bluuebunny/crossref_metadata_2025 huggingface dataset:
Dynamic autoregulation of cerebral blood flow measured non-invasively with fast diffuse correlation spectroscopy
Authors: Parthasarathy Ashwin B , Gannon Kimberly P , Baker Wesley B , Favilla Christopher G , Balu Ramani , Kasner Scott E , Yodh Arjun G , Detre John A , Mullen Michael T
Published: December 2017

Cerebral autoregulation (CA) maintains cerebral blood flow (CBF) in the presence of systemic blood pressure changes. Brain injury can cause loss of CA and resulting dysregulation of CBF, and the degree of CA impairment is a functional indicator of cerebral tissue health. Here, we demonstrate a new approach to noninvasively estimate cerebral autoregulation in healthy adult volunteers. The approach employs pulsatile CBF measurements obtained using high-speed diffuse correlation spectroscopy (DCS). Rapid thigh-cuff deflation initiates a chain of responses that permits estimation of rates of dynamic autoregulation in the cerebral microvasculature. The regulation rate estimated with DCS in the microvasculature (median: 0.26 s−1, inter quartile range: 0.19 s−1) agrees well (R = 0.81, slope = 0.9) with regulation rates measured by transcranial Doppler ultrasound (TCD) in the proximal vasculature (median: 0.28 s−1, inter quartile range: 0.10 s−1). We also obtained an index of systemic autoregulation in concurrently measured scalp microvasculature. Systemic autoregulation begins later than cerebral autoregulation and exhibited a different rate (0.55 s−1, inter quartile range: 0.72 s−1). Our work demonstrates the potential of diffuse correlation spectroscopy for bedside monitoring of cerebral autoregulation in the microvasculature of patients with brain injury.
The Concept of Grooming and How It Can Help Victims
Authors: Berliner Lucy
Published: December 2017

This commentary describes the clinical benefits of the concept of “grooming” for certain types of sexual abuse situations.
Tribological properties of surface topography in ultrasonic vibration-assisted grinding of zirconia ceramics
Authors: Li Zhihua , Zheng Kan , Liao Wenhe , Xiao Xingzhi
Published: December 2017

In order to clarify the friction phenomenon of zirconia ceramics in the dental prosthodontics, tribological properties of surface topography in ultrasonic vibration-assisted grinding (UVAG) are studied in this work. The mechanism of material removal is researched to introduce the discontinuous grooves in UVAG theoretically. The UVAG experiments are conducted on zirconia ceramics. Through investigating and comparing experimental results, it is found that UVAG surface has better tribological properties compared with diamond grinding surface. 3D surface roughnesses of UVAG surface are improved when suitable spindle speed, large feed, small cutting depth, and large vibration amplitude are adopted. Surface topography in UVAG changes from thorn scaly to discontinuous shallow furrow when feed increases and spindle speed decreases. The discontinuous grooves are most apparent when vibration amplitude is maximum. Furthermore, the friction coefficient is experimentally studied. The results indicate that there is no significant difference among all the friction coefficients in UVAG. Proper cutting and vibration parameters can improve the average friction coefficient.
Learning from guidelines on the sexual healthcare of men who have sex with men
Authors: Clutterbuck Dan
Published: December 2017

The British Association for Sexual Health and HIV (BASHH) United Kingdom national guideline on the sexual health care of men who have sex with men (MSM) was published in electronic format in this journal in 2018. In common with other BASHH guidelines, the document fulfils the dual role of scrutinising and evaluating the available evidence according to the accredited Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology, as well as the often more challenging job of codifying and summarising expert opinion in areas where the evidence base is incomplete or lacking. In addition to the learning gained from developing the recommendations included in the final document, further benefit was derived from the process through a number of learning and development actions for the writing group and through this the MSM special interest group and the wider sexual health community.
Late-Holocene dynamics of sea-surface temperature and terrestrial hydrology in southwestern Africa
Authors: Granger Robyn , Meadows Michael E , Hahn Annette , Zabel Matthias , Stuut Jan-Berend W , Herrmann Nicole , Schefuß Enno
Published: December 2017

Southwest Africa is an important region for paleo-climatic studies, being influenced by both tropical and temperate climate systems and thus reflecting the interplay of variable controls. The aim of this study was to unravel the interaction of sea-surface temperature (SST) changes in the southernmost Benguela upwelling system with precipitation changes in South Africa’s winter rainfall zone (WRZ) during the late Holocene. Therefore, a marine sediment core from the southernmost Benguela upwelling system was investigated to reconstruct climate changes in this region for the past ~2000 years. Grain size and geochemical analyses were conducted to reconstruct changes in fluvial sediment discharge and weathering intensity, while SST changes were estimated using alkenone paleo-thermometry. Results show that the southernmost Benguela behaves distinctly in comparison with the rest of the Benguela system reflecting amplified SST changes. Decreasing SSTs accompanied increasing river discharge during times of increased precipitation in the WRZ, reflecting northerly shifted westerly winds during austral winter. We infer a control of past SST changes by processes not analogous to modern processes driving seasonal SST changes by changes through upwelling intensity. The findings suggest that late-Holocene SST changes in the southernmost Benguela upwelling system and the precipitation in the WRZ were both driven by latitudinal shifts of the austral westerly wind belt and associated changes in advection of cold sub-Antarctic waters and/or changes in Agulhas leakage of warm Indian Ocean waters.
FT-NIR the method of choice to verify the authenticity of extra virgin olive oils
Authors: Kramer John KG , Azizian Hormoz
Published: December 2017

