bluuebunny/crossref_metadata_2025_split huggingface dataset:
The co-production of public value in community development: can street-level professionals make a difference?
Authors: Vanleene Daphne , Voets Joris , Verschuere Bram 
Published: January 2019

This article deals with the different roles of the street-level professional in achieving public value in a co-productive community development project. The article focuses, in particular, on the question of how engaged street-level professionals combine different roles – as friend, leader, representative and mediator – in order to empower and include their target audience, thereby contributing to public value creation. This question was explored in a qualitative case study in a community development project in Ostend (Belgium). The study indicated that the street-level professional needed to adopt different role combinations in a well-considered way in order to influence the co-productive process that affected public value creation. More specifically, the combination of friend–leader, as well as the leader–mediator combination, can empower co-producers and thus create personal value for these co-producers. Moreover, professionals carefully consider the combination of friend–leader to support community value over personal value. Also, by combining the friend, leader and representative roles, professionals can include more co-producers and create a stronger sense of community value. This article concludes that there is a need for an engaged professional who has sufficient time and autonomy to apply the combinations as needed. Additionally, we note that more research on these different role cocktails is necessary in order to provide a clear framework of the different combinations that professionals can apply. Points for practitioners From our research, we can make two key recommendations for practitioners. First, in order to empower and include vulnerable participants to co-produce, professionals need to develop the right skill set to fulfil the roles needed to engage with participants. Second, and relatedly, this also implies sufficient autonomy (vis-a-vis policymakers) for the professionals at the street level, which will enable them to consider what is needed for the co-production project to become successful in terms of inclusion and empowerment.
Hand hygiene compliance and accuracy in a university dental teaching hospital
Authors: Cheng Hsin-Chung , Peng Bou-Yue , Lin Meei-Liang , Chen Sam Li-Sheng 
Published: January 2019

Objective This study aimed to evaluate compliance with guidelines on hand hygiene by examining five handwashing categories in postgraduate year (PGY) dentists at a university teaching hospital and to evaluate the accuracy rates of handwashing. Methods Through direct observation, trained PGY dentists were monitored throughout their daily care routine of before contact with patients, before using an instrument, after contact with patients, upon direct exposure to patients’ fluids, and while touching the patients’ surrounding area. Hand hygiene opportunities were considered complete in each category. A total of 16,597 hand hygiene opportunities across 37 individuals were observed from July to October 2012 and from September to October 2013. Results The overall handwashing compliance rate was 34.7%. The handwashing compliance rate was higher during work in oral surgery services (92.8%) than during work in general clinical practice (34.2%). The accuracy rate of handwashing was also higher during work in oral surgery services (87.5%) than during work in general clinical practice (51.0%). Similar results were obtained across all five handwashing categories. Conclusions Handwashing compliance and accuracy rates are low in PGY dentists. More education and continuous monitoring are suggested to improve handwashing compliance, as well as the correct handwashing procedures for dentists.
An Analysis of Excess Mortality not Predicted to Occur by Apache III in an Australian Level III Intensive Care Unit
Authors: Buist M. , Gould T. , Hagley S , Webb R. 
Published: January 2019

The APACHE III derived standardized mortality ratio has been suggested as a statistic to measure intensive care unit (ICU) effectiveness. From 1991 data collected on 519 consecutive admissions to the Royal Adelaide Hospital ICU a standardized mortality ratio of 1.25 was calculated. Of the 174 deaths only 95 had a prediction of death greater than 0.5. As part of a quality assurance study we undertook a retrospective case note audit to try to identify factors that were associated with the low mortality prediction (<0.5) in hospital deaths. Firstly we analysed the patient population that died to determine the factors that were different between patients who had a mortality prediction of greater than 0.5 versus those who had a mortality prediction of less than 0.5. Next we analysed the patient population with a mortality prediction of less than 0.5 and compared actual survivors with patients who died in hospital. Amongst low mortality prediction patients admitted to the Royal Adelaide Hospital ICU we identified age, a history of acute myocardial infarction, presentation to ICU after a cardiac arrest or with an elevated creatinine and the development of acute renal failure and septicaemia during the ICU admission as being associated with in-hospital mortality. We also documented that late hospital deaths on the ward after ICU discharge occurred more frequently with low predicted hospital mortality ICU patients. Factors other than the APACHE III score may be associated with hospital deaths of ICU patients.
The European Donor Hospital Education Programme (EDHEP): Enhancing Communication Skills with Bereaved Relatives
Authors: Morton J. , Blok G. A. , Reid C. , Van Dalen J. , Morley M. 
Published: January 2019

