bluuebunny/crossref_metadata_2025 huggingface dataset:
Introducing a Clinical Pathway in Fluid Management
Authors: Davidson Jennifer , Griffin Richard , Higgs Simon
Published: December 2017

Following the publication of the National Confidential Enquiry into Perioperative Death's (NCEPOD) report, Extremes of Age (NCEPOD 1999), several recommendations were made relating to the management of patients admitted via Accident and Emergency (A&E) with fractured necks of femur (NOF). An audit was carried out relating fluid management in the elderly. A multidisciplinary clinical pathway for patients with fractured NOF was produced. The audit was repeated in 2002, 2003 and 2005 to obtain data as to whether the pathway had improved the management of patients admitted with fractured NOF. Comparing audit data between 2000 and 2005 there were significant reductions in the incidence of perioperative hypotension and an increase in the percentage of patients who were prescribed and received intravenous fluids (p<0.05). A protocol-based pathway produced as a result of a recommendation from NCEPOD has greatly improved the fluid management of patients admitted to a general hospital with fractures.
Decontamination and Traceability of Flexible Endoscopes
Authors: Crawford Angus
Published: December 2017

The Ear, Nose and Throat (ENT) and Oral and Maxillofacial Surgery (OMFS) departments at Glasgow's Southern General Hospital use their 21 flexible endoscopes on a daily basis for a variety of surgical and anaesthetic procedures, including difficult intubations and the examination of the throat and airway. This article will examine the possible risks to the patient with these procedures and some cost-effective methods of minimising those risks within these departments.
Bunions: Their Origin and Treatment
Authors: Kitson Kathryn
Published: December 2017

As theatre practitioners we are on our feet for long periods of time. How many of us can truthfully say that we treat our feet with the respect that they deserve, for example, wearing the correct footwear and generally taking good care of our feet? It is established that theatre clogs, while practical, are not a fashion statement. Most of us probably take our feet for granted - that is until something becomes painful or a deformity occurs. One common and often painful deformity of the foot is a bunion. This article describes how bunions occur and explores the surgical options.
Inguinal Hernia Repair
Authors: Kurzer Martin , Kark Allan , Hussain Tahir
Published: December 2017

In excess of 100,000 inguinal hernia repairs are performed in the UK each year (Devlin & Kingsnorth 1998). It is the most commonly performed general surgical procedure and is routinely undertaken in patients receiving local anaesthesia in the day case setting. The Royal College of Surgeons has recommended that >50% inguinal hernias are undertaken on day cases, although at present this figure is only 30% (RCSE 1993). This article defines hernias and describes the aetiology and surgical treatment of inguinal and femoral hernia. The differences between the traditional and laparoscopic repair of hernias are explored as well as the use of materials such as polypropylene mesh to enhance the repair. The need for thromboprophylaxis and antibiotic therapy are outlined together with patient discharge advice.
Palliation of Tracheobronchial Carcinoma: The Role of Cryosurgery
Authors: Beeson Julia
Published: December 2017

Bronchoscopy is a common day case procedure that can aid in the diagnosis and treatment of tracheobronchial disorders. The controlled application of extreme cold through a bronchoscope to endobronchial lesions (malignant and benign) is known as endobronchial cryosurgery. This procedure improves respiratory function and reduces shortness of breath and is performed in a cycle of three treatments. This article describes the instrumentation required, how cryosurgery is performed and how endobronchial cryosurgery can improve the patient's functional status and survival.
Kilner's Needle Holder
Authors: Ellis Harold
Published: December 2017

Anyone who has assisted, single-handedly, at a long plastic surgery operation, which will inevitably involve dozens of skin sutures, will have blessed the name of Thomas Pomfret Kilner (1890–1964) and his needle holder. This ingenious instrument combines the dual functions of a stitch-cutting scissors with a needle holder, so that the surgeon can put in a stitch, tie it and cut it without having, on each occasion, to put down the needle holder and pick up a pair of scissors, or to get his assistant to snip it for him.
The Efficacy of Cricoid Pressure in Preventing Gastro-Oesophageal Reflux in Rapid Sequence Induction of Anaesthesia
Authors: Ewart Luke
Published: December 2017

Aspiration pneumonitis (AP) is a recognised complication of general anaesthesia (GA) that has an associated morbidity and mortality. Sellick's manoeuvre – the application of a sustained pressure to the cricoid cartilage – is one commonly taught anaesthetic practice that is deemed to reduce this risk of aspiration. However, this practice is not without its failings and some of the evidence base surrounding the use of cricoid pressure is examined in this short article.
The Multi-Skilled Day Surgery Practitioner
Authors: Gindill Judith
Published: December 2017

This article will explore the concept of multi-skilled staff within Jersey general hospital's day surgery unit. The role, specific to day surgery, is discussed as are the driving factors behind multi-skilling. The benefits of multi-skilling to the practitioner, to the client and to the unit are considered. The importance and the role of a training coordinator who facilitates the multi-skilling ethos is also discussed.
The Provision of Care for Children in Shared Units
Authors: Nicholas-Holley Jane
Published: December 2017

