bluuebunny/crossref_metadata_2025 huggingface dataset:
At Your Convenience: Preoperative Assessment by Telephone
Authors: Digner Marie
Published: December 2017

This article describes how practitioners in one trust have worked in partnership with colleagues at NHS Direct to develop a telephone preoperative assessment service for elective day case surgery patients. The service has improved theatre utilisation by reducing the numbers of ‘did not attends’ (DNAs) and ensures the safe preparation of appropriately selected patients for day case surgery. It has reduced the number of trips to hospital patients need to make and, more recently, the length of time spent there.
Tracheal Intubation, Tracheal Tubes and Laryngeal Mask Airways
Authors: Chethan Doddamanegowda B , Hughes Richard C
Published: December 2017

Tracheal intubation is used when a clear airway is difficult to achieve with a face mask or laryngeal mask, or if there is a risk of dislodgement of other forms of airway control. Tracheal intubation is considered to be an important part of patient management when a major intraoperative complication develops (for example anaphylaxis, massive haemorrhage or malignant hyperpyrexia).
The First Operation for Intussusception
Authors: Ellis Harold
Published: December 2017

Because of its vivid manifestations of blood-stained mucus passed per rectum, the violent abdominal colic, the easily palpable abdominal mass and, in late cases, a prolapsing ‘tumour’ to be seen extruding through the anal verge, it is not suprising that intussusception in infants was one of the earliest causes of intestinal obstruction to be clearly recognised. Treatment was conservative. Efforts were made to reduce the mass with rectal bougies or enemas. Surgeons were encouraged to do this by the all too rare reports of successes, or by the still rarer accounts of spontaneous cure as a result of the passage per rectum of the segment of gangrenous bowel.
The First Successful Elective Laparotomy
Authors: Ellis Harold
Published: December 2017

The first time the abdomen was opened at an elective operation, the pathology excised and made a smooth recovery was not, as you might guess, performed in some famous university hospital in the British Isles or mainland Europe about a hundred years ago, but in a private house in the backwoods of Kentucky in 1807, and the story is a fascinating one.
Surgical Site Infection, Preoperative Body Washing and Hair Removal
Authors: Tanner Judith , Khan Debra
Published: December 2017

Estimates suggest one in 20 patients develop an infection following surgery, costing the NHS around £1bn each year (SSHAIP 2004). This article discusses surgical site infections and the commonest bacteria which cause them. It then explores two practices, preoperative body washing and preoperative hair removal, and their effect on bacterial reduction and surgical site infection.
The Safety of Medical Devices: The Tools of Your Working Day
Authors: Cutler Ian
Published: December 2017

You are trained and skilled in the practice of safe clinical procedures. Are you aware however that the safety of the medical devices, which includes medical equipment, that you use routinely in your clinical working day have been designed to be safe for both you and for patients? This is a legal requirement of the Medical Device Regulations by which manufacturers of medical devices and medical equipment are required to design and manufacture their products. That they conform to these regulations is designated by the CE Mark that has to be displayed on the product or on its labelling. This article will outline the legislative requirements of the regulations with which manufacturers have to comply.
Future Perioperative Registered Nurses: An Insight into a Perioperative Programme for Undergraduate Nursing Students
Authors: Clark-Burg Karen
Published: December 2017

An Australian College of Operating Room Nurses (ACORN) submission (ACORN 2002–2008) recently stated that the specialities that suffered significantly from the transition of hospital-based nursing training to university training were the perioperative specialty, critical care and emergency. The main reason for this was that perioperative nursing was not included in the undergraduate nursing curriculum. Less than a handful of universities in Australia offer the subject as a compulsory unit. The University of Notre Dame Australia (UNDA) is one of these universities. This paper will provide an insight into the perioperative nursing care unit embedded within the Bachelor of Nursing (BN) undergraduate curriculum.
Managing Acute Pain in Opioid Tolerant Patients
Authors: Bourne Nicola
Published: December 2017

Managing acute pain in opioid tolerant patients can be a significant challenge. This article will provide an overview of the terminology used when managing acute pain in these patients. This understanding is essential to ensure adequate pain relief while avoiding opioid withdrawal. It is also crucial that these patients are identified and that sufficient peri- and postoperative pain management plans are formulated. This article will present an overview of the terms tolerance, physical dependence and addiction. The literature on the management of acute pain in opioid tolerant patients will be considered. Finally an audit that explores and compares the practises of a group of London hospitals, with regard to managing post-surgical pain in opioid-dependent patients will be discussed.
Acute Compartment Syndrome – a Life and Limb Threatening Surgical Emergency
Authors: Malik A A , Khan W S A , Chaudhry A , Ihsan M , Cullen N P
Published: December 2017

Acute compartment syndrome is a life and limb threatening condition. Clinical assessment is the diagnostic cornerstone of compartment syndrome but pressure monitoring also has a role in equivocal cases, in unconscious or uncooperative patients, and in patients with nerve blocks and other forms of regional and epidural anesthesia. A high degree of suspicion and early decompression of all compartments at risk are important for a satisfactory outcome.
Novice Researchers' Reflection on Conducting a Focus Group
Authors: O'connor Caroline , Murphy Siobhan
Published: December 2017