Intensive care medical and nursing staff self-rate their communication skills as improved following attendance at the European Donor Hospital Education Programme (EDHEP) workshop. A prospective study was conducted to determine what impact EDHEP has on communication skills. Doctor-nurse pairs from 10 experimental and 10 control Intensive Care Units undertook two standardized simulated relative encounters (Breaking Bad News and Donation Request) at three measurement points (pre, post and follow-up). Nurses showed no change in communication skills. Experimental group doctors showed significant improvement in breaking bad news and requesting donation; most of these improvements were not maintained. Control group doctors showed some improvement in breaking bad news, indicating that participating in measurement by itself initiates some transient change in communication skills. Attendance at EDHEP does lead to significant improvement in some, but not all, communication skills essential in breaking bad news and requesting donation. Further research is necessary to determine what factors additional to EDHEP will contribute to enduring change in these particular skills.
A Comparison of the GlideScope® with the Macintosh Laryngoscope for Tracheal Intubation in Patients with Simulated Difficult Airway
Authors: Lim Y. , Yeo S. W. 
Published: January 2019

We compared the use of the GlideScope® and the conventional Macintosh laryngoscope in a simulated difficult airway. The primary hypothesis was that time to intubation would be shorter using the GlideScope® than using the Macintosh laryngoscope. After obtaining approval from the ethics committee and written informed consent, we recruited 60 ASA 1 and 2 patients to our randomized controlled trial. Group G (n=30) had tracheal intubation performed using the GlideScope® and Group M (n=30) were intubated using a Macintosh laryngoscope. We simulated a difficult airway in each patient by having an experienced assistant provide in-line manual stabilization of the head and neck. We recorded the best laryngeal view; difficulty of the tracheal intubation; time taken for successful tracheal intubation; manoeuvre needed to aid tracheal intubation and complications associated with the tracheal intubation. The median Cormack and Lehane grade was significantly better in Group G than Group M. Group G had a significantly shorter intubation time than group M (mean 41.8s±SD 20.2 vs mean 56.2s±26.6, P<0.05). The GlideScope® improved the laryngeal view and decreased time for tracheal intubation time when compared with the Macintosh laryngoscope in patients with simulated difficult airway. The GlideScope® may be a good alternative for managing the difficult airway but clinical trials evaluating its use on patients with an actual difficult airway are needed.
Effect of Low-Dose Vasopressin Infusion on Vital Organ Blood Flow in the Conscious Normal and Septic Sheep
Authors: Di Giantomasso D. , Morimatsu H. , Bellomo R. , May C. N. 
Published: January 2019

The effect of low-dose vasopressin (AVP) on vital regional circulations may be clinically relevant but has not been fully described. We sought to determine the effect of low-dose AVP on systemic haemodynamics, coronary, mesenteric and renal circulations in the conscious normal and septic mammal. We studied seven Merino sheep using a prospective randomized cross-over double-blind placebo-controlled animal design. We inserted flow probes around aorta, coronary, mesenteric and renal arteries and, three weeks later, we infused low-dose AVP (0.02 IU/min) or placebo in the normal and septic state induced by intravenous E.coli. In normal sheep, AVP (0.02 IU/min) induced a 17% decrease in mesenteric blood flow (393.0±134.9 vs 472.1± 163.8 ml/min, P<0.05) and a 14% decrease in mesenteric conductance (P<0.05). In septic sheep, AVP decreased heart rate and cardiac output by 28% and 22%, respectively (P<0.05). It also decreased mesenteric blood flow and mesenteric conductance by 23% (flow: 468.5±159.7 vs 611.3±136.3 ml/min, P<0.05; conductance: 6.3±2.7 vs 8.2±2.7 ml/min/mmHg; P<0.05). Renal blood flow was unchanged but urine output and creatinine clearance increased (P<0.05). We conclude that low-dose AVP infusion has similar effects in the normal and septic mammalian circulation: bradycardia, decreased cardiac output, decreased mesenteric blood flow and conductance and increased urine output and creatinine clearance. This information is important to clinicians considering its administration in humans.
The ProSeal™ Laryngeal Mask Airway is an Effective Alternative to Laryngoscope-Guided Tracheal Intubation for Gynaecological Laparoscopy
Authors: Lim Y. , Goel S. , Brimacombe J. R. 
Published: January 2019

