonly told account of the development of antisepsis displays several characteristics of whig history. This investigation will highlight these whiggish features, showing that Lister's original antiseptic technique was not without its failures and that there were other important figures who contributed to its development.
Thomas Hodgkin
Authors: Ellis Harold
Published: December 2017

In the general field of medicine, more so than in any other occupation; we use eponyms in our everyday work. An eponym comes from the Greek word for a name. It is used, often, to commemorate the person or persons responsible for the first description of a disease, discoverer of cause of an illness, or the developer of an operation or intervention. Eponymous terms are used constantly in the operating suite area; we have already published in this journal a whole series of eponyms devoted to surgical instruments and appliances - Spencer Wells' forceps, Cushing's clips and so on.
Burrill Bernard Crohn
Authors: Ellis Harold
Published: December 2017

In 1932 an article appeared in the Journal of the American Medical Association (JAMA) which must be one of the most quoted papers in the whole field of gastroenterology. It took up seven pages and was entitled ‘Regional ileitis, a pathological and clinical entity’. It emanated from Mount Sinai Hospital, New York and its three authors were given in alphabetic order: B.B. Crohn, L. Ginzburg and G. Oppenheimer.
Respect, Compassion and Dignity: The Foundations of Ethical and Professional Caring
Authors: Reid Jane
Published: December 2017

Throughout 2011, and for much of this year, the national and professional press have been dominated by reports of failures in health and social care. Stories have focussed on the avoidable harm and disturbing cruelty suffered by individuals and the distress of distraught families seeking answers in the light of systemic organisational failure on an incredible scale (Francis 2010, CQC 2011a, CQC 2011b)
Ambulatory Orthopaedic Surgery Patients' Emotions When Using Two Different Patient Education Methods
Authors: Heikkinen Katja , Salanterä Sanna , Leppänen Tiina , Vahlberg Tero , Leino-Kilpi Helena
Published: December 2017

A randomised controlled trial was used to evaluate elective ambulatory orthopaedic surgery patients' emotions during internet-based patient education or face-to-face education with a nurse. The internet-based patient education was designed for this study and patients used websites individually based on their needs. Patients in the control group participated individually in face-to-face patient education with a nurse in the ambulatory surgery unit. The theoretical basis for both types of education was the same. Ambulatory orthopaedic surgery patients scored their emotions rather low at intervals throughout the whole surgical process, though their scores also changed during the surgical process. Emotion scores did not decrease after patient education. No differences in patients' emotions were found to result from either of the two different patient education methods.
Da Vinci's Codex and the Anatomy of Healthcare
Authors: Stephens-Borg Keith
Published: December 2017

We usually display a laid-back approach to medical jargon throughout our theatre work. The word ‘perioperative’ is built from the Greek word ‘peri’ (around) and the Latin ‘operari’ (to work). Latin and Greek became the prefixed language of choice for Leonardo da Vinci, and his research was pivotal in determining the way in which surgical procedures are documented. Ancient manuscripts aided the unfolding of the secrets of anatomy, and Leonardo revealed that art was the key in expressive detailed explanation.
Preoperative Blood Tests in Elective General Surgery: Cost and Clinical Implications
Authors: Phoenix Gokulan K , Elliott Tamara , Chan James K , Das Saroj K
Published: December 2017

A retrospective observational study was performed in our trust in October 2010 that examined compliance, and the financial and clinical implications of performing inappropriate preoperative blood tests on adult patients prior to elective surgery, against the 2003 NICE guidelines. An unacceptable proportion of inappropriate tests (31.3%) were being performed. None were associated with adverse outcome or changes in management. Based on our results, we estimate that an extrapolated cost of £11.2 million is being spent on inappropriate blood tests in NHS England and Wales.
The WHO Surgical Safety Checklist: A Review
Authors: Alnaib Mustafa , Samaraee Ahmad Al , Bhattacharya Vish
Published: December 2017

Surgery plays a prominent role in healthcare worldwide. It has been estimated that the rate of fatal events occurring in surgery is about one in ten thousand exposures and up to one million deaths per year. Most errors are caused by failure of non-technical skills. The WHO surgical safety checklist has shown that patient safety could be improved by using a simple and effective method. However, achieving high compliance requires research, training and local adaptation.
Practitioner Led Extubation in Recovery: A Report into Viability in the Post Anaesthetic Care Unit
Authors: Harvey Paul
Published: December 2017

Patients entering recovery often have a requirement for their airway to be managed. This can be performed in a variety of ways: either by having an airway adjunct placed in-situ, or by airway manoeuvres performed by recovery practitioners (Scott 2012). One of the adjuncts that patients may have is the endotracheal tube [ETT]. Traditionally patients have been extubated before leaving the operating theatre, with trained anaesthetic assistants helping the anaesthetist to remove the airway in a safe and controlled environment. Alternatively the anaesthetist extubates in recovery with experienced recovery practitioners.
Harvey Cushing: Cushing's Disease
Authors: Ellis Harold
Published: December 2017

