bluuebunny/crossref_metadata_2025 huggingface dataset:
From Servicescape to Loyalty in the Medical Tourism Industry: A Medical Clinic’s Service Perspective
Authors: Kim Minseong , Koo Dong-Woo , Shin Dong-Jin , Lee Sae-Mi
Published: December 2017

Medical tourism organizations have increasingly recognized that loyalty makes a medical clinic a marketing success. To increase understanding of the importance of medical clinics, this study examined the roles of servicescapes, emotions, and satisfaction in the development of customer loyalty toward medical clinics and destination. Data were collected among international medical tourists visiting Korea. Results identified that dimensions of medical clinics’ servicescape (ie, medical clinic environment, medical treatment, staff, and doctor) influenced emotions and satisfaction among international medical tourists. Also, positive emotions and the 2 dimensions of satisfaction with a medical clinic and doctor mediate the influence of medical clinics’ servicescapes on 2 types of loyalty (the medical clinic and Korea for medical care). Overall, these findings indicate that the interrelationship of servicescapes, positive emotion, and satisfaction is essential in influencing international medical tourists’ loyalty to a medical clinic.
Managing missionary identity in the digital age: How missionaries utilize digital media among multiple social groups
Authors: Nehrbass Kenneth
Published: December 2017

The way that missionaries manage their identities has changed significantly since the days they mailed out several printed newsletters a year to a small audience “back home.” The space for this negotiation of identity has moved from private to public; and the interlocutors who access these blogs, emails, and posts are no longer homogenous. This original research study uses quantitative and qualitative methods to understand how missionaries avow the multiple layers of their identities in the digital age. I conclude that missionary updates are encoded along indexical “cultural scripts” that can be decoded idiosyncratically by various audiences.
On the So-Called Transmission of Schriftkultur in the Self-Presentations of Payeftjauemawyneith
Authors: Bassir Hussein
Published: December 2017

This article revisits the issue of Saite copying from earlier sources and, more specifically, addresses the possible transmission of the older phraseology and thematic conceptions of the genre (Schriftkultur or Textkultur) in the self-presentations of Payeftjauemawyneith in late Saite Egypt. The discussion is based on a comparison of textual similarities of his self-presentations on naophorous statues Louvre A 93 and BM EA 83 to the earlier self-presentations of the Old Kingdom text of Djau (stela CG 1431 from Abydos), the Middle Kingdom text of Djefaihapi I at Asyut (Siut I), and the New Kingdom text of Puyemre at Thebes (TT 39)—comparisons already made in the past by other scholars. Although there are similarities between these texts and those of Payeftjauemawyneith, the textual features of his self-presentations do not reflect direct transmission from those earlier texts. Moreover, it is not entirely obvious that the older phraseology of the genre was known to Payeftjauemawyneith. Thus, in this case, there is no evidence the scribes of the texts of Payeftjauemawyneith had any direct, or even indirect, knowledge of Old Kingdom, Middle Kingdom, and New Kingdom texts such as those to which his texts have been compared.
Integrative Literature Review on Shame
Authors: Shaughnessy Molly J.
Published: December 2017

Shame is a universal living experience that is just beginning to be explored within the discipline of nursing. Development of a broad understanding of shame is needed to aid nurse researchers in clarifying this phenomenon from a nursing perspective. Pursuant to this goal, the author in this article reviews the extant literature on shame from the disciplines of nursing, psychology, sociology, philosophy, and theology. Three themes that emerged from the scholarly literature were (a) shame propels miring in paralysis, (b) shame captures the illusionary seen-unseen, and (c) shame permeates the struggle for identity.
A linear polycarbosilane containing m-carborane units: Synthesis and characterization as precursor for SiC/B4C ceramics
Authors: Zhou Quan , Peng Zhengqiang , Yang Mingze , Hu Hao , Song Ning , Ni Lizhong
Published: December 2017

The precursor of poly(carborane)(silicon-acetylene) (PCBS) for silicon carbide (SiC)/B4C composite ceramics was synthesized by a salt metathesis reaction. The molecular weight of PCBS was measured by gel permeation chromatography and the corresponding structures were identified by Fourier transform infrared (FTIR) spectroscopy and nuclear magnetic resonance (NMR). After thermal curing, the PCBS was converted to a dark red brittle nonporous monolith and the thermal stability was significantly improved, especially in an air atmosphere. Thermogravimetric analysis indicated that the 5% weight loss temperatures were 595°C and 633°C under nitrogen and air atmospheres, respectively, and the corresponding residues at 1000°C were 86.42% and 90.42%. After a heat treatment at 1600°C under inert atmosphere, the well-dispersed SiC/B4C ceramic was obtained and characterized by FTIR, X-ray diffraction analysis, Raman spectroscopy, scanning electron microscopy (SEM) and transmission electron microscopy (TEM). The obtained SiC/B4C ceramic has a good high-temperature and oxidation resistance which can be applied to aviation, aerospace, and other ultra-high temperature conditions.
Exploring new territories in pedagogical stylistics: An investigation of high-school EFL students’ assessments
Authors: Viana Vander , Zyngier Sonia
Published: December 2017