Fourier transform near infrared spectroscopy was recently demonstrated to be an excellent method to evaluate the authenticity and adulteration of extra virgin olive oil. Since this method is matrix dependent, it takes a chemical fingerprint of all the components which sets it apart from the targeted methods. Careful examinations of the Fourier transform near infrared spectra lead to the identification of a minor carbonyl overtone absorption at 5269 cm−1 associated with the volatile fraction in extra virgin olive oil that appears to be a reliable indicator of authenticity. The same spectra were used to identify the fatty acids present in the oil using models based on comparison to accurate GC data. Gravimetric mixtures of extra virgin olive oil with refined edible oils were then prepared to develop PLS1 calibration models to identify possible adulterants and by how much. The great varietal difference in olive oils made it necessary to develop four unique sets of PLS1 calibration models for each extra virgin olive oil variety. As a result, an extra virgin olive oil acceptance specification was established.
How a cycle of information literacy assessment and instruction stimulates attitudes and motivations of LIS students: A competency-based case study
Authors: Pinto Maria , Fernández-Pascual Rosaura
Published: December 2017

The main goal of this study is better understanding of LIS students’ affective and effective status with regard to a range of basic information literacy competencies, through their attitudes – belief in importance (BI), motivations – self/efficacy (SE) and actual levels of knowledge and skills (KS). In order to check to what extent specific pedagogical intervention may result in an improvement, a cycle of combined instruction and assessment was implemented with the following steps: (1) pre-test on affective and actual values concerning information literacy competencies; (2) information literacy instruction on ‘content analysis’ subject; (3) post-test replicating the same questionnaires (ILHUMASS and EVALCI). Various statistical methods such as paired sample tests, factor analysis and correlations were used for data analysis. Some significant relationships between students’ attitudes, motivations and actual levels of knowledge and skills are confirmed, but not in all competencies. Instruction has greater impact on students’ self-efficacy (SE) and lower on belief-in-importance (BI). Latent structures at pre- and post-instruction remain stable in SE and vary considerably in BI. In sum, instruction/assessment experience has been relevant for LIS students’ motivations (SE), ant to a lesser extent for their attitudes (BI). Thus, both information literacy dimensions should be approached separately, with higher emphasis on BI. Though limited to a group of LIS students from one institution, a new research path towards better understanding of the relationships between their affective and actual values on information literacy competencies is suggested. Through the combination of paradigms on both information literacy frameworks and information literacy competencies, outstanding results on the relationships between LIS students’ affective and actual status concerning information literacy competencies are delivered.
Image schemas across modes and across cultures: Communicating horror in Philip Roth’s Nemesis and Ridley Scott’s Alien
Authors: Senkbeil Karsten
Published: December 2017

This paper examines two cultural texts, Philip Roth’s Nemesis and Ridley Scott’s Alien, based on cognitive linguistic approaches to figurative language in communication, cognitive metaphor theory and its pragmalinguistic applications. It explores how far very similar image schemas are functionally employed across modes and genres to communicate a certain affect, in this case horror, to a global, culturally diverse audience. The results are put into the perspective of ongoing debates about the universality and variation of metaphors and image schemas across types of texts and, in extrapolation, across cultures. The paper aims to contribute to discussions about the functions and modalities of intercultural transfers of literature and popular culture, combining the cognitive, the linguistic and the cultural dimension of literary texts communicating across cultures.
Self-consistent micromechanical approach for damage accommodation in rock-like polycrystalline materials
Authors: Pouya Amade , Zhu Cheng , Arson Chloé
Published: December 2017

In quasi-brittle polycrystalline materials, damage by cracking or cleavage dominates plastic and viscous deformation. This paper proposes a micromechanical model for rock-like materials, incorporating the elastic-damage accommodation of the material matrix, and presents an original method to solve the system of implicit equations involved in the formulation. A self-consistent micromechanical approach is used to predict the anisotropic behavior of a polycrystal in which grain inclusions undergo intragranular damage. Crack propagation along planes of weakness with various orientation distributions at the mineral scale is modeled by a softening damage law and results in mechanical anisotropy at the macroscopic scale. One original aspect of the formulated inclusion–matrix model is the use of an explicit expression of Hill’s tensor to account for matrix ellipsoidal anisotropy. To illustrate the model capabilities, a uniaxial compression test was simulated for a variety of polycrystals made of two types of mineral inclusions with each containing only one plane of weakness. Damage always occurred in only one mineral type: the damaging mineral was that with a smaller shear modulus (respectively higher bulk modulus) when bulk modulus (respectively shear modulus) was the same. For two minerals with the same shear moduli but different bulk moduli, the maximum damage in the polycrystal under a given load was obtained at equal mineral fractions. However, for two minerals with different shear moduli, the macroscopic damage was not always maximum when the volume fraction of two minerals was the same. When the weakness planes’ orientations in the damaging mineral laid within a narrow interval close to the loading direction, the macroscopic damage behavior was more brittle than when the orientations were distributed over a wider interval. Parametric studies show that upon proper calibration, the proposed model can be extended to understand and predict the micro–macro behavior of different types of quasi-brittle materials.
Eight Events for Entering a PhD: A Poetic Inquiry Into Happiness, Humility, and Self-Care
Authors: Moore Amber
Published: December 2017

