bluuebunny/crossref_metadata_2025 huggingface dataset:
Dame Sheila Sherlock: Pioneer in Liver Diseases
Authors: Ellis Harold
Published: December 2017

Within living memory of some of us, liver disease was a Cinderella subject. If you look up the first edition of the standard medical textbook of the time, Sir William Osler's ‘Principles and Practice of Medicine’, published in 1892, you will find a mere 24 of its 1079 pages devoted to the liver, compared with 38 pages on typhoid fever alone; and matters hardly changed throughout the first half of the 20th century. Although ‘cirrhosis' and ‘hepatitis' were well recognised conditions when I was a house surgeon in 1948, their classification, aetiologies, detailed pathology and management were little understood, while laboratory investigations of the liver diseases were few and non - specific.
The Shape of Things to Come: Operating Theatre Targets the Way We Eat
Authors: Stephens-Borg Keith
Published: December 2017

We are becoming victims of change and, unless provisions are made to ensure regular adequate meal times, our ability to help others may be severely damaged. Most of us feel the urge to eat and are turning to fast snacks for temporary solace owing to the toil of busy operating sessions.
Agency Nursing in Australia
Authors: Cipelletti Luisa
Published: December 2017

Working as an agency nurse has not been easy, but it has been a great way to explore Australia and the different hospital systems – private and public.
Perioperative Communication
Authors: Smith Brian , Jones Chris
Published: December 2017

Communication has always been a key aspect of effective perioperative care. Operating departments continually attempt to improve communication between all parties in the perioperative setting, and articles on this subject are common in professional publications. However it is also true that examples of bad communication abound. In one study which examined communication during 48 operative procedures, a total of 421 communication events produced 129 instances of ‘communication failure’ (Lingard et al 2004). Sometimes these failings have severe consequences on the patient, the trust and the practitioner. Lessons in error management drawn from high risk areas of healthcare such as operating theatre practice have been derived from aviation and aircraft incidents. Frequently, errors will have similar root causes. Psychologist Robert L Helmreich has argued that one of the main parallel areas of error generation is flawed communication. He cites his own studies which show that, in one hospital under review, two thirds of doctors and nurses quoted ‘better communication’ as being the most useful way of reducing errors (Helmreich 2000).
Would you Speak up if the Consultant Got it Wrong? …And Would you Listen if Someone Said You'd Got it Wrong?
Authors: Bromiley Martin , Mitchell Lucy
Published: December 2017

In 2005 my late wife died during an attempted operation. I'm an airline pilot and I recognised early on that the factors that lead to Elaine's death mirrored those commonly found in many aviation accidents.

In this article I'll ask you to reflect on the culture within healthcare around human error and ‘teamwork’. I will ask you to reflect on your own personal responsibilities about safety. I will also argue that technical competence is not a guarantee of safe outcomes; alongside it you must have competence in ‘non-technical’ skills.
Sucrose Has Been Shown to Have Analgesic Properties When Administered to Neonates and Infants: Is There the Potential for Its Use in Post-Operative Pain Management?
Authors: Hardcastle Teresa
Published: December 2017

Since the early 1980s pain has been recognised in neonates. Much research has been performed over the years into the analgesic effect of sucrose administered for painful procedures performed on the neonate and infant. Studies have reported the endogenous effect of sucrose when used in conjunction with non-nutritive sucking (pacifiers). Sucrose is routinely administered to neonates and infants in the US either on its own or as an adjunct to other pharmacological interventions post-operatively.
Recent Developments in Total Hip Replacements: Cementation, Articulation, Minimal-Invasion and Navigation
Authors: Dheerendra Sujay , Khan Wasim , Saeed Mohammed Z , Goddard Nicholas
Published: December 2017

Total hip replacement is a commonly performed procedure with good results. The implants could be cemented or cementless, and there has been a resurgence of resurfacing procedures. It is important that special consideration is given to the choice of the material used at the bearing surfaces. There have been many developments in recent years that influence our choice of implant and have shaped our practice, including minimally invasive surgery and computer-assisted surgery. This article aims to provide an overview of these developments.
The Early Days of Gall Bladder Surgery
Authors: Ellis Harold
Published: December 2017

Gall stones have been found in ancient Egyptian mummies, and have presumably caused symptoms and suffering since the early days of mankind. ‘Inflammation of the liver’ was well recognised by the Greeks, and, in many cases, might well have represented attacks of biliary colic. Giovanni Morgagni, Professor of Anatomy in Padua, and regarded as one of the fathers of modern pathology, described, in 1761, 20 autopsies in which gall stones were found.
The Use of Ionising Radiation in Trauma and Orthopaedic Theatres
Authors: Prime Matthew , Khan Wasim , Dheerendra Sujay , Maruthainar Nimlan
Published: December 2017

