bluuebunny/crossref_metadata_2025 huggingface dataset:
The Growth of Complementary Therapies: And their Benefits in the Perioperative Setting
Authors: O'regan Patricia , Wills Teresa
Published: December 2017

Complementary therapies support and enhance the quality of life and people ' s wellbeing. Increasingly, people are seeking out complementary therapies in managing their healthcare. Practitioners in the perioperative setting, who are at the forefront of healthcare delivery, should be aware of the current complementary therapies available to patients, including the potential benefits and any contraindications of the therapies.
Anaesthetic Medicines: Back to Basics
Authors: Cox Felicia , Bhudia Nisha
Published: December 2017

Anaesthesia has developed since the first description of curare. Today there are a myriad of anaesthetic and analgesic medicines available. This article explores the function of medicines in a patient ' s perioperative journey and describes how pharmacokinetics and pharmacodynamics play such a large role. The different routes of administration are described and the main categories of anaesthetic medicines outlined. The characteristics and precautions associated with the different classes of medicines are highlighted.

NB Unless otherwise indicated all information related to a medicine ' s dose, pharmacokinetics and pharmacodynamics have been sourced from the Special Product Characteristics (SPC) of individual medicines available from the electronic Medicines Compendium at www.medicines.org.uk .
Evidence for the Use of Non-Steroidal Anti-Inflammatory Drugs for Acute Pain in the Post Anaesthesia Care Unit
Authors: Frampton Claire , Quinlan Jane
Published: December 2017

Successful management of acute post-operative pain in the post anaesthesia care unit (PACU) is vitally important. A multimodal approach incorporating analgesics with varying sites of action is recommended. Anti-inflammatory drugs are effective analgesics in the treatment of mild to moderate acute pain (Bandolier Oxford league table of analgesic efficacy 2007). The purpose of this article is to consider the evidence for the use of non-steroidal anti-inflammatory drugs (NSAIDs) for acute postoperative pain.
Helen Taussig: Children's Cardiologist
Authors: Ellis Harold
Published: December 2017

When I was a medical student in the 1940's, we were familiar with ‘Blue Babies' in the children's medical wards. Cyanosed, breathless to the extent of being unable to lie down, and with no effective treatment available, they were condemned to a miserable life and early death. Many of these children suffered from Fallot's tetralogy, where the main problem is stenosis of the pulmonary artery. This greatly diminishes the flow of de-oxygenated blood from the right side of the heart to the lungs.
The Monitoring of Heparin Induced Thrombocytopenia following Surgery: An Audit and International Survey
Authors: Rogers Benedict A , Cowie Andrew S
Published: December 2017

Heparin-induced thrombocytopenia (HIT) is a serious postoperative complication of low-molecular-weight heparin (LWMH) prescribed following surgery and recent evidence based guidelines recommend routine platelet count monitoring for all at-risk patients. With the implementation of these guidelines this clinical study demonstrated a significant improvement (2 – 56% p<0.05) in HIT diagnosis in postoperative patients receiving LMWH. An international survey showed a lack of awareness of heparin-induced thrombocytopenia and its management.
Meeting the Health Professions Council's Standards of Proficiency: A Student's Experience
Authors: Scott Bevan
Published: December 2017

A core component of healthcare courses involves reflective learning. This article discusses a student‘s learning experience while undertaking the diploma in operating department practice. Core skills development is important in facilitating the learing process, and can be identified through reflective practice. Reflecting on individual learning experiences can support students in meeting the Health Professions Council‘s (HPC) standards of proficiency.
The Importance of Correct Patient Positioning in Theatres and Implications of Mal-Positioning
Authors: Adedeji Rimi , Oragui Emeka , Khan Wasim , Maruthainar Nimalan
Published: December 2017

Patient positioning in theatre pertains to how a patient is transferred and positioned for a specific procedure. Patient safety is a central focus of care within the NHS and every healthcare practitioner must ensure that patients are protected from harm where possible. Mal-positioning of the patient has important implications in terms of associated problems of pressure sores, nerve compressions, deep vein thrombosis and compartment syndrome, and should be avoided.
Perioperative Care: It's All a Matter of Competency - Isn't It?
Authors: Raven-Vause Anne
Published: December 2017

Many operating department practitioners believe that career success depends solely on technical ability. In this article Anne Raven-Vause challenges the nature of competent performance in busy perioperative settings and explores the skill set that needs to be developed in tomorrow's leaders.
Patient Care in the Perioperative Environment
Authors: Pirie Susan
Published: December 2017

This article focuses on issues relating to patient positioning, by providing an overview of various patient positions, pressure area care and an awareness of some preventative measures to ensure safe patient care.
Promoting the Dignity of Patients in Perioperative Practice
Authors: Baillie Lesley , Ilott Lorraine
Published: December 2017

UK health policy has increasingly recognised that the quality of patients' experiences is important and there is a clear expectation that patients' dignity should be promoted in healthcare. Patients undergoing surgery are particularly vulnerable to their dignity being diminished. Operating department staff should ensure that dignity is promoted through attention to patients' privacy and through interactions that help patients to feel comfortable, in control and valued. They should also challenge colleagues whose practice compromises patients' dignity.
The Obese Patient. Anaesthetic Issues: Airway and Positioning
Authors: Bale Emma , Berrecloth Richard
Published: December 2017

The authors have combined experience of over forty years working within the NHS and private hospitals as registered operating department practitioners.