This article will look at the implementation of the National Service Framework (NSF) for children, young people and maternity services with specific reference to the segregation of children from adult patients, and the requirements for appropriately trained staff in the care of children, within the Post Anaesthetic Care Unit (PACU).
Hypnosis to Alleviate Perioperative Anxiety and Stress: A Journey to Challenge Ideas
Authors: Fern Patricia A
Published: December 2017

Mention the possibility of surgery to a patient and most will react with a feeling of apprehension at best. Some will be horrified at the mere thought of being ‘cut open’. For others, it will be the suggestion of entering a hospital for anything longer than an out patient appointment. Newspaper reports of healthcare-acquired infections (HAIs) may spring to mind: ‘Will I leave with more than I came in for?’; ‘What if it goes wrong?’; ‘Who will look after the family?’. All this worrying leads to increased anxiety and stress, and the patient has not even been put on the waiting list yet, let alone been admitted.
Local Anaesthetic during Cataract Surgery: Factors Influencing Perception of Pain, Anxiety and Overall Satisfaction
Authors: Modi Neil , Shaw Steve , Allman Keith , Simcock Peter
Published: December 2017

To assess factors influencing perception of pain, anxiety and overall satisfaction during local anaesthetic cataract surgery an audit was carried out at the West of England Eye Unit. Patients receiving sub-Tenons after previous peribulbar anaesthesia had significantly higher pain scores. Patient satisfaction was significantly higher when a handholder was present in theatre. Finally, no difference was found in the three variables whether anaesthesia was administered by an anaesthetic practitioner or an anaesthetist.
The First Successful Gastrectomy
Authors: Ellis Harold
Published: December 2017

Today, gastrectomy is a routine surgical procedure which any competent abdominal surgeon is expected to be able to perform efficiently and, in a reasonably fit patient, to achieve a speedy and safe recovery. It is worth remembering that the first successful gastrectomy, performed in the late 19th century, was hailed as something of a miracle and opened the way for modern elective abdominal surgery.
The Value of Portfolio Building and the Registered Nurse: A Review of the Literature
Authors: McColgan Karen
Published: December 2017

The purpose of this literature review is to explore the value of portfolio building and the registered nurse under the following themes: assessment of competence; work-based reflection; lifelong learning; creating career pathways and the contribution a portfolio makes to the professional development of the nurse. This review concludes that for portfolios to work effectively, nurses and their employers require a working partnership to see the value and the opportunities that exist through the development of a personal portfolio. The need exists for an organisational culture of learning that encourages a facilitative environment combined with nurses who support their colleagues and explore their skills through experiential learning. This work was submitted in part fulfilment for the Degree of Master of Science in Nursing at Queen's University of Belfast, School of Nursing and Midwifery in 2007 and was supported by ERFF.
Theoretical and Practical Aspects of Anaesthesia for Thoracic Surgery
Authors: Faber Peter , Klein Andrew A
Published: December 2017

Thoracic surgical procedures account for only a small fraction of all surgery undertaken in the NHS. Thoracic surgery is performed in specialist centres as patients often suffer serious co-morbidities and require vigilant care and observation by staff involved in their treatment. Anaesthesia for thoracic surgery challenges the theoretical and practical experience of all involved. This review briefly summarises the anaesthetic skills and knowledge required to deliver a safe and professional service to patients with thoracic pathology.
Diabetic Retinopathy
Authors: Studholme Suki
Published: December 2017

The focus of this article is to discuss the care given to an elderly lady, Mrs Pitt, (a pseudonym) who is suffering from Diabetic Retinopathy (DR) and attending our Out Patient Department (OPD). It will start with a brief description of diabetes and the associated complications, and then give a more in-depth description of DR and the relevant anatomy and physiology. It will then give details of Mrs Pitt's history and her current care and treatment. All information will be supported by current, relevant literature.
Errors in Medicine Administration: How Can They be Minimised?
Authors: Venkatraman Ramya , Durai Rajaraman
Published: December 2017

Errors in medicine administration often go unnoticed and unreported. This article describes three medicine-related errors and provides recommendations to reduce risk. All medicine-related errors should be reported locally and to the National Patient Safety Agency (NPSA) so that they can be collated and trends identified. Electronic prescribing and patient/medicine identification by bar codes, double checking and using colour coded syringes for intravenous and enteral administration, employing more clinical pharmacists and regular education may reduce medicine-related errors.
Surgical Dressings and the Turbulent Years of the Cotton Industry
Authors: Stephens-Borg Keith
Published: December 2017

Everyday use of a simple cotton bud should remind us of our not so distant past and of the appalling trade in people. Harvesting this precious commodity required forced labour eventually leading to a key turning point in the history of surgery, as civil war raged in America during the 1860s. The fight to end slavery was to reveal a new weapon against disease and certain death. A material used in this struggle against wound infection was the available stockpiles of redundant cotton. Once boiled to make softer, its use on patients in military hospitals proved to be the first clinical application of sterile surgical dressings.
Newly-Registered Odps: What Support Do They Receive?
Authors: Lewsey Claire
Published: December 2017

