bluuebunny/crossref_metadata_2025 huggingface dataset:
Charge-induced geometrical reorganization of DNA oligonucleotides studied by tandem mass spectrometry and ion mobility
Authors: Ickert Stefanie , Hofmann Johanna , Riedel Jens , Beck Sebastian , Pagel Kevin , Linscheid Michael W
Published: December 2017

Mass spectrometry is applied as a tool for the elucidation of molecular structures. This premises that gas-phase structures reflect the original geometry of the analytes, while it requires a thorough understanding and investigation of the forces controlling and affecting the gas-phase structures. However, only little is known about conformational changes of oligonucleotides in the gas phase. In this study, a series of multiply charged DNA oligonucleotides (n = 15–40) has been subjected to a comprehensive tandem mass spectrometric study to unravel transitions between different ionic gas-phase structures. The nucleobase sequence and the chain length were varied to gain insights into their influence on the geometrical oligonucleotide organization. Altogether, 23 oligonucleotides were analyzed using collision-induced fragmentation. All sequences showed comparable correlation regarding the characteristic collision energy. This value that is also a measure for stability, strongly correlates with the net charge density of the precursor ions. With decreasing charge of the oligonucleotides, an increase in the fragmentation energy was observed. At a distinct charge density, a deviation from linearity was observed for all studied species, indicating a structural reorganization. To corroborate the proposed geometrical change, collisional cross-sections of the oligonucleotides at different charge states were determined using ion mobility-mass spectrometry. The results clearly indicate that an increase in charge density and thus Coulomb repulsion results in the transition from a folded, compact form to elongated structures of the precursor ions. Our data show this structural transition to depend mainly on the charge density, whereas sequence and size do not have an influence.
Issues facing postgraduate international students: a view from an international students’ group on a Masters programme in Art Psychotherapy
Authors: Skaife Sally , Reddick Dean
Published: December 2017

This paper describes case study research of four years of a support group for self-identified international students on an MA Art Psychotherapy programme. The research sought to understand the role of the group in the processing of international students’ issues, to broaden thinking on the internationalising of curricula. A key finding was that the students’ experiences were dependent on the relationship between them and the whole learning community, and that this was inseparable from a history of post colonialism.
The adaptation process of international lecturers in a South African university: The centrality of agency and collegiality
Authors: Jeannin Loïse
Published: December 2017

Teaching in a new country initiates a process of adaptation requiring emotional, cognitive and behavioural adjustments. This qualitative study explores international lecturers’ perceptions of their adaptation process in a South African university. The findings, based on semi-structured interviews with six lecturers from six different countries, indicate that teachers’ agency and collegiality are crucial interrelated factors of adaptation. Agency and collegiality enabled lecturers to receive context-relevant information and decide how to modify their pedagogical practices. The description of the adaptation process provides new insights for staff induction programmes.
Race, Class, and the Framing of Drug Epidemics
Authors: Tiger Rebecca
Published: December 2017

race is key in constructing drug scares, but by looking at the framing of america’s opiate epidemic, class is highlighted as another dividing line between those drug users subjected to or exempted from punitive social control.
Why sentence? Comparing the views of jurors, judges and the legislature on the purposes of sentencing in Victoria, Australia
Authors: Warner Kate , Davis Julia , Spiranovic Caroline , Cockburn Helen , Freiberg Arie
Published: December 2017

In recent times, parliaments have introduced legislation directing judges to take defined purposes into account when sentencing. At the same time, judges and politicians also acknowledge that sentencing should vindicate the values of the community. This article compares the views on the purposes of sentencing of three major participants in the criminal justice system: legislators who pass sentencing statutes, judges who impose and justify sentences and jurors who represent the community. A total of 987 Australian jurors in the Victorian Jury Sentencing Study (2013–2015) were asked to sentence the offender in their trial and to choose the purpose that best justified the sentence. The judges’ sentencing remarks were coded and the results were compared with the jurors’ surveys. The research shows that, in this jurisdiction, the views of the judges, the jurors and the legislators are not always well aligned. Judges relied on general deterrence much more than jurors and jurors selected incapacitation as the primary purpose in only about a fifth of ‘serious offender’ cases where parliament has provided that community protection must be the principal purpose.
To Smile Again: Reanimation for Unilateral Facial Palsy
Authors: Mitchell Helen
Published: December 2017

‘A smile adds a lot to your face value.’ Anon

The above quotation is a reflection of the value placed by society on the humble smile. But for the person suffering from a facial paralysis, this simple act of expression is impossible.
Threats and Opportunities Facing the Theatre Nurse
Authors: White Jean , Coleman Mick , Williams Marilyn , County Bernadette
Published: December 2017

This research based article confronts fundamental questions which concern every theatre nurse. The questions are not new; they have been asked since the 1960s, and on the basis of evidence presented here, answers are still elusive. As with any piece of research, readers should not accept what is offered at face value. Indeed, the authors point out that the views presented are those of a small sample of theatre managers. Give this article the benefit of your open mind and constructive critical opinion. Open Forum and letters to the editor are your avenues for expressing agreement or argument with what you read in the British Journal of Perioperative Nursing - read on and let us know what you think.
Life at the Britfor Military Hospital in Kosovo
Authors: Bernthal Emm
Published: December 2017