In 1932 Harvey Cushing published an article entitled ‘Basophil adenomas of the pituitary and their clinical manifestations'. These are rare tumours of the anterior pituitary gland, at the base of the brain, with striking manifestations, which include adiposity of the face and trunk, but not the limbs, weakness, fatigue, abdominal striae, facial hair, high blood pressure and raised blood sugar. Although I spent two years in an army neurosurgical unit, I never saw a case. More frequently, the same clinical picture is produced by a benign adenoma of the suprarenal cortex, but today by far the commonest cause of this condition is seen in the patient receiving high dosage of cortisone, when we talk about the person exhibiting ‘Cushingoid features'. Most readers of this journal will have seen such cases.
Preoperative Fasting: A Clinical Audit
Authors: Roberts Stuart
Published: December 2017

This clinical audit examines the adherence to guidelines suggested by the Royal College of Nursing (2005); the results uphold previous studies of a preoperative starving period for patients undergoing elective surgical procedures. Patients excessively starved of food or fluids report problems relating to their health. These include hunger, distress and complaints of nausea.
Is There a Relationship between Preoperative Shaving (Hair Removal) and Surgical Site Infection?
Authors: Jose Binu , Dignon Andrée
Published: December 2017

The preoperative preparation of patients for surgery has traditionally included the routine hair removal at the operating site as a part of cleanliness. This literature review will investigate the relationship between preoperative hair removal and surgical site infection. It aims to identify the best method of hair removal to reduce the infection if hair removal is necessary, and to apply the evidence findings into nursing practice.
To Admit or Not to Admit on the Morning of Surgery: Patients' Perspectives on Day of Surgery Admission
Authors: Harries RL , Bradshaw CA , Jones EA , Lewis P
Published: December 2017

Patient experience of day of surgery admission (DOSA) has not been studied in depth. Over a one-month period a questionnaire was given to consecutive patients prior to their surgery to obtain their perspective on the desirability of DOSA and to examine whether other factors influenced this decision. 149 patients participated; across all age groups there was a statistically significant difference in preferring DOSA (p=0.01).
A Randomised Controlled Trial of the Resistive Heating Blanket versus the Convective Warming System for Preventing Hypothermia during Major Abdominal Surgery
Authors: Tanaka Noriyoshi , Ohno Yuko , Hori Megumi , Utada Mai , Ito Kenji , Suzuki Toshiyasu
Published: December 2017

We compared resistive heating (RH) and upper-body convective warming (CW) in 70 patients (RH 33, CW 31, 6 excluded) undergoing major abdominal surgery. The effect of RH was not inferior to that of CW for the time-weighted average core temperature, and the lower limit of 95% CW was greater than −0.5°C. Resistive heating showed no inferiority in maintaining core temperature compared with convective warming.
Speaking Up: A Professional Imperative
Authors: Reid Jane
Published: December 2017

Safeguarding patients is a professional responsibility. Perioperative staff must take account of their sphere of practice and influence and must report when either care or the environment falls short and patients are at risk of harm, or of a poor quality experience. This will require speaking up and making representation to colleagues and managers. This article explores the distinctions between whistleblowing and speaking up and explores the associated challenges.
Reducing the Carbon Footprint of the Operating Theatre: A Multicentre Quality Improvement Report
Authors: Southorn T , Norrish AR , Gardner K , Baxandall R
Published: December 2017

Currently, there are very few provisions for recycling in theatres. We measured the weight of clinical waste for several orthopaedic operations. This waste was then examined and sorted into domestic waste and clinical waste. With staff education it is possible to reduce the amount of clinical waste generated by the operating theatre by roughly 50%. A greater awareness of disposal options leads to a reduction in waste disposed of by incineration.
Students in the Perioperative Learning Environment and Emotional Support
Authors: Mccallum Heather
Published: December 2017

This article examines the responsibilities of perioperative practitioners and students faced with the potentially emotional, stressful and occasionally distressing events of the perioperative clinical placement. It examines emotional growth and reflective learning. Specifically, it looks at the responsibilities of practitioners and students faced with the challenges of an unpredictable perioperative environment. Solutions and strategies for mentors/supervising practitioners supporting the student in the perioperative placement are offered, together with tips for emotional care.
From Point of Wounding: Damage Control Resuscitation
Authors: Chewter Michelle
Published: December 2017

According to Dawes and Thomas (2009) the major priority of Defence Medical Services in battlefield casualties is haemorrhagic control. In recent years the author has witnessed a marked change in clinical guidelines regarding haemorrhagic shock. The purpose of this article is to outline the recent changes to protocol.
Leo Buerger: Buerger's Disease
Authors: Ellis Harold
Published: December 2017