These two poetry clusters comprised a total of eight poems that offer (a) reflective, “past” event poetry and (b) hopeful “humbling” event pieces for future use. Inspired by scholarship examining novice academics’ emotions upon entering graduate school, each poem outlines a potential path to accessing happiness, humility—an especially important quality in graduate school, particularly while writing—and ideas for self-care. As such, through poetic inquiry, which encourages “poetic living,” this article offers avenues for engaging with authorial voice through “vox autobiographia/autoethnographia,” to confront emotional “messiness,” with a “tender” poetic approach.
The impact of tourism firm’s philanthropy decision on its business objective
Authors: Wang Keling , Lin Chien-Pang , Chen Ming-Hsiang , Gillard Evelina
Published: December 2017

This study explains the impact of tourism firm’s corporate philanthropy (CP) decision on its business objective in a competition environment from a strategic management perspective. Key results are summarized as follows. First, tourism firms can use CP as an effective strategy to compete for higher sales revenue and achieve their organizational objective of higher profit if CP generates market competitiveness. Second, if only one of the two competing tourism firms gives to charity and CP generates market competitiveness, the tourism firm’s giving will deteriorate its competitor’s performance. Third, if CP induces no competitive advantage, neither competing tourism firm has an incentive to engage in CP.
Resonances of elastic rotor induced by roller bearing with consideration of cage vibration
Authors: Huang Dawei , Liu Yi , Liu Heng , Yi Jun
Published: December 2017

The rotor system supported by rolling bearings usually provides a resonance effect due to the nonlinearity of bearings. In this paper, the causes of these anomalous resonance effects are discussed by establishing coupling dynamic model of the flexible rotor-roller bearings system. The 4-degrees of freedom (DOF) Timoshenko finite element and the free interface modal synthesis technique are used to model the elastic rotor. Then, a piece-wise flexible rotor model coupling with a 5-DOF dynamic bearing model is obtained by fixing the inner race to rotor. And waterfall plots are mainly obtained using the method of adaptive Runge-Kutta. Comparisons are made between the simulated response of the rotor-simplified bearing and rotor-bearing coupling models. Firstly, the vibration of cage can cause supercritical anomaly vibration except for the subcritical vibration induced by the variable compliance vibration. Secondly, the vibration amplitude of the coupling model is lower than the rotor-nonlinear springs model.
Analysis of air-, moisture- and solvent-sensitive chemical compounds by mass spectrometry using an inert atmospheric pressure solids analysis probe
Authors: Mosely Jackie A , Stokes Peter , Parker David , Dyer Philip W , Messinis Antonis M
Published: December 2017

A novel method has been developed that enables chemical compounds to be transferred from an inert atmosphere glove box and into the atmospheric pressure ion source of a mass spectrometer whilst retaining a controlled chemical environment. This innovative method is simple and cheap to implement on some commercially available mass spectrometers. We have termed this approach inert atmospheric pressure solids analysis probe ( iASAP) and demonstrate the benefit of this methodology for two air-/moisture-sensitive chemical compounds whose characterisation by mass spectrometry is now possible and easily achieved. The simplicity of the design means that moving between iASAP and standard ASAP is straightforward and quick, providing a highly flexible platform with rapid sample turnaround.
Differences between Slovak and Dutch patients scheduled for coronary artery bypass graft surgery regarding clinical and psychosocial predictors of physical and mental health-related quality of life
Authors: El-Baz Noha , Ondusova Daniela , Studencan Martin , Rosenberger Jaroslav , Reijneveld Sijmen A , van Dijk Jitse P , Middel Berrie
Published: December 2017

Background:

Differences in health-related quality of life in coronary artery disease patients and associated factors between patients of central and western European descent are rarely investigated. We aim to test differences between Dutch and Slovak health-related quality of life, whether nationality predicted health-related quality of life and if standardised beta weights of health-related quality of life determinants differ across countries.

Design:

An observational multicentre study at university cardiac centres in the Netherlands and Slovakia.

Methods:

In 226 coronary artery disease patients, health-related quality of life was measured by the Short Form Health Survey 36, anxiety and depression were measured using the Hospital Anxiety and Depression Scale, and type D personality was assessed with the 14-item Type D Scale. Multivariate analysis was used to explore the effect of patient characteristics on the physical and mental component summaries. Estimates of each predictor’s beta value of the physical and mental component summaries in the Slovak and Dutch patient sample were separately calculated using the Cummings criterion for comparison of two independent betas.