Life is full of new experiences and on 27 April 2000 a new one occurred for me. As a Nursing Officer in QARANC I was deployed for three months to the Britfor Military Hospital in Pristina, Kosovo to join 22 Field Hospital for my first operational tour. I was to be the only theatre sister in charge of two surgical teams which comprised five theatre technicians, two anaesthetists and two surgeons (one general and one orthopaedic).
Oscillometric Blood Pressure Monitors
Authors: Burton Janet
Published: December 2017

The mercury sphygmomanometer has been used to measure blood pressure for over a century (O'Brien 2000, Smith 2000), but due to the hazards associated with mercury spillage, there is increasing reliance on other methods, such as automatic oscillometric blood pressure monitors and aneroid sphygmomanometers. Within the theatre and recovery areas, the oscillometric method appears to be most common (Ramsey 1991).
Temperature and Its Effect on Bone Cement
Authors: Eveleigh Rebecca
Published: December 2017

This is the last of our series of four articles on bone cement mixing. In this article, Rebecca Eveleigh discusses the importance of temperature.
Staff Rostering in the Operating Department
Authors: Tanner Judith , Bailey Gloria
Published: December 2017

The smooth running of the operating department is often facilitated by the goodwill of the staff who agree to stay behind when cases overrun, or work through lunch and coffee breaks. Many perioperative staff also cover on-calls and stand-bys, causing disruption to their social and family lives. These demands may make working in the operating department harder for some staff. With reference to current shortages of perioperative staff and staff retention, Judith Tanner and Gloria Bailey discuss some suggestions for being flexible with the off duty rota which may give staff more control and more choices over when they work.
Finding Solutions
Authors: Wicker Paul
Published: December 2017

This year's NATN Managing Theatres Conference took as its theme ‘Finding Solutions’. Paul Wicker, Editor of the British Journal of Perioperative Nursing, attended the conference and here points out the many highlights of the event.

Managing Theatres: Finding Solutions Olympia, London, 18-19 May 2001
Team-Based Self-Rostering
Authors: Fudge Lesley
Published: December 2017

In this article in the Improving Working Lives series, Lesley Fudge follows up on the discussion of self-rostering begun by Judith Tanner and Gloria Bailey in the May issue of the BJPN. This article looks at team-based self-rostering, identifying the benefits, the pitfalls, its implementation and some of the key questions arising from the concept.
Handling Conflict
Authors: Westwood Fiona
Published: December 2017

Fiona's second series of articles develops the theme of ‘Effective Management – What is it?’ and will be launched at the NATN Annual Congress in October 2001. Since the publication of her book Achieving Best Practice - shaping professionals for success last year, many people have asked for the tools to implement her Model for Success. The following articles will offer the tools as practical suggestions of how to put best practice into practice. Fiona has selected four key areas where we can have a direct and immediate effect: handling conflict, influencing without authority, doing deals and making meetings effective.
The Journey from Expert to Novice and Beyond
Authors: Sampson Heather , Beesley John
Published: December 2017

In this first article of a new series for practitioners in perioperative education and practice development, Heather Sampson takes us on a humorous journey from novice to expert.
Singled Out?
Authors: Waller Frank
Published: December 2017

The increasing use of single use medical devices is being driven by a growing awareness of iatrogenic (from the Greek; caused by the doctor) and nosocomial infections. Public health perceptions relating to transmissible spongiform encephalopathies, specifically variant Creutzfeldt-Jakob disease (vCJD), the Human Immunodeficiency Virus (HIV) and Hepatitis B are high on the political agenda and a matter of concern to healthcare professionals.
Gravitational Platelet Separation Accelerating the Body's Own Healing Process
Authors: Saleh Hadi , Cox Felicia
Published: December 2017

In this month's article in our blood series, Hadi Saleh and Felicia Cox explore how autologous blood products can be used to facilitate haemostasis and enhance wound healing. This article focuses on the functions of platelets and how gravitational platelet separation can be used in a wide variety of clinical settings.
Reducing Nhs Bureaucracy Arm's-Length Bodies Review, July 2004
Authors: Beesley John
Published: December 2017

The number of NHS (National Health Service, UK) bodies that work at arm's-length from the Department of Health will be reduced, saving at least £500m in funds and increasing resources that can be channelled directly to front line NHS patient care. John Reid, Health Secretary, has decided that by 2007–08 there will be a 50% reduction in the number of arm's-length bodies and a reduction in posts of 25%.
The Doctor-Nurse Relationship in the Operating Theatre
Authors: Reynolds Anika , Timmons Stephen
Published: December 2017

This article examines the organisational culture in theatres, specifically the doctor-nurse relationship, based on the literature and the experience of one author (Anika Reynolds) on placement in theatres. The initial motivation for the study was noticing how well these doctors and nurses got on in a friendly, informal and efficient atmosphere. This relationship between the multidisciplinary team was especially surprising when compared with the experience of hospital wards. Why did such a difference exist?
Correct Site Surgery
Authors: Beesley John
Published: December 2017

Dear AfPP

I am an anaesthetic practitioner working within a busy surgical day unit. In recent months, while undertaking presurgical checks with the patient and ward nurse, I have reported a number of incidents where patients have not had their site of surgery marked. On one particular occasion the wrong site had been marked. There is confusion among medical staff as to how the intended surgical site should be marked. Please could you clarify whether there are any national standards for correct site surgery.