This study used a quantitative, descriptive survey design to examine the level and nature of support that newly-registered Operating Department Practitioners (ODPs) receive in the clinical area. The findings suggest that support provided directly by people, such as preceptorship/mentorship and peer support, is rated as being more useful than support from systems, such as orientation programmes. Overall, 73.33% of the sample were either very or moderately satisfied with the support that they received.
Heparinised Saline or Normal Saline?
Authors: Kannan Anand
Published: December 2017

Using heparinised saline as a flush to maintain the patency of arterial and central venous lines is a well-known practice. A literature search was undertaken but found no evidence to support the use of heparinised saline over normal saline. In addition, the use of heparinised saline may be associated with adverse effects. The literature search strategy utilised Ovid CINAHL and Medline databases, as well as hand-searching bibliographies of clinical and research articles from the University of Cambridge Medical Library. Keywords and phrases included ‘heparin’, ‘normal saline’, ‘arterial’, ‘haemodynamic lines’ and ‘catheters’. All types of evidence from each of these resources were examined to identify major themes, areas of agreement and disagreement across clinical practice, changes in the concept over time and emerging trends.
Elizabeth Garrett-Anderson
Authors: Ellis Harold
Published: December 2017

Nowadays well over half the new graduates coming out of the medical schools in the United Kingdom are women. Women are found in the highest ranks in the profession and are well represented on the Councils of the Royal Colleges and the other medical institutions. Yet it was only during the second half of the 19th century that a handful of dedicated women invaded what was until then an entirely male profession. Perhaps the most prominent of these was Elizabeth Garrett-Anderson, the first female to graduate in medicine in the UK.
Cultural Perspectives on Pain Management
Authors: Briggs Emma
Published: December 2017

Bedouin women tend to remain quiet and expressionless while giving birth despite reporting high levels of pain and fear (Harrison 1991). Culture undoubtedly influences pain perception and expression but there are dangers in making assumptions about particular groups. This article explores the underlying research and the complex clinical picture highlighting the need for cultural awareness – but ultimately we must care for the individual person in pain.
Ten Reasons Why Operating Department Practitioners and Theatre Nurses Might Not Want to Quote or Cite from this Article
Authors: Pennington Bernard V.
Published: December 2017

Academic writing can fill pre- and post-registration students with fear and dread. Students often construct written work around re-worded passages from their sources. This results in poor quality work, low marks and frustration. The aim of this article is to inform students embarking on courses in higher education about what academic writing is – and equally importantly what it is not.
Anaesthesia for Repair of Cleft Lip and Palate
Authors: Hardcastle Teresa
Published: December 2017

Cleft lip and palate is one of the most common craniofacial anomalies. The surgery is not performed usually until the baby is three months of age. The anaesthesia technique is dependent on the difficulty of the airway. The anaesthetic practitioner therefore requires knowledge of the paediatric airway and of this particular anomaly and skill in the thorough preparation of the equipment used for intubating a baby for this procedure.
HIV-Infected Patients: The Risks of Surgery
Authors: Nelson Lisa , Fried Mike , Stewart Kenneth
Published: December 2017

There are increasing demands for surgical interventions in Human Immunodeficiency Virus (HIV)-infected patients as a consequence of antiretroviral therapy. This article will discuss various risk factors involved in the surgical management of patients with HIV infection including: anaesthetic and surgical risk to patients with HIV infection undergoing surgical procedures; risk to healthcare professionals involved in the treatment of HIV-infected patients; and measures taken to ensure a safe and optimal outcome from surgery.
Cartilage Repair Using Autologous Chondrocyte Implantation Techniques
Authors: Schindler Oliver S
Published: December 2017

Articular cartilage in adults has a poor ability to self-repair after injury. A variety of cartilage resurfacing techniques have the potential to improve the repair of cartilage defects and reduce the patient's disability. The most advanced of these techniques is autologous chondrocyte implantation. It promises to provide normal organogenesis leading to histologically and functionally normal articular cartilage. The procedure is technically demanding and requires patients to adhere to a specific post-operative rehabilitation protocol. Clinical results have so far been encouraging and have allowed many patients to resume high levels of sporting activity.
Femoral Nerve Blocks
Authors: Kasibhatla Renuka Devi , Russon Kim
Published: December 2017

Femoral nerve blocks and indeed all peripheral nerve blocks have become a popular, safe and effective method of providing postoperative analgesia. The advantages of a femoral nerve block for lower limb surgery include good postoperative analgesia, a reduction in the need for opioids (thus reducing the associated complications of opioids such as nausea, vomiting, itching and confusion (Allen et al 1998, Wang et al 2002)) and the potential for earlier mobilisation and discharge from the hospital (Wang et al 2002, Ilfeld et al 2008).
Marie Stopes: Pioneer of Family Planning
Authors: Ellis Harold
Published: December 2017