I expect that every reader of this Journal is only too familiar with seeing an elderly patient, male more commonly than female, who is admitted with a gangrenous leg. Younger subjects, in their twenties and thirties, are fortunately much less common; the majority of these are severe and poorly controlled diabetics. I very much doubt if any of you, unless you work in a specialised vascular unit, have seen in this age group an example of thromboangiitis obliterans, more commonly called Buerger's disease.
The Issues Surrounding Social Network Sites and Healthcare Professionals
Authors: Azizi Taraneh
Published: December 2017

This article discusses issues surrounding online social networking, and the implications of the use of these sites by healthcare professionals. The article provides guidance to healthcare professionals, as the increased use of sites like Facebook and Twitter have the potential to bring risks to healthcare. Use of these websites can be a very grey area, and boundaries need to be clearly set to ensure protection of service users and healthcare staff alike.
Effects of Food Colouring added to 2% Chlorhexidine Gluconate and 70% Alcohol for Surgical Site Antisepsis
Authors: Chow Jason , Ng Jonathan , Pun Alvin
Published: December 2017

Preoperative cleansing of a patient's skin with chlorhexidine gluconate (CHG) in alcohol is superior to cleansing with povidone-iodine for preventing surgical site infection (SSI) after clean-contaminated surgery (Darouilche et al 2010). However, 2% CHG in 70% alcohol, tinted pink, is colourless when applied to limbs for surgery and complete coverage cannot be assured. The purpose of the study was to evaluate the efficacy of food colouring added to CHG in preoperative skin preparation. Two hundred and eight subjects were randomly selected from a population of healthy young adults and were given a questionnaire. They were excluded if they had a known allergy to CHG or food dye, a current infection at the preparation site, or previous preparation with CHG at the site. CHG with food dye additive was applied on the subject's left foot while CHD without the additive was applied on the right. Skin swabs were then taken of both feet and plated on blood agar plates and incubated for 48 hours. Assessment of growth was compared. Patients treated with tinted CHG had around 3.4 times (95% CI: 1.5, 7.8) the risk of a positive bacterial swab compared with those treated with untinted CHG. The efficacy of CHG significantly decreased with food colouring additive. This is consistent with previous studies conducted on similar incompatible substances. In order to have the full efficacy of CHG as a preparation, much thought and care needs to be taken to prevent contamination of the site and substance.
Increasing compliance with the World Health Organisation's Surgical Safety Checklist
Authors: Kieffer Wkm , Quaye Mc , Chotai N , Ricketts Dm
Published: December 2017

The World Health Organisation Surgical Safety Checklist (WHO SSC) is a validated tool for reducing in-patient surgical morbidity and mortality. It is not performed universally with full compliance. Two audit cycles were completed at two different trauma and orthopaedic units and compliance was measured. Site 1 was found to have a significantly lower compliance with the team-brief (p<0.001). Following a change in practice the compliance significantly increased (p>0.00001) at Site 1. The team de-brief was found to be consistently poorly complied with. We recommend regular audit of compliance and change in practice for all surgical units, and suggest national monitoring to ensure the benefits of the WHO checklist are applied to all in-patient surgery.
Rationalising Cross-Match Requests in Vascular Surgery is Safe and Cost Effective
Authors: Bamford Rf , Hall A , Loftus Im , Thompson Mm , Black Sa
Published: December 2017

This study describes how a vascular centre rationalised their blood transfusion policy. A multidisciplinary panel reviewed data for blood transfusion protocols and implemented improvements that were analysed. The number of units cross-matched fell from 272 to 183 over a six month period. Unused blood reduced from 80% to 61%. The study concluded that rationalisation of cross matching policies is safe and provides cost and resource benefits.
Coming to a Theatre near you Soon ‘A Witnessed Cpr Event’
Authors: Turton Karen
Published: December 2017

A current review of the last thirty years is indicative of improvement in outcome across surgical specialities with the implementation of safer working practices and initiatives in enhanced recovery, preparing patients to be ‘fit’ for surgery.

The focus of training for nurses and operating department practitioners lies with assuring technical competence and the drive is to establish best practice based on evidence. Once qualified, training for professionals within the perioperative environment is developed to enable participation in areas of anaesthesia, surgery and recovery roles. Advanced, intermediate and basic life support as well as advanced scrub practitioner courses are available, further aspects for patient safety have been implemented and pathways developed.
Improved Patient Education Facilitates Adherence to Preoperative Fasting Guidelines
Authors: Kyrtatos Pg , Constandinou N , Loizides S , Mumtaz T
Published: December 2017

Preoperative fasting is recognised as an important factor in perioperative patient care. Implementation of guidelines on preoperative fasting remains sub-optimal. We audited perioperative fasting in a district general hospital, implemented changes to the preoperative information leaflet and improved fasting practices. The manner in which information is presented to patients impacts behavior and adherence to recommendations. Improving this domain of clinical practice requires thorough and conscious effort and repeated reassessment.
Same Day Discharge following Inter-Scalene Block Administration for Arthroscopic Shoulder Surgery: Implementing a Change in Practice
Authors: Lane S , Blundell C , Mills S , Charalambous Cp
Published: December 2017