Ionising radiation is used extensively in trauma and orthopaedic perioperative practice for operative planning and intraoperative decision making. Radiation poses risks to patients and theatre staff, and it is important to always justify, optimise and limit the exposure. This is facilitated by a thorough understanding and awareness of radiation, as well as a sound knowledge of the precautions required for using this technology to minimise the risks of radiation.
Setting up Pre-Admission Visits for Children Undergoing Day Surgery: A Practice Development Initiative
Authors: O'Shea Maria , Cummins Ann , Kelleher Ann
Published: December 2017

The hospital experience can bring about a range of negative emotions for children. The literature clearly states that children who are prepared for surgery recover faster and have fewer negative effects. Pre-admission programmes seek to prepare children (and their parents) for surgery. This paper describes in detail how a pre-admission programme was established for children and their families who were scheduled for day case surgery.
Surgical Gowning and Gloving
Authors: Pirie Susan
Published: December 2017

Surgical gowning and gloving is an essential element of perioperative practice and is undertaken by the members of the anaesthetic and surgical teams involved in a perioperative intervention or procedure. Gowning and gloving will take place immediately after surgical hand antisepsis and the whole process is often referred to as scrubbing, gowning and gloving. Surgical hand antisepsis is defined as ‘an extension of hand washing’ (AfPP 2007), and ‘the antiseptic surgical scrub or antiseptic hand rubs performed before donning sterile attire preoperatively’” (AORN 2008).

The aim of these processes is to improve the perioperative outcome of interventions and procedures by enhancing and further promoting aseptic techniques (ACORN 2006, AfPP 2007).
Is There Adequate Information on Operation Notes? the Application of the Royal College of Surgeons of England Guidelines
Authors: Rogers Benedict A , Pleat Jonathan
Published: December 2017

An audit was performed to review the compliance and applicability of the Royal College of Surgeons of England (RCSEng) guidelines for operation notes in a regional plastic surgery department. 137 operation notes were initially audited revealing a variable quality when compared to the guidelines. An aide-memoire (Figure 1) was used to detail each of the ten guidelines and allowed the surgeon to record if any of the guidelines were not applicable. 151 operation notes were subsequently reviewed, and showed an improvement in the recording of the operative note and the varied applicability of the guidelines to this particular speciality. It is concluded that the RCSEng guidelines are not universally applicable to plastic surgery. The difference between ‘not applicable’ and ‘failure to record’ is potentially important if these guidelines are used by non-clinical audit staff in a target driven environment.
Orthopaedic Initiative for the Gaza Strip, Palestine
Authors: Khan Sohail A , Naylor Peter A
Published: December 2017

Knowledge has no borders; wisdom has no race or nationality.
Elective Caesarean Section: A Case Study
Authors: Edwards Zoe , McColgan Karen
Published: December 2017

Caesarean section as a means of delivering babies has been around for centuries with numerous references to the procedure appearing in ancient writings (Simm & Matthew 2008). It is now the most common major surgical intervention carried out on women in the world, with between 23% and 30% of deliveries in the UK performed by caesarean section (Beech 2004). This rate is all the more surprising when one considers that caesarean section accounted for just 5.3% of UK births in 1973 (Kitzinger 1998). This rising rate has many implications for both clinical practice and the NHS. An Audit Commission report (1997) suggested that each 1% rise in the caesarean section rate would cost the NHS five million pounds per year. However, the increased rate also has clinical implications, with some studies suggesting that maternal mortality is three to seven times greater following abdominal rather than vaginal birth and maternal morbidity is proportionately even greater, even with elective procedures (McCourt et al 2004).
The Productive Ward and the Productive Operating Theatre
Authors: Bloodworth Kerry
Published: December 2017

A new approach: The Productive Ward, facilitates removal of time wastage in a busy modern hospital. The lessons learnt from this system are potentially generic and can be applied to other departments, such as in the operating theatres. Inherent to this innovative approach are the ‘lean’ principles that are now spreading across many organisational settings. Womack et al (1990) set out the key steps to organising companies to deliver value to their customers. We now apply those principles and witness the value to patient care.
The Early Days of Parathyroid Surgery
Authors: Ellis Harold
Published: December 2017

The parathyroid endocrine glands, usually four in number and about the size of a split pea, lie on either side of the posterior aspect of the thyroid gland. Occasionally one or more of these structures are found in an aberrant position in the neck or even in the superior mediastinum. The parathyroid secretion, parathormone, regulates the level of serum calcium within sharply defined limits. Lack of parathormone, with lowering of the serum calcium, results in hyper-irritability of skeletal muscle, the clinical condition known as tetany. This is encountered following inadvertent removal or bruising of the parathyroid glands at thyroidectomy.
Optimising Perioperative Patient Care: ‘Enhanced Recovery’ following Colorectal Surgery
Authors: Kelliher Leigh , Jones Chris , Day Andrew
Published: December 2017