Focus group data collection can capture what is unknown about nurses' perceptions of routine patient care issues in clinical settings. Using Gibbs Reflective Cycle (1988) novice researchers Caroline O'Connor and Siobhan Murphy critically analysed the practicalities of conducting a focus group interview.
Use of Drains in Surgery: A Review
Authors: Durai Rajaraman , Mownah Abdoolla , Philip C H Ng
Published: December 2017

Drains have been used in surgery for several years to remove body fluids thereby preventing the accumulation of serous fluid and improving wound healing. Drains may be classified as closed or open systems, and active or passive depending on their intended function. Closed vacuum drains apply negative suction in a sealed environment, producing apposition of tissues and thus promoting healing. Correct assessment of clinical indications might reduce unnecessary usage. This article will introduce the principles and practice of various types of drains and highlight the importance of understanding how surgical drains promote quality patient care.
Obstetric Surgery for Perioperative Staff and Midwives
Authors: O'Connell Rhona
Published: December 2017

Where a pregnant woman experiences trauma or has acute surgical needs there are additional concerns for the well being of both the woman and her foetus. This article explores obstetric procedures for the pregnant woman and discusses the implications for perioperative staff and midwives.
Pain Management: An Adolescent Scoliosis Patient
Authors: Koya-Rawlinson Christine
Published: December 2017

Recovery units can be busy environments not often conducive to reflective practice. Reflection is, however, an important aspect of high quality care. Using Gibbs model of reflection (see Figure 1), applied to the experience of caring for a 15 year old patient who had undergone surgery to correct a scoliosis deformity, this article illustrates how a deeper understanding of holistic pain management and assessment can be achieved and high standards of care maintained through careful reflective practice.
Circulation and Invasive Monitoring: Back to Basics
Authors: Milton Sherran
Published: December 2017

Introduction

The monitoring of patients within the perioperative environment has become increasingly sophisticated as technological advances are made within anaesthesia and anaesthetic technique. The contemporary anaesthetic practitioner (AP) is required to prepare an ever mounting array of complex monitoring equipment within their daily routine. For clarification, in this article the abbreviation AP will refer to a nurse or operating department practitioner who is performing the anaesthetic assistant role, not to a physicians' assistant (anaesthesia) (AAGBI 2008).
My Life Changing Experience following Wrong Site Surgery
Authors: McMonagle Claudia
Published: December 2017

Since being asked to write this article for the Journal of Perioperative Practice, I have been thinking a lot more about myself being a patient and not so much as a medical professional. Before this, being an Orthopaedic Nurse Practitioner took precedence as I couldn't get my head around being a patient or indeed that I had suffered as a result of wrong site surgery!
Safety in Anaesthesia
Authors: Merry Alan F
Published: December 2017

Iatrogenic harm is a major problem in healthcare, and incident reporting is one of various methods of identifying areas for improvement in patient safety. The World Health Organisation has introduced a three-phase checklist to reduce error and improve teamwork and communication during surgery. Use of this checklist has been shown to reduce harm. Incident reporting will be invaluable in monitoring its effectiveness and identifying areas for refinement.
Who is in Your Operating Theatre?
Authors: Wainwright Deborah
Published: December 2017

The presence of healthcare industry representatives poses a challenge for operating department managers. The healthcare industry is taken largely on trust, but in an era of clinical governance this is no longer acceptable. Managers need to establish criteria against which competencies can be measured to risk manage the presence of company personnel in theatre and maintain a safe environment for the patient.
Not just a Patient that Snores. Obstructive Sleep Apnoea: The Perioperative Concerns through the Eye of the Anaesthetist
Authors: Jigajinni Suyogi , Sultan Pervez , Radhakrishnan Dharshini
Published: December 2017

Obstructive sleep apnoea (OSA) has life threatening perioperative cardiorespiratory implications. As patients present to hospital for incidental surgery unaware of their condition, perioperative practitioners need a thorough knowledge of OSA to allow optimisation before theatre. Elective cases should be delayed for investigation and treatment if OSA is suspected. In theatre cardiorespiratory problems should be managed by a senior anaesthetist and a perioperative team alert to the risk of post-operative hypoxia.
Introduction to Instruments
Authors: Pirie Susan
Published: December 2017

An essential component of any clinical intervention or clinically invasive procedure in the perioperative setting will involve the use of instruments. It is therefore essential that all practitioners in the perioperative setting are able to identify the instruments required for a case, for both preparation and checking purposes, be able to verify the sterility of the instrument and/or set, and be aware of the actions to be taken if any problems arise.
Fractures of the Wrist and Hand
Authors: Malik Atif A , Yousaf Naveed , Khan Wasim , Ihsan Mohammed , Ravenscroft Matt
Published: December 2017