Patients who had arthroscopic shoulder surgery with the provision of an inter-scalene nerve block (ISB) at Blackpool Teaching Hospitals, were previously required to remain in hospital overnight. We introduced a new protocol that allowed same day discharge following arthroscopic shoulder surgery under general anaesthesia and ISB. The aim of this study was to review the outcome of this change in practice. Our results indicated that providing a discharge protocol for patients having arthroscopic shoulder surgery with the inclusion of ISB can avoid unnecessary overnight stay and enable significant cost savings, without detriment to patient safety or satisfaction.
The First Resection of An Aortic Aneurysm
Authors: Ellis Harold
Published: December 2017

In 1951 the report from Paris that an abdominal aortic aneurysm had been successfully resected greatly influenced surgeons throughout the world who, until then, had regarded such an operation as being outside the bounds of surgery. Indeed, as a young surgeon I could hardly believe such a procedure would be possible, having seen an unsuccessful attempt at producing thrombosis of the aneurysm by introducing coils of wire into the sac, (Colt's operation) and, in other cases, merely standing by helplessly as the patient exsanguinated from rupture of the aneurysm.
Patients' Willingness to Drink Carbohydrate Liquids Two Hours before Surgery
Authors: Veziant J , Slim K
Published: December 2017

Carbohydrate loading is an important component of enhanced recovery pathways. Some practitioners argue that patients' low acceptance for drinking such solutions could hamper the implementation of a full protocol. The aim of this study was to assess patients' actual acceptance of drinking carbohydrate solutions. Thirty patients scheduled to undergo digestive surgery participated in a survey which asked them to evaluate the taste of a carbohydrate loading drink mix (Clinutren® Preload®). They were asked whether they took all the solution, experienced nausea or vomiting, and whether they would be willing to take the solution again. Twenty two patients (73%) took all the solution, 27 (90%) judged the solution easy or quite easy to drink, 25 (83%) found the taste good or quite good, and 23 experienced (76%) no nausea. Finally 16 patients (54%) responded that they would be willing to take it again if indicated. We concluded that patient-related factors were not sufficient to hamper the implementation of carbohydrate loading before major surgery. The lack of implementation is probably related more to the attitude of the practitioner.
… It's about the Journey!
Authors: Paduraru A
Published: December 2017

The aim of this article is to discuss: the importance of effective communication, the importance of maintaining confidentiality and equality for all individuals, the importance of maintaining a secure, safe and hygienic environment within the operating department, the principles of maintaining sterility and controlling infection, and the resulting hazards if these are not maintained.

A paediatric patient was followed through her perioperative journey to find out if routinely, at the author's trust, the values of the NHS constitution – the six Cs – are being upheld.
The Right Skin Preparation Technique: A Literature Review
Authors: Silva P
Published: December 2017

Recent debates and guidelines are suggesting back and forth motion to be the optimal preoperative technique for skin preparation. There is a lack of conclusive evidence showing this to be the case, but it may be reasonable to follow this technique, in preference to the widely used concentric circles motion, as the antiseptic agent will reach deeper cell layers of the skin where most of the microbes are found.
Assessing Scrub Practitioner Nontechnical Skills: A Literature Review
Authors: McClelland G
Published: December 2017

A review by Catchpole et al (2009) into the causes and types of harm experienced by the surgical patient emphasised the high risk nature of the perioperative period. Investigations into recent failures at NHS organisations have emphasised the relevance of non-technical skills education in improving clinical performance and patient outcomes. However, scrub practitioner non-technical skills are often developed on a tacit basis, making assessment of performance difficult. This literature review identifies strategies that facilitate assessment of non-technical skills during surgery. Recommendations are made that will assist scrub practitioners in using a validated scrub practitioner non-technical skills assessment framework reliably.
Amputation of the Breast
Authors: Ellis Harold
Published: December 2017

Today we take for granted the blessing of anaesthesia and it is almost impossible for us to imagine the agonies that surgical patients underwent in the past. This description of a mastectomy, performed in 1720 by Lorenz Heister, Professor of Surgery and Anatomy in Altdorf in the republic of Nurnberg, (now part of Germany), gives a vivid idea of major surgery in those days. In this much shortened abstract from his lengthy report, which appears in the 1775 English edition of his textbook entitled ‘Medical, Chirurgical and Anatomical cases and Observations’ he discusses the preoperative preparation, the mastectomy itself, performed as quickly as possible and the tedious postoperative dressings of the inevitably suppurating wound;-
Four Steps to Interpreting Arterial Blood Gases
Authors: Rogers Kma , McCutcheon K
Published: December 2017

This article examines acid-base balance and the interpretation of arterial blood gases (ABG). The article begins with a brief revision of related physiology, followed by a description of the primary disorders associated with acid-base imbalance. The normal ranges and the significance of abnormal ABG results are explored. The article concludes by providing an easy to follow four-step guide to ABG interpretation with practice examples presented in the CPD task section.
Who Are Physicians' Assistants (Anaesthesia) and Where Do They Work?
Authors: Fisher Mona Guckian
Published: December 2017

