Capital planning for operating theatres based on projecting future theatre requirements.

PubMed

Sheehan, Jennifer A; Tyler, Peter; Jayasinha, Hirani; Meleady, Kathleen T; Jones, Neill

2011-05-01

During 2006, NSW and ACT Health Departments jointly engaged KPMG to develop an Operating Theatre Requirements' Projection Model and an accompanying planning guideline. A research scan was carried out to identify drivers of surgical demand, theatre capacity and theatre performance, as well as locating existing approaches to modelling operating theatre requirements for planning purposes. The project delivered a Microsoft Excel-based model for projecting future operating theatre requirements, together with an accompanying guideline for use of the model and interpretation of its outputs. It provides a valuable addition to the suite of tools available to Health staff for service and capital planning. The model operates with several limitations, largely due to being data dependent, and the state and completeness of available theatre activity data. However, the operational flexibility built into the model allows users to compensate for these limitations, on a case by case basis, when the user has access to suitable, local data. The design flexibility of the model means that updating the model as improved data become available is not difficult; resulting in revisions being able to be made quickly, and disseminated to users rapidly.

How can we maximize the use of our operating lists? An analysis of factors influencing theatre efficiency in oculoplastic day surgery.

PubMed

Nagendran, Sonali T; Siah, We Fong; Litwin, Andre; Barbosa, Christine; Jayatilake, Jan; Malhotra, Raman

2016-12-01

Operating theatre utilization has become the principal measure of NHS operating theatre service performance. We analysed data from oculoplastic theatres in a tertiary centre to identify factors influencing theatre efficiency. We conducted three audits on operating theatre utilization in 2011, 2014 and 2015. Data was collected from real time information entered into the hospital database, including time of arrival, induction, first cut and close of operation. The primary outcome measure was the operating list utilization rate, a combined value of anaesthetic and surgical time as a proportion of the total planned session time. The initial 2011 audit recorded an operating list utilization rate of 81.2%. However, this dropped to 64.5% in 2014 following new management and a move to a new theatre suite. Analysis of the factors contributing to poor theatre efficiency led to changes that streamlined the patient pathway, including standardized case scheduling and reducing staggered patient arrival. A 2015 reaudit analyzing the effects of these changes demonstrated an increase in the operating list utilization rate to 78%. It was significantly higher (p < 0.01) for whole-day lists (85%) compared to half-day lists (75%), suggesting that whole-day lists were more efficient. Operating theatres are a valuable resource and the factors affecting theatre efficiency within our unit are common and will be relevant to units elsewhere. Correcting them can lead to significant improvements in patient care. Data from this study may provide a benchmark for other units in the United Kingdom.

Social structures in the operating theatre: how contradicting rationalities and trust affect work.

PubMed

Rydenfält, Christofer; Johansson, Gerd; Larsson, Per Anders; Akerman, Kristina; Odenrick, Per

2012-04-01

This article is a report of a study of how healthcare professionals involved in surgery orientate themselves to their common task, and how this orientation can be affected by the social and organizational context. Previous research indicates that surgical teams are not as cohesive as could be expected and that communication failures frequently occur. However, little is known about how these problems are related to their social, cultural and organizational context. Semi-structured interviews were conducted with 15 healthcare professionals, representing all personnel categories of the surgical team. During the interview, a virtual model, visualizing a real operating theatre, was used to facilitate reflection. The interviews were conducted in 2009. Themes were created from the interviews, with a focus on similarities and differences. An activity analysis was conducted based on the themes. Poor team functionality and communication failures in the operating theatre can to some degree be explained by differences in activity orientation between professions and by insufficient support from social and organizational structures. Differences in activity orientation resulted in different views between professional groups in their perceptions of work activities, resulting in tension. Insufficient support resulted in communication thresholds that inhibited the sharing of information. Organizing work to promote cross-professional interaction can help the creation of social relations and norms, providing support for a common view. It can also help to decrease communication thresholds and establish stronger relations of trust. How this organization structure should be developed needs to be further investigated. © 2011 The Authors. Journal of Advanced Nursing © 2011 Blackwell Publishing Ltd.

Electrosurgical Smoke: Ultrafine Particle Measurements and Work Environment Quality in Different Operating Theatres

PubMed Central

Romano, Francesco; Gustén, Jan; De Antonellis, Stefano; Joppolo, Cesare M.

2017-01-01

Air cleanliness in operating theatres (OTs) is an important factor for preserving the health of both the patient and the medical staff. Particle contamination in OTs depends mainly on the surgery process, ventilation principle, personnel clothing systems and working routines. In many open surgical operations, electrosurgical tools (ESTs) are used for tissue cauterization. ESTs generate a significant airborne contamination, as surgical smoke. Surgical smoke is a work environment quality problem. Ordinary surgical masks and OT ventilation systems are inadequate to control this problem. This research work is based on numerous monitoring campaigns of ultrafine particle concentrations in OTs, equipped with upward displacement ventilation or with a downward unidirectional airflow system. Measurements performed during ten real surgeries highlight that the use of ESTs generates a quite sharp and relevant increase of particle concentration in the surgical area as well within the entire OT area. The measured contamination level in the OTs are linked to surgical operation, ventilation principle, and ESTs used. A better knowledge of airborne contamination is crucial for limiting the personnel’s exposure to surgical smoke. Research results highlight that downward unidirectional OTs can give better conditions for adequate ventilation and contaminant removal performances than OTs equipped with upward displacement ventilation systems. PMID:28146089

Operating unit time use is associated with anaesthesia type in below-knee surgery in adults.

PubMed

Lohela, T J; Chase, R P; Hiekkanen, T A; Kontinen, V K; Hynynen, M J

2017-03-01

Peripheral nerve blocks could reduce the operating unit and theatre time spent on high-risk patients who are particularly vulnerable to complications of general anaesthesia or have medications that prevent application of central neuraxial blocks. Medical record data of 617 and 254 elderly adults undergoing below-knee surgery in Jorvi and Meilahti hospitals (Helsinki University Hospital) between January 2010 and December 2012 were used to investigate the influence of anaesthetic technique on operating theatre times and on operating unit times using flexible parametric survival models. We report operating theatre and unit exit ratios (i.e. hazard ratios but using ratios of exit rates) for different types of anaesthesia. Adjusted analyses: In Jorvi Hospital, anaesthesia type was associated with large initial differentials in operating theatre times. The theatre exit ratios remained lower for general anaesthesia and central neuraxial blocks compared to peripheral nerve blocks until 30 min. In Meilahti Hospital, anaesthesia type did not influence theatre time, but was the best predictor of operating unit times. Compared to peripheral nerve blocks, the exit ratio remained lower for general anaesthesia until five operating unit hours in both hospitals and for central neuraxial blocks until 1 h in Meilahti Hospital and until 3 h in Jorvi Hospital. Holding area was used more in Jorvi Hospital compared to Meilahti Hospital. Peripheral nerve block anaesthesia reduces time spent in the operating unit and can reduce time spent in the operating theatre if induced in holding area outside of theatre. © 2017 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

A short report on knowledge exchange through research-based theatre: ‘Inside out of mind’

PubMed Central

Schneider, Justine; Lowe, Stephen; Myers, Tanya; Scales, Kezia; Bailey, Simon; Middleton, Joanne

2014-01-01

The short report describes the development from page to stage of a work of theatre based on an ethnographic study. The originating research focused on the work of health care assistants (nurse's aides) whose direct impact on the quality of life of highly dependent people is often overlooked. The research followed hospital personnel on wards specialising in the 'challenging behaviour' associated with dementia in central England. Conventional research outputs failed to engage the health care assistants themselves, so we turned to theatre to remedy this. The development of the field notes into theatre was characterised by the artistic freedom given to the playwright, in contrast to more data-led approaches to theatre making. The account of the process of creating the play, Inside Out of Mind, is followed a description of how the work was received by specialist and general audiences totalling 2000+. The discussion seeks to locate the whole enterprise in relation to the field of research-based theatre and explores how the production and its associated learning events relate to definitions of research-based theatre in the light of recent attempts to encapsulate this broad and diverse methodology. PMID:25103152

How do early emotional experiences in the operating theatre influence medical student learning in this environment?

PubMed

Bowrey, David J; Kidd, Jane M

2014-01-01

The emotions experienced by medical students on first exposure to the operating theatre are unknown. It is also unclear what influence these emotions have on the learning process. To understand the emotions experienced by students when in the operating theatre for the first time and the impact of these emotions on learning. Nine 3rd-year medical students participated in semistructured interviews to explore these themes. A qualitative approach was used; interviews were transcribed and coded thematically. All participants reported initial negative emotions (apprehension, anxiety, fear, shame, overwhelmed), with excitement being reported by 3. Six participants considered that their anxiety was so overwhelming that it was detrimental to their learning. Participants described a period of familiarization to the environment, after which learning was facilitated. Early learning experiences centered around adjustment to the physical environment of the operating theatre. Factors driving initial negative feelings were loss of familiarity, organizational issues, concerns about violating protocol, and a fear of syncope. Participants considered that it took a median of 1 week (range = 1 day-3 weeks) or 5 visits to the operating theatre (range = 1-10) before feeling comfortable in the new setting. Emotions experienced on subsequent visits to the operating theatre were predominantly positive (enjoyment, happiness, confident, involved, pride). Two participants reported negative feelings related to social exclusion. Being included in the team was a powerful determinant of enjoyment. These findings indicate that for learning in the operating theatre to be effective, addressing the negative emotions of the students might be beneficial. This could be achieved by a formal orientation program for both learners and tutors in advance of attendance in the operating theatre. For learning to be optimized, students must feel a sense of inclusion in the theatre community of practice.

A longitudinal study of the incidence of pressure sores and the associated risks and strategies adopted in Italian operating theatres.

PubMed

Bulfone, Giampiera; Marzoli, Ilaria; Quattrin, Rosanna; Fabbro, Carmen; Palese, Alvisa

2012-02-01

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

Introducing the productive operating theatre programme in urology theatre suites.

PubMed

Ahmed, Kamran; Khan, Nuzhath; Anderson, Deirdre; Watkiss, Jonathan; Challacombe, Ben; Khan, Mohammed Shamim; Dasgupta, Prokar; Cahill, Declan

2013-01-01

The Productive Operating Theatre (TPOT) is a theatre improvement programme designed by the UK National Health Service. The aim of this study was to evaluate the implementation of TPOT in urology operating theatres and identify obstacles to running an ideal operating list. TPOT was introduced in two urology operating theatres in September 2010. A multidisciplinary team identified and audited obstacles to the running of an ideal operating list. A brief/debrief system was introduced and patient satisfaction was recorded via a structured questionnaire. The primary outcome measure was the effect of TPOT on start and overrun times. Start times: 39-41% increase in operating lists starting on time from September 2010 to June 2011, involving 1,365 cases. Overrun times: Declined by 832 min between March 2010 and March 2011. The cost of monthly overrun decreased from September 2010 to June 2011 by GBP 510-3,030. Patient experience: A high degree of satisfaction regarding level of care (77%), staff hygiene (71%) and information provided (72%), while negative comments regarding staff shortages and environment/facilities were recorded. TPOT has helped identify key obstacles and shown improvements in efficiency measures such as start/overrun times. Copyright © 2013 S. Karger AG, Basel.

Nurses' perceptions and experiences of communication in the operating theatre: a focus group interview

PubMed Central

Nestel, Debra; Kidd, Jane

2006-01-01

Abstract Nurses' perceptions and experiences of communication in the operating theatre: a focus group interview Background Communication programmes are well established in nurse education. The focus of programmes is most often on communicating with patients with less attention paid to inter-professional communication or skills essential for working in specialised settings. Although there are many anecdotal reports of communication within the operating theatre, there are few empirical studies. This paper explores communication behaviours for effective practice in the operating theatre as perceived by nurses and serves as a basis for developing training. Methods A focus group interview was conducted with seven experienced theatre nurses from a large London teaching hospital. The interview explored their perceptions of the key as well as unique features of effective communication skills in the operating theatre. Data was transcribed and thematically analysed until agreement was achieved by the two authors. Results There was largely consensus on the skills deemed necessary for effective practice including listening, clarity of speech and being polite. Significant influences on the nature of communication included conflict in role perception and organisational issues. Nurses were often expected to work outside of their role which either directly or indirectly created barriers for effective communication. Perceptions of a lack of collaborative team effort also influenced communication. Conclusion Although fundamental communication skills were identified for effective practice in the operating theatre, there were significant barriers to their use because of confusion over clarity of roles (especially nurses' roles) and the implications for teamwork. Nurses were dissatisfied with several aspects of communication. Future studies should explore the breadth and depth of this dissatisfaction in other operating theatres, its impact on morale and importantly on patient safety. Interprofessional communication training for operating theatre staff based in part on the key issues identified in this study may help to create clarity in roles and focus attention on effective teamwork and promote clinical safety. PMID:16466581

A short report on knowledge exchange through research-based theatre: 'inside out of mind'.

PubMed

Schneider, Justine; Lowe, Stephen; Myers, Tanya; Scales, Kezia; Bailey, Simon; Middleton, Joanne

2014-10-01

The short report describes the development from page to stage of a work of theatre based on an ethnographic study. The originating research focused on the work of health care assistants (nurse's aides) whose direct impact on the quality of life of highly dependent people is often overlooked. The research followed hospital personnel on wards specialising in the 'challenging behaviour' associated with dementia in central England. Conventional research outputs failed to engage the health care assistants themselves, so we turned to theatre to remedy this. The development of the field notes into theatre was characterised by the artistic freedom given to the playwright, in contrast to more data-led approaches to theatre making. The account of the process of creating the play, Inside Out of Mind, is followed a description of how the work was received by specialist and general audiences totalling 2000+. The discussion seeks to locate the whole enterprise in relation to the field of research-based theatre and explores how the production and its associated learning events relate to definitions of research-based theatre in the light of recent attempts to encapsulate this broad and diverse methodology. Copyright © 2014 The Authors. Published by Elsevier Ltd.. All rights reserved.

Noise in the operating rooms of Greek hospitals.

PubMed

Tsiou, Chrisoula; Efthymiatos, Gerasimos; Katostaras, Theophanis

2008-02-01

This study is an evaluation of the problem of noise pollution in operating rooms. The high sound pressure level of noise in the operating theatre has a negative impact on communication between operating room personnel. The research took place at nine Greek public hospitals with more than 400 beds. The objective evaluation consisted of sound pressure level measurements in terms of L(eq), as well as peak sound pressure levels in recordings during 43 surgeries in order to identify sources of noise. The subjective evaluation consisted of a questionnaire answered by 684 operating room personnel. The views of operating room personnel were studied using Pearson's X(2) Test and Fisher's Exact Test (SPSS Version 10.00), a t-test comparison was made of mean sound pressure levels, and the relationship of measurement duration and sound pressure level was examined using linear regression analysis (SPSS Version 13.00). The sound pressure levels of noise per operation and the sources of noise varied. The maximum measured level of noise during the main procedure of an operation was measured at L(eq)=71.9 dB(A), L(1)=84.7 dB(A), L(10)=76.2 dB(A), and L(99)=56.7 dB(A). The hospital building, machinery, tools, and people in the operating room were the main noise factors. In order to eliminate excess noise in the operating room it may be necessary to adopt a multidisciplinary approach. An improvement in environment (background noise levels), the implementation of effective standards, and the focusing of the surgical team on noise matters are considered necessary changes.

Cost analysis of injection laryngoplasty performed under local anaesthesia versus general anaesthesia: an Australian perspective.

PubMed

Chandran, D; Woods, C M; Schar, M; Ma, N; Ooi, E H; Athanasiadis, T

2018-02-01

To conduct a cost analysis of injection laryngoplasty performed in the operating theatre under local anaesthesia and general anaesthesia. The retrospective study included patients who had undergone injection laryngoplasty as day cases between July 2013 and March 2016. Cost data were obtained, along with patient demographics, anaesthetic details, type of injectant, American Society of Anesthesiologists score, length of stay, total operating theatre time and surgeon procedure time. A total of 20 cases (general anaesthesia = 6, local anaesthesia = 14) were included in the cost analysis. The mean total cost under general anaesthesia (AU$2865.96 ± 756.29) was significantly higher than that under local anaesthesia (AU$1731.61 ± 290.29) (p < 0.001). The mean operating theatre time, surgeon procedure time and length of stay were all significantly lower under local anaesthesia compared to general anaesthesia. Time variables such as operating theatre time and length of stay were the most significant predictors of the total costs. Procedures performed under local anaesthesia in the operating theatre are associated with shorter operating theatre time and length of stay in the hospital, and provide significant cost savings. Further savings could be achieved if local anaesthesia procedures were performed in the office setting.

Making the invisible visible--operating theatre nurses' perceptions of caring in perioperative practice.

PubMed

Blomberg, Ann-Catrin; Bisholt, Birgitta; Nilsson, Jan; Lindwall, Lillemor

2015-06-01

The aim of this study was to describe operating theatre nurses' (OTNs') perceptions of caring in perioperative practice. A qualitative descriptive design was performed. Data were collected with interviews were carried out with fifteen strategically selected operating theatre nurses from different operating theatres in the middle of Sweden. A phenomenographic analysis was used to analyse the interviews. The findings show that operating theatre nurses' perceptions of caring in perioperative practice can be summarised in one main category: To follow the patient all the way. Two descriptive categories emerged: To ensure continuity of patient care and keeping a watchful eye. The operating theatre nurses got to know the patient and as a result became responsible for the patient. They protected the patient's body and preserved patient dignity in perioperative practice. The findings show different aspects of caring in perioperative practice. OTNs wanted to be more involved in patient care and follow the patient throughout the perioperative nursing process. Although OTNs have the ambition to make the care in perioperative practice visible, there is today a medical technical approach which promotes OTNs continuing to offer care in secret. © 2014 Nordic College of Caring Science.

Music and communication in the operating theatre.

PubMed

Weldon, Sharon-Marie; Korkiakangas, Terhi; Bezemer, Jeff; Kneebone, Roger

2015-12-01

To observe the extent and the detail with which playing music can impact on communication in the operating theatre. According to the cited sources, music is played in 53-72% of surgical operations performed. Noise levels in the operating theatre already exceed World Health Organisation recommendations. There is currently a divide in opinions on the playing of music in operating theatres, with few studies conducted and no policies or guidance provided. An ethnographic observational study of teamwork in operating theatres through video recordings. Quantitative and qualitative data analysis approaches were used. This study was conducted between 2012-2013 in the UK. Video recordings of 20 operations over six months in two operating theatres were captured. The recordings were divided into music and non-music playing cases. Each case was logged using a request/response sequence identified through interactional analysis. Statistical analysis, using a χ(2) , explored the difference between the proportion of request repetitions and whether music was playing or not. Further interactional analysis was conducted for each request repetition. Request/response observations (N = 5203) were documented. A chi-square test revealed that repeated requests were five times more likely to occur in cases that played music than those that did not. A repeated request can add 4-68 seconds each to operation time and increased tensions due to frustration at ineffective communication. Music played in the operating theatre can interfere with team communication, yet is seldom recognized as a potential safety hazard. Decisions around whether music is played and around the choice of music and its volume, are determined largely by surgeons. Frank discussions between clinicians, managers, patients and governing bodies should be encouraged for recommendations and guidance to be developed. © 2015 John Wiley & Sons Ltd.

[Aseptic non-touch technique in the operating room: keep it simple].

PubMed

Pans, Solange J A; Molmans, Eva; Marczinski, Susanne C; Bijker, Jilles B; Snijdelaar, Dik G

2015-01-01

The Dutch national patient safety platform developed a protocol for the preparation of intravenous medication; the Aseptic Non-Touch Technique (ANTT). Use of ANTT on nursing wards has shown to reduce contamination of intravenous medication. Therefore it is dictated by the Dutch Healthcare Inspectorate that this technique has to be used at all departments in the hospital, including the operating theatre. However, because of the use of air treatment and operating theatre uniforms, the operating theatre cannot be compared with a nursing ward. In this study, the bacterial contamination of syringes prepared in the operating theatre by anesthesia nurses was determined. Simulation study 45 anesthesia nurses prepared 1000 syringes of 10 ml bacterial culture medium, using their routine method of drawing up iv medication from vials. Turbidity in a syringe after culturing for 14 days at 30° C was used as evidence for bacterial contamination. Using questionnaires, nurses were interviewed in what degree their working method equals ANTT-protocol. We calculated how much extra time must be invested when using the strict ANTT-protocol in the operating theatre. Six syringes (0,6%) were contaminated. Normal dermal bacteria were identified in all syringes. The nurses who prepared the contaminated syringes worked similar manner as their colleagues. It takes an additional 54 minutes per day per operating theatre to work strictly using the ANTT technique. Contamination rates of aseptic preparations in the OR are very low, and are as low as ANTT preparations in a GMP-certified hospital pharmacy. Therefore it is legitimate to develop a modified ANTT-protocol for use in the operating theatre.

Global operating theatre distribution and pulse oximetry supply: an estimation from reported data.

PubMed

Funk, Luke M; Weiser, Thomas G; Berry, William R; Lipsitz, Stuart R; Merry, Alan F; Enright, Angela C; Wilson, Iain H; Dziekan, Gerald; Gawande, Atul A

2010-09-25

Surgery is an essential part of health care, but resources to ensure the availability of surgical services are often inadequate. We estimated the global distribution of operating theatres and quantified the availability of pulse oximetry, which is an essential monitoring device during surgery and a potential measure of operating theatre resources. We calculated ratios of the number of operating theatres to hospital beds in seven geographical regions worldwide on the basis of profiles from 769 hospitals in 92 countries that participated in WHO's safe surgery saves lives initiative. We used hospital bed figures from 190 WHO member states to estimate the number of operating theatres per 100,000 people in 21 subregions throughout the world. To estimate availability of pulse oximetry, we sent surveys to anaesthesia providers in 72 countries selected to ensure a geographically and demographically diverse sample. A predictive regression model was used to estimate the pulse oximetry need for countries that did not provide data. The estimated number of operating theatres ranged from 1·0 (95% CI 0·9-1·2) per 100,000 people in west sub-Saharan Africa to 25·1 (20·9-30·1) per 100,000 in eastern Europe. High-income subregions all averaged more than 14 per 100,000 people, whereas all low-income subregions, representing 2·2 billion people, had fewer than two theatres per 100,000. Pulse oximetry data from 54 countries suggested that around 77,700 (63,195-95,533) theatres worldwide (19·2% [15·2-23·9]) were not equipped with pulse oximeters. Improvements in public-health strategies and monitoring are needed to reduce disparities for more than 2 billion people without adequate access to surgical care. WHO. Copyright © 2010 Elsevier Ltd. All rights reserved.

Patient monitoring in the operating theatre.

PubMed

Forrest, A L; Douglas, D M; Rimmer, A R

1976-09-01

Anaesthetised patients are monitored to ensure their safety. Simple clinical observations must not be replaced by electronic instruments--these provide an extension of the clinical senses. The choice of parameters for monitoring is discussed. The design of the Ninewells main operating theatre suite is described. An 8-channel bourne in the base of the theatre table conveys patient signals to a 4-channel recorder in a monitoring laboratory. Outputs are displayed on a wall mounted display in theatre. Two-way speech intercommunication exists with monitoring technician and students.

Multidisciplinary team simulation for the operating theatre: a review of the literature.

