bluuebunny/crossref_metadata_2025 huggingface dataset:
Principles of Acute Pain Management
Authors: McMain Lorraine
Published: December 2017

Acute pain is a predominant feature of the perioperative experience for the majority of patients. This paper aims to describe the adverse effects of poorly controlled acute, postoperative pain and provides an overview of the organisational aspects involved in pain management in hospitals. Following this there will be an examination of the role information giving has in improving the patient's perioperative experience. Pharmacological and non-pharmacological interventions to prevent or reduce pain will also be described and because of its importance in setting the standard for logical prescribing in pain, the Analgesic Ladder, devised by the World Health Organisation (WHO 1986) will be given special consideration. Finally, the importance of pain assessment and re-assessment will be discussed.
Strabismus: Background and Surgical Techniques
Authors: Modi Neil C , Jones David H
Published: December 2017

Through the process of evolution, the position of the eyes within the head has moved from lateral to frontal. Although reducing the panoramic view afforded by the lateral positioning, this new arrangement allowed stereopsis (depth perception) (Hubel and Wiesel 1965).
Reflections on a Perioperative Career: 1970–2008
Authors: Williams Marilyn
Published: December 2017

This paper is a personal journey through nurse training and perioperative practice. Nurse education is also explored alongside some of the social, academic and political changes that have influenced healthcare in the United Kingdom between 1966 and 2008. The views expressed are those of the author only, and the anecdotal descriptions are anonymous.
Perioperative Use of Antibiotics in Elective Surgical Patients: Timing of Administration
Authors: Zaidi Nadeem , Tariq Muhammad , Breslin Dara
Published: December 2017

The practice of perioperative antibiotics administration in relation to surgical incision was analyzed in 525 elective surgical patients at St Vincent University Hospital, Dublin. 82.86 % (435) patients received the perioperative antibiotics before surgical incision was made and 17.14 % (90) patients received it after the surgical incision was made. The issue of timely administration of perioperative antibiotic should be included in the surgical time out to improve compliance in this regard.
Morphine Delays Discharge following Ambulatory Surgery: A Prospective Institutional study
Authors: Basu Narendra Nath , Kald Bengt , Heath Dugal
Published: December 2017

Introduction

- Morphine is used regularly in day surgery despite its known side-effects. We assessed whether this delayed discharge.

Patients and methods

- 100 patients were divided into 2 groups: 50 patients received morphine and 50 patients received non-morphine analgesia. Demographic data and reasons for delayed discharge were recorded.

Results

– 73% of all major cases received morphine compared to only 19% of minor cases. Operative and recovery times were significantly greater in the morphine group. 58% of patients given morphine had a delayed discharge compared to 14% of patients not given morphine.

Conclusions

- Morphine use in day surgery is associated with increased operating and recovery times and higher rates of delayed discharge.
Elizabeth Kenny: An Early and Controversial Physiotherapist
Authors: Ellis Harold
Published: December 2017

Elizabeth Kenny became world-famous in her day for her treatment of paralysed children -especially those suffering from paralytic poliomyelitis. Young doctors and nurses of my generation, in the 1940's and 50's, were really scared of getting ‘polio’. A medical student a year ahead of me at Oxford died in an ‘iron lung’ at the Radcliffe Infirmary.
Mary Seacole: Self Taught Nurse and Heroine of the Crimean War
Authors: Ellis Harold
Published: December 2017

Mary Jane Seacole was born Mary Grant in Kingston Jamaica in 1805. Her father was a Scottish army officer and her mother a free Jamaican black, (slavery was not fully abolished in Jamaica until 1838). Her mother ran a hotel, Blundell Hall, in Kingston and was a traditional healer. Her skill as a nurse was much appreciated, as many of her residents were disabled British soldiers and sailors. It was from her mother that Mary learned the art of patient care, and she also assisted at the local British army hospital.
Controlling the Process: Legislation and Guidance Regulating the Decontamination of Medical Devices
Authors: O'Brien Val
Published: December 2017

The reprocessing of medical devices, in particular surgical instruments, is an extremely technical and highly regulated industry. There are many guidance documents, and European and international standards that cover different aspects of decontamination. This article provides an outline of the main documents covering the critical elements of reprocessing which aim to ensure that reusable medical devices are provided which are fit for purpose and safe for patient use.
Perioperative Role Development: Evaluating a Fast-Track Approach to Advanced Scrub And/Or Dual Role Practitioner Training
Authors: Timpany Michaela D , McAleavy Janet
Published: December 2017

This report describes the service evaluation of a newly developed fast-track advanced scrub practitioner (ASP)/dual role training programme. The evaluation examines whether the introduction of new policies and training based on risk assessment have strengthened quality assurance measures and controls which aim to ensure that staff work safely within their scope of practice. A further aim is to establish if the fast-track route is adequately meeting the training and development needs of staff within the organisation and supporting service requirements.
Pain Management in Recovery
Authors: McMain Lorraine
Published: December 2017