Introduction

The hand is one of the most important organs of human body serving multiple day to day functions and, as such, disability resulting from poorly managed fractures of the hand can have huge implications for patients. This not only includes incapacity to complete actions of daily living but also inability to satisfactorily undertake many forms of employment. This not only has implications for the individual but also socio-economic implications.
The Early Days of Gastrectomy
Authors: Ellis Harold
Published: December 2017

In the 19th century, gastric cancer was the commonest cause of deaths from malignant disease in the Western World. (Interestingly enough, for no certain reason, it has progressively dropped down to seventh place).
The Benefits of Pre-Assessment with Cardio-Pulmonary Exercise Testing
Authors: Collier Shirley
Published: December 2017

This article reviews the benefits of pre-assessment with cardio-pulmonary exercise testing (CPX) and the effectiveness of preoperative interventions in high-risk patients undergoing major surgery. Three patient case studies will be presented from local practice, to give examples of how patients' co-morbidity has been improved prior to surgery or how decisions for surgery can be modified as a result of the CPX test.
Legal, Professional and Ethical Considerations of Advanced Perioperative Practice
Authors: Quick Julie
Published: December 2017

Advances within the NHS have recognised nurses in roles that go beyond the historical parameters of their initial training and role characteristics (DH 1999, DH 2000). Working within such a role creates added responsibilities of advancing practice and the continuing development of knowledge and skills. Nurses working at a higher level of practice will require an understanding of not only the professional and legal implications that new roles create, but also an awareness of the ethical dilemmas that will undoubtedly become increasingly complex (Bartter 2002). This article examines the professional, legal and ethical implications of advanced perioperative practice through the author's role as a surgical care practitioner (SCP).
Work-Based Learning: Supporting Advanced Perioperative Practice
Authors: Quick Julie
Published: December 2017

The arrival of work-based learning awards in professional education offers an alternative route for healthcare professionals looking to undertake post-registration education. The unique way that work-based learning integrates individual learning needs with that of role requirements makes the award an ideal choice for the advanced perioperative practitioner (APP) who wishes to combine academic study with professional development. As an experienced and professionally qualified practitioner (Thatcher 2003) the APP will have an accumulation of knowledge, skills and experience that may go unrecognised in alternative awards.

The term APP refers to a nurse, ODP or allied healthcare professional who undertakes a role that challenges the traditional boundaries of care within the perioperative environment (Radford 2004), such as that of a surgical care practitioner (SCP). Here Julie Quick, a SCP, examines the changes within post-registration education and in particular describes why work-based learning awards may be an appropriate choice for practitioners working at a higher level of practice.
Laundering of Theatre Scrubs at Home
Authors: Al-Benna Sammy
Published: December 2017

Infections, particularly those caused by antibiotic-resistant gram-positive bacteria, such as methicillin-resistant staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE), are a growing concern, particularly in units in which patients are immunosuppressed either intentionally (as for transplantation) or as a result of trauma (severe burns) or disease (such as acquired immunodeficiency disease) (Steinstraesser et al 2009). As more bacteria become resistant to antibiotics, our ability to control the spread of these bacteria with antibiotic treatments decreases (Steinstraesser et al 2009).
Management of Patients with Diabetes Mellitus Referred for Elective Surgery from Primary Care: The Challenge of the 18 Weeks Pathway
Authors: Kaczynski Jakub , May Julie , Pogoda Iwona , Caldwell Gordon
Published: December 2017

A retrospective audit of diabetes glycaemic control optimisation in one primary care practice prior to elective surgery was undertaken. Collected data included: demographics, glycosylated haemoglobin A1c (HbA1c) records, evidence of diabetes related glycaemic control optimisation. Of the 82 patients in this study only 46 had an HbA1c measured pre-operatively and only 8 had a review with the practice nurse to optimise glycaemic control. Actions arising from quality improvement programmes are needed to optimise glycaemic control in diabetic patients undergoing elective surgery.
Cyanoacrylate as a Microbial Sealant: Examining the Evidence
Authors: Lipp Allyson , Phillips Cheryl , Harris Paul , Dowie Iwan
Published: December 2017

This article examines the evidence base for the use of microbial sealant as a skin preparation prior to surgery. Firstly, using the steps of evidence-based practice the use of cyanoacrylate as a microbial sealant was explored. Next the evidence regarding the use of cyanoacrylate based microbial sealant was sought and then critically appraised. Having found evidence to support its use to be lacking in rigour and quality, an argument is made for the omission of cyanoacrylate-based microbial sealants as part of current preoperative preparation.
A Simple Guide to Gaining Ethical Approval for Perioperative Nursing Research
Authors: Rees Colin
Published: December 2017

Research ethics relate to three groups of perioperative nurses: those who undertake research within the clinical area, those clinically responsible for patients taking part in research studies or trials, and finally the students and qualified staff who critique research articles and want to ensure that the standard of ethical rigour is acceptable. This article contains guidelines based on essential research ethical principles for each of these three groups and outlines the application process for gaining ethical approval.
The Postoperative Anaesthetic Review
Authors: Sultan Pervez , Jigajinni Suyogi , McGlennan Alan , Butwick Alexander
Published: December 2017