PubMed

Tan, Shaw Boon; Pena, Guilherme; Altree, Meryl; Maddern, Guy J

2014-01-01

Analyses of adverse events inside the operating theatre has demonstrated that many errors are caused by failure in non-technical skills and teamwork. While simulation has been used successfully for teaching and improving technical skills, more recently, multidisciplinary simulation has been used for training team skills. We hypothesized that this type of training is feasible and improves team skills in the operating theatre. A systematic search of the literature for studies describing true multidisciplinary operating theatre team simulation was conducted in November and December 2012. We looked at the characteristics and outcomes of the team simulation programmes. 1636 articles were initially retrieved. Utilizing a stepwise evaluation process, 26 articles were included in the review. The studies reveal that multidisciplinary operating theatre simulation has been used to provide training in technical and non-technical skills, to help implement new techniques and technologies, and to identify latent weaknesses within a health system. Most of the studies included are descriptions of training programmes with a low level of evidence. No randomized control trial was identified. Participants' reactions to the training programme were positive in all studies; however, none of them could objectively demonstrate that skills acquired from simulation are transferred to the operating theatre or show a demonstrable benefit in patient outcomes. Multidisciplinary operating room team simulation is feasible and widely accepted by participants. More studies are required to assess the impact of this type of training on operative performance and patient safety. © 2013 Royal Australasian College of Surgeons.

Effect of an exfoliating skincare regimen on the numbers of epithelial squames on the skin of operating theatre staff, studied by surface microscopy.

PubMed

Wernham, A G; Cain, O L; Thomas, A M

2018-03-23

The shedding of epithelial squames (skin scales) by staff in operating theatre air is an important source of deep infection following joint replacement surgery. This is a serious complication, resulting in significant morbidity for the patient and substantial cost implications for healthcare systems. Much effort has been put into providing clean air in operating theatres, yet little attention has been given to reducing the shedding of surface skin scales at source. To develop a novel method for calculating surface skin scale density using surface microscopy, and to use it to evaluate the effect of a skincare regimen on operating theatre staff. Surface microscopy with Z-stacked imaging was used to visualize the effect of a skincare regimen involving three stages: washing with soap; exfoliation; and application of emollient. A USB microscope was then used in a field study to take images of the skin of operating theatre staff who applied the regimen to one lower limb the night before testing. The other limb was used as a control. Two blinded assessors analysed scale density. Z-stack images from the surface microscope enabled observations of the skincare regimen. The USB microscope also provided adequate images that enabled assessment of skin scale density. In the operating theatre staff, a 72.1% reduction in visible skin scales was observed following application of the skincare regimen. Further work is required to demonstrate how this effect correlates with dispersion of skin particles in a cleanroom, and subsequently in live operating theatre studies. Copyright © 2018 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

[Assessment of occupational exposure of medical personnel to inhalatory anesthetics in Poland].

PubMed

Kucharska, Małgorzata; Wesołowski, Wiktor

2014-01-01

Despite common use of inhalatory anesthetics, such as nitrous oxide (N2O), halothane, sevoflurane, and the like, occupational exposure to these substances in operating theatres was not monitored in Poland until 2006. The situation changed when maximum admissible concentration (MAC) values for anesthetics used in Poland were established in 2005 for N2O, and in 2007 for sevoflurane, desflurane and isoflurane. The aim of this work was to assess occupational exposure in operating rooms on the basis of reliable and uniform analytical procedures. The method for the determination of all anesthetics used in Poland, i.e. nitrous oxide, sevoflurane, isoflurane, desflurane, and halothane, was developed and validated. The measurements were performed in 2006-2010 in 31 hospitals countrywide. The study covered 117 operating rooms; air samples were collected from the breathing zone of 146 anesthesiologists, and 154 nurses, mostly anaesthetic. The measurements were carried out during various surgical operations, mostly on adult patients but also in hospitals for children. Time weighted average concentrations of the anesthetics varied considerably, and the greatest differences were noted for N2O (0.1-1438.5 mg/m3); 40% of the results exceeded the MAC value. Only 3% of halothane, and 2% of sevoflurane concentrations exceeded the respective MAC values. Working in operating theatres is dangerous to the health of the operating staff. The coefficient of combined exposure to anesthesiologists under study exceeded the admissible value in 130 cases, which makes over 40% of the whole study population. Most of the excessive exposure values were noted for nitrous oxide.

Reducing the carbon footprint of the operating theatre: a multicentre quality improvement report.

PubMed

Southorn, T; Norrish, A R; Gardner, K; Baxandall, R

2013-06-01

Currently, there are very few provisions for recycling in theatres. We measured the weight of clinical waste for several orthopaedic operations. This waste was then examined and sorted into domestic waste and clinical waste. With staff education it is possible to reduce the amount of clinical waste generated by the operating theatre by roughly 50%. A greater awareness of disposal options leads to a reduction in waste disposed of by incineration.

Five-year microbiological monitoring of wards and operating theatres in southern Italy.

PubMed

La Fauci, V; Genovese, C; Facciolà, A; Palamara, M A R; Squeri, R

2017-06-01

Nosocomial infections are one of the greatest problems in public health. Several studies have highlighted the role played by the hospital environment as a possible source of transmission of nosocomial pathogens. A five-year monitoring of bacterial contamination on healthcare workers hands, surfaces most closely in contact with inpatient wards, operating theatres and "at rest" and "in use" operating theatre air samples. For the samples, we used sterile swabs, contact slides, manual API, and automated VITEK systems for identification. In the five-year period, a total of 9396 samples were collected and analysed. In ward patients, 4398 samplings were carried out with 4.7%, 9.4%, 7%, 10.8% and 7.9% positive results respectively from 2010 to 2014. For hands, 648 samplings were carried out, with a positivity of 40.74%. In operating theatres, 4188 samples were taken, with a positivity of 11.9%. Regarding air in empty and full theatres, 1962 samplings were carried out with a positivity rate equal to 31.9%. The monitoring showed a low rate of contamination with a progressive decrease in the fiveyear period on operating theatres surfaces and hands, while there was an increase in the surgical site wards and in the air of operating rooms. Our investigation has revealed the presence of pathogens on the assessed surfaces and the need for environmental monitoring, which can be a valuable tool for reducing contamination.

The operating theatre as classroom: a qualitative study of learning and teaching surgical competencies.

PubMed

Kieu, Violet; Stroud, Leanne; Huang, Paul; Smith, Mitchell; Spychal, Robert; Hunter-Smith, David; Nestel, Debra

2015-01-01

There has been a worldwide movement toward competency-based medical education and training. However, this is the first qualitative study to analyze the perceptions of surgical trainees and surgeons toward competency-based education in the operating theatre. We aim to examine views toward the specific learning and teaching of the nine competencies of the Royal Australasian College of Surgeons (RACS) and to explore perceived ideal conditions and challenges for learning and teaching these competencies in the operating theatre. Individual semi-structured interviews with surgical trainees and surgeons in the specialty of General Surgery. Ten surgical trainees and surgeons who worked together were purposively sampled, for maximum variation, from an outer metropolitan public hospital in Melbourne, Australia, to identify emergent themes relating to learning and teaching surgical competencies in the operating theatre. Five themes were identified as: (1) Learning and teaching specific surgical competencies is through relationship based mentoring and experiential learning; (2) Ideal conditions and challenges in the operating theatre are availability of time and personal attitude; (3) Level of pre-operative briefing was variable; (4) Intra-operative teaching is perceived as structured; and, (5) Post-operative debriefing is recognized as ideal but not consistently performed. Professional relationships are important to both surgical trainees and surgeons in the process of learning and teaching competencies. Ad hoc apprenticeship style learning is perceived to remain prominent in the operating theatre. Sufficient time for training is valued by both groups. The surgical competencies are inherently different to each other. Some appear more difficult to learn and teach in the operating theatre, with technical expertise most readily identified and health advocacy least so. Elements of guided discovery learning and other educational models are described. Further emphasis on structured competency-based teaching methods may be beneficial for surgical trainees, surgeons and other specialties, both in Australia and worldwide.

A comparison of the teamwork attitudes and knowledge of Irish surgeons and U.S Naval aviators.

PubMed

O'Connor, Paul; Ryan, Stephen; Keogh, Ivan

2012-10-01

Poor teamwork skills are contributors to poor performance and mishaps in high risk work settings, including the operating theatre. A questionnaire was used to assess the attitudes towards, and knowledge of, Irish surgeons (n = 72) towards the human factors that contribute to mishaps and poor teamwork in high risk environments. The responses were compared to those obtained from U.S. Naval aviators (n = 552 for the attitude questions, and n = 172 for the knowledge test). U.S. Naval aviators were found to be significantly more knowledgeable, and held attitudes that were significantly more positive towards effective teamworking than the surgeons. Moreover, 78.9% of Senior House Officers and Registrars stated that junior personnel were frequently afraid to speak-up (compared with 31.3% of Consultants). Only 7.3% of surgeons stated that an adequate pre-operative brief team brief was frequently conducted, and only 15% stated that an adequate post-operative team brief was frequently conducted. It is suggested that the human factors training currently provided to surgeons in Ireland is a positive first step. However, there is a need to stress the importance of assertiveness in juniors, listening in seniors, and more reinforcement of good teamworking behaviours in the operating theatre. Copyright © 2011 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland. Published by Elsevier Ltd. All rights reserved.

Music in the operating theatre: opinions of staff and patients of a Nigerian teaching hospital.

PubMed

Makama, J G; Ameh, E A; Eguma, S A

2010-12-01

The role of music during surgery has been studied, including its effect on theatre staff, users and patients. However, little attention has been paid to its application especially in our environment. It was a prospective study, involving theatre staff, users, and patients. Their opinions on acceptability and the role of music in operating theatre were determined. Information was obtained by questionnaire. There were 162 respondents; age range 25 to 76 years (median age 39). There were 109 (67.2%) males and 53 (32.7%) female. One hundred and forty five (89.5%) respondents agree that music should be played in the operating theatre. One fifty eight, (97.5%) considered low tone of music to be most appropriate in the theatre while 3(1.9%), and 1(0.6%) considered moderate and high tone respectively to be most appropriate. One hundred and sixteen, (71.6%) preferred jazz music while 19(11.7%) reggae, 11(6.8%) African music, 13 (8.0%) others (not specify), 2 (1.2%) classical, and 1(0.6%) Irish folk. The majority of the respondents were aware of the role of music in terms of its anxiolytic effect, reduction of stress and enhancement of performance when familiar music is played. Music in the operating theatre has immeasurable effects. It can prevent distraction, minimize annoyance, reduce stress and diminish the anxiety of patients, staff and users.

Recent Experiences and Challenges of Military Physiotherapists Deployed to Afghanistan: A Qualitative Study

PubMed Central

Carpenter, Christine

2011-01-01

ABSTRACT Purpose: Military physiotherapists in the Canadian Forces meet the unique rehabilitation needs of military personnel. Recently, the physiotherapy officer role has evolved in response to the Canadian Forces' involvement in the combat theatre of operations of Afghanistan, and this has created new and unique challenges and demands. The purpose of this study was to describe the experiences and challenges of military physiotherapists deployed to Afghanistan. Methods: A qualitative research design guided by descriptive phenomenology involved recruitment of key informants and in-depth interviews as the data collection method. The interviews were transcribed verbatim and the data analyzed using a foundational thematic analysis approach. Strategies of peer review and member checking were incorporated into the study design. Results: Six military physiotherapists were interviewed. They described rewarding experiences that were stressful yet highly career-satisfying. Main challenges revolved around heavy workloads, an expanded scope of practice as sole-charge practitioners, and the consequences and criticality of their clinical decisions. Conclusions: Our findings suggest that enhanced pre-deployment training and the implementation of a stronger support network will improve the capabilities of military physiotherapists deployed to difficult theatres of operations. This type of systematic and comprehensive research is needed to assist the Canadian Forces in proactively preparing and supporting physiotherapists deployed on future missions. PMID:22942524

Improving the ability to review preoperative radiographs intraoperatively in trauma and orthopaedic theatres at Lancashire teaching hospitals

PubMed Central

Jump, Christopher

2017-01-01

Background The ability to review preoperative radiographs during trauma and orthopaedic surgery is essential for the surgeon to provide optimum treatment to the patient. However, due to current information technology (IT) systems, screen-savers frequently interrupt the ability to review images and theatre staff are not routinely available to deactivate the screen-saver. This prolongs theatre time for the patient and affects the quality of care provided. The aim of this quality improvement project was to improve the availability of radiographs for the surgeon to review intraoperatively. Method/results Data were collected from all trauma and orthopaedic theatres at two hospital sites covering all subspecialties and including emergency and elective cases. Baseline measurements showed that the frequency of preoperative radiographs not interrupted during an operation was 0% (0/50). Following this the Trust’s IT systems were improved to prevent activation of the screen-saver on the theatre computers using the generic theatre login details. After the first-cycle intervention, data were collected showing 52% (14/27) of preoperative radiographs were not interrupted by a screen-saver. The cause for this result being less than expected was investigated and found to be due to an alternative computer login being used on the theatre computers at one of the hospital sites. Education of theatre staff was then undertaken to ensure the correct theatre login was used and notices to remind staff placed on the theatre computers. After the second-cycle intervention, data were collected showing that 100% (26/26) of preoperative radiographs were not interrupted during operative time allowing the surgeon to review images when required. Conclusion/implications This quality improvement project has made changes to theatre IT systems and practices of theatre staff which has resulted in a significant improvement in the ability for the operating surgeon to review preoperative radiographs intraoperatively. PMID:29450269

Improving the ability to review preoperative radiographs intraoperatively in trauma and orthopaedic theatres at Lancashire teaching hospitals.

PubMed

Jump, Christopher

2017-01-01

The ability to review preoperative radiographs during trauma and orthopaedic surgery is essential for the surgeon to provide optimum treatment to the patient. However, due to current information technology (IT) systems, screen-savers frequently interrupt the ability to review images and theatre staff are not routinely available to deactivate the screen-saver. This prolongs theatre time for the patient and affects the quality of care provided. The aim of this quality improvement project was to improve the availability of radiographs for the surgeon to review intraoperatively. Data were collected from all trauma and orthopaedic theatres at two hospital sites covering all subspecialties and including emergency and elective cases. Baseline measurements showed that the frequency of preoperative radiographs not interrupted during an operation was 0% (0/50). Following this the Trust's IT systems were improved to prevent activation of the screen-saver on the theatre computers using the generic theatre login details. After the first-cycle intervention, data were collected showing 52% (14/27) of preoperative radiographs were not interrupted by a screen-saver. The cause for this result being less than expected was investigated and found to be due to an alternative computer login being used on the theatre computers at one of the hospital sites. Education of theatre staff was then undertaken to ensure the correct theatre login was used and notices to remind staff placed on the theatre computers. After the second-cycle intervention, data were collected showing that 100% (26/26) of preoperative radiographs were not interrupted during operative time allowing the surgeon to review images when required. This quality improvement project has made changes to theatre IT systems and practices of theatre staff which has resulted in a significant improvement in the ability for the operating surgeon to review preoperative radiographs intraoperatively.

Novel utilization of 3D technology and the hybrid operating theatre: Peri-operative assessment of posterior sterno-clavicular dislocation using cone beam CT

DOE Office of Scientific and Technical Information (OSTI.GOV)

Crowhurst, James A; Campbell, Douglas; Whitby, Mark

A patient with a medial and posterior dislocation of the right sterno-clavicular (SC) joint and displacement of the trachea and brachiocephalic artery by the medial head of the clavicle underwent general anaesthetic in the operating theatre for an open reduction procedure. The surgeon initially attempted a closed reduction, but this required imaging to check SC alignment. The patient was transferred to an adjacent hybrid operating theatre for imaging. Cone beam computed tomography (CBCT) was performed, which successfully demonstrated a significant reduction in the dislocation of the SC joint. The trachea and brachiocephalic artery were no longer compressed or displaced. Thismore » case study demonstrates an alternative to the patient being transferred to the medical imaging department for multi-slice CT. It also describes a novel use of the hybrid operating theatre and its CBCT capabilities.« less

Special requirements in UCV theatres.

PubMed

Hall, Graeme

2016-09-01

Graeme Hall FIHEEM, MIET, managing director of Brandon Medical, considers in detail the particular requirements and criteria for operating lights used in ultraclean ventilation (UCV) theatres, and explains how the recent establishment of a standard for testing of lighting's suitability for such theatre environments will help designers and manufacturers, as well as those specifying UCV theatre illumination, going forward.

Understanding and Supporting Visual Communication within Costume Design Practice

ERIC Educational Resources Information Center

Bradley, Rachael Leigh

2009-01-01

Theatres provide artistic value to many people and generate revenue for communities, yet little research has been conducted to understand or support theatrical designers. Over 1,800 non-profit theatres and 3,522 theatre companies and dinner theatres operate in the United States. In 2008, 11 million people attended 1,587 Broadway shows for a total…

Transforming a conventional theatre into a gynaecological endoscopy unit.

PubMed

Anastasakis, E; Protopapas, A; Daskalakis, G; Papadakis, M; Milingos, S; Antsaklis, A

2007-01-01

Most minimally invasive procedures are now performed in operating rooms that were originally designed for traditional open surgery. We designed an endoscopic theatre based on our experience with special features specific for gynaecological endoscopy. We designed a detailed plan with an architect's aid of a gynaecological unit (based on a Greek presidential decree published in 1991). The space utilized was that of a conventional theatre. With the architectural plan we anticipated every area needed in a gynaecological endoscopic theatre. A twin theatre was considered appropriate in order for the surgical team to operate alternatively in one theatre while the other is being cleaned and prepared for use. The design of a unit dedicated to gynaecologic laparoscopy is a multidisciplinary task where the endoscopic surgeon undertakes an active and prominent role. It is a project with great benefits and rewards for all parties involved. We present our design for evaluation.

Education in the attic: an insight into the educational services of the Old Operating Theatre Museum and Herb Garret, London Bridge.

PubMed

Edge, Stevie

2009-01-01

Hidden for almost a century in the attic of St Thomas' Church the oldest operating theatre in Britain is now part of a museum. This precious building now houses a collection of pre-anaesthetic tools, items relating to medicine in the home and various Apothecary displays. The museum aims to preserve the theatre and items relating to medicine, in order to contribute to the understanding of the development of medical knowledge, with particular reference to St Thomas' hospital. An independent museum with a long history of educational provision: this article explores some of the education services of The Old Operating Theatre Museum and Herb Garret at London Bridge.

Can Particulate Air Sampling Predict Microbial Load in Operating Theatres for Arthroplasty?

PubMed Central

Cristina, Maria Luisa; Spagnolo, Anna Maria; Sartini, Marina; Panatto, Donatella; Gasparini, Roberto; Orlando, Paolo; Ottria, Gianluca; Perdelli, Fernanda

2012-01-01

Several studies have proposed that the microbiological quality of the air in operating theatres be indirectly evaluated by means of particle counting, a technique derived from industrial clean-room technology standards, using airborne particle concentration as an index of microbial contamination. However, the relationship between particle counting and microbiological sampling has rarely been evaluated and demonstrated in operating theatres. The aim of the present study was to determine whether particle counting could predict microbiological contamination of the air in an operating theatre during 95 surgical arthroplasty procedures. This investigation was carried out over a period of three months in 2010 in an orthopedic operating theatre devoted exclusively to prosthetic surgery. During each procedure, the bacterial contamination of the air was determined by means of active sampling; at the same time, airborne particulate contamination was assessed throughout the entire procedure. On considering the total number of surgical operations, the mean value of the total bacterial load in the center of the operating theatre proved to be 35 CFU/m3; the mean particle count was 4,194,569 no./m3 for particles of diameter ≥0.5 µm and 13,519 no./m3 for particles of diameter ≥5 µm. No significant differences emerged between the median values of the airborne microbial load recorded during the two types of procedure monitored. Particulates with a diameter of ≥0.5 µm were detected in statistically higher concentrations (p<0.001) during knee-replacement procedures. By contrast, particulates with a diameter of ≥5 µm displayed a statistically higher concentration during hip-replacement procedures (p<0.05). The results did not reveal any statistically significant correlation between microbial loads and particle counts for either of the particle diameters considered (≥0.5 µm and ≥5 µm). Consequently, microbiological monitoring remains the most suitable method of evaluating the quality of air in operating theatres. PMID:23285189

Can particulate air sampling predict microbial load in operating theatres for arthroplasty?

PubMed

Cristina, Maria Luisa; Spagnolo, Anna Maria; Sartini, Marina; Panatto, Donatella; Gasparini, Roberto; Orlando, Paolo; Ottria, Gianluca; Perdelli, Fernanda

2012-01-01

Several studies have proposed that the microbiological quality of the air in operating theatres be indirectly evaluated by means of particle counting, a technique derived from industrial clean-room technology standards, using airborne particle concentration as an index of microbial contamination. However, the relationship between particle counting and microbiological sampling has rarely been evaluated and demonstrated in operating theatres. The aim of the present study was to determine whether particle counting could predict microbiological contamination of the air in an operating theatre during 95 surgical arthroplasty procedures. This investigation was carried out over a period of three months in 2010 in an orthopedic operating theatre devoted exclusively to prosthetic surgery. During each procedure, the bacterial contamination of the air was determined by means of active sampling; at the same time, airborne particulate contamination was assessed throughout the entire procedure. On considering the total number of surgical operations, the mean value of the total bacterial load in the center of the operating theatre proved to be 35 CFU/m(3); the mean particle count was 4,194,569 no./m(3) for particles of diameter ≥0.5 µm and 13,519 no./m(3) for particles of diameter ≥5 µm. No significant differences emerged between the median values of the airborne microbial load recorded during the two types of procedure monitored. Particulates with a diameter of ≥0.5 µm were detected in statistically higher concentrations (p<0.001) during knee-replacement procedures. By contrast, particulates with a diameter of ≥5 µm displayed a statistically higher concentration during hip-replacement procedures (p<0.05). The results did not reveal any statistically significant correlation between microbial loads and particle counts for either of the particle diameters considered (≥0.5 µm and ≥5 µm). Consequently, microbiological monitoring remains the most suitable method of evaluating the quality of air in operating theatres.

Listen while you work? The attitude of healthcare professionals to music in the operating theatre.

PubMed

Faraj, A A; Wright, A P; Haneef, J H S; Jones, A

2014-09-01

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

The sensitivity to chlorhexidine and cetyl pyridinium chloride of staphylococci on the hands of dental students and theatre staff exposed to these disinfectants.

PubMed

Millns, B; Martin, M V; Field, E A

1994-02-01

The aim of this investigation was to study the possible emergence of resistant isolates of the genus Staphylococcus on the hands of dental personnel who use 'Hibiscrub' (chlorhexidine-detergent preparation) and cetyl pyridinium-coated gloves. Resistance was determined by a rate-of-kill technique. In four dental student groups (first, second, third and fourth years) no microorganisms survived 30 min exposure to cetyl pyridinium chloride (CPC) or to chlorhexidine diacetate (CDA). In a theatre staff group, no microorganisms survived 30 s exposure to CPC; and only one of 23 isolates survived 30 min exposure to CDA, but was killed after 60 min exposure. It is concluded that staphylococci resistant to either of these disinfectants do not present a problem in dental students or theatre staff.

Pre-surgery briefings and safety climate in the operating theatre.

PubMed

Allard, Jon; Bleakley, Alan; Hobbs, Adrian; Coombes, Lee

2011-08-01

In 2008, the WHO produced a surgical safety checklist against a background of a poor patient safety record in operating theatres. Formal team briefings are now standard practice in high-risk settings such as the aviation industry and improve safety, but are resisted in surgery. Research evidence is needed to persuade the surgical workforce to adopt safety procedures such as briefings. To investigate whether exposure to pre-surgery briefings is related to perception of safety climate. Three Safety Attitude Questionnaires, completed by operating theatre staff in 2003, 2004 and 2006, were used to evaluate the effects of an educational intervention introducing pre-surgery briefings. Individual practitioners who agree with the statement 'briefings are common in the operating theatre' also report a better 'safety climate' in operating theatres. The study reports a powerful link between briefing practices and attitudes towards safety. Findings build on previous work by reporting on the relationship between briefings and safety climate within a 4-year period. Briefings, however, remain difficult to establish in local contexts without appropriate team-based patient safety education. Success in establishing a safety culture, with associated practices, may depend on first establishing unidirectional, positive change in attitudes to create a safety climate.