The growing number of recent publications on pedagogical stylistics indicates that this area is still of much interest to those who invest in the integration of language and literature. However, evidence-based assessments of pedagogical stylistics are still few and depend mostly on teachers’ intuitions. The present study contributes towards filling this gap by examining 28 reflective accounts produced by high-school English as a foreign language (EFL) teenagers who participated in a literary awareness workshop on iconicity. Branching out from pedagogical stylistics, literary awareness is here described as a program which aims at sensitizing students to verbal artistry. The bottom-up analysis of the participants’ accounts reveals five main aspects – “applicability,” “learning,” “materials,” “students” and “teaching” – and indicates that the workshop was to a certain degree transformative. Instead of an instrumental approach to language learning, the workshop aimed mostly at consciousness-raising. Students’ assessment of the workshop was quite positive, and they linked in-class experience with their lives outside the school. The results indicate that, besides learning a foreign language, the process of reflection has led students beyond the text. We conclude by discussing the implications of the workshop for both pedagogy and research.
The voluntary precariat in the value chain: The hidden patterns of home-based garment production in Turkey
Authors: Tartanoğlu Şafak
Published: December 2017

This article explores the organizational characteristics and distinctive settings of the labour process of home-based garment work in the context of embedded control and consent relations in local garment productions in Turkey. Using Turkey as the case example of a garment export country in the global economy, the article explores the nature and organization of home-based piecework at the micro level within a broader global garment production chains perspective. Conducted in two Turkish cities, the study analyses the different cultural backgrounds of female workers and two distinct types of work, namely hand stitching and machine sewing of garments. The findings highlight the relationship between the cultural backgrounds of workers and the different types of work they undertake with control and consent practices as well as the patriarchal societal structure and relations in the context of local labour control regimes.
Development of a Computerized Adaptive Test for Anxiety Based on the Dutch–Flemish Version of the PROMIS Item Bank
Authors: Flens Gerard , Smits Niels , Terwee Caroline B. , Dekker Joost , Huijbrechts Irma , Spinhoven Philip , de Beurs Edwin
Published: December 2017

We used the Dutch–Flemish version of the USA PROMIS adult V1.0 item bank for Anxiety as input for developing a computerized adaptive test (CAT) to measure the entire latent anxiety continuum. First, psychometric analysis of a combined clinical and general population sample ( N = 2,010) showed that the 29-item bank has psychometric properties that are required for a CAT administration. Second, a post hoc CAT simulation showed efficient and highly precise measurement, with an average number of 8.64 items for the clinical sample, and 9.48 items for the general population sample. Furthermore, the accuracy of our CAT version was highly similar to that of the full item bank administration, both in final score estimates and in distinguishing clinical subjects from persons without a mental health disorder. We discuss the future directions and limitations of CAT development with the Dutch–Flemish version of the PROMIS Anxiety item bank.
An Accessible and Affordable Transport Intervention for Older People Living in the Community
Authors: Lee Elinda Ai Lim , Same Anne , McNamara Beverley , Rosenwax Lorna
Published: December 2017

The ability to remain mobile is linked to the independence, health, and well-being of older people, but studies are needed to confirm the impact of community transport services. This study investigated the need for, and the impact of, a transport intervention on the independence and well-being of older people living in an Australian urban community. Using qualitative and quantitative data collected from pre-intervention ( n = 32) and post-intervention interviews ( n = 11), the need and impact of a community transport service were examined. The results of the study indicate investment in community transport has the potential to positively affect the lives of older people. Accessible affordable transport for older people signals an age-friendly society that values participation of all members of society, regardless of age.
Multi-hole gasoline direct injection:In-nozzle flow and primary breakup investigated in transparent nozzlesand with X-ray
Authors: Bornschlegel Sebastian , Conrad Chris , Durst Alexander , Wang Jin , Wensing Michael
Published: December 2017

The contribution describes the flow field inside modern gasoline direct-injection nozzles and sprays. Starting from the internal nozzle flow, results from transparent real-size nozzles are shown, where a significant vapor fraction even for cold fuel conditions is proven. Based on vapor fraction inside the nozzle, evidence for (super-)sonic flow conditions inside the nozzle is shown. The nozzle outlet velocity is determined by means of X-ray structure tracking velocimetry, which is a very powerful measurement technique to gain access to the very dense spray at the nozzle outlet. The X-ray velocities are compared to values that are determined by means of optical—phase Doppler anemometry/laser Doppler anemometry and Schlieren imaging—measurement techniques. By extrapolating the maximum droplet velocities found by laser Doppler anemometry in the more downstream regions of the spray to the nozzle outlet region, very similar velocities to the one derived from the X-ray measurements close to Bernoulli velocity are evaluated for typical gasoline direct-injection engine conditions. A third access to the nozzle outlet velocity is given by the derivation of penetration curves. The combination of vapor fractions and outlet velocities provides a measure for the initial spray momentum.
MALDI-TOF mass spectrometry provides high accuracy in identification of Salmonella at species level but is limited to type or subtype Salmonella serovars
Authors: Kang Lin , Li Nan , Li Ping , Zhou Yang , Gao Shan , Gao Hongwei , Xin Wenwen , Wang Jinglin
Published: December 2017