Marie Charlotte Carmichael Jones was a truly remarkable woman. In the face of enormous opposition and difficulties, she pioneered safe and effective birth control for women. She wrote the first popular book on this subject, which first appeared 90 years ago and which became an instant best seller. Marie was born in Edinburgh in 1880. Her father was a wealthy architect who also had a deep knowledge of palaeobotany - the study of fossilised plants. Her mother, Charlotte Carmichael, was a fervent feminist; a keen promoter of education for women, when this subject was held in scorn by most of the (male!) population. Marie inherited the interests and support of both her parents.
Eleanor Davies-Colley: The First Woman F.R.C.S.
Authors: Ellis Harold
Published: December 2017

Women have had to fight a long and hard battle to break into the medical profession. In 1876, after a long and hard battle, the General Medical Council (the GMC) agreed to accept women for registration as medical practitioners. In 1895 the staff of the London School of Medicine for Women and of the Royal Free Hospital for Women, headed by Elizabeth Garrett Anderson, the Dean and the first woman to obtain the Licentiate Diploma of the Society of Apothecaries, (the LSA), which she had achieved thirty years before, petitioned the Royal College of Surgeons of England (RCS) and the Royal College of Physicians (RCP) with the request that their College examinations should be thrown open to women. This petition was rejected by both Colleges -by the surgeons at their annual meeting of Fellows and Members by 58 votes to 39, and by the physicians at an extraordinary meeting of its Comitia to consider this petition by 59 votes to 50.
Patient Anxiety and Conscious Surgery
Authors: Mitchell Mark
Published: December 2017

The amount of surgery undertaken on the conscious patient is increasing. However, many patients are anxious and resistant to such surgery. Patients (n=214) were surveyed to determine their related apprehensions. Being awake, feeling or seeing the body cut open and experiencing pain all increased anxiety. The potential for insufficient information provision was also a source of concern. Formal management of intraoperative apprehension may help limit anxiety and expel apparent misapprehensions.
A Review of Operating Department Practitioner Preceptorship
Authors: Reynolds John
Published: December 2017

This project aimed to review current practice within a large National Health Service teaching hospital and to provide a rationale for implementing a change to existing working practice. At the time, operating department practitioners only received a period of mentorship as part of the Trust induction course. There is evidence to support changes to current practices in the directorate with a view to implementing a more structured preceptorship programme.
Mentorship: The Experiences of a Tutor in a Pre-registration Operating Department Practice Education Programme
Authors: Hinton Jean
Published: December 2017

Introduction

The author is a theatre nurse with more than twenty years experience of perioperative care. For the majority of her time in clinical practice the author was involved in the training and education of both student nurses and student operating department practitioners (ODPs). This involvement started, following training, as a mentor and assessor for both groups of students, leading to the position of internal verifier for the NVQ programmes for ODPs and perioperative health support workers. This experience in education and training led to promotion as training co-ordinator for the critical care directorate of a busy district general hospital. For the past seven years the author has been employed as a senior lecturer on a three year ODP pre-registration programme at a North West university.
Pleural Effusion: Diagnosis and Management
Authors: Ahmad Z , Krishnadas R , Froeschle P
Published: December 2017

Pleural effusion is defined as an accumulation of fluid in the pleural space in excess of 15 to 20mls. The aetiology for the development of a pleural effusion includes changes in hydrostatic or colloid-osmotic pressure of pleural and pulmonary capillaries, changes in pleural vascular permeability and impaired lymphatic drainage. About 5% to 12% of patients referred for emergency medical treatment are diagnosed with a pleural effusion, making it a common finding on hospital admission. The excess of pleural fluid may be triggered by pleuro-pulmonary infection, malignancy, or conditions of cardiac, renal or hepatic origin. Subsequent management is guided mainly by aetiology and to a lesser degree by symptoms. This paper provides a review of pathophysiology, diagnosis and management of the condition and addresses specific issues regarding the perioperative care of these patients.
Teamwork: How Does this Relate to the Operating Room Practitioner?
Authors: Corbett Sue
Published: December 2017

Teamwork in the operating room is vital. We must view a picture of the evolving role of operating room practitioners and our educational needs. By raising our profile, we can encourage team work amongst multidisciplinary groups and secure the future of operating room practitioners in this complex matrix of patient care. With support we can create professional teams that will meet the values and expectations of trusts as well as government targets on a day to day basis.
Thyroid Eye Disease
Authors: Modi Neil C , James Jennifer , Sleep Tamsin
Published: December 2017

Introduction

Thyroid eye disease (TED), also known as Graves opthalmopathy is the most common orbital disease and affects 25–50% of patients with Graves' disease (Kuryan et al 2008). Most patients are only mildly affected, suffering ocular irritation with redness and watering, ‘staring eyes' due to retraction of the eyelids, exophthalmos (protrusion of the eyeballs) and periorbital swelling (Figure 1). A minority of patients (around 28%) will develop ocular motility problems, leading to diplopia (double vision), exposure/damage to the cornea and optic neuropathy (Kumar & Clarke 2002, Forbes & Jackson 2003, Meyer 2006).
Surgery: A Risky Business
Authors: Vats Amit , Nagpal Kamal , Moorthy Krishna
Published: December 2017