[Microbial air monitoring in operating theatre: active and passive samplings].

PubMed

Pasquarella, C; Masia, M D; Nnanga, Nga; Sansebastiano, G E; Savino, A; Signorelli, C; Veronesi, L

2004-01-01

Microbial air contamination was evaluated in 11 operating theatres using active and passive samplings. SAS (Surface Air System) air sampling was used to evaluate cfu/m3 and settle plates were used to measure the index of microbial air contamination (IMA). Samplings were performed at the same time on three different days, at three different times (before, during and after the surgical activity). Two points were monitored (patient area and perimeter of the operating theatre). Moreover, the cfu/m3 were evaluated at the air inlet of the conditioner system. 74.7% of samplings performed at the air inlet and 66.7% of the samplings performed at the patient area before the beginning of the surgical activity (at rest) exceeded the 35 cfu/m3 used as threshold value. 100% of IMA values exceeded the threshold value of 5. Using both active and passive sampling, the microbial contamination was shown to increase significantly during activity. The cfu values were higher at the patient area than at the perimeter of the operating theatre. Mean values of the cfu/m3 during activity at the patient area ranged from a minimum of 61+/-41 cfu/m3 to a maximum of 242+/-136 cfu/m3; IMA values ranged from a minimum of 19+/-10 to a maximum of 129+/-60. 15.2% of samplings performed at the patient area using SAS and 75.8% of samplings performed using settle plates exceeded the threshold values of 180 cfu/m3 and 25 respectively, with a significant difference of the percentages. The highest values were found in the operating theatre with inadequate structural and managerial conditions. These findings confirm that the microbiological quality of air may be considered a mirror of the hygienic conditions of the operating theatre. Settle plates proved to be more sensitive in detecting the increase of microbial air contamination related to conditions that could compromise the quality of the air in operating theatres.

Recruitment and retention. The Derby Theatre Project experience.

PubMed

Ainsworth, David

2003-10-01

The National Theatre Project was set up in March 2001 by the Modernisation Agency to improve the patient and carer experience, improve employee satisfaction, optimise theatre utilisation and reduce cancelled operations. This is the second article in the series where David Ainsworth, manager of a pilot site project in Derby, describes issues around the Theatre Project. This month the focus is on recruitment, retention and staff morale.

Understanding surgery: multimedia comes to theatre.

PubMed

Dakin, S; Garner, M; Plura, M

1997-01-01

Educational technology is well established within Schools of Nursing, however there are few computer based learning packages within the clinical environment. It was felt within the Operating Services Directorate, Royal Hallamshire Hospital, that the development of a multimedia package would enhance and complement existing teaching methods. This paper describes the theory behind the choice of a multimedia presentation and its development within the operating theatres. The package, concentrating on general surgery, has been developed by two experienced theatre nurses and a graphic designer. This has resulted in a structured but flexible, fun package which is relevant to all learners within the operating theatre environment and allied healthcare fields. The feedback obtained from users within the clinical area has reinforced the project team's original feeling that multimedia is a highly appropriate resource for clinical education.

The use of theatre time for paediatric dentistry under general anaesthesia.

PubMed

Foley, Jennifer; Soldani, Francesca

2007-01-01

The aim of this paper was to determine the use of theatre time for all procedures performed under general anaesthetic on a paediatric dental list. A prospective study of paediatric dental general anaesthetic procedures was undertaken at Ninewells Hospital and Medical School, NHS Tayside, Dundee, UK. Data were collected prospectively for 71 operating lists over a 3-year period from April 2003 to March 2006. Both operator status and the procedure being undertaken were recorded. In addition, pre-anaesthetic, anaesthetic, operating and disconnection times were recorded. Of the 71 lists examined, 61 either finished early or on time, with a median unused time of 32.50 min (interquartile range = 19.50, 50.00 min), whilst 10 lists finished late with a median overrun time of 30.50 min (interquartile range = 9.25, 45.50 min). Comparing lists which finished late with those which were completed within time, the median pre-anaesthetic time was significantly longer (Mann-Whitney U-test, W = 20.05, P = 0.048). Overall, the theatre was in use for 78.22% of time combining pre-anaesthetic, anaesthetic, operating and disconnection times; hence, there was poor time utilization of theatre for 21.78% of the total theatre time. Overall, 85.9% of theatre sessions for dental procedures under general anaesthetic in children finished early or on time. Where lists finished late, the duration of the pre-anaesthetic time appeared to be the significant factor.

Reducing the risk of surgical site infection: a case controlled study of contamination of theatre clothing.

PubMed

Sivanandan, Indu; Bowker, Karen E; Bannister, Gordon C; Soar, Jasmeet

2011-02-01

Surgical site infections are one of the most important causes of healthcare associated infections (HCAI), accounting for 20% of all HCAIs. Surgical site infections affect 1% of joint replacement operations. This study was designed to assess whether theatre clothing is contaminated more inside or outside the theatre suite. Petri dishes filled with horse blood agar were pressed on theatre clothes at 0, 2, 4, 6 and 8 hours to sample bacterial contamination in 20 doctors whilst working in and outside the theatre suite. The results showed that there was greater bacterial contamination when outside the theatre suite at 2 hours. There were no differences in the amount of contamination at 4, 6 and 8 hours. This study suggests that the level of contamination of theatre clothes is similar both inside and outside the theatre setting.

Nursing in a technological environment: nursing care in the operating room.

PubMed

Bull, Rosalind; FitzGerald, Mary

2006-02-01

Operating room nurses continue to draw criticism regarding the appropriateness of a nursing presence in the operating room. The technological focus of the theatre and the ways in which nurses in the theatre have shaped and reshaped their practice in response to technological change have caused people within and outside the nursing profession to question whether operating room nursing is a technological rather than nursing undertaking. This paper reports findings from an ethnographic study that was conducted in an Australian operating department. The study examined the contribution of nurses to the work of the operating room through intensive observation and ethnographic interviews. This paper uses selected findings from the study to explore the ways in which nurses in theatre interpret their role in terms of caring in a technological environment.

Compliance and use of the World Health Organization checklist in U.K. operating theatres.

PubMed

Pickering, S P; Robertson, E R; Griffin, D; Hadi, M; Morgan, L J; Catchpole, K C; New, S; Collins, G; McCulloch, P

2013-11-01

The World Health Organization (WHO) Surgical Safety Checklist is reported to reduce surgical morbidity and mortality, and is mandatory in the U.K. National Health Service. Hospital audit data show high compliance rates, but direct observation suggests that actual performance may be suboptimal. For each observed operation, WHO time-out and sign-out attempts were recorded, and the quality of the time-out was evaluated using three measures: all information points communicated, all personnel present and active participation. Observation of WHO checklist performance was conducted for 294 operations, in five hospitals and four surgical specialties. Time-out was attempted in 257 operations (87.4 per cent) and sign-out in 26 (8.8 per cent). Within time-out, all information was communicated in 141 (54.9 per cent), the whole team was present in 199 (77.4 per cent) and active participation was observed in 187 (72.8 per cent) operations. Surgical specialty did not affect time-out or sign-out attempt frequency (P = 0.453). Time-out attempt frequency (range 42-100 per cent) as well as all information communicated (15-83 per cent), all team present (35-90 per cent) and active participation (15-93 per cent) varied between hospitals (P < 0.001 for all). Meaningful compliance with the WHO Surgical Safety Checklist is much lower than indicated by administrative data. Sign-out compliance is generally poor, suggesting incompatibility with normal theatre work practices. There is variation between hospitals, but consistency across studied specialties, suggesting a need to address organizational culture issues. © 2013 British Journal of Surgery Society Ltd. Published by John Wiley & Sons Ltd.

Fire in operating theatres: DaSH-ing to the rescue.

PubMed

Wilson, Liam; Farooq, Omer

2018-01-01

Operating theatres are dynamic environments that require multi professional team interactions. Effective team working is essential for efficient delivery of safe patient care. A fire in the operating theatre is a rare but potentially life threatening event for both patients and staff. A rapid and cohesive response from theatre and allied staff including porters, fire safety officer etc is paramount. We delivered a training session that utilised in situ simulation (simulation in workplace). After conducting needs analysis, learning objectives were agreed. After thorough planning, the date and location of the training session were identified. Contingency plans were put in place to ensure that patient care was not compromised at any point. To ensure success, checklists for faculty were devised and adhered to. A medium fidelity manikin with live monitoring was used. The first part of the scenario involved management of a surgical emergency by theatre staff. The second part involved management of a fire in the operating theatre while an emergency procedure was being undertaken. To achieve maximum learning potential, debriefing was provided immediately after each part of the scenario. A fire safety officer was present as a content expert. Latent errors (hidden errors in the workplace, staff knowledge etc) were identified. Malfunctioning of theatre floor windows and staff unawareness about the location of an evacuation site were some of the identified latent errors. Thorough feedback to address these issues was provided to the participants on the day. A detailed report of the training session was given to the relevant departments. This resulted in the equipment faults being rectified. The training session was a very positive experience and helped not only in improving participants' knowledge, behaviour and confidence but also it made system and environment better equipped.

[Comparison of perforated metal ceiling systems (supported airflow ceilings) with laminar airflow ceilings in type A (DIN 1946 T.4) operating rooms under surgical conditions].

PubMed

Bischoff, W E; Kindermann, A; Sander, U; Sander, J

1995-10-01

In eleven centrally ventilated operating theatres the concentration of particles and airborne germs in wound vicinity was measured on three workdays. Five theatres were equipped with air supply ceilings with supporting flow outlets (supporting flow ceilings), five with laminar air flow ceilings and one with an air supply ceiling, a body exhaust system and a partition wall between the anesthetic and operating areas. Under routine conditions the air supply of the laminar air flow ceiling with its lower turbulence shielded the operating field from the largely staff-related air contamination in the rest of the theatre better than in the case of the supporting flow ceilings. Particles and airborne germs were removed from the endangered wound area faster. A spatial separation between the anesthetic and the operating areas as well as a body exhaust system lead to a considerable reduction of the contamination. Two theatres were conspicuous by reason of their considerably raised values due to defective control engineering and the wrongly positioning of the operating table. From the point of view of ventilation technique the laminar air flow ceilings with lower turbulence are superior to air supply ceilings with supporting flow outlets in the working day of an operating theatre. In order to minimize the influence of the staff, which up till now has been neglected in testing specifications, constructional possibilities such as the size of ceiling, the partitioning off of operating and anaesthetic areas and the positioning of the operating table in relation to the incoming air should be coordinated rationally. Taking measurements regularly during operations can provide the impulse for considerable improvements in both operational and planning phases.

Teaching and learning in the operating theatre: a framework for trainers and advanced trainees in obstetrics and gynaecology.

PubMed

Mukhopadhyay, S; China, S

2010-04-01

Surgical training of 'advanced trainees' in Obstetrics and Gynaecology currently occurs in a rather unstructured fashion. This is even more complicated by reduced training time of doctors necessitated by the European working time directive. Teaching and learning in theatre is a combination of art and science. This paper attempts to address the issues hampering effective theatre training and suggests ways to overcome them. The 'operating theatre' plan includes a needs assessment of trainees, goal setting and instructional methodologies. Various learning styles could potentially be adopted, although it might be difficult to choose a learning style suitable for a particular trainee. Additionally, team working skills and experiential learning need to be facilitated.

Building clinical practice in the Palestine Red Crescent operation theatres in Lebanon: reflections from the perspective of an expatriate nurse.

PubMed

Tjoflåt, I; Karlsen, B

2013-12-01

This paper, based on the experience of the first author as an expatriate nurse, aims to describe and discuss some aspects of collaboration that contributed to the building of clinical practice when implementing an operating theatre programme in the Palestine Red Crescent Society (PRCS) hospitals in Lebanon. The operation theatre programme lasted for 8 months: 6 months in 2008 and 2 months in 2009. The programme was part of the partnership project 'Quality of care in the five PRCS hospitals in Lebanon' between the International Committee of the Red Cross and the PRCS Lebanon (PRCS-L) branch. The essential aspects that may have contributed to the building of clinical practice in the operation theatre programme included the expatriate nurse and the Palestine Red Crescent operating theatre nurses working together over time as colleagues, the socio-cultural pedagogic perspective selected for the implementation and the collaboration with the management of the hospitals and counterparts in the PRCS-L branch. One should also note the human and structural issues that seemed to influence the implementation of the programme in a more negative way. This experience may provide insight for other nurses into the importance of working as colleagues, selecting an appropriate pedagogic perspective and establishing productive collaboration with all partners when building clinical practice during a humanitarian mission. © 2013 International Council of Nurses.

PubMed Central

Genovese, C.; Facciolà, A.; Palamara, M.A.R.; Squeri, R.

2017-01-01

Summary Introduction. Nosocomial infections are one of the greatest problems in public health. Several studies have highlighted the role played by the hospital environment as a possible source of transmission of nosocomial pathogens. Methods. A five-year monitoring of bacterial contamination on healthcare workers hands, surfaces most closely in contact with inpatient wards, operating theatres and "at rest" and "in use" operating theatre air samples. For the samples, we used sterile swabs, contact slides, manual API, and automated VITEK systems for identification. Results. In the five-year period, a total of 9396 samples were collected and analysed. In ward patients, 4398 samplings were carried out with 4.7%, 9.4%, 7%, 10.8% and 7.9% positive results respectively from 2010 to 2014. For hands, 648 samplings were carried out, with a positivity of 40.74%. In operating theatres, 4188 samples were taken, with a positivity of 11.9%. Regarding air in empty and full theatres, 1962 samplings were carried out with a positivity rate equal to 31.9%. The monitoring showed a low rate of contamination with a progressive decrease in the fiveyear period on operating theatres surfaces and hands, while there was an increase in the surgical site wards and in the air of operating rooms. Conclusions. Our investigation has revealed the presence of pathogens on the assessed surfaces and the need for environmental monitoring, which can be a valuable tool for reducing contamination. PMID:28900357

Undergraduate surgical nursing preparation and guided operating room experience: A quantitative analysis.

PubMed

Foran, Paula

2016-01-01

The aim of this research was to determine if guided operating theatre experience in the undergraduate nursing curricula enhanced surgical knowledge and understanding of nursing care provided outside this specialist area in the pre- and post-operative surgical wards. Using quantitative analyses, undergraduate nurses were knowledge tested on areas of pre- and post-operative surgical nursing in their final semester of study. As much learning occurs in nurses' first year of practice, participants were re-tested again after their Graduate Nurse Program/Preceptorship year. Participants' results were compared to the model of operating room education they had participated in to determine if there was a relationship between the type of theatre education they experienced (if any) and their knowledge of surgical ward nursing. Findings revealed undergraduates nurses receiving guided operating theatre experience had a 76% pass rate compared to 56% with non-guided or no experience (p < 0.001). Graduates with guided operating theatre experience as undergraduates or graduate nurses achieved a 100% pass rate compared to 53% with non-guided or no experience (p < 0.001). The research informs us that undergraduate nurses achieve greater learning about surgical ward nursing via guided operating room experience as opposed to surgical ward nursing experience alone. Copyright © 2015 Elsevier Ltd. All rights reserved.

A model of teaching and learning in the operating theatre.

PubMed

Lyon, Patricia

2004-12-01

This paper extends the work of an earlier publication by the same author which reported the findings of a case study designed to investigate how medical students learn and are taught in the operating theatre. The earlier paper was descriptive in nature, examining the challenges students face as learners in theatres. These were conceptualised around 3 key domains: the challenge posed by the physical environment; the challenge of the educational task, and the challenge of managing and negotiating a role as a participant in the professional workplace of theatres. This paper focuses exclusively on the third domain. It presents an interpretive model of teaching and learning in the operating theatre, drawing largely on conceptual frameworks developed within the literature on learning in work-based settings. A multimethod strategy included observation in theatres, interviews with students and surgeons, and a student survey. The themes that characterised the case were identified and the relationships among these themes were explored, leading to the development of the model. Symbolic interactionism provided the underlying theoretical framework. In any particular theatre session, the way in which learning evolves or is obstructed for any student, and the shape that teaching takes, depends on the interpretations that the student and the surgeon make in 'sizing up' the teaching and learning environment. How surgeons and students interpret and respond to each others' behaviour, style, attitude and even demeanour, has consequences for the way teaching and learning develop. The concepts of legitimacy and trust underpin these interpretations and are central to understanding the processes of teaching and learning in this setting.

Operating theatre related syncope in medical students: a cross sectional study

PubMed Central

Jamjoom, AAB; Nikkar-Esfahani, A; Fitzgerald, JEF

2009-01-01

Background Observing surgical procedures is a beneficial educational experience for medical students during their surgical placements. Anecdotal evidence suggests that operating theatre related syncope may have detrimental effects on students' views of this. Our study examines the frequency and causes of such syncope, together with effects on career intentions, and practical steps to avoid its occurrence. Methods All penultimate and final year students at a large UK medical school were surveyed using the University IT system supplemented by personal approach. A 20-item anonymous questionnaire was distributed and results were analysed using the Statistical Package for Social Sciences, version 15.0 (Chicago, Illinois, USA). Results Of the 630 clinical students surveyed, 77 responded with details of at least one near or actual operating theatre syncope (12%). A statistically significant gender difference existed for syncopal/near-syncopal episodes (male 12%; female 88%), p < 0.05. Twenty-two percent of those affected were graduate entry medical course students with the remaining 78% undergraduate. Mean age was 23-years (range 20 – 45). Of the 77 reactors, 44 (57%) reported an intention to pursue a surgical career. Of this group, 7 (9%) reported being discouraged by syncopal episodes in the operating theatre. The most prevalent contributory factors were reported as hot temperature (n = 61, 79%), prolonged standing (n = 56, 73%), wearing a surgical mask (n = 36, 47%) and the smell of diathermy (n = 18, 23%). The most frequently reported measures that students found helpful in reducing the occurrence of syncopal episodes were eating and drinking prior to attending theatre (n = 47, 61%), and moving their legs whilst standing (n = 14, 18%). Conclusion Our study shows that operating theatre related syncope among medical students is common, and we establish useful risk factors and practical steps that have been used to prevent its occurrence. Our study also highlights the detrimental effect of this on the career intentions of medical students interested in surgery. Based on these findings, we recommend that dedicated time should be set aside in surgical teaching to address this issue prior to students attending the operating theatre. PMID:19284564

Operating theatre related syncope in medical students: a cross sectional study.

PubMed

Jamjoom, A A B; Nikkar-Esfahani, A; Fitzgerald, J E F

2009-03-10

Observing surgical procedures is a beneficial educational experience for medical students during their surgical placements. Anecdotal evidence suggests that operating theatre related syncope may have detrimental effects on students' views of this. Our study examines the frequency and causes of such syncope, together with effects on career intentions, and practical steps to avoid its occurrence. All penultimate and final year students at a large UK medical school were surveyed using the University IT system supplemented by personal approach. A 20-item anonymous questionnaire was distributed and results were analysed using the Statistical Package for Social Sciences, version 15.0 (Chicago, Illinois, USA). Of the 630 clinical students surveyed, 77 responded with details of at least one near or actual operating theatre syncope (12%). A statistically significant gender difference existed for syncopal/near-syncopal episodes (male 12%; female 88%), p < 0.05. Twenty-two percent of those affected were graduate entry medical course students with the remaining 78% undergraduate. Mean age was 23-years (range 20 - 45). Of the 77 reactors, 44 (57%) reported an intention to pursue a surgical career. Of this group, 7 (9%) reported being discouraged by syncopal episodes in the operating theatre. The most prevalent contributory factors were reported as hot temperature (n = 61, 79%), prolonged standing (n = 56, 73%), wearing a surgical mask (n = 36, 47%) and the smell of diathermy (n = 18, 23%). The most frequently reported measures that students found helpful in reducing the occurrence of syncopal episodes were eating and drinking prior to attending theatre (n = 47, 61%), and moving their legs whilst standing (n = 14, 18%). Our study shows that operating theatre related syncope among medical students is common, and we establish useful risk factors and practical steps that have been used to prevent its occurrence. Our study also highlights the detrimental effect of this on the career intentions of medical students interested in surgery. Based on these findings, we recommend that dedicated time should be set aside in surgical teaching to address this issue prior to students attending the operating theatre.

[Hygienic Inspections of Ventilation Systems Under Resting Conditions (According to DIN 1946-4:1999-03) - A Retrospective Assessment].

PubMed

Friedrich, Lena; Boeckelmann, Irina

2018-01-11

Hygienic and microbiologically sterile air quality is essential for successful guideline-based work in operating theatres. To ensure clean air and to reduce contamination during surgery, ventilation systems are indispensable. Ventilation systems should be especially designed to keep the number of particles and germs under statutory limits. Therefore, they must be operated to recognised standards of good practice and be periodically inspected and maintained. The objective of this study was to prove, through the analysis of observation outside surgery time (rest condition), the effects of ventilation systems on air quality in a medical facility. Measurements were taken in 34 operating theatres annually over a period of ten years outside surgery time (resting condition) but with the air ventilation system operating under full load. 29 operating theatres were provided with laminar air flow and five theatres with turbulent air flow systems. In each operating theatre, air cleanliness was analysed by measuring the amount of airborne particles and airborne germs. Measuring points were determined 10 mm beneath the supply-air ceiling in the centre of the operating theatre and at one position outside the supply-air ceiling. The number of airborne particles at the supply-air ceiling was between 0/m³ and 4,441/m³ of air and, as such, the limiting factor was never exceeded. However, airborne germ measurements of between 0 CFU/m³ and 200 CFU/m³ (CFU: colony forming units) demonstrated that the limiting factor for this criterion was exceeded in 10.9% of occasions. In general, the values in the middle of the room were higher than at the supply-air ceiling. There were significant differences (p < 0.001) between the values at the supply-air ceiling, the surgery table and the values outside the supply-air ceiling. The results show the positive impact of ventilation systems on the air cleanliness in operating theatres. However, laminar airflow systems seem to create cleaner air than conventional ventilation systems. The size of the supply-air ceiling plays an important role in the prevention of the contamination of the staff, the surgical field, the instrument table and the patient. However, the effect on surgical site infections has not been verified. Improved measuring methods should be considered. Georg Thieme Verlag KG Stuttgart · New York.

Implementing situation-background-assessment-recommendation in an anaesthetic clinic and subsequent information retention among receivers: A prospective interventional study of postoperative handovers.

PubMed

Randmaa, Maria; Swenne, Christine L; Mårtensson, Gunilla; Högberg, Hans; Engström, Maria

2016-03-01

Communication errors cause clinical incidents and adverse events in relation to surgery. To ensure proper postoperative patient care, it is essential that personnel remember and recall information given during the handover from the operating theatre to the postanaesthesia care unit. Formalizing the handover may improve communication and aid memory, but research in this area is lacking. The objective of this study was to evaluate whether implementing the communication tool Situation-Background-Assessment-Recommendation (SBAR) affects receivers' information retention after postoperative handover. A prospective intervention study with an intervention group and comparison nonintervention group, with assessments before and after the intervention. The postanaesthesia care units of two hospitals in Sweden during 2011 and 2012. Staff involved in the handover between the operating theatre and the postanaesthesia care units within each hospital. Implementation of the communication tool SBAR in one hospital. The main outcome was the percentage of recalled information sequences among receivers after the handover. Data were collected using both audio-recordings and observations recorded on a study-specific protocol form. Preintervention, 73 handovers were observed (intervention group, n = 40; comparison group, n = 33) involving 72 personnel (intervention group, n = 40; comparison group, n = 32). Postintervention, 91 handovers were observed (intervention group, n = 44; comparison group, n = 47) involving 57 personnel (intervention group, n = 31; comparison group, n = 26). In the intervention group, the percentage of recalled information sequences by the receivers increased from 43.4% preintervention to 52.6% postintervention (P = 0.004) and the SBAR structure improved significantly (P = 0.028). In the comparison group, the corresponding figures were 51.3 and 52.6% (P = 0.725) with no difference in SBAR structure. When a linear regression generalised estimating equation model was used to account for confounding influences, we were unable to show a significant difference in the information recalled between the intervention group and the nonintervention group over time. Compared with the comparison group with no intervention, when SBAR was implemented in an anaesthetic clinic, we were unable to show any improvement in recalled information among receivers following postoperative handover. Current controlled trials http://www.controlled-trials.com Identifier: ISRCTN37251313.