The concept of ‘enhanced recovery’ following elective surgery is becoming increasingly prominent in the world of perioperative practice. Enhanced recovery pathways (ERP) are being implemented in more and more trusts throughout the UK, and in multiple different surgical specialties. But what does enhanced recovery actually mean and how does it impact upon both patients and healthcare professionals? Our unit has been using an ERP in colorectal surgery since 2007 and we are currently in the process of implementing a pathway for both our orthopaedic and gynaecological patients. This article comprises some background information on the evolution of enhanced recovery, a summary of its key elements and a review of the evidence, including a look at our unit's experience.
The Early Days of Splints and Splinting
Authors: Ellis Harold
Published: December 2017

There can be little doubt that fractures and wounds would have been among the first problems that the healers within primitive communities would have been called upon to treat. Indeed, this has been amply confirmed by anthropologists and archaeologists. The Australian aboriginals seem to have taken the adage ‘splint the patient where he lies' quite literally. Early observers saw the relatives take it in turns simply to hold the injured leg still until union occurred, a shelter being erected over the patient and his succession of ‘human splints'. The excavation of ancient Egyptian burial sites by Sir Grafton Elliot Smith in the early years of the 20th century revealed fractures of some 5000 years ago, bound up in splints of bark, wrapped in linen and held by bandages. Where the fractures were compound, dressings of vegetable fibre were used to plug the wound and some still showed traces of 50 century old blood!
Airway Management: From Pre-Assessment to Intubation a Student ODP's Perspective
Authors: Meachin James A
Published: December 2017

Airway management is a fundamental skill in the implementation and maintenance of a general anaesthetic. An anaesthetised patient does not have full control over their airway, and without management a partial obstruction or other more serious complication may occur (Griffiths 1999). There are many ways to reduce the risk of complications occurring in the anaesthetic process. These methods can be subdivided into two main categories: prior preparation (Chethan & Hughes 2008) and pre-assessment (Neacsu 2002).
Perioperative Transoesophageal Echocardiography
Authors: Parizkova Barbora , Webb Stephen T
Published: December 2017

New technologies are being introduced every day in the perioperative setting and perioperative practitioners will need to become increasingly familiar with transoesophageal echocardiography (TOE). TOE is used as a diagnostic tool during cardiac surgery in the operating theatre to direct the surgical procedure and to detect acute complications. TOE is also used to monitor cardiac function in patients undergoing non-cardiac surgery and in the intensive care unit (ICU) (Figure 1). The use of TOE is increasing in the cardiac catheterisation laboratory for percutaneous transcatheter procedures such as patent foramen ovale (PFO) closure, atrial septal defect (ASD) closure, aortic and mitral valvuloplasty, aortic valve implantation and mitral valve repair. Since the oesophagus is located directly behind the heart, TOE provides better image quality than transthoracic imaging for the assessment of posterior cardiac structures such as the mitral valve, left atrium and pulmonary veins.
Endotracheal Tube Cuff Pressure Monitoring: A Review of the Evidence
Authors: Sultan Pervez , Carvalho Brendan , Rose Bernd Oliver , Cregg Roman
Published: December 2017

Tracheal intubation constitutes a routine part of anaesthetic practice both in the operating theatre as well as in the care of critically ill patients. The procedure is estimated to be performed 13–20 million times annually in the United States alone. There has been a recent renewal of interest in the morbidity associated with endotracheal tube cuff overinflation, particularly regarding the rationale and requirement for endotracheal tube cuff monitoring intra-operatively.
Evaluating the Effect of Music on Patient Anxiety during Minor Plastic Surgery
Authors: Mcleod Roddy
Published: December 2017

Aim

The study sought to assess the effectiveness of music on patient anxiety levels during minor surgery.

Methods

Eighty patients attending a minor plastic surgery out-patient department were assessed using the Spielberger State-Trait Anxiety Inventory Questionnaire. Forty participants in the experimental group listened to music which was self selected and played during their operation. Forty participants in the control group received the standard care during their operation but with no music. The questionnaire was used to collect data pre and post-operatively. During the recovery period all participants were asked to reflect on their level of anxiety during surgery while completing the questionnaire. Analysis was carried out using Statistical Package for Social Sciences (SPSS) version 12.

Results

The postoperative mean anxiety score of the control group was 33.5 (SD 10.6). The mean anxiety score for the experimental group was 30.52 (SD 9.82). Statistical analysis revealed that there was no significant difference among those who did and did not listen to music during their procedure.

Conclusion

Although the researcher did not find statistically significant differences in the selected outcome measures, the intervention seemed to be enjoyed by the patients in the experimental group. Minimising anxiety prior to and during a minor operation may help promote relaxation and enhance patient comfort.
Reflections of a Newly Appointed Consultant
Authors: Ingham Christopher
Published: December 2017

I had no idea what kind of medicine I wanted to practise when I left medical school. What I did know was that I didn't want to do psychiatry, and I didn't want to do obstetrics and gynaecology. My father is a GP, and I thought I'd follow in his footsteps, but general practice struck me as a tough specialty. In my opinion the hardest job in the NHS to do well, but one of the easiest to do badly. I was jealous of my peers at medical school who loudly declared their love of a particular specialty, and trauma and orthopaedics was particularly popular. I ended up in Colchester, Essex where I met two people who changed my life forever.
Edward Hallarran Bennett: Bennett's Fracture of the Base of the Thumb
Authors: Ellis Harold
Published: December 2017