It is widely accepted that obesity is a growing problem in the populations of all developed and, increasingly, developing countries. It is also agreed that this sector of the population present specific challenges when required to undergo general anaesthesia. What is not so evident is a universal approach to assessing, predicting and overcoming these challenges. Furthermore, where there is the presentation of a clearly high risk patient, there can be limitations in optimizing the environment for reasons such as saving time, a lack of resources or sheer apathy. This article reviews the challenges, assessment and solutions available to the clinician faced with a high BMI patient with particular reference to the technique of ramping.
Surgical Care Practitioners… Our Experience
Authors: Quick Julie , Williams Sarah , Addison Sarah
Published: December 2017

Julie Quick and Sarah Williams - surgical care practitioners and Sarah Addison - consultant surgeon, present their own experiences of the surgical care practitioner (SCP) role and answer the question posed by Kim Sayers (pseudonym): ‘Surgical care practitioners …why?’ (JPP March 2010).
The Early Days of Antibiotics
Authors: Ellis Harold
Published: December 2017

Today most of us take antibiotics used in our everyday practice very much for granted. Few of us, indeed, have escaped being dosed with them at one time or another. Yet professionals of my generation, as nurses, medical students or doctors in the 1940's, will well remember our amazement at the seemingly miraculous recoveries we saw of desperately ill septic patients when Penicillin, dispensed in little ampoules of brown powder, first became generally available in civilian hospitals.
The Early Days of Blood Transfusion
Authors: Ellis Harold
Published: December 2017

I think it is true to say that most of us in healthcare regard blood transfusion as just a routine, although very important, part of the care of patients undergoing major surgery. Yet behind that container of blood dripping into your patient lies a long and fascinating story of the endeavours of some brilliant and very determined pioneers.
Preoperative Antisepsis: Critiquing a Research Article
Authors: Lipp Allyson , Edwards Peggy
Published: December 2017

A critique of a research article on preoperative skin antisepsis was undertaken using a recognised framework. This critique drew out issues which may be of use for clinicians in making a judgement regarding implementing change into their clinical practice.
Evidence-Based Practice in Arthroscopic Knee Surgery
Authors: Onyema Christopher , Oragui Emeka , White Jonathan , Khan Wasim S
Published: December 2017

Knee arthroscopy is a minimally-invasive technique that allows intra-articular assessment and treatment of knee joint pathology. It has proven benefits of reduced patient morbidity, earlier recovery and mobilisation, and it is cost-effective. In this paper we review the anatomy of the knee joint, indications and contra-indications to knee arthroscopic use, and consider the main techniques of knee arthroscopy including types of anaesthetic, prophylactic antibiotics, theatre setup and arthroscopic portals, and post-operative care.
Colour Coding Scrubs as a Means of Improving Perioperative Communication
Authors: Litak Dominika
Published: December 2017

Effective communication within the operating department is essential for achieving patient safety. A large part of the perioperative communication is non-verbal. One type of non-verbal communication is ‘object communication’, the most common form of which is clothing. The colour coding of clothing such as scrubs has the potential to optimise perioperative communication with the patients and between the staff. A colour contains a coded message, and is a visual cue for an immediate identification of personnel. This is of key importance in the perioperative environment. The idea of colour coded scrubs in the perioperative setting has not been much explored to date and, given the potential contribution towards improvement of patient outcomes, deserves consideration.
Laser Safety: Practical Measures and Latest Legislative Requirements
Authors: Simon Mary
Published: December 2017

Lasers are used for a wide range of applications in operating departments and all persons working in a laser environment are required to understand the safety issues involved. This article details the various hazards associated with laser use and the management structure, procedures and control measures that should be implemented to ensure the health and safety of staff and patients. Recommendations are made in the context of the latest guidance and legislative requirements with reference to common issues that may arise in the workplace.
Surgical Care Practitioner Practice: One Team's Journey Explored
Authors: Jones Adrian , Arshad Homa , Nolan John
Published: December 2017

Surgical practice in the UK changed in 1993, when Suzanne Holmes and her cardiac surgical colleagues introduced the surgical care practitioner role (SCP). Within a consultant led extended surgical team, SCPs work alongside a variety of healthcare practitioners to provide safe patient care, meet service demands and educate the future surgical workforce. This article reviews the history of this development over the last fifteen years in the context of a busy orthopaedic department and discusses some unforeseen consequences.
The Early Days of Diverticula of the Colon
Authors: Ellis Harold
Published: December 2017