Recovery room practitioners lay the corner stone for postoperative recuperation in patients undergoing surgical procedures. This article highlights how some aspects of the role, such as pain assessment, commencement of the prescribed analgesic regimen and pain control can be very challenging, for a variety of reasons. The aim, therefore, is to follow a typical patient journey in a structured manner, beginning with a demonstration of how provision of information empowers patients during the key phase of postoperative recovery. This is followed by a description of some assessment tools best suited to patients recovering from anaesthesia who are experiencing acute, postoperative pain. Consequences of under-treated pain are discussed and treatment modalities are described.
Sudden Hypotensive Syncope and Significant Iatrogenic Maxillofacial Trauma following Administration of Oral Sodium Phosphate Purgative Solution
Authors: Williams John V , Colbert Serryth D , Revington Peter J
Published: December 2017

Oral sodium phosphate (NaP) solution is used globally as a bowel preparation for colonoscopy, surgery and medical-imaging (Balaban 2008). We present a case of a patient who suffered sudden hypotensive syncope and iatrogenic mandibular fractures within an hour of ingesting a NaP solution. We discuss the uses of these medicines and highlight the need to warn patients of possible adverse side effects to avoid patient harm and subsequent litigation.
Sparsh Vachana: The Promise of a Better Life
Authors: Armitage Amanda , Pearson Anita , Smith Jane
Published: December 2017

Amanda Armitage, Anita Pearson and Jane Smith from South Yorkshire, share their experience of a week-long charitable surgical event.
Chlorhexidine's Complications
Authors: Sivathasan Niroshan , Sivathasan Nirupa , Vijayarajan Lavnya
Published: December 2017

Chlorhexidine is an effective cleansing skin-preparation agent and has many user benefits. It has, however, been associated with a number of complications which are highlighted in this paper. All users of chlorhexidine must be aware of these risks and employ insightful use of this chemical.
The Differences of Anaesthetic Care in Paediatrics Compared to Adults
Authors: Clarke Sue
Published: December 2017

In the study of holistic perspectives in perioperative care the following article focuses on the care required for paediatric patients through the perioperative period. This incorporates an understanding of the anatomical, physiological and pharmacological differences from adult practice, acknowledging the most important principles of patient safety. The planning, implementation, equipment adaptations and psychological challenges associated with this group will be discussed in relation to improving the overall perioperative experience.
Diathermy in Perioperative Practice
Authors: Potty Anish G , Khan Wasim , Tailor Hitesh D
Published: December 2017

Diathermy has revolutionised modern surgery and is an important tool for efficient and safe surgical practice. It has evolved to become the modern day scalpel, being used for cutting and coagulating tissues. This article addresses the functioning and safe use of diathermy in the perioperative setting. The various precautionary checks before surgery, which are prerequisite for safe usage, are highlighted along with the necessary safety drills during and after operation. A specific note is included about the use of electrical equipment in specialised surgeries like cardiac and laparoscopic surgery. The issues regarding the maintenance and repair of equipment are acknowledged and finally, the anticipation for a future with precise and safer cutting and coagulation devices is addressed.
Care of Patients with Parkinson's Disease in the Operating Department
Authors: Holland Joanna
Published: December 2017

As our elderly population increases, theatre staff are frequently presented with the challenges of caring for patients with co-morbidities who are undergoing surgery. This article aims to educate the reader about Parkinson's disease, and suggest interventions that perioperative practitioners may want to consider in order to improve the patient's experience in the operating department.
Advanced Trauma Life Support Radiographic Trauma Series: Part 2 - the Chest Radiograph
Authors: Chimutengwende-Gordon Mukai , Khan Wasim S , Sidhu Jasmeet , Longo Umile G , Maruthainar Nimalan
Published: December 2017

The chest radiograph is used as a screening test to exclude significant thoracic injuries in cases of major trauma. A systematic approach to reviewing chest radiographs is necessary for accurate interpretation. Radiographic findings should be considered together with clinical assessment.
Glaucoma Surgery
Authors: Modi Neil , Vahdani Kaveh , Booth Adam P
Published: December 2017

Glaucoma is a potentially blinding condition that cannot be easily defined. There are various types of glaucoma which may vary in symptoms from none at all to sudden pain and redness. There is a characteristic optic neuropathy, or damage to the optic nerve, which results in progressive loss of visual field. The most important risk factor is an increase in the intraocular pressure (IOP) secondary to a reduction in the drainage of aqueous fluid from the drainage pathways in the eye, the filtration angle(Kanski 2007, Allingham et al 2011).
Multidisciplinary Education Improves Prescription of Balanced Crystalloids: A Pilot Study
Authors: Bosworth Kerry , Findlay John M , Spencer Sarah
Published: December 2017

Objective

To assess the use of balanced and unbalanced crystalloids in adult surgical patients.

Method

Prospective study of 65 adult emergency general surgical admissions in a UK acute district general hospital, with a further 45 patients studied following educational interventions.