Concerned from Cambridge
The National Patient Safety Agency and Theatre Practitioners
Authors: Edwards Peggy
Published: December 2017

Theatre practitioners have been involved in patient safety for years. Each time you check a patient into the department you are using a risk management tool: the check-list. Each time you check the position of a patient on the operating table, check their consent form, ensure the sterile field is maintained and that the instrument count is correct, you are intrinsically involved in patient safety.
The Spencer Wells Forceps
Authors: Ellis Harold
Published: December 2017

This is the first of a six-part biographical series tracing the lives of the people behind some of today's most commonly used surgical instruments. Surely the most recognisable ‘name behind the instrument’ must be that of Sir Thomas Spencer Wells (1818–1897), whose ratchet haemostatic forceps represented a simple but important advance in surgical instrument technology.
Professional Indemnity Insurance: The Nmc and Bar Council Requirements
Authors: Fullbrook Suzanne
Published: December 2017

In 2004, the Nursing and Midwifery Council (NMC) produced an updated version of its Code of Professional Conduct, entitled The NMC Code of Professional Conduct: Standards for Conduct, Performance and Ethics (2004). In part the aim of this latest version was to include for the first time certain groups of nurses. Specialist community public health nurses are named whereas the previous version (2002) referred to nurses and midwives only. However, the updated version also incorporates a new section – paragraph 9 – which concentrates the registrant's mind towards the issue of insuring their practice. This article discusses the ramifications of this addition.
Pulse Oximetry: An Overview
Authors: Rajkumar Ashish , Karmarkar Amar , Knott Jennifer
Published: December 2017

Pulse oximetry has emerged as a very common and useful method to measure oxygen saturation since it was first described by Takuo Aoyagi in 1974. It measures the oxygen saturation of haemoglobin in the arterial blood and the pulse rate. It is an indirect indicator of cardiac output. It also gives an audible signal varying in pitch depending on the oxygen saturation. It displays a plethysmographic image and also gives a digital readout. The following is an overview of the device and an examination of its applications.
Surgical Glove Practice: The Evidence
Authors: Tanner Judith , Parkinson Hazel
Published: December 2017

Surgical gloves are worn to protect both the patient and the surgical team from transferred infections. Wearing two pairs of gloves, perforation indicator systems, glove liners, knitted gloves and triple gloving are said to offer additional protection. This paper presents the main findings from a Cochrane systematic review of 30 trials examining surgical gloving practice.
The Change Experience: How We Updated Our Perioperative Nursing Documentation
Authors: Healy Kathleen , Hegarty Josephine , Keating Geraldine , Landers Fiona , Leopold Sheila , O'gorman Fionuala
Published: December 2017

This article aims to describe the review and modification process of the perioperative nursing documentation forms within a large urban theatre complex. It is hoped that by making this process more transparent other perioperative practitioners will be encouraged to review and update the documentation used within their departments.
Instrument Integrity and Sterility: The Perioperative Practitioners Responsibilities
Authors: Gilmour Diane
Published: December 2017

Surgical instruments, whether single use or reusable, are defined by the University of Newcastle's Online Medical Dictionary as ‘Hand held tools or implements used by health professionals for the performance of surgical tasks’ (CancerWEB 1998). This definition, in its broadest terms, recognises that the inter-professional team (health professionals) are involved in the use, care and management of that tool or implement (performance of surgical tasks). Spry (2007) identifies that a surgical instrument could last 10 years if well made, carefully handled and appropriately used and that it is the responsibility of the surgical team and sterile services personnel to preserve and protect the life of each individual instrument. This article will identify the perioperative practitioner's responsibility in ensuring that each surgical instrument is fit for purpose, safe for use and will not harm the patient during use. The article will outline the process of instrument/set selection and the pre-, intra- and postoperative checks that should be made by the inter-professional team prior to, during and after use of that set/instrument. This article will also enable the practitioner to gain or reinforce their knowledge and understanding of the decontamination process and its application within the perioperative environment.
Acupressure and Acupuncture in Preventing and Managing Postoperative Nausea and Vomiting in Adults
Authors: Abraham Jenny
Published: December 2017

This literature review sets out to investigate the effectiveness of acupressure and acupuncture in preventing and managing postoperative nausea and vomiting (PONV) in adult patients. PONV is problematic, affecting patient satisfaction, delayed discharge and even patient re-admission. Current treatment of PONV constitutes a variety of drug therapies, which are only partially effective.

