bluuebunny/crossref_metadata_2025 huggingface dataset:
The Caregiver Burden Alert: A Graphic Tool for Dementia Caregiver Burden Screening and Referral
Authors: Brown Ellen L. , Ruggiano Nicole , Meadows James T.
Published: December 2017

Annually, 5.4 million people are affected by Alzheimer’s disease and other forms of dementia (AD), most of whom are cared for by unpaid family caregivers and are medically supervised by primary care providers (PCPs). AD caregivers report feelings of satisfaction in their ability to provide care, though they often experience caregiver burden (CB) from the extensive physical and emotional effort involved in AD caregiving, especially when providing care to someone with advanced AD. Standardized measures have been developed to assess for CB among AD caregivers, and effective interventions have been developed for reducing CB. However, there currently lacks a standardized, feasible approach for CB screening. This article presents an innovative, evidence-based tool to prompt CB screening and referrals among AD caregivers receiving home care services.
Friendships and social participation as markers of quality of life of adolescents and adults with fragile X syndrome and autism
Authors: DaWalt Leann Smith , Usher Lauren V , Greenberg Jan S , Mailick Marsha R
Published: December 2017

Friendships and social participation are key domains of quality of life for individuals with intellectual disabilities. This study examined the friendships, social and recreational activities, and family social networks of individuals with intellectual disabilities from two distinct diagnostic groups: individuals diagnosed with fragile X syndrome (n = 81) compared with those diagnosed with autistic disorder (n = 226). Within each diagnostic group, individuals in two developmental stages were compared: adolescence and adulthood. Quality of life in friendships and social participation domains was notably low for individuals with fragile X and those with autism. Individuals with fragile X had more friendships and a less negative social impact on the family than individuals with autism. Across both groups, adolescents spent less time with friends and neighbors, and more time in exercising, than did adults.
Using aromatic polyamines with high proton affinity as “proton sponge” dopants for electrospray ionisation mass spectrometry
Authors: Wirth Marisa A , Rüger Christopher P , Sklorz Martin , Zimmermann Ralf
Published: December 2017

Proton sponges are polyamines with high proton affinity that enable gentle deprotonation of even mildly acidic compounds. In this study, the concept of proton sponges as signal enhancing dopants for electrospray ionisation is presented for the first time. 1,8-Bis(dimethylamino)naphthalene (DMAN) and 1,8-bis(tetramethylguanidino)naphthalene (TMGN) were chosen as dopants, using methanol and acetonitrile/methanol as solvents. Individual standard compounds, compound mixtures and a diesel fuel as a complex sample matrix were investigated. Both proton sponges enhanced signal intensities in electrospray ionisation negative mode, but TMGN decomposed rapidly in methanolic solution. Significantly higher signals were only achieved using the acetonitrile/methanol mixture. On average a more than 10-fold higher signal intensity was measured with 10−3 mol l−1 DMAN concentration. A stronger signal increase of alcohol functionalities was observed compared to acid functionalities. All compound classes which were detected in the diesel fuel (CH– and CHOx–class) received roughly 100-fold higher signal intensities when using DMAN as a dopant. Furthermore, the number of detected compounds as well as the double bond equivalent of the detected compounds increased. The compound class distribution shifted when adding DMAN and the formerly dominant CHO2–, CHO3–, and CHO4– classes received similar relative intensities as formerly less accessible classes. The findings depict DMAN as a promising additive for electrospray ionisation negative analysis of at least mildly acidic compounds, even within complex sample material.
The investigation of the bio-oil produced by hydrothermal liquefaction of Spirulina platensis using ultrahigh resolution Fourier transform ion cyclotron resonance mass spectrometry
Authors: Kostyukevich Yury , Vlaskin Mikhail , Vladimirov Gleb , Zherebker Alexander , Kononikhin Alexey , Popov Igor , Nikolaev Eugene
Published: December 2017

We report the investigation of the hydrothermal liquefaction products of the Spirulina platensis microalgae by using the Fourier transform ion cyclotron resonance mass spectrometry. The hydrothermal liquefaction produced two fractions: one with boiling temperature below 300℃ and the dense residue that remained in the reactor. It was observed that N2 and N classes of compounds that dominate in the positive ESI Fourier transform ion cyclotron resonance spectra for both fractions, and that the light fraction is considerably more saturated then the heavy one. The performed hydrogen/deuterium exchange reaction indicated the presence of the onium compounds in the bio-oil.
Tautomerism of uracil and related compounds: A mass spectrometry study
Authors: Colasurdo Diego D , Pila Matías N , Iglesias Dacio A , Laurella Sergio L , Ruiz Danila L
Published: December 2017