Salmonella can cause global foodborne illnesses in humans and many animals. The current diagnostic gold standard used for detecting Salmonella infection is microbiological culture followed by serological confirmation tests. However, these methods are complicated and time-consuming. Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) analysis offers some advantages in rapid identification, for example, simple and fast sample preparation, fast and automated measurement, and robust and reliable identification up to genus and species levels, possibly even to the strain level. In this study, we established a reference database for species identification using whole-cell MALDI-TOF MS; the database consisted of 12 obtained main spectra of the Salmonella culture collection strains belonged to seven serotypes. Eighty-two clinical isolates of Salmonella were identified using established database, and partial 16S rDNA gene sequencing and serological method were used as comparison. We found that MALDI-TOF mass spectrometry provided high accuracy in identification of Salmonella at species level but was limited to type or subtype Salmonella serovars. We also tried to find serovar-specific biomarkers and failed. Our study demonstrated that (a) MALDI-TOF MS was suitable for identification of Salmonella at species level with high accuracy and (b) that MALDI-TOF MS method presented in this study was not useful for serovar assignment of Salmonella currently, because of its low matching with serological method and (c) MALDI-TOF MS method presented in this study was not suitable to subtype S. typhimurium because of its low discriminatory ability.
Regio-isomeric effects in tandem mass spectra of sulfonium cations generated from thiacyclane based sulfonium salts under soft ionization conditions
Authors: Zaikin Vladimir G , Kozlov Anton V , Borisov Roman S , Shchapin Igor Yu
Published: December 2017

The influence of regio-isomerism of even-electron sulfonium ions on tandem electrospray and matrix-assisted laser desorption/ionization mass spectra recorded by using collision-induced dissociation was investigated. The initial organic sulfides belonged to isomeric thiabicyclane series (substituted 7- and 8-thiabicyclo[4.3.0]nonanes, 2- and 3-thiabicyclo[4.4.0]decanes) and phenylthiolanes. To investigate by the abovementioned mass spectrometry methods, the sulfides were preliminary S-alkylated by methyl, ethyl iodides, their deuterated analogs and trialkoxonium tetrafluoroborates to form corresponding sulfonium salts. The latter salts readily gave off corresponding sulfonium cations under abovementioned desorption/ionization conditions and these cations were precursor ions in collision-induced dissociation experiments. The main quantitative and frequently qualitative differences between collision-induced dissociation spectra of isomers were manifested in mass numbers and relative intensities of the ions Alk-S+ = CHR (formal structure) that originated from the destruction of sulfur-containing ring. Corresponding peaks are particularly abundant for cations Alk-S+ = CH2 and their intensities are usually greater than for other C-substituted homologues. Qualitative difference between fragmentation features of 2- and 3-phenylthiolanium cations is that only the latter can eliminate neutral C2H4S molecule.
Stereospecificity of the Hofmann elimination in the gas phase
Authors: Figadére Bruno , Cao Tangyuan , Morton Thomas H
Published: December 2017

The Hofmann elimination of ammonium ions having a single positive charge is demonstrated to exhibit stereospecificity with regard to expulsion of neutral alkene. For the 3-hexyl series of threo and erythro 4-monodeuterated ions (3-hexylammonium ion; N,N,N-trimethyl- d3-3-hexylammonium ion; N-ethyl-3-hexylammonium ion; N-methyl, N-ethyl-3-hexylammonium ion; N,N-dimethyl, N-ethyl-3-hexylammonium ion), the upper limit of the E:Z ratio of the expelled alkene (r) approaches 2 (the stereospecificity) with a deuterium isotope effect close to 2.0, although the effects of isotopic substitution diminish the E:Z ratio somewhat. Two fragmentations compete with that reaction: hydride shift (which gives the same products but with hydrogen scrambling) and loss of a neutral amine to give an alkyl cation. These competing reactions render our calculation approximate, but the results suggest a value not too far from the upper limit.
The association between the metabolic syndrome and metabolic syndrome score and pulmonary function in non-smoking adults
Authors: Yoon Hyun , Gi Mi Young , Cha Ju Ae , Yoo Chan Uk , Park Sang Muk
Published: December 2017

Objective:

This study assessed the association of metabolic syndrome and metabolic syndrome score with the predicted forced vital capacity and predicted forced expiratory volume in 1 s (predicted forced expiratory volume in 1 s) values in Korean non-smoking adults.

Methods:

We analysed data obtained from 6684 adults during the 2013–2015 Korean National Health and Nutrition Examination Survey.

Results:

After adjustment for related variables, metabolic syndrome ( p < 0.001) and metabolic syndrome score ( p < 0.001) were found to be inversely associated with the predicted forced vital capacity and forced expiratory volume in 1 s values. The odds ratios of restrictive pulmonary disease (the predicted forced vital capacity < 80.0% with forced expiratory volume in 1 s/FVC ⩾ 70.0%) by metabolic syndrome score with metabolic syndrome score 0 as a reference group showed no significance for metabolic syndrome score 1 [1.061 (95% confidence interval, 0.755–1.490)] and metabolic syndrome score 2 [1.247 (95% confidence interval, 0.890–1.747)], but showed significant for metabolic syndrome score 3 [1.433 (95% confidence interval, 1.010–2.033)] and metabolic syndrome score ⩾ 4 [1.760 (95% confidence interval, 1.216–2.550)]. In addition, the odds ratio of restrictive pulmonary disease of the metabolic syndrome [1.360 (95% confidence interval, 1.118–1.655)] was significantly higher than those of non-metabolic syndrome.