An anaesthetic preoperative assessment for all patients is the standard of care in UK hospitals. The Royal College of Anaesthetists (RCoA) 2009 guidelines state that a postoperative visit, within 24 hours following surgery, is recommended for patients only in certain circumstances. This article critiques these guidelines and explores factors which must be taken into consideration when deciding whether or not anaesthetists should routinely visit their patients after they leave the recovery area. We discuss the physiological rationale for performing a postoperative anaesthetic visit; the identification of post-operative morbidity including provision of adequate post-operative analgesia; patient benefits; limitations of performing postoperative review, and the implications that expanding anaesthetists’ responsibilities as perioperative physicians has had upon anaesthetic training and service provision. Finally, this article offers an alternative model for deciding when to perform a post-anaesthetic visit.
Pressure Exerted by Finger Traps
Authors: Spurrier Edward , Pathak Gora , Khanna Anil
Published: December 2017

It is common practice in wrist arthroscopy to suspend the patient's arm using Chinese finger traps and to distract the wrist joint by applying weight to the arm at the elbow. This may apply significant pressure to the fingers, and potentially damage the digital nerves. We examined the pressure applied by finger traps and considered whether this poses a risk to the digital nerves.
Recent Advances in Designs, Approaches and Materials in Total Knee Replacement: Literature Review and Evidence Today
Authors: Wong James M , Khan Wasim S , Chimutengwende-Gordon Mukai , Dowd George S E
Published: December 2017

Ever since Themistocles Gluck described the use of an ivory cup as a tibial hemiarthroplasty in 1894, knee arthoplasty has continued to evolve. Both human ingenuity and intensive clinical research has led to an improved understanding of biomaterials and knee kinematics, resulting in the modern total knee replacement which has enjoyed such a clinical and commercial success. As it increases in popularity, attempts to improve knee arthroplasty have been driven by demands for improved function and implant survival, particularly in younger, more demanding patients. Research continues to see if advances in implant instrumentation, materials and design will translate into improved clinical outcomes and longevity.
The Early Days of Surgery for Stones in the Bladder
Authors: Ellis Harold
Published: December 2017

Man has suffered from bladder stones since the earliest times. The oldest specimen of a bladder stone so far discovered was obtained at the excavation of a grave of a boy of about 16 in an ancient Egyptian burial ground and was dated at around 4800 BC. Of the triad of ‘elective” operations first performed by our surgical forefathers - circumcision, trephination of the skull and cutting for the stone - only the last was for a purely surgical indication and not for religious or ritual reasons; it may safely be pronounced as the most ancient operation performed for a specific surgical pathology.
Perioperative Implications of Surgery in Elderly Patients with Hip Fractures: An Evidence-Based Review
Authors: White Jonathan J E , Khan Wasim S , Smitham Peter J
Published: December 2017

Hip fracture is a major cause of morbidity, mortality and loss of independence for the elderly. Surgical fixation of the fractured hip remains the standard of care to allow for early mobilisation and a return to independence. Operative management in this population carries its own set of problems. The altered physiological state of the older person, often coupled with significant co-morbidity, can present challenges for the anaesthetist, the surgeon and the rest of the perioperative team. This article provides an evidence-based review of the important perioperative factors associated with hip fractures in the older person and their management.
Perioperative Management of Liver Resection Surgery
Authors: Jones Chris , Kelliher Leigh , Thomas Rhys , Quiney Nial
Published: December 2017

Advances in liver resection surgery have lead to reductions in both mortality and morbidity. However morbidity remains high so effective multidisciplinary teamwork is essential to optimise the perioperative care of this patient group. In this article we review the current literature on the perioperative management of patients undergoing liver resection surgery.
Cricoid Pressure: A Review of the Literature
Authors: Holmes Norah , Martin Daphne , Begley Ann Marie
Published: December 2017

Aspiration pneumonitis (Mendelson's syndrome) is universally accepted as a complication of general anaesthesia. According to Ellis et al (2007) death from aspiration was first described by Simpson in 1848, and it was not until 1946 that Mendelson identified acid aspiration in a significant number of obstetric patients undergoing facemask anaesthesia. The advent of techniques to secure the airway, through the use of airway adjuncts has gone some way to reduce the likely incidence of aspiration in today's perioperative arena. The positive outcome for patients is corroborated by Neilipovitz &Crosby (2007) who report aspiration as a rare complication with an overall incidence of 1:2,000–3,000. As Ewart (2007) highlights, Mendelson's syndrome is due to pharmacological effects at a molecular level which occur in the airway tissues and are caused by the use of induction and neuromuscular blocking agents. The resultant loss of consciousness and consequent diminished protective airway reflexes ultimately places the patient at risk until their airway is secured. Preventative measures to protect the lung from contamination with gastric contents, for example preoperative fasting, are therefore instigated prior to securing the airway.
Your Life in WHO's Hands: The World Health Organization Surgical Safety Checklist: A Critical Review of the Literature
Authors: Jones Susan
Published: December 2017

Safe surgery is a world-wide recognised issue. The World Health Organization statistics show that the occurrence of major complications is between 3 and 16%, and the occurrence of disability and death is between 0.4 and 0.8% (WHO 2009).