Bennett's fracture involves part of the base of the metacarpal bone of the thumb. The fracture line runs obliquely and involves the joint between the first metacarpal and the adjacent carpal bone - the trapezium. The shaft of the metacarpal is pulled proximally by the action of the long muscles attached to the thumb, so a fracture-dislocation of the thumb carpo-metacarpal joint results. The injury occurs typically in young men as a result of a blow on the clenched fist, either in a fall or, very often, in landing a blow in boxing. Now this joint happens to be of extreme importance in fine movements of the thumb, because it is here that opposition of the thumb takes place. Look at your own hand; now put the tip of your thumb onto the tip of your index finger; this is opposition and only man and monkeys can carry out this action. It is this important movement that you use when writing, when holding a scissors or a scalpel. When you look at the two bones articulating together they resemble someone sitting on a saddle and the joint, the only one of its kind in your limbs, is appropriately called a ‘saddle joint’.
An Evidence Based Protocol for Preoperative Skin Preparation
Authors: Silva Pedro
Published: December 2017

Surgical site infections (SSIs) represent a major source of morbidity and mortality among surgical patients (Swenson et al 2009). The most common source of SSIs is the patient's own skin flora (Zinn et al 2010). A literature review was performed on the impact of the different intraoperative skin preparation solutions in reducing the risk of SSIs, concluding that 2% chlorhexidine in spirit is the most effective.
Perioperative Nurses' Experiences as Students: The Perceived Status of Being at University
Authors: Tame Susan
Published: December 2017

Literature relating to student experience during post-registration education is limited, and focuses on the outcome of the education rather than on the perspectives of the practitioner about what it is like to be a student. This paper illustrates perceptions of 23 perioperative nurses (the participants) with respect to their experiences as students during continuing professional education. Interviews indicated that, whilst study could be stressful, all the nurses enjoyed their educational experiences. Possession of a university student identification card was perceived as symbolic of raised social status.
Allergic Reaction to a Red Plastic Allergy Alert Patient Identification Bracelet: Implications for Surgical Patient Safety
Authors: Colbert Serryth , Williams John V , Mackenzie Neil , Brennan Peter A
Published: December 2017

We present a case of allergy to a hospital thermally-printed red plastic allergy alert bracelet in a 48 year old lady admitted to the day surgery unit. Two hours postoperatively, an intensely itchy area of erythema and oedema was seen extending from her left wrist distally to the fingers. The bracelet was removed and the rash resolved overnight without further complication. A diagnosis of contact dermatitis was made, secondary to exposure to an agent within the bracelet. We discuss the safety implications for surgical patients unable to wear an identification bracelet and the steps that may be taken to minimise the risk of harm from misidentification. We believe this to be the first documented case of an allergy to a patient identification bracelet in the medical literature.
Do Current Methods for Endotracheal Tube Cuff Inflation Create Pressures above the Recommended Range? A Review of the Evidence
Authors: Grant Thomas
Published: December 2017

Inflation and measurement of endotracheal (ET) tube cuff pressure is often not seen as a critical aspect of care in surgical patients. The morbidity associated by an overinflated cuff has been regularly highlighted in literature, for example mucosal ulceration (Combes et al 2001) and vocal cord paralysis (Holley & Gildea 1971). This article will outline techniques for the methods of inflation based on the latest scientific evidence. The author will seek to examine if intra-operative cuff assessment and monitoring should become routine for the anaesthetic practitioner and if current practice for inflating cuffs creates pressures outside the safe range.
The Role of Navigation in Total Knee Replacement Surgery
Authors: Wong James Min-Leong , Khan Wasim S , Saksena Joyti
Published: December 2017

Since the introduction of modern implants in the 1970s, total knee replacement surgery has been a great clinical and commercial success. Implants and techniques have continued to evolve, driven by the desire for improved function and longevity. However, inaccurate insertion of these implants may cause them to loosen and fail. Computer navigation has been introduced as a modification to existing surgical techniques to improve the accuracy with which the bones are cut prior to inserting the knee replacement implants. Research continues to see if this potentially costly and time consuming technique can contribute to improved longevity of knee replacements.
A Novel Glucose-Insulin Infusion Maintains Perioperative Glycaemic Control through Multiple Transitions of Care
Authors: Renthal Nora , Roe Erin D , Adams-Huet Beverley , Raskin Philip
Published: December 2017

To measure the efficacy of the Glucose-Insulin Infusion–Parkland Protocol (GIPPr) compared to subcutaneous (SC) insulin, blood glucose readings were reviewed in diabetic adults admitted for surgical intervention of a soft tissue or bone infection in Dallas, Texas. Hypoglycaemia occurred in 0.69% of readings in GIPPr-treated patients compared to 4.52% in SC-treated patients. The GIPPr maintained a higher proportion of blood glucose readings between 3.89-10mmol/L compared to SC insulin (85.40% versus 50.68%).
Evaluative survey-questionnaire exploring the perceptions and experiences of endoscopy and sterile service staff
Authors: Cobbold A
Published: December 2017