It has been demonstrated that uracil has a preponderant tautomeric form, but it is also known that different tautomers co-exist in this equilibrium. In this work, mass spectrometry is used as a helpful tool to analyse the equilibria, using derivative compounds to forbid the presence of some tautomers and ion trap mass spectrometry to follow relevant fragmentation pathways. Theoretical calculations were performed to confirm tautomers abundance by energy minimization in gas phase. Analysis of mass spectra of uracil, three methyl-substituted uracils, 2-thiouracil and three benzouracils suggest that uracil exists mainly as three tautomers in gas phase: one major structure that corresponds to the classical structure of uracil (pyrimidine-2,4(1H,3H)-dione) bearing two carbonyls and two NH moieties, and two minor enolic forms (4-hydroxypyrimidin-2(1H)-one and 2-hydroxypyrimidin-4(1H)-one). Such tautomeric distribution is supported by theoretical calculations, which show that they are the three most stable tautomers.
Tissue imaging with in situ solid-phase extraction micro-funnel based spray ionization mass spectrometry
Authors: Li Wan , Chen Xiangfeng , Wang Ze , Wong YL Elaine , Wu Ri , Hung Y-L Winnie , Chan T-W Dominic
Published: December 2017

Current imaging mass spectrometry techniques are faced with a major challenge related to ion suppression effect. Data regarding low-abundance components or low-polarity compounds cannot be normally obtained presumably because of the discrimination effect of easily ionized chemical components on desorption/ionization process. In this study, a new method was proposed to obtain images of chemical components in biological tissues or sections through in situ solid-phase extraction in sorbent mounted micro-funnel based spray ionization mass spectrometry. An imprint of a strawberry section was formed by gently pressing against a 2D array of micro-funnels. The sorbent mounted micro-funnels were then subjected to in situ single-pixel solid-phase extraction to alleviate the matrix-related ion suppression effect. The achievable spatial resolution is approximately 250 µm. The imaging of the spatial distribution of low-abundance or low-polarity chemicals in the strawberry imprint could be obtained by using a gradient elution strategy. Results demonstrated that the “not observed” remark does not necessarily indicate that a specific compound is non-existent when traditional imaging mass spectrometry techniques are used. The proposed method can be applied to conduct low-abundance chemical imaging through in situ single-pixel sample pretreatment.
Study on submerging operation design for heavy-lift barges based on a real case analysis
Authors: Wang Xin , Ko Wei Jun
Published: December 2017

Semi-submersible heavy-lift barges are widely used for transporting large offshore structures over long distances. The float-on and float-off operations of such vessels are considered as high-risk tasks even today. Improper flooding sequence may lead to accidents including loss of vessels and human lives. The main objective of this study is to provide valuable findings and guidelines for the design of submerging operations based on the case study of an unsuccessful submerging sea trial. A quasi-static time-domain simulation was conducted to investigate the unsuccessful trial and design a new flooding sequence. Based on the simulation results, the causes of the unsuccessful trial have been identified. Moreover, a new flooding sequence is proposed after examining various options. Since the vessel’s dimensions and ballast tank layout are typical and similar to many other heavy-lift barges, general conclusions for the design of submerging operations are summarized.
Commuter Spouses and the Changing American Family
Authors: Lindemann Danielle J.
Published: December 2017

the rise of commuter marriage reflects decades of social change in women’s workplace participation, american individualism, technological saturation, bureaucratic hurdles, and the symbolic significance of marriage itself.
Accountability after Genocide
Authors: Brehm Hollie Nyseth
Published: December 2017

working to prosecute the perpetrators of genocide, remember its victims, and move forward is an enormous undertaking. after nearly 2 million trials in under a decade, rwanda provides an case study in local legal adaptation toward accountability.
It’s Better to be Angry Together
Authors: Cohen Philip N.
Published: December 2017

Capturing the emotion of the March for Racial Justice
The Diaper Dilemma
Authors: Randles Jennifer
Published: December 2017

jennifer randles on diaper need, a truly shitty situation.
Self-Efficacy for Adoption and Maintenance of Exercise Among Fibromyalgia Patients: A Pilot Study
Authors: Scioli-Salter Erica R. , Smith Brian N. , McSheffrey Savannah , Bair Matthew J. , Sillice Marie A. , Driscoll Mary , Higgins Diana M. , Allsup Kelly , Amalathas Aneline , Gerber Megan R.
Published: December 2017

Objective. While multimodal treatment approaches for fibromyalgia (FM), incorporating exercise, have been found most effective, information about factors associated with exercise adoption and maintenance is lacking. Design, Setting, and Methods. Women veterans with FM (N = 19) completed an anonymous Internet survey measuring FM impact (FI), adoption of exercise behavior, and self-efficacy for exercise. Using classifications of behavior specified by the transtheoretical model, the self-efficacy of participants classified in the action or maintenance (AM) stages was compared with those in earlier stages (precontemplation through preparation) of exercise readiness. Multivariate analysis of variance analyses examined differences in FI domains by stage of change. Analysis of covariance examined whether exercise self-efficacy differed by stage of change while controlling for FI. Results. Higher levels of self-efficacy were detected among participants in the AM stages. Participants in the AM stages also reported higher levels of FI symptoms. After controlling for FI, self-efficacy did not differ significantly between the 2 groups; however the effect size was large (η2 = .11). Conclusions. Findings of this pilot study suggest a role for self-efficacy in exercise adoption and maintenance, even in the setting of higher FM symptoms. Replication of this study with a larger sample size is warranted.
Computer-assisted detection of tardus parvus waveforms on Doppler ultrasound
Authors: Gunabushanam Gowthaman , Millet John D , Stilp Erik , Crawford Forrest W , McNamara Robert L , Scoutt Leslie M
Published: December 2017

Objective

To determine if a novel computer-generated metric, effective acceleration time, improves accuracy for detecting tardus parvus waveforms on spectral Doppler ultrasound.

