bluuebunny/crossref_metadata_2025 huggingface dataset:
The Utility of Simulation in the Management of Patients With Congenital Heart Disease: Past, Present, and Future
Authors: Subat Ali , Goldberg Andrew , Demaria Samuel , Katz Daniel
Published: December 2017

Significant advancements have been made in the diagnosis and management of congenital heart disease (CHD). As a result, a higher percentage of these patients are surviving to adulthood. Despite this improvement in management, these patients remain at higher risk of morbidity and mortality, particularly in the perioperative setting. One new area of interest in these patients is the implementation of simulation-based medical education. Simulation has demonstrated various benefits across high-acuity scenarios encountered in the hospital. In CHD, simulation has been used in the training of pediatrics residents, assessment of intraoperative complications, echocardiography, and anatomic modeling with 3-dimensional printing. Here, we describe the current state of simulation in CHD, its role in training care providers for the management of this population, and future directions of CHD simulation.
Influence of temperature change and humidity condition on free vibration analysis of a nano composite sandwich plate resting on orthotropic Pasternak foundation by considering agglomeration effect
Authors: Sharif Zarei Mohammad , Hajmohammad Mohammad Hadi , Mostafavifar Mostafa , Mohammadimehr Mehdi
Published: December 2017

This research presents an investigation into the free vibration of a sandwich plate with a transversely flexible polymeric core and two carbon nanotubes reinforced nanocomposite face sheets based on high-order sandwich plate theory. The material properties are considered to be temperature- and moisture-dependent. The mathematical model of the face sheets is developed based on the classical plate theory and modified strain gradient theory. Also, Eshelby–Mori–Tanaka approach is used to estimate the material properties of the face sheets and consider the agglomeration effect of carbon nanotubes. The governing equations of motion which included the size effect as well as hygrothermal effect are derived based on Hamilton’s principle and solved by means of Navier’s solution method. The influence of various parameters such as agglomeration effect and the volume fraction of carbon nanotubes, material length scale parameters, aspect and side ratios, temperature changes, and humidity condition is presented. In addition, orthotropic Pasternak foundation is taken into account to study the influence of orthotropic angle on the vibrational behavior of the sandwich plate, and also a comparison of a symmetric sandwich plate and two types of asymmetric ones is carried out for different values of normal and shear Pasternak foundation modulus. Employing carbon nanotubes reinforced nanocomposite face sheets, orthotropic Pasternak foundation and size-dependent theory leads to an increase in the stiffness of the sandwich structure and considering the temperature and humidity changes and agglomeration effect of carbon nanotubes in the face sheets helps to achieve the results with higher accuracy which can be used in modern engineering applications.
The Gendered Mirror on the Wall
Authors: Alm Susanne , Låftman Sara Brolin
Published: December 2017

The study investigated gender differences in satisfaction with physical appearance as a domain-specific aspect of self-esteem, and its association with global self-esteem and psychosomatic complaints. The data used was from the Stockholm School Survey, conducted among ninth grade students (15–16 years), with pooled information from six cross-sectional surveys in 2004–14 (n = 32,117). Girls reported lower satisfaction with their appearance than boys. Satisfaction with appearance was more strongly associated with global self-esteem among girls, while the association with psychosomatic complaints was similar for both genders. There was a tendency towards a decline in satisfaction with appearance at the end of the study period for both genders, albeit more strong for girls. We conclude that satisfaction with appearance may contribute to our understanding of poor mental well-being among adolescent girls.
On sex in fieldwork: Notes on the methodology involved in the ethnographic study of anonymous sex
Authors: Langarita Adiego Jose Antonio
Published: December 2017

This article addresses the use of sexual relations with research informants in fieldwork for the purpose of gathering information. The analysis is based on the research that the author himself carried out between 2009 and 2014 on anonymous sexual encounters between men in public places in Catalonia. The article aims to demonstrate that sexual interaction with informants – notwithstanding appeals to scientific objectivity and professional ethics – can be a useful tool for gaining a better understanding of social reality. This study on anonymous sex shows that participating in sexual activity can provide the researcher with a great deal of information which would not be accessible via other relationships with research informants. However, the article also addresses certain limitations – which cannot be ignored – in fieldwork of this sort and in the interpretation of the data obtained.
Analytical model for harmonic response of dissimilar single-lap joints
Authors: Gafar Mohamed O , Almitani Khalid H , Othman Ramzi
Published: December 2017

Adhesive bonding is increasingly used in automobile, marine and aeronautical structures. The dynamic response of adhesively bonded joints is therefore a main concern. This paper deals with the harmonic response of single-lap joints. A closed-form analytical solution is derived to account for the case of joints with dissimilar substrates. The transfer functions predicted by the analytical model match well the transfer functions predicted by a two-dimensional finite element analysis, and so do the natural frequencies. The numerical and analytical models show that the natural frequencies are sensitive to the order of substrates. Mainly, fixing the end of the stiffer substrate leads to natural frequencies that are mostly higher than those which are obtained by fixing the end of the softer substrate.
Investigation of real gas effects on combustion and emissions in internal combustion engines and implications for development of chemical kinetics mechanisms
Authors: Yue Zongyu , Hessel Randy , Reitz Rolf D
Published: December 2017