As a 17 year old first-year medical student at Oxford University in 1943, busily dissecting a cadaver in the Anatomy Department, I could not help noticing a series of peculiar pea-sized swellings along the course of the sigmoid colon. I showed these to our Professor of Anatomy, the much respected Sir Wilfred Le Gros Clarke FRS, who said ‘Those are diverticula, my boy. As an Oxford student you should know, (which, in fact, I did not!), that the word ‘diverticulum’ is Latin for a ‘wayside house of ill fame or ill repute’, and well do they deserve that descriptive term’. I carefully excised the affected piece of colon, put it in a bottle of formalin and, at the end of term, put it onto the mantelpiece of my bedroom at home. A few years later, my mother, in a clearing-up mode, threw the dusty bottle away. What a pity that I am unable to produce a photograph of my specimen to illustrate this article!
Inadvertent Perioperative Hypothermia: A Literature Review
Authors: Knaepel Abigail
Published: December 2017

Up to 70% of surgical patients develop hypothermia perioperatively. Inadvertent hypothermia can be caused by a cold operating theatre, anaesthetic effects, exposure to the environment and administration of cold intravenous or irrigation fluids. The adverse effects of unplanned hypothermia include increased blood loss, morbid cardiac events, impaired wound healing and increased mortality.

Preventing unplanned hypothermia increases patient comfort and prevents associated complications. It can be achieved by simple preventative measures (Burger &Fitzpatrick 2009, Lynch et al 2010).
Reflective Account of a Significant Event in Practice: A Student ODP's Perspective
Authors: Wishart Karl
Published: December 2017

This is an account of a significant event that occurred in clinical practice. The incident highlights issues that can arise from a breakdown of verbal and non-verbal communication between members of staff. It also demonstrates how professional conduct and effective team working can overcome such breakdowns to elicit a positive outcome. Using Johns (2009) model of structured reflection (MSR), this article reflects on the student operating department practitioner's (ST/ODP) role as anaesthetic support, exploring the impact on the care received by the patient, whilst examining the ethico-legal (governing body and legislation) considerations involved. Furthermore, the ST/ODP proposes to identify environmental and intra-operative factors that are potentially damaging to the patient's well being, through understanding the principles of negligence, emphasising clinical governance, vicarious liability and risk management issues.
Robert Graves: Graves' Disease of the Thyroid
Authors: Ellis Harold
Published: December 2017

In the English-speaking world, the eponym ‘Graves' Disease’ is commonly used to describe hyperthyroidism, usually in association with exopthalmos and usually in young women. I personally avoid this term and I hope to convince you of my reason for this in this paper.
Reducing Mortality for High Risk Surgical Patients in the UK
Authors: Rogers BA , Carrothers AD , Jones Chris
Published: December 2017

Over 40 million surgical procedures are performed per annum in the USA and Europe, including several million patients who are considered to be high risk (Bennett-Guerrero et al 2003). Overall, the risk of death or major complications after surgery in the general surgical patient population is low, with a post-operative mortality rate of less than 1% during the same hospital admission (Niskanen et al 2001).
Role of the Mentor in the Theatre Setting
Authors: Harvey Paul
Published: December 2017

Mentorship has been present in healthcare for many years and much has been written about it. This article will explore the role of the mentor in the operating theatre in light of the new standards of mentor preparation.
Thomas Addison: Addisonian (Pernicious) Anaemia, Addison's Disease of the Suprarenal Gland
Authors: Ellis Harold
Published: December 2017

Keen young medical researchers today might be forgiven if they believe that their labours require expensive equipment in sophisticated laboratories. It is salutary for them to be reminded that close clinical study of their patients may lead to remarkably important advances. One has only to think of Sir Richard Doll's work on the association of lung cancer and smoking, (which only cost the salary of a part-time secretary), or of Dennis Burkett's research on a peculiar tumour in children in tropical Africa which now bears his name. In 1855, Thomas Addison, physician at Guy's Hospital, published a slim, beautifully produced monograph of 39 pages, illustrated with 11 large colour plates entitled ‘Disease of the suprarenal capsules'. I have a facsimile copy of the book open in front of me as I write. Briefly, in the preface, he notes the discovery of another ‘new’ disease, of idiopathic anaemia. This condition was invariably fatal, with no organic lesion to be found at post-mortem examination.
Factors Affecting the Risk of Surgical Site Infection and Methods of Reducing it
Authors: Lobley Sarah N
Published: December 2017

According to estimates by the National Audit Office (NAO) hospital acquired infections (HAI), in particular surgical site infections (SSIs), cost the NHS on average £3200 per SSI and cause a mortality rate of at least five thousand patients a year (Leaper 2010). Despite practitioners' knowledge of safe working technique and control of infection, reported cases of nosocomial infections are still high, despite a reduction in rate from 9% in 1993/4 to 8.2% in 2006 (Roberts &Cookson 2009).
The General Surgical Care Practitioner Improves Surgical Outpatient Streamlining and the Delivery of Elective Surgical Care
Authors: Kumar Rohan , Debono Lisa , Sharma Paritosh , Basu Sanjoy
Published: December 2017