Methods

Patients with echocardiography-confirmed aortic valve stenosis ( n = 132; 60 mild, 44 moderate, 28 severe) and matched controls ( n = 48) who underwent carotid Doppler ultrasound were identified through an imaging database search at a single medical center. A custom-built spectral analysis computer program generated effective acceleration time values for spectral Doppler waveforms in the carotid arteries and a receiver operating characteristic analysis was performed to determine the optimal median effective acceleration time cutoff value to detect tardus parvus waveforms. Two radiologists, blinded to subject disease status, reviewed and rated all carotid sonograms for presence of tardus parvus waveforms. Inter-rater variability was measured, and the accuracy of aortic valve stenosis detection with and without use of the effective acceleration time cutoff was calculated.

Results

Receiver operating characteristic analysis revealed an optimal effective acceleration time cutoff of ≥ 48 ms with a corresponding area under the curve of 0.77 (95% CI: 0.70–0.84). Use of the effAT cutoff demonstrated an accuracy of 74%. Accuracy of visual waveform interpretation by raters ranged from 43% to 61%. Inter-rater agreement in detection of tardus parvus waveforms was 76% (136/180 cases, K = 0.44, p < 0.001).

Conclusions

Detection of tardus parvus waveforms through visual interpretation of spectral Doppler waveform morphology is limited by low accuracy and moderate inter-rater variability. Use of a computer-generated median effective acceleration time cutoff value markedly improves diagnostic accuracy and avoids observer variability.
Energy envelope maintenance among patients with myalgic encephalomyelitis and chronic fatigue syndrome: Implications of limited energy reserves
Authors: O’connor Kelly , Sunnquist Madison , Nicholson Laura , Jason Leonard A , Newton Julia L , Strand Elin B
Published: December 2017

Objective

The Energy Envelope Theory of myalgic encephalomyelitis and chronic fatigue syndrome postulates that individuals with myalgic encephalomyelitis and chronic fatigue syndrome may experience some increase in functioning if their level of exertion consistently remains within the limits of their available energy. Findings of several studies support this theory; however, the current study is the first to explore how an individual’s initial level of available energy may influence the relation between energy envelope maintenance and level of functioning.

Method

The functioning, activity, and symptomatology of six groups of individuals with myalgic encephalomyelitis and chronic fatigue syndrome were compared. Groups were created based upon level of available energy (higher or lower) and energy envelope adherence (underextended, within, overextended).

Results

Results indicate that, as expected, individuals with myalgic encephalomyelitis and chronic fatigue syndrome who had higher available energy also had better functioning than individuals with lower available energy; however, this relation was less pronounced for individuals who were overexerting themselves.

Discussion

These results are consistent with the Energy Envelope Theory, and they suggest that overexertion was particularly impactful for individuals with higher levels of available energy.
Human rights and youth justice reform in England and Wales: A systemic analysis
Authors: Cunneen Chris , Goldson Barry , Russell Sophie
Published: December 2017

This article examines critically the persistently antagonistic relationship – across the past quarter-century – between the provisions of international human rights instruments and the nature and direction of youth justice reform in England and Wales. It introduces the core provisions of the human rights framework that pertain to youth justice and it sketches the nature and direction of policy reform over the 25-year period under scrutiny (1991–2016). To obtain a comprehensive sense of the relationship between human rights and youth justice reform in the jurisdiction, it applies a detailed systemic analysis; beginning at the point at which criminal responsibility is formally imputed and progressing through each stage of the youth justice system, up to the point where the child might ultimately be deprived of her/his liberty. By taking a ‘long-view’ of youth justice reform and by adopting a systemic end-to-end analysis of the human rights–youth justice interface, the article presents an analytical account of both change (policy reforms) and continuity (the enduring nature of human rights violations).
Legal systems abuse and coercive control
Authors: Douglas Heather
Published: December 2017

This article considers how legal engagement can be an opportunity to exercise coercive control over a former intimate partner. Drawing on interviews with 65 women who engaged with the legal system as a result of violence in their intimate relationships, this article explores how women’s engagement with the legal system is frequently experienced as an extension of an intimate partner’s coercive control. It builds on existing research showing how legal processes provide an opportunity for perpetrators to continue and even expand their repertoire of coercive and controlling behaviours post-separation. I refer to this as legal systems abuse. This article explores women’s reported experiences and considers how expectations of equality of access to justice and fair hearing; concepts that underpin legal processes, can be reconciled with legal engagements that seek to end coercive and controlling behaviours. The article concludes that improved understanding of domestic and family violence as coercive control by legal actors may help to circumvent the opportunities for legal systems abuse.
Organ Donation: Brain Stem Death
Authors: Bothamley Janet , Williams Marilyn , County Bernadette
Published: December 2017