Results

36.4% of patients studied were prescribed inappropriate saline for resuscitation/replacement before the intervention. This compared with no inappropriate prescriptions (0%) after educational intervention (p = 0.0137).

Conclusion

Simple multidisciplinary educational interventions can improve intravenous fluid prescription.
The Patient with a Pierced Tongue
Authors: Clapham Edward , Crooke James
Published: December 2017

Patients with a pierced tongue are appearing with increasing frequency in our anaesthetic practice and much has been written in the literature over the past decade. Some patients are reluctant to remove their piercing when requested to do so. The literature suggests that it can take between 4 and 6 weeks to consolidate the tract, and patients often complain that removing piercings before this time leads to rapid healing due to the highly vascular nature of the tongue (Marenzi 2004). A telephone survey of our local body piercing establishments suggested that even an established tract can heal in a matter of a few hours. A new tract can certainly become functionally closed within an hour. We have recently seen two cases in our practice which highlighted interesting learning points.
The Development of An Extended Care Facility in the Recovery Unit: The Post-Anaesthesia Care Unit
Authors: Reed Helen
Published: December 2017

This article describes the development of a new service – the post-anaesthesia care unit (PACU) -that provides extended care in a recovery unit for patients who would have formerly been ‘fast-tracked’ through a high dependency unit (HDU). Patients requiring major surgery who stay in the recovery unit overnight are invasively monitored, have tight fluid management, blood chemistry analysis and frequently have pharmacological support. However, our overnight recovery service is not considered suitable for ventilated patients. Over 90% of patients are able to be discharged to a surgical ward within 24 hours of admission, following medical review.
Perioperative Management of Morbid Obesity
Authors: Al-Benna Sammy
Published: December 2017

Data from the NHS Information Centre reveals that more than one in three adults (36.9%) is overweight. In addition, almost a quarter of adults (24% of men and 25% of women aged 16 or over) are obese, with their need for treatment placing a growing burden on the NHS (The NHS Information Centre 2010). Given these proportions, and that an increasing number of morbidly obese patients are undergoing weight loss surgery and procedures related to obesity, it is an opportune time to review the perioperative care of morbidly obese patients.
Effectiveness of Hydrocolloid Dressing in Postoperative Hip and Knee Surgery: Literature Review and Our Experience
Authors: Siddique Khurram , Mirza Shirin , Housden Philip
Published: December 2017

Hydrocolloid dressings are impermeable dressings that provide an optimal environment for wound healing. These dressings are very effective in healing chronic wounds but evidence regarding their use for the post-operative knee and hip surgery is scarce. Our experience shows that hydrocolloid dressing (Duoderm®) helps in preventing not only superficial surgical site infection (SSSI) but also blister formation in patients undergoing lower limb orthopaedic surgery.
Bone Cement: Perioperative Issues, Orthopaedic Applications and Future Developments
Authors: O'dowd-Booth Christopher John , White Jonathan , Smitham Peter , Khan Wasim , Marsh David R
Published: December 2017

Bone cement has been increasingly used in orthopaedic surgery over the last 50 years. Since Sir John Charnley pioneered the use of polymethylmethacrylate cement in total hip replacements, there have been developments in cementing techniques and an expansion in the number of orthopaedic procedures that use cement. This review covers the perioperative issues surrounding bone cement including storage, cementing techniques and complications. It also discusses specific orthopaedic applications of bone cement and future developments.
Workplace Bullying in the NHS
Authors: Randle Jacqueline
Published: December 2017

Bullying is a sensitive issue which is no longer confined to the school playground; adults are increasingly aware that workplace bullying is on the rise. Healthcare workers as well as patients are affected by bullying which can result in anxiety, dismay and powerlessness. The impact of workplace bullying on patient care is identified in this article as this is an under-researched area. The influence of the environment on workplace bullying is also considered. The NHS, like any other organisation, is characterised by circumstances that make bullying and harassment likely. Healthcare workers can minimise these and strategies are offered in this paper to make the workplace environment more positive from both an individual and an organisational perspective.
The early days of arterial surgery
Authors: Ellis Harold
Published: December 2017

Severe arterial bleeding must have been a common, much feared and often fatal complication of trauma since man appeared on Earth. The early surgeons would have used direct pressure on the wound, which would only have provided temporary relief, or learned to apply a tight dressing. If it was an injured limb, this would often result in gangrene. Application of styptics such as turpentine or the use of the cautery or boiling oil is described in ancient Greek, Roman, Hindu and Arab manuscripts. Indeed, boiling oil to cauterise gunshot wounds was strongly advised by John de Vigo in his surgical textbook that was widely used in the 16th century.
Treatment and Management of Obesity: Is Surgical Intervention the Answer?
Authors: Cobbold Angela , Lord Sue
Published: December 2017

Obesity is rapidly becoming a major health concern and could be considered equal to smoking as a preventable cause of premature death. The National Institute for Health and Clinical Excellence (NICE 2006) estimated that 1.1 billion people are overweight, a number rivalling those who are underweight globally. Recent statistics for England from the National Health Service (NHS 2011) report that in 2009/10 there were 7,214 bariatric surgical procedures performed on people of varying ages.
Airway Management in Post Anaesthetic Care
Authors: Scott Bevan
Published: December 2017