Results:

Stronger predictors of physical health-related quality of life in Slovak patients were educational level, current smoking, poor functional status, history of diabetes and amount of social support. In Dutch patients, only more symptoms of depression was a stronger predictor ( P<0.05). Regarding Slovak mental health-related quality of life, stronger predictors were educational level, current smoking and amount of social support. Female gender, history of myocardial infarction and more symptoms of depression were stronger predictors in Dutch patients ( P<0.05).

Conclusion:

Descent and differences between both populations in determinants of health-related quality of life should be considered while planning care, follow-up, health education and rehabilitation.
SOS1 gene polymorphisms are associated with gestational diabetes mellitus in a Chinese population: Results from a nested case-control study in Taiyuan, China
Authors: Chen Qiong , Yang Hailan , Feng Yongliang , Zhang Ping , Wu Weiwei , Li Shuzhen , Thompson Brian , Wang Xin , Peng Tingting , Wang Fang , Xie Bingjie , Guo Pengge , Li Mei , Wang Ying , Zhao Nan , Wang Suping , Zhang Yawei
Published: December 2017

Gestational diabetes mellitus is a growing public health concern due to its large disease burden; however, the underlying pathophysiology remains unclear. Therefore, we examined the relationship between 107 single-nucleotide polymorphisms in insulin signalling pathway genes and gestational diabetes mellitus risk using a nested case-control study. The SOS1 rs7598922 GA and AA genotype were statistically significantly associated with reduced gestational diabetes mellitus risk ( ptrend = 0.0006) compared with GG genotype. At the gene level, SOS1 was statistically significantly associated with gestational diabetes mellitus risk after adjusting for multiple comparisons. Moreover, AGGA and GGGG haplotypes in SOS1 gene were associated with reduced risk of gestational diabetes mellitus. Our study provides evidence for an association between the SOS1 gene and risk of gestational diabetes mellitus; however, its role in the pathogenesis of gestational diabetes mellitus will need to be verified by further studies.
Biomarkers of Stroke Recovery: Consensus-Based Core Recommendations from the Stroke Recovery and Rehabilitation Roundtable
Authors: Boyd Lara A. , Hayward Kathryn S. , Ward Nick S. , Stinear Cathy M. , Rosso Charlotte , Fisher Rebecca J , Carter Alexandre R. , Leff Alex P. , Copland David A. , Carey Leeanne M. , Cohen Leonardo G. , Basso D. Michele , Maguire Jane M. , Cramer Steven C.
Published: December 2017

The most difficult clinical questions in stroke rehabilitation are “What is this patient’s potential for recovery?” and “What is the best rehabilitation strategy for this person, given her/his clinical profile?” Without answers to these questions, clinicians struggle to make decisions regarding the content and focus of therapy, and researchers design studies that inadvertently mix participants who have a high likelihood of responding with those who do not. Developing and implementing biomarkers that distinguish patient subgroups will help address these issues and unravel the factors important to the recovery process. The goal of the present paper is to provide a consensus statement regarding the current state of the evidence for stroke recovery biomarkers. Biomarkers of motor, somatosensory, cognitive and language domains across the recovery timeline post-stroke are considered; with focus on brain structure and function, and exclusion of blood markers and genetics. We provide evidence for biomarkers that are considered ready to be included in clinical trials, as well as others that are promising but not ready and so represent a developmental priority. We conclude with an example that illustrates the utility of biomarkers in recovery and rehabilitation research, demonstrating how the inclusion of a biomarker may enhance future clinical trials. In this way, we propose a way forward for when and where we can include biomarkers to advance the efficacy of the practice of, and research into, rehabilitation and recovery after stroke.
The social origins of gender differences in anticipated feelings of guilt and shame following delinquency
Authors: De Boeck Arne , Pleysier Stefaan , Put Johan
Published: December 2017

In this study, we investigate gender differences in adolescents’ anticipated feelings of guilt and shame for engaging in shoplifting and retaliatory violence. More specifically, we examine the extent to which interpersonal relations with parents and teachers, perceived peer delinquency and traditional gender role beliefs have different effects on levels of shame-guilt among males and females, and to what extent these variables mediate gender differences in shame-guilt. We use data collected in a sample of 852 adolescents in Genk, a multi-ethnic city in the north-east of Belgium. Our findings confirm those of earlier research indicating that females experience a considerably higher threat of shame-guilt for engaging in delinquency than males. Factors explaining males’ and females’ anticipated shame-guilt feelings are similar in the case of shoplifting, but different in the case of violence. Differential exposure to peer delinquency and parental follow-up partially mediate the effect of gender on shame-guilt for engaging in shoplifting. Among males, endorsement of traditional masculinity predicts lower levels of shame-guilt for engaging in shoplifting and violence. Among females, endorsement of traditional femininity predicts lower levels of shame-guilt for engaging in shoplifting, but has no effect on shame-guilt for engaging in violence. We discuss the implications of our findings for understanding the contribution of shame-guilt to the social control of delinquency across gender.
Tension between Policy and Practice
Authors: Dickson Niall , Williams Marilyn
Published: December 2017