Real gas effects on combustion and emissions in internal combustion engines are investigated using three-dimensional computational fluid dynamics. The Peng–Robinson equation of state is implemented to describe pressure–volume–temperature relationships and to calculate thermodynamic properties and relevant partial derivatives. Four facilities are modeled, including non-reacting compression in a motoring engine, combustion in a conventional diesel combustion engine and in a reactivity controlled compression ignition engine, as well as for a non-reacting reflected wave in a shock tube. It is found that the real gas effects of gas mixtures in practical internal combustion engine operation are sensitive to the operating load and the amount of premixed fuel. Excellent agreement against experiments was found for engine simulations with the Peng–Robinson equation of state in terms of cylinder pressure and apparent heat release rate. However, discrepancies with predictions from the ideal gas law grow with increased load and larger amounts of premixed fuel. In particular, the predicted emissions of soot, NOx, CO and unburnt hydrocarbons show increasing sensitivity to real gas effects as a result of changes in combustion phasing. Fuel condensation is also modeled using a vapor–liquid phase equilibrium solver and significant dependency on the equation of state used is found. Therefore, it is recommended to include real gas effects in internal combustion engine modeling to capture combustion and emissions characteristics accurately. Additionally, the results emphasize the role of real gas effects on reaction rates. Shock tube simulations are used to demonstrate the importance of using the real gas equation of state in the interpretation of chemical kinetic measurements. Significantly different compressed gas temperatures behind the reflected shock are predicted when real gas effects are considered. This needs to be realized when developing chemical kinetic models and rate constants for engine applications from shock tube data.
Simulation of the influence of constant uniform magnetic field on a miniature LIT mass spectrometer
Authors: Feng Yan , Pei Xiaoqiang , Cheng Yongjun , Sun Wenjun , Li Gang , Wang Yongjun , Xi Zhenhua , Zhang Huzhong
Published: December 2017

In this paper, the effects of constant uniform magnetic fields on a miniature linear ion trap mass spectrometer with hyperbolic electrodes are simulated using SIMION 8.0 3D software. Magnetic fields in different directions have different effects on the trajectories of the trapped ions and the shape of the ion cloud. When the magnetic field is applied in the z-direction, namely the ion injection direction, the magnetic field will cause the ions focusing to the z-axis, and exert a compression effect on the ion cloud. When the magnetic field is applied in the x-y plane, the original ion cloud will be expanded due to the action of the applied magnetic field, and the ion cloud plane after expansion is always perpendicular to the direction of the magnetic field. The discovery of influence field of magnetic will bring some useful inspiration for the improvement of ion trapping efficiency, mass resolution, sensitivity and trapping capacity, which is conductive to the performance enhancement utilization of magnetic field, even in the industrial application development and other aspects.
Modelling the effects of inter-observer variation on colour rendition
Authors: Murdoch MJ , Fairchild MD
Published: December 2017

The colour rendition characteristics of light sources are quantified with measures based on CIE standard observers, which are reasonable representations of population averages. However, even among people with normal colour vision, the natural range of variation in colour sensitivity means any individual may see something different than the standard observer. Modelling results quantify the effects of these inter-observer differences on colour rendition measures defined by IES TM-30-15. In general, inter-observer differences tend to be smaller for light sources with high colour fidelity values, and they are affected by spectral characteristics of different lighting technologies. The magnitude of variation in colour rendition measures, up to 5–10 units in IES TM-30-15 ( Rf, Rg), measures is compared with other sources of variability and ambiguity.
Assess, Identify, Make it Happen (AIM) for Preschools: A Tool to Decrease Early Childhood Obesity
Authors: Farewell Charlotte V. , Puma Jini E. , Powers Jamie , Belansky Elaine S.
Published: December 2017

Early childhood obesity is at epidemic proportions and is a major risk factor for the development of chronic diseases in adulthood. Since the majority of preschoolers are placed in center-based care, best practice policy, system, and environment (PSE) changes in early child care settings plays an important role in defining early development of obesogenic behaviors. However, implementation of best practice PSE changes is often a challenge in low resource settings due to staff turnover, time constraints, cultural beliefs, and lack of health-related knowledge. Assess, Identify, Make it Happen for Preschools (AIM-P) is a strategic planning process that was used with wellness teams in early child care centers to implement PSE changes that support adoption of health behaviors. AIM-P uses key change-making strategies based on intervention mapping including assets and needs assessments, prioritization of changes based on importance and feasibility, development of action steps and action plans, and identification of dissemination and sustainability plans. The AIM-P process resulted in implementation of 6.5 best practice PSE changes per site. Qualitative findings highlight lessons learned and the facilitators and barriers associated with using AIM-P to implement PSEs.
Revitalizing Vinyl
Authors: Breckenridge R. Saylor , Tsitsos William
Published: December 2017

r. saylor breckenride and william tsitsos on wax’s recent waxing.
Three Anastomotic Techniques Following Laparoscopic Rectal Cancer Resection: Our Experience in 155 Patients
Authors: Zanguie Mahtab , Abdollahi Abbas , Salek Roham , Jangjoo Ali , Jabbari Nooghabi Mehdi , Shabahang Hosein , Golmohammadzadeh Hamed
Published: December 2017