There is considerable research surrounding professionalization and the barriers that emerging allied health professions may face. In order to develop any emerging profession, the move to voluntary registration and academic qualification will substantially pave the way towards raising the profile and professional recognition with a regulatory governing body. The aim of this evaluative survey-questionnaire was to explore the attitudes and experiences of endoscopy and sterile service staff in their current job roles and to identify any perceived barriers during the proposed transition to professionalization. This article concludes by highlighting the positive and negative aspects of current job roles in relation to job satisfaction, staff retention and career progression opportunities.
Do current methods for endotracheal tube cuff inflation create pressures above the recommended range? A review of the evidence
Authors: Grant Thomas
Published: December 2017

Inflation and measurement of endotracheal (ET) tube cuff pressure is often not seen as a critical aspect of care in surgical patients. The morbidity associated by an overinflated cuff has been regularly highlighted in literature, for example mucosal ulceration (Combes et al 2001) and vocal cord paralysis (Holley & Gildea 1971). This article will outline techniques for the methods of inflation based on the latest scientific evidence. The author will seek to examine if intraoperative cuff assessment and monitoring should become routine for the anaesthetic practitioner and if current practice for inflating cuffs creates pressures outside the safe range.
The Challenge of Creating a ‘We'Re All in this Together’ Culture in Addenbrooke's Theatres
Authors: Ward Maggie , Harrison Julia
Published: December 2017

In the wake of seven consecutive never events in theatres during 2011–2012, senior managers at Addenbrooke's had a challenge – to raise morale and support staff to fully support the WHO surgical safety checklist process. Theatres operations manager Maggie Ward and the theatres team took some innovative steps to change culture in theatres.
White Ship - Red Crosses. Reflections on a Falklands War Experience
Authors: Pugh M/S Nicci
Published: December 2017

I first joined the National Association of Theatre Nurses (NATN) in 1974, which must make me nearly as old as the 50th anniversary you are commemorating this year! The previous year I had successfully completed the English National Board (ENB) course in Operating Theatre (OT) Technique at St. George's Hospital SW1, and would soon be appointed the youngest OT sister at the Royal Cornwall Hospital, Treliske. From 1980 to 1985 I served a Short Service Commission in Queen Alexandra's Royal Naval Nursing Service (QARNNS), as a direct result of answering an advertisement in the then printed NATN journal. So, it could be said, I owe a great deal to the forebears of AfPP! It was, therefore, both a surprise and privilege to be invited by one of your Trustees, Adrian Jones, to write this article for the fiftieth anniversary of our association, covering the role of Her Majesty's Hospital Ship Uganda during the Falklands War, fought between Britain and Argentina in 1982.
A Typical Day in Cardiac Theatres… Or Was It? Expect the Unexpected!
Authors: Joseph Minija , Relano Rodolfo
Published: December 2017

The operating theatre department is a high risk area and the expectations from the surgical teams are very high in terms of delivering safe and good quality patient care. As healthcare practitioners working in this complex environment we are the guardians of our patients and are their eyes and ears. Scrub practitioners need to be focused, alert and vigilant during all surgical procedures and avoid complacency. As this incident account shows, never take anything for granted.
The Surgical First Assistant: Are you Compliant?
Authors: Quick J , Hall S
Published: December 2017

It is over a century now since the importance of the knowledge and skills of the surgeon's assistant were first considered (Brickner 1907). More recently both the Royal College of Surgeons of England (RCSE 1999, 2011) and the Perioperative Care Collaborative (PCC 2007) have reviewed the role of the non-medically qualified surgical assistant. In 2012, the PCC published their review of the surgical first assistant (SFA) role in response to a call by the RCSE for greater clarity in relation to the plethora of titles afforded to non-medical surgical assistants (RCSE 2011).
An Unusual Finding at Laryngoscopy: Remember All is Not Always What it Seems!
Authors: Collins Jpw , Kzreminska K
Published: December 2017

We present the unexpected finding of an unusual upper airway foreign body during induction of anaesthesia in a six year old girl. We review the aetiology and management of upper airway foreign bodies, discussing the role of the anaesthetic practitioner in extracting such items, and remind the reader of the potential hazard of task-fixation during tracheal intubation.
Admiral Nelson's above Elbow Amputation
Authors: Ellis Harold
Published: December 2017

The loss of Horatio Nelson's right arm is undoubtedly the best known amputation in this country's history and the story is well worth the telling. In 1797, the 38 year old Nelson, then a Rear Admiral, devised a plan for a surprise night attack to seize treasure ships, which he believed were sheltering at Santa Cruz on Tenerife, (one of the Canary Islands). On the night of July 24th, Nelson led an armada of rowing boats from his fleet, anchored below the horizon. The plan was to land on the harbour mole and then rush the main square of the town. Unfortunately, the Spaniards were ready for them. As the little boats approached the harbour, the Spaniards opened fire with cannon and muskets and the British losses were heavy. As Nelson scrambled off his boat his right arm was shattered with grapeshot; “I am shot through the arm, I am a dead man” he exclaimed.
Accountability versus Blame
Authors: Moss Sir Stephen
Published: December 2017