The feasibility of implementing a surgical care practitioner (SCP) role for the delivery of secondary care within the general surgery department of a district general hospital was evaluated. Streamlining patients into an SCP-led ‘one-stop’ gallbladder clinic for symptomatic uncomplicated cholelithiasis led to a reduction in follow-up clinic workload for major elective laparoscopic work and more appropriate triaging of primary care referrals. Each of these improvements contributed to an efficient service model.
Has the Introduction of an Admissions Lounge Affected Theatre Start Times in a Busy Teaching Hospital Environment?
Authors: Wardell Harry J , Lovell Martyn E
Published: December 2017

The Admissions Lounge (AL) was introduced with the aims of reducing the number of late starts, improving the patient experience and reducing preoperative length of stay to save bed days. To determine whether a reduction in number of late starts was achieved, 237 start times from pre and post introduction of the AL were collected and analysed. There was no statistically significant difference (p>0.05) between the percentage of lists delayed or the mean delay between pre and post introduction of the AL (mean delay for post AL was 10.17 minutes compared to 9.85 minutes pre AL). The AL had no impact on theatre start times, neither improving nor reducing the operating theatre efficiency in this respect.
Multi-Disciplinary Simulation Training for Anaesthetic Practitioners
Authors: Hughes Rob
Published: December 2017

A multi-disciplinary simulation training course devised and implemented at Morriston Hospital is described. The participants in the simulation exercise included both medical and non-medical professionals in a pilot study intended to analyse the effectiveness of a multi-disciplinary approach to this training technique. Questionnaires completed by the participants both immediately after the training session and again some months later highlight the desirability of this multi-disciplinary training. The success of the training course and the lessons learned from its implementation are being used to plan a similar second session in the near future.
Enhanced Recovery after Surgery (ERAS): An Orthopaedic Perspective
Authors: White Jonathan J E , Houghton-Clemmey Robert , Marval Paul
Published: December 2017

Enhanced recovery after surgery (ERAS) is a programme that aims to improve the care of elective surgical patients. Accelerated care pathways are delivered using a multidisciplinary approach, leading to reduced lengths of hospital stay, improved quality of treatment, and better outcomes. These programmes have gained considerable popularity in orthopaedics recently, however their widespread adoption remains to be seen. This article highlights the key evidence concerning ERAS in orthopaedic surgery.
Scrub Skills Audit
Authors: Cuttell Jenny
Published: December 2017

The aim of this study was to improve the knowledge and understanding of the evidence which encompasses extended roles and advanced practice for theatre scrub practitioners. The intention was also to develop a local policy and training strategy for advanced roles, benchmarked against professional standards (PCC 2007) and clinical practice audit.
Preceptorship: Professional development and support for newly registered practitioners
Authors: Mccusker C
Published: December 2017

Preceptorship is one aspect of continuous professional development which is vital to support healthcare professionals in the delivery of safe, effective, person-centred care. This article outlines the various aspects of preceptorship for nurses, midwives and specialist community public health nurses in Northern Ireland. It is hoped that the elements within it have transferability across other healthcare professions. The article will help the reader understand where preceptorship fits within a professional development and support continuum.
Surgical Swab Counting: A Qualitative Analysis from the Perspective of the Scrub Nurse
Authors: D'lima D , Sacks M , Blackman W , Benn J
Published: December 2017

The aim of the study was to conduct a qualitative exploration of the sociotechnical processes underlying retained surgical swabs, and to explore the fundamental reasons why the swab count procedure and related protocols fail in practice. Data was collected through a set of 27 semistructured qualitative interviews with scrub nurses from a large, multi-site teaching hospital. Interview transcripts were analysed using established constant comparative methods, moving between inductive and deductive reasoning. Key findings were associated with interprofessional perspectives, team processes and climate and responsibility for the swab count. The analysis of risk factors revealed that perceived social and interprofessional issues played a significant role in the reliability of measures to prevent retained swabs. This work highlights the human, psychological and organisational factors that impact upon the reliability of the process and gives rise to recommendations to address contextual factors and improve perioperative practice and training.
A Reflective Study on Abortions in Theatre
Authors: Murray H
Published: December 2017

This article discusses the concept of conscientious objection in relation to surgical terminations of pregnancy. It explores a scrub nurse's duty of care not only to the patient but to themselves. It highlights the importance of being self-aware of one's moral and emotional attitude towards abortions in theatre. Doing so enables the nurse/ODP to practice professionally and autonomously, and to deliver the highest level of perioperative care whilst respecting their personal rights.
The Productive Operating Theatre and Lean Thinking Systems
Authors: Kasivisvanathan R , Chekairi A
Published: December 2017