Purpose. This study aimed to assess the impact of 3 anastomotic techniques after laparoscopic rectal cancer resection. Methods. In a cross-sectional study, the data of 155 patients who underwent surgery for rectal cancer were retrieved. An anastomosis was created between the left colon and anal canal with 3 different methods: coloanal anastomosis with protective ileostomy (group A), coloanal anastomosis without ostomy (group B), and delayed coloanal anastomosis (group C). The rates of anastomotic problems (leakage, peritonitis, and collection) were calculated for each treatment method. Multivariate analysis was used to verify the effect of anastomosis techniques. Results. In 5 (3.2%) patients, peritonitis was observed in which 3 (9.7%) of them belonged to group B and 2 (4.1%) belonged to group C. In 9 (5.8%) patients, presacral collection and anastomotic leakage were observed; 4 (8.2%) patients belonged to group C, 4 (12.9%) patients to group B, and 1 (1.3%) patient to group A. Postoperative obstructions occurred in 5 (10.2%) patients of group C, 2 (6.5%) patients of group B, and 2 (2.7%) patients of group A. Rectovaginal fistula was detected in 2 patients from group B. Conclusions. Laparoscopic surgery of rectal cancer with transanal method is reliable and acceptable in terms of oncologic and surgical results. This study showed the best results in patients who had protective ostomy.
Advocating for Behavior Change With Education
Authors: Arlinghaus Katherine R. , Johnston Craig A.
Published: December 2017

Education is ubiquitous with clinical care. However, not all education supports behavioral change. Education is a broad term that encompasses the process of obtaining general knowledge, personal awareness, and skills training. Although not sufficient, education is a necessary component for behavior change. This article outlines the role of education in behavior change and offers practical suggestions for how clinicians can provide education to their patients to help them change behavior.
Awareness of Cancer Risk: Variation in Measurement Approaches
Authors: Banna Jinan
Published: December 2017

Cancer is a major cause of morbidity and mortality. Diet, nutrition, physical inactivity, and obesity have been identified as important contributors to the increasing cancer incidence worldwide. To effectively plan interventions to reduce cancer incidence and to influence the public’s decisions regarding health behaviors, it is important for professionals to have an understanding of the ways in which people understand risk with regard to development of cancer. Selecting an appropriate method to evaluate awareness of cancer risk is an important consideration. Quantitative approaches such as surveys may be used to investigate awareness of risk, and recall of risk factors as well as recognition of such factors may form part of such assessments. Such quantitative methods may be used to evaluate risk in different demographic groups, as well as to examine the link between risk factors and behavior. Qualitative approaches include in-depth interviews, focus groups, and open-ended survey items and may be used to explain findings derived using quantitative methods. Mixed methods approaches may also be employed, involving use of a survey as well as interviews or focus groups to gather in-depth information. Assessment of awareness of cancer risk using an appropriate method has important implications for educators, as professionals must evaluate understanding of risk factors and tailor messages accordingly for educational programs. Ongoing evaluation of awareness is a key part of determining the effectiveness of education initiatives and identifying new and emerging issues.
Sterilization of those with intellectual disability: Evolution from non-consensual interventions to strict safeguards
Authors: Rowlands Sam , Amy Jean-Jacques
Published: December 2017

Non-consensual sterilization is one of the characteristic historical abuses that took place mainly in the first half of the 20th century. People with intellectual disability (ID) were a prime target as part of the ideology of negative eugenics. In certain jurisdictions, laws were in force for several decades that permitted sterilization without the need for consent or with consent from third parties. The long-term adverse effects on those sterilized against their will have only more recently been recognized. In the latter half of the 20th century, human rights treaties were introduced and developed; they have, in the main, curbed sterilization abuses. Courts have developed more stringent criteria for making decisions on applications for sterilization, and nowadays there are mostly adequate safeguards in place to protect those with ID from non-consensual sterilization. The only exception should be the particular case in which, all medical and social factors having been taken into account, sterilization is overwhelmingly thought to be the right decision for the individual unable to give consent.
Policing as a performing art? The contradictory nature of contemporary police performance management
Authors: de Maillard Jacques , Savage Stephen P
Published: December 2017