The advancement of surgical technology has made surgery an increasingly suitable management option for an increasing number of medical conditions. Yet there is also a growing concern about the number of patients coming to harm as a result of surgery. Studies show that this harm can be prevented by better teamwork and communication in operating theatres. This article discusses the extent of adverse events in surgery and how effective teamwork and communication can improve patient safety. It also highlights the role checklists and briefing in improving teamwork and reducing human error in surgery.
Progressing Safer Surgery
Authors: Reid Jane , Clarke Julia
Published: December 2017

Surgical care has been an essential component of health care worldwide for over a century. As the incidence of traumatic injuries, cancers and cardiovascular disease continues to rise, the impact of surgical intervention on public health systems is growing. Approximately 234 million interventions are now performed every year, representing one intervention for every 25 people on earth. In the United Kingdom this equates to a ratio of one operation for every eight people (WHO 2008a).
Diathermy Smoke Plume: Why do we Put up with it?
Authors: Rimmer Victoria
Published: December 2017

Diathermy is used in most theatres for every case but how many people think about the contents of diathermy plume or surgical smoke? Surgical smoke is an unpleasant smell that leaves many considering whether surgical masks reduce the risk of inhaling its contents. This article suggests that practitioners should be more aware of its contents and take action to lessen the risk to themselves and their colleagues.
A Critical Analysis of Theatre as a Learning Environment in Relation to Placement Duration
Authors: Barry Prue
Published: December 2017

This article examines the potential impact of a shortened theatre placement for pre-registration student nurses. The positive nature of a theatre placement is examined. The change in placement length is related to learning styles and Kolb's experiential learning theory as well as the need to bridge the theory-practice gap. The discussion concludes that a decreased placement length in theatre is a negative change and offers little benefit to the student.
A Case of Acute Post-Laparoscopy Bowel Hypermotility and Treatment with Hyoscine Butylbromide
Authors: Bonnett Tessa J , Lashen Hany
Published: December 2017

Post-laparoscopic pain is multi-factorial and many modes of perioperative analgesia have been proposed. We present the case of a patient who experienced severe abdominal pain following gynaecologic laparoscopy. Repeat laparoscopy revealed small bowel hypermotiliy which was successfully treated with intravenous (IV) hyoscine butylbromide. Neostigmine, a widely used muscle relaxant reversal agent, is known to increase small bowel motility. Intravenous hyoscine butylbromide is a rapid treatment of neostigmine-induced small bowel hypermotility post-laparoscopy.
Perioperative Care Planning for a Down's Syndrome Patient
Authors: Hayes Julie
Published: December 2017

Introduction

This article will be looking specifically at caring for a Down's syndrome patient, and will focus on the specialist care that they may require throughout the perioperative environment. This article will therefore explain Down's syndrome and include the related characteristics and health problems associated with this condition, which will then be used to highlight specific areas of care which may need to be improvised in order to accommodate this condition within the operating theatre.
The Surgical Care Practitioner: A Critical Analysis
Authors: Nicholas Michael
Published: December 2017

The role of the surgical care practitioner has been in existence for many years in some form or another with a variety of job titles and a wide range of duties. With the adoption of the European Working Time Directive and the need for skilled assistance, not only at the operating table but also pre and post surgery, the role is becoming formalised with voluntary codes of conduct, performance, ethics, standards and scope of practice.
Preoperative Starvation in Elective General Surgery
Authors: Khoyratty Saleem , Modi Bhavik N , Ravichandran Duraisamy
Published: December 2017

Objective

Study preoperative fasting times of adult elective surgical patients.

Methods

Fasting times for food and clear fluids, and the information used by patients to decide when to start fasting were studied.

Results

Among 200 patients, median fasting times were 2–4 times the guideline recommendations. Most patients used hospital written instructions but many started fasting substantially earlier than the instructions stipulated.

Discussion

Improved communication with patients could improve fasting times.
Developing Communication in Informed Consent
Authors: Quick Julie
Published: December 2017

Changes within the NHS have established perioperative practitioners, as well as other healthcare professionals, in roles that include obtaining informed consent. Practitioners involved in these roles require highly developed communication skills (Church 2008a). This article examines the philosophy of risk communication and explores the often complex skill of communication in informed consent.
Principles of Fracture Fixation in Orthopaedic Trauma Surgery
Authors: Al-Rashid Mamun , Khan Wasim , Vemulapalli Kishan
Published: December 2017

Fractures are common injuries and their management has evolved over the last 30 years with a greater propensity to treat fractures surgically. There have also been advances in the understanding of the principles of bone healing and the implications on implant choice. This article highlights the various surgical fixation devices available for the management of fractures and their underlying principles of action.
The Early Days of Caesarian Section
Authors: Ellis Harold
Published: December 2017