With the integration of complementary and alternative medicines in healthcare, this review examined 10 research studies investigating the use of acupressure and acupuncture in treating PONV. Three studies found acupressure to be effective in preventing PONV. However, population samples were small and the research designs had numerous anomalies. Overall the article suggests that acupuncture and acupressure are ineffective in preventing and managing PONV in adult patients. Further investigation of the effectiveness of acupressure and acupuncture, combined with current drug therapies, using well designed and adequately powered studies is needed. Published studies predominantly examined the use of P6 as the pressure point. Further studies should examine other ‘acupoint’ sites, to ascertain whether these are effective dependent upon the operative site.
Facilitating Small Group Learning in the Operating Department
Authors: Lipp Allyson , Holmes Alex
Published: December 2017

Optimising learning in the operating department is crucial to ensure that all staff are appropriately skilled and knowledgeable in their sphere of practice. Learning in small groups is popular and a good use of limited resources for professional development. This paper explores three types of small groups and how this type of facilitation can be used in the operating department.
Dame Hilda Lloyd: First President of the Royal College of Obstetricians and Gynaecologists
Authors: Ellis Harold
Published: December 2017

Since earliest times, women have been looked after by women in their confinements. By the Middle Ages the profession of the female midwife, often an experienced older woman, was well recognised. The service of a male doctor was often frowned upon. Indeed, in 1522 a Dr Wertt of Hamburg was burned at the stake for attending a delivery dressed as a woman.
Traction Splint: To Use or Not to Use
Authors: Agrawal Yuvraj , Karwa Jyoti , Shah Nikhil , Clayson Anthony
Published: December 2017

Traction splints are widely used for immobilisation of fractures of the lower limb. There is brevity of evidence-based research on their efficacy. We present a case of skin complication following traction splint for spiral fracture of femur. It is prudent to identify patients at higher risk of developing complications of immobilisation. In circumstances where delays are inevitable, the indication and appropriateness of continuation of traction splint should be re-evaluated.
Are We Doing Enough to Prevent Patient Injury Caused by Positioning for Surgery?
Authors: Beckett Alison E
Published: December 2017

Patient positioning is an integral part of perioperative care and yet it is an area of patient care which can easily be compromised as staff try to accommodate surgeons and work through busy operating lists. Inadequate padding and incorrect positioning can cause serious and long term injury and disability, and can result in litigation against perioperative nurses and ODPs.
Anaesthesia for Phacoemulsification Surgery: Is it as Comfortable as We Think?
Authors: Mowatt Lizette , Youseff Evelyn , Langford Maria
Published: December 2017

We report an observational prospective study to determine which local anaesthetic technique gave the most comfort during phacoemulsification (cataract) surgery. 1835 patients were recruited. 61.8% were female. Peribulbar (18.2%), subtenons (28.6%), and topical (53.2%) anaesthesia was used. The pain score was assessed by the visual analogue pain scale (VAPS) which ranged from 0 (no pain) to 10 (worse possible pain). The lowest mean pain score occurred in the subtenons group, mean VAPS 0.2 (95% CI 0.1–0.3). The mean pain scores for topical and peribulbar anaesthesia were 0.6 (95% CI 0.5–0.7) and 0.59 (95% CI 0.41–0.76) respectively. Subtenons anaesthesia gave the most comfort during phacoemulsification. Patients experienced more discomfort with 2nd eye surgery. Older patients and males had a higher pain threshold in all three anaesthetic groups.
The Early Days of Open Cardiac Surgery
Authors: Ellis Harold
Published: December 2017

I can well remember as a house surgeon in 1948 how amazed we were that surgeons could pass a finger through the wall of the beating heart and split a stenosed mitral valve or even dilate a narrowed pulmonary valve. In those far-off days, mitral stenosis as a late result of carditis secondary to rheumatic fever was a common condition in this country, and large numbers of extremely ill young men and women were restored to health following their successful mitral valvotomy surgery. During World War II, missiles embedded within the heart had been removed with success. However, by 1950 it was obvious that any future progress would depend on being able to stop the heart and to operate directly on the quiet, empty organ. How to do this, when it was well known that depriving the brain of blood for four to five minutes would mean irreparable damage to the vital centres and inevitable death of the patient?
Psychosocial Considerations of Perioperative Care in Children, with a Focus on Effective Management Strategies
Authors: Amin Avnita , Oragui Emeka , Khan Wasim , Puri Ansuya
Published: December 2017

Children are not just ‘small adults’. They have specific physical, psychological and social requirements that must be identified and addressed to optimise their well-being in the perioperative period. The healthcare practitioner should be trained to understand the needs of the paediatric patient in hospital, including the ever increasing need to take into account cultural differences. Hospital policy should include a preoperative preparation programme, specially aimed at the paediatric population, where parental involvement is encouraged throughout.
Common Fractures and Injuries of the Ankle and Foot: Functional Anatomy, Imaging, Classification and Management
Authors: Khan Wasim , Oragui Emeka , Akagha Edwin
Published: December 2017

The ankle and foot are functionally important and complex joints. Bony fractures and ligamentous injuries are common. In this review paper we will discuss the functional anatomy, imaging, classification and the management of common ankle and foot injuries including ankle fractures, Achilles tendon ruptures, Lisfranc joint injuries, calcaneo fractures and fractures of the metatarsals and phalanges.
The Early Days of Surgery for Abdominal Aortic Aneurysm
Authors: Ellis Harold
Published: December 2017