According to Vijayasekar and Steele (2009) 234 million major surgical procedures are undertaken globally each year. The National Patient Safety Agency (NPSA) has collated over 1 million reports of surgical incidences in England and Wales between October 2006 and September 2007. Weiser et al (2008) quote a world-wide figure of 7 million individuals affected with a disabling complication, and a death rate of 1 million.
Management of Anticoagulation Therapy in the Perioperative Patient
Authors: Dhinsa Baljinder , Khan Wasim S , Tailor Hiteshkumar
Published: December 2017

With the increasing use of oral anticoagulation therapy the appropriate management of perioperative anticoagulation is of surgical importance. There is a delicate balance between the risk of a perioperative thromboembolic event and the risk of operative bleeding from anticoagulation. Whilst there are a range of options available to the clinician, there appears to be no precise agreement about how to best manage this problem.
A Literature Review and Guidance for Nurse-Led Patient Extubation in the Recovery Room/Post Anaesthetic Care Unit: Endotracheal Tubes
Authors: Dawkins Sarah
Published: December 2017

A review of current literature highlighted the lack of national or local guidelines for post anaesthetic care unit (PACU) practitioners/recovery room nurses to extubate their own patients. This article documents the findings of a systematic literature review and gives simple diagrammatic representations from a comprehensive flow chart that has been developed to assist nurses in the extubation process. A knowledge and skills competency validated training package was developed locally with the anaesthetic department to train practitioners to undertake endotracheal extubation safely.
To Scrub or Not to Scrub? That is the Question
Authors: Timmons Jean , Johnson Susanne
Published: December 2017

The assistant theatre practitioner (ATP) is increasingly being developed across a range of healthcare settings to support the role of the registered practitioner (Skills for Health 2010). Where ATPs take on roles that were previously the domain of registered practitioners, it is essential that safety and quality of care is maintained. This article describes the experience within one acute hospital trust of implementing an assistant practitioner role in a theatre setting and sets out to answer the question – should assistant theatre practitioners be allowed to scrub?
The Future of Patient Safety for the New NHS in England
Authors: Woodward Suzette
Published: December 2017

‘You don't need to work around a hospital for long to realise that there are loads of opportunities for things to go wrong. And you only have to listen to a story from a patient or actually be a patient to understand that it doesn't take much to make things an awful lot better and safe’.

Participant, Patient Safety First, 2010
Modern Perioperative Teamwork: An Opportunity for Interprofessional Learning
Authors: Quick Julie
Published: December 2017

The notion of different professional groups working and learning together is by no means new in healthcare. Members of each professional group within the perioperative environment frequently work and learn together in order to improve the care of the surgical patient. However traditional perioperative teamwork is being transformed as national and international directives bring members of the perioperative team closer together to promote the holistic care of the patient. As interprofessional teamwork increases an opportunity for interprofessional learning occurs.
The Role of Perioperative Care in Reducing Rates of Methicillin Resistant Staphylococcus Aureus
Authors: Byrne Clare , Hazlerigg Alexandra , Khan Wasim , Smitham Peter
Published: December 2017

Methicillin resistant Staphylococcus aureus (MRSA) is defined as any strain of Staphylococcus aureus resistant to beta-lactam antibiotics, including the penicillins and cephalosporins. Over the past ten years the UK has seen a dramatic increase in MRSA prevalence in healthcare facilities and the community, with an estimated 30–50% of healthy adults thought to be colonised with MRSA. Surgical patients are among those at highest risk. With potential sequelae including septicaemia, septic shock, septic arthritis, osteomyelitis, meningitis, pneumonia or endocarditis, it is vital that all care facilities have up to date evidence-based guidelines to tackle this problem. The purpose of this review is to highlight the current evidence supporting some of the key perioperative measures which may be implemented in preventing MRSA.
A Critical Review of the Literature regarding the Use of Povidone Iodine and Chlorhexidine Gluconate for Preoperative Surgical Skin Preparation
Authors: Scowcroft Tammy
Published: December 2017

This paper presents a critical analysis of studies regarding the effectiveness of preoperative skin preparation solutions. The aim was to allow evidence based practice at a local level.
Retained Swabs? A Never Event or a ‘Clever’ Event that has the Potential to Act as a Fundamental Driver to Improve Practice and Systems
Authors: Coates Tracy
Published: December 2017

‘Never events' are definable, known sources of risk for which there is existing national guidance and/or safety recommendations on how the event can be prevented, there is support for implementation and as such should be largely preventable if the guidance is implemented (DH 2011)
Surgical Smoke
Authors: Sanderson Cara
Published: December 2017