The concept of ‘lean thinking’ first originated in the manufacturing industry as a means of improving productivity whilst maintaining quality through eliminating wasteful processes. The purpose of this article is to demonstrate how the principles of ‘lean thinking’ are relevant to healthcare and the operating theatre, with reference to our own institutional experience.
The Strangulated Umbilical Hernia of Queen Caroline
Authors: Ellis Harold
Published: December 2017

One of the lessons we learn from medical history is how great the improvement has been in the management of commonplace surgical emergencies. Less than three hundred years ago, the Queen of England, in her healthy middle age, died of a straightforward strangulated umbilical hernia.
The Rapid Sequence Spinal for Category 1 Caesarean Section: Anaesthetic Trainee Knowledge and Practice
Authors: Jigajinni Sv , Rajala B , Sharawi N El
Published: December 2017

Rapid sequence induction of general anaesthesia (GA) is the fastest anaesthetic technique in a category-1 caesarean section (C1CS) for foetal distress. Recently rapid sequence spinal anaesthesia (RSS) has been explored as a technique to avoid the potential risks of GA in such cases. Out of hours, trainee anaesthetists are often required to provide anaesthesia for these emergencies. We surveyed their practices when performing a RSS.

The aim of a RSS is to rapidly and safely achieve anaesthesia for C1CS, while optimising foetal oxygenation and preparing for possible GA. It requires anaesthetic skill, team work and communication. Many trainees understood the principles of the RSS, however, a significant number did not. Practice varied widely and no trainee had received any formal RSS training. Training for junior anaesthetists and those working in obstetric theatres, in the conduct of the RSS is crucial, to ensure safe practice, avoid delays in delivery and safely avoid the risks associated with GA in the C1CS.
Improving Preoperative Medication Instructions and Patient Adherence: A Collaborative, Hospital-Based Quality Improvement Project
Authors: Renew Jr , Bolton Je , Alvarado Jm Irizarry , De Ruyter Ml
Published: December 2017

The goal of this project was to improve preoperative medication instructions. After baseline data were collected prospectively through standardised patient surveys, preoperative care providers were educated to convey clear, appropriate preoperative medication instructions. After the education period, patient surveys were again completed to assess improvement. Hospital-wide education effectively increased the percentage of medications with written, colour-coded, and medically appropriate instructions. Patients found the instructions clearer and easier to follow.
Neurosurgical versus Endovascular Treatment of Subarachnoid Haemorrhage Caused by Ruptured Cerebral Aneurysm: Comparison of Patient Outcomes
Authors: Kamensky J
Published: December 2017

The aim of this critical review is to determine whether endovascular treatment (EVT) of a subarachnoid haemorrhage (SAH) has better patient outcomes than neurosurgical treatment (NST). A review of six cohort studies (listed in Table 1) was carried out and the main findings were summarised in the conclusion. In addition the list of author's recommendations is included at the end of the paper.

Theatre practitioners involved in neurosurgery might find this review useful in enhancing their understanding of how SAH is currently treated. It could also bring some insights about the reasons why a particular modality of the treatment was chosen for their patient.
Part One: An Introduction to the Research Process
Authors: Quick J , Hall S
Published: December 2017

Research modules have become a common inclusion to graduate healthcare programmes. To the novice researcher, undertaking a study or dissertation can appear daunting. This article is the first of a series of four that aims to help perioperative practitioners feel more positive about undertaking a project by examining the research process and the theoretical frameworks of qualitative and quantitative approaches. The final of the four articles provides advice on writing a dissertation.
The First Royal Appendix Abscess Drainage
Authors: Ellis Harold
Published: December 2017

On January 22nd 1901, at Osborne House on the Isle of Wight, Queen Victoria, nearing her 82nd birthday and having ruled for 64 years, drew her last breath. Edward Prince of Wales, 59 years of age, was now King Edward VII. A year of mourning was proclaimed and his coronation scheduled for June 26th. It was unexpectedly delayed by an attack of royal appendicitis. On Saturday June 14th 1902, less than two weeks before the coronation, Edward travelled to Aldershot to attend a military review. It was a cold, rainy day and the King did not feel well. That night, his abdominal discomfort was getting worse and by five next morning the King's personal physician, Sir Francis Laking, was called to see him. Laking asked Sir Thomas Barlow, Physician-Extraordinary to the King, for a second opinion. By now there was fever, rigor and distinct tenderness in the right iliac fossa of the very obese abdomen. Under heavy sedation, the King was transferred to Windsor Castle, leaving his Queen, Alexandra, to review the parade of 30,000 soldiers gathered at Aldershot.
Closing the Audit Cycle: Improving Short Term Outcomes of Oesophagectomy in a Provincial Hospital
Authors: Al-Herz F , Sammour T , Milne H , Rhind B , Young M
Published: December 2017