Aneurysms of the abdominal aorta, usually due to arteriosclerosis, have been long recognised as presenting a formidable challenge to the surgeon. At first symptomless, the aneurysm then presents as a pulsatile swelling. Once it reaches about 6cm in diameter, it is at risk of rupture, and this danger increases as the mass gets larger. Untreated, of course, rupture means death from massive haemorrhage.
Regional Anaesthesia: Back to Basics
Authors: Cobbold Angela , Money Trevor
Published: December 2017

Regional anaesthesia has become more popular in recent years with an emphasis on cost effectiveness, bed occupancy, and reduction in hospital acquired infections (HAIs). Anaesthesia is a worrying time for any patient, but now the emphasis is to encourage patient empowerment by involving patients in their own care throughout their holistic journey. This article explores patient selection for regional anaesthesia, and the different types of central and peripheral blocks in line with national policies. The equipment required, pharmacology, toxicity of local anaesthetics, and their physiological effects on the cardiovascular, respiratory, and gastrointestinal systems of the body will also be discussed.
Advanced Trauma Life Support Radiographic Trauma Series: Part 1 - the Cervical Spine Radiograph
Authors: Chimutengwende-Gordon Mukai , Sidhu Jasmeet , Khan Wasim S , Maruthainar N
Published: December 2017

Plain cervical spine radiographs are the first line investigation in trauma patients to exclude cervical spine fractures and dislocations. Adequate views are essential to reduce the risk of missing diagnoses. Injuries may however not be visible on plain cervical spine radiographs despite adequate views. Additional imaging such as computer tomography scanning is indicated in the event of a normal plain radiograph if there is any clinical suspicion of injury.
The Early Days of Splenectomy
Authors: Ellis Harold
Published: December 2017

For centuries the function of the spleen was widely debated. Vesalius, while Professor of Anatomy in Padua in the first part of the 16th century, is reported to have removed the spleen in living animals and to have shown that this was consistent with survival. An English surgeon, Timothy Clark reported in 1663 that he had removed the spleen of a stray dog, that the animal lived in good health for a year following this, and was ‘subsequently enthusiastic in its pursuit of sexual activity’.
Clinical Review of Adult Tracheostomy
Authors: Vallamkondu Vamsidhar , Visvanathan Vikranth
Published: December 2017

Tracheostomy is a surgical procedure which is increasingly being performed in the intensive care unit (ICU) rather than the operating room (Griffiths et al 2005, Delaney et al 2006). Procedural knowledge including postoperative care is essential for ENT surgeons and ICU practitioners alike. Our article aims to highlight the operative technique, surgical complications and various types of tracheostomy tubes available, including their management.
The Perceived Effectiveness of a Pre-Admission Visit for Children (And Their Parents) Undergoing Day Surgery Procedures
Authors: O'shea Maria , Cummins Ann , Kelleher Ann
Published: December 2017

The purpose of this paper is to present the findings of an evaluation study which examines the perceived effectiveness of a pre-admission visit for children (and their parents) undergoing day surgery procedures in the Republic of Ireland. This follow on paper provides the findings of an evaluation study subsequent to the pre-admission, practice development initiative published in the Journal of Perioperative Practice, June 2010, 20 (6) 203–206.
No Formalin Please, it Could be TB!
Authors: Thomas David , Jarvis Miles , Williams Alan
Published: December 2017

Historically, tuberculosis (TB) in the UK was primarily associated with pulmonary infection. However, as the rates of TB in the UK have risen, so has the proportion of extra pulmonary disease. In 1987, the total number of new TB cases was 5,085 and 21% of these were extra pulmonary. By 2009, the annual number of TB cases had risen to 9,040 with 46% being extra pulmonary (HPA 2010).
Cricoid Pressure: Are we Doing it Right?
Authors: Chewter Michelle
Published: December 2017

I am an operating department practitioner (ODP) who routinely applies cricoid pressure under the direction of an anaesthetist in order to prevent gastric aspiration. This article examines the current use of cricoid pressure in anaesthetics.
Preoperative Blood Tests: An Expensive Tick Box Exercise
Authors: Pastides Philip , Tokarczyk Szymon , Ismail Laura , Ahearne David , Sarraf Khaled M
Published: December 2017

The purpose of preoperative investigations is to provide diagnostic and prognostic information. Preoperative tests requested for a cohort of patients admitted for simple trauma related procedures were retrospectively reviewed. Adherence to the NICE guidelines was found to be 5%. No result from a blood test led to a change in the management of the patient. The authors believe that implementation of the NICE guidelines will reduce clinical time and result in huge financial savings for individual institutions.
A Longitudinal Study of the Incidence of Pressure Sores and the Associated Risks and Strategies Adopted in Italian Operating Theatres
Authors: Bulfone Giampiera , Marzoli Ilaria , Quattrin Rosanna , Fabbro Carmen , Palese Alvisa
Published: December 2017