We tested the hypothesis that the ProSeal™ laryngeal mask airway is superior to laryngoscope-guided tracheal intubation for gynaecological laparoscopy. One-hundred and eighty consecutive patients (ASA grade 1-2, aged 18-80y) were divided into two equal-sized groups for airway management with the ProSeal™ laryngeal mask airway or tracheal tube. Induction was with fentanyl/propofol, maintenance with sevoflurane and muscle relaxation with atracurium. The following primary variables were tested: time to achieve an effective airway, ventilatory capability, peak airway pressure before and after pneumoperitoneum, duration of surgery and pneumoperitoneum and haemodynamic responses. Data about gastric size, airway trauma and sore throat were collected. The number of attempts for successful insertion were similar, but effective airway time was shorter for the ProSeal™ laryngeal mask airway (20±2s vs 37±3s, P<0.001). All devices were successfully inserted within three attempts. There was no episode of failed ventilation or hypoxia. The haemodynamic stress responses to insertion and removal were greater for the tracheal tube than the ProSeal™ laryngeal mask airway. The duration of surgery, duration of pneumoperitoneum and intraabdominal pressures were similar. Gastric size was similar at the start and end of surgery. There were no differences in the frequency of complications or sore throat. We conclude that the ProSeal™ laryngeal mask airway is a similarly effective airway device to conventional laryngoscope-guided tracheal intubation for gynaecological laparoscopy, but is more rapidly inserted and associated with an attenuated haemodynamic response to insertion and removal.
The Evaluation of Anaesthesia-related Information on the Internet
Authors: Corcoran T. B. , Ward M. , Jarosz K. , Schug S. A. 
Published: January 2019

The quality and accessibility of anaesthesia-related information available to patients on the internet is a growing concern for the specialty. We sought to evaluate the quality of anaesthesia-related websites using a simple scoring system. The scoring system comprised quality and technical scores individually, and these were also combined into a total score. Test-retest reliability was assessed by calculating intraclass correlation coefficients. We employed the four most popular search engines and one meta-search engine, using the search term “general anaesthesia”. Only the first 10 sites retrieved were scored. The intraclass correlation coefficients for all terms demonstrated at least moderate agreement and the total scores demonstrated high consistency r=0.852, 0.774 (P <0.001, and P <0.003 respectively). There were 18 duplicate websites and 32 were scored. There was no difference between search engines for any of the three scores awarded. The majority of websites were rated as either ‘poor’ or fair’ across all scores. Our study indicates that quality anaesthesia-related information is unlikely to be retrieved by patients using the internet.
A Survey of Anaesthetists' Perspectives of Communication in the Operating Suite
Authors: Elks K. N. , Riley R. H. 
Published: January 2019