Physicians' Assistants (Anaesthesia) (PA(A) s) were introduced in the UK almost a decade ago, and are now established within many NHS hospitals. PA(A)s are highly trained and skilled practitioners that work within an anaesthetic team under the direction and supervision of a consultant anaesthetist. These professionals are involved in all aspects of general anaesthesia delivery and some organisations have trained PA(A)s to additionally perform regional and local anaesthesia procedures.
Diversities in Perceived Knowledge and Practice of Preoperative Skin Preparation in Swedish Orthopaedic Surgery
Authors: Markström I , Bjerså K
Published: December 2017

Preoperative skin preparations may reduce the risk of hospital-acquired infections. This cross sectional questionnaire study aimed to identify the practice and knowledge of preoperative skin preparation in Swedish orthopaedic surgery departments. One hundred and six respondents (response rate 68%) from 13 Swedish orthopaedic departments reported a diversity of current recommendations and evidence, and good knowledge of skin preparations. This study found variations in practice and deviations from recommendations, despite high levels of knowledge.
Lifting Incise Drapes off the Skin during Wound Closure Can Cause Contamination
Authors: Makki D , Probert N , Gedela V , Kustos I , Thonse R , Banim R
Published: December 2017

Incise drapes adhere well to skin and reduce bacterial migration into the wound. We took skin swabs before and after the application of incise drapes during 49 hip and knee arthroplasty procedures. Contamination was detected under incise drapes in four cases (8.1%) and consisted mainly of skin flora. We conclude that it is important to clean the skin again with antiseptics if the incise drape is removed by the surgeon.
The Soothing Patients' Anxiety ‘Spa’ Experience
Authors: Harris P
Published: December 2017

This paper examines a blended approach to minimising patient anxiety levels prior to general anaesthesia for adult and paediatric patients with a learning disability by introducing reasonable adjustments and reasonable distractions. A therapeutic environment is created that promotes wellbeing; restrictive interventions are used only when there is potential for harm to the patient or others. The result can be excellent holistic individual patient care, the patient receiving ‘added value’ and a positive experience.
The First Successful Gastrectomy
Authors: Ellis Harold
Published: December 2017

In the latter part of the 19th century safe and effective elective abdominal surgery seemed to be, at last, more than just a dream. This possibility followed two vital advances. First, the introduction of anaesthesia, heralded by the use of ether by William Morton in Boston in 1845 and then of chloroform by J.Y. Simpson in Edinburgh a couple of years later, and second the work of Joseph Lister on the antiseptic method of surgery, following his publication on this subject in the Lancet in 1867. (Interestingly enough, as far as I know, Lister himself never performed a laparotomy - if anything he was principally an orthopaedic surgeon.) The major elective abdominal problem facing the surgeon at that time was the surgical management of carcinoma of the stomach - then the commonest killing cancer.
Intraosseous Access to the Circulatory System: An Under-Appreciated Option for Rapid Access
Authors: Benson G
Published: December 2017

In many emergency situations rapid vascular access is a priority, particularly in cases involving haemodynamic compromise. Traditional vascular access through the use of an intravenous cannula, although the preferred first line method, can in certain circumstances have a high rate of failure. A study by Minville et al (2006) showed that the success rate of first attempt venous cannulation can be as low as 76%. Repeated attempts at venous cannulation in patients with difficult vascular access wastes valuable time which in some situations could prove fatal.
The First Successful Elective Laparotomy
Authors: Ellis Harold
Published: December 2017

From time to time I ask a group of nurses or medical students or even surgeons if they can tell me when the first successful elective laparotomy was performed, where it took place and who was the surgeon. After much thought, someone will guess “end of the 19th century”, suggest some great teaching hospital in London or Edinburgh or Vienna and hazard the name of Joseph Lister. To date, no one has given me the correct answer - the date was 1809, the place Danville, in Kentucky USA and the surgeon was Ephraim McDowell.
Vulnerability in Perioperative Patients: A Qualitative Study
Authors: Cousley A
Published: December 2017

The study aimed to explore perioperative practitioners’ knowledge, awareness and experiences of perioperative vulnerability in clinical practice. A qualitative descriptive design was used; data was obtained by conducting semi-structured interviews with ten perioperative practitioners over a two week period in July 2014. The study found that perioperative practitioners were aware of the concept of perioperative vulnerability and had varied experience of it in practice. Data analysis identified three main themes in relation to vulnerability: labels, recognition and management. We conclude that the concept of perioperative vulnerability exists in practice and that perioperative practitioners manage the concept effectively using strategies that promote positive outcomes.