Conclusion:

Metabolic syndrome and metabolic syndrome score were inversely associated with the predicted forced vital capacity and forced expiratory volume in 1 s values in Korean non-smoking adults. In addition, metabolic syndrome and metabolic syndrome score were positively associated with the restrictive pulmonary disease.
Successful Endovascular Management of a Transplant Renal Artery Pseudoaneurysm Complicated With Arterioureteral Fistula
Authors: Turunç Volkan , Eroğlu Aşkın , Tabandeh Babek , Dheir Hamad , Soylu Özer , Demir Mustafa K.
Published: December 2017

We report a case of renal artery pseudoaneurysm at the anastomosis site complicated with arterioureteral fistula (AUF) in a 57-year-old kidney transplant recipient who presented with intermittent massive hematuria at one month post-transplant. We successfully treated the pseudoaneurysm and AUF with endovascular covered stent implantation. The diagnosis of AUF is rare and it is a condition that occurs in patients with previous pelvic or vascular surgery, chronic ureteral catheterization and radiotherapy. This diagnosis requires the expertise of the urologist, vascular surgeon and interventional radiologist. The fistula most often occur in the iliac arteries and are often associated with pseudoaneurysms or abscesses. Angiography and ureteral contrast studies (antegrade or retrograde pyelography) are the most valuable diagnostic tools. Treatment of AUF via endovascular approach using covered stents is effective and safe, and is becoming the reference treatment in AUFs.
Partisan Cues and Opinion Formation on Foreign Policy
Authors: Cavari Amnon , Freedman Guy
Published: December 2017

How does the extension of party conflict to a foreign policy issue affect the ability of Americans to form an opinion about the issue? We test this using elite references and longitudinal public opinion data about the Israeli–Palestinian conflict, a salient foreign policy issue in the United States that is increasingly characterized by partisan divisions. Our findings demonstrate that since the turn of the 21st century, the availability and clarity of party cues have increased, as well as the share of Americans who hold an opinion about the issue. Applying regression models to individual-level data, we reveal that the extension of party conflict to this issue has made it easier for more Americans to form an opinion.
Aging Toward Disaster
Authors: Hanson Kenneth R.
Published: December 2017

kenneth r. hanson on an unsettling convergence.
Is the Public Getting Smarter on Crime?
Authors: Uggen Christopher , Larson Ryan
Published: December 2017

christopher uggen and ryan larson on uneven progress in public opinion.
Improving the Development, Monitoring and Reporting of Stroke Rehabilitation Research: Consensus-Based Core Recommendations from the Stroke Recovery and Rehabilitation Roundtable
Authors: Walker Marion F. , Hoffmann Tammy C. , Brady Marian C. , Dean Catherine M. , Eng Janice J. , Farrin Amanda J. , Felix Cynthia , Forster Anne , Langhorne Peter , Lynch Elizabeth A. , Radford Kathryn A. , Sunnerhagen Katharina S. , Watkins Caroline L.
Published: December 2017

Recent reviews have demonstrated that the quality of stroke rehabilitation research has continued to improve over the last four decades but despite this progress, there are still many barriers in moving the field forward. Rigorous development, monitoring and complete reporting of interventions in stroke trials are essential in providing rehabilitation evidence that is robust, meaningful and implementable. An international partnership of stroke rehabilitation experts committed to develop consensus-based core recommendations with a remit of addressing the issues identified as limiting stroke rehabilitation research in the areas of developing, monitoring and reporting stroke rehabilitation interventions. Work exploring each of the three areas took place via multiple teleconferences and a two-day meeting in Philadelphia in May 2016. A total of 15 recommendations were made. To validate the need for the recommendations, the group reviewed all stroke rehabilitation trials published in 2015 (n=182 papers). Our review highlighted that the majority of publications did not clearly describe how interventions were developed or monitored during the trial. In particular, under-reporting of the theoretical rationale for the intervention and the components of the intervention call into question many interventions that have been evaluated for efficacy. More trials were found to have addressed the reporting of interventions recommendations than those related to development or monitoring. Nonetheless, the majority of reporting recommendations were still not adequately described. To progress the field of stroke rehabilitation research and to ensure stroke patients receive optimal evidence-based clinical care, we urge the research community to endorse and adopt our recommendations.
Unplanned stents in thoracic endovascular aortic repair for type B aortic dissection: A 16-year single-center report
Authors: Liu Junjun , Zhang Rongjie , Feng Rui , Feng Jiaxuan , Zhao Zhiqing , Li Zhenjiang , Zhao Yuxi , Li Yiming , Zhou Jian , Jing Zaiping
Published: December 2017

Background

Unplanned stents in thoracic endovascular aortic repair mean additional stents implantation beyond the preoperative planning to achieve operation success. This study aimed to reveal the prevalence and consequences of unplanned stents in thoracic endovascular aortic repair for type B aortic dissection and explore the reasons, risk factors and solutions for unplanned stents.