The exam question “Who should be held to account for the delivery of safe, effective and compassionate care?”
Perceptions of the Assistant Theatre Practitioner Role: A View from My Ivory Tower
Authors: Weir J
Published: December 2017

At a recent AfPP event, during a debating session amongst fellow perioperative practitioners, the role and remit of assistant theatre practitioner (ATP) was raised. The debating panel's views were sought from several quarters and the subject seemed to spark discussion and much ‘harrumphing’ in the audience. A recently qualified ATP, who, having spent an intensive two years studying for a foundation degree, expressed his frustration about on-going role ambiguity and the struggle to have his newly acquired knowledge and skills recognised in practice. As a heated discussion went around the room, polarised views were emergent, in particular themed around concerns about delegation, accountability and scope of practice.
The First Identical Twin Renal Transplant
Authors: Ellis Harold
Published: December 2017

There is no doubt that it was the work of one man, Alexis Carrel, which laid the foundations of modern organ transplantation. Working first in his native city of Lyons, then in Chicago and finally at the Rockefeller Institute New York, he developed the techniques of successful anastomosis of blood vessels, using extremely fine silk sutures and tiny needles. As early as 1892, he successfully grafted a kidney into the neck of a dog. He was soon able to demonstrate that, although a dog's kidney transplanted into its own neck could survive, even when the opposite kidney was excised, transplant of a kidney to another animal would fail after a few days. Further experiments included transplantation of other organs, including ovary, thyroid, lower limb and heart. In 1914 he wrote to fellow Nobel Prize winning Swiss surgeon, Theodor Kocher about his experiments; “Concerning homoplastic transplantation (from one animal to another) of organs such as the kidney, I have never found positive results to continue after a few months, whereas in autoplastic transplants the results were always positive. The biological side of the question has to be investigated very much more and we must find out by what means to prevent the reaction of the organism against a new organ” (my italics). This, in fact, was going to occupy the next half century of world wide research!
Process Management
Authors: Stott Dawn L
Published: December 2017

Continuously meeting, and exceeding, the needs of our customers is one of the core requirements for any successful organisation. This is no different for hospital trusts when providing secondary health services within the UK, they are continually in the spotlight to save costs and are being urged to take on the role of ‘small businesses’ and have an independent view of their business and their stakeholders.
Pathophysiology and Perioperative Management of Sickle Cell Disease
Authors: Paradowski K
Published: December 2017

Sickle cell disease has become the most common genetic condition in some European countries (Roberts & De Montalembert 2007). The disease is characterised by the painful sickle cell crisis often experienced by sufferers. This article sets out to examine the pathophysiology of this disease, alongside the factors that perioperative practitioners need to be aware of in order to reduce the risk of triggering a sickle cell crisis.
“They Seem to be Able to Read Your Mind.” An Interview Study to Identify the Cognitive Non-Technical Skills of Anaesthetic Assistants
Authors: Rutherford Js , Flin R , Mitchell L
Published: December 2017

The aim of this study was to identify the cognitive non-technical skills (i.e. situation awareness and decision making) used by anaesthetic assistants, as part of the development of a specialty-specific behavioural rating system for anaesthetic assistants. Semi-structured interviews were conducted with anaesthetic assistants (n=22), anaesthetic consultants (n=11) and trainee anaesthetists (n=12) in Scotland. The interviews were transcribed and thematically analysed. All 45 participants described the presence or failure of situation awareness (i.e. gathering information, its comprehension and anticipation) in 713 phrases. Decision making (i.e. considering options, selecting actions and reviewing decisions) by the anaesthetic assistants was reported much less frequently – only 34 participants described 89 phrases. Situation awareness is a key non-technical skill used by anaesthetic assistants, however decision making was less commonly described as required by anaesthetic assistants. This provides qualitative data to support the development of a non-technical skills taxonomy for anaesthetic assistants.
Tools for the Assessment of the Recovery Process following Discharge from Day Surgery: A Literature Review
Authors: Stomberg Margareta Warrén , Saxborn Eva , Gambreus Sofia , Brattwall Metha , Jakobsson J
Published: December 2017

This literature review provides an overview of ten studies which assessed the patient's general recovery after discharge from hospital following elective surgery and anaesthesia. Ten multidimensional tools were identified and these included six common domain assessments: pain, physiological function, activities of daily living (ADL), emotions, nausea/vomiting and nutrition/ elimination. Most of the tools assessed the recovery process by using patient-subjective reported outcomes on visual analogue (VAS) or pre-graded scales.
An Interview with Professor Jane Reid
Authors: Fisher M Guckian
Published: December 2017