Performance management in criminal justice organizations has become a prominent issue in many countries and has faced increasing criticisms by scholars and practitioners. In this regard it is important to examine empirically how performance frameworks work concretely. We do so through the empirical examination of ‘performance regimes’, that is, the sets of performance indicators, internal procedures, instruments and processes of internal accountability through which performance is defined, assessed and monitored work in police organizations. By using the categories of traditional (target-based, top–down and short-term) and advanced (processes, more deliberative and creative and long-term) performance regimes, we have charted a process of evolution illustrated by the experience of two police forces in England. We argue that police performance management is a contradictory and hybrid process containing elements of both traditional and advanced regimes and in constant flux between them. Problem-solving and a focus on the quality of processes coexist with cascading pressures, an emphasis on numerical targets and other features of more traditional regimes.
Implementing a perpetrator-focused partnership approach to tackling domestic abuse: The opportunities and challenges of criminal justice localism
Authors: Davies Pamela Ann , Biddle Paul
Published: December 2017

This article reports on a perpetrator-focused partnership approach to tackling domestic abuse. The package of interventions includes an identification tool and a unique multi-agency partnership approach to violence prevention and tackling abuse through perpetrator-focused early interventions. An overview of the key outcomes and issues emerging from this innovative package and partnership approach in one policing area in England is offered. Our discussion focuses on issues relating to the development of the co-ordination of the multi-agency tasking and co-ordination (MATAC) approach to addressing domestic abuse, particularly within the context of the opportunities and challenges of the localism agenda in criminal justice. Perceived concerns within the MATAC partnership, about victim safety alongside a heightened ‘focus on perpetrators’, caused us to critically reflect on the convergence of the politics of multi-agency working at very local levels. Our conclusion is that partnership working remains important in the shifting economic and political context in which local agenda setting and commissioning is occurring. The local still matters, and is as challenging as it ever was, in ensuring victim safety.
Implications of Working Time Regulations for Theatre Nurses Working in the NHS
Authors: Richards Jon , Williams Marilyn , County Bernadette
Published: December 2017

The European Working Times Regulations have implications for staff throughout the NHS. In particular, theatre staff and others working on call and shifts need to be aware of the implications of these regulations. In this article, Jon Richards, National Officer for Unison, explains the background to and implications of these regulations for theatre staff.
How can Autologous Blood Transfusions Help Our Patients?
Authors: Seal Julie
Published: December 2017

In modern day clinical nursing practice, respecting and encouraging patient autonomy, together with acting as advocate for the patient, is an integral part of holistic patient care. We have a ‘duty of care’ to our patients. So why, in the early days of the 21st century, are we still transfusing our patients with homologous blood products when there is a safer alternative which has been recognised for almost 200 years?
Professional Regulation: Now and in the Future
Authors: Norman Sue
Published: December 2017

The professional regulation of nursing, midwifery and health visiting is a partnership between the public which expects it, the practitioners who practise it and the UKCC and the four National Boards which co-ordinate and administer the system.
The Air we Breathe: Audit to Evaluate how Healthy the Working Environment is in Recovery
Authors: Layzell Mandy
Published: December 2017

Health hazards can often affect workers slowly and quietly over many years. Risks may not be immediately apparent, especially when no rigorous monitoring, research or follow-up is carried out by the employer. The worker remains in ignorance of the dangers and the link between damage to health and occupational hazard remains unexposed (Rogers & Salvage 1988). This article examines the potential hazards in the recovery environment.
Chaos, Cosmology and Evolution: The Key to Understanding Practice Development in Perioperative Nursing?
Authors: Walsh Mike
Published: December 2017

This article looks at the challenges facing practice development today and uses key topics in the natural sciences as metaphors to try and stimulate fresh ways of thinking about the way forward. The fundamental challenge we face is one of borders and boundaries, and this is a theme I will keep returning to in this paper.
The Benefits of Using Customised Procedure Packs
Authors: Baines Rw , Colquhoun Gary , Jones Nathan , Bateman Richard
Published: December 2017

Discrete item purchasing is the traditional approach for hospitals to obtain consumable supplies for theatre procedures. Although most items are relatively low cost, the management and co-ordination of the supply chain, raising orders, controlling stock, picking and delivering to each operating theatre can be complex and costly. Customised procedure packs provide a solution.
The Preparation of Bone Cement
Authors: Eveleigh Rebecca
Published: December 2017

In this second in a series of four articles, Rebecca Eveleigh explains why it is essential for bone cement to be properly prepared, mixed and delivered.
Caring for the Carers
Authors: Campbell Claire
Published: December 2017

In this further article of the series, Claire Campbell introduces and explores the needs of Health Service employees who care for their own relatives or companions who cannot cope due to sickness, disability or age, why it is important to recognise their needs, what kind of support they need, and how policies can be put in place.
Electrosurgical Smoke Plume is it Harmful to Staff?
Authors: Hughes Angharad , Hughes Jonathan
Published: December 2017