Following an exploration of nurses' perceptions of organ donation, and of consent and patient's rights in the preceding articles, this series concludes with an examination of brain stem death, and in particular the literature which challenges popular assumptions about it. This makes challenging and sometimes disturbing reading, but as the author reminds us, these are issues which theatre nurses cannot ignore.
Risk Assessment: A Five Step Process
Authors: Champion June
Published: December 2017

Risk assessment is a process which involves identifying hazards in the workplace and assessing the risk of them causing harm (Croner's Health Service Risks 1997). This step by step approach to risk assessment should make the whole process seem less daunting and encourage active participation in this effective method of proactive risk management.
Patient Perceptions of Day Surgery
Authors: James David , Williams Marilyn , County Bernadette
Published: December 2017

Having an operation is always a cause for some anxiety, and probably fear for most people. Being told that you don't need to stay in hospital, and that your surgery can be done as a day case with no need for even a one night stay would probably be a comfort. The thought that it will be all over on one day, and that you can go home to your own bed, makes the prospect less daunting. Indeed research has shown that patients prefer day surgery for these and other reasons. Because day surgery means more patients treated at less cost than inpatient surgery, the Government is encouraging the expansion of day surgery services and Trusts are responding. Treating more patients more quickly has got to be good news for the many thousands of patients on waiting lists, but having your operation as a day case should not mean production line treatment. Caring for the personal and meeting individual needs is equally applicable to day case patients as it is to inpatients. This study presents an exploration of some of the actual and potential problems which need to be addressed if day surgery is to become part of the ‘first class service’ the Government has promised.
Back to Basics in Anaesthesia
Authors: Griffiths Rachelle , Plowes Dina
Published: December 2017

This is the last in the Back to Basics series of articles - for now at least. I would like to thank all the authors for their pieces. I've learnt and relearnt from each of them. The completed set of articles will be available as one document in October, and will be launched at Congress - yet another reason to attend! Bye for now.
An Ethical Dilemma
Authors: County Bernie
Published: December 2017

The purpose of this critical incident analysis is to demonstrate how knowledge of legal, moral and ethical issues has affected my nursing practice. This is a personal journey - an exploration of my own values and beliefs. The piece demonstrates how reviewing the literature has changed my stance on the issues discussed. Consequently the piece is written in the first person, but references are used to substantiate my findings.
Confidentiality: The Caldicott Report
Authors: Campbell Libby
Published: December 2017

You will probably look at the title of this and want to move on to more interesting material, but do hang on for a little bit longer. You may already know about it, but there will be an impact on you and your department as a result of this initiative. Caldicott may just be one of the seminal moments in the development of the NHS; it does have impact and could develop the cause of patients' rights a little bit further. This is a very broad overview, but it does have some helpful hints.
The Underpinnings
Authors: Fudge Lesley
Published: December 2017

In last month's Journal, readers were introduced to the government's Improving Working Lives Strategy. This month some of the underpinning detail will be examined in order to show what is expected from employers and employees when getting the balance right between work and life away from work.
How do You Keep your Patient Safe?: Biological Issues that Impact on Procedures
Authors: Williams Mriga , Clancy John , McVicar Andrew
Published: December 2017

In this fourth article in the Concepts in Anatomy series, Mriga Williams discusses the issue of keeping patients safe within the operating theatre department. This series is based on Physiology and Anatomy, a homeostatic approach, John Clancy and Andrew McVicar (eds), Edward Arnold, London, 1995.
Childcare Support
Authors: Fudge Lesley
Published: December 2017

In this third article of this new series, Lesley Fudge outlines the government strategy on improving childcare support for healthcare workers.
Waving Not Drowning!
Authors: Campbell Libby , Mba Eunice E Muir Rn, Rm Adm
Published: December 2017

Since April 2000 Eunice Muir has been seconded from her post as Deputy Director of Nursing and Planning at Forth Valley Acute Hospitals NHS Trust. She is providing the clinical and managerial expertise to the implementation and assessment of the Risk Management Standards of the new Clinical Negligence and Other Risks Indemnity Scheme (CNORIS) for the NHS in Scotland (Scottish Executive: NHS MEL (1999) 86, NHS MEL (2000) 14, and NHS HDL (2000) 02). In this second article in our Risk Management series, she explains the reasons for having a risk management framework as provided by CNORIS.
Common Head Injuries, Their Diagnosis and Treatment
Authors: Williams Marilyn , Flint Graham
Published: December 2017

Head injuries are common. Between three-quarters and one million cases, ranging from superficial to life threatening injuries, attend accident and emergency (A&E) departments in the UK each year. This new series on neurosurgery was inspired by head injuries recently suffered by boxers. It does not deal directly with neurosurgery undertaken for other reasons. The series begins with this article by consultant neurosurgeon Graham Flint. It will be followed by other articles on neurosurgical nursing and on the experiences of a neurosurgical patient who also happens, at the present time, to be a nurse in training. The fourth article will describe the rehabilitation of patients by the charity, Headway.
Making Meetings Effective
Authors: Westwood Fiona
Published: December 2017