Some patients recovered in the post anaesthetic care unit (PACU) will require airway management and close monitoring to prevent any post operative complications. Ineffective airway management will lead rapidly to hypoxaemia, and will ultimately compromise patient care. This article discusses physiological principles and monitoring of airway management in the PACU, an understanding of which is essential when providing appropriate care for patients emerging from anaesthesia.
Perioperative Careers
Authors: Wicker Paul
Published: December 2017

When I look back at how my career started, I think to myself, what if I had undertaken the BA in Business Studies which I had been accepted for, instead of the BSc in Nursing for which I was still waiting to hear the results of my interview? Well, probably I would have spent four years studying business, followed by 40 years sitting in an office somewhere; Tesco, Sainsbury's or Marks and Spencer probably. I was lucky though, my father phoned up every couple of weeks (I was only 17 and didn't really have a clue what I wanted to do) and eventually they said ‘yes' and I started my nursing career. Perhaps this is the first bit of advice for anybody thinking of a career in health:
Trauma Care Services in the United Kingdom: Past, Present and Future
Authors: Kaczynski Jakub , Hilton Joanna
Published: December 2017

Current provision of trauma services in the United Kingdom is insufficient, resulting in a high mortality of trauma patients. Multiple studies proved that regionalisation of the trauma care can significantly reduce mortality and morbidity by avoiding unnecessary transfer and reducing delay in delivering definitive surgery. This evidence led to changes in delivering trauma care in London which showed a significant reduction in mortality from severe injuries.
Accounting for Specialist Items in Neurosurgery
Authors: Mardell Andy , Davies Arsenia
Published: December 2017

This short article explores the issues surrounding the use of certain specialist items used during some neurosurgical procedures. It discusses the results of a benchmarking exercise that sought to investigate how these items are accounted for since there appear to be no nationally agreed guidelines for perioperative practice. The returns from the exercise suggest that, while practice for patties seems to be consistent, there is variation between neurosurgical centres in the use of other items. It is hoped that this work may stimulate discourse and that guidance can be produced to assist perioperative practitioners and enhance safe practice for patients.
Pediatric Perioperative Education Current Practices: A National Survey of Children's Hospitals in the United States
Authors: Heckmann Maura , Beauchesne Michelle A.
Published: December 2017

Identifying existing practices is a first step in the creation of developmentally and culturally effective teaching materials for children and families. This national survey queried two groups to explore current pediatric perioperative education practices: 81 nurses from a perioperative pediatric specialty association and 30 administrators representing leading children's hospitals within the United States. The aim was to improve perioperative care through the design of educational materials from the child's perspective.
Surgery for Infantile Esotropia: Is Timing Everything?
Authors: Sarwar Humera , Waqar Salman
Published: December 2017

Infantile esotropia affects binocular alignment and development of binocular vision. Delayed correction may lead to loss of stereopsis. Waiting for the angle of deviation to stabilise prior to surgery does not impact overall postoperative outcomes greatly. Early surgical intervention produces better outcomes in terms of sensory and motor development, binocular vision and stereoacuity. The period of misalignment has the greatest effect on postoperative outcome therefore early surgery is recommended.
Emergence Delirium
Authors: Munk Louise , Andersen Lars Peter Holst , Gögenur Ismail
Published: December 2017

Emergence delirium (ED) is a well-known phenomenon in the postoperative period. However, the literature concerning this clinical problem is limited. This review evaluates the literature with respect to epidemiology and risk factors. Treatment strategies are discussed. The review concludes that there is a need for guidelines concerning diagnosis and treatment of ED. Risk factors should be investigated further in the clinical setting in the future.
James Parkinson: Parkinson's Disease
Authors: Ellis Harold
Published: December 2017

Parkinson's disease is a condition that anyone with a modicum of medical knowledge can recognise in the street - as indeed how it was studied by James Parkinson himself. Its three characteristic features are:

1. Increase in the tone of the voluntary muscles (rigidity).

2. Slowness of movement (bradykinesis).

3. Tremor (the characteristic ‘pill rolling’ movements of the fingers).
Safeguarding Adults
Authors: Richardson V
Published: December 2017

The safeguarding of patients is a key concern for all health and care professionals. Research shows that more instances of unacceptable care are likely to occur due to an increase in population of those deemed to be vulnerable. Increasing professionals’ awareness, knowledge and understanding of safeguarding and of the systems in place for reporting concerns is essential for best practice and for protecting patients and their families.
The Management of Central Venous Catheters and Infection Control: Is it Time to Change Our Approach?
Authors: Langton H
Published: December 2017

Catheter related bloodstream infections (CR-BSIs) can lead to a number of serious conditions for the patient, including death. There is much recent evidence both in the UK and abroad which identifies the sources of CR-BSIs, yet they continue to occur. This article seeks to review some of the current evidence in relation to the prevention of CR-BSIs at insertion point.
Vulnerability in the Perioperative Patient: A Concept Analysis
Authors: Cousley A , Martin Dse , Hoy L
Published: December 2017