A previously published study regarding the outcomes of oesophagectomy at a provincial hospital identified issues with perioperative care (Al-Herz et al 2012). The aim of this study was to evaluate the effect of changes in management at the institution concerned. This was a cohort study which compared the outcomes of 30 patients undergoing oesophagectomy before the unit audit and 30 patients after it. Demographics, operative details, recovery parameters, and oncological data were collected retrospectively. There was a significant reduction in the use of intravenous fluid, both intraoperatively (6.6 vs 3.3L, P<0.0001) and during the first 24 hours (9.2 vs 5.5L, P<0.0001). Patients were extubated three days earlier (P<0.001) after the audit, and the percentage of patients requiring tracheostomy was smaller (26.7% vs 0%, P=0.003). The length of total hospital stay was shorter (15 vs 13 days, P=0.035). We conclude that the publication of a unit audit changed perioperative practice and resulted in a significant improvement in the short term outcomes after oesophagectomy.
Perioperative Management of a Placenta Percreta: A Case Review
Authors: McGarry Jr
Published: December 2017

This paper presents the management of a woman undergoing her fifth caesarean section in the presence of a placenta percreta. It reviews the incidence and surgical management of this complex pathology. Advanced planning and multidisciplinary coordination is crucial to successful treatment of this condition. There are implications for theatre staff of all professions to be confident and familiar with specialist equipment. Such cases represent a trend of multidisciplinary working that is increasingly part of current practice.
Perioperative Management of Traumatic Limb Amputations Due to Civilian Trauma: Current Practice and Future Directions
Authors: Cumberworth J , Kieffer Wkm , Harry Le , Rogers Ba
Published: December 2017

Traumatic limb amputations are serious injuries. They require urgent multidisciplinary management and emergency surgical intervention to save life and, where possible, preserve limb function. It is therefore vital that perioperative management follows established evidence-based principles to optimise outcomes. In recent years a vast quantity of research on traumatic amputations in the military setting has been published, but civilian injuries, which often have strikingly different mechanisms, have been neglected. This article reviews existing information on epidemiology, pathophysiology, perioperative management strategies, outcomes and future directions in the field.
Perioperative Management of Chronic Respiratory Disease
Authors: Ihsan Khan M , Nannaparaju Madhusudhan R , Aftab Syed , Khan Wasim S , Malik Atif A , White Jonathan J E
Published: December 2017

Respiratory disease contributes significantly to the perioperative challenges of surgery. Preexisting pulmonary co-morbidities and respiratory complications can have profound effects on patient outcomes. Knowledge of these conditions and the potentially deleterious effects of anaesthesia and surgery can enable clinicians to optimise lung function, reduce complications and improve results.
Transfusion Associated Circulatory Overload: A Critical Incident
Authors: Goodall E
Published: December 2017

Transfusion associated circulatory overload (TACO) is a serious but under-recognised complication of blood transfusion. While the exact incidence rate is unknown the associated morbidity and mortality make this a transfusion reaction worthy of attention. This article provides details of a critical incident involving TACO followed by a literature review and discussion written from the perspective of a student ODP. The goal of this article is to raise awareness of TACO amongst hospital staff to facilitate faster recognition and earlier intervention in future events.
What's in My Buckets Today? Foreseeing and Forestalling Patient Harm
Authors: Carthey J
Published: December 2017

Operating theatre teams work in an imperfect system characterised by time pressure, goal conflicts, lack of team stability and steep authority gradients between consultants and other team members. Despite this, they often foresee and forestall errors that could harm patients. The paper discusses the strengths and limitations of using Reason's three buckets model of error prevention as a framework for training operating theatre staff how to foresee and forestall incidents.
Compression Bandaging Improves Mobility following Total Knee Replacement in An Enhanced Recovery Setting
Authors: Cheung A , Lykostratis H , Holloway I
Published: December 2017

The early functional outcome was assessed in 180 patients undergoing total knee replacement (TKR) using compression bandaging versus standard crepe bandaging. Patients with a compression bandage following TKR were significantly more likely to be discharged with a walking stick (p=0.002) and less likely to be discharged with a rollator frame (p=0.001). These patients demonstrated an improved range of knee flexion and ability to straight leg raise at discharge.
Robotic Surgery and Its Impact on Teamwork in the Operating Theatre
Authors: Gill A , Randell R
Published: December 2017

Effective teamwork in the operating theatre is important for safe patient care. In robotic surgery, the surgeon is physically separated from the operating theatre team, which could potentially have an impact on teamwork. With robotic surgery increasing internationally, this article reviews relevant published literature on teamwork in the operating theatre and reflects on how this might be impacted by robotic surgery. We conclude by describing a research study we are currently undertaking on this topic.
Pressure Ulcers or Moisture Lesions: The Theatre Perspective
Authors: Rego A
Published: December 2017

Pressure ulcers continue to be a cause for concern in the healthcare industry (IHI 2015). Unfortunately older patients are at a greater risk of developing pressure ulcers (Kottner et al 2013); moisture lesions and the presence of other comorbidities could have long term effects on the patient's health and recovery.
Auditing the Needs of Recovery Room Staff Providing Care for the Child in An Acute Hospital
Authors: Nicholas-Holley J
Published: December 2017