This is the last in the current series of articles considering various elements of effective management. Fiona Westwood has already looked at managing conflict, influencing people and doing deals. This article looks at one of the major causes of frustration for any organisation – the amount of time people spend in meetings and the limited value that such time investment produces
Prediction of Difficult Intubation a Pre-Assessment Nurses’ Guide
Authors: Neacsu Ancuta
Published: December 2017

This article summarises a literature review which examined the best ways of predetermining difficult intubations for elective surgery. At Central Middlesex Hospital, patients are pre-assessed by nurses before intervention to ensure that they are fit for their operation. In the Ambulatory Care and Diagnostic Centre (ACAD), concern was expressed about the lack of a standardised protocol for nurses’ assessment of the airway.
DVT Prophylaxis in the Perioperative Setting
Authors: Arnold Agnes
Published: December 2017

In last month's BJPN, Agnes Arnold discussed the pathophysiology of deep vein thrombosis and suggested ways that the risk could be reduced, particularly with respect to DVTs resulting from endothelial damage in surgery. In this, the second of a two-part series, Agnes continues by looking at hypercoagulability of blood and venous stasis and the impact of these conditions on the risk of DVT.
The Importance of Research in Nursing Practice
Authors: Bassett Chris , Bassett Jane , Tanner Judith
Published: December 2017

Current, valid and reliable research is becoming more and more important in modern healthcare practice. Patients and their families’ expectations are increasing and they, quite rightly, expect their nursing care to be the very best available. Over the next five issues, this series will explore the following areas: • The value of research in nursing • What is research? • Qualitative and quantitative research • Reading and critiquing research • Implementing research in practice
Critical Incident Analysis in An Accident and Emergency Department
Authors: Connor Joanna
Published: December 2017

The analysis of critical incidents is crucial to the provision of safe, high quality healthcare services to patients. It is essential to analyse the incident and make decisions about how future similar incidents should be dealt with. This article is a reflection on a critical incident involving a theatre practitioner working outside her normal field of responsibility which was used to change practice.
Effective Theatre Scheduling the Derby Theatre Project Experience
Authors: Ainsworth David
Published: December 2017

In this month's article by David Ainsworth from the theatre project, the role of theatre scheduler is discussed. The article examines how the role was set up and the impact it has had on theatre utilisation, giving practical examples of good practice.
Redefining Perioperative Advanced Practice the Nurse Specialist in Anaesthesia and Emergency Surgery
Authors: Radford Mark , Abbassi Ann , Williamson Alastair , Johnston Paul
Published: December 2017

There are increasing demands placed upon the services offered by the modern NHS, the causes of which are wide ranging and complex. In combating the rising demands, new approaches to practice will form an overall strategy for improving the care delivered to patients. This is a two part series in which Mark Radford discusses an innovative approach to the management of surgical emergencies, through the specialist nurse program in anaesthesia and emergency surgery. Part One will focus on the introduction of the role and the approach taken for training and development. Part Two will examine the scope of practice, the clinical and operational impact of the role, and future developments.
Patient Involvement the Derby Theatre Project Experience
Authors: Ainsworth David
Published: December 2017

In the last of a series of articles written by David Ainsworth, we look this month at the role of the service improvement manager at Southern Derbyshire Acute Hospitals. The article highlights the importance and value of involving patients in a national project.
The Nurse Anaesthetist
Authors: McCulloch Bernadette
Published: December 2017

With the ongoing debate on New Ways of Working in the National Health Service, the role of nurses and other perioperative practitioners in anaesthetics is becoming an increasingly prominent issue. The opening up of new anaesthetic roles to nurses and their non-medical colleagues raises questions as to their own acceptance of these new roles and their acceptance by their medical colleagues. In this article, the author addresses the question as to whether perioperative practitioners are ready for the nurse anaesthetist, and whether the UK as a whole is ready for this initiative.
How Safe is Your Endoscope Disinfectant?
Authors: Gray Joan
Published: December 2017

Glutaraldehyde may have been virtually eliminated from UK hospitals as a flexible endoscope disinfectant, but in many cases it has been replaced with alternatives that may not be as safe as was first thought. This article highlights the need for healthcare professionals and hospitals to take urgent action to review the way these newer disinfectants are used and handled.
A Surgical Care Practitioners’ Pilot Programme in Wales
Authors: Morgan Alun , Ward Paul
Published: December 2017

The Surgical Care Practitioner Pilot Programme, funded by the Welsh Assembly Government, commenced in October 2003. Preliminary evidence suggests that the pilot is making a significant difference to the care of surgical patients in those NHS trusts involved. The authors describe why the programme was initiated and what it was designed to deliver, together with the preliminary evaluation.
The History of NATN 40 Years and Counting
Authors: Cox Nancy
Published: December 2017