The story of the early days of caesarian section is shrouded in mystery, myths and old folk tales. The very name itself is the subject of debate. One thing is certain - it is nothing at all to do with Julius Caesar; his mother was still alive when he invaded Britain in 55BC. The most probable explanation of the term is the law promulgated by King Numa Pompillius of Rome in the year 715BC.
Current Practice on Preoperative Correct Site Surgical Marking
Authors: Masud Dhalia , Moore Alice , Massouh Farouk
Published: December 2017

Performing surgery at an incorrect site has devastating outcomes. The National Patient Safety agency and Royal College of Surgeons England have provided recommendations to promote correct site surgery with emphasis on surgical markings. There is little published data on surgical site marking practices amongst surgeons. A prospective audit on surgical site marking was performed on 500 surgical procedures: 204 inguinal hernias, 35 umbilical hernias, 48 varicose veins, 40 toenail removals, 123 excisions of skin lesions, 10 femoral artery procedures and 40 breast procedures. The results showed that 59% of markings were visible in theatre post sterile draping, 40.4% markings were not visible, and 0.6% (3/500) were not marked. Recommendations suggest the use of an arrow with an indelible marker pen. Our results show the use of an arrow in 64% of patients and this was the most common form of mark used. An appropriate marker pen was used on 88% of patients. There is no evident published data to compare our practice to that of other surgical units, however, to improve correct site surgery markings should be visible, recognisable and understood by all specialties and grades. A universal marking system to improve correct site surgery may be beneficial.
Perioperative Blood Transfusion: The Role of Allogenous and Autologous Transfusions, and Pharmacological Agents
Authors: Chimutengwende-Gordon Mukai , Khan Wasim S , Maruthainar Nimalan
Published: December 2017

The decision to transfuse patients perioperatively is made on an individual basis and should consider factors such as duration and severity of anaemia, symptoms, physiological parameters and comorbidities. Autologous blood transfusion has the benefit of avoiding some of the immunological and infective complications associated with allogenic blood transfusion. Pharmacological agents as well as anaesthetic and surgical techniques have a role in avoiding the need for blood transfusion.
The Early Days of Anaesthesia
Authors: Ellis Harold
Published: December 2017

If you should ask me to name the most important date in the whole history of surgery, I would reply, without a moment's hesitation, Friday October 16th 1846. The operation was a simple, almost trivial procedure, the removal of a small benign lump in the neck, but it marked the watershed between the past agonies of surgery and the modern era, where our patients enjoy the blissful oblivion of anaesthesia.
Management of the Patient with Diabetes in the Perioperative Period
Authors: Dhinsa Baljinder S , Khan Wasim S , Puri Ansuya
Published: December 2017

With the ever-increasing number of patients with diabetes undergoing surgical procedures, effective perioperative management of diabetes mellitus has become progressively more important. In this review we discuss a number of strategic approaches to improve perioperative management, where the fine balance between aggressive blood glucose management and prevention of hypoglycaemia must be considered. We also discuss complications of diabetes mellitus, particularly where these directly compromise patient health and interventional outcomes.
Audio-Visual Distraction during Spinal Anaesthesia for Orthopaedic Surgery
Authors: O'Connor Kenneth , Pace Nick
Published: December 2017

Spinal anaesthesia is an effective method of delivering anaesthesia for primary total knee replacement. A regional technique has several benefits over an opioid based general anaesthetic (Fischer 2009) (Figure 1). Pre-medication and sedation is commonly used as an adjunct to create anxiolysis and reduce stress which could be provoked by being awake in the theatre environment. However, sedation is not without its disadvantages (Absalom & Adapa 2007) (Figure 2).
Blood Conservation in Cardiac Surgery
Authors: Anderson Lynne
Published: December 2017

Cardiac surgery is one of the largest users of blood and blood products – currently estimated at 15% of UK blood stocks. While the blood supply could be considered to be the safest it has ever been, there are well recognised risks associated with the transfusion of red cells and blood products. It is appropriate that attempts should be made to decrease and optimise the transfusion of blood and blood products.
‘The Price of Everything and the Value of Nothing’: Cost Awareness in Anaesthesia
Authors: Hadjipavlou Marios , Bailey Craig R.
Published: December 2017

Cost awareness for the drugs and disposables commonly used by anaesthetic staff has previously been poor. In our study, fifty anaesthetic staff were asked to estimate the cost of thirty-three commonly used drugs and disposables. Expensive items were consistently underestimated whereas inexpensive items were consistently overestimated. There was no overall correlation between the number of years of anaesthetic experience and cost awareness. These findings demonstrate poor knowledge regarding the cost of drugs and consumables amongst anaesthetic staff.
Documentation and Record Keeping
Authors: Pirie Susan
Published: December 2017

Documentation and record keeping is an important aspect of healthcare practice and perioperative practice is no exception to this rule. For some time now, recording every activity or intervention that a patient receives has assisted with enhancing perioperative practice; equally, it has played a key part in resolving legal and professional incidents that have occurred. There are numerous national guidelines that uphold accurate record keeping as an intrinsic aspect to patient safety (DH 2006, HPC 2008, NMC 2008, Scottish Executive 2008, DH 2009). The intention of this article is to identify and discuss some of the more common errors associated with record keeping which may have a direct or indirect effect on practitioners’ misconceptions of using electronic record systems.
Simple Multidisciplinary Education of Junior Doctors and Nurses Improves Prescription of Venous Thromboembolism Prophylaxis
Authors: Findlay John , Keogh Michael
Published: December 2017