This study aims to report the analysis of the concept of perioperative vulnerability. Literature searches were conducted in databases CINAHL, Medline, PsychINFO, OVID, InterNurse, as well as a manual library search from article reference lists. Search terms were restricted to ‘concept analysis’, ‘vulnerability’, ‘perioperative’, ‘patient’ and ‘perioperative patient’. Retrieved literature was analysed using the Walker & Advant (2005) concept analysis framework. Based on the concept analysis, vulnerability can be seen as having both physical and psychological elements and can be influenced by personal traits. Vulnerability is affected by previous experiences, perceptions of life, disease and ultimately the level of control an individual has over a given situation. The study concludes that inclusion of the concept of vulnerability within both pre- and post-registration training programmes would facilitate awareness of the issues surrounding perioperative vulnerability and the need to plan individualised care accordingly. It is hoped that this analysis will inspire further research and theoretical underpinning of perioperative practice, facilitating the development of new ways to manage vulnerability that will benefit individual patients, develop practice and promote positive patient outcomes.
Two, Four, Six, Eight… Stop and Count before it is Too Late! An Audit on Swab, Needle and Instrument Counts in Theatre
Authors: Donnelly T
Published: December 2017

A concurrent audit was conducted over a four week period to determine if the counting of swabs, needles and instruments for surgery adhered to local policy and recommended guidelines. Data were collected on 30 abdominal surgical procedures. This audit highlighted failings in the count process. It identified poor communication within the multidisciplinary team. There needs to be an increased awareness about local policy, national and international guidelines regarding the counting of swabs, needles and instruments for all surgical procedures.
Sir Harold Ridley: Innovator of Cataract Surgery
Authors: Sarwar H , Modi N
Published: December 2017

Cataract surgery has evolved greatly over the years, from the ancient practice of ‘couching’ where the lens is dislodged, to the modern surgical techniques of today. Sir Harold Ridley's invention of the intraocular lens (IOL) has altered the approach towards cataract surgery, benefitting individuals worldwide. This has been his most notable contribution, it is therefore interesting to explore the build up to this event and gain an understanding of the issues faced by Sir Ridley. This paper explores the significant events and key developments that influenced one of the most valuable innovations in the context of cataract surgery – the intraocular lens.
The Red Zone
Authors: Donnelly Teresa
Published: December 2017

This simple quality initiative won the best innovation in clinical practice at the recent CEO healthcare awards gala event in the North West of Ireland. It demonstrated how a simple collaborative idea led to improving the quality and safety of care in the operating room. As practitioners we have a huge contribution to make in providing quality and safe care to our patients. It is crucial that we share knowledge and have our input recognised.
Improving Operation Notes and Postoperative Care: An Audit of Current Practice
Authors: Whitehead-Clarke T , Varma N , Hadjimichael A , Gillham F , O'brien K
Published: December 2017

The operation note is the single most important document in surgical practice. Ninety one operation notes were assessed on their adherence to guidelines, as well as their legibility and ability to inform postoperative care; as judged by five different healthcare professionals. Results showed a deficiency in essential information and poor legibility overall. Re-audit of 103 operation notes after intervention showed an improvement in nearly all criteria measured. The results indicate that education about current guidelines and an increase in word processing of operation notes improves quality of documentation, and therefore of postoperative care.
Management of ‘Do Not Attempt Cardiopulmonary Resuscitation’ (Dnacpr) Decisions in the Perioperative Period
Authors: Dawson Sr , McBrien Me
Published: December 2017

It is increasingly common for patients to be scheduled for anaesthesia and surgery with a ‘Do Not Attempt Cardiopulmonary Resuscitation’ (DNACPR) decision in place. Updated guidelines for the implementation and management of DNACPR decisions were published jointly by the British Medical Association (BMA), the Resuscitation Council (UK) and the Royal College of Nursing (RCN) in 2014 (BMA, RC(UK), RCN 2014). The Association of Anaesthetists of Great Britain and Ireland (AAGBI) published specific guidelines in 2009 to guide the perioperative management of such patients (AAGBI 2009). In this article, we explain these guidelines with a focus on how DNACPR decisions are made and how they can be modified in order to permit appropriate surgery to take place.
Exploring the Perceptions of Sterile Services Staff: A Qualitative Constructivist Study
Authors: Cobbold A
Published: December 2017

With innovations in medicine and science, the extended roles for practitioners continue to evolve and merge, often crossing interprofessional boundaries. This paper presents a qualitative study which explored sterile services staff experiences of current practices and how they perceive the prospect of professionalisation.
Are you Prepared to Take the Risk: Extending Governance for Perioperative Roles
Authors: Quick J , Hall S , Jones A
Published: December 2017