Nancy Cox joined NATN in 1970, becoming deputy secretary in 1972, and national secretary from 1985–1989. This article is the second part of the Daisy Ayris Memorial Lecture given at Congress 2004. Nancy gives us a fascinating insight into the early days of the organisation, and how it has become the association it is today.
Theatre-Based Hospital Placements for Firefighters
Authors: Durmaz Emma
Published: December 2017

Airway obstruction is the most common cause of death in the prehospital environment. It is estimated that 85% of these patients had otherwise survivable injuries. The aim of the project was to increase firefighters' skills in airway management techniques, to include the laryngeal mask airway (LMA), by providing theatre-based hospital placements under the supervision of a consultant anaesthetist. The training in the use of the LMA by firefighters is currently a pilot project to assess the potential for its use operationally, based on ease of training to a competent level and retention of skills after one year.
Waiting Lists: What are we Doing Right?
Authors: Butler Debra
Published: December 2017

According to The Sunday Times Good Hospital Guide (2004), the Mater Hospital scored highest for waiting lists, admitting 84% of inpatients within six months of referral. To achieve this result the Trust was originally invited by commissioners to submit a bid to develop a service which ensures that patients currently waiting for elective surgery receive it as quickly as possible.
Looking Back, Looking Forward
Authors: Spinks Mary
Published: December 2017

This was the second time that Mary Spinks, a former Chairman of NATN, has given the Daisy Ayris Lecture. This unprecedented move indicates the Association's respect for Mary's influence and commitment to patient care in her current role as Director of the Florence Nightingale Foundation. Her address, given below in full, covers key themes of education, reasoning and communication.
Thackray: Past and Present
Authors: Stewardson Joanne
Published: December 2017

This article explores the work and collections of the Thackray Museum of Medical History and its link with the former medical supplies company, Chas F Thackray Ltd. It focuses particularly on the Museum's surgical artefacts, and on the Thackray company's involvement in developments in the history of surgery during the twentieth century. The article is based on a presentation given to the National Association of Theatre Nurses Conference in October 2004.
Setting up the Role of Emergency Surgical Nurse Practitioner
Authors: Davis Jacqueline
Published: December 2017

At the beginning of the new millennium the government published a document entitled The NHS Plan (DoH 2000) giving details of their plans to reform the NHS and improve the working lives of its staff. As a result of this plan many projects aimed at redefining the traditional structure of the NHS have been initiated, some of which require demolishing the time-honoured demarcations between professional groups.
An Audit of Analgesia after Day Case Gynaecological Laparoscopic Surgery
Authors: Dowdles Wendy , Whiteside Jonathan
Published: December 2017

An audit of patients’ pain relief following day case gynaecological laparoscopic surgery was conducted to identify postoperative analgesic requirements. In this article the authors also look at the incidence of nausea and vomiting, length of hospital stay and recorded overnight admissions.
Effects of Chlorine Solutions on Footwear
Authors: Wakeford-Brown Roger , Croft Kelly
Published: December 2017

Operating theatre personnel need to disinfect floors, other surfaces and sometimes their footwear with chlorine solutions in order to comply with Department of Health (DH) guidance on the safe method of dealing with blood spills. This study was designed to determine the effect of repeated applications of chlorine solutions to a new theatre clog manufactured from high density polyurethane.
Arbuthnot Lane
Authors: Ellis Harold
Published: December 2017

As part of his series of articles exploring the lives of those behind great surgical innovations, Professor Harold Ellis looks at the work of Sir William Arbuthnot Lane, who was responsible for pioneering many surgical techniques.
Hands-Free Technique: Preventing Occupational Exposure during Surgery
Authors: Stringer Bernadette , Haines Ted
Published: December 2017

Occupational exposure to blood borne pathogens has led to HBV, HCV and HIV infections among surgeons, nurses and other operating room (OR) personnel and, to a lesser degree, patients (Ross et al 2000, The incident investigation teams and others 1997). Of seven OR studies in which an observer or circulating nurse recorded exposures, there was a percuataneous injury in 1.7–15% of all surgeries, and a mucocutaneous contamination in 6.2–50% of all surgeries. (Gerberding et al 1990, Panlilio et al 1991, Popejoy & Fry 1991, Quebbeman et al 1991, Tokars et al 1992, Lynch & White 1993, Stringer, Infante-Rivard & Hanley 2002). Surgeons and residents usually sustained the greatest number of percutaneous and other exposures during surgery.
Decontamination and CJD: The Latest Guidance
Authors: Jeffries Don
Published: December 2017

Professor Don Jeffries, Chair of the Advisory Committee on Dangerous Pathogens Working Group on Transmissible Spongiform Encephalopathies (ACDP TSE), Deputy Chair of the Creutzfeldt-Jakob Disease (CJD) Incidents Panel, and Chair of the Department of Health Decontamination Research Group discusses the latest guidance on the prevention of transmissible spongiform encephalopathies (TSEs). This article is based on the presentation he gave at AfPP's Annual Congress in October 2005.
United States Operating Room Nurses: Work Environment Perceptions
Authors: Sexton Kathleen , Teasley Susan , Cox Karen , Carroll Cathryn
Published: December 2017