Please note: the term ‘practitioner’ and ‘nurse’ are used interchangeably and denote a professional who provides care in the perioperative clinical situation.
Infection Control in Operating Theatres
Authors: Al-Benna Sammy
Published: December 2017

The operating theatre complex is the heart of any major surgical hospital. Good operating theatre design meets the functional needs of theatre care professionals. Operating theatre design must pay careful consideration to traffic patterns, the number and configuration of nearby operating rooms, the space required for staff, administration and storage, provisions for sterile processing and systems to control airborne contaminants (Wan et al 2011). There have been infection control issues with private finance initiative built operating theatres (Unison 2003, Ontario Health Coalition 2005). The aim of this article is to address these issues as they relate to infection control and prevention.
Topical Negative Pressure Therapy: Current Concepts and Practice
Authors: Malahias M , Hindocha S , Saedi F , Mcarthur P
Published: December 2017

Research into topical negative pressure therapy (TNPT) started in 1989 with Dr Louis Argenta and Prof Michael Morykwas of Wake Forest University School of Medicine in North Carolina, USA.

In 1997, Morykwas and Argenta concluded that TNPT both enhanced granulation tissue formation and helped bacterial clearance, through the actions of negative pressure Armstrong and Lavery confirmed this in 2005, concluding that TNPT therapy was promoting the development of granulation tissue

Numerous other studies have proved that TNPT is beneficial for a myriad of other wounds including: sternotomy wounds, extensive de-gloving injuries, various soft tissue injuries prior to surgical closure), skin grafting, pressure sores, leg ulcers, sacral pressure ulcers, acute traumatic soft tissue defects, and soft tissue defects following rigid stabilisation of lower extremity fractures.

This review aims to summarise the clinical and scientific concepts of TNPT and its future applications.
The Power of Elaine's Story: A Personal Reflection
Authors: Kamensky J
Published: December 2017

There will be few perioperative students (nursing, ODP) or surgical and anaesthetic trainees, who will not have heard of the tragic case of Mrs Elaine Bromiley. A 37 year old mother of two, admitted for an elective endoscopic sinus surgery and septoplasty, Elaine suffered major complications during the induction of general anaesthesia that resulted in her death due to hypoxic brain damage (Harmer 2005).

As a student ODP, watching the DVD of the reconstruction of the events that contributed to Elaine's death, I am conscious of the profound impact it had on me and the key learning points for practice.
The Trainee's Voice: Recognising the Importance of Preoperative Briefings for Surgical Trainees
Authors: Bethune R , Blencowe Ns
Published: December 2017

Preoperative briefings and the ‘time out’ component of the WHO surgical safety checklist offer unique opportunities to improve the technical and non-technical skills of surgical trainees. The addition of a training briefing – a succinct adjunct to these processes – offers a novel method by which training opportunities can be maximised and learning needs better understood by theatre staff. However, more training is needed for staff in the use of briefings and checklists to achieve the best possible benefit for trainees and patients.
Reducing Same Day Cancellations Due to Patient Related Factors in Elective Orthopaedic Surgery: Experience of a Centre in the Uk
Authors: Singhal R , Warburton T , Charalambous Cp
Published: December 2017

Cancellations on the day of surgery represent a major wastage of resources and can impose significant distress on patients. Minimising same day cancellations can improve cost effectiveness of operating theatre running. The aim of the study was to determine the impact of administering a questionnaire, by phone to elective orthopaedic patients, the week prior to surgery. This questionnaire was aimed at identifying factors that could lead to same day cancellation for patient related reasons. The questionnaire was administered to elective orthopaedic patients over a nine month period. The rate of same day cancellations due to patient related reasons in this cohort (Phase 2) was compared with a previous cohort assessed over a five month period when the questionnaire was not in place (Phase 1). Administering the questionnaire reduced the same day cancellations due to patient reasons from 11 out of 110 (10%) to 2 out of 118 (1.60%) (p = 0.01). Theatre wastage in terms of national tariff lost due to cancellations was reduced from £25,881 to £1,650 (p<0.001). The study concludes that administering a questionnaire aimed at addressing patient related reasons can significantly reduce same day cancellations.
A Reflection on the Experiences of Implementing Gynaecology Robotic Surgery
Authors: Taylor D
Published: December 2017

When the decision is made to introduce a new technological innovation, it is only the very start of a complex journey. New technology can often be met with mixed emotions from the perioperative team such as excitement and apprehension. If the correct implementation process is not established at the beginning, perioperative teams can fear change instead of embracing it; this could also potentially have a negative effect on the desired result, which is the delivery of safe patient care.
Improving Efficiency in Robotic Theatres in the Royal Wolverhampton Nhs Trust: A Gynaecology Theatres Perspective
Authors: Harding V , Williams J
Published: December 2017

Improving efficiency within the operating theatre is always a key concern when running a successful operating list. However, with robotic surgery, this can become paramount. Robotic procedures require a more technical set up, additional planning, and good solid communication within the multidisciplinary team. Efficiency needs to be at the forefront of everyone's mind. Forward planning requires knowledge of the procedures being carried out and adequate training with the robot. Trouble shooting will also improve efficiency in robotic surgery, as being able to expect the unexpected can be a major advantage. This article looks at the hurdles encountered by the theatre team at Royal Wolverhampton Trust at the implementation of the robotic programme, and how the theatre team made adjustments to working practice in order to minimise disruption and maximise efficiency.
Nursing and Midwifery Revalidation
Authors: Cannon F , McCutcheon K
Published: December 2017