To explore the incidence of intraoperative pressure sores, the associated risk factors and the preventive strategies adopted by nurses, we adopted a longitudinal study in a 900-bed teaching hospital with multiple operating theatres, located in the North of Italy. Patients who underwent major surgery were evaluated four times: at the moment of operating theatre admission, at operating theatre discharge, and on their third and sixth postoperative day. Of the patients included (n=102) who had an average age of 62.3 years (range 20–87), 12.7% (13/102) developed a pressure ulcer in the operating theatre; 46.1% (6/13) of these ulcers were still present on the third postoperative day. Some health conditions (diabetes mellitus, cardiac diseases) and intra-operative factors (lying on the operating table for more than 6.15 hours, intraoperative hypothermia) are associated with the occurrence of pressure sores.
Legal and Professional Issues for the Perioperative Practitioner
Authors: Pirie Susan
Published: December 2017

The aim of this article is to provide guidance to perioperative practitioners on some of the legal and professional issues associated with their practice. It is anticipated that students and practitioners new to the perioperative environment will find this article can assist them in relating the issues discussed to their own practice. More experienced practitioners can refresh their knowledge of these issues.
The Early Days of Pneumonectomy for Lung Cancer
Authors: Ellis Harold
Published: December 2017

There is no doubt that the widespread habit of cigarette smoking, which commenced among the troops in the First World War and which became almost universal in the second, was responsible for the rise in incidence of cancer of the lung throughout the Western World to its position today as the commonest cause of deaths from malignant disease.
Routine Repeat Radiographic Examination Post Fracture Fixation: Is it Necessary?
Authors: Idowu OK , Menakaya CU , Pidikiti PS
Published: December 2017

In spite of the widespread availability of image intensifier for fracture fixation and storage of images on a radiological computer system, routine check radiography is still a common practice. This is even so in situations with no clear indications such as fall or increasing patients' discomfort.
The Story of Anterior Cruciate Ligament Reconstruction - Part 2
Authors: Schindler Oliver S.
Published: December 2017

The first part of The story of anterior cruciate ligament reconstruction, was published in the previous issue of this journal, and the reader is encouraged to study both parts in order to become better acquainted with the subject. Those who have read the first part will remember that it concerned the historical developments surrounding the ligament's discovery, the acknowledgement of its function and the appreciation of the detrimental effects once it becomes damaged. It also described the efforts of the early pioneers who recognised the need to reestablish ligament function by ways of ligament repair or reconstruction with autologous tissue. The second part, presented here, explores the surgeons' quests to find the ideal graft material by experimenting with various synthetic materials, as well as those derived from animals (xenografts) and other human beings (allografts). It looks at historic efforts to stabilise an unstable knee by means of extra-articular reinforcements which were popular until not too long ago and reviews the developments of the various graft fixation methods available today. Furthermore it evaluates the influence of arthroscopy which revolutionised not just the procedure of ACL reconstruction but knee surgery in general, and also focuses on the more recent developments of double bundle techniques and the recreation of the ligament's native anatomy.
Denis Burkitt: Burkitt's Lymphoma
Authors: Ellis Harold
Published: December 2017

It is unusual for a medical investigator to have his name attached to a disease or syndrome during his lifetime. An exception to this rule was Denis Burkitt.
Theatre Time Utilisation in Elective Orthopaedic Surgery
Authors: Sultan J , Charalambous CP
Published: December 2017

A prospective review of theatre time utilisation of the senior author's elective orthopaedic lists was carried out over a period of 10 weeks. A total of 41 cases were included. Only 54.0% of theatre time was utilised for operating. The anaesthetic time was 12.0%, and 9.3% of theatre time was used for positioning and draping. Delays in starting the list and turnover time accounted for the remaining 25%.
Abraham Colles: Colles' Fracture
Authors: Ellis Harold
Published: December 2017

Every reader of this journal will be all too familiar with Colles' fracture; either seeing patients with it in A &E, helping with its reduction and splinting or being part of the anaesthetics team involved in its management. On an icy winter's day there might be half a dozen patients with this injury in your accident unit, mostly elderly ladies. Yet it was not until 1814 that Abraham Colles accurately described this injury and its treatment in his paper ‘On the fracture of the carpal extremity of the radius', published in the Edinburgh Medical and Surgical Journal of that year.
Which is the Better Method of Wound Closure in Patients Undergoing Hip or Knee Replacement Surgery: Sutures or Skin Clips?
Authors: Dignon Andrée , Arnett Nicola
Published: December 2017

Surgical wound closure plays an important part in any procedure and there are a considerable number of closure techniques in use today. This literature review will discuss the use of skin clips (staples) and sutures as used in an orthopaedic setting, specifically among patients having hip or knee replacement surgery. This subject has generated a considerable amount of debate and both types of closure are widely used. We were therefore interested in which technique had a lower incidence of infection.
Sir James Paget: Paget's Disease of the Nipple, Paget's Disease of Bone
Authors: Ellis Harold
Published: December 2017

Sir James Paget was one of the ‘great’ Victorians. Eminent as a surgeon, pathologist and teacher, his nobility of character and application to his work made him a leader in his profession in that age of great men.
Anaesthetic Nurse Specialist Role: Leading and Facilitation in Clinical Practice
Authors: Fynes E , Martin Dse , Hoy L , Cousley A
Published: December 2017