Methods

Retrospectively analysis consecutive patients diagnosed as type B aortic dissection with initial tear originating distal from the left subclavian artery and underwent thoracic endovascular aortic repair from September 1998 to June 2014 in our center.

Results

Under the criteria, this study enrolled 322 patients, with 83 (25.8%) patients in unplanned group. The incidence rate of unplanned stents in thoracic endovascular aortic repair for type B aortic dissection in each year demonstrates as a bimodal curve. The curve showed that, 2003 and, 2004 was the first and highest peak and 2007 was the second peak. There was no difference in five-year survival rate between planned and unplanned patients (log-rank test, p = 0.994). The unplanned group had higher hospitalization expenses (142,699.08 ± 78,446.75 yuan vs. 175,238.58 ± 34,838.01 yuan; p = 0.019), longer operation time (104.50 ± 93.24 min vs. 179.08 ± 142.47 min; p < 0.001) and hospitalization time (17.07 ± 16.62 d vs. 24.00 ± 15.34 d; p = 0.001). The reasons for unplanned stents were type Ia endoleak (46 patients, 55.4%), bird beak (25 patients, 30.1%), and inappropriate shaping of stent (9 patients, 10.8%). Asymptomatic aortic dissection patients had higher incidence of unplanned stents. Short proximal neck length (2.66 ± 0.59 mm vs. 2.50 ± 0.51 mm; p = 0.016), short stent coverage length (154.62 ± 41.12 mm vs. 133.60 ± 44.33 mm; p = 0.002), and large distal stent oversize (75.44±10.77% vs. 82.68±15.80%; p <0.001) were risk factors for unplanned stents in thoracic endovascular aortic repair.

Conclusion

There are some special risk factors and reasons for unplanned stents in thoracic endovascular aortic repair for type B aortic dissection. Knowing these can we reduce the utilization of unplanned stents with appropriate methods.
Is restorative justice conferencing appropriate for youth offenders?
Authors: Suzuki Masahiro , Wood William R
Published: December 2017

While many studies on restorative justice conferencing (RJC) for youth offenders have shown favourable outcomes such as victim satisfaction and fairness, and offender accountability and perceived legitimacy, other studies have demonstrated more problematic outcomes in terms of mutual understanding, sincerity of apology and reoffending. Given the complexity of RJC as a concept and as a process, such ‘limits’ might be attributed to the capacity and characteristics of youth offenders. To date, however, there has been little examination of developmental, cognitive or environmental impediments on the part of youth offenders in terms of achieving restorative outcomes in RJC. This article discusses the potential impacts of limited developmental and cognitive capacities of youth offenders on the RJC process and outcomes.
Forward Waiting in Theatre
Authors: Belbin Heidi
Published: December 2017

Waiting to go into theatre on the day of your surgery is probably the most stressful time for patients. What happens to patients during this crucial time can make a tremendous difference to the whole experience of going to theatre.

Heidi Belbin and her colleagues realised that there was a problem at Lincoln City Hospital with patients being kept waiting at theatre reception and were concerned that the quality of patient care in this respect was not acceptable. A plan was developed to improve this situation, and the story of what was done is told in this article. The project was entered for the 3M/NATN award, and earned a commendation from the judges.
Pain Management in Recovery
Authors: Starritt Trudi , Plowes Dina
Published: December 2017

I make no mistake in mixing anaesthetic care with recovery room nursing, as it is my belief that the two are linked. So this month we look at pain in the recovery room - or is this the only place to which this article is relevant? You decide. Pain is something which, quite rightly, occupies the minds of perioperative practitioners greatly. It is only human, and humane, to use our expertise to alleviate, control and understand it. In this piece, Trudi Starritt from St John's Hospital, Livingston, explores the concept of pain and pain relief from the recovery nurse's perspective.
Health and Safety: Your Problem or Mine?
Authors: Rose Raymond , Reid Jane
Published: December 2017

This year the topic of Health and Safety has been selected by the Education Committee as the theme for the annual programme. To complement the February Study day held at Birmingham in February, the National Workshop planned for Harrogate in July and the Study Day to be held in Newcastle in November, we are publishing a series of papers on the same theme. Publication can disseminate best practice on a much wider scale and stimulate work based discussion. Over the coming months, different contributors will cover a variety of health and safety topics in the domains of personal care, patient care and environmental considerations, such as latex sensitivity, manual handling, COSHH and risk assessment. In this issue Raymond Rose ‘kicks off the series with a brief outline of social and workplace reforms that have led to key legal statutes and European directives that continue to influence our workbased practices.