This article examines the results of an audit into recovery nurse knowledge and understanding of paediatric care standards. It will critically analyse the availability of current standards for children's services in the recovery room and discuss the need for a national document specifically dedicated to standards of practise for the care of the child in the recovery room providing immediate post operative care. The article will also look at the development of such a document.
Surgical Safety Checklists Briefings: Perceived Efficacy and Team Member Involvement
Authors: McDowell DS , McComb S
Published: December 2017

Researchers have shown inconsistencies in compliance, outcomes and attitudes of surgical team members related to surgical safety checklist briefings. The purpose of this study was to examine surgical circulator and scrub practitioners’ perceptions of safety checklist briefings and team member involvement, and to identify potential improvements in the process based on those perceptions. An anonymous survey was conducted with members of the Association of periOperative Registered Nurses (AORN) and the Association of Surgical Technologists (AST). Questions focused on perceptions of checklist briefing efficacy and team member involvement in safety practices. From the 346 usable responses, a third respondent group of self-identified perioperative leaders emerged. Significant results were obtained related to leaders’ perceptions, post-procedure briefings and various perceptions of team member involvement. Study results indicate that variances in safety practices continue as perceived by surgical team members thus presenting opportunities for further examination and improvement of processes in reducing surgical errors.
Ergonomics: An Important Factor in the Operating Room
Authors: Vural F , Sutsunbuloglu E
Published: December 2017

There is a mutual interaction between health and the workplace. Health affects the capacity to work and working conditions affect a worker's health. Operating rooms (ORs) are stressful, complex settings in which there are ergonomic risk factors, such as lifting/moving heavy equipment. Work-related musculoskeletal disorders (WRMSDs) can arise due to unhealthy ergonomic conditions. Our study showed that nurses had been absent from work and/or retired early due to WRMSDs. Good ergonomic conditions in ORs increase nurses’ occupational health and safety, their job satisfaction and performance. These factors contribute to patient care outcomes in a positive way.
The Perfect Surgical Assistant: Calm, Confident, Competent and Courageous
Authors: Hall S , Quick J , Hall AW
Published: December 2017

Poor surgical assistance has been identified as a major stressor in surgeons, making the ability to provide effective surgical assistance an important skill which will have a lifelong impact on the surgical patient. Knowledge and technical ability are clearly important, but strong personal qualities are more so in the long run. This applies to all who provide assistance either as a surgical first assistant or surgical care practitioner. These skills and attributes are needed to provide a safe service that meets the expectations of both the professional regulatory authorities and surgical Royal Colleges. Advice is given in this article as to how non-medical practitioners may acquire these skills.
Prophylactic Amiodarone vs Dronedarone for Prevention of Perioperative Arrhythmias in off-pump Coronary Artery Bypass Grafting: A Pilot Randomized Controlled Trial
Authors: Som A , Sen C , Goswami A
Published: December 2017

The aim of this study was to compare the effects of prophylactic dronedarone and amiodarone in prevention of arrhythmias during and following off-pump coronary artery bypass grafting (OPCAB). This randomized, controlled, double-blinded, parallel-group study was carried out on 36 adult male patients aged 30–70 years, with modified Parsonnet score 0–10 undergoing off-pump coronary artery bypass grafting. After obtaining approval from the institutional ethics committee and informed consent, the patients were randomly allocated to two equal groups (n=18). In one group, patients were given inj. amiodarone 3mg/kg in 100ml of normal saline prior to skin incision intravenously over 20 minutes. In the second group patients received tablet dronedarone 400mg orally twice daily, commencing three days prior to the date of surgery Patients in the amiodarone group received placebo tablet while patients in the dronedarone group received placebo infusion for the sake of blinding. The frequency and profile of arrhythmias intraoperatively and 24 hours postoperatively were studied. Intraoperative arrhythmias occurred in 50% of patients receiving amiodarone and 16.67% of patients receiving dronedarone. Maximum ventricular rate during atrial fibrillation was significantly lower in the dronedarone group (121 beats per min) than in the amiodarone group (168 beats per min, p< 0.05). The study concludes that dronedarone appears to be at least as effective as amiodarone in prophylaxis of intraoperative and postoperative arrhythmias in patients undergoing OPCAB, with a better control of ventricular response.
Parent Pagers: Improving Patient Experience and Efficiency in Paediatric PACU
Authors: Byrn G
Published: December 2017

A quality improvement initiative undertaken by the paediatric recovery team at the Leeds Children's Hospital sought to improve patient experience and efficiency by implementing an electronic pager system to contact parents/carers following their child's surgery.
Cost Effectiveness of Preoperative Screening for Healthy Patients Undergoing Robotic Hysterectomy
Authors: Rayborn MK , Turner JL , Park SG
Published: December 2017