Concerns about pending retirement of nurses working in the operating room (OR) are undeniable. The nurses’ work environment and level of perceived support is part of the equation of why a nurse may choose to retire or stay in the workforce. This study compares nurses’ perceptions of the work environment between OR nurses and nurses who work in other type units; and compares the work environment perceptions of OR nurses between institutions of two sizes (<300 beds and >300 beds). Findings include: OR nurses have better perceptions of their work environment than nurses in other type units and OR nurses in smaller hospitals are more satisfied with their work environment, workload and perceptions of organisational support. Implications for OR work environments are discussed.
Preoperative Hair Removal: A Systematic Review
Authors: Tanner Judith , Moncaster Kate , Woodings Dianne
Published: December 2017

Preparing patients for surgery has traditionally included the routine removal of body hair from the intended surgical wound site. However, there are studies which claim that preoperative hair removal is deleterious to patients, perhaps by causing surgical site infections (SSIs), and should not be carried out. The objective of this review was to determine if routine preoperative hair removal results in fewer SSIs than not removing hair. Eleven randomised controlled trials were included in this review. There is insufficient evidence to state whether removing hair impacts on surgical site infection or when is the best time to remove hair. However, if it is necessary to remove hair then both clipping and depilatory creams results in fewer SSIs than shaving using a razor.
HCAIs: A Statutory Code of Practice in England and Wales
Authors: Gilmour Diane
Published: December 2017

Healthcare-associated infections (HCAIs) such as Meticillin resistant Staphylococcus aureus (MRSA) and Clostridium difficile (C. dif) are never far from the media headlines. In January 2006 a leaked memo identified the government's concerns that its target of halving MRSA infection rates by April 2008 may not be met (Boseley 2007). During 2004–5, 30 people died following two outbreaks of C. dif at Stoke Mandeville (Boseley 2007). In this article the author will focus on and discuss in detail key components of the new Code of Practice on Health Care Associated Infections (DH 2006a) to show how legislation has provided the framework to ensure that not only do NHS bodies have a duty to comply with this Act but so do we as practitioners.
The First Resection of An Aortic Aneurysm
Authors: Ellis Harold
Published: December 2017

The report of the first successful resection of an abdominal aortic aneurysm, carried out in Paris in 1951, greatly influenced surgeons throughout the world who, until then, had regarded such an operation as probably being outside the bounds of surgical removal and vascular reconstruction. I well remember as a young surgeon reading of attempts to control such aneurysms by wrapping them in cellophane, or introducing coils of wire into them to induce thrombosis and I was familiar with having to stand by hopelessly as patients exsanguinated when their aneurysms ruptured.
Basic Concepts in Mechanical Ventilation
Authors: Carbery Catherine
Published: December 2017

Mechanical ventilatory support is a major component of the clinical management of critically ill patients admitted into intensive care. Closely linked with the developments within critical care medicine, the use of ventilatory support has been increasing since the polio epidemics in the 1950s (Lassen 1953). Initially used to provide controlled mandatory ventilation, today with advances in technology, most mechanical ventilators are triggered by the patient, increasing the awareness of the complexity of patient/ventilator interaction (Tobin 1994). Though ventilator appearance and design may have changed quite significantly and the variety of options for support extensive, the basic concepts of mechanical ventilatory support of the critically ill patient remains unchanged. This paper aims to outline these concepts so as to gain a better understanding of mechanical ventilatory support.
Feedback from Members on Decontamination Services
Authors: Gilmour Diane , Cooper Richard
Published: December 2017

In February 2007 AfPP asked its members for their feedback on decontamination services. For example, decontamination services to perioperative areas and issues experienced on a daily basis, particularly service issues from those outsourced services. AfPP asked its members to share their experiences, concerns and issues – both positive and negative.
Surgical Hand Antisepsis: The Evidence
Authors: Tanner Judith
Published: December 2017

For 150 years members of the surgical team have been washing their hands with solutions designed to remove micro-organisms and therefore reduce surgical site infections in patients. This article discusses the evidence surrounding aspects of surgical hand antisepsis.
Salpingectomy for Ruptured Ectopic Pregnancy
Authors: Ellis Harold
Published: December 2017

Not much more than a century ago, a ruptured ectopic pregnancy was a death sentence. In 1876, John Parry wrote in his book on this subject: ‘Here is a wife in the most useful period of her existence, which good authorities have said is never cured; and for which, even in this age when science and art boast of such high attainments, no remedy, either medical or surgical, has been tried with a single success’. When we read that eminent authorities were advising the use of electric shocks, injection of narcotics into the sac and copious and frequent bleeding, one is hardly suprised. Parry himself suggested that the only remedy would be to open the abdomen and either tie the bleeding vessels or remove the sac entirely.
Noisiness in Operating Theatres: Nurses’ Perceptions and Potential Difficulty Communicating
Authors: Stringer Bernadette , Haines Ted A , Oudyk John D
Published: December 2017