Leadership and its effectiveness is becoming more prevalent within the nursing profession with anaesthetic nurse specialists showing their ability to lead, inspire and motivate others to work towards a shared vision in the rapidly changing peri-anaesthesia environment. Anaesthetic nurse specialists must therefore be aware of their personal leadership skills and continually develop these within clinical practice. They are also well placed regarding the facilitation of learning.
The Shocking Stocking Audit: An Audit on the Use of Thromboembolic Deterrent Stockings (Teds) for Patients Having Surgery at Sligo Regional Hospital
Authors: Donnelly T , McNeely B
Published: December 2017

A concurrent audit was conducted over a four week period to determine if patients coming for surgery and wearing thromboembolic deterrent stockings (TEDS) adhered to local policy and recommended guidelines. Data was collected on 30 surgical procedures. The audit highlighted failings in the application of TEDS, identifying poor compliance with correct measurement, application and documentation. It also recognised poor communication between care givers and surgical patients regarding TEDS use. There needs to be an increased awareness about local policy, national and international guidelines regarding the use of TEDS for patients having surgery.
Part Three: The Quantitative Approach
Authors: Quick J , Hall S
Published: December 2017

The previous articles in this series have explored the need for perioperative practitioners to select a research approach that supports the aims of the study to be undertaken (Quick & Hall 2015a, b). The quantitative approach is considered by some authors to be ‘the epitome of the scientific approach’ (Meadows 2003) and this article, the third in a series, aims to give an overview of this model.
Patient Satisfaction Questionnaires in Surgery: Inpatients' Perceptions and Experiences of Surgical Wards in General Surgery
Authors: Hafiz S , Kurrimboccus Ms
Published: December 2017

The NHS continually promotes patient-centred care. One way of assessing this is by looking at inpatient satisfaction rates as this is a central aspect of patient care. A patient's experience during their surgical admission can impact their perception of the care they receive, their treatment, recovery and follow-up. Currently NHS questionnaires are often posted out following patient discharge to assess patient satisfaction rates. However, it is important to assess inpatient satisfaction as this can change following discharge. Our survey highlighted areas for improvement when delivering care.
Part Four: The Research Dissertation: Planning, Producing and Writing a Thesis
Authors: Quick J , Hall S
Published: December 2017

Dissertations have become common inclusions to postgraduate degrees in healthcare. To the novice researcher, undertaking an extensive project of this kind can appear daunting. In this final article in the series ‘ Spotlight on Research’, Julie Quick and Susan Hall advise perioperative practitioners on how to plan, produce and write a research dissertation. Guidance is also given on disseminating the results from research studies.
A Student Nurse Experience of an Intervention that Addresses the Perioperative Nursing Shortage
Authors: Monahan J Carter
Published: December 2017

Registered nurses are the largest group of professionals in the global healthcare system. The number of nurses is estimated to be 19.3 million throughout the world (Flinkman et al 2013). In the United States the need for registered nurses is growing. It has been predicted that 260,000 positions for registered nurses will remain unfilled by the year 2025 (Harris et al 2014) with a shortage of registered nurses projected to spread across the United States between 2009 and 2030 (Juraschek et al 2012). Compounding the projected nursing shortage is the increased attrition rate, which is as high as 61% within the first year (Pine & Tart 2007). There are several reasons for this shortage including supply and demand issues, projected changes to healthcare and the aging population. Additionally, the number of college graduates who have majored in nursing has not met the demand (Dunn 2014).
Awake and Unable to Move: What Can Perioperative Practitioners Do to Avoid Accidental Awareness under General Anaesthesia?
Authors: Almeida D
Published: December 2017

I thought the last thing I would remember about my surgery was counting up to 10 … but that didn't happen… I could hear people talking, instruments banging, the sound of my heart beat coming from the anaesthetic machine and all of a sudden, that horrible pain digging inside my body. Oh my God! I thought. I'm awake! I tried to tell someone but no sound came out of my mouth. I tried to kick my legs, shake my arms, blink, breathe… Nothing!! I couldn't move a muscle. I was paralysed and awake during my operation… I thought I was going to die!!!
One-Stop Cholecystectomy Clinic: An Application of Lean Thinking - Can it Improve the Outcomes?
Authors: Siddique Khurram , Elsayed Sameh Effat Abd , Cheema Raza , Mirza Shirin , Basu Sanjoy
Published: December 2017

Lean thinking principles were utilised to set up ‘One-stop cholecystectomy clinics' at which patients underwent the surgical and the preoperative assessment during the same visit. The main aims were to reduce the number of patient hospital visits, preoperative admissions and the waiting time to surgery. The results showed a significant reduction in the number of patient visits as well as the waiting time to surgery thus highlighting that patient care can be improved by good team working and lean management.
Compulsory External Standardised Education for Decontamination Sciences: Going in the Right Direction or a Step Too Far?
Authors: Cobbold Angela , Lord Sue
Published: December 2017