This is the first in a series of articles in which the political influences on the health service are examined. Niall Dickson, currently Social Affairs Editor with the BBC, gave this paper at Congress 1999 - which had the overall theme of Rewind, Pause, Fastforward. Niall Dickson is a former editor of Nursing Times (1983-1988) and he has a continuing interest in matters affecting health and social policy.
A Train of Events
Authors: Waller Olivia , Waller Frank , Williams Marilyn , County Bernadette
Published: December 2017

What sort of relationship do you have with your Sterile Services Department? Do you know what goes on in that department? Do their staff know what goes on in your department? In making a strong case for recognised training in Sterile Services, Olivia and Frank Waller see an exchange of experiences between operating theatres and SSD as a valuable part of the learning process. Too often separate departments only contact each other when things go wrong. The authors quote a damning judgement from an enquiry following the death of five patients: a powerful reminder of the fact that perioperative care gives only one chance to get it right. Just because you work in theatre does not mean you can ignore or take for granted those departments on which you rely for supplies and services. Get involved, find out and understand what they can do for you and what you can do for them.
The Surgical Neonate
Authors: Clancy John , McVicar Andrew , Boyd Stevie
Published: December 2017

This is the third article in the Concepts in Anatomy series, based on Physiology and Anatomy, a homeostatic approach, by John Clancy and Andrew McVicar. In this article, Stevie Boyd discusses some of the problems encountered in neonatal surgery.
Manna from Heaven: Welcome to the Information Age!
Authors: Wicker Paul
Published: December 2017

This article is based on a talk given by Paul Wicker at the EORNA Conference, held 11-14 May 2000 in Bergen, Norway. It looks at the implications of computers and information technology on nursing and the healthcare profession.
Annualised Hours
Authors: Campbell Claire
Published: December 2017

In this third article in the Improving Working Lives series, Claire Campbell introduces and explores the concept of annualised hours.
Developments in the Care of Patients who Require Surgery for an Abscess
Authors: Biggins Jill
Published: December 2017

This is the first of a series of three articles which won the Alison Bell Writer's Award this year. Jill Biggins won first prize for this article which looks at a way of improving the patient's experience of day surgery. The Writer's Award is sponsored by NATN and Regent Medical.
Bullying and Harassment in Perioperative Settings
Authors: Gilmour Diane , Hamlin Lois
Published: December 2017

This article explores the concepts of bullying and harassment, defines the terms and their implications, and explores similarities and differences between the two. It also examines pertinent legislation and identifies strategies to raise awareness and optimise a bullying and harassment-free perioperative environment. Bullying and harassment in the workplace was the focus of this presentation at NATN Congress 2002. Challenging behaviours involving patients and carers is another topic in itself.
Implementing Research in Practice
Authors: Bassett Chris , Bassett Jane , Tanner Judith
Published: December 2017

The final part of the research process is the implementation of research into practice. This article will outline some of the barriers to research and explore some of the ways you might overcome them. So, following your reading you have found a piece of research that you want to have a go at implementing. You have discussed it with the manager and there is agreement that it will be implemented. But what is the next step? What is the best way to actually implement the research?
Assistance for Anaesthetists in Scotland
Authors: Howie John Cameron
Published: December 2017

Trained and dedicated anaesthetic assistance is regarded as an essential prerequisite for the delivery of a minimum standard of care. A recent report from the Scottish Medical and Scientific Advisory Committee sets out a strategy for recruitment, training and retention of anaesthetic assistants in Scotland.
An Ethical Dilemma is it Ever Acceptable to Lie to a Patient?
Authors: Fowler Esther
Published: December 2017

Ethical decision-making, and the choice of whether or not to be truthful, is an important part of everybody's life. For nurses, decisions such as these are made every day and affect not just themselves, but also the lives of others. This article will examine the ethics of truth-telling from the point of view of a theatre nurse dealing with a seriously ill patient.
Beneficence and Autonomy in Nursing a Moral Dilemma
Authors: Kennedy Wendy
Published: December 2017

Nurses frequently have to make decisions which require moral judgements, influenced by the ethical standards expected of the profession. They have a duty of care, promoting good, and minimising harm, whilst acting in the patients’ best interests. In complicated situations it is not uncommon to wonder whether further ethical consideration is pertinent before a decision or action is made.
The Expert Witness
Authors: Mewburn Judy
Published: December 2017

This article defines the role of the expert witness. The author outlines what is needed to become an expert witness and gives an overview of what is involved, highlighting the positive as well as the negative aspects of the task.
Necrotising Fasciitis
Authors: Mason Philippa
Published: December 2017

Necrotising fasciitis is a rare soft tissue infection, primarily involving the superficial fascia and resulting in extensive undermining of the surrounding tissues. The author of this article describes her experience when encountering this distressing condition.
Awareness during Anaesthesia: What can be Done to Prevent it?
Authors: Pollard Erin
Published: December 2017