We surveyed 222 anaesthetists attending a University of Western Australia conference (n=110) and two public hospitals in Perth (n=112) by anonymous questionnaire in March 2006 regarding communication issues in the operating suite. Forty-one percent (n=92) responded. Questions concerned communication skills, experiences of good and poor communication and relationship to outcome, attitudes to music and communication courses. Stress in anaesthetists due to poor communication, staff naming practices, information on courses with communication content attended and attitudes to non-verbal communication were also surveyed. Anaesthetists’ communication skills were self-rated as “very good” by 52% and “average” by 39% of respondents. It was strongly agreed that good verbal communication leads to better patient outcome (57%) and was important between surgeons and anaesthetists (76%). Regarding the current state of surgeon/anaesthetist communication, 25% (23/92) agreed this was acceptable, 33% (30/92) were undecided and 42% (39/92) regarded this as poor. Silence in theatre was generally not desired, 71% preferring background music. Ninety-nine percent of respondents believed good communication decreased stress and 89% felt personally stressed in situations where poor communication occurred. Email/text communication was not preferred to spoken language regarding case information. Sixty-four percent of respondents would attend a communications course voluntarily, with implementation of a compulsory communications course supported by 45%. Most anaesthetists surveyed used staff first names and 94% believed poor communication caused procedural delay. The data suggest that further work is required to improve communication in the stressful operating room environment, particularly at the surgeon/anaesthetist interface.
Tropisetron plus Subhypnotic Propofol Infusion is more Effective than Tropisetron Alone for the Prevention of Vomiting in Children after Tonsillectomy
Authors: Erdem A. F. , Yoruk O. , Silbir F. , Afici H. A. , Cesur M. , Dogan N. , Aktan B. , Sutbeyaz Y. 
Published: January 2019

This study evaluated the efficacy of tropisetron compared with tropisetron and a subhypnotic propofol infusion in preventing postoperative vomiting following tonsillectomy. One hundred and forty healthy children, aged four to 12 years, undergoing tonsillectomy were recruited in a randomised, double-blind study. After induction with sevoflurane, anaesthesia was maintained with sevoflurane and nitrous oxide. All patients received tropisetron (0.2 mg/kg up to 5 mg; intravenously) and fentanyl (2 μg/kg; intravenously) and were intubated after atracurium which was reversed with neostigmine (and atropine). The tropisetron-plus-propofol group received a single dose of propofol (1 mg/kg) before intubation and a continuous infusion of propofol throughout surgery at 15 μg/kg/min. Data for postoperative vomiting were grouped into zero to four and four to 24 hour time intervals. A P value of <0.05 was considered statistically significant. The percentage of patients exhibiting a complete response (no retching or vomiting for 24 hours) was 47.1% (33/70) in the tropisetron-alone group and 72.8% (51/70) in the tropisetron-plus-propofol group (P=0.002). The 0.257 absolute risk reduction of vomiting with the addition of propofol represents a number needed to treat of 3.87, and a risk ratio of 0.51 (95% CI 0.32 to 0.79). Significantly fewer patients vomited in the tropisetron-plus-propofol group than in the tropisetron-alone group during the zero to four post-surgery interval (P=0.016), but the difference was not statistically significant for the four to 24 hour postoperative period (P=0.116). Intraoperative subhypnotic propofol infusion combined with tropisetron is more effective than tropisetron alone in reducing postoperative vomiting after tonsillectomy in children.
Differential Increases in Blood Flow Velocity in the Middle Cerebral Artery after Tourniquet Deflation during Sevoflurane, Isoflurane or Propofol Anaesthesia
Authors: Kadoi Y. , Kawauchi C. H. , Ide M. , Saito S. , Mizutani A. 
Published: January 2019

The purpose of this study was to examine the comparative effects of sevoflurane, isoflurane or propofol on cerebral blood flow velocity after tourniquet deflation during orthopaedic surgery. Thirty patients undergoing elective orthopaedic surgery were randomly divided into sevoflurane, isoflurane and propofol groups. Anaesthesia was maintained with sevoflurane, isoflurane or propofol infusion in 33% oxygen and 67% nitrous oxide, in whatever concentrations were necessary to keep bispectral index values between 45 and 50. Ventilatory rate or tidal volume was adjusted to target PaCO2 of 35 mmHg. A 2.0 MHz transcranial Doppler probe was attached to the patient's head at the temporal window and mean blood flow velocity in the middle cerebral artery was continuously measured. The extremity was exsanguinated with an Esmarch bandage and the pneumatic tourniquet was inflated to a pressure of 450 mmHg. Arterial blood pressure, heart rate, velocity in the middle cerebral artery and arterial blood gas analysis were measured every minute for 10 minutes after release of the tourniquet in all three groups. Velocity in the middle cerebral artery in the three groups increased for five minutes after tourniquet deflation. Because of the different cerebrovascular effects of the three agents, the degree of increase in flow velocity in the isoflurane group was greater than in the other two groups, the change in flow velocity in the propofol group being the lowest (at three minutes after deflation 40∓7%, 32∓6% and 28∓10% in the isoflurane, sevoflurane and propofol groups respectively, P <0.05).
Pilot Study of the Air-Q Intubating Laryngeal Airway in Clinical Use
Authors: Bakker E.J. , Valkenburg M. , Galvin E. M. 
Published: January 2019