In the 25 years since the Oxford Heart Centre in England appointed the first British nurse to be formally trained as a non-medically qualified surgical assistant, the number of nurses and allied health professionals (AHPs) undertaking advancing surgical roles has increased in order to backfill the deficit of a surgical workforce(Quick and Hall 2014). Despite initial concerns over nurses and AHPs undertaking roles and responsibilities which were previously performed solely by doctors, the role of non-medical surgical assistants has been shown to maintain surgical services, provide an additional career route for nurses, and enhance patient care (Abraham 2011, Quick 2013, Jones et al 2012). In the early days however, a lack of role specific regulation, practice guidelines and a variety of educational standards led to variances in job titles and role responsibilities for nurses and AHPs performing surgical assistance (Box 1).
An Opportunity in Op-Notes
Authors: Rudra S , Kieffer Wkm , Briffa N , Kantak A
Published: December 2017

Operative notes in surgical practice are a vital source of information and communication between healthcare professionals as well as being a legal document. Errors and omissions can have serious effects on patient care and lead to confusion. We audited our compliance within trauma and orthopaedics at a busy district general hospital in South East England with the standard set by the Royal College of Surgeons (England) before and after the introduction of an operation note template. We achieved significant improvements in compliance across almost all of the standard's domains and recommend widespread implementation of similar templates nationally.
The Effect of Anaemia on Hospital Length of Stay in Lumbar Decompression and Fusion Procedures
Authors: Sanoufa M , Smisson W , Floyd H , Robinson Js
Published: December 2017

Ways of reducing the length of hospital stay have received increased attention in recent years. Both preoperative and postoperative anaemia have been implicated as causative agents in increasing postoperative length of stay (LOS). In a retrospective study, 317 patients that underwent lumbar decompression and fusion surgery were assessed. Two separate block multivariate linear regression analyses were performed to evaluate the impact of preoperative anaemia, postoperative anaemia, and the degree of perioperative haemoglobin drop on LOS. Other anaemia related factors were also assessed. Preoperative anaemia, postoperative anaemia, and the amount of perioperative haemoglobin drop were all shown to prolong the length of hospitalisation and therefore to increase overall healthcare costs. Following strict anaemia corrective maneuvers could reasonably be expected to reduce expenditure.
Becoming an Advanced Scrub Practitioner: My Personal Journey
Authors: Halliwell Gail L
Published: December 2017

Theatre nursing has been my life for over twenty years and I have regularly assisted the surgeon, often taking on the ‘dual role’. However, the realisation that I was not legally covered to undertake this role, along with desiring to improve my knowledge and skills, led me to enrol on the advanced scrub practitioner course run by Edge Hill University. This article is about my journey of personal and professional development.
Perioperative Management of Cardiac Disease
Authors: Aresti Na , Malik Aa , Ihsan Km , Aftab Sme , Khan Ws
Published: December 2017

Pre-existing cardiac disease contributes significantly to morbidity and mortality amongst patients undergoing non cardiac surgery. Patients with pre-existing cardiac disease or with risk factors for it, have as much as a 3.9% risk of suffering a major perioperative cardiac event (Lee et al 1999, Devereaux 2005). Furthermore, the incidence of perioperative myocardial infarction (MI) is increased 10 to 50 fold in patients with previous coronary events (Jassal 2008).
Constant Exposure to the Operating Theatre Can Change Our Perception of the Perioperative Journey
Authors: Charnock Rebecca
Published: December 2017

The following is a personal reflection of my experience of interactions with hospital staff and how that has impacted on my own attitudes and practices in studying to become an operating department practitioner (ODP).
Coordinating Perioperative Care for the ‘High Risk’ General Surgical Patient Using Risk Prediction Scoring
Authors: Hafiz S , Lees Np
Published: December 2017

Identifying ‘high risk’ (>5% mortality score) emergency general surgical patients early, allows appropriate perioperative care to be allocated by securing critical care beds and ensuring the presence of senior surgeons and senior anesthetists intraoperatively. Scoring systems can be used to predict perioperative risk and coordinate resources perioperatively. Currently it is unclear which estimate of risk correlates with current resource deployment. A retrospective study was undertaken assessing the relationship between deployment of perioperative resources: senior surgeon, senior anesthetist and critical care bed. The study concluded that almost all high risk patients with high POSSUM mortality and morbidity scores had a consultant senior surgeon present intraoperatively. Critically unwell patients with higher operative severity and perioperative morbidity scores received higher care (HDU/ICU) beds postoperatively, ensuring that they received appropriate care if their condition deteriorated. Therefore POSSUM scoring should be used perioperatively in emergency cases to coordinate appropriate perioperative care for high risk general surgical patients.
Wiring of Patellar Fractures by Joseph Lister
Authors: Ellis Harold
Published: December 2017

Joseph Lister (1827–1912) was the father of modern surgery and, in particular, of today's orthopaedic surgery. Before Lister, surgeons seldom opened into a joint or performed an open operation for failed reduction or malunion of a fracture. Indeed, most surgical teachers condemned such procedures because of the almost invariable complications of wound suppuration, pyaemia prolonged illness and often death.
Review of Practice: Facilitating Normality at Caesarean Section
Authors: Simmonds C
Published: December 2017