Surgical smoke is produced when tissues are dissected or cauterised by heat generating devices. Perioperative personnel and patients are routinely exposed to this smoke, and the use of smoke evacuation devices in operating theatres is not mandatory. This review will examine the most recent literature relating to surgical smoke in an attempt to discover guidelines for best practice and thereby provide recommendations for future practice.
Prone Positioning for Surgery
Authors: Bowers Mark
Published: December 2017

The role of the registered perioperative practitioner (Operating Department Practitioner or Registered Nurse) includes the responsibility for safely positioning patients for surgery. The prone position is in common use for a variety of surgical procedures. The formal term for this surgical position is ventral decubitus (meaning laying face down).
The Story of Anterior Cruciate Ligament Reconstruction - Part 1
Authors: Schindler Oliver S.
Published: December 2017

Once upon a time the anterior cruciate ligament (ACL) enjoyed a relatively unchartered existence, when only a fall from a jousting horse or chariot might have sent a knight or gladiator into early retirement due to an unstable knee. In today's world of high speed travel and an ever increasing number of sports enthusiasts, injuries of the ACL are almost common place with a yearly incidence of about 35 per 100,000 of the population. Although we have known about the existence of the cruciate ligaments since they were first described by Galen over 2000 years ago, awareness of their function and the consequences of their loss were not appreciated until much later. Robert Adams observed the first clinical case of an ACL tear in 1837 but treatment in those days was largely conservative and surgery was reserved for life threatening conditions as mortality was high. The first ACL repair was performed in 1895 by Mayo-Robson of Leeds and was followed by Grekow and Hey Groves who initiated ACL reconstruction with autologous tissue between 1914 and 1920, almost as we know it today.
The Impact of Late-Starts and Overruns on Theatre Utilisation Rates
Authors: Al-Benna Sammy
Published: December 2017

The NHS Management Executive recommends that hospitals should aim to use 90% of planned theatre time and that theatre utilisation should be used as a key performance indicator. This study aims to investigate the impact of late-starts and overruns on theatre utilisation rates. Data were retrieved from a prospectively updated theatre database for all elective plastic surgical main theatre operating sessions carried out over a one year period. Theatre list utilisation was calculated as the percentage of the total allocated session time that was used for anaesthesia and operating. A total of 2,944 elective main theatre operations were performed in one year. Total theatre utilisation was 90.9%. Utilisation of lists starting less than one hour after the scheduled start time was similar to the utilisation of sessions starting more than one hour late (90.1% versus 91.7% respectively, p=0.527). In contrast, overrunning lists demonstrated much higher utilisation rates than those that finished before the end of the session (96.7 % versus 76.6% respectively, p<0.001). The study shows that late-starts and overruns represent obvious sources of theatre inefficiency yet their impact on utilisation is misleading: overruns exaggerate theatre usage and late-starts have little impact upon it. We conclude that the use of utilisation as a marker of theatre performance requires caution.
The Relationship between Continuing Professional Education and Horizontal Violence in Perioperative Practice
Authors: Tame Susan
Published: December 2017

Continuing professional development must be undertaken by all registered perioperative practitioners. However, interviews with 23 perioperative nurses employed by one NHS trust suggested a link between workplace culture and intra-professional conflict which was associated with horizontal violence and perceived as a direct consequence of formal study. Such experiences appeared to affect participants' study and their psychological wellbeing. Further work is required to explore this concept.
Deep Vein Thrombosis and Caesarean Section
Authors: Meneilly Zoe , Mccutcheon Karen
Published: December 2017

Deep vein thrombosis (DVT) presents a significant risk for women requiring Caesarean section. Venous thromboembolism (VTE) remains the leading direct cause of maternal death in the UK and is the second most common cause of maternal death worldwide, accounting for 11% of maternal deaths (RCOG 2009). This article uses a reflective cycle to explore the role of the preoperative practitioner in the prevention of DVT for women undergoing elective Caesarean section.
Patient Comprehension of Informed Consent
Authors: Richardson Victoria
Published: December 2017

Obtaining informed consent is an essential process in the patient centred approach to modern medicine. However, research shows that patients have a poor understanding of the process of informed consent, as well as a poor understanding of the procedures they are consenting for. Improvements need to be made to improve comprehension and ensure that consent is truly valid.
The Air we Breathe: Our Practice Awareness with Volatile Gases and Vapours
Authors: Stephens-Borg Keith
Published: December 2017

The distinctive aroma that once identified hospitals is reminiscent of the days of using open ether anaesthesia. Throughout this period the risk of explosions posed a very real threat to operating theatres, and the attention to safety produced the means of maintaining security for clinical practitioners; moreover protecting the vulnerability of the unconscious patient. The creation of the Davy lamp in 1815 was to spark our continual awareness regarding the impact of gas and chemical pollution.
Understanding Arterial Blood Gases
Authors: Rogers Katherine M A , Mccutcheon Karen
Published: December 2017