Venous thromboembolism is the most common preventable cause of hospital death. Rates of thromboprophylaxis were studied prospectively in 158 surgical patients before and after multidisciplinary intervention. Prescription of mechanical prophylaxis improved from 58.8% to 76.6% (p=0.015) following multidisciplinary education. Non-significant increases were seen in pharmacological prescription. Simple multidisciplinary education improves prescription of thromboprophylaxis. As postgraduate curricula for junior doctors and nurses evolve, we advocate routine inclusion of such sessions.
The Early Days of Ruptured Ectopic Pregnancy
Authors: Ellis Harold
Published: December 2017

Today, when lives are routinely saved by early open or laparoscopic surgery, it is hard to imagine that young women suffering from ruptured ectopic pregnancy were left to their fate or submitted to procedures which had no possibility of dealing effectively with the haemorrhaging fallopian tube. As we shall describe, the first success in dealing with this emergency was not until 1883.
The Advanced Scrub Practitioner Role: A Student's Reflection
Authors: Brame Karen
Published: December 2017

This article will reflect on my experiences in becoming an advanced scrub practitioner (ASP), using a reflective model to support the structure. Since Dewey's simple claim (1938, cited by Rolfe 2001) that ‘we learn by doing and realising what came of what we did’, many other authors have advocated and adapted this mantra (Rogers 1983 cited by Rolfe 2001, Gibbs 1988). A reflective model enables learning whilst utilising experiential knowledge from previous reflections (Rolfe 2001). Using Gibbs'’ reflective model this article reflects and evaluates the experience of becoming an ASP looking at both positive and negative issues, benefits to patients, colleagues and the organisation I work within. It examines issues of accountability and concludes by asking the question ‘what next?’
Innovative Perioperative Role Improves Patient and Organisational Outcomes in Minimal Invasive Surgery
Authors: Abraham Jenny
Published: December 2017

The drive to improve clinical care and productivity in the NHS has required an innovative approach in the use of the resources and skills of the workforce. With rapidly evolving technology, surgical and anaesthetic techniques, concentration is increasingly being placed on improving patient focused pathways, aiming to return patients back to normal activities as soon as possible. The article highlights the exciting new perioperative role developed at University Hospitals Coventry and Warwickshire (UHCW) NHS Trust in the care of patients undergoing laparoscopic cholecystectomy. It includes the history and development of the post and its current impact in improving the care of patients.
‘Pass the Buzzy Thing, Please.’ Recognising and Understanding Information: An Essential Non-Technical Skill Element for the Efficient Scrub Practitioner
Authors: Mitchell Lucy , Mitchell Janet
Published: December 2017

Adverse events are unintended injuries or complications that are caused by the management of a patient's care rather than by their underlying medical condition. Research into adverse events in hospitals has demonstrated that the operating theatre is one area of healthcare where there is room for improvement, with 41% of all adverse events occurring in the operating theatre, according to one systematic review (deVries et al 2008). Despite technical guidelines, there are still instances of sponges and instruments being retained within patients (Gawande et al 2003) and the factors contributing to this may include assertiveness issues and communication between perioperative and medical staff, i.e. non-technical skills.
The Early Days of Thyroidectomy
Authors: Ellis Harold
Published: December 2017

Although the normal thyroid gland is invisible and impalpable, its enlargement gives such an obvious swelling in the front of the neck that this pathology has been observed from ancient times. Old names for the swollen gland included ‘bronchocele’, which means a cystic mass in the neck, ‘struma’, (Latin for a swollen gland) and ‘goitre’, which comes from the Latin word ‘gutta’, the throat, and which is a term which is still used today. The term ‘thyroid’ was introduced by the 17th century anatomist Thomas Wharton, of London, and is derived from the Greek word thyreos, a shield, based on its shield-like appearance wrapped over the front of the trachea. He believed that its function was to give women a beautifully rounded neck!
Intraoperative Cell Salvage in Obstetrics
Authors: Grainger Hannah , Catling Sue
Published: December 2017

The use of Intraoperative Cell Salvage (ICS) in obstetrics has been slow to develop as a result of theoretical concerns relating to amniotic fluid embolism and fetal red cell contamination. In this article we examine the current UK position on the use of ICS in this clinical speciality and the recommendations for its safe and appropriate use.
Anaesthesia and the Autistic Child
Authors: Bagshaw Maria
Published: December 2017

There appears to be little literature in paediatric anaesthetic practice relevant to children suffering with autism (Rainey & Van der Walt 1998). Recent findings suggest a need for rigorous study of the potential problems that autistic children may have when undergoing an anaesthetic (Kirz 2007). Some healthcare professionals do not have the knowledge or professional guidance to be able to identify these children (DH 2001, Disability Rights Commission 2006, DH 2008a, b, 2009, Rankin 2009).
Surgical Never Events Should Never Happen…
Authors: Reid Jane H
Published: December 2017