This is your Journal and we are always keen to respond to your concerns. Please write to either the Editor or myself about topics you feel could be included in this important series. I look forward to hearing from you.
Electrosurgery in Perioperative Practice
Authors: Wicker Paul , Plowes Dina
Published: December 2017

No series looking at basics in the perioperative environment would be complete without a good look at electrosurgery. And who better to inform us than Paul Wicker, who gives us all the information and advice we need to maintain patient and staff safety whilst this potentially dangerous but essential apparatus is in use. Paul also answers some of the most common questions about diathermy and its use, and I have certainly been asked all of these myself over the past couple of years. Thanks, Paul.
Hand Washing
Authors: Pinney Elizabeth , Plowes Dina
Published: December 2017

What could be more basic than the simple act of washing your hands? Children at junior school are taught to do it. Yet research tends to point to the lack of hand washing as being a major contributor to hospital acquired infection. I have summarised this piece by Elizabeth Pinney which takes us right back to the 18th century - and bang up to date! Reflect on your practices and that of your colleagues before you tell me this is old news.
The Musculo-Skeletal System: The Spine
Authors: Clancy John , Mcvicar Andrew , Williams Mriga
Published: December 2017

This is the second of a series of articles based on Physiology and Anatomy, a homeostatic approach by John Clancy and Andrew McVicar. This article looks at the musculo-skeletal system, with particular emphasis on the spine. It identifies spinal deformities, injuries and maladies, and various types of surgical intervention.
Bone Cement Mixing: Theatre Staff's Views and Opinions
Authors: Dunne Nicholas , Orr John
Published: December 2017

Acrylic bone cement has not substantially changed since it was first introduced more than 30 years ago, however the method by which it is mixed has evolved greatly (Dunne 1996).
Online Education Demo: How to Get Started!
Authors: Wicker Paul
Published: December 2017

The purpose of this article is to provide a brief tutorial on how to use the online education demo that is on the NATN website.
Leadership Makes a Difference
Authors: Woodhead Kate
Published: December 2017

This article is based on a presentation given by Kate Woodhead, NATN chairman, at last year's EORNA conference, 11-14 May 2000, in Bergen, Norway. Kate was named Best Lecturer of the Conference for her presentation and won a weekend in Germany, awarded by Aesculap.
Gastroentological Investigations
Authors: Ramsay Anne-Marie , Clancy John , McVicar Andrew
Published: December 2017

In this fourth article in the Concepts in Anatomy series, Anne-Marie Ramsay joins John Clancy and Andrew McVicar in examining the upper and lower gastrointestinal tract and identifies some common homeostatic imbalances. Diagnostic tests for detecting abnormalities are described, highlighting the importance of the nurse's role in caring for the patient throughout these procedures. This series is based on Physiology and Anatomy, a homeostatic approach, 2nd ed, John Clancy and Andrew McVicar (eds), Edward Arnold, London, 1995, currently in print.
Are We Truly Patient Focussed?
Authors: Westwood Fiona
Published: December 2017

The end user of all healthcare activity is the patient. But how do we know whether we are providing a good service? Do we take time to listen to our patients, or do we simply hide behind our professional title and pass the buck to someone else? In this, the fourth article of our series, Fiona Westwood asks some challenging questions. The answers may indicate that some changes need to be made.
How Well Do We Use Our Resources?
Authors: Westwood Fiona
Published: December 2017

We have already considered that the resources we have to work with in our organisations are not infinite. The most valuable of these are our people and our time. In addition, some patient work is not ‘cost effective’. As technology and treatment options become more and more sophisticated, our overall fixed and variable costs can increase alarmingly. In this fifth article in the series, Fiona Westwood says we need, therefore, to look at all of our resources to maximise the value that they can bring.
My Story Surviving a Neurological Accident
Authors: Williams Marilyn , Kemp Sarah
Published: December 2017

The piece that follows is a truly remarkable story of a young lady who experienced a devastating riding accident and lived to tell the tale. She has some interesting insights for us regarding the nursing of unconscious patients and the surprising recoveries that are sometimes possible for victims of brain damage. Sarah's story dramatically illustrates the importance of speaking positively in the presence of an unconscious patient.
Introducing Clinical Supervision the Pitfalls and Problems
Authors: Smith Doreen
Published: December 2017

In July 1999 I published an article in the BJPN entitled ‘Introducing Clinical Supervision into the Perioperative Environment’ (Smith 1999). I described what I believed to be the successful implementation of clinical supervision to the trained theatre staff. I discussed the perceived benefits of improved communication, assistance with learning, professional development and reflective practice, provision of emotional support, evidence for PREPP, clinical effectiveness and governance, and improvement practice and policy making. Results from many other authors and professional bodies also proclaim both the need for, and the benefits, of clinical supervision for nurses.
Contamination of the Surgical Field: What Does the Published Research Say about Face Masks?
Authors: Edwards Peggy
Published: December 2017

Is there sufficient evidence to suggest that the wearing of face masks is imperative during surgical procedures for maximum patient protection? Or is it just another ritual that needs to be re-examined in the light of today's emphasis on evidence-based medicine. Should we be re-educating theatre staff that the wearing face masks is more for their own protection than for that of the patient? To help us towards some conclusions, Peggy Edwards presents the results of her review of the literature on the face mask debate.
Cross Infection and the Laryngoscope
Authors: Pidduck David
Published: December 2017

Laryngoscope blades and handles that have been inadequately decontaminated or are unsterile can be harmful to patients. The literature suggests that this may be a current problem in many operating departments. David Pidduck examines the risks to patients that could be posed by current practice, reviews the literature on the subject, and makes some recommendations for change. He encourages nurses and operating department practitioners (ODPs) to take a more proactive approach to highlighting these problems.
Making Sense of the Agenda for Change Modernising the Nhs Pay System
Authors: Beesley John
Published: December 2017