This article examines acid-base balance and the interpretation of arterial blood gases (ABG). The article begins with a brief revision of related physiology followed by a description of the primary disorders of acid-base balance. The normal ranges and the significance of abnormal ABG results are explored. The article concludes by providing an easy to follow four-step guide to ABG interpretation with practice examples presented in the continuing professional development (CPD) task section.
Moritz (Maurice) Kaposi: Kaposi's Sarcoma
Authors: Ellis Harold
Published: December 2017

Fifty years ago an elderly Russian gentleman, living in Pimlico, was referred to my out patient clinic at the old Westminster Hospital. He showed me his peculiar bluish red nodular lesion on his lower leg and on the dorsum of his foot. It looked like some sort of vascular tumour, but I certainly could not put a name to it. I took a biopsy. A few days later my pathologist came to see me in great excitement and said that this was his first case of Kaposi's sarcoma. I referred my patient to our radiotherapist, the lesion melted away under the high voltage machine and the old gentleman was delighted with us all!
Podiatry: An Illustration of Surgery Provided by Allied Health Professionals
Authors: Maher Anthony
Published: December 2017

As with the prescribing of medicines, the provision of surgery continues to evolve and this is particularly true in the delivery of foot surgery which, until the 1960s, in the United Kingdom was practiced exclusively by medically qualified surgeons. Over the last 40 years however podiatric surgery performed by podiatrists has become established as a viable, safe and cost effective alternative to traditional models of service provision.
Quality of operation notes in orthopaedic hip arthroplasty surgery: Are we complying with British Orthopaedic Association's guide to good practice?
Authors: Menakaya Cu , Ingoe H , Malhotra R , Shah M , Boddice T , Mohsen A
Published: December 2017

This retrospective audit evaluates the compliance of our operation notes with the British Orthopaedic Society Primary Hip Arthroplasty ‘A guide to good practice’ using a 24-data point question (BOA 2006). Ninety-nine notes reviewed, of which 94% had patient identifiers, the surgical team was documented in 92.5%, post-operative instruction in 97%, and prosthesis stability in 97% of cases. Despite high standards, we did not achieve the 100% gold standard. We suggest that increased awareness of the 24-point BOA guideline via education and proformas would help to ensure better practice
Older Patient Perioperative Care as Experienced via Transurethral Resection of the Prostate (Turp)
Authors: Hartley B
Published: December 2017

This reflective piece takes a holistic approach to an older patient having a transurethral resection of the prostate, commonly known as a TURP. It concentrates on the effects of age and likely co-morbidities, and how the care given at each stage – preoperatively, anaesthetically, surgically and postoperatively – by the perioperative team can help to optimise the outcome for the patient. The article offers a critical appraisal of the best evidence available which supports the development of evidence based practitioners.
Listen While you Work? the Attitude of Healthcare Professionals to Music in the Operating Theatre
Authors: Faraj Aa , Wright Ap , Haneef Jhs , Jones A
Published: December 2017

Although the playing of music is commonplace in the operating theatre, there is nothing in the literature examining whether staff feel this is beneficial. Questionnaires were distributed amongst a random selection of staff in practice at a district general hospital: medical staff from a range of surgical specialities, anaesthetists, and all grades of perioperative staff (nurse/operating department practitioners/healthcare assistants) were encouraged to participate. There were 121 health professionals in total working in the operating theatres. The authors compared the responses to each question amongst the respondents, to check for the tendency to correlate. Out of the 52 health professionals who responded, 36 stated that music is played in their theatre either every day, or two to three times a week. Only five respondents felt that this was too often. Fifteen percent of medical staff were of the opinion that the nursing staff controlled the choice of music. Nursing staff were almost evenly split in thinking that nursing staff, surgical staff and the whole theatre team controlled the choice of music. The majority of both nursing and medical staff felt that they enjoyed their work more and performed better when music was played in theatre. The study concluded that the majority of theatre staff found listening to music while they work a positive experience. The potential for music to have a distracting or detrimental effect on a minority of individuals should always be considered.
Surgical Care Practitioners: Regulation and Revalidation: A Discussion
Authors: Quick J , Hall S
Published: December 2017

The regulation of healthcare professionals is far from new. It continues to evolve, responsive to changes in the professional workforce and the needs of society.
The Anaesthetic Practitioner and Type 1 Diabetes Mellitus
Authors: Wade T
Published: December 2017

Type 1 diabetes mellitus (T1DM) is a serious lifelong condition affecting many people in the UK. With the increasing prevalence of T1DM, it is inevitable that more patients will present for anaesthesia and surgery. This article will inform anaesthetic practitioners about the condition, the challenges involved with glycaemic control, complications such as hyperglycaemia and hypoglycaemia, and the importance of maintaining good glycaemic control. It will offer advice about what anaesthetic practitioners can do to help manage and care for their patients.
A Retained Catheter in the Radial Artery
Authors: Kumar A
Published: December 2017