Surgical procedures are intended to save lives and improve the quality of life, however omissions in essential practices (system and human error) contribute to unsafe surgical care, and cause significant harm to patients. For centuries it was believed that patients' co-morbidities and the surgeon's technical competence were the key determinants of surgical outcome; it is only within the last decade, that the relationship between failure to follow safety procedures, sub-optimal team work, poor communication and clinical outcomes has been appreciated (Vincent et al 2001). Recognition of the interdependencies for good surgical outcomes owes much to safety oriented research focusing on interpersonal behaviours and cognitive performance, the science of ‘human factors', and the route cause analysis (RCA) of surgical harm.
An Audit of Pressure Sores Caused by Intermittent Compression Devices Used to Prevent Venous Thromboembolism
Authors: Skillman Joanna , Thomas Sunil
Published: December 2017

When intermittent compression devices (ICDs) are used to prevent venous thromboembolism (VTE) they can cause pressure sores in a selected group of women, undergoing long operations. A prospective audit pre and post intervention showed a reduced risk with an alternative device, without increasing the risk of VTE.
The Early Days of Spinal Tumour Surgery
Authors: Ellis Harold
Published: December 2017

In numerous examples in this series of essays on ‘The Early Days of…’ there is argument and debate about who should be given the credit for introducing a particular major advance in treatment. However, in the story of the management of tumours involving the spinal cord, there is no doubt at all about priority; the surgeon was Victor Horsley and the date was June 1887! The patient was a Captain Gilbey, a business man and a retired Army officer. In 1884, shortly after his wife's death following a road traffic accident, he developed severe upper thoracic back pain. He was seen over succeeding months and years by numbers of specialists, whose diagnoses ranged from an aneurysm to neurasthenia, and whose treatments included advice to take a long sea voyage, to have Turkish baths and to take the cure at the medicinal baths at Aix-la-Chapelle. His various medical advisors thought his condition to be functional, even though he was gradually losing sensation and movement in his legs and trunk, was having considerable difficulty in passing his urine and was now requiring morphia for the pain.
Perioperative Death: A Critical Reflection-on-Action
Authors: Breadon Ruth , Mccolgan Karen
Published: December 2017

Perioperative death is thankfully not a regular occurrence in UK operating theatres. However, when it does occur the perioperative practitioner is often denied the opportunity to grieve. The use of a clinical supervision session enabled a critical reflective approach to be followed after the death of a patient in the operating theatre.
The Perioperative Management of Skeletal Metastases
Authors: Bhamra Jagmeet S , Malik Atif A , Aresti Nick A , Khan Wasim S , Pollock Rob
Published: December 2017

Bone metastasis is a common problem affecting a significant proportion of patients with metastatic cancer. Bone metastasis can present in a number of ways and the patients may need surgical stabilisation of their lesions. There are many important considerations in the care of these patients that need to be borne in mind including their increased anesthetic risks and potential risk of complications. There are continuous developments in the prevention, diagnosis and treatment with advances in imaging, orthopaedic technique and medication, particularly radiopharmaceuticals and cytotoxic, endocrine treatments with newer treatments based around the tumour cell-osteoclast interaction. Having a better understanding of these considerations and developments is important in allowing the optimisation of the care of the patient with bone metastasis.
The Management of Rotator Cuff Tears in the Elderly
Authors: Rogers Benedict A , Little Nick J , Ricketts David M
Published: December 2017

Rotator cuff tears occur commonly in the elderly causing significant pain and disability. In light of new treatment options developed over recent years, this article reviews the diagnosis and operative options available for this condition.
Parental Presence during Child Resuscitation: A Critical Review of a Research Article
Authors: Litak Dominika
Published: December 2017

The article reviewed is: Parental presence during resuscitation in the PICU: the parents' experience. Sharing and surviving the resuscitation: a phenomenological study (Maxton 2008). The article provides an insight into parents' experiences of being present or absent during successful or unsuccessful resuscitation attempts on their child. It can help healthcare practitioners to understand what parents' perspectives and needs may be during this difficult time. Lack of such understanding could potentially lead healthcare practitioners to neglect or misjudge the parents' needs and apply inappropriate interventions which may result in long-lasting and detrimental effects on parental welfare (Dingeman et al 2007). Patient care on this particular occasion extends to a family and therefore it becomes a professional duty of the healthcare practitioners to ensure best practice through provision of a well informed support (HPC 2008).
Comparison of Surgical Hand Scrub and Alcohol Surgical Hand Rub on Reducing Hand Microbial Burden
Authors: Ghorbani Azam , Shahrokhi Akram , Soltani Zahra , Molapour Azam , Shafikhani Mahin
Published: December 2017

This study was performed to compare the effects of two hand decontamination methods on the microbial burden of operating room staff hands. The surgical hand washing methods compared were a traditional surgical hand scrub using a povidone iodine solution, and a social wash using a liquid non-antibacterial soap followed by the application of an alcoholic hand rub.