When a potential problem was identified by several staff regarding electrosurgical smoke plume, Angharad Hughes and Jonathan Hughes decided to look into the situation using an evidence-based approach. What follows is a précis of literature found, and information about how this approach was carried out. It shows that there is some evidence that particles present in smoke plume are potentially harmful to health, but that the extent of the risk is as yet unknown.
Healthcare Support Workers and the Scrubbed Role
Authors: Tanner Judith , Hind Martin
Published: December 2017

The scrub role during surgery is clearly important and is currently dominated by nurses and operating department practitioners (ODPs). Recently, there has been discussion about whether this role could be undertaken by healthcare support workers (HCSWs). This article by Martin Hind reports on a survey of operating theatre nurses, where little support was found for allowing HCSWs to develop into a scrubbed role. The professional and legal issues to role boundaries are also discussed and the article illustrates that, despite the lack of nursing support for such a development, the issue is far from resolved. Recommendations are made for further discussion and deliberation as well as a review of all roles within the operating department.
A New Lens done through a Colleage’ Eye
Authors: Matthews Michael
Published: December 2017

Just like other members of the wider community, medical practitioners experience disorders that require corrective surgery. Michael Matthews has been retired for more than 18 years. At one time he was in charge of a coronary care unit. Recently, the tables were turned on him, when he had to go back into hospital, this time as a patient for day surgery to remove a cataract and receive a replacement lens. Dr Matthews describes his experience of eye problems and of receiving his new lens.
Partnership in Head Injury Rehabilitation
Authors: Pardoe Pat
Published: December 2017

It is estimated that every year one million people in Britain attend hospital as a result of a head injury (McMillan & Greenwood 1988). The age group most at risk of head injury is 15-29 years and a large proportion of young survivors will have a more or less normal life expectancy. This can have a serious impact on family life, roles and relationships both within the household and outside.
Hepatitis C in Perioperative Practice
Authors: Dyke Maureen
Published: December 2017

This is the second of a series of three articles which won the Alison Bell Writer's Award this year. Maureen Dyke won second prize for this article, which looks at nurses’ knowledge and appreciation of the dangers of the various hepatitis infections. The Writer's Award is sponsored by NATN and Regent Medical.
Fume Levels during Bone Cement Mixing
Authors: Eveleigh Rebecca
Published: December 2017

This article compares some of the various products available for mixing and preparing bone cement. It should be noted that the tests were not independent as the author is employed by one of the product manufacturers. It should also be noted that the tests were carried out under laboratory conditions and therefore do not include practices carried out by scrubbed staff that could affect the results.
Ethical Theories and Dilemmas
Authors: Hughes Suzanne
Published: December 2017

Nurses are daily faced with questions of ethics. Most of these questions are minor, everyday issues that individual nurses can resolve on their own, without the need for involvement of their colleagues, and with no, or few, implications for patient care. From time to time, however, issues with major implications for patient care will arise that require the members of the perioperative team to make significant ethical decisions. In this article, Suzanne Hughes discusses the nature of ethics, the ethical questions that nurses might have to address and the consequences arising from decisions.
Surgical Gloves how Do you Change Yours?
Authors: Duxbury Mark , Brown Cheryl , Lambert Anthony
Published: December 2017

Surgical gloves are frequently changed intraoperatively, and different techniques exist. We surveyed surgeons and scrub staff in our hospital and prospectively compared contamination between two glove changing techniques. We questioned 25 surgeons and 25 scrub staff regarding their intra-operative glove changing technique. Twenty scrub staff performed a standard ‘surgical scrub’, following which aliquots of fluorescent powder were applied symmetrically to each forearm prior to donning gown and gloves. Subjects were randomised to group 1 – open technique (OT) followed by closed technique (CT), or group 2 – CT followed by OT. Following unassisted glove change, glove and hand contamination was assessed.
Decontamination and Control of Infection in Theatre
Authors: Line Stuart
Published: December 2017

Decontamination covers all aspects of reprocessing of reusable equipment. It is understandable that patient well-being is perceived to take precedence over infection control. Unfortunately the spread of infection is based on the opportunity for organisms able to move from a controlled area to the patient or staff. Continued vigilance and adherence to good practice is essential to combat the ever-present problem. This article covers the problem of local decontamination within the theatre complex, and sources of potential infection are identified and discussed.
What is Nursing Research?
Authors: Bassett Chris , Bassett Jane , Tanner Judith
Published: December 2017

The first article in this series looked at the value of research in nursing. This second article explains what nursing research is, and provides a list of steps to carry out research. There is, unfortunately, a great deal of anxiety associated with the word ‘research’, for many nurses. Over recent years, government and trust managers have placed more and more emphasis on developing a research culture in nursing. The anxiety is caused mainly by a general lack of understanding about the subject. Also, frankly, there can be at times a feeling of exclusivity for research that is cultivated by some academics and researchers. Research, as outlined in part one of this series (Bassett & Bassett 2003), however, is something that we all need to incorporate into our practice.
UK Surgical Draping Practices a National Survey
Authors: Davidson Kenny , Dobb Mandy , Tanner Judith
Published: December 2017