The government has announced its intention to reorganise the pay structure of the NHS. Three years on from the launch of the initiative, NATN Professional Officer, John Beesley, explains why the government decided on the undertaking, its implications for perioperative practitioners, and why nurses need to make their views and opinions known.
The Rise and Withdrawal of Droperidol
Authors: Cox Felicia , Tanner Judith
Published: December 2017

Predicting which patients will experience postoperative nausea and vomiting is difficult. Prophylactic antiemetic administration has been shown to reduce unplanned admission after day case surgery. In published comparative studies of antiemetic efficacy, droperidol has been considered to be the ‘gold standard’ against which other agents are measured. The recent withdrawal of droperidol due to reports of cardiac arrhythmias and the potential for sudden death has left a vacancy for a safe and effective antiemetic. This article explores the published literature for alternatives to droperidol as a single dose or prophylaxis in patient controlled analgesia devices.
Perioperative Nursing and Acute Pain Management
Authors: Williams Heather
Published: December 2017

This article explores the broader aspects and opportunities available to perioperative nurses in the field of pain management. It will help to develop nurses’ insight into how perioperative nurses can develop their role in pain management. In turn this will benefit patients’ service provision and enhance nurses’ career pathways.
Theatre Staff's Knowledge of Surgical Face Masks
Authors: Biggins Jill , Tanner Judith
Published: December 2017

This study supports other studies which identify the need for high quality research into the hazards within the operating theatre and the benefits of wearing face masks. Studies are required which determine the effect of face masks in reducing postoperative wound infection. The findings of the Cochrane Review of surgical face masks found it unclear whether they resulted in any harm or benefit for patients undergoing clean surgery (Lipp & Edwards 2003). Studies are also required to determine the effect of face masks in protecting staff from potential hazards such as surgical smoke. As yet, no studies have shown how much, if any, smoke is inhaled by the surgical team and what effect, if any, this has on them.
A Guide to Blood Groups, Transfusion and Coagulation
Authors: Sharp Sally
Published: December 2017

Recent medical advances have resulted in more patients surviving increasingly complex surgery. This series of articles aims to refresh our knowledge of blood – its composition, the origins and roles of blood's components and how coagulation occurs. New technologies that have developed to reduce inappropriate transfusion of blood and blood products will be explored. We will be updated on national projects to reduce inappropriate transfusion.
Ethical Reflection in An Organisational and Technological World
Authors: McKie Andrew
Published: December 2017

Recent articles featured in the BJPN have examined different ethical aspects of theatre nurse practice (Hughes 2002, Sutton 2003). In this article, however, we look a little deeper at some of the wider issues which may influence our ethical reflection. Nursing today, in all its various forms, is a complex and serious human endeavour. The social context of such care is the organisation, and its typical mode of delivery is via technology. Both organisation and technology, by turning issues into problems to be solved rationally, may serve to weaken our understanding of the way in which ethics is concerned with everyday practice. A number of these issues are illustrated from the perspective of theatre nursing.
The National Blood Service Supporting Better Blood Transfusion
Authors: Gerrard Rebecca , Cox Felicia
Published: December 2017

The National Blood Service (NBS) is an integral part of the National Health Service that provides blood, blood components, blood products and tissues from fifteen blood centres to England and North Wales. Each year, the NBS collects tests, processes, stores and issues approximately 2.3 million blood donations. The service also undertakes research into blood safety, provides clinical advice to hospital staff and supports hospital transfusion practitioners. Rebecca Gerrard describes some of the initiatives to improve blood transfusion practices, including monitoring of the serious hazards of transfusion, bench marking schemes and the roles of blood transfusion liaison (BTL) nurses.
Herbs: Where's the Harm?
Authors: Abraham Jenny
Published: December 2017

The increased use of complementary and alternative medicine within our society requires us as professionals to educate our patients and ourselves as to the potential risks of taking herbs and vitamins. Herbs may be natural, but natural does not always equate to safe, and so this article provides a review of the literature and potential risks that herbs pose to surgery. Therefore we should encourage patients and health professionals alike to consider herbs as natural drugs and treat accordingly.
The Digital Revolution
Authors: Blain Colin , Mackay Margaret
Published: December 2017

Digital image technology has advanced considerably in recent years and it has never been simpler to capture digital images or send them around the world. This new technology can bring tremendous benefits to healthcare but, if used inappropriately, will compromise patient confidentiality and increase the risk of litigation to the health providers. It is now time to assess the risks and agree safeguards which will promote the safe use of digital technology in the healthcare environment.
The Afc Reality
Authors: Pirie Susan
Published: December 2017

The Agenda for Change (AfC) proposals were implemented in the workplace with effect from 1 December 2004. AfC is the new pay and conditions package applicable to every NHS organisation in all four countries of the UK.
Applying Cricoid Pressure
Authors: Gardiner Esther , Grindrod Eirlys
Published: December 2017