This article details the Nursing and Midwifery Council revalidation requirements essential for all registered nurses and midwives in the United Kingdom. Nursing revalidation is effective from April 2016 and is built on the pre-existing post-registration education and practice. Unlike the previous process, revalidation provides a more robust system which is clearly linked to the code and should assist towards the delivery of quality and safe effective care.
Reflecting on the Development of the Decontamination Services: Pondering the Past, Presenting the Future
Authors: Cobbold A , Lord S
Published: December 2017

This paper explores the historical developments of the UK decontamination services workforce over the past century. It will look back at how the services originated and look forward towards what the future could hold. This evolving workforce has progressed from traditional in-house training programmes towards accredited education, aiming to pave the way towards becoming a new profession – the healthcare scientist. The paper also explores some of the main drivers behind how previous healthcare professions have developed, and how these may impact on evolving professions such as decontamination services. The paper concludes by highlighting the importance of ensuring that staff are educated to national standards and keep abreast of current healthcare advances, in order to develop and retain the sterile services leaders of the future.
‘The Sister’ in the Early Days of the Nhs
Authors: Ellis Harold
Published: December 2017

All the readers of this journal will have read and heard about the ward and operating theatre sisters in ‘the old days’. What were they really like, and what was it like to work with them in the hospitals of those far-off times? I entered the old Radcliffe Infirmary Oxford in the summer of 1945, just as World War II was drawing to a close, as a 19 year old student to start my clinical training. I then qualified in July 1948, the very month the NHS came into being, and started my surgical career as house surgeon. The Radcliffe was the only acute hospital in the town and dealt with all emergency admissions. In addition, we worked at the Churchill Hospital, then a hutted hospital, erected during the War to deal with Canadian military casualties and now handed over for civilian use. Elective orthopaedics was carried out at the Wingfield Morris Hospital, later the Nuffield Orthopaedic Centre. The patients here were mostly children with bone and joint tuberculosis or poliomyelitis. The Slade Isolation Hospital dealt with the infectious fevers; I was admitted there twice as a student, with first chicken pox and then measles, both caught from my patients!
So, you Think you Would like to Publish?
Authors: Hains Toni
Published: December 2017

Nurses are becoming much more active in the academic world. A recent survey I conducted into a specialty group of Registered Nurses showed 42 (54%) of respondent holding or working towards a Master Degree in the nursing field. The suggestion that nurses are undertaking higher education courses is also supported by the Australian Bureau of Statistics who in 2012 cited nurses as occupying 5% of all higher education courses conducted in Australia (Australian Bureau of Statistics 2013).
Nice Guidance on Interventional Procedures: The Perspectives of a New Clinical Advisor
Authors: Harris Kevin
Published: December 2017

A commitment to delivering the very best care to patients is central to the work of all clinicians. The introduction of new interventional procedures to clinical practice is essential to improve patient care. Yet, history tells us that when interventional procedures are introduced without due regard to their efficacy and safety there can be significant adverse consequences for the patient (DH 2001). Nearly three decades ago the concept of Clinical Governance was introduced to the NHS to address these concerns. The aim was to allow continuous improvement in the quality of services while safeguarding patient safety and ensuring high standards of care (Scally & Donaldson 1998).
Astley Cooper's Ligation of the Abdominal Aorta
Authors: Ellis Harold
Published: December 2017

I have to confess that Sir Astley Cooper (1768–1841), of Guy's Hospital, is high on my list of “surgical heroes”. Indeed, I chose his remarkable and successful operation of amputation at the hip joint as my first article in this series. Among his other astonishing “firsts” must surely be his ligation of the abdominal aorta for a patient with a leaking iliac aneurysm.
Airway Management of the Morbidly Obese Patient
Authors: Hodgson E
Published: December 2017

A UK study found that obese patients are twice as likely as non-obese patients to develop airway problems during general anaesthesia (Cook et al 2011). This article focuses on airway management of morbidly obese patients during anaesthesia and examines the associated respiratory, gastric, and existing co-morbidity complications that can be expected. Strategies that practitioners can use to reduce these risks are discussed.
The Rise of Inventory Management in Operating Theatre Departments
Authors: Hall N
Published: December 2017

The procurement and inventory management challenges within our healthcare sector have been the subject of debate for some time, but with new government initiatives recently introduced, procurement and inventory management have become the new areas of focus behind much-needed change within the NHS back-office.
Using a Stop/Go Protocol in the Preoperative Area to Increase Patient Safety
Authors: Harris AM , Preece K , Harris C
Published: December 2017