The air-Q Intubating Laryngeal Airway (ILA) is a newly introduced extraglottic airway device. In this pilot study, we evaluated its use as a routine airway device during positive pressure ventilation. Ease of endotracheal intubation through the device was also assessed. Fifty-nine ASA I and II patients undergoing elective surgery received an air-Q ILA and an endotracheal tube where indicated. Insertion, ventilation and intubation characteristics were noted, as well as throat morbidity and occurrence of adverse events. An air-Q ILA was successfully inserted in 100% of patients. Mean leak pressure was 19±5 cmH2O. Endotracheal intubation was indicated in 19 patients and successful in 58% on the first attempt and 74% in total. Ten percent of the study patients were noted to have dysphagia. One patient was diagnosed with bilateral lingual nerve injury but made a complete recovery in four weeks. The air-Q ILA is an adequate extraglottic airway device in terms of insertion and ventilation. However, the proposed advantage of ease of endotracheal intubation requires further investigation.
Out-of-Hours Surgery – a Snapshot in Time
Authors: O'Loughlin E. , Smithies W. J. , Corcoran T. B. 
Published: January 2019

Anaesthesia in Australia is amongst the safest in the world. This record of safety is under threat from increasing pressures to operate at times of poor human performance, particularly late at night. Our institution has a policy mandating the prioritisation of surgery based on clinical need while minimising the risks associated with after-hours surgery. The policy states that “only Category 1 (urgent, needing immediate surgery) and Category 2 cases which cannot wait until the morning should be done between 2230 and 0800”. From 5 March 2007 we performed an eight-week prospective audit of all cases where surgery occurred in this time period. The anaesthetic senior registrar on duty recorded the clinical priority of the case. There were 95 cases commenced between 2230 and 0800 hours during the audit period, of which 28 (30%) were in clear breach of this policy, in some cases delaying urgent surgery. The potential implications of such breaches are significant in the context of worse outcomes for patients undergoing surgery in the after-hours period. When non-urgent cases occupy resources, the capacity of the system to deal with the truly urgent case is significantly impaired. Adequate ‘in-hours’ resourcing, capacity and appropriate scheduling may be key to maintaining the excellent safety record of anaesthesia. A large study prospectively examining morbidity, error and outcomes of after-hours operating would serve to further elucidate the risk benefit ratio of after-hours operating.
Ultrasound-Guided Axillary Plexus Block in a Child with Dystrophic Epidermolysis Bullosa
Authors: Englbrecht J. S. , Langer M. , Hahnenkamp K. , Ellger B. 
Published: January 2019

We report the use of ultrasound-guided axillary brachial plexus block in a child with dystrophic epidermolysis bullosa needing surgical treatment of the right hand. The regional anaesthesia was used in association with sedation/anaesthesia. This technique is suitable for these difficult patients because it can minimise the risk of new bullae formation due to palpation of landmarks or unintentional intra- or subcutaneous injections. Initial anaesthesia/sedation was provided with sevoflurane until intravenous access was obtained, following which intravenous propofol infusion with ketamine boluses without any invasive airway management was continued for performance of the block and the procedure. This management plan provided good surgical conditions, early postoperative analgesia, minimised stress for the patient and avoided the need to manipulate the airway with instruments and the associated risk of mucosal bullae. The classification and breadth of clinical manifestation of epidermolysis bullosa is complex and briefly summarised. The anaesthetist should clarify the details of a particular patient's form of epidermolysis bullosa, especially in terms of mucosal involvement, as this may greatly influence planning for a procedure.