The productive operating theatre and lean thinking systems.

PubMed

Kasivisvanathan, R; Chekairi, A

2014-11-01

The concept of 'lean thinking' first originated in the manufacturing industry as a means of improving productivity whilst maintaining quality through eliminating wasteful processes. The purpose of this article is to demonstrate how the principles of 'lean thinking' are relevant to healthcare and the operating theatre, with reference to our own institutional experience.

Promoting Inter-Professional Teamwork and Learning--The Case of a Surgical Operating Theatre

ERIC Educational Resources Information Center

Collin, Kaija; Paloniemi, Susanna; Mecklin, Jukka-Pekka

2010-01-01

Hospitals, and surgical operating theatres (OTs) in particular, are environments in which inter-professional teamwork and learning are essential to secure patient safety and effective practice. However, it has been revealed in many studies that inter-professional collaborative work in hospital organisations faces many challenges and constraints.…

A study to assess the influence of interprofessional point of care simulation training on safety culture in the operating theatre environment of a university teaching hospital.

PubMed

Hinde, Theresa; Gale, Thomas; Anderson, Ian; Roberts, Martin; Sice, Paul

2016-01-01

Interprofessional point of care or in situ simulation is used as a training tool in our operating theatre directorate with the aim of improving crisis behaviours. This study aimed to assess the impact of interprofessional point of care simulation on the safety culture of operating theatres. A validated Safety Attitude Questionnaire was administered to staff members before each simulation scenario and then re-administered to the same staff members after 6-12 months. Pre- and post-training Safety Attitude Questionnaire-Operating Room (SAQ-OR) scores were compared using paired sample t-tests. Analysis revealed a statistically significant perceived improvement in both safety (p < 0.001) and teamwork (p = 0.013) climate scores (components of safety culture) 6-12 months after interprofessional simulation training. A growing body of literature suggests that a positive safety culture is associated with improved patient outcomes. Our study supports the implementation of point of care simulation as a useful intervention to improve safety culture in theatres.

Storying Worlds: Using Playback Theatre to Explore the Interplay between Personal and Dominant Discourses amongst Adolescents

ERIC Educational Resources Information Center

Jordaan, Odia; Coetzee, Marié-Heleen

2017-01-01

This article explores the ways in which playback theatre was used to interrogate the views of adolescents on their social context(s) and establish what the personal and dominant discourses operating in their views were. Playback theatre, with its focus on reframing personal stories to generate new perspectives on these stories, was an appropriate…

Outcomes of in-hospital, out of intensive care and operation theatre cardiac arrests in a tertiary referral hospital

PubMed Central

Chakravarthy, Murali; Mitra, Sona; Nonis, Latha

2012-01-01

Objective Cardiac arrest in the hospital wards may not receive as much attention as it does in the operation theatre and intensive care unit (ICU). The experience and the qualifications of personnel in the ward may not be comparable to those in the other vital areas of the hospital. The outcome of cardiac arrest from the ward areas is a reasonable surrogate of training of the ward nurses and technicians in cardiopulmonary resuscitation. We conducted an audit to assess the issues surrounding the resuscitation of cardiac arrest in areas other than operation theatre and ICU in a tertiary referral hospital. Aims of the audit To assess the outcomes of cardiac arrest in a tertiary referral hospital. Areas such as wards, dialysis room and emergency room were considered for the audit. Methods This is a retrospective observational audit of the case records of all the adult patients who were resuscitated from ‘code blue’. Data for 2 years from 2007 was analysed by a research fellow unconnected with the resuscitations. Results Twenty-two thousand three hundred and forty-four patients were admitted as in-patients to the hospital during the 2 years, starting May 2007 through May 2009. One hundred code blue calls were received during this time. Twenty-two of the total calls received were false. Among the 78 confirmed cardiac arrests 69 occurred in the wards, 2 in emergency room, 1 in cardiac catheterisation laboratory and 3 in dialysis room. Twenty-eight patients were declared dead after unsuccessful cardiopulmonary resuscitation. Among the 50 who were resuscitated with a return of spontaneous rhythm 26 died. Twenty-four patients were discharged (survival rate of 30%). The survival decreased significantly as the age progressed beyond 60. The resuscitation rates were better in day shifts in contrast to the night. Higher survival was noted in patients who received resuscitation in less than a minute. Conclusion A overall survival to discharge rate of 30% was noted in this audit. Higher survival rates might be attributable to high rate and degree of training at the time of their employment, which was repeated at yearly interval. PMID:22572417

The lived experiences of operating theatre scrub nurses learning technical scrub skills 'I'm doing this right, aren't I? Am I doing this right?'

PubMed

Radford, Eleanor J; Fotis, Theo

2018-01-01

Operating theatre scrub nurses (OTSNs) are not required to have undertaken a secondary or specialist post-registration theatre qualification to work in the operating theatre (OT) setting in the UK. From the systematic review there is only very limited literature or research in how technical scrub skills are acquired. This study explores the lived experiences of OTSNs learning technical scrub skills. The study employed the qualitative methodology of interpretative phenomenological analysis. Data was collected from six participating OTSNs using semi-structured interviews. Four superordinate themes emerged: How technical scrub skills are established, Gatekeepers, How the learner feels whilst learning and, Reflections of the experienced scrub nurse. The study found that the experiences of OTSNs learning technical scrub skills are varied and a variety of teaching and learning methods are utilised. These experiences were influenced by the team, mentor and surgeon within the OT environment. Lived experiences were also influenced by organisational structure and service pressures within the NHS.

Perceived effect of deployment on families of UK military personnel.

PubMed

Thandi, G; Greenberg, N; Fear, N T; Jones, N

2017-10-01

In the UK, little is known about the perceived effects of deployment, on military families, from military personnel in theatre. To investigate military personnel's perceptions of the impact of deployment on intimate relationships and children. Deployed service personnel who were in a relationship, and who had children, completed a survey while deployed on combat operations. Data were taken from four mental health surveys carried out in Iraq in 2009 and Afghanistan in 2010, 2011 and 2014. Among 4265 participants, after adjusting for military and social-demographic covariates, perceiving that deployment had a negative impact on intimate relationships and children was associated with psychological distress, and traumatic stress symptoms. Military personnel who reported being in danger of being injured or killed during deployment, were more likely to report a perceived negative effect of deployment on their intimate relationships. Reservists were less likely to report a perceived negative impact of deployment on their children compared with regulars. Military personnel who themselves planned to separate from their partner were more likely to report psychological distress, and stressors at home. Perceived insufficient support from the Ministry of Defence was associated with poor mental health, and holding a junior rank. Deployed UK military personnel with symptoms of psychological distress, who experienced stressors at home, were especially likely to perceive that their family were inadequately supported by the military. Those planning to separate from their partner were at increased risk of suffering with mental health problems while deployed. © The Author 2017. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For Permissions, please email: journals.permissions@oup.com

LISTEN WHILE YOU WORK? The Attitude of Healthcare Professionals to Music in the OR.

PubMed

Faraj, Adna Abdilmajeedn; Wright, P; Haneef, J H S; Jones, Adrian

2015-06-01

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

Theatre and Oral Interpretation: Abstracts of Doctoral Dissertations Published in "Dissertation Abstracts International," July 1979 through June 1980 (Vol. 40 Nos. 1 through 12).

ERIC Educational Resources Information Center

ERIC Clearinghouse on Reading and Communication Skills, Urbana, IL.

This collection of abstracts is part of a continuing series providing information on recent doctoral dissertations. The 15 titles deal with the following topics: (1) a taxonomy of educational objectives in acting; (2) contemporary musical theatre in Utah; (3) applying management concepts to educational theatre operations; (4) creative drama and…

You Are Who I Say You Are: The Rhetorical Construction of Identity in the Operating Theatre

ERIC Educational Resources Information Center

Bleakley, Alan

2006-01-01

Purpose: The paper seeks to show that narrative close call reporting is one strand of an ongoing collaborative inquiry project with 300 staff aiming to improve teamwork in operating theatres in a large UK hospital. How teams deal with close calls ("accidents waiting to happen") reveals resourcefulness but exposes flaws, including…

[Role expectations of various professional groups in the operating theatre].

PubMed

Gfrörer, R; Bernard, U; Schaper, C; Bauer, M; Schüpfer, G K

2007-11-01

Clearly defined professional roles have the advantage that team members know what they are expected to do and what their expectations of other professional groups are. For the definition of roles a distinct number of interactions between persons are a prerequisite. In a typical operations room (OR) team members are not constantly involved and are often exchanged. Interactions between personnel are not strong enough to fulfil the designing process of role shaping. In this study the possible substitution of defined roles by a distinct professional culture in an OR was studied. Using a shortened form of the SYMLOG questionnaire, 179 persons working in the ORs of 2 Swiss hospitals were interviewed. The three main professional groups in the OR setting were represented in this cohort: anaesthesia personnel (physicians and nurses), surgeons and operating room technicians and nurses. The SYMLOG questionnaire allows the rating of sympathy, influence and goal orientation of the professional groups. Surgeons and anaesthetists had the strongest influence and higher ratings for goal orientation. In comparison, the influence of members of the nursing profession was less valued. All three professional groups rated themselves higher than in the perception of the other professional groups. It is concluded that in this analysis the role definition was not clear. Optimization is therefore possible which could reduce conflict potential and contribute to a higher productivity.

Randomized clinical trial of immersive virtual reality tour of the operating theatre in children before anaesthesia.

PubMed

Ryu, J-H; Park, S-J; Park, J-W; Kim, J-W; Yoo, H-J; Kim, T-W; Hong, J S; Han, S-H

2017-11-01

A virtual reality (VR) tour of the operating theatre before anaesthesia could provide a realistic experience for children. This study was designed to determine whether a preoperative VR tour could reduce preoperative anxiety in children. Children scheduled for elective surgery under general anaesthesia were randomized into a control or VR group. The control group received conventional information regarding anaesthesia and surgery. The VR group watched a 4-min video showing Pororo, the famous little penguin, visiting the operating theatre and explaining what is in it. The main outcome was preoperative anxiety, assessed using the modified Yale Preoperative Anxiety Scale (m-YPAS) before entering the operating theatre. Secondary outcomes included induction compliance checklist (ICC) and procedural behaviour rating scale (PBRS) scores during anaesthesia. A total of 69 children were included in the analysis, 35 in the control group and 34 in the VR group. Demographic data and induction time were similar in the two groups. Children in the VR group had a significantly lower m-YPAS score than those in the control group (median 31·7 (i.q.r. 23·3-37·9) and 51·7 (28·3-63·3) respectively; P < 0·001). During anaesthesia, the VR group had lower ICC and PBRS scores than the control group. This preoperative VR tour of the operating theatre was effective in alleviating preoperative anxiety and increasing compliance during induction of anaesthesia in children undergoing elective surgery. Registration number: UMIN000025232 (http://www.umin.ac.jp/ctr). © 2017 BJS Society Ltd Published by John Wiley & Sons Ltd.

Air-conditioning vs. presence of pathogenic fungi in hospital operating theatre environment.

PubMed

Gniadek, Agnieszka; Macura, Anna B

2011-01-01

Infections related to modern surgical procedures present a difficult problem for contemporary medicine. Infections acquired during surgery represent a risk factor related to therapeutical interventions. Eradication of microorganisms from hospital operating theatre environment may contribute to reduction of infections as the laminar flow air-conditioning considerably reduces the number of microorganisms in the hospital environment. The objective of the study was to evaluate the occurrence of fungi in air-conditioned operating theatre rooms. The study was carried out in one of the hospitals in Krak6w during December 2009. Indoor air samples and imprints from the walls were collected from five operating theatre rooms. A total of fifty indoor air samples were collected with a MAS-100 device, and twenty five imprints from the walls were collected using a Count Tact method. Fungal growth was observed in 48 air samples; the average numbers of fungi were within the range of 5-100 c.f.u. in one cubic metre of the air. Fungi were detected only in four samples of the wall imprints; the number of fungi was 0.01 c.f.u. per one square centimetre of the surface. The mould genus Aspergillus was most frequently isolated, and the species A. fumigatus and A. versicolor were the dominating ones. To ensure microbiological cleanness of hospital operating theatre, the air-conditioning system should be properly maintained. Domination of the Aspergillus fungi in indoor air as well as increase in the number of moulds in the samples taken in evenings (p < 0.05) may suggest that the room decontamination procedures were neglected.

Experiences of Australian Army theatre nurses.

PubMed

Biedermann, Narelle

2002-02-01

As battles have raged throughout the centuries, nurses have cared for ill and wounded soldiers. One nursing role during war is theatre (i.e., OR) nursing. This article describes the role of Australian Army theatre nurses during the Vietnam War. It is based on information collected in a study of the experiences of Australian Army nurses who worked in operating theatres in Vietnam between 1967 and 1971. As nurses today focus on the future to find new ways to meet the demands of nursing ahead, it is important to reflect on the past, as they can learn from history and from other nurses' experiences.

Interrogation of patient data delivered to the operating theatre during hepato-pancreatic surgery using high-performance computing.

PubMed

John, Nigel W; McCloy, Rory F; Herrman, Simone

2004-01-01

The Op3D visualization system allows, for the first time, a surgeon in the operating theatre to interrogate patient-specific medical data sets rendered in three dimensions using high-performance computing. The hypothesis of this research is that the success rate of hepato-pancreatic surgical resections can be improved by replacing the light box with an interactive 3D representation of the medical data in the operating theatre. A laptop serves as the client computer and an easy-to-use interface has been developed for the surgeon to interact with and interrogate the patient data. To date, 16 patients have had 3D reconstructions of their DICOM data sets, including preoperative interrogation and planning of surgery. Interrogation of the 3D images live in theatre and comparison with the surgeons' operative findings (including intraoperative ultrasound) led to the operation being abandoned in 25% of cases, adoption of an alternative surgical approach in 25% of cases, and helpful image guidance for successful resection in 50% of cases. The clinical value of the latest generation of scanners and digital imaging techniques cannot be realized unless appropriate dissemination of the images takes place. This project has succeeded in translating the image technology into a user-friendly form and delivers 3D reconstructions of patient-specific data to the "sharp end"-the surgeon undertaking the tumor resection in theatre, in a manner that allows interaction and interpretation. More time interrogating the 3D data sets preoperatively would help reduce the incidence of abandoned operations-this is part of the surgeons' learning curve. We have developed one of the first practical applications to benefit from remote visualization, and certainly the first medical visualization application of this kind.

How can positive and negative trainer feedback in the operating theatre impact a surgical trainee’s confidence and well-being: a qualitative study in the north of England

PubMed Central

Kamali, Dariush; Illing, Jan

2018-01-01

Objective To identify the perception of positive feedback (PF) and negative feedback (NF) provided by trainers in the operating theatre on surgical trainees' confidence and well-being. Design Narrative interview study. Setting Twelve hospitals that form part of one deanery within the UK. Participants Maximum variation sampling of 15 higher general surgical trainees provided insight into how PF and NF from trainers in the operating theatre affect confidence and well-being. Methods Narrative telephone interviews were conducted with general surgical trainees between April and June 2016. All interviews were recorded, transcribed and anonymised. Transcriptions were analysed using the five-step framework analysis by two independent researchers. Results Fifteen trainees (age 28–38 years) were interviewed (median interview time: 29 min). Thematic framework analysis identified nine themes within the data. PF, which included corrective feedback, helped the trainees to relax and seemed to enhance their operative performance. All trainees reported significant and unjustified NF, some of which would be defined as undermining and bullying. Many believed this to have a negative impact on their training with minimal educational benefit. Many trainees felt NF adversely affected their performance in the operating theatre with some expressing a wish to leave the profession as a consequence. Conclusion Both PF and NF exist in the operating theatre. Both have an important influence on the trainee, their performance and career. PF, if specific, helped aid progression of learning, increased motivation and performance of surgical trainees. In contrast, NF was perceived to have detrimental effects on trainees’ performance and their well-being and, in some, introduced a desire to pursue an alternative career. PMID:29440141

Effectiveness of facilitated introduction of a standard operating procedure into routine processes in the operating theatre: a controlled interrupted time series.

PubMed

Morgan, Lauren; New, Steve; Robertson, Eleanor; Collins, Gary; Rivero-Arias, Oliver; Catchpole, Ken; Pickering, Sharon P; Hadi, Mohammed; Griffin, Damian; McCulloch, Peter

2015-02-01

Standard operating procedures (SOPs) should improve safety in the operating theatre, but controlled studies evaluating the effect of staff-led implementation are needed. In a controlled interrupted time series, we evaluated three team process measures (compliance with WHO surgical safety checklist, non-technical skills and technical performance) and three clinical outcome measures (length of hospital stay, complications and readmissions) before and after a 3-month staff-led development of SOPs. Process measures were evaluated by direct observation, using Oxford Non-Technical Skills II for non-technical skills and the 'glitch count' for technical performance. All staff in two orthopaedic operating theatres were trained in the principles of SOPs and then assisted to develop standardised procedures. Staff in a control operating theatre underwent the same observations but received no training. The change in difference between active and control groups was compared before and after the intervention using repeated measures analysis of variance. We observed 50 operations before and 55 after the intervention and analysed clinical data on 1022 and 861 operations, respectively. The staff chose to structure their efforts around revising the 'whiteboard' which documented and prompted tasks, rather than directly addressing specific task problems. Although staff preferred and sustained the new system, we found no significant differences in process or outcome measures before/after intervention in the active versus the control group. There was a secular trend towards worse outcomes in the postintervention period, seen in both active and control theatres. SOPs when developed and introduced by frontline staff do not necessarily improve operative processes or outcomes. The inherent tension in improvement work between giving staff ownership of improvement and maintaining control of direction needs to be managed, to ensure staff are engaged but invest energy in appropriate change. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Time and motion studies of National Health Service cataract theatre lists to determine strategies to improve efficiency.

PubMed

Roberts, Harry W; Myerscough, James; Borsci, Simone; Ni, Melody; O'Brart, David P S

2017-11-24

To provide a quantitative assessment of cataract theatre lists focusing on productivity and staffing levels/tasks using time and motion studies. National Health Service (NHS) cataract theatre lists were prospectively observed in five different institutions (four NHS hospitals and one private hospital). Individual tasks and their timings of every member of staff were recorded. Multiple linear regression analyses were performed to investigate possible associations between individual timings and tasks. 140 operations were studied over 18 theatre sessions. The median number of scheduled cataract operations was 7 (range: 5-14). The average duration of an operation was 10.3 min±(SD 4.11 min). The average time to complete one case including patient turnaround was 19.97 min (SD 8.77 min). The proportion of the surgeons' time occupied on total duties or operating ranged from 65.2% to 76.1% and from 42.4% to 56.7%, respectively. The correlations of the surgical time to patient time in theatre was R 2 =0.95. A multiple linear regression model found a significant association (F(3,111)=32.86, P<0.001) with R 2 =0.47 between the duration of one operation and the number of allied healthcare professionals (AHPs), the number of AHP key tasks and the time taken to perform these key tasks by the AHPs. Significant variability in the number of cases performed and the efficiency of patient flow were found between different institutions. Time and motion studies identified requirements for high-volume models and factors relating to performance. Supporting the surgeon with sufficient AHPs and tasks performed by AHPs could improve surgical efficiency up to approximately double productivity over conventional theatre models. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Operating theatre nurses: emotional labour and the hostess role.

PubMed

Timmons, Stephen; Tanner, Judith

2005-04-01

Emotional labour has been established as a significant factor in nursing work, although no studies have been done looking at emotional labour specifically in an operating theatre nursing context. Theatre staff (17 nurses and three Operating Department Practitioners (technicians) were observed in practice over a period of nine months by one of the authors. Each of the staff was subsequently interviewed. The transcriptions of the observation fieldwork notes and the semistructured interviews were analysed for themes and content. The (predominantly female) nurses perceived that one of their responsibilities was 'looking after the surgeons'. We have described this as the 'hostess' role. This role consisted of two major areas of activity: 'keeping the surgeons happy' and 'not upsetting the surgeons'. Examples are given of how this was accomplished through talk and actions. The (predominantly male) operating department practitioners did not see this as part of their work. This 'hostess' role is a kind of emotional labour, but performed with coworkers rather than patients. Like other forms of emotional labour, it is strongly gendered. The emotional labour performed by the theatre nurses was necessary to maintain what has been called elsewhere the 'sentimental order'.

Analysis of clothing and urine from Moscow theatre siege casualties reveals carfentanil and remifentanil use.

PubMed

Riches, James R; Read, Robert W; Black, Robin M; Cooper, Nicholas J; Timperley, Christopher M

2012-01-01

On October 26, 2002, Russian Special Forces deployed a chemical aerosol against Chechen terrorists to rescue hostages in the Dubrovka theatre. Its use confirmed Russian military interest in chemicals with effects on personnel and caused 125 deaths through a combination of the aerosol and inadequate medical care. This study provides evidence from liquid chromatography-tandem mass spectrometry analysis of extracts of clothing from two British survivors, and urine from a third survivor, that the aerosol comprised a mixture of two anaesthetics--carfentanil and remifentanil--whose relative proportions this study was unable to identify. Carfentanil and remifentanil were found on a shirt sample and a metabolite called norcarfentanil was found in a urine sample. This metabolite probably originated from carfentanil.

Suicide bomber detection

NASA Astrophysics Data System (ADS)

Alexander, Naomi; Callejero, Carlos; Fiore, Franco; Gómez, Ignacio; Gonzalo, Ramón; Enríquez de Luna, Álvaro; Ederra, Iñigo; Palacios, Inés

2009-05-01

The chance of suicide bomber attacks against troops in the Theatre of Operations is currently quite high. Most of the time checkpoints and compound gates are not equipped with the appropriate equipment to screen for potential suicide bombers. The ultimate solution would be to be able to perform stand-off screening under various weather conditions whilst avoiding contact between Force Protection personnel and potential suicide bombers. Radiation in the millimeterwave and the lower Terahertz range, having the useful property of being able to penetrate clothing in addition to fog and rain, makes it a clear candidate for imaging in this situation. A study has been made simulating real case scenarios to test practical detection performance and stand-off distances at a range of frequencies in this band, the results of which will be presented.

The cost of trauma operating theatre inefficiency

PubMed Central

Ang, W.W.; Sabharwal, S.; Johannsson, H.; Bhattacharya, R.; Gupte, C.M.

2016-01-01

The National Health Service (NHS) is currently facing a financial crisis with a projected deficit of £2billion by the end of financial year 2015/16. As operating rooms (OR) are one of the costliest components in secondary care, improving theatre efficiency should be at the forefront of efforts to improve health service efficiency. The objectives of this study were to characterize the causes of trauma OR delays and to estimate the cost of this inefficiency. A 1-month prospective single-centre study in St. Mary's Hospital. Turnaround time (TT) was used as the surrogate parameter to measure theatre efficiency. Factors including patient age, ASA score and presence of surgical and anaesthetic consultant were evaluated to identify positive or negative associations with theatre delays. Inefficiency cost was calculated by multiplying the time wasted with staff capacity costs and opportunity costs, found to be £24.77/minute. The commonest causes for increased TT were delays in sending for patients (50%) and problems with patient transport to the OR (31%). 461 min of delay was observed in 12 days, equivalent to loss of £951.58/theatre/day. Non-statistically significant trends were seen between length of delays and advancing patient age, ASA score and absence of either a senior clinician or an anaesthetic consultant. Interestingly, the trend was not as strong for absence of an anaesthetic consultant. This study found delays in operating TT to represent a sizable cost, with potential efficiency savings based on TT of £347,327/theatre/year. Further study of a larger sample is warranted to better evaluate the identified trends. PMID:27047660

The cost of trauma operating theatre inefficiency.