A multitude of surgeries are performed each year and 15% of cases have an adverse event, most of which are preventable. A culture of safety must be adopted by the entire surgical team. A preoperative checklist in addition to the intraoperative checklist can help decrease errors. We adapted a Stop/Go process in the preoperative area which had to be completed prior to moving the patient into the operating room. We examined adverse events before and after this process. Adverse events decreased from 1.5% to nearly 0% over the time examined. The Stop/Go preoperative checklist, adapted to our specific operating room needs, helped to decrease adverse events.
An Exploration of the Factors that Influence the Successful Implementation of the World Health Organization Surgical Safety Checklist
Authors: Robertson-Smith B
Published: December 2017

This study presents an exploration of the factors which influence the successful implementation of the WHO Surgical Safety Checklist. A mixed methodological approach using a questionnaire was sent to 348 healthcare professionals in a single NHS trust who use the WHO checklist. 103 questionnaires were returned; five were incomplete and discarded. Data was analysed from 98 questionnaires. Results were evaluated alongside recommendations from a previous audit that took place in this trust in 2013. 63% of surgeons and 54% of anaesthetists within the trust remain untrained as regards the surgical safety checklist. Sign out was the poorest performing component; time out also needed improvement. The biggest obstacle in successful implementation was found to be disengagement of the surgical team. Simulation and team training can enhance non-technical skills, improving communication between staff. The study concludes that differing staff perceptions were found to create barriers to successful implementation of the checklist. Training of all staff is necessary for effective communication within the operating theatre.
Simple Foot Holder Saves Your Theatre Practitioner's Back: A Technical Tip
Authors: Kurup HV , Katugampola A , McClean C
Published: December 2017

We provide a simple technique for foot positioning during preoperative skin preparation. Prone headrest made of gel polymer is used to support the patient's leg to keep the foot up. This will protect your operating theatre practitioner's back avoiding any mechanical back strain. It will also save money by preventing sickness and reducing workplace litigation from back injuries.
An Interview with Martin Bromiley
Authors: Fisher M Guckian
Published: December 2017

Many of you will have heard of Martin Bromiley and many will have met him over the years since he became a prominent figure within the environs of perioperative care. Martin came into our lives as a result of the tragic death of his wife Elaine Bromiley a 37 year old mother of two who was admitted for an elective endoscopic sinus surgery. Elaine suffered major complications during the induction of general anaesthesia that resulted in her death due to hypoxic brain damage.
Calculating Drug Infusion Rates
Authors: England J
Published: December 2017

Intravenous drug administration is necessary for most patients who undergo general anaesthesia, and calculating correct dosages is essential, if those patients are to benefit from the proper therapeutic effects from their administered drugs, rather than suffering from any toxic effects which might result from overdosing.
Man behind the Laryngoscopy is Important
Authors: Zaidi N
Published: December 2017

Tracheal intubation is the most fundamental and effective resuscitation skill in many emergency situations. It is also performed to facilitate various surgical procedures and mechanical ventilation in critically ill patients. Tracheal intubation is also one of the most commonly taught clinical skills.
The Human Element of Giving and Receiving Feedback
Authors: Stott DL
Published: December 2017

Human factors is the scientific subject that concerns the understanding of interactions amongst humans, it is what affects behaviour and performance in the work place (Ives & Hillier 2015), particularly in high risk areas such as the aviation industry and healthcare. In this opinion piece it will be limited to the healthcare profession.
Preceptorship for Practitioners New to Theatre Departments
Authors: Richardson C
Published: December 2017

The aim of this study was to identify the influences and constraints of a preceptorship programme for perioperative practitioners and to assess the potential impact on the learning process. The programme takes into account the values of the NHS trust for which I work: to care about our patients, quality, the future, serving local people, improvement and being stronger together. This foundation NHS trust has a vision for the future that puts the patient at the heart of everything it does and is guided by the principles and values about which the people care deeply.
Case Study: Laparoscopic Appendicectomy Requirements and Human Factors Surrounding Emergency Care
Authors: Widdecombe J , Owen M
Published: December 2017

The purpose of this case study is to inform practitioners of the requirements for non-scheduled surgery and the legal, professional and ethical issues surrounding emergencies. Areas for learning include the surgical requirements for appendectomy, evaluation of the differences between scheduled and unscheduled care, and consideration of the vital role that human factors play in emergency situations.
Digital Health and Perioperative Care
Authors: Fotis Theofanis
Published: December 2017

According to the U.S. Food and Drug Administration ‘the broad scope of digital health includes categories such as mobile health (mHealth), health information technology (IT), wearable devices, telehealth and telemedicine, and personalised medicine, and is used by providers and other stakeholders in their efforts to reduce inefficiencies, improve access, reduce costs, increase quality, and make medicine more personalised for patients (FDA 2016). More recently, Paul Sonier, a digital health strategist and founder of the Linkedin Digital Health Group with more than 40,000 members, defined digital health as ‘the convergence of the digital and genomic revolutions with health, healthcare, living, and society’ ( storyofdigitalhealth.com 2016).