The objective of this study was to determine whether routine preoperative type and screen blood testing is cost effective and medically warranted for benign diagnosis in healthy patients undergoing robotic hysterectomy. The study was designed as a cross sectional retrospective descriptive study. Four hundred and twenty-two medical records of American Society of Anesthesiologists (ASA) Classifications I and II patients undergoing robotically-assisted laparoscopic hysterectomy between 1 June 2011 and 31 May 2014 at a 211 bed regional medical center were analysed. The results from this study paralleled the findings of other published research. Preoperative type and screen testing was performed on 249 (59%) of the patients in the study. Ten patients (2.4% of the group) converted to open laparotomy. Mean estimated blood loss was 59.59ml. No perioperative transfusions were required. The results indicate that preoperative type and screen testing is not warranted for patients meeting the inclusion criteria.
Leadership: Briefing and Debriefing in the Operating Room
Authors: Donnelly T
Published: December 2017

Steelman (2014) stated that the concept of briefing and debriefing used in operating theatres derived from the airline industry in the 1970s. There had been a series of devastating air crashes and the airline industry had come under severe public scrutiny. Investigations identified that, while the crews operating these aircrafts were very skilled and knowledgeable, they lacked competence in their ability to perform as part of a team.
A Comparative Prospective Cohort Study Comparing Physical Exam to Ultrasound for Identifying the Cricoid Cartilage
Authors: Williams P , Umranikar A
Published: December 2017

Applying cricoid pressure is a common practice when intubating patients thought to be at risk of pulmonary aspiration. Recently, the perceived benefits of applying cricoid pressure have been questioned. Prior research has shown that cricoid pressure is applied incorrectly and that palpation of adjacent anatomy of the cricothyroid membrane is also inaccurate. We compared physical palpation to ultrasound for identifying the location of the cricoid cartilage using a total of 50 assessments. The median distance to target was 10mm. We concluded that palpation is an inaccurate method to locate the cricoid cartilage in the studied population.
Pioneers of Pneumonectomy for Carcinoma of the Lung
Authors: Ellis Harold
Published: December 2017

In the early years of the 20th century, carcinoma of the lung, although quite common in the Western world, had not reached the epidemic proportions of today, where in the United Kingdom it remains the commonest cause of deaths from cancer in both sexes. The cause of this rise can be explained quite easily. At the beginning of the 20th century, tobacco consumption took the form of pipe and cigar smoking, chewing tobacco and inhaling snuff. The tobacco carcinogens produced carcinomas of lip, tongue, mouth and larynx in greater extent than lung. During the First World War of 1914–18, cigarette smoking became common, especially among the armed forces, and this was rapidly followed by the rapid rise in prevalence of lung cancer in the late 1930s.
Care, Compassion, Courage, Commitment, Communication and Competence: The 6 Cs
Authors: Chadwick Dot
Published: December 2017

These are words we are all very familiar with and perhaps already some of you may be thinking ‘oh no not again’. In the document One Year On (NHS England/Nursing Directorate 2013), comments from patients have been positive on the care they have received, but can we with hand on heart say it happens on a national scale at all times? This may be a reason for the continued requests for the inclusion of the six Cs as a topic for educational days.
A Review of Nausea and Vomiting in the Anaesthetic and Post Anaesthetic Environment
Authors: Matthews C
Published: December 2017

Postoperative nausea and vomiting (PONV) has long been known as a complication of anaesthesia and surgery. This paper focuses on the assessment of the risk factors related to PONV along with the strategies and interventions which can be put in place to manage the condition. The pharmacological and multi-modal treatment methods of managing the risk factors that contribute to PONV are discussed.
From Working Hours’ Restrictions to Professional Identity: The Development of the Surgical Care Practitioner Role
Authors: Britton C
Published: December 2017

This article describes how restrictions to working hours have encouraged the expansion of the surgical care practitioner role. It also discusses how this role has evolved and the identity that has been formed in the context of interprofessional surgical education.
Molitor: Pattern the Future You Wish to See
Authors: Inayatullah Sohail
Published: December 2017

This essay is a personal narrative of meetings with Graham Molitor, both as person and as text. His contribution is not just his invention of emerging issues analysis but his graciousness as a scholar and practitioner.
Financial burden of diabetic foot ulcers to world: a progressive topic to discuss always
Authors: Raghav Alok , Khan Zeeshan Ahmad , Labala Rajendra Kumar , Ahmad Jamal , Noor Saba , Mishra Brijesh Kumar
Published: December 2017

Diabetic foot complications are the most common occurring problems throughout the globe, resulting in devastating economic crises for the patients, families and society. Diabetic foot ulcers (DFUs) have a neuropathic origin with a progressive prevalence rate in developing countries compared with developed countries among diabetes mellitus patients. Diabetic patients that are of greatest risk of ulcers may easily be diagnosed with foot examination. Economic burden may be carefully examined. The budget costing must include both the clinical and social impact of the patients.