PubMed

Ang, W W; Sabharwal, S; Johannsson, H; Bhattacharya, R; Gupte, C M

2016-05-01

The National Health Service (NHS) is currently facing a financial crisis with a projected deficit of £2billion by the end of financial year 2015/16. As operating rooms (OR) are one of the costliest components in secondary care, improving theatre efficiency should be at the forefront of efforts to improve health service efficiency. The objectives of this study were to characterize the causes of trauma OR delays and to estimate the cost of this inefficiency. A 1-month prospective single-centre study in St. Mary's Hospital. Turnaround time (TT) was used as the surrogate parameter to measure theatre efficiency. Factors including patient age, ASA score and presence of surgical and anaesthetic consultant were evaluated to identify positive or negative associations with theatre delays. Inefficiency cost was calculated by multiplying the time wasted with staff capacity costs and opportunity costs, found to be £24.77/minute. The commonest causes for increased TT were delays in sending for patients (50%) and problems with patient transport to the OR (31%). 461 min of delay was observed in 12 days, equivalent to loss of £951.58/theatre/day. Non-statistically significant trends were seen between length of delays and advancing patient age, ASA score and absence of either a senior clinician or an anaesthetic consultant. Interestingly, the trend was not as strong for absence of an anaesthetic consultant. This study found delays in operating TT to represent a sizable cost, with potential efficiency savings based on TT of £347,327/theatre/year. Further study of a larger sample is warranted to better evaluate the identified trends.

Staff Development, Deception Operations, and Force Projection: Lessons from the Normandy Invasion

DTIC Science & Technology

2015-12-21

1940.8 The Allies needed to breach Germany’s Atlantic Wall and establish a lodgment and logistic center before large-scale ground operations could...invasion of Italy in 1943 — was the third allied amphibious operation in the North African, Mediterranean, and European Theatre . Between 1942 and 1943, the...Schuster 1948), 122-125. 18 Pogue, The Supreme Command, 45-48; Douglas Porch, The Mediterranean Theatre in World War II: The Path to Victory (New

The impact of deployment length on the health and well-being of military personnel: a systematic review of the literature.

PubMed

Buckman, Joshua E J; Sundin, Josefin; Greene, Talya; Fear, Nicola T; Dandeker, Christopher; Greenberg, Neil; Wessely, Simon

2011-01-01

To determine the current state of knowledge regarding the effects of deployment length and a 'mismatch' between the expected and actual length of deployments on the health and well-being of military personnel in order to draw relevant conclusions for all organisations that deploy personnel to conflict zones. A systematic review was conducted of studies measuring deployment length to theatres of operations and the issue of 'mismatch' between expected and actual tour lengths. The nine studies included were rated for quality. Of the nine studies reviewed, six were rated as high quality, two as moderate quality and one as low quality. Seven of these studies found adverse effects of longer deployments on health and well-being. The two studies that measured 'mismatch' found adverse effects on mental health and well-being when deployments lasted longer than personnel expected. There are a limited number of studies which have assessed the effects of deployment length and very few that have assessed the effects of 'mismatch' on health and well-being. However, this review suggests that, as deployment length increases, the potential for personnel to suffer adverse health effects also increases. Further research is required to investigate the effects of spending prolonged periods of time away from family and friends, especially when deployment lasts longer than expected by personnel. These results are important not only for the Armed Forces, but also for other organisations that place employees in similar working conditions. Taking account of these findings may allow better preparation for the potentially harmful effects that deployments can have on employees' health and well-being.

Effect of perioperative inefficiency on neurosurgical theatre efficacy: A 15-year analysis.

PubMed

Kamat, Ameya S; Parker, Andrew

2015-01-01

Effective utilisation of operating theatre time is an important issue in neurosurgery. There is a commonly held belief amongst surgeons that throughput of theatre is decreasing secondary to worsening perioperative delays. The aim of this paper is to explore some of the factors that lead to delays in the perioperative period by determining whether there has been a trend in the increasing length of case time over a fifteen-year period. Case notes of all elective patients who consented for surgery between January 1998 and the end of 2012 were reviewed. Only patients who underwent elective surgery were included. Variables recorded included transit time from the ward to theatre, anaesthetic time, surgical time and time spent in recovery. These were compared over the 15-year period to look for apparent trends. The total number of patients who consented for elective surgery at our institution between January 1998 and December 2012 was 6760. The mean anaesthetic time considering all operations performed was 43 mins each over the 15-year period. Anaesthetic time was deemed to be trending upwards from 1998 where the mean time was 27 -60 mins in December 2012, thus reflecting an increase of 33 mins. The mean surgical times over the 15-year period were 131 mins. However in 1998, mean surgical time was 127 mins compared with 133 mins in 2012. For the operations analysed, anaesthetic time seems to be increasing and has effectively doubled over a 15-year period. Surgical time and non-clinical time are shown to be virtually constant. This delays the overall theatre list and increases the cancellation rate. For compensating this, changes need to be made when allocating resources to both elective and emergency theatres. Staff recruitment needs to be assessed and internal audits need to be conducted within institutions to analyse ways to optimise the throughput of an operation theatre. If these principles are not adhered to, it will have a negative impact as our populations, and hence our case loads increase to instrumental levels. This will in turn have a negative impact on health workers and patients alike.

A framework for identifying and managing risk in the operating theatre.

PubMed

Simpson, A

1995-09-01

There is much advice available about the development of risk management strategies within the NHS. There are booklets and magazines and there are many management consultancies willing to give advice on the development of strategies. NATN is also working on the development of advice on risk management within the operating theatre department and a document should be available at Congress this year. It was felt, however, that it may be useful to hear a little about the specific experience of the development of a strategy within one operating theatre area and Andrea Simpson, Directorate Nurse Manager for Clinical Services, West Lothian NHS Trust has recorded the development within the directorate. There has been some additional comment from the Director of Nursing and Quality within the Trust, Libby Campbell, who is responsible for risk management there.

Creating an environment for patient safety and teamwork training in the operating theatre: A quasi-experimental study.

PubMed

Wallin, Carl-Johan; Kalman, Sigridur; Sandelin, Annika; Färnert, May-Lena; Dahlstrand, Ursula; Jylli, Leena

2015-03-01

Positive safety and a teamwork climate in the training environment may be a precursor for successful teamwork training. This pilot project aimed to implement and test whether a new interdisciplinary and team-based approach would result in a positive training climate in the operating theatre. A 3-day educational module for training the complete surgical team of specialist nursing students and residents in safe teamwork skills in an authentic operative theatre, named Co-Op, was implemented in a university hospital. Participants' (n=22) perceptions of the 'safety climate' and the 'teamwork climate', together with their 'readiness for inter-professional learning', were measured to examine if the Co-Op module produced a positive training environment compared with the perceptions of a control group (n=11) attending the conventional curriculum. The participants' perceptions of 'safety climate' and 'teamwork climate' and their 'readiness for inter-professional learning' scores were significantly higher following the Co-Op module compared with their perceptions following the conventional curriculum, and compared with the control group's perceptions following the conventional curriculum. The Co-Op module improved 'safety climate' and 'teamwork climate' in the operating theatre, which suggests that a deliberate and designed educational intervention can shape a learning environment as a model for the establishment of a safety culture.

Accreditation and quality approach in operating theatre departments: the French approach.

PubMed

Soudée, M

2005-01-01

Since 1996, French health establishments are subjected to a process of evaluating the quality of care, called "accreditation". This process was controlled by ANAES, which, after January 1st, 2005 became the Haute Autorité de Santé (HAS). The accreditation is characterized by a dual process of self-assessment and external audit, leading to four levels of accreditation. In spite of requiring a time-consuming methodology, this approach provides an important means of consolidating the development of the quality approach and re-stimulating the compliance of establishments with standards of safety and vigilance. The professional teams of many French operating theatre departments have been able to use the regulatory and restricting framework of accreditation to organize quality approaches specific to the operative system, supported by the organizational structures of the department such as the operating suite committee, departmental boards and the steering group. Based on quality guidelines including a commitment from the manager and operating suite committee, as well as a quality flow chart and a quality system, these teams describe the main procedures for running the operating theatre. They also organize the follow-up of incidents and undesirable events, along with the risks and points to watch. Audits of the operative system are planned on a regular basis. The second version of the accreditation process considerably reinforces the assessment of professional practices by evaluating the relevance, the risks and the methods of managing care for pathologies. It will make it possible to implement assessments of the health care provided by operating theatre departments and will reinforce the importance of search for quality.

An evaluation of the psychological impact of operational rest and recuperation in United Kingdom Armed Forces personnel: a post-intervention survey

PubMed Central

Jones, Norman; Fertout, Mohammed; Parsloe, Laura; Greenberg, Neil

2013-01-01

Objective Rest and Recuperation (R&R) is a period of home leave taken during an operational deployment; we sought to examine the relationship between taking R&R and mental health. Design A survey-based post-intervention evaluation. Setting UK Participants 232 members of the UK Armed Forces; 42 of which completed pre and post R&R surveys. Main Outcome Measures Alcohol use, Post Traumatic Stress Disorder, Common Mental Disorder Symptoms and R&R experiences. Results 12.1% of respondents (n=27) reported symptoms of common mental disorder and 3.7% (n=8) reported probable PTSD. 50.0% (n=110) reported hazardous use of alcohol during R&R. In the pre- and post-assessed sample, mental health status and alcohol use levels were similar at both survey points. Using principal component analysis, five components of R&R were identified; mentally switching off from deployment, travel experience, physical recovery, relaxation, rest and social support. R&R was extremely popular and although it did not improve mental health overall, the ability to engage with or derive satisfaction from aspects of the five components was significantly associated with better mental health and less alcohol use at the end of R&R. Conclusion Operational commanders should advise personnel about the best way to actively engage with R&R before they leave theatre and be aware of the significant detrimental impact of disrupted travel arrangements upon the ability to benefit from R&R. PMID:23824329

An evaluation of the psychological impact of operational rest and recuperation in United Kingdom Armed Forces personnel: a post-intervention survey.

PubMed

Jones, Norman; Fertout, Mohammed; Parsloe, Laura; Greenberg, Neil

2013-11-01

Rest and Recuperation (R&R) is a period of home leave taken during an operational deployment; we sought to examine the relationship between taking R&R and mental health. A survey-based post-intervention evaluation. UK PARTICIPANTS: 232 members of the UK Armed Forces; 42 of which completed pre and post R&R surveys. Alcohol use, Post Traumatic Stress Disorder, Common Mental Disorder Symptoms and R&R experiences. 12.1% of respondents (n=27) reported symptoms of common mental disorder and 3.7% (n=8) reported probable PTSD. 50.0% (n=110) reported hazardous use of alcohol during R&R. In the pre- and post-assessed sample, mental health status and alcohol use levels were similar at both survey points. Using principal component analysis, five components of R&R were identified; mentally switching off from deployment, travel experience, physical recovery, relaxation, rest and social support. R&R was extremely popular and although it did not improve mental health overall, the ability to engage with or derive satisfaction from aspects of the five components was significantly associated with better mental health and less alcohol use at the end of R&R. Operational commanders should advise personnel about the best way to actively engage with R&R before they leave theatre and be aware of the significant detrimental impact of disrupted travel arrangements upon the ability to benefit from R&R.

Outcomes of in-hospital, out of intensive care and operation theatre cardiac arrests in a tertiary referral hospital.

PubMed

Chakravarthy, Murali; Mitra, Sona; Nonis, Latha

2012-01-01

Cardiac arrest in the hospital wards may not receive as much attention as it does in the operation theatre and intensive care unit (ICU). The experience and the qualifications of personnel in the ward may not be comparable to those in the other vital areas of the hospital. The outcome of cardiac arrest from the ward areas is a reasonable surrogate of training of the ward nurses and technicians in cardiopulmonary resuscitation. We conducted an audit to assess the issues surrounding the resuscitation of cardiac arrest in areas other than operation theatre and ICU in a tertiary referral hospital. AIMS OF THE AUDIT: To assess the outcomes of cardiac arrest in a tertiary referral hospital. Areas such as wards, dialysis room and emergency room were considered for the audit. This is a retrospective observational audit of the case records of all the adult patients who were resuscitated from 'code blue'. Data for 2 years from 2007 was analysed by a research fellow unconnected with the resuscitations. Twenty-two thousand three hundred and forty-four patients were admitted as in-patients to the hospital during the 2 years, starting May 2007 through May 2009. One hundred code blue calls were received during this time. Twenty-two of the total calls received were false. Among the 78 confirmed cardiac arrests 69 occurred in the wards, 2 in emergency room, 1 in cardiac catheterisation laboratory and 3 in dialysis room. Twenty-eight patients were declared dead after unsuccessful cardiopulmonary resuscitation. Among the 50 who were resuscitated with a return of spontaneous rhythm 26 died. Twenty-four patients were discharged (survival rate of 30%). The survival decreased significantly as the age progressed beyond 60. The resuscitation rates were better in day shifts in contrast to the night. Higher survival was noted in patients who received resuscitation in less than a minute. A overall survival to discharge rate of 30% was noted in this audit. Higher survival rates might be attributable to high rate and degree of training at the time of their employment, which was repeated at yearly interval. Copyright © 2012 Cardiological Society of India. Published by Elsevier B.V. All rights reserved.

Ethics surrounding the medical evacuation of catastrophically injured individuals from an operational theatre of war.

PubMed

Bennett, Rebecca A

2016-10-01

Although prolonging life is usually in the best interests of patients, the British Medical Association states that it is not appropriate to prolong life with no regard to its quality. Medical advances both on the battlefield and within the field hospitals have resulted in the unexpected survival of a number of British personnel, and in some cases, soldiers are being repatriated with injuries categorised as 'catastrophic'. This paper considers medical ethics based on the Beauchamp and Childress Four Principles framework with regard to whether catastrophically injured individuals should be repatriated without any prior advanced directive and without evaluation of future quality of life. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

[The effect of the ventilation rate on air particle and air microbe concentration in operating rooms with conventional ventilation. 1. Measurement without surgical activity].

PubMed

Kruppa, B; Rüden, H

1993-05-01

The question was if a reduction of airborne particles and bacteria in conventionally (turbulently), ventilated operating theatres in comparison to Laminar-Airflow (LAF) operating theatres does occur at high air-exchange-rates. Within the framework of energy consumption measures the influence of air-exchange-rates on airborne particle and bacteria concentrations was determined in two identical operating theatres with conventional ventilation (wall diffusor panel) at the air-exchange-rates 7.5, 10, 15 and 20/h without surgical activity. This was established by means of the statistical procedure of analysis of variance. Especially for the comparison of the air-exchange-rates 7.5 and 15/h statistical differences were found for airborne particle concentrations in supply and ambient air. Concerning airborne bacteria concentrations no differences were found among the various air-exchange-rates. Explanation of variance is quite high for non-viable particles (supply air: 37%, ambient air: 81%) but negligible for viable particles (bacteria) with values below 15%.

The accuracy of real-time procedure coding by theatre nurses: a comparison with the central national system.

PubMed

Maclean, Donald; Younes, Hakim Ben; Forrest, Margaret; Towers, Hazel K

2012-03-01

Accurate and timely clinical data are required for clinical and organisational purposes and is especially important for patient management, audit of surgical performance and the electronic health record. The recent introduction of computerised theatre management systems has enabled real-time (point-of-care) operative procedure coding by clinical staff. However the accuracy of these data is unknown. The aim of this Scottish study was to compare the accuracy of theatre nurses' real-time coding on the local theatre management system with the central Scottish Morbidity Record (SMR01). Paired procedural codes were recorded, qualitatively graded for precision and compared (n = 1038). In this study, real-time, point-of-care coding by theatre nurses resulted in significant coding errors compared with the central SMR01 database. Improved collaboration between full-time coders and clinical staff using computerised decision support systems is suggested.

Achilles tenotomy as an office procedure and current practising trends among New Zealand orthopaedic surgeons.

PubMed

Agius, Lewis; Wickham, Angus; Walker, Cameron; Knudsen, Joshua

2018-05-18

Percutaneous Achilles tenotomy (PAT) is performed during the final phase of casting with Ponseti method. Several settings have been proposed as venues for this procedure, however it is increasingly being performed in theatre under a general anaesthetic (GA). General anaesthesia, however, is expensive and not without risks. The purpose of the present study was to compare results of outpatient releases to theatre releases, and assess current practising trends among orthopaedic surgeons. Retrospective comparison of patients with idiopathic clubfoot managed by Ponseti method who had Achilles tenotomy performed in outpatient clinic and in theatre. Surveys were sent to all POSNZ members to determine current practising trends in New Zealand. Parental satisfaction surveys were performed. Comparative cost analysis was performed using hospital billing information. The current study includes 64 idiopathic congenital clubfeet (19 bilateral cases). PAT was performed on 26 clubfeet under local anaesthetic in an outpatient setting, and 33 clubfeet under GA in a theatre setting. There was no significant difference for post-operative complications, or recurrence (p=0.67). Those in theatre group were exposed to a greater number of general anaesthetics before the age of four. Among practising New Zealand paediatric orthopaedic surgeons, 77.78% perform this in theatre under general anaesthesia, while only 22.22% perform PAT in outpatient clinic. The main barriers included concerns regarding pain control, concerns regarding incomplete release, concerns regarding distress to family and concerns regarding sterility. Parental satisfaction surveys found pain management to be excellent. Financial data was analysed and indicative costs were $6,061 NZD per procedure in theatre, compared to $378 NZD per procedure in clinic. PAT performed in a clinic setting is both safe and efficacious with results comparative to that performed in theatre. There was no difference in post-operative complications or recurrence. Parental satisfaction to this procedure is excellent. There are significant financial advantages. Based on this data, our institution now performs all releases in an outpatient setting.

Attitudes to teamwork and safety among Italian surgeons and operating room nurses.

PubMed

Prati, Gabriele; Pietrantoni, Luca

2014-01-01

Previous studies have shown that surgical team members' attitudes about safety and teamwork in the operating theatre may play a role in patient safety. The aim of this study was to assess attitudes about teamwork and safety among Italian surgeons and operating room nurses. Fifty-five surgeons and 48 operating room nurses working in operating theatres at one hospital in Italy completed the Operating Room Management Attitudes Questionnaire (ORMAQ). Results showed several discrepancies in attitudes about teamwork and safety between surgeons and operating room nurses. Surgeons had more positive views on the quality of surgical leadership, communication, teamwork, and organizational climate in the theatre than operating room nurses. Operating room nurses reported that safety rules and procedures were more frequently disregarded than the surgeons. The results are only partially aligned with previous ORMAQ surveys of surgical teams in other countries. The differences emphasize the influence of national culture, as well as the particular healthcare system. This study shows discrepancies on many aspects in attitudes to teamwork and safety between surgeons and operating room nurses. The findings support implementation and use of team interventions and human factor training. Finally, attitude surveys provide a method for assessing safety culture in surgery, for evaluating the effectiveness of training initiatives, and for collecting data for a hospital's quality assurance programme.

[Dampness in an electric plug as a cause of electricity failure in an operation theatre].

PubMed

Andersen, C; Pold, R; Nielsen, H D

2000-02-07

Two cases of electricity failure in an operation theatre during open heart surgery are discussed. The fuse for the patient monitor, ventilator, surgery instruments and heart lung machine was blown. Short-circuit was established because of humidity in the plug of the heater for fluid and blood. We recommend sealed or founded plugs and that anaesthesia equipment should not be used as an electrical supply for other electronic apparatus.

Cost accounting in a surgical unit in a teaching hospital--a pilot study.

PubMed

Malalasekera, A P; Ariyaratne, M H; Fernando, R; Perera, D; Deen, K I

2003-09-01

Economic constraints remain one of the major limitations on the quality of health care even in industrialised countries. Improvement of quality will require optimising facilities within available resources. Our objective was to determine costs of surgery and to identify areas where cost reduction is possible. 80 patients undergoing routine major and intermediate surgery during a period of 6 months were selected at random. All consumables used and procedures carried out were documented. A unit cost was assigned to each of these. Costing was based on 3 main categories: preoperative (investigations, blood product related costs), operative (anaesthetic charges, consumables and theatre charges) and post-operative (investigations, consumables, hospital stay). Theatre charges included two components: fixed (consumables) and variable (dependent on time per operation). The indirect costs (e.g. administration costs, 'hotel' costs), accounted for 30%, of the total and were lower than similar costs in industrialised nations. The largest contributory factors (median, range) towards total cost were, basic hospital charges (30%; 15 to 63%); theatre charges fixed (23%; 6 to 35%) and variable (14%; 8 to 27%); and anaesthetic charges (15%; 1 to 36%). Cost reduction in patients undergoing surgery should focus on decreasing hospital stay, operating theatre time and anaesthetic expenditure. Although definite measures can be suggested from the study, further studies on these variables are necessary to optimise cost effectiveness of surgical units.

PubMed Central

SPAGNOLO, A.M.; OTTRIA, G.; AMICIZIA, D.; PERDELLI, F.

2013-01-01

Summary Surgical site infections (SSI) account for 14% to 17% of all hospital-acquired infections and 38% of nosocomial infections in surgical patients. SSI remain a substantial cause of morbidity and death, possibly because of the larger numbers of elderly surgical patients or those with a variety of chronic and immunocompromising conditions, and emergence of antibiotic-resistant microorganisms. Factors causing surgical site infection are multifarious. Several studies have identified the main patient-related (endogenous risk factors) and procedure-related (external risk factors) factors that influence the risk of SSI. The rate of surgical wound infections is strongly influenced by operating theatre quality, too. A safe and salubrious operating theatre is an environment in which all sources of pollution and any micro-environmental alterations are kept strictly under control. This can be achieved only through careful planning, maintenance and periodic checks, as well as proper ongoing training for staff. Many international scientific societies have produced guidelines regarding the environmental features of operating theatres (positive pressure, exchanges of filtered air per hour, air-conditioning systems with HEPA filters, etc.) and issued recommendations on healthcare-associated infection, including SSI, concerning surveillance methods, intervention to actively prevent SSI and approaches to monitoring the implementation of such strategies. Therefore, the prevention of SSI requires a multidisciplinary approach and the commitment of all concerned, including that of those who are responsible for the design, layout and functioning of operating theatres. PMID:24783890

A traffic-light coding system to organize emergency surgery across surgical disciplines.

PubMed

Leppäniemi, A; Jousela, I

2014-01-01

Emergency surgery is associated with night-time procedures and disruption of elective surgery. An analysis was undertaken of the effect of classifying emergency operations uniformly with a three-tier urgency colour code and the use of dedicated daytime operating rooms. Observed changes from 2001 to 2012 in the number, timing and ability to meet the urgency-designated colour code deadline were retrieved from the computer-based operating theatre organization system for all emergency operations. The number of emergency operations performed annually ranged from 3330 to 4341, with an increasing trend. The proportion of night-time emergency operations decreased from 27.4 per cent (2563 of 9347) before to 23.5 per cent (7731 of 32,959) after introduction of the colour coding system in 2004 (χ2  = 61.94, 1 d.f., P < 0.001). In 2007, owing to long preoperative delays in patients with acute appendicitis and acute cholecystitis, colour codes for these patients were upgraded from 'orange' to 'red' and from 'yellow' to 'orange' respectively. The proportion of patients operated on with a red code before and after this change increased from 45.2 per cent (5831 of 12,907 operations) to 62.7 per cent (13,020 of 20,778 operations; χ2  = 986.99, 1 d.f., P < 0.001). In 2012, the office-hours raw utilization time for the principal emergency operation theatre was 85.4 per cent. The structural separation of elective and emergency surgery, the use of dedicated daytime operating theatres and the implementation of a universal classification of emergency operations reduced night-time surgery, improved the efficiency of operating theatre utilization during daytime, shortened preoperative delay in patients requiring urgent surgery, and enabled monitoring and corrective actions for providing emergency surgery services. © 2013 BJS Society Ltd. Published by John Wiley & Sons Ltd.