Surgical draping practices throughout the UK vary between hospitals. This national survey (funded through an NATN/3M Clinical Fellowship) sought to determine the extent of various draping practices and identify practitioners’ reasons for selecting specific draping products.
Reducing Pressure Damage in the Operating Theatre
Authors: Hartley Lynne
Published: December 2017

Pressure sores occurring in surgical patients are often not attributed to time spent in the operating theatre. Initial underlying damage can occur whilst undergoing a surgical procedure but may not become apparent until hours or days later. In carrying out a literature review, the author concluded that such a fundamental aspect of nursing care in the operating theatre is a low priority and that nurses could do more in terms of pressure relief for their patients. The author concludes by identifying implications for practice.
Valid Consent to Surgery Dispelling the Myth and Establishing the Evidence
Authors: Reid Jane
Published: December 2017

This is a transcript of a paper given at the 3rd EORNA Conference on the Island of Crete, Greece, in May 2003.
Role Perception in a Climate of Change the Role of the Anaesthetic Nurse
Authors: Mehigan Sinead
Published: December 2017

This article reports some research that asks the question ‘Within the current climate of change, how do anaesthetic nurses perceive their role?’ Impetus for the study came from the author's personal experience as both a nurse within theatres, and an educator of nurses. The paper was presented at the conference of the European Operating Room Nurses Association (EORNA) in Crete in April 2003.
An Audit of the Skin Condition and Epidural Dressings
Authors: Daykin Sue , Cox Felicia
Published: December 2017

The maintenance of the security and sterility of epidural catheter insertion site dressings is paramount. Sue Daykin and Felicia Cox describe a prospective audit of the adhesive tapes used to provide a window to view the epidural catheter insertion site. Insertion sites were viewed on postoperative day one and the day after catheter removal by the acute pain nurse. A description and drawing of the site were documented. The most important implication of this audit is that if adhesive tape is used to provide a window for epidural analgesia, there is a possibility of skin irritation however long the epidural dressing remains in place.
Redefining Perioperative Advanced Practice Scope of Practice: Measuring Impact and Sustainability
Authors: Radford Mark , Abbassi Ann , Williamson Alastair , Johnston Paul
Published: December 2017

There are increasing demands placed upon the modern NHS, particularly in emergency care. In combating these demands, new approaches to practice will form an overall strategy for improving care delivered to patients. This is the second in a series by authors from the Good Hope Hospital NHS Trust and explains their experience of developing an innovative approach to the management of surgical emergencies through the specialist nurse role in anaesthesia and emergency surgery. It examines the scope of practice, clinical and operational impact of the role, and future developments.
Agenda for Change Will it Resolve the Grading Issue?
Authors: Beesley John , Pirie Susan
Published: December 2017

It has now been nine months since Investigating Agenda fo Change was published as a supplement to the May 2003 issue of the BJPN. Negotiations on the terms of Agenda for Change have continued and a number of issues have been clarified. This article revisits our original publication and brings readers up to date on how Agenda for Change will affect them.
Clinical Supervision
Authors: Wood Janet
Published: December 2017

The NHS Plan (DoH 2000) states that the modern National Health Service (NHS) will be driven by a cycle of continuous quality improvement. This will enhance the efficiency, productivity and performance of the NHS. The aim of this article is to examine clinical supervision as a quality assurance initiative. To achieve this, clinical governance and lifelong learning will be evaluated within a theoretical framework with the focus on clinical supervision.
A New Anti-Embolism Stocking Use of Below-Knee Products and Compliance
Authors: Parnaby Claire
Published: December 2017

This article highlights the need to use graduated compression stockings (GCS) in deep vein thrombosis (DVT) prophylaxis. A survey carried out at the Middlesex Hospital, part of the UCLH NHS Trust, London, ascertains the prevalence of patients wearing either above- or below-knee GCS and whether or not these were worn correctly through two trials. The findings show how the choice of product can influence compliance, safety and economy, which in turn influences adherence to hospital policy.
Latex Sensitivity Awareness in Preoperative Assessment
Authors: Rose Dianne
Published: December 2017

The role of the preoperative assessment practitioner (POAP) has evolved hugely to allow them to become more autonomous in decision-making, particularly in the design of local protocols and guidelines for preoperative assessment. Good practice guidelines are imperative to ensure that all requirements for the patient have been identified before the day of surgery, which minimises the risk of late cancellations.
Postoperative Endophthalmitis: Caution is the Watchword
Authors: Field Dorothy , Merrick Edward
Published: December 2017

Postoperative endophthalmitis is the most feared complication following cataract surgery. It can be caused by infection entering the eye during surgery or by inadequately cleaned instruments. Sterile phaco handpieces might retain remnants of soft lens matter or viscoelastic which might later contaminate other patients, causing inflammation in their eyes. The costs of an endophthalmitis outbreak are heavy, including poor patient outcomes, temporary theatre closure, rising waiting lists and damage to a hospital's reputation. This article raises awareness of endophthalmitis and provides useful recommendations for ophthalmic theatre personnel.
A Cover Up? Potential Risks of Wearing Theatre Clothing outside Theatre
Authors: Roxburgh Michelle , Gall Pat , Lee Karen
Published: December 2017