Elevated operating theatre noise can be hazardous to patient safety and may cause occupational stress. In a nine-hospital study, background noise and average noise were measured, during operations in different subspecialties, and found to be higher than noise levels recommended by the World Health Organization (WHO) for hospital areas in which patient care takes place. In operations in which nurses had also answered a question about hearing ‘quiet’, ‘normal’, and ‘loud’ talking, speech interference levels were estimated and indicated that nurses and other personnel had to substantially raise their voices to be well understood.
Pain Assessment in the Recovery Room
Authors: Brown Donna N
Published: December 2017

The assessment and management of pain in the acute hospital setting is an important issue for practitioners (Layman Young et al 2005). Despite advances in pain management (Fotiadis et al 2004, Powell et al 2004, Wu & Richman 2004) and the use of multimodal analgesic techniques in the theatre/recovery environment (Jin & Chung 2001), for a variety of reasons (Turk & Okifuji 1999, Pasero 2003), patients’ reports of pain following surgery suggest that it remains problematic (Rawal 2002, Brown 2004, Coll et al 2004). In the recovery room disorientation, anxiety, fear and nausea may add to and alter patients’ perception of pain, making it crucial that recovery room practitioners understand pain and pain assessment. This article outlines and critiques pain assessment tools that may be used to enhance pain management practices in the recovery room.
Thoracic Paravertebral Block (Pvb) Analgesia
Authors: Cox Felicia , Cousins Angela
Published: December 2017

Paravertebral blockade is a safe and effective technique for intraoperative and postoperative management of acute surgical pain. The block may be performed as a single injection or a catheter may be inserted to allow for the continuous or bolus administration of a long acting local anaesthetic. This mode of analgesia is not considered to be a stand alone technique (in contrast to epidural analgesia) and most patients will require additional analgesia (usually parenteral patient controlled analgesia). Compared to epidural analgesia, the paravertebral administration of analgesia is considered to be safer in anti-coagulated patients, but the risk of local anaesthetic toxicity remains. There is little published about the care of patients receiving this form of analgesia. This article provides an overview of the technique of thoracic paravertebral analgesia, the choice of analgesics and side effects together with recommendations for patient care.
Pain Management in the Critically Ill
Authors: Ashley Elizabeth , Given Jamie
Published: December 2017

The treatment of pain continues to be a major concern in the critically ill patient. Despite advances in pain management, a greater understanding of the mechanisms of pain and advanced methods of analgesic delivery, the treatment of pain is not always a priority on the intensive care unit. Difficulties with pain assessment, in the critically ill ventilated, sedated patient compound the problems of pain management. Physiological signs are difficult to interpret and psychological factors must be considered.
A Patient's Journey through the Operating Department from an Infection Control Perspective
Authors: Barrow Claire
Published: December 2017

The path a patient negotiates through an operating department is shaped by its design and layout, which should be determined by infection control requirements to ensure the safety of both patients and practitioners. How this is achieved is discussed in relation to an operating department in a local trust, together with how infection control, and therefore the prevention of surgical site infection, is achieved through hospital policies and key practices within a theatre by theatre practitioners and surgeons.
To Catheterise or Not to Catheterise: A Study in Hip and Knee Primary Arthroplasty
Authors: Bigsby Ewan , Madhusudana Kattepura
Published: December 2017

This cross sectional study examines the rate of catheterisation of patients after elective primary hip and knee arthroplasty in an English district general hospital. 50 patients were included in this study, with 19 (37%) being catheterised pre-operatively. Of the remainder, 10 went into retention and had to be catheterised, while the other 21 were managed without a catheter. There was a trend towards more patients requiring catheterisation after axial anaesthetic (42%) compared to non-axial anaesthetic (21%), although this was not significant. We examine the rationale for catheterisation in hip and knee arthroplasty and review the available literature.
Organisational Skills and Tools
Authors: Wicker Paul
Published: December 2017

While this article mainly applies to practitioners who have responsibilities for leading teams or supervising practitioners, many of the skills and tools described here may also apply to students or junior practitioners. The purpose of this article is to highlight some of the main points about organisation, some of the organisational skills and tools that are available, and some examples of how these skills and tools can be used to make practitioners more effective at organising their workload. It is important to realise that organising work and doing work are two completely different things and shouldn't be mixed up. For example, it would be very difficult to start organising work in the middle of a busy operating list: the organisation of the work must come before the work starts and therefore preparation is often an important first step in organising work. As such, some of the tools and skills described in this article may need to be used hours or even days prior to the actual work taking place.
Minimizing the Risk of Infection in the Operating Department: A Review for Practice
Authors: Richmond Samantha
Published: December 2017

Much press speculation has projected the controversy of infection control amidst raised public concern over fatalities caused by nosocomial infections. Attention to detailed ultra-cleanliness can never be compromised in the preservation of life, health and wellbeing of the evermore discerning patient. Moreover, complacency to best practice and theatre etiquette potentially endangers a practitioner's own protection, and infringes their Code of Conduct substantiating possible professional disciplinary and/or legal action. To be well versed is to be well armed.