This is the first in a series of interviews planned with key people of interest who influence perioperative practice and patient care.
Difficulties in Intraoperative Care
Authors: Mauléon Annika Larsson , Ekman Sirkka-Liisa
Published: December 2017

Difficult situations which occur intraoperatively have a direct impact on nurses working within the area. A study was undertaken focusing nurses' confrontations with difficult situations where the narrations from twelve nurses were taped. A phenomenological method was used to analyse this information and revealed how difficult intraoperative situations arise and how the nurses found different ways of handling these situations.
A Review of Shoulder Replacement Surgery
Authors: Wand RJ , Dear KEA , Bigsby E , Wand JS
Published: December 2017

Shoulder replacement surgery is employed in the treatment of severe shoulder arthritis and following some proximal humeral fractures. Three different replacements are available: hemiarthroplasty (HAS), total shoulder replacement (TSR) and reverse shoulder replacement (RSR). HAS and TSR are indicated in patients with intact rotator cuffs and RSR for cuff deficient older patients. Outcomes are favourable, with the majority of patients having improvements in shoulder pain and function.
A Critical Guideline Appraisal Overview: Choice Framework for Local Policy and Procedures (CFPP) 01-01: Management and Decontamination of Surgical Instruments (Medical Devices) Used in Acute Care. Part A: The formulation of Local Policy and Choices Manual Version 1.0: England
Authors: Cobbold Angela , Lord Sue
Published: December 2017

Efficient decontamination of reusable invasive surgical instruments (medical devices) endeavours to eliminate inadvertent transmission of disease by infectious agents and human prions. Although there are several pertinent regulatory British, European and international decontamination standards to adhere to, the Department of Health (DH) is now emphasising the need for individual departments to be proactive in the local decision-making processes, with the aim of improving patient experience in line with health policy direction and support. The following article aims to address some of the questions that many nursing and allied health professionals may want to be answered in relation to Part A of this series.
The Principles and Practice of Interpreting Cardiac Rhythm Strips: A Seven-Step Model
Authors: McCutcheon K , Rogers Kma
Published: December 2017

This open learning zone article examines the cardiac cycle and the interpretation of cardiac rhythm strips. The article begins with a brief revision of related physiology followed by a description of normal sinus rhythm and the main cardiac rhythm abnormalities. The article concludes by providing easy to follow steps for use in the interpretation of cardiac rhythm strips with practice examples presented in the continuing professional development (CPD) task section.
Edward Cock: Cock's ‘Peculiar Tumour’
Authors: Ellis Harold
Published: December 2017

I must first apologise to my readers for including in this series a condition which I have never personally seen in 40 years of general surgery, nor, I believe, have any of the readers of this article. My excuse is that the condition has such a charming name and that the surgeon, Edward Cock, was such an interesting character.
Positioning of the Anaesthetised Patient during Robotically Assisted Laparoscopic Surgery: Perioperative Staff Experiences
Authors: Mangham M
Published: December 2017

Safe, patient centred care is a large part of our trust values at the Royal Wolverhampton NHS Trust. Robotic assisted laparoscopic surgery (RALS) is still in its infancy within our trust, and we decided to look at what we have learned so far regarding patient positioning during robotic surgery for gynae-oncology and uro-gynae procedures. We also considered what we believe needs to be achieved in order to deliver high standards of care in positioning patients during robotic surgery, not only now, but also for the future of robotic surgery.
Increasing Operating Room Efficiency through Electronic Medical Record Analysis
Authors: Attaallah AF , Elzamzamy OM , Phelps AL , Ranganthan P , Vallejo MC
Published: December 2017

We used electronic medical record (EMR) analysis to determine errors in operating room (OR) time utilisation. Over a two year period EMR data of 44,503 surgical procedures was analysed for OR duration, on-time, first case, and add-on time performance, within 19 surgical specialties. Maximal OR time utilisation at our institution could have saved over 302,620 min or 5,044 hours of OR efficiency over a two year period. Most specialties (78.95%) had inaccurately scheduled procedure times and therefore used the OR more than their scheduled allotment time. Significant differences occurred between the mean scheduled surgical durations (101.38 ± 87.11 min) and actual durations (108.18 ± 102.27 min; P<0.001). Significant differences also occurred between the mean scheduled add-on durations (111.4 ± 75.5 min) and the actual add-on scheduled durations (118.6 ± 90.1 minutes; P<0.001). EMR quality improvement analysis can be used to determine scheduling error and bias, in order to improve efficiency and increase OR time utilisation.
A Pathway to Clinician-Led Culture Change in the Operating Theatre
Authors: Gibbs J , Smith P
Published: December 2017

Noise in the operating theatre environment has remained a persistent and unresolved problem (Szalma & Hancock 2011). The problem currently lacks an effective solution (Schafer et al 2012). In order to partially resolve this issue, the authors created a behavioural noise reduction tool called ‘Below Ten Thousand’. This study identifies a potential solution to the problem of behavioural noise in the operating theatre, and indicates further research must be undertaken to identify the full scale of benefits this technique can deliver to the team environment in the operating theatre.
The Pathophysiology of Coronary Heart Disease from a Student's Perspective
Authors: White C
Published: December 2017