Awareness during general anaesthesia is a potentially traumatising risk of any general anaesthetic, which can have lasting effects on the patients who experience it. This article assesses the issues and causes of anaesthetic awareness, together with the current status of research being conducted into its prevention, and the effect of market forces and litigation.
Non-Heart Beating Organ Donation: A Case Study
Authors: Stirling John
Published: December 2017

The aim of this case study is to discuss the clinical management of a non-heart beating organ donor. This case study will concentrate in particular on the clinical assessment of the potential donor patient undertaken by the donor transplant coordinator (DTC) and the donation process up to the time of transplantation. The author will also describe the differences between heart beating and non-heart beating donors and discuss how transplantation can benefit renal recipient patients.
Has Not Passed Urine: But is the Bladder Full?
Authors: Carrington Fiona
Published: December 2017

Is bladder volume of concern to the perioperative team when the patient is undergoing a procedure not related to the same anatomical area? A common scenario is that the patient is requested to void prior to leaving the ward and their word taken that they have done so. The patient then enters the theatre environment and the only time that urinary function is taken into account is if the blood pressure falls and kidney function needs to be monitored.
The Foley Catheter
Authors: Ellis Harold
Published: December 2017

In the third of our biographical series tracing the origination of some of today's most commonly used surgical instruments and the people behind them, Professor Ellis explores the history of the catheter, and the breakthrough design by American urologist Frederick Foley.
Fool's Gold or Real Gold?
Authors: Roxburgh Michelle , Gall Pat
Published: December 2017

The term evidence-based practice is not new. For over twenty years the debate has been ongoing about how to make it happen. To practice within an evidence base, practitioners must determine if the evidence available is relevant for the particular patient (DiCenso et al 1998). This article aims to contextualise, clarify and explore the meaning of evidence-based practice for perioperative practitioners and, through introducing two models, identify and categorise sources of evidence to base practice on.
Reducing the Risk of Surgical Fires: Are you Assessing the Risk?
Authors: Beesley John , Taylor Linda
Published: December 2017

In this article the authors reflect on a critical incident involving a fire in the operating theatre and review best practice for ensuring organisations assess potential fire hazards and manage the risks.
Practice Education: Delivering the Vision
Authors: Ferbrache Jill , Pearson Eloise
Published: December 2017

While acknowledging the inherent challenges of the practice education rhetoric being translated into reality, the aim of this paper is to examine the challenges, issues and innovations surrounding the delivery of education in practice within a departmental context. Organisational context, national initiatives, political directives and departmental challenges were added to the intrinsic educational issues which were required to be addressed in order for the authors’ shared educational vision to be delivered within their own sphere of responsibility.
Alleviating Stress with Humour: A Literature Review
Authors: Chinery Winifred
Published: December 2017

The use of humour was reviewed to establish whether it could be used constructively to reduce work-related stress within the perioperative environment. It is clear from the review that further research is required in order to gain a better understanding of the concept of humour and its uses in healthcare and it is hoped that this review will contribute towards the increasing body of knowledge in this field.
An Audit of Preoperative Blood Tests
Authors: Putnis Soni , Nanuck Joe , Heath Dugal
Published: December 2017

Purpose

Audit of the use of preoperative blood tests in elective general surgery in a district general hospital. Comparison is made with the National Institute for Health and Clinical Excellence (NICE) guidelines and recommendations.

Methodology

Retrospective audit of preoperative blood tests performed for elective general surgical patients in a district general hospital over a one month period.

Findings

Patients attending preoperative assessment for general surgery have blood tests performed in excess of the NICE guidelines. The most frequently requested test that is performed against NICE guidelines is a coagulation screen. This was requested in excess of the national guidelines in 17.8% of cases.

Practical implications

This audit highlights the overuse of preoperative blood tests and provides suggestions for improving efficiency and economics in the preoperative setting.

Originality/value of paper

There have been no published audits assessing the current practice against the 2003 NICE guidelines for the use of routine preoperative tests for elective surgery.
Intraoperative Handling and Wound Healing of Arthroscopic Portal Wounds: A Clinical Study Comparing Nylon Suture with Wound Closure Strips
Authors: Bhattacharyya Mayukh , Bradley Helen
Published: December 2017

This prospective, single-centre study compared wound closure methods in patients undergoing arthroscopy. Closure of arthroscopic portal wounds with sterile adhesive strips is effective and convenient for wound management. The method was associated with a reduced potential for infection, faster renewal of tensile strength, greater cost effectiveness, and better cosmetic effects comparing with suture closure. This method of wound closure may also reduce the incidence of needle stick injury in the theatre environment. Thereby the incidence of percutaneous exposure following a surgical procedure may not facilitate transmission of blood borne pathogens such as human immunodeficiency virus (HIV), hepatitis C virus and hepatitis B virus. As a result it may reduce litigation in today's changing healthcare climate.
Dame Agnes Hunt: Pioneer of Orthopaedic Nursing
Authors: Ellis Harold
Published: December 2017