An 86 year old lady underwent trans-urethral resection of bladder tumour (TURBT) under general anaesthetic at a local hospital. She suffered from aortic stenosis and the anaesthetist inserted a radial artery line to monitor her blood pressure intraoperatively whilst using a phenylephrine infusion. Her surgery was uneventful and the arterial line dressing was cut off her wrist prior to removal of the line. The puncture site bled profusely and pressure was applied. The bleeding stopped and on examination, a rigid structure was palpable in her radial artery. This was believed to be the arterial line catheter which had been cut when the dressing was removed. There was no vascular compromise of her hand and she was referred to the local Vascular Centre.
The First ‘Antiseptic’ Operation
Authors: Ellis Harold
Published: December 2017

On August 12th 1865, 150 years ago, the Professor of Surgery at the University of Glasgow, Joseph Lister, performed a relatively minor operation in a side ward at the Royal Infirmary, the dressing and splintage of a compound fracture of the left leg. Yet this operation must be regarded as the watershed between two eras of surgery - the primitive and the modern - since it was the first to be performed as an antiseptic procedure.
Part Two: Qualitative Research
Authors: Quick J , Hall S
Published: December 2017

This second article in the series Spotlight on Research focuses on qualitative research, its applications, principles and methodologies. It provides an insight into how this approach can be used within the perioperative setting and gives advice for practitioners looking to undertake a qualitative research study.
Richard von Volkmann: Volkmann's Ischaemic Contracture
Authors: Ellis Harold
Published: December 2017

In the German surgical journal Zentralblatt fur Chirurgie of 1881, Richard von Volkmann wrote; ‘The paralyses and contractures that follow tightly applied bandages, chiefly in the forearm and hand, and less often in the lower extremity, are to be viewed as ischemic. They arise from the arterial supply being interrupted for too long’. The article then goes on to state; ‘contractures of a similar nature also appear after ligatures, avulsions and contusions of large vessels'.
Percival Pott; Pott's Fracture, Pott's Disease of the Spine, Pott's Paraplegia
Authors: Ellis Harold
Published: December 2017

There is a commonly held belief that Percival Pott sustained that ankle fracture that bears his name. This probably is not true; the injury was more likely a fracture of the tibial shaft, as suggested by careful reading of the account of the accident left to us by his son-in-law.
Just a Piece of Equipment? The Importance of Medical Device Education
Authors: Brand Darren
Published: December 2017

The use of medical devices is an increasingly important element of a healthcare professional's role. It is crucial that users receive regular teaching and education to ensure that they are competent in the use of devices. This is particularly relevant in the increasingly litigious society in which we live. This article focuses upon the importance of a medical device education.
Wrong Site Surgery: A Critical Incident Analysis of a near Miss
Authors: Tichanow S
Published: December 2017

This article is a reflective account of a near miss that happened in clinical practice during a particularly busy operating list. This critical incident highlights issues that can arise from a breakdown of communication between members of a multidisciplinary team and demonstrates how ineffective teamwork can jeopardise a patient's safety and wellbeing. It emphasises the effects of human factors on professional performance and how they can contribute to mistakes and misconducts. It also stresses the importance of reporting patient safety incidents so that the lessons can be learned and future practice improved.
Regional Uptake and Variations in Orthopaedic Enhanced Recovery Pathways in Knee and Hip Total Arthroplasty
Authors: Mawdsley MJ , Baker PN , Desai A , Green RN , Jevons L
Published: December 2017

The use of enhanced recovery (ER) pathways for hip and knee arthroplasty has increased over the last decade, and the adoption within orthopaedics is becoming more common. We have demonstrated a regional variation and institutional inconsistency of uptake and delivery of ER pathways in our region.

Units that have a unified pathway were more likely to have consistency in treatment and early analgesia for patients. We would advocate that units use an agreed enhanced recovery pathway to optimise patient recovery from hip and knee arthroplasties.
The Healthcare Team's Perception of the Role of the Perioperative Nurse: A Qualitative Study
Authors: Espinoza P , Letelier LM Galaz , Leppe MD Cunill , Bravo M Yercic , Ferdinand C , Lagunas L Ferrer
Published: December 2017

The surgical process requires the coordination of a number of professionals who understand their own roles and responsibilities, as well as those of the team. In the perioperative setting, expectations are established around behaviors and competencies of every team member. These expectations are influenced by knowledge, training and experience, and may ultimately influence results and the ability to adapt and respond to work demands. In Chile, there exists an ambiguity and lack of definition in the role of the nurse. The objective of this study was to examine the healthcare team's perception of the current role of the perioperative nurse, as well as the expected and desired characteristics of the role from the team's perspective. A qualitative, descriptive case study was carried out, using semi-structured interviews conducted with a purposive sample of surgeons, anaesthesiologists, professional nurses and technical nurses from three hospitals in Santiago, Chile. The accounts were analysed using an inductive, thematic format. It was found that the current perioperative nursing role, with a predominance of administrative charting, recordkeeping and guidelines for the management of safety, quality control and human and material resources, restricts direct patient care. Expected characteristics of the role included comprehensive theoretical and practical training and the development of relational skills for teamwork, direct patient care and advocacy in the surgical context. These results provided initial steps towards redefining the role of the perioperative nurse, strengthening collaborative efforts and optimising patient care during a time of high vulnerability.