Guidelines for Acoustical Measurements Inside Historical Opera Houses: Procedures and Validation

NASA Astrophysics Data System (ADS)

POMPOLI, ROBERTO; PRODI, NICOLA

2000-04-01

The acoustics of Italian historical theatres is to be regarded as a cultural heritage, which is to be preserved and studied. These actions are imperative for handing down the heritage to future generations and to avoid its loss. In this paper, the technical means for scientific quantification of the acoustical heritage are presented in the form of operative guidelines for acoustical measurements inside historical theatres. The document includes the advice of international experts and is being employed during an extended measurement campaign inside renaissance and baroque historical theatres. A relevant part of the paper deals with the experimental validation of the recommendations given in the guidelines, achieved by a dedicated test session inside the Municipal Theatre of Ferrara.

Air sampling procedures to evaluate microbial contamination: a comparison between active and passive methods in operating theatres.

PubMed

Napoli, Christian; Marcotrigiano, Vincenzo; Montagna, Maria Teresa

2012-08-02

Since air can play a central role as a reservoir for microorganisms, in controlled environments such as operating theatres regular microbial monitoring is useful to measure air quality and identify critical situations. The aim of this study is to assess microbial contamination levels in operating theatres using both an active and a passive sampling method and then to assess if there is a correlation between the results of the two different sampling methods. The study was performed in 32 turbulent air flow operating theatres of a University Hospital in Southern Italy. Active sampling was carried out using the Surface Air System and passive sampling with settle plates, in accordance with ISO 14698. The Total Viable Count (TVC) was evaluated at rest (in the morning before the beginning of surgical activity) and in operational (during surgery). The mean TVC at rest was 12.4 CFU/m3 and 722.5 CFU/m2/h for active and passive samplings respectively. The mean in operational TVC was 93.8 CFU/m3 (SD = 52.69; range = 22-256) and 10496.5 CFU/m2/h (SD = 7460.5; range = 1415.5-25479.7) for active and passive samplings respectively. Statistical analysis confirmed that the two methods correlate in a comparable way with the quality of air. It is possible to conclude that both methods can be used for general monitoring of air contamination, such as routine surveillance programs. However, the choice must be made between one or the other to obtain specific information.

Using color intensity projections to visualize air flow in operating theaters with the goal of reducing infections

NASA Astrophysics Data System (ADS)

Cover, Keith S.; van Asperen, Niek; de Jong, Joost; Verdaasdonk, Rudolf M.

2013-03-01

Infection following neurosurgery is all too common. One possible source of infection is the transportation of dust and other contaminates into the open wound by airflow within the operating theatre. While many modern operating theatres have a filtered, uniform and gentle flow of air cascading down over the operating table from a large area fan in the ceiling, many obstacles might introduce turbulence into the laminar flow including lights, equipment and personal. Schlieren imaging - which is sensitive to small disturbances in the laminar flow such as breathing and turbulence caused by air warmed by a hand at body temperature - was used to image the air flow due to activities in an operating theatre. Color intensity projections (CIPs) were employed to reduce the workload of analyzing the large amount of video data. CIPs - which has been applied to images in angiography, 4D CT, nuclear medicine and astronomy - summarizes the changes over many gray scale images in a single color image in a way which most interpreters find intuitive. CIPs uses the hue, saturation and brightness of the color image to encode the summary. Imaging in an operating theatre showed substantial disruptions to the airflow due to equipment such as the lighting. When these disruptions are combined with such minor factors as heat from the hand, reversal of the preferred airflow patterns can occur. These reversals of preferred airflow patterns have the potential to transport contaminates into the open wound. Further study is required to understand both the frequency of the reversed airflow patterns and the impact they may have on infection rates.

Briefing and debriefing in the cardiac operating room. Analysis of impact on theatre team attitude and patient safety.

PubMed

Papaspyros, Sotiris C; Javangula, Kalyana C; Adluri, Rajeshwara Krishna Prasad; O'Regan, David J

2010-01-01

Error in health services delivery has long been recognised as a significant cause of inpatient morbidity and mortality. Root-cause analyses have cited communication failure as one of the contributing factors in adverse events. The formalised fighter pilot mission brief and debrief formed the basis of the National Aeronautics and Space Administration (NASA) crew resource management (CRM) concept produced in 1979. This is a qualitative analysis of our experience with the briefing-debriefing process applied to cardiac theatres. We instituted a policy of formal operating room (OR) briefing and debriefing in all cardiac theatre sessions. The first 118 cases were reviewed. A trouble-free operation was noted in only 28 (23.7%) cases. We experienced multiple problems in 38 (32.2%) cases. A gap was identified in the second order problem solving in relation to instrument repair and maintenance. Theatre team members were interviewed and their comments were subjected to qualitative analysis. The collaborative feeling is that communication has improved. The health industry may benefit from embracing the briefing-debriefing technique as an adjunct to continuous improvement through reflective learning, deliberate practice and immediate feedback. This may be the initial step toward a substantive and sustainable organizational transformation.

Cost Analysis of Operation Theatre Services at an Apex Tertiary Care Trauma Centre of India.

PubMed

Siddharth, Vijaydeep; Kumar, Subodh; Vij, Aarti; Gupta, Shakti Kumar

2015-12-01

Operating room services are one of the major cost and revenue-generating centres of a hospital. The cost associated with the provisioning of operating department services depends on the resources consumed and the unit costs of those resources. The objective of this study was to calculate the cost of operation theatre services at Jai Prakash Narayan Apex Trauma Centre, AIIMS, New Delhi. The study was carried out at the operation theatre department of Jai Prakash Narayan Apex Trauma Centre (JPNATC), AIIMS from April 2010 to March 2011 after obtaining approval from concerned authorities. This study was observational and descriptive in nature. Traditional (average or gross) costing methodology was used to arrive at the cost for the provisioning of operation theatre (OT) services. Cost was calculated under two heads; as capital and operating cost. Annualised cost of capital assets was calculated according to the methodology prescribed by the World Health Organization and operating costs were taken on actual basis; thereafter, per day cost of OT services was obtained. The average number of surgeries performed in the trauma centre per day is 13. The annual cost of providing operating room services at JPNATC, New Delhi was calculated to be 197,298,704 Indian rupees (INR) (US$ 3,653,679), while the per hour cost was calculated to be INR 22,626.92 (US$ 419). Majority of the expenditures were for human resource (33.63 %) followed by OT capital cost (31.90 %), consumables (29.97 %), engineering maintenance cost (2.55 %), support services operating cost (1.22 %) and support services capital cost (0.73 %). Of the total cost towards the provisioning of OT services, 32.63 % was capital cost while 67.37 % is operating cost. The results of this costing study will help in the future planning of resource allocation within the financial constraints (US$ 1 = INR 54).

Effect of noise on tasks in operating theatres: a survey of the perceptions of healthcare staff.

PubMed

Padmakumar, A D; Cohen, O; Churton, A; Groves, J B; Mitchell, D A; Brennan, P A

2017-02-01

Noise in the operating theatre has an adverse impact on healthcare professionals, both physically and psychologically. It can be distracting, make communication difficult, and contribute to a perceived increase in stress. Staff in theatre must deliver high quality care, and overlook noise as a potentially damaging influence. The aim of this survey was to obtain further information about the perspective of healthcare professionals on how noise can affect their practice and whether it affects their work in theatre. We distributed six closed-ended questions in the form of a Survey Monkey ® questionnaire to about 50 hospitals across the UK and target groups such as medical students, the Leeds Advanced Trauma Life Support faculty group, the Court of Examiners of the Royal College of Surgeons of England, and surgical trainees sitting the Member of the Royal College of Surgeons examination. We received 519 responses of which 415 respondents (83%) thought that noise contributed to human errors. A total of 282 participants (57%) thought that the theatre was the noisiest area within the theatre suite. Both communication among staff (n=400, 80%) and concentration (n=384, 77%) were thought to be adversely affected by noise. However, 385 (78%) did not feel that music adversely affected their performance. The results provide insights into the interplay of noise and its effect on people. Although the role of music remains contentious, our results suggest that it might have a calming influence. Crown Copyright © 2016. Published by Elsevier Ltd. All rights reserved.

Stressors and Coping in the Norwegian Aeromedical Detachment in Afghanistan 2008-2010

DTIC Science & Technology

2011-04-01

Tehnology, ***University of Bergen, ****University Hospital of Trondheim, *****Laanke Nursing Home. Adress: cmoldjord@lksk.mil.no Luftkrigsskolen...and IV in Afghanistan. We also compared potential differences in the stress burden between NAD and similar service in Bosnia and Kosovo. A survey of...modern war theatres combat-related risk and exposure to extreme stress are to a great degree experienced as potential threats to all personnel in mission

Identifying and training non-technical skills for teams in acute medicine

PubMed Central

Flin, R; Maran, N

2004-01-01

The aviation domain provides a better analogy for the "temporary" teams that are found in acute medical specialities than industrial or military teamwork research based on established teams. Crew resource management (CRM) training, which emphasises portable skills (for whatever crew a pilot is rostered to on a given flight), has been recognised to have potential application in medicine, especially for teams in the operating theatre, intensive care unit, and emergency room. Drawing on research from aviation psychology that produced the behavioural marker system NOTECHS for rating European pilots' non-technical skills for teamwork on the flightdeck, this paper outlines the Anaesthetists Non-Technical Skills behavioural rating system for anaesthetists working in operating theatre teams. This taxonomy was used as the design basis for a training course, Crisis Avoidance Resource Management for Anaesthetists used to develop these skills, based in an operating theatre simulator. Further developments of this training programme for teams in emergency medicine are outlined. PMID:15465960

[Economic assessment of low flow anesthesia with analysis of the break-even point. Experience at an underutilized operating room].

PubMed

Varesio, V; Agosta, I; Masullo, F; Malnati, R; Martegani, G M

1997-04-01

Many authors indicate the importance of economic saving obtained with the use of the inhalation rebreathing anaesthesia instead of non rebreathing anaesthesia, always referring to parameters which are the duration of anesthesia (1 hour) and the use of the operating theatre each year. It is presumed that the utilization of rebreathing system is at least a 1.000 hours/year. However it is not necessary that all the operating theatres employ 1.000 hours/year in rebreathing anesthesia. This method requires annual depreciation costs of the capital invested for the purchase of new adequate ventilators, to modificative those already existing and guarantee adequate monitoring and the maintenance of these equipment. The importance is stressed of individuating a method of economical evaluation comparing the effective savings obtained with the real utilization of rebreathing anesthesia for each operating theatre and the costs of purchasing and maintaining the equipment. From our point of view the break-even point analysis has demonstrated to be a consistent instrument for the evaluation of the real economic advantage of rebreathing system in each hospital. It is suggested to utilize a conventional formula for the determination of the break even point, which means the minimal number of hours for year that justifies economically the adoption of rebreathing anaesthesia. An example of this analysis has been applied for an operating theatre in the hospital of Morbegno, where the major utilization of regional anaesthesia leads to a reduced number hours/year of rebreathing anesthesia which remains anyhow economically advantageous.

A Survey of Theatre in American Secondary Schools.

ERIC Educational Resources Information Center

Gillespie, Patti; And Others

In a survey of the status of theatre in high schools throughout the United States, questionnaires were sent to a random sample of high schools stratified by state and by school size. Analysis of the responses obtained from 606 schools (20.2% return) indicated that most secondary-school drama programs operate on the cocurricular level and emphasize…

Surgical Theatre (Operating Room) Measure STEEM (OREEM) Scoring Overestimates Educational Environment: The 1-to-L Bias

ERIC Educational Resources Information Center

Dimoliatis, Ioannis D. K.; Jelastopulu, Eleni

2013-01-01

The surgical theatre educational environment measures STEEM, OREEM and mini-STEEM for students (student-STEEM) comprise an up to now disregarded systematic overestimation (OE) due to inaccurate percentage calculation. The aim of the present study was to investigate the magnitude of and suggest a correction for this systematic bias. After an…

Air sampling procedures to evaluate microbial contamination: a comparison between active and passive methods in operating theatres

PubMed Central

2012-01-01

Background Since air can play a central role as a reservoir for microorganisms, in controlled environments such as operating theatres regular microbial monitoring is useful to measure air quality and identify critical situations. The aim of this study is to assess microbial contamination levels in operating theatres using both an active and a passive sampling method and then to assess if there is a correlation between the results of the two different sampling methods. Methods The study was performed in 32 turbulent air flow operating theatres of a University Hospital in Southern Italy. Active sampling was carried out using the Surface Air System and passive sampling with settle plates, in accordance with ISO 14698. The Total Viable Count (TVC) was evaluated at rest (in the morning before the beginning of surgical activity) and in operational (during surgery). Results The mean TVC at rest was 12.4 CFU/m3 and 722.5 CFU/m2/h for active and passive samplings respectively. The mean in operational TVC was 93.8 CFU/m3 (SD = 52.69; range = 22-256) and 10496.5 CFU/m2/h (SD = 7460.5; range = 1415.5-25479.7) for active and passive samplings respectively. Statistical analysis confirmed that the two methods correlate in a comparable way with the quality of air. Conclusion It is possible to conclude that both methods can be used for general monitoring of air contamination, such as routine surveillance programs. However, the choice must be made between one or the other to obtain specific information. PMID:22853006

Air sampling methods to evaluate microbial contamination in operating theatres: results of a comparative study in an orthopaedics department.

PubMed

Napoli, C; Tafuri, S; Montenegro, L; Cassano, M; Notarnicola, A; Lattarulo, S; Montagna, M T; Moretti, B

2012-02-01

To evaluate the level of microbial contamination of air in operating theatres using active [i.e. surface air system (SAS)] and passive [i.e. index of microbial air contamination (IMA) and nitrocellulose membranes positioned near the wound] sampling systems. Sampling was performed between January 2010 and January 2011 in the operating theatre of the orthopaedics department in a university hospital in Southern Italy. During surgery, the mean bacterial loads recorded were 2232.9 colony-forming units (cfu)/m(2)/h with the IMA method, 123.2 cfu/m(3) with the SAS method and 2768.2 cfu/m(2)/h with the nitrocellulose membranes. Correlation was found between the results of the three methods. Staphylococcus aureus was detected in 12 of 60 operations (20%) with the membranes, five (8.3%) operations with the SAS method, and three operations (5%) with the IMA method. Use of nitrocellulose membranes placed near a wound is a valid method for measuring the microbial contamination of air. This method was more sensitive than the IMA method and was not subject to any calibration bias, unlike active air monitoring systems. Copyright © 2011 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

Latex sensitisation in healthcare workers in Singapore.

PubMed

Tang, M B Y; Leow, Y H; Ng, V; Koh, D; Goh, C L

2005-06-01

Epidemiological data on latex sensitisation among Asian healthcare workers is lacking. The aim of the study is to determine the rate of latex sensitisation in our healthcare workers. We recruited 313 healthcare workers, of which 46.6% were operating theatre staff and 53.4% were non-operating theatre staff. Seventy-one administrative staff served as controls. All participants answered a self-administered questionnaire relating to latex exposure and glove-related symptoms. Latex sensitisation was determined by skin prick testing to latex and latex-specific IgE detection. The prevalence of latex sensitisation among healthcare workers was 9.6%, with no difference between operating theatre and nonoperating theatre staff. Glove-related symptoms were reported in 13.7% of all healthcare workers, of which 22.9% were sensitised to latex. Only 26.7% of latex-sensitised healthcare workers had glove-related symptoms while the rest were asymptomatic. The most common symptoms were itch and hand eczema but the most important discriminating symptom was contact urticaria. Personal history of atopy was more common in sensitised healthcare workers (40.0%) compared to non-sensitised workers (31.8%). Only 1 out of 9 (11.2%) symptomatic latex-sensitised subjects had sought previous medical attention for the problem. Latex sensitisation among healthcare workers in Singapore should be considered a significant occupational health risk, as it is in the West. Increased screening and awareness of this problem is essential to identify those at risk.

Proposal for single and mixture biological exposure limits for sevoflurane and nitrous oxide at low occupational exposure levels.

PubMed

Accorsi, Antonio; Valenti, Simona; Barbieri, Anna; Raffi, Giovanni Battista; Violante, Francesco Saverio

2003-03-01

Assessment of individual exposures to sevoflurane plus nitrous oxide (N(2)O) by biological monitoring of unmodified analytes in post-shift urine of exposed personnel. Anaesthetics in urine and breathing area were monitored in 124 subjects in 11 operating theatres. Passive samplers were collected after 2.5-7 h of exposure, at the same time as post-shift urinary samples, to evaluate the individual time-weighted average (TWA) exposures to sevoflurane and N(2)O. A static headspace sampler coupled with a gas chromatograph mass spectrometer was used for analytical determinations (sensitivity sufficient to reveal biological/environmental exposures of 0.1 microg/l(urine) and 50 ppb for sevoflurane, and 1 microg/l(urine) and 80 ppb for N(2)O). Median (range) post-shift urinary and environmental values were 1.2 microg/l(urine) (0.1-5.0) and 0.4 ppm (0.05-3.0) for sevoflurane ( n=107) and 10.9 microg/l(urine) (0.5-74.9) and 8.6 ppm (0.2-123.4) for N(2)O ( n=121) (all low-exposure range). At log-log regression, urinary levels closely correlated with environmental data (sevoflurane, r(2)=0.7538; N(2)O, r(2)=0.8749). Biological equivalent limits (BELs) based on National Institute for Occupational Safety and Health (NIOSH) TWA exposure limits, calculated as means of regression slope and y-intercept, were 3.6 microg/l(urine) for sevoflurane (corresponding to 2 ppm) and 22.3 microg/l(urine) for N(2)O (corresponding to 25 ppm). Individual "mixture BELs", which we calculated by applying the American Conference of Governmental Industrial Hygienists (ACGIH) threshold limit value (TLV) mix formula to biomarker values and using the obtained NIOSH-based BELs as a reference, closely correlated with mixture TLVs (rho=0.816, Lin's concordance test). CONCLUSIONS. We propose urinary sevoflurane as a new, specific, internal dose biomarker for routine biological monitoring of personal exposures among operating-theatre personnel, and use of reliable "mixture BELs" to provide safer levels of internal exposure for workers exposed to mixtures of sevoflurane and N(2)O, and conceivably also to other mixtures of toxicants with possible additive effects.

Extended operating times are more efficient, save money and maintain a high staff and patient satisfaction.

PubMed

Herron, Jonathan Blair Thomas; French, Rachel; Gilliam, Andrew Douglas

2018-01-01

Current public sector austerity measures necessitate efficiency savings throughout the NHS. Performance targets have resulted in activity being performed in the private sector, waiting list initiative lists and requests for staff to work overtime. This has resulted in staff fatigue and additional agency costs. Adoption of extended operating theatre times (0800-1800 hours) may improve productivity and efficiency, with potentially significant financial savings; however, implementation may adversely affect staff morale and patient compliance. A pilot period of four months of extended operating times (4.5 hour sessions) was completed and included all theatre surgical specialties. Outcome measures included: the number of cases completed, late starts, early finishes, cancelled operations, theatre overruns, preoperative assessment and 18-week targets. The outcomes were then compared to pre-existing normal working day operating lists (0900-1700). Theatre staff, patient and surgical trainee satisfaction with the system were also considered by use of an anonymous questionnaire. The study showed that in-session utilisation time was unchanged by extended operating hours 88.7% (vs 89.2%). The service was rated as 'good' or 'excellent' by 87.5% of patients. Over £345,000 was saved by reducing premium payments. Savings of £225,000 were made by reducing privately outsourced operation and a further £63,000 by reviewing staff hours. Day case procedures increased from 2.8 to 3.2 cases/day with extended operating. There was no significant increase in late starts (5.1% vs 6.8%) or cancellation rates (0.75% vs 1.02%). Theatre over-runs reduced from 5% to 3.4%. The 18 weeks target for surgery was achieved in 93.7% of cases (vs 88.3%). The number of elective procedures increased from 4.1 to 4.89 cases/day. Only 13.33% of trainees (n = 33) surveyed felt that extended operating had a negative impact on training. The study concludes that extended operating increased productivity from 2.8 patients per session to 3.2 patients per session with potential savings of just over £2.4 million per financial year. Extrapolating this to the other 155 trusts in England could be a potential saving of £372 million per year. Staff, trainee and patient satisfaction was unaffected. An improved 18 weeks target position was achieved with a significant reduction in private sector work. However, some staff had difficulty with arranging childcare and taking public transport and this may prevent full implementation.

Beyond clinical priority: what matters when making operational decisions about emergency surgical queues?

PubMed

Fitzgerald, Anneke; Wu, Yong

2017-08-01

Objective This paper describes the perceptions of operating theatre staff in Australia and The Netherlands regarding the influence of logistical or operational reasons that may affect the scheduling of unplanned surgical cases. It is proposed that logistical or operational issues can influence the priority determination of queue position of surgical cases on the emergency waiting list. Methods A questionnaire was developed and conducted in 15 hospitals across The Netherlands and Australia, targeting anaesthetists, managers, nurses and surgeons. Statistical analyses revolved around these four professional groups. Six hypotheses were then developed and tested based on the responses collected from the participants. Results There were significant differences in perceptions of logistics delay factors across different professional groups when patients were waiting for unplanned surgery. There were also significant differences among different groups when setting logistical priority factors for planning and scheduling unplanned cases. The hypotheses tests confirm these differences, and the findings concur with the paradigmatic differences mentioned in the literature. These paradigmatic differences among the four professional groups may explain some of the tensions encountered when making decisions about scheduling emergency surgical queues, and therefore should be taken into consideration for management of operating theatres. Conclusions Queue positions of patients waiting for unplanned surgery, or emergency surgery, are determined by medical clinicians according to clinicians' indication of clinical priority. However, operating theatre managers are important in facilitating smooth operations when planning for emergency surgeries. It is necessary for surgeons to understand the logistical challenges faced by managers when requesting logistical priorities for their operations. What is known about the topic? Tensions exist about the efficient use of operating theatres and negotiating individual surgeon's demands, especially between surgeons and managers, because in many countries surgeons only work in the hospital and not for the hospital. What does this paper add? The present study examined the logistical effects on functionality and purports the notion that, while recognising the importance of clinical precedence, logistical factors influence queue order to ensure efficient use of operating theatre resources. What are the implications for practitioners? The results indicate that there are differences in the perceptions of healthcare professionals regarding the sequencing of emergency patients. These differences may lead to conflicts in the decision making process about triaging emergency or unplanned surgical cases. A clear understanding of the different perceptions of different functional groups may help address the conflicts that often arise in practice.

[Specialist's training for laparoscopic surgery in Wet-lab educational operating theatre].

PubMed

Khubezov, D A; Sazhin, V P; Ogoreltsev, A Yu; Puchkov, D K; Rodimov, S V; Ignatov, I S; Tazina, T V; Evsyukova, M A

2018-01-01

To develop system for students training in laparoscopic surgery by using of Wet-lab educational operating theatre. We have launched laparoscopic surgery teaching program for students of Ryazan State Medical University. This system includes several stages. At the first stage professional selection was carried out on 'dry' laparoscopic simulators among III-IV-year students of medical faculty. So, 10 people were selected. The second stage included theoretical and practical parts consisting of development of basic laparoscopic skills on 'dry' simulators. 5 students who scored the maximum points were admitted to the next stage. The third stage is working in Wet-lab operating theatre with a mentor. There were 10 sessions on 10 laboratory pigs. Final stage of our study compares two groups of participants: main group - 5 students who underwent above-described program and control group of 5 residents without experience for laparoscopic operations. The participants of the main group had significantly higher OSATS score compared with another group (20 vs. 10; p<0.05). Movements effectiveness estimated by measuring of movements trajectory total length was also higher in main group than in control group (6 vs. 20; p<0.05). Experts' subjective assessment according to 10-point scale was also higher for students than for interns (9 vs. 5, p<0.05). Participants in the main group required significantly less time to complete the task compared with the control group (40 vs. 90 minutes, p<0.05). Our experience has shown that training system with Wet-lab operating theatre is effective for quick and efficient training of medical students in main laparoscopic procedures. In our opinion, introduction of students into 'advanced' surgery from early age will make it possible to get finally highly professional specialists.