A report from the Hospital Infection Society Working Group (2002) examined ritualistic practices in theatre and evidence was sought to establish which practices could be supported with clear scientific evidence. The report stated that there is little or no research to show that wearing theatre attire outside the theatre and returning without changing into clean theatre attire increases wound infection rates. It is difficult to implement infection control practices on a scientific basis as there is often a lack of evidence to support the practice. Moreover, many practices are grounded in ‘this is the way things are done around here’ (Ward 2000).
Increasing Surgical Throughput in a Busy Day Procedure Unit
Authors: Mccolgan Karen
Published: December 2017

In August 2001 the Mater Hospital in Belfast opened a new day procedures unit. The unit comprises an admissions area, two theatres, an endoscopy suite and a 23-bed ward, with one theatre almost solely dedicated to ophthalmic surgery. There are three consultant ophthalmologists who currently perform cataract, orbital, corneal, vitreoretinal and plastic surgery on a regular basis. In the four years that the unit has been running we have had a 57% increase in ophthalmic day case surgery.
Cryosurgery for Prostate Cancer
Authors: Harvey Candi
Published: December 2017

This article describes a new minimally invasive treatment for men with recurrent cancer post radiotherapy and localised prostate cancer utilising argon and helium gases. Cryosurgery utilises high pressure argon and helium gas linked by a computer-controlled delivery system to cryoneedles which are introduced through the perineum into the prostate gland. Transrectal ultrasound allows accurate placement of the needles. Temperature needles are used to protect the sphincter muscle and rectum.
Support Staff Roles in the Operating Department: A Survey of Staff Opinion
Authors: Hennessy Paul , Morgan Alun
Published: December 2017

The expansion of support staff roles throughout the NHS was identified as a key element in the drive for service improvements set out in the NHS plan (Department of Health 2000). However, while examination of the literature identified the opinions of professional representative bodies (Perioperative Care Collaborative 2002a&b), little published data is available of the opinions of staff ‘on the shop floor’.
Inter-Professional Education: Registered Nurses + Odps = Theatre Practitioners
Authors: Steevenson Grania
Published: December 2017

The structure of theatre management should ensure that the patient receives the most appropriate care available, with every team member knowing their role and their expected contribution in order to meet the needs of the patient. Inter-professional healthcare is an integral feature of the NHS and this article will focus on the interaction and teamwork experienced in the theatre department between qualified nurses and qualified operating department practitioners (ODPs) and the perceived differences and similarities in their roles both historically and in future practice. Taylor and Campbell (1999) state the operating department is unique in that various members of the multidisciplinary teams are all present at the same time and work together for the successful completion of the perioperative period of care. Anonymous clinical examples have been used to highlight certain points and to illustrate the differing roles of the perioperative staff.
Inadvertent Hypothermia in the Operating Theatre: An Examination
Authors: Bellamy Carol
Published: December 2017

Inadvertent hypothermia is a condition prevalent within the perioperative setting, since it has been estimated that as many as 70% of surgical patients suffer some degree of hypothermia (Litwack 1995, cited in Arndt 1999). This article will focus primarily on increasing the practitioner's awareness of patient risk and will discuss preventative measures. It will also provide the required underpinning knowledge to implement quality patient care.
Conscientious Objection: Justified or Just Refusal to Care?
Authors: Nuttall Coral-Kay
Published: December 2017

In general terms, healthcare professionals are not at liberty to refuse to care for any patient (UKCC 2004). However, as the law permits patients to do what is morally and ethically right for them with regard to termination of pregnancy, it must also extend this right to the healthcare professional. The Abortion Act (1967, Section 4 (i)) permits healthcare professionals to refuse participation on the grounds of conscientious objection. As there is no statutory definition of conscientious objection, it is left to the individual to prove that they have an objection to being involved in terminations of pregnancy.
Lister's Sinus Forceps
Authors: Ellis Harold
Published: December 2017

There is little doubt that Joseph Lister (1827–1912) was the greatest surgical benefactor to mankind. His name is perpetuated in our theatres, wards and accident departments every time we use that humble but very useful instrument, his sinus forceps.
Getting Patients Back to Work after Carpal Tunnel Surgery
Authors: Newey Martyn , Clarke Malcolm
Published: December 2017

This article describes the condition known as carpal tunnel syndrome and reviews a carpal tunnel service that was started in Leicester in 1999. We look at how the service has developed to meet patient needs, and how we now aim to return patients back to function and employment as quickly as possible after surgery.
Safe Learning and Assessment for Anaesthetic Apparatus Checks
Authors: Bowers Mark
Published: December 2017