As a young surgeon in the early 1950s, I trained in various orthopaedic units. Much of the work was concerned with children and young adults suffering from two devastating diseases: tuberculosis and poliomyelitis. These were to vanish almost entirely from our hospitals soon afterwards, thanks to Bacillus Calmette-Guérin (BCG), antibiotics and the polio vaccines. However, the dedicated nursing that long term orthopaedic patients of today still require –those with congenital deformities, spinal injuries, multiple traumas and so on – owes much to the teaching of Agnes Hunt, pioneer of orthopaedic care.
Health Economics: What Value to the Theatre Practitioner?
Authors: Evans Jeff , Lipp Allyson
Published: December 2017

Clinical effectiveness has become embedded into healthcare in the last decade. In juxtaposition with this philosophy lies health economics with its mantra of resources being finite, whilst the need for healthcare remains infinite. An outline of a provocative cost-benefit analysis is provided to increase the knowledge of health economics for those working in the operating department. This paper argues that cost effectiveness must be embedded within clinical effectiveness.
Ruth Watson FRCS: Surgeon in Nepal
Authors: Ellis Harold
Published: December 2017

In 1971, I was sent by the British Council to Nepal to teach and to operate. There, in the little town of Pokhra, I met the most extraordinary woman surgeon that I have ever encountered before or since. Her name was Ruth Watson. She was a slimly built, smiling young woman, dressed in a Nepalese sari and speaking to her staff in fluent Nepalese. She had arrived in Pokhra 20 years before, at the age of 25, and established a hospital there. Initially it was constructed out of matting, but this was soon replaced with corrugated iron Nissen huts. Because the metal walls shone in the blazing Nepalese sunshine the hospital came to be called the ‘Shining Hospital’ by the patients, and the name stuck. It served an enormous population from the far flung villages -mostly poor peasant farmers and their families. By the time of my visit, there were about 50 beds, a small operating theatre and a single-bedded labour ward. Ruth told me that she had once delivered two sets of twins synchronously on that one bed!
Surgical Gloves
Authors: Ellis Harold
Published: December 2017

Surgeons and obstetricians, over the centuries, were only too aware that accidental open injuries during their work, especially in a septic case, could lead to an infected wound, a fulminating illness and often death. Even before the bacterial nature of infection had been established in the mid 19th century, it was still obvious that this dangerous and often fatal condition was caused by the transfer of some poisonous material or ‘miasma’ from the patient to his surgeon. As long ago as 1758, an obstetrician named Walbaum protected his hands by covering them with sheep's caecum. Others used gloves of cotton, silk and leather. After Charles Goodyear developed the vulcanisation process to stabilise rubber in 1844, this became the material of choice for these rather crude protective gloves.
Clinical and Cost Effectiveness of Urethral Catheterisation: A Review
Authors: Scott Bevan Michael
Published: December 2017

Reducing the number of catheter-associated urinary tract infections (CAUTI) in the National Health Service (NHS) has the potential for large cost savings. This review identifies factors which affect the incidence rate of CAUTI, as well as the need for further studies investigating cost-effectiveness, particularly in the areas of silver alloy catheters and education.
The Early Days of Appendicectomy
Authors: Ellis Harold
Published: December 2017

I suppose the commonest abdominal emergency operation performed throughout most of the world today is an appendicectomy - usually through an abdominal incision of various shapes and now, increasingly, by laparoscopic surgery. The results are excellent, with a low morbidity and tiny mortality. Indeed, in my own experience of 40 years of surgery, (1948 to 1989), there was not a single death in the various units that I worked on, although we had some fairly hairy near-misses among patients with advanced peritonitis at the time of their surgery.
The Comparison of Double Gloving to Single Gloving in the Theatre Environment
Authors: Phillips Steven
Published: December 2017

The role of surgical gloving is to minimise the risk of surgical site infection (SSI) and to protect the surgical team from cross infection. However, different practitioners have different views as to when double gloving is appropriate, with many factors like speciality and procedure dictating their use. This review will look at best practice through the evidence available and provide recommendations for practice.
Alexis Carrel: Innovator Extraordinaire
Authors: Rothwell Ann
Published: December 2017

Alexis Carrel was awarded the 1912 Nobel Prize for Physiology or Medicine for pioneering surgical techniques in vascular surgery. His triangulation technique enabled successful anastomosis of blood vessels and subsequently led to advances in blood vessel and organ transplantation. However, Alexis Carrel did not limit his research to the vascular speciality. During the First World War he developed the Carrel-Dakin method of wound irrigation and later his interests lay in aging cells.
A Retrospective Observational Study of Patient Cancellations on the Day of Surgery in the General Surgical Directorate
Authors: Rymaruk Sophy
Published: December 2017

‘On the day’ cancellations carry significant consequences. This article reviews all cases that were cancelled on the day of surgery within the general surgical directorate of the Royal Hallamshire Hospital, Sheffield from 2005 – 2010. 978 cancellations were made on the day of surgery. Most significant reasons were due to patients' fitness (40%) and lack of theatre time (21%). The conclusion is drawn that 80% of cancellations are avoidable or potentially avoidable, and we suggest implementation of further strategies to reduce cancellations.
The Early Days of Prostatectomy for Benign Prostatic Hypertrophy
Authors: Ellis Harold
Published: December 2017

The syndrome of bladder neck obstruction, often leading to retention of urine, in ageing men has been recognised since earliest times.