Music does not alter anxiety in patients with suspected lung cancer undergoing bronchoscopy: a randomised controlled trial.

PubMed

Jeppesen, Elisabeth; Pedersen, Carsten M; Larsen, Klaus R; Rehl, Anne; Bartholdy, Karen; Walsted, Emil S; Backer, Vibeke

2016-01-01

The use of music to relieve anxiety has been examined in various studies, but the results are inconclusive. From April to October 2015, 160 patients undergoing examination of pulmonary nodules were randomly assigned to MusiCure or no music. MusiCure was administered through earplugs to ensure blinding of the staff and was played from admission to the operating theatre to the end of the bronchoscopy. Spielberger's State-Trait Anxiety Inventory (STAI) was administered on admission, immediately before bronchoscopy, and on discharge. Secondary outcomes were p -cortisol, physiological variables, dosage of sedatives, movements measured by Actigraph, bronchoscopy duration, number of re-examinations, and overall perception of the sounds in the operating theatre measured by Visual analogue scale. The STAI scores were similar on admission, but after a 10-min wait in the operating theatre, scores varied significantly between patients with and without music, with lower scores in the music group [median (interquartile range, IQR) 35 (18) vs. 43 (25); p= 0.03]. Post hoc multiple regression revealed treatment group as insignificant when adjusting for sex and baseline anxiety. However, there was a significantly more positive perception of the sounds in the operating theatre in the music group (median (IQR) 8.2 (1.8) vs. 5.4 (6.8); p <0.0001) and fewer re-examinations in the music group (19.2% vs. 7.7%, p< 0.032). Ten minutes with MusiCure does not alter anxiety when adjusting for baseline anxiety and sex. The current study indicates that this field of research has many confounders.

Unsettled teamwork: communication and learning in the operating theatres of an urban hospital.

PubMed

Bezemer, Jeff; Korkiakangas, Terhi; Weldon, Sharon-Marie; Kress, Gunther; Kneebone, Roger

2016-02-01

To explore the unsettling effects of increased mobility of nurses, surgeons and other healthcare professionals on communication and learning in the operating theatre. Increasingly, healthcare professionals step in and out of newly formed transient teams and work with colleagues they have not met before, unsettling previously relatively stable team work based on shared, local knowledge accumulated over significant periods of close collaboration. An ethnographic case study was conducted of the operating theatre department of a major teaching hospital in London. Video recordings were made of 20 operations, involving different teams. The recordings were systematically reviewed and coded. Instances where difficulties arose in the communication between scrub nurse and surgeons were identified and subjected to detailed, interactional analysis. Instrument requests frequently prompted clarification from the scrub nurse (e.g. 'Sorry, what did you want?'). Such requests were either followed by a relatively elaborate clarification, designed to maximize learning opportunities, or a by a relatively minimal clarification, designed to achieve the immediate task at hand. Significant variation exists in the degree of support given to scrub nurses requesting clarification. Some surgeons experience such requests as disruptions, while others treat them as opportunities to build shared knowledge. © 2015 John Wiley & Sons Ltd.

Effect of forced-air warming on the performance of operating theatre laminar flow ventilation.

PubMed

Dasari, K B; Albrecht, M; Harper, M

2012-03-01

Forced-air warming exhaust may disrupt operating theatre airflows via formation of convection currents, which depends upon differences in exhaust and operating room air temperatures. We investigated whether the floor-to-ceiling temperatures around a draped manikin in a laminar-flow theatre differed when using three types of warming devices: a forced-air warming blanket (Bair Hugger™); an over-body conductive blanket (Hot Dog™); and an under-body resistive mattress (Inditherm™). With forced-air warming, mean (SD) temperatures were significantly elevated over the surgical site vs those measured with the conductive blanket (+2.73 (0.7) °C; p<0.001) or resistive mattress (+3.63 (0.7) °C; p<0.001). Air temperature differences were insignificant between devices at floor (p=0.339), knee (p=0.799) and head height levels (p=0.573). We conclude that forced-air warming generates convection current activity in the vicinity of the surgical site. The clinical concern is that these currents may disrupt ventilation airflows intended to clear airborne contaminants from the surgical site. Anaesthesia © 2012 The Association of Anaesthetists of Great Britain and Ireland.

Reconstruction of improvised explosive device blast loading to personnel in the open

NASA Astrophysics Data System (ADS)

Wiri, Suthee; Needham, Charles

2016-05-01

Significant advances in reconstructing attacks by improvised explosive devices (IEDs) and other blast events are reported. A high-fidelity three-dimensional computational fluid dynamics tool, called Second-order Hydrodynamic Automatic Mesh Refinement Code, was used for the analysis. Computer-aided design models for subjects or vehicles in the scene accurately represent geometries of objects in the blast field. A wide range of scenario types and blast exposure levels were reconstructed including free field blast, enclosed space of vehicle cabin, IED attack on a vehicle, buried charges, recoilless rifle operation, rocket-propelled grenade attack and missile attack with single subject or multiple subject exposure to pressure levels from ˜ 27.6 kPa (˜ 4 psi) to greater than 690 kPa (>100 psi). To create a full 3D pressure time-resolved reconstruction of a blast event for injury and blast exposure analysis, a combination of intelligence data and Blast Gauge data can be used to reconstruct an actual in-theatre blast event. The methodology to reconstruct an event and the "lessons learned" from multiple reconstructions in open space are presented. The analysis uses records of blast pressure at discrete points, and the output is a spatial and temporal blast load distribution for all personnel involved.

Increased risk environment for emergency general surgery in the context of regionalization and specialization.

PubMed

Beecher, S; O'Leary, D P; McLaughlin, R

2015-09-01

The pressures on tertiary hospitals with increased volume and complexity related to regionalization and specialization has impacted upon availability of operating theatres with consequent displacement of emergencies to high risk out of hours settings. A retrospective review of an electronic emergency theatre list prospectively maintained database was performed over a two year period. Data gathered included type of operation performed, Time to Theatre (TTT), operation start time and length of stay (LOS). Of 7041 emergency operations 25% were performed out of hours. 2949 patient had general surgical emergency procedures with 910 (30%) performed out of hours. 53% of all emergency laparotomies and 54% of appendicectomies were out of hours. 57% of cases operated on out of hours had been awaiting surgery during the day. Mean TTT was shorter for those admitted at the weekend compared to those admitted during the week (15.6 vs 24.9 h) (p < 0.0001). The majority of major emergency surgery is performed out of hours in a way unfavorable to good clinical outcomes. It is of concern that more than half of the most life threating procedures involving laparotomy, take place out of hours. Regionalization needs to be accompanied by infrastructure planning to accommodate emergency surgery. Copyright © 2015 IJS Publishing Group Limited. Published by Elsevier Ltd. All rights reserved.

Factors associated with inconsistency in self-reported mild traumatic brain injury over time among military personnel in Iraq.

PubMed

Nelson, Nathaniel W; Anderson, Carolyn R; Thuras, Paul; Kehle-Forbes, Shannon M; Arbisi, Paul A; Erbes, Christopher R; Polusny, Melissa A

2015-03-01

Estimates of the prevalence of mild traumatic brain injury (mTBI) among military personnel and combat veterans rely almost exclusively on retrospective self-reports; however, reliability of these reports has received little attention. To examine the consistency of reporting of mTBI over time and identify factors associated with inconsistent reporting. A longitudinal cohort of 948 US National Guard Soldiers deployed to Iraq completed self-report questionnaire screening for mTBI and psychological symptoms while in-theatre 1 month before returning home (time 1, T1) and 1 year later (time 2, T2). Most respondents (n = 811, 85.5%) were consistent in their reporting of mTBI across time. Among those who were inconsistent in their reports (n = 137, 14.5%), the majority denied mTBI at T1 and affirmed mTBI at T2 (n = 123, 89.8%). Respondents rarely endorsed mTBI in-theatre and later denied mTBI (n = 14, 10.2% of those with inconsistent reports). Post-deployment post-traumatic stress symptoms and non-specific physical complaints were significantly associated with inconsistent report of mTBI. Military service members' self-reports of mTBI are generally consistent over time; however, inconsistency in retrospective self-reporting of mTBI status is associated with current post-traumatic stress symptoms and non-specific physical health complaints. Royal College of Psychiatrists.

The role of simulation in surgical training.

PubMed Central

Torkington, J.; Smith, S. G.; Rees, B. I.; Darzi, A.

2000-01-01

Surgical training has undergone many changes in the last decade. One outcome of these changes is the interest that has been generated in the possibility of training surgical skills outside the operating theatre. Simulation of surgical procedures and human tissue, if perfect, would allow complete transfer of techniques learnt in a skills laboratory directly to the operating theatre. Several techniques of simulation are available including artificial tissues, animal models and virtual reality computer simulation. Each is discussed in this article and their advantages and disadvantages considered. Images Figure 1 Figure 2 Figure 3 Figure 4 PMID:10743423

[Microbial air purity in hospitals. Operating theatres with air conditioning system].

PubMed

Krogulski, Adam; Szczotko, Maciej

2010-01-01

The aim of this study was to show the influence of air conditioning control for microbial contamination of air inside the operating theatres equipped with correctly working air-conditioning system. This work was based on the results of bacteria and fungi concentration in hospital air obtained since 2001. Assays of microbial air purity conducted on atmospheric air in parallel with indoor air demonstrated that air filters applied in air-conditioning systems worked correctly in every case. To show the problem of fluctuation of bacteria concentration more precisely, every sequences of single results from successive measure series were examined independently.

The systems approach to error reduction: factors influencing inoculation injury reporting in the operating theatre.

PubMed

Cutter, Jayne; Jordan, Sue

2013-11-01

To examine the frequency of, and factors influencing, reporting of mucocutaneous and percutaneous injuries in operating theatres. Surgeons and peri-operative nurses risk acquiring blood-borne viral infections during surgical procedures. Appropriate first-aid and prophylactic treatment after an injury can significantly reduce the risk of infection. However, studies indicate that injuries often go unreported. The 'systems approach' to error reduction relies on reporting incidents and near misses. Failure to report will compromise safety. A postal survey of all surgeons and peri-operative nurses engaged in exposure prone procedures in nine Welsh hospitals, face-to-face interviews with selected participants and telephone interviews with Infection Control Nurses. The response rate was 51.47% (315/612). Most respondents reported one or more percutaneous (183/315, 58.1%) and/or mucocutaneous injuries (68/315, 21.6%) in the 5 years preceding the study. Only 54.9% (112/204) reported every injury. Surgeons were poorer at reporting: 70/133 (52.6%) reported all or >50% of their injuries compared with 65/71 nurses (91.5%). Injuries are frequently under-reported, possibly compromising safety in operating theatres. A significant number of inoculation injuries are not reported. Factors influencing under-reporting were identified. This knowledge can assist managers in improving reporting and encouraging a robust safety culture within operating departments. © 2012 John Wiley & Sons Ltd.

Usability Tests in Medicine: A Cost-Benefit Analysis for Hospitals Before Acquiring Medical Devices for Theatre.

PubMed

Gonser, Phillipp; Fuchsberger, Thomas; Matern, Ulrich

2017-08-01

The use of active medical devices in clinical routine should be as safe and efficient as possible. Usability tests (UTs) help improve these aspects of medical devices during their development, but UTs can be of use for hospitals even after a product has been launched. The present pilot study examines the costs and possible benefits of UT for hospitals before buying new medical devices for theatre. Two active medical devices with different complexity were tested in a standardized UT and a cost-benefit analysis was carried out assuming a different device bought at the same price with a higher usability could increase the efficiency of task solving and due to that save valuable theatre time. The cost of the UT amounted up to €19.400. Hospitals could benefit from UTs before buying new devices for theatre by reducing time-consuming operator errors and thereby increase productivity and patient safety. The possible benefits amounted from €23.300 to €1.570.000 (median = €797.000). Not only hospitals could benefit economically from investing in a UT before deciding to buy a medical device, but especially patients would profit from a higher usability by reducing possible operator errors and increase safety and performance of use.

Communicating the location of potential skin neoplasms for excision between the referring and the operating doctor--an audit of skin lesion referrals in Whanganui, New Zealand.

PubMed

Welsh, Fraser; Bullen, Naomi; Aiono, Semisi

2013-08-30

The importance of correctly defining the location of potential skin cancer when surgical treatment may be required is self-evident. Clear communication is essential if the professional diagnosing potential skin cancer is not the same professional providing treatment. We aimed to assess the nature of the localising information provided in referrals to the local anaesthetic skin lesion theatre in our institution. Information localising target lesions for new patients seen in our local anaesthetic skin excision theatre was recorded during a 2-month period April to May 2012 inclusive 100 patients were seen in our skin excision theatre during the study period; 16 patients were not able to identify the target skin lesion at the time they entered the operating theatre. The target lesion could not be determined from the referral text in 30/100 cases. Diagrams were provided in 19/100 cases. Photographs were provided in 3/100 cases. Pictorial and photographic means of communicating the location of suspicious lesions are under-utilised in our service. Relying on the patient or the referral text to correctly identify the lesion leaves considerable room for error. We suggest that photographic information for skin lesion referrals is adopted as a minimum standard.

Systematic review of methods for quantifying teamwork in the operating theatre

PubMed Central

Marshall, D.; Sykes, M.; McCulloch, P.; Shalhoub, J.; Maruthappu, M.

2018-01-01

Background Teamwork in the operating theatre is becoming increasingly recognized as a major factor in clinical outcomes. Many tools have been developed to measure teamwork. Most fall into two categories: self‐assessment by theatre staff and assessment by observers. A critical and comparative analysis of the validity and reliability of these tools is lacking. Methods MEDLINE and Embase databases were searched following PRISMA guidelines. Content validity was assessed using measurements of inter‐rater agreement, predictive validity and multisite reliability, and interobserver reliability using statistical measures of inter‐rater agreement and reliability. Quantitative meta‐analysis was deemed unsuitable. Results Forty‐eight articles were selected for final inclusion; self‐assessment tools were used in 18 and observational tools in 28, and there were two qualitative studies. Self‐assessment of teamwork by profession varied with the profession of the assessor. The most robust self‐assessment tool was the Safety Attitudes Questionnaire (SAQ), although this failed to demonstrate multisite reliability. The most robust observational tool was the Non‐Technical Skills (NOTECHS) system, which demonstrated both test–retest reliability (P > 0·09) and interobserver reliability (Rwg = 0·96). Conclusion Self‐assessment of teamwork by the theatre team was influenced by professional differences. Observational tools, when used by trained observers, circumvented this.

Non-technical skills of surgeons and anaesthetists in simulated operating theatre crises.

PubMed

Doumouras, A G; Hamidi, M; Lung, K; Tarola, C L; Tsao, M W; Scott, J W; Smink, D S; Yule, S

2017-07-01

Deficiencies in non-technical skills (NTS) have been increasingly implicated in avoidable operating theatre errors. Accordingly, this study sought to characterize the impact of surgeon and anaesthetist non-technical skills on time to crisis resolution in a simulated operating theatre. Non-technical skills were assessed during 26 simulated crises (haemorrhage and airway emergency) performed by surgical teams. Teams consisted of surgeons, anaesthetists and nurses. Behaviour was assessed by four trained raters using the Non-Technical Skills for Surgeons (NOTSS) and Anaesthetists' Non-Technical Skills (ANTS) rating scales before and during the crisis phase of each scenario. The primary endpoint was time to crisis resolution; secondary endpoints included NTS scores before and during the crisis. A cross-classified linear mixed-effects model was used for the final analysis. Thirteen different surgical teams were assessed. Higher NTS ratings resulted in significantly faster crisis resolution. For anaesthetists, every 1-point increase in ANTS score was associated with a decrease of 53·50 (95 per cent c.i. 31·13 to 75·87) s in time to crisis resolution (P < 0·001). Similarly, for surgeons, every 1-point increase in NOTSS score was associated with a decrease of 64·81 (26·01 to 103·60) s in time to crisis resolution in the haemorrhage scenario (P = 0·001); however, this did not apply to the difficult airway scenario. Non-technical skills scores were lower during the crisis phase of the scenarios than those measured before the crisis for both surgeons and anaesthetists. A higher level of NTS of surgeons and anaesthetists led to quicker crisis resolution in a simulated operating theatre environment. © 2017 BJS Society Ltd Published by John Wiley & Sons Ltd.

Time-driven activity based costing of total knee replacement surgery at a London teaching hospital.

PubMed

Chen, Alvin; Sabharwal, Sanjeeve; Akhtar, Kashif; Makaram, Navnit; Gupte, Chinmay M

2015-12-01

The aim of this study was to conduct a time-driven activity based costing (TDABC) analysis of the clinical pathway for total knee replacement (TKR) and to determine where the major cost drivers lay. The in-patient pathway was prospectively mapped utilising a TDABC model, following 20 TKRs. The mean age for these patients was 73.4 years. All patients were ASA grade I or II and their mean BMI was 30.4. The 14 varus knees had a mean deformity of 5.32° and the six valgus knee had a mean deformity of 10.83°. Timings were prospectively collected as each patient was followed through the TKR pathway. Pre-operative costs including pre-assessment and joint school were £ 163. Total staff costs for admission and the operating theatre were £ 658. Consumables cost for the operating theatre were £ 1862. The average length of stay was 5.25 days at a total cost of £ 910. Trust overheads contributed £ 1651. The overall institutional cost of a 'noncomplex' TKR in patients without substantial medical co-morbidities was estimated to be £ 5422, representing a profit of £ 1065 based on a best practice tariff of £ 6487. The major cost drivers in the TKR pathway were determined to be theatre consumables, corporate overheads, overall ward cost and operating theatre staffing costs. Appropriate discounting of implant costs, reduction in length of stay by adopting an enhanced recovery programme and control of corporate overheads through the use of elective orthopaedic treatment centres are proposed approaches for reducing the overall cost of treatment. Copyright © 2015 Elsevier B.V. All rights reserved.

Patient-specific instrumentation for total knee arthroplasty does not match the pre-operative plan as assessed by intra-operative computer-assisted navigation.

PubMed

Scholes, Corey; Sahni, Varun; Lustig, Sebastien; Parker, David A; Coolican, Myles R J

2014-03-01

The introduction of patient-specific instruments (PSI) for guiding bone cuts could increase the incidence of malalignment in primary total knee arthroplasty. The purpose of this study was to assess the agreement between one type of patient-specific instrumentation (Zimmer PSI) and the pre-operative plan with respect to bone cuts and component alignment during TKR using imageless computer navigation. A consecutive series of 30 femoral and tibial guides were assessed in-theatre by the same surgeon using computer navigation. Following surgical exposure, the PSI cutting guides were placed on the joint surface and alignment assessed using the navigation tracker. The difference between in-theatre data and the pre-operative plan was recorded and analysed. The error between in-theatre measurements and pre-operative plan for the femoral and tibial components exceeded 3° for 3 and 17% of the sample, respectively, while the error for total coronal alignment exceeded 3° for 27% of the sample. The present results indicate that alignment with Zimmer PSI cutting blocks, assessed by imageless navigation, does not match the pre-operative plan in a proportion of cases. To prevent unnecessary increases in the incidence of malalignment in primary TKR, it is recommended that these devices should not be used without objective verification of alignment, either in real-time or with post-operative imaging. Further work is required to identify the source of discrepancies and validate these devices prior to routine use. II.

Comparison of the time taken for localised breast surgery pre- and post-introduction of intra-operative digital specimen mammography.

PubMed

Carraro do Nascimento, Vinicius; Bourke, Anita G

2018-02-01

More than half of the patients with an impalpable malignant breast lesion have a mammographically detected and imaged-guided localisation, which can be technically challenging for the breast surgeon. Specimen imaging is used to confirm successful excision of the localised index lesion and has improved the operating list efficiency resulting in a higher number of excisions per surgical list. The aim of this study was to evaluate whether introducing IDSM (intra-operative digital specimen mammography) saved operation time for localised breast surgery. A single-centre retrospective review was undertaken to compare the operation time (from incision to wound closure) taken for excision of 114 consecutive image-guided localised impalpable breast lesions, performed using departmental specimen radiography (DSR), 6 months prior to the introduction of IDSM (Hologic, Trident ® ) in March 2013, with the theatre time taken for excision of 121 consecutive image-guided localised impalpable breast lesions in the 6 months following introduction of IDSM. There was no significant difference in mean surgical time, which were 47.8 (±27.3) minutes in the CSR group and 48.8 (±25.7) minutes in the IDSM group. We were expecting to confirm a reduction in theatre time with the introduction of IDSM. Surprisingly, no difference in operating times was demonstrated. Factors that influenced the impact of IDSM included the proximity of the imaging department to the operating theatre. © 2017 The Royal Australian and New Zealand College of Radiologists.

[Possible Instrument Contamination in the Operating Room During Implantation of Knee and Hip Arthroplasty].

PubMed

Quint, U; Benen, T

2016-04-01

Integrated ventilation systems with low turbulence displacement flow (TAV) are generally legally required in the architectural structure of operating theatres. However, it seems that the instruments laid out on sterile covered tables do not have the best possible protection from bacteria. Within an operating theatre, different bacteria counts are possible on the instruments. This prospective controlled study was conducted to demonstrate the influence of instrument tables with integrated horizontal flow on contamination with pathogens in comparison with conventional tables. In an operating theatre (OT) with a ceiling legally appropriate for TAV (2.40 m × 1.20 m), microbiological samples were placed on a table with integrated TAV flow (n = 100) and on a conventional instrument table (n = 100). The routine qualification of the OT was on an ongoing basis and was in accordance with DIN 1946-4: 1999 standards (in accordance with DIN measurement of recovery time 1946-4: 12-2008). This corresponds to the OT of the room class Ib. The results show significant differences between the two tables. The bacteria count and the percentage of contamination were many times higher on the conventional table. It is important to understand that the instruments are not completely protected against contamination after opening the pack and during the operation. Remedial measures are possible to optimise the sterility the instrument table. Georg Thieme Verlag KG Stuttgart · New York.

Sharpening the Tip of the Spear: Preparing Special Forces Detachment Commanders for the Future

DTIC Science & Technology

2008-05-19

Persian Farsi, Korean, and Thai ) is 24 weeks long. Soldiers must successfully pass the Defense Language Proficiency Test (DLPT) by demonstrating...Brief (Fort Bragg, NC: 2007), 2. 29 real world GWOT project in coordination with one of the Theatre Special Operation Commands (TSOC).89 Weeks 13...Forces (JSOTF) with parallel major general Division commanders within theatre ? A second suggestion for future research begins with the question

Changing the Paradigm: Implementation of Combined Law Enforcement, Fire, and Emergency Medical Service (EMS) Cross-Disciplinary Response to Hostile Events

DTIC Science & Technology

2014-12-01

Mumbai , India; and Aw-ora Movie Theatre in Colorado require ftrst responders to incorporate methods and tactics that integrate operations and challenge...Cross-Disciplinaty Team, PAGES Cross-Disciplinary Response, Culture Change, Marauding Terrorist Fireatms Attack, Integrated 127 Response Framework...Columbine High School; Virginia Tech University; Mumbai , India; and Aurora Movie Theatre in Colorado require first responders to incorporate methods and

Collaborative project optimises LED lighting.