It is estimated that 2.3 million people in the UK are living with coronary heart disease (CHD) (ONS 2014a). It is therefore important to have a deeper understanding of the pathophysiology of the condition and an awareness of the complex interplay of contributory factors. Written from the perspective of a student ODP, this article investigates the aetiology, presentation and progression of the disease, and puts CHD into the context of the emerging anaesthetic practitioner's practice.
ASA Grading: A Step Forward
Authors: Kannan T
Published: December 2017

ASA grading is universally used as a predictor of postoperative outcome. It has been incorporated as part of the WHO checklist to make everyone involved in patient care aware of the patient's physical status, and infer a possible postoperative outcome. Everyone in theatre involved in the care of the patient is aware of the patient's physical status, except the patient! This article is an innovative way of representing ASA physical status to enhance patient involvement and understanding, and to facilitate shared decision making.
Operating Department Practitioners Care of the Patient with Diabetes in the Perioperative Period
Authors: Morley N
Published: December 2017

Diabetes mellitus (DM) is a of group metabolic diseases which are defined by hyperglycaemia affecting multiple organs. The condition is found in people of all ages and ethnicities. Diabetes mellitus affects 180 million people worldwide and increasing numbers of patients are presenting with diabetic complications and the need for surgical intervention. This article describes the pathophysiology of DM and the management of the condition, particularly type I and type 2, in the perioperative phase of the surgical patient journey.
Career Opportunities for Theatre Practitioners
Authors: Lord Susan
Published: December 2017

Never have there been such a vast number of career opportunities for all levels of staff within the perioperative environment including healthcare support workers, operating department practitioners and nurses.
Patients' Experiences with At-home Preoperative Skin Disinfection before Elective Hip Replacement Surgery
Authors: Qvistgaard M , Österberg Sofia Almerud , Heikkilä K , Thorén A-B , Lovebo J
Published: December 2017

The aim of the study was to describe patients' experiences with preoperative skin disinfection carried out in their home before elective hip replacement surgery with the aim of lowering the microbial burden and avoiding surgical site infections. The literature was reviewed for relevant studies. Optimal preparations before surgery depend on patients being able to assimilate preoperative information and instructions. The study was based on 14 interviews with patients who had undergone elective hip replacement surgery. Data were analysed with qualitative manifest content analysis according to Graneheim and Lundman (2004). The main categories of findings were: patients' experience of obstacles and limitations, the importance of supportive surroundings, and personal resources as strength when performing preoperative skin disinfection. The findings of this study agree with earlier studies showing a lack of compliance to preoperative skin disinfection. The findings also suggest reasons for non-compliance. Preoperative skin disinfection involves many important steps that need to be accomplished to ensure the maximum effect on microbial burden on skin surface. These steps can be difficult for some patient groups. Perioperative dialogue is one way to identify patients' individual needs and to help patients participate in the process. The study concludes that patients who carried out skin disinfection at home before surgery have a great responsibility to prepare themselves. The challenge for perioperative nurses who work with preoperative information is to identify and individually guide those patients who need extended support so that all patients with elective hip replacement surgery receive the same quality of care. Further research should focus on how caregivers discover individuals with extended needs and on identifying the kind of support that is effective to achieve optimal conditions for hip replacement surgery.
Hospital Stay and Blood Transfusion in Elderly Patients with Hip Fractures
Authors: Iliopoulos E , Yousaf S , Watters H , Khaleel A
Published: December 2017

Neck of femur (NOF) fractures in elderly patients are the most frequent condition which an orthopaedic surgeon confronts nowadays. The incidence of these fractures is increasing as the population continues to age. These patients absorb the majority of the resources in the hospitals, as their healthcare demands are increased. This study included all patients who were admitted to our hospital between January and October 2015 following a neck of femur fracture. A total of 336 patients were included (72.3% female). We gathered demographic and hospitalisation data from patients’ files. Haemoglobin (Hb) levels at admission and transfusion data were also collected. Male patients appeared to have a relatively higher risk of mortality than females (p=0.01). Patients with high ASA grade (IV) had a higher mortality rate (p=0.01). Age, delay of surgery, type of surgery, AMTS and Hb at admission and type of fracture on the other hand did not have a significant impact on mortality (p>0.05). Patients who needed transfusion during their hospitalisation had significantly lower Hb at admission (p=0.044). More specifically, patients who had Hb<110 at admission were more likely to need transfusion (p<0.001). Hospitalisation of patients who needed transfusion was significantly prolonged. In our effort to deliver the best services to our patients, this study considers transfusing the elderly patients with low Hb at admission (Hb<110) pre-operatively, with a view to increasing their reserves for the operation and potentially speeding up the rehabilitation process and decreasing their hospitalisation time.