This article discusses the safe learning and assessment for a component of the anaesthetic apparatus check. It reports on an innovation to facilitate a realistic medical gas pressure check. For clarity, the term ‘anaesthetic practitioner’ (Wicker & Smith 2006) is used to refer to operating department practitioners and perioperative nurses who work as members of the anaesthetic team, as opposed to ‘anaesthesia practitioner’ (Wilkinson 2007) which refers to non-medical anaesthetists.
Ensuring Correct Site Surgery
Authors: Edwards Peggy
Published: December 2017

Surgery at the wrong site is fortunately an infrequent event, but when it does happen the consequences can be devastating for the patient, their family and the surgical team. Wrong site surgery doesn't just refer to taking out the wrong organ, it is also includes such errors as making an incision on the wrong side, putting in a prosthesis the wrong way round, and administering a local anaesthetic block to the wrong side prior to the surgical procedure – for example an ophthalmic procedure under local anaesthetic. Ensuring the correct surgery is performed on the correct patient at the correct site is a key responsibility for the whole surgical team.
Anaesthetic Assistant Competencies: Our Experience
Authors: Smith Brian , Rawling Paul
Published: December 2017

The purpose of this article is to share our findings since introducing the recently-developed anaesthetic assistant competencies (NHS Education for Scotland 2006). The term ‘anaesthetic assistant’ will be used throughout this article to refer to those who support the anaesthetist during anaesthesia. It is in no way meant to be derogatory to any person practising currently in this speciality.
Prion Disease Transmission: Can We Apply Standard Precautions to Prevent or Reduce Risks?
Authors: McDonnell Gerald
Published: December 2017

Prion diseases present unique challenges to healthcare facilities, both in the care and treatment of patients. A significant cause for concern is in the routine reprocessing of medical devices used on patients and how disease transmission can be prevented on the reuse of devices. Investigations have shown that prion disease can be transmitted on medical devices, which can be a concern given the long incubation times associated with these diseases and that guidelines to control transmission only really apply in a small number of known or at risk cases. It is only recently that medical device-associated cleaning, disinfection and sterilization technologies have been investigated and the results of these studies are summarized in this report. The evidence would suggest that many simple decontamination steps can be applied to dramatically reduce the risks to patients, but the research has also given some surprises. Overall, it is reasonable to expect that standard precautions will be able to be applied both today as well as in the future to reduce the risk of prion disease transmission as well as the many other human pathogen concerns, although this may mean changes in some of our practices.
Checking the Anaesthetic Machine
Authors: Wicker Paul , Smith Brian
Published: December 2017

Making sure that anaesthetic equipment is working correctly is an essential part of the anaesthetic practitioner's role. During induction of anaesthesia the patient is at one of the most vulnerable points in his or her perioperative journey. This is the point at which equipment error may put the patient at high risk of harm, for example, through compromising the airway, causing circulatory problems, preventing satisfactory oxygenation or even causing death. Many writers have drawn comparisons between anaesthesia and aviation, with the suggestion that practitioners should check the anaesthetic machines using a ‘cockpit drill’ (Ranasinghe 2000). The purpose of this detailed check is to ensure the machine is safe to use. The careful attention to the check is a reflection of good practice which the practitioner's codes of professional practice demand (HPC 2004, NMC 2004). This article discusses the importance of following the anaesthetic checklist to the recommended standards for both the practitioner and the patient.
The Non-Technical Skills of Theatre Nurses
Authors: Mitchell Lucy
Published: December 2017

What are ‘non-technical’ skills and why would they be relevant to theatre practitioners? This is a new area of research for healthcare based on a well developed approach from the world of aviation. Non-technical skills are the cognitive and social skills that complement technical skills to achieve safe and efficient practice in safety-critical occupations. These skills include communication, leadership, teamwork, stress management and situation awareness.
Florence Nightingale: Creator of Modern Nursing and Public Health Pioneer
Authors: Ellis Harold
Published: December 2017

In starting this series of articles on distinguished women in nursing, medicine and the related healthcare professions, the choice of the first name is obvious. Florence Nightingale is, I suggest, the most famous female in the long history of medicine and is a name that is known and revered throughout the world. Most people – even those in ‘the trade’ – think of her as ‘the lady with the lamp’, the heroine who went out to the Crimean War and nursed the sick and wounded at Scutari. Important though this was, her main contribution was her continued work, long after the war, in nursing organisation and training, hospital planning, public and military health and her pioneering work in the efficient gathering of medical statistics.
‘Indirect Vac: A Novel Technique of Applying Vacuum-Assisted Closure Dressing
Authors: Durai Rajaraman , Hoque Happy , Davies Tony W
Published: December 2017

Vacuum-assisted closure (VAC) wound dressing is increasingly used to assist closure in various wounds ranging from simple finger pulp defect to complex wounds such as laparostomy or infected sternotomy. The traditional application of direct vacuum therapy can cause discomfort and put the patient at risk of injuring the affected area while mobilising. We describe a novel technique of applying VAC therapy indirectly which is much more comfortable and convenient for the patient while mobilising.