Expectant women often write detailed birth plans outlining their preferences for the birth of their baby. These plans are pushed aside when a caesarean is deemed necessary, being replaced with medical decisions in a clinical setting. In the busiest maternity unit in the South West, our team are trying to change this attitude, encompassing many of the key points of ‘normal’ birth choices that are important to mothers during caesarean section, without compromising clinical care.
Pharyngotomy for a Swallowed Denture
Authors: Ellis Harold
Published: December 2017

The introduction of inhalation anaesthesia, first by the use of ether in 1845 and then of chloroform in the following year, saw an explosion in the range and extent of major surgical procedures as patients were spared the agonies of the surgeon's knife. A good example of this was the operation of pharyngotomy - opening the cervical oesophagus through a lateral incision of the neck - to remove an impacted foreign body. One cannot imagine a surgeon being able to do this without the benefit of an anaesthetic! Edward Cock, a surgeon at Guy's Hospital, performed this operation successfully on two occasions; the second was reported in detail in the Guy's Hospital Reports 1868, Volume 28.
From Novice to Expert: A Surgical Care Practitioner's Reflection on Their Role Development
Authors: Quick J
Published: December 2017

As co-lead for the AfPP Advancing Surgical Roles Specialist Interest Group, I was recently asked about which procedures a surgical care practitioner (SCP) can be trained to undertake and how the SCP role can be developed fully within the remit of the surgical team. This question enabled me to reflect upon and explore the development of my own role of a vascular and general SCP using Benner's adaptation of the Dreyfus’ expertise acquisition model that describes the transition that nurses and, one could argue, all healthcare professionals make from novice to expert practitioners (Benner 1984) (Figure 1)
Implementing An Integrated In-Situ Coaching, Observational Audit, and Story-Telling Intervention to Support Safe Surgery
Authors: Carthey J , McCormack K , Coombes J , Gilbert D , Farrar D
Published: December 2017

This article describes an intervention that combined in-situ coaching, observational audits and story-telling to educate theatre teams at University College London Hospitals about the Five steps to safer surgery (NPSA 2010). Our philosophy was to educate theatre teams about ‘what goes right’ (good catches, exemplary leadership etc) as well as ‘what could be improved’. Results showed improvements on ‘behavioural reliability’ metrics, a 68% increase in near miss reporting and a reduction in surgical harm incidents.
Challenges to the Orthopaedic Arthroplasty Enhanced Recovery Programme
Authors: Kerr HL , Armstrong LA , Beard L , Teichmann D , Mutimer J
Published: December 2017

We performed a retrospective study of patients undergoing total knee and hip arthroplasty on an enhanced recovery programme, to identify pre- and postoperative factors contributing to an increased length of hospital stay. Of 109 patients, only 61 (56%) were ready for discharge on the fifth postoperative day. The three most common reasons for delays were oozing wounds, postoperative medical problems and failure to reach physiotherapy goals.
Perioperative Teamwork for the Patient with a Shared Airway: A Case Study
Authors: Jones G
Published: December 2017

Teamwork is an essential element of perioperative care. Shared airway surgery requires additional considerations for the perioperative team. This article analyses a case study of a patient undergoing thyroid surgery. Whilst the anaesthetic team is responsible for maintaining the patient's airway, the theatre and surgical teams have their own individual roles to assist in airway management and surgical care.
Analysis of Neuro-theatre Utilisation and Reasons for Cancellation to Improve Efficiency and Productivity
Authors: Sharouf F , Mirza A Baig , Moosajee V , Plummer S , Bhatti I , Zaben M
Published: December 2017

In neurosurgery, much emphasis has recently been placed on theatre cancellation and time utilization as a key hospital management performance indicator. We sought to evaluate our unit's theatre throughput efficiency and identify the causes of elective surgery cancellations. We retrospectively audited all scheduled elective neurosurgical procedures over a period of nine months. Mean theatre utilization time was 47.0%. The common causes of cancellations were lack of theatre time (32%), non-availability of beds in recovery room (18.6%), and insufficient preoperative patient preparation (5.5%). Inefficiencies were noted in turnover of patients and inaccurate prediction of operative time. Our theatre utilization time is consistent with available literature; however, cancellations of elective surgery waste valuable operative time and resources. The study concludes that a multi-dimensional approach must be taken to improve theatre utilization and reduce cancellation rates. A pre-assessment clinic has been introduced in order to reduce cancellation rates.
Thromboembolic Diseases and the Use of Vena Cava Filters
Authors: De Silva S
Published: December 2017

Mr GW is a 77-year-old gentleman who is hoping to have a total knee replacement of his left knee. He underwent a knee replacement on the right in 2011 under spinal anaesthetic, where his postoperative period was complicated by a saddle pulmonary embolus (PE).
John Hunters Operation for Popliteal Aneurysm
Authors: Ellis Harold
Published: December 2017