This article discusses the literature surrounding the application of cricoid pressure during rapid sequence induction and suggests ways in which the training of this skill can be improved.
The Operating Room a Personal History
Authors: Cox Nancy
Published: December 2017

This is the first of two articles based on a presentation given at NATN Congress 2004. The presentation was given as the Daisy Ayris Memorial Lecture. In this article NATN archivist Nancy Cox describes her experiences working in the operating room beginning in the 1950s.
Maternity Rights
Authors: Pirie Susan
Published: December 2017

The blue line has appeared in the relevant window and a potential future perioperative practitioner is on the way. There are a number of issues and requirements which parents to be who are working in the perioperative environment should consider.
Malignant Hyperthermia
Authors: Mcneil Beverley
Published: December 2017

Malignant Hyperthermia (MH) is a rare genetic condition which may manifest for the first time during anaesthesia associated with a routine surgical procedure. Characterised initially by muscle rigidity, increased body temperature and metabolic acidosis, the syndrome may prove fatal unless prompt, effective treatment is administered. The sudden development of MH constitutes a medical emergency; hence it is essential that theatre practitioners are knowledgeable about the presenting symptoms and management of the condition.
Surgical Gloves: Perforation and Protection
Authors: Tanner Judith
Published: December 2017

The risk of surgical glove perforation is affected by a number of factors including the type of surgery, length of operative procedure, hand dominance and role of the glove wearer. This article provides an overview of each of these factors and discusses protective gloving measures taken to reduce perforations based on the findings of the Cochrane review.
Esmarch's Bandage
Authors: Ellis Harold
Published: December 2017

Over the centuries, surgeons have battled with the problem of blood loss in trauma and surgery. In major limb surgery, amputation for example, the assistant would apply digital pressure over the artery or a tourniquet would be used – a pad over the arterial pressure point would be bound down with a bandage, tape or rope tied around the limb. However, this had a tendency to slip and the limb could not be exsanguinated efficiently.
Conflict Resolution Training in the Nhs
Authors: Molloy Steve , Henderson Iain
Published: December 2017

The following article is based on a presentation at AfPP's Annual Congress in October 2005. It deals with the increasing level of violence and aggression directed towards NHS staff in the workplace and advises on conflict resolution.
Should it Happen to you …
Authors: Stonehouse Alison
Published: December 2017

The bombings in London (7 July 2005) have highlighted the need for operating theatre staff to raise their level of knowledge and preparedness in response to the threat of terrorist attacks. What can we expect and be prepared for when bombings occur? This article uses the recent experience of the operating theatre staff at The Royal London Hospital to provide practical advice on how to prepare and care for patients who have received bomb blast injuries and require life-saving surgical intervention.
Cutting Edge Neurosurgery
Authors: Williams Marilyn
Published: December 2017

Neurosurgery and the neurosurgeons who deliver it assumed a temporarily raised profile when the series The Brain Hospital was shown on UK television last year. An editorial in The Lancet (2006), commented on the passion and humanity of the surgeons portrayed, as well as their skill and care for their patients. Patients telling their stories following neurosurgery in the guise of entertainment may seem perverse, but the public has always been fascinated by medicine in both fact and fiction, remembering such TV series as Doctor Kildare and Your Life in Their Hands from the 1960s. This article will examine recent developments and aspects of current practice in neurosurgery and neurological investigation, through a review of recent literature.
Extubation Reflectivity
Authors: Mason Paula , Hardy Dawn , Smith Brian
Published: December 2017

The purpose of this article is to share a recovery room practitioner's experience using reflection and to explore the issues surrounding extubation in the post anaesthetic care unit (PACU). Currently there are no national standards of practice for practitioners’ learning and safe practice of extubation techniques within the PACU. Therefore, the possibility of an adverse incident is significantly increased, potentially causing harm to the patient and damage to any hospital's reputation as well as the practitioners’ profession. The authors wish to identify the concerns by citing a clinical incident that lead to reflection and sharing of the experience through this article.
Non-Physician Anaesthesia in the UK: A History
Authors: Wilkinson David
Published: December 2017

David Wilkinson, Anaesthesia Practitioner (AP) and current representative of APs on the National Reference Panel, discusses the history of non-physician anaesthesia and its introduction into the UK; the arguments for and against the role; and offers a reflective view of the training.
Barriers to Effective Pain Management
Authors: Carr Eloise
Published: December 2017

In this article my sole aim is to engage the reader to think about the management of pain in a different way. I have deliberately taken a less formal style but provided references if you are interested in following up. The management of pain has often been assumed to be a routine part of care, in fact in the perioperative arena it is the second most common nursing intervention (Juntilla et al 2005). Despite this activity, pain after surgery has been reported to be a consistent problem which has spanned several decades (Marks & Sachar 1973, Wu et al 2002, Ekstein et al 2006). The reasons for this are well documented and include: patient barriers, inadequate knowledge of healthcare professionals, lack of assessment and organisational practices which impede the administration of analgesics and non-pharmacological interventions. Despite this knowledge the changes required in practice are not necessarily forthcoming. The purpose of this paper is to explore the patient, professional and organisational barriers which affect the optimal management of pain in the perioperative period, and provide some practical solutions to help you think about and manage pain more effectively.