Catheterisation for the relief of urinary retention was used by the ancient Chinese and Egyptians and is described in the writings of the Indian surgeon Susrata, who flourished in Benares sometime after Christ. Although many of these cases were the result of urethral stricture from trauma or gonorrhoea, we can assume that, in older men, the cause was often benign prostatic hypertrophy (BPH).
Legal, Ethical and Professional Concepts within the Operating Department
Authors: Wilson Rachel
Published: December 2017

There are a number of desirable healthcare practices, such as the requirement for consent and confidentiality, and a respect for the patient, that are ethically sound and legally required (Staunton &Chiarella 2008). The purpose of the law is to provide a deterrent to malpractice, and compensation when things go wrong. All health professionals should be actively aware of the law and its various key concepts. These are primarily negligence, consent, accountability, confidentiality and advocacy (Watson &Tilley 2004). This article is designed to identify the concepts that are important within the operating department. Legal, ethical and professional perspectives that underpin these concepts will be discussed along with relevant case law, ethical theory and the Health Professions Council's (HPC) code of conduct.
Surgical Efficacy of the Ankle Tourniquet for Forefoot Surgery
Authors: Roberts Rk , Cleave Es , Rambani R
Published: December 2017

For precise, safe and proficient procedures haemostasis is critical. For forefoot surgery, the customary thigh tourniquet is commonly accepted for this role as the additional muscle mass and minimal bony prominences in the thigh avert neuromuscular and skin injury. However, for patients with pathophysiological issues that may be exacerbated by a thigh tourniquet, application of an ankle tourniquet may decrease the risks and increase cuff tolerance as the volume of ischaemic tissue is reduced.
A Training Programme for Operating Theatre Personnel in Transanal Endoscopic Operation Procedures for Local Excision of Rectal Tumours
Authors: Swift Jp , Hershman MJ
Published: December 2017

The transanal endoscopic operation (TEO) is a minimal access surgical procedure for the removal of benign and early malignant rectal tumours (Nieuwenhuis et al 2009). This surgery involves specialist equipment, set up and positioning by the perioperative team. We report on and evaluate the first ever TEO course designed specifically for theatre practitioners.
Acute Pain Management in the Older Person
Authors: Malcolm C
Published: December 2017

The proportion of older people in society is growing steadily. This particular group is more likely to be admitted to hospital and a number of papers have highlighted the inadequate or inappropriate assessment and management of their pain, particularly in the perioperative period. Pain relief is possible for the majority of people. This paper aims to give an overview of the assessment and management of pain in older people.
Considerations of the Dual Role
Authors: Guckian Mona
Published: December 2017

‘What you practice you become and what you become has consequences’ was part of the title for my dissertation when studying for my masters degree in health law. This piece of work engaged in looking at the legal, ethical and professional dilemma faced by perioperative practitioners undertaking a dual role. We all understand that the dual role is a combination of the role of the scrub nurse/practitioner and the surgical first assistant (SFA), previously known as the advanced scrub practitioner.
Reducing Unnecessary Preoperative Testing in Elective Ent Surgery: Clinical and Financial Implications
Authors: Leung BC , Nazeer S , Smith M , McRae D
Published: December 2017

Guidelines on appropriate preoperative testing in elective surgery were published by the National Institute for Health and Care Excellence (NICE) in 2003. However, compliance has been poor, with frequent unnecessary tests being performed. We aimed to assess our trust's guideline compliance and to implement changes to optimise adherence. Preoperative investigations performed for elective ENT surgery during a three-month period were retrospectively audited. Unnecessary investigations were identified and costs calculated. A staff-training program was implemented and targeted written information was provided for clinics. A second audit cycle was conducted subsequently. Overall, 69.2% of blood tests were unnecessary (FBC 44.9%, U&Es 63.5%, clotting 99.2%), which equated to £1955.77 with an annual estimate of £7,823.08. None of the test results affected the management of the patient. Post-intervention, full compliance was achieved. It was concluded that preoperative investigations are overused in elective surgery, with obvious financial implications and causing unnecessary anxiety to patients. Through basic training and guideline dissemination, complete compliance can be achieved.
Emergency Laparotomy in High Risk General Surgical Patients: A Review of Perioperative Care
Authors: Rymaruk Sophy
Published: December 2017

High risk general surgical patients account for the largest proportion of surgical deaths. There is concern from the Royal College of Surgeons of England (RCSEng) and National Confidential Enquiry into Patient Outcome and Death (NCEPOD) that these patients may receive suboptimal care. Patients undergoing an emergency laparotomy were identified and the notes reviewed; patients had high observed and predicted mortalities. Consultant involvement, patient consent and nutritional planning were all assessed. An agreed method of patient identification and quantification of risk was recommended. The use of an emergency laparotomy proforma was suggested.