An aneurysm is defined as a “sac communicating with the lumen of an artery” and the treatment of the various types of this disease has intrigued surgeons through the ages. Aneurysms of the popliteal artery today are fairly uncommon. However, in the 18th century they were quite frequently encountered, many of them in coach drivers. We can only surmise that this was the result of repetitive trauma to the artery, already the seat of arteriosclerosis, against the rim at the top of the long leather riding boot which was worn at that time.
Adaptation of a Tool to Assess Nontechnical Skills of Scrub Practitioners in Denmark
Authors: Mundt AS , Spanager L , Lyk-Jensen HT , Østergaard D
Published: December 2017

The aim of this study was to adapt the Scottish tool, Scrub Practitioners' List of Intraoperative NonTechnical Skills, to Danish organisation and culture (Mitchell et al 2013). With an explorative and qualitative approach, four group interviews with scrub practitioners, surgeons and anaesthesia staff were conducted. The main differences found were related to communication and teamwork regarding scrub practitioners' focus on the team and speaking up. Differences in the non-technical skills described in the behavioural markers are perhaps explained by cultural differences between Scotland and Denmark. A new tool for scrub practitioners in Denmark was adapted.
Identification and Management of Non-traumatic Splenic Rupture
Authors: De Silva S
Published: December 2017

A 43-year old previously fit and well gentleman presented to the emergency department (ED) with a two day history of worsening epigastric pain. He had had coryzal symptoms the preceding week but had no other past medical history. He was haemodynamically stable at presentation and an ultrasound scan (US) performed in the ED could not definitively rule out intra-abdominal fluid. In view of his tender abdomen on examination and a haemoglobin level of 9.2g/dL, a computerised tomography (CT) scan was performed and revealed extensive high-density fluid within the peritoneal cavity, raising the possibility of a concealed bleed but no obvious source was identified by the scan.
Day surgery: Improving care through follow up contact
Authors: Mason Lesley
Published: December 2017

In this article I will outline the method of evidence based practice we have implemented during the last three years following the introduction of day surgery as a specific speciality in our Trust. I will outline the method of accessing information on a regular basis and how this information was used to improve the service we offer. Finally I will suggest how, as a group of professionals, we may take this initiative forward towards AD 2000.
Preoperative visiting in Wales
Authors: White Jean , Coleman Mick
Published: December 2017

There is clear evidence in the nursing literature that preoperative visits conducted by theatre nurses have a therapeutic benefit for surgical patients. However, it would appear that the actual uptake of this practice is limited (Wicker 1995). The aim of this study is to investigate the prevalence of preoperative visiting in Wales and to identify factors associated with its occurrence or non-occurrence.
CANDLE: The critical analysis of the nocturnal distribution of light exposure – A prospective pilot study quantifying the nocturnal light intensity on a critical care unit
Authors: Craig Thomas , Mathieu Steve
Published: December 2017

Patients with critical illness have disrupted circadian rhythms, which can lead to increased morbidity, mortality and length of intensive care unit stay. Light intensity within the intensive care unit influences the circadian rhythm and may therefore impact on patient outcome. We performed an observational single-centre pilot study monitoring nocturnal light exposure of intensive care unit patients between November and December 2016. As there are currently no medical guidance on recommended light levels, we audited our findings against building regulation standards. The median light intensity was 1.5 lux, which is below the 20 lux standards; however, there were significant outliers. There was positive correlation between patient illness severity based on SOFA score and maximum lux (R = 0.45, P = 0.026); however, there was no relationship between patient illness severity and median lux exposure (R = 0.23, P = 0.28). As illness severity increased so did the time spent greater than 20 lux (R = 0.59, P = 0.0021), and the individual occasions where lux breached the 20 lux limit (R = 0.52, P = 0.009). There was no relationship between illness severity of neighbouring patients and maximum lux (R = −0.11, P = 0.69) or neighbouring illness severity and median lux (R = −0.04, P = 0.87). This preliminary work will form the basis of future projects, including national guidance and evaluating the impact of environmental light on patient-centred outcomes.
Comparison study of metaheuristics
Authors: Asih Anna Maria Sri , Sopha Bertha Maya , Kriptaniadewa Gilang
Published: December 2017

Many existing studies have used hypothetical data to evaluate the performance of various metaheuristics in solving delivery route optimization. As empirical data impose characteristics of a particular problem, it is necessary to evaluate whether the problem characteristics may influence to the performance of metaheuristics. This article therefore attempts to compare the performance of metaheuristics, that is, genetic algorithm, ant colony optimization (ACO), particle swarm optimization, and simulated annealing (SA), to solve an empirical delivery problem in Yogyakarta, Indonesia. Two cases are developed to capture different characteristics of empirical data. The first case introduces delivery problem of one logistics operator and 58 retailers; the second case presents collaborative strategy in delivery problem, involving two logistics operators and 142 retailers. Results indicate that ACO and SA perform better with respect to less distance traveled for both cases and higher truck utility and lower number of routes for the second case.