In the United States, approximately 46.5 million surgical and medical procedures, including approximately 5 million gastrointestinal endoscopies are performed annually (Rutala & Weber 2008). In contrast, there are some 4.2 million surgical operations carried out annually in England (RCS 2012). The majority of these procedures involve patient contact with reusable invasive medical devices (RIMDs). Over the past 15 years, there have been significant changes in guidance and legislation relating to decontamination processes, mainly resulting from the focus on variant Creutzfeldt-Jakob disease (vCJD) (NSH 2001, DH 2003) and the need to tackle increasing problems with healthcare associated infections (HCAIs). Therefore, with approximately 350 NHS hospitals in England alone (RCS 2012), there is potential for a major risk of cross contamination for patients and staff.
Non-Technical Skills: Enhancing Safety in Operating Theatres (And Drilling Rigs)
Authors: Flin R
Published: December 2017

On April 20th 2010, a large Transocean drilling rig called the Deepwater Horizon was operating in the Gulf of Mexico to drill the Macondo well, for the oil company BP. The job was six weeks behind schedule and $58 million over budget and had not been without difficulty: it was a high pressure well, 2.5 miles below the seabed. At 5.45am, the Halliburton cementing engineer sent an email to say: ‘We have completed the job and it went well’. At 9.43pm, 16 hours later, there was a release of hydrocarbons into the well bore and the drilling rig experienced a catastrophic blowout as the high pressure oil and gas escaped onto the rig and into the ocean. The resulting explosions and fire killed 11 of the crew of 126, injured many more and created an enormous oil spill across the Gulf.
A Critical Guideline Appraisal Overview: Choice Framework for Local Policy and Procedures (Cfpp) 01–06 Decontamination of Flexible Endoscopes 2013 Part 1: Policy and Management and Part 3: Operational Management Manual
Authors: Cobbold A , Lord S
Published: December 2017

Inadequate decontamination of flexible endoscopes potentially exposes patients and staff to pathogenic bacteria and blood borne-viruses. In the UK there have been 176 deaths from definite or probable cases of variant Creutzfeldt-Jakob Disease (vCJD). The peak year of deaths was 2000, since then numbers of cases have fallen (DH 2013a). Effective decontamination removes surface contaminants, organisms and organic matter such as grease or dirt, which may otherwise inactivate the disinfection process (Weston 2008). There are 1134 hospitals listed in the UK (Hospitals Worldwide 2013) of which 215 acute units, 162 independent sector, 49 community units and 6 paediatric units are engaged with Joint Advisory Group in England (JAG 2013). Currently there are several pertinent regulatory British (BS), European (EU) and International (ISO) decontamination standards which are intended to prevent contact transmission and environmental contamination. The Department of Health aims to empower individual departments to be more proactive in their own local decision-making processes by setting standards in the form of CFPP 01–06 (DH 2013a).
Glass Ceilings of Professionalisation
Authors: Stott Dawn L
Published: December 2017

The term glass ceiling is a political term often used to describe an unbreakable barrier that is not visible with the human eye, but it keeps minorities from rising up i.e. it is a barrier to minority groups, in the past (and sometimes still) for women, that stops them from achieving their true potential.
Nursing Postoperative Visit as a Quality Indicator for Surgical Patient Care
Authors: Silva R , Martins MM , Jardim HG
Published: December 2017

The postoperative visit as a quality indicator for surgical patient care, demands some consideration from perioperative nurses. We evaluated the nursing perioperative interventions on postoperative visits, and adjusted them to the needs of the patients with postoperative pain. Our study indicated that 73% of patients visited didn't have postoperative pain whereas 27% had pain. The pain is aggravated when the patient is mobilised, one of the most common signs and symptoms being gastrointestinal changes. Pharmacological and non-pharmacological measures were used in pain management. The results showed that the percentage of patients with postoperative visits needs to be improved. We aim to have high quality perioperative nursing interventions which raise levels of patient satisfaction.
West Midlands Major Trauma Centre Theatre Practitioner Collaborative
Authors: Doyle G
Published: December 2017

The following article highlights the establishment of the West Midlands Major Trauma Centres (MTC) in April 2012 and specifically the West Midlands Major Trauma Centre Theatre Practitioner Collaborative in June 2013. The article looks at the involvement of theatre practitioners working as an integral part of the emergency department and supporting anaesthetists when attending alerts. There is a summary of clinical responsibilities, mentorship opportunities and the educational programme associated with the role. The MTC collaborative ensures that there is support for individual centres with regular meetings covering clinical and educational issues as well as conducting cross site skill programmes. The collaborative are working toward a formal approach to a higher educational institution, to consider establishing a post graduate training module and to prepare theatre practitioners for the role in the emergency department.
Interprofessional Simulation Training for Perioperative Management Team Development and Patient Safety
Authors: Komasawa N , Berg BW
Published: December 2017

Establishment of a perioperative management team construct including anaesthesiologists, surgeons, nurses, and other medical staff is essential to optimize safe surgical care. Simulation based education and training provides a unique and effective approach to development of competency and application of relevant technical and non-technical perioperative professional skills such as meta-cognitive ability, caution, shared decision-making, leadership and communication. Development of high functioning perioperative teams can be accomplished through simulation based training.