PubMed

Baillie, Jonathan

2014-05-01

Early 2013 saw Brandon Medical, which designs and manufactures equipment ranging from operating theatre lighting to medical AV and control systems, celebrate '20 years of innovation and growth', with a move to a new pounds 2 million, 50,000 ft2 headquarters in Morley near Leeds, twice the size of its former premises. A milestone year then for the entrepreneurial Yorkshire company, but, as HEJ editor, Jonathan Baillie, discovered, when he met with joint MD, Graeme Hall, 2014 should prove an equally exciting one for the medical technology specialist, with the launch of several new 'field-leading' medical lighting products designed for use in operating theatres and minor examination settings.

The surgical management of facial trauma in British soldiers during combat operations in Afghanistan.

PubMed

Wordsworth, Matthew; Thomas, Rachael; Breeze, John; Evriviades, Demetrius; Baden, James; Hettiaratchy, Shehan

2017-01-01

The recent Afghanistan conflict caused a higher proportion of casualties with facial injuries due to both the increasing effectiveness of combat body armour and the insurgent use of the improvised explosive device (IED). The aim of this study was to describe all injuries to the face sustained by UK service personnel from blast or gunshot wounds during the highest intensity period of combat operations in Afghanistan. Hospital records and Joint Theatre Trauma Registry data were collected for all UK service personnel killed or wounded by blast and gunshot wounds in Afghanistan between 01 April 2006 and 01 March 2013. 566 casualties were identified, 504 from blast and 52 from gunshot injuries. 75% of blast injury casualties survived and the IED was the most common mechanism of injury with the mid-face the most commonly affected facial region. In blast injuries a facial fracture was a significant marker for increased total injury severity score. A facial gunshot wound was fatal in 53% of cases. The majority of survivors required a single surgical procedure for the facial injury but further reconstruction was required in 156 of the 375 of survivors aero medically evacuated to the UK. The presence and pattern of facial fractures was significantly different in survivors and fatalities, which may reflect the power of the blast that these cohorts were exposed to. The Anatomical Injury Scoring of the Injury Severity Scale was inadequate for determining the extent of soft tissue facial injuries and did not predict morbidity of the injury. Copyright © 2016. Published by Elsevier Ltd.

[Influence of the space layout of a surgical department on use efficiency].

PubMed

Weiss, G; von Baer, R; Riedl, S

2002-02-01

There is a growing gap between the rapidly increasing diagnostic and therapeutic opportunities and the patient demands on one side and the continuously declining hospital budgets on the other side. This gap forces hospitals to search for rationalization potentials and ways to increase their efficiency. It is well known that the operating theatre unit is one of the most important internal cost factors. Many reorganization projects therefore focus on operating theatres. In Germany, several alternative operating room layouts have been developed in order to reduce running und building costs and to reach a high degree of flexibility in their everyday use by means of an improved design. This article analyses and compares the classic operating room and four alternative layouts intended to make them suitable for reaching the promised objectives and, especially, achieving an economically run business management. Furthermore, preferred layouts for certain types of operations are recommended.

Surgical and anaesthetic capacity of hospitals in Malawi: key insights

PubMed Central

Henry, Jaymie Ang; Frenkel, Erica; Borgstein, Eric; Mkandawire, Nyengo; Goddia, Cyril

2015-01-01

Background Surgery is increasingly recognized as an important driver for health systems strengthening, especially in developing countries. To facilitate quality improvement initiatives, baseline knowledge of capacity for surgical, anaesthetic, emergency and obstetric care is critical. In partnership with the Malawi Ministry of Health, we quantified government hospitals’ surgical capacity through workforce, infrastructure and health service delivery components. Methods From November 2012 to January 2013, we surveyed district and mission hospital administrators and clinical staff onsite using a modified version of the Personnel, Infrastructure, Procedures, Equipment and Supplies (PIPES) tool from Surgeons OverSeas. We calculated percentage of facilities demonstrating adequacy of the assessed components, surgical case rates, operating theatre density and surgical workforce density. Results Twenty-seven government hospitals were surveyed (90% of the district hospitals, all central hospitals). Of the surgical workforce surveyed (n = 370), 92.7% were non-surgeons and 77% were clinical officers (COs). Of the 109 anaesthesia providers, 95.4% were non-physician anaesthetists (anaesthesia COs or ACOs). Non-surgeons and ACOs were the only providers of surgical services and anaesthetic services in 85% and 88.9% of hospitals, respectively. No specialists served the district hospitals. All of the hospitals experienced periods without external electricity. Most did not always have a functioning generator (78.3% district, 25% central) or running water (82.6%, 50%). None of the district hospitals had an Intensive Care Unit (ICU). Cricothyroidotomy, bowel resection and cholecystectomy were not done in over two-thirds of hospitals. Every hospital provided general anaesthesia but some did not always have a functioning anaesthesia machine (52.2%, 50%). Surgical rate, operating theatre density and surgical workforce density per 100 000 population was 289.48–747.38 procedures, 0.98 and 5.41 and 3.68 surgical providers, respectively. Conclusion COs form the backbone of Malawi’s surgical and anaesthetic workforce and should be supported with improvements in infrastructure as well as training and mentorship by specialist surgeons and anaesthetists. PMID:25261799

Lean Participative Process Improvement: Outcomes and Obstacles in Trauma Orthopaedics

PubMed Central

New, Steve; Hadi, Mohammed; Pickering, Sharon; Robertson, Eleanor; Morgan, Lauren; Griffin, Damian; Collins, Gary; Rivero-Arias, Oliver; Catchpole, Ken; McCulloch, Peter

2016-01-01

Objectives To examine the effectiveness of a “systems” approach using Lean methodology to improve surgical care, as part of a programme of studies investigating possible synergy between improvement approaches. Setting A controlled before-after study using the orthopaedic trauma theatre of a UK Trust hospital as the active site and an elective orthopaedic theatre in the same Trust as control. Participants All staff involved in surgical procedures in both theatres. Interventions A one-day “lean” training course delivered by an experienced specialist team was followed by support and assistance in developing a 6 month improvement project. Clinical staff selected the subjects for improvement and designed the improvements. Outcome Measures We compared technical and non-technical team performance in theatre using WHO checklist compliance evaluation, “glitch count” and Oxford NOTECHS II in a sample of directly observed operations, and patient outcome (length of stay, complications and readmissions) for all patients. We collected observational data for 3 months and clinical data for 6 months before and after the intervention period. We compared changes in measures using 2-way analysis of variance. Results We studied 576 cases before and 465 after intervention, observing the operation in 38 and 41 cases respectively. We found no significant changes in team performance or patient outcome measures. The intervention theatre staff focused their efforts on improving first patient arrival time, which improved by 20 minutes after intervention. Conclusions This version of “lean” system improvement did not improve measured safety processes or outcomes. The study highlighted an important tension between promoting staff ownership and providing direction, which needs to be managed in “lean” projects. Space and time for staff to conduct improvement activities are important for success. PMID:27124012

The Falklands/Malvinas 1982: Why Didn’t Argentina Win the War?

DTIC Science & Technology

2009-01-01

respond in a military way to bring the islands back under British rule. The outcome of these gambles proved to be disastrous and ultimately left no...reports that were sent to the headquarters in Puerto Argentino came from units under fire. 16 They certainly did not contain information on the enemies...Theatre. Now, with the Malvinas back under Argentinean rule, the islands fell under the South Atlantic Operational Theatre Command. 23 On 7 April

[The endoscopic operating room OR 1].

PubMed

Dubuisson, J B; Chapron, C

2003-04-01

During the last few years, the development of surgical laparoscopy has been the major turning point, and the most important progress in the field of surgery. The specific installation requirements of surgical laparoscopy, as well as the technological progress proper to this surgical technique, justify the need of a new organization of the operating theatre. The new operating room OR 1 is especially designed to fit and satisfy the requirements of a modern operating theatre, where surgical laparoscopy plays a major role. The organization and the design of this new operating room (OR 1) rely on 2 main concepts: architectural, and computerized, through 2 PC systems SCB and AIDA. The main objectives of this new concept are: allowing the surgeon to control and command all the functions and the instruments, as well as the lighting of the room and the operating field; managing the surgical data and images required for medical files; establishing a communication network either from the inside or outside the sterile zone.

Cardiac surgery productivity and throughput improvements.

PubMed

Lehtonen, Juha-Matti; Kujala, Jaakko; Kouri, Juhani; Hippeläinen, Mikko

2007-01-01

The high variability in cardiac surgery length--is one of the main challenges for staff managing productivity. This study aims to evaluate the impact of six interventions on open-heart surgery operating theatre productivity. A discrete operating theatre event simulation model with empirical operation time input data from 2603 patients is used to evaluate the effect that these process interventions have on the surgery output and overtime work. A linear regression model was used to get operation time forecasts for surgery scheduling while it also could be used to explain operation time. A forecasting model based on the linear regression of variables available before the surgery explains 46 per cent operating time variance. The main factors influencing operation length were type of operation, redoing the operation and the head surgeon. Reduction of changeover time between surgeries by inducing anaesthesia outside an operating theatre and by reducing slack time at the end of day after a second surgery have the strongest effects on surgery output and productivity. A more accurate operation time forecast did not have any effect on output, although improved operation time forecast did decrease overtime work. A reduction in the operation time itself is not studied in this article. However, the forecasting model can also be applied to discover which factors are most significant in explaining variation in the length of open-heart surgery. The challenge in scheduling two open-heart surgeries in one day can be partly resolved by increasing the length of the day, decreasing the time between two surgeries or by improving patient scheduling procedures so that two short surgeries can be paired. A linear regression model is created in the paper to increase the accuracy of operation time forecasting and to identify factors that have the most influence on operation time. A simulation model is used to analyse the impact of improved surgical length forecasting and five selected process interventions on productivity in cardiac surgery.

[Teamwork in the operating theatre: the German Observational Teamwork Assessment for Surgery (OTAS-D) and its first application in Germany].

PubMed

Passauer-Baierl, S; Chiapponi, C; Bruns, C J; Weigl, M

2014-12-01

The quality of surgical teamwork contributes to performance of the operating theatre team, service quality and patient safety in surgery. Observational tools are a feasible and reliable way to capture and evaluate teamwork in the operating theatre (OT). We introduce the German version of the Observational Teamwork Assessment for Surgery (OTAS-D) and present the first observational results from German OTs. Quality of surgical teamwork was assessed with observational teamwork assessment for surgery (OTAS-D). It evaluates five dimensions of OT teamwork: communication, coordination, cooperation/backup behaviour, leadership, and team monitoring/situation awareness. Each dimension is evaluated for each profession (surgical, nursing, and anaesthesia team) as well for each phase of the procedure (pre-, intra-, and post-operative). We observed n = 63 procedures, mainly in abdominal/general and orthopaedic surgery. Additionally, all OT team members scored their individual evaluation of the intra-operative teamwork (standardised 1-item questions). The OTAS-D evaluations showed meaningful results and differences for the OT professions as well as across the different phases of the procedures. Overall, a medium to good level of the OT teamwork was observed. There were no differences in regard to type of surgery (minimally invasive vs. open) or surgical specialties. With an increased coordination of the surgical team we observed a significantly increased cooperation of the nursing team (r = 0.36, p = 0.004). Concerning the OT staffs self-reports, the surgical and nursing teams reported higher scores for quality of surgical teamwork during the procedure than their anaesthesia team members. No significant relationships between observed quality of OT teamwork and self-reports were found. The German version of OTAS-D is a psychometrically robust method to capture the quality of teamwork in operating theatres. It enables the analyses of teamwork between the surgical, nursing and anaesthesia professions in acute surgical care. Limitations of the first application results are considered. Finally, potential applications for surgical teaching, research and quality management are discussed. Georg Thieme Verlag KG Stuttgart · New York.

Cost analysis of the surgical treatment of fractures of the proximal humerus: an evaluation of the determinants of cost and comparison of the institutional cost of treatment with the national tariff.

PubMed

Sabharwal, S; Carter, A W; Rashid, A; Darzi, A; Reilly, P; Gupte, C M

2016-02-01

The aims of this study were to estimate the cost of surgical treatment of fractures of the proximal humerus using a micro-costing methodology, contrast this cost with the national reimbursement tariff and establish the major determinants of cost. A detailed inpatient treatment pathway was constructed using semi-structured interviews with 32 members of hospital staff. Its content validity was established through a Delphi panel evaluation. Costs were calculated using time-driven activity-based costing (TDABC) and sensitivity analysis was performed to evaluate the determinants of cost The mean cost of the different surgical treatments was estimated to be £3282. Although this represented a profit of £1138 against the national tariff, hemiarthroplasty as a treatment choice resulted in a net loss of £952. Choice of implant and theatre staffing were the largest cost drivers. Operating theatre delays of more than one hour resulted in a loss of income Our findings indicate that the national tariff does not accurately represent the cost of treatment for this condition. Effective use of the operating theatre and implant discounting are likely to be more effective cost containment approaches than control of bed-day costs. This cost analysis of fractures of the proximal humerus reinforces the limitations of the national tariff within the English National Health Service, and underlines the importance of effective use of the operating theatre, as well as appropriate implant procurement where controlling costs of treatment is concerned. ©2016 The British Editorial Society of Bone & Joint Surgery.

A review of the number and severity of injuries sustained following a single motocross event.

PubMed

Dick, Charles G; White, Simon; Bopf, Daniel

2014-03-01

Competitive and recreational motocross is an increasingly popular sport in Australia and worldwide. Children as young as 4-year-old can participate in this activity. It is recognised that this is a high risk sport despite the use of protective equipment and developments in course design. Injuries sustained range from minor contusions and fractures to severe life threatening spine and head injuries in adults and the paediatric population. In addition organised events can generate a surge of trauma that can burden small local hospitals, resulting in an unpredicted increase in the workload with subsequent delays to treatment. We present the trauma workload generated in a district hospital following a single motocross event. All patients attending a district hospital emergency department with injuries sustained during a single motocross event were identified through hospital and ambulance records. The nature of their injuries and the treatment required, the length of hospital stay and operative theatre time generated by their injuries were obtained from hospital and theatre records. 14 patients attended the emergency department over a 24-hour period, requiring 5 ambulances from the scene. 7 patients required hospital admission with 7 operations performed, consuming 12.2 h of operating theatre time and 21 days of hospital beds. 2 patients sustained head injuries requiring observation, one of which was transferred to a spinal unit for management of their spinal injuries. Motocross is a popular sport and at times has unacceptable risks of injury in organised competitions, especially with regards to paediatric injuries. Better course design, restrictions on participant age and limitations in vehicle speeds may help reduce the number of severe injuries. These events can also generate a sudden trauma burden to local hospital facilities with knock on effects on waiting times for theatre and potentially compromising not only treatment of the injured participants but also the treatment of other patients in the hospital. Cooperation with event organisers may enable extra staff and theatre time to be arranged in advance but at increased cost to the local health services.

Measuring nursing competencies in the operating theatre: instrument development and psychometric analysis using Item Response Theory.

PubMed

Nicholson, Patricia; Griffin, Patrick; Gillis, Shelley; Wu, Margaret; Dunning, Trisha

2013-09-01

Concern about the process of identifying underlying competencies that contribute to effective nursing performance has been debated with a lack of consensus surrounding an approved measurement instrument for assessing clinical performance. Although a number of methodologies are noted in the development of competency-based assessment measures, these studies are not without criticism. The primary aim of the study was to develop and validate a Performance Based Scoring Rubric, which included both analytical and holistic scales. The aim included examining the validity and reliability of the rubric, which was designed to measure clinical competencies in the operating theatre. The fieldwork observations of 32 nurse educators and preceptors assessing the performance of 95 instrument nurses in the operating theatre were used in the calibration of the rubric. The Rasch model, a particular model among Item Response Models, was used in the calibration of each item in the rubric in an attempt at improving the measurement properties of the scale. This is done by establishing the 'fit' of the data to the conditions demanded by the Rasch model. Acceptable reliability estimates, specifically a high Cronbach's alpha reliability coefficient (0.940), as well as empirical support for construct and criterion validity for the rubric were achieved. Calibration of the Performance Based Scoring Rubric using Rasch model revealed that the fit statistics for most items were acceptable. The use of the Rasch model offers a number of features in developing and refining healthcare competency-based assessments, improving confidence in measuring clinical performance. The Rasch model was shown to be useful in developing and validating a competency-based assessment for measuring the competence of the instrument nurse in the operating theatre with implications for use in other areas of nursing practice. Crown Copyright © 2012. Published by Elsevier Ltd. All rights reserved.

Deep radio imaging of the UKIDSS Ultra Deep Survey field : the nature of the faint radio population, and the star-formation history of the Universe

NASA Astrophysics Data System (ADS)

Arumugam, Vinodiran

2013-08-01

Breast cancer remains a significant cause of morbidity and mortality. Assessment of the axillary lymph nodes is part of the staging of the disease. Advances in surgical management of breast cancer have seen a move towards intra-operative lymph node assessment that facilitates an immediate axillary clearance if it is indicated. Raman spectroscopy, a technique based on the inelastic scattering of light, has previously been shown to be capable of differentiating between normal and malignant tissue. These results, based on the biochemical composition of the tissue, potentially allow for this technique to be utilised in this clinical context. The aim of this study was to evaluate the facility of Raman spectroscopy to both assess axillary lymph node tissue within the theatre setting and to achieve results that were comparable to other intra-operative techniques within a clinically relevant time frame. Initial experiments demonstrated that these aims were feasible within the context of both the theatre environment and current surgical techniques. A laboratory based feasibility study involving 17 patients and 38 lymph node samples achieved sensivities and specificities of >90% in unsupervised testing. 339 lymph node samples from 66 patients were subsequently assessed within the theatre environment. Chemometric analysis of this data demonstrated sensitivities of up to 94% and specificities of up to 99% in unsupervised testing. The best results were achieved when comparing negative nodes from N0 patients and nodes containing macrometastases. Spectral analysis revealed increased levels of lipid in the negative nodes and increased DNA and protein levels in the positive nodes. Further studies highlighted the reproducibility of these results using different equipment, users and time from excision. This study uses Raman spectroscopy for the first time in an operating theatre and demonstrates that the results obtained, in real-time, are comparable, if not superior, to current intra-operative techniques of lymph nodes assessment.

Decompressive craniectomy and cranioplasty: experience and outcomes in deployed UK military personnel.

PubMed

Roberts, S A G; Toman, E; Belli, A; Midwinter, M J

2016-10-01

In recent conflicts, many UK personnel sustained head injuries requiring damage-control surgery and aeromedical transfer to the UK. This study aims to examine indications, complications and outcomes of UK military casualties undergoing craniectomy and cranioplasty from conflicts in Afghanistan and Iraq. The UK military Joint Theatre Trauma Registry (JTTR) was searched for all UK survivors in Afghanistan and Iraq between 2004 and 2014 requiring craniectomy and cranioplasty resulting from trauma. Fourteen decompressive craniectomies and cranioplasties were performed with blast and gunshot wounds equally responsible for head injury. Ten survivors (71%) had an Injury Severity Score (ISS) of 75, normally designated as 'unsurvivable'. Most were operated on the day of injury. Seventy-one percent received a reverse question mark incision and 7% received a bicoronal incision. Seventy-nine percent had bone flaps discarded. Overall infection rate was 43%. Acinetobacter spp was the causative organism in 50% of cases. Median Glasgow Outcome Scale (GOS) at final follow-up was 4. All casualties had a GOS score greater than 3. Timely neurosurgical intervention is imperative for military personnel given high survival rates in those sustaining what are designated 'un-survivable' injuries. Early decompression facilitates safe aeromedical evacuation of casualties. Excellent outcomes validate the UK military trauma system and the stepwise performance gains throughout recent conflicts however trauma registers most evolving to have specific relevance to military casualties. In high-energy trauma with contamination and soft-tissue destruction, surgery should be conducted with regard for future soft tissue reconstruction. Bone flaps should be discarded and cranioplasty performed according to local preference. Facilities receiving military casualties should have specialist microbiological input mindful of the difficulties treating unusual microbes.

Patient and staff satisfaction with 'day of admission' elective surgery.

PubMed

Sofela, Agbolahan A; Laban, James T; Selway, Richard P

2013-04-01

To evaluate patient and staff satisfaction with day of admission surgery in a neurosurgical unit and its effect on theatre start times. Patients were admitted to a Neurosciences admission lounge (NAL) for neurosurgery on the morning of their operation if deemed appropriate by their neurosurgical consultant. All patients in the NAL were asked to complete patient satisfaction questionnaires. Staff members involved in the care of these patients also completed a satisfaction questionnaire. Theatre start times were compared with those whose patients had been admitted prior to the day of surgery. 378 patients admitted on the day of surgery, 16 doctors (5 anaesthetists, 7 neurosurgeons and 4 neuro high dependency unit, HDU doctors) and 5 nurses. Patients completed an anonymised emotional mapping patient satisfaction questionnaire, and short interviews were carried out with staff members. Theatre start times were obtained retrospectively from the theatre database for lists starting with patients admitted on the day of surgery, and lists starting with patients admitted prior to the day of surgery. 83% of patients felt positive on arrival in the NAL and 88% felt positive on being seen by the doctors and nurses prior to surgery. Overall 79% of patients gave positive responses throughout their patient pathway. 90% of staff were positive about day of admission surgery and all staff members were satisfied that there were no negative effects on surgical outcome. Theatre start time was on average 27 minutes earlier in patients admitted on the day of surgery. Neurosurgical patients, appropriately selected, can be admitted on the day of surgery with high staff and patient satisfaction and without delaying theatre start times.

Diagnosis and outcome of psychiatric referrals to the Field Mental Health Team, 202 Field Hospital, Op Telic I.

PubMed

Scott, J N

2005-06-01

To assess referrals to a Field Hospital Mental Health Team (FMHT), assign a diagnosis, provide appropriate treatment, and decide whether suitable for safe return to unit in theatre (RTU), or evacuation home on psychiatric grounds (evac). All documented referrals to the FMHT of 202 Field Hospital during the Op Telic 1 study period of 17 March (day 1) to 23 July 2003 (day 129) were included. Data were collected on rank, gender, diagnosis, outcome (whether RTU or evac), and whether TA before mobilisation. Diagnosis was assigned by ICD-10 criteria. The FMHT documented 170 cases, 12 of whom were seen twice and one on three occasions, resulting in 184 referrals, all of whom were British. The commonest diagnosis was adjustment reaction (F43), accounting for 68% of all cases (n = 116). These were divided between chiefly theatre-related (n = 77) or chiefly home-related (n = 39) reactions. The majority (94%) of these cases were RTU. Referrals where the diagnosis was a Depressive disorder (F32, n = 23) or Intentional self-harm (by sharp object, X78, n = 7) were evacuated. Outcome was similar for Regular and TA personnel, with on average 72% of cases RTU. The majority of cases seen were ORs, reflecting their numbers in theatre. Only 14 NCOs and 14 officers were referred. Thirteen of the latter were TA before mobilisation. Gender was not associated with outcome, or TA status, but was associated with rank, in that significantly more female officers were referred. The FMHT role tasks emerged as (a) psychiatric triage and treatment, (b) psychological support of hospital staff, and (c) welfare and pastoral care liaison. The utility of the psychiatric management model employed, built upon previous military medical doctrines, was tested in a modern theatre of conflict, and seemed to prove its worth.

Routine laparoscopic repair of primary unilateral inguinal hernias--a viable alternative in the day surgery unit?

PubMed

Duff, M; Mofidi, R; Nixon, S J

2007-08-01

In September 2004 the NICE institute revised its guidelines on the management of primary inguinal hernias to include laparoscopic repair of unilateral hernias. While published trials have confirmed the equal efficacy of the two approaches, it is not clear what impact a switch to laparoscopic repairs would have on resources and patient throughput in a Day Surgery Unit. All elective hernia repairs performed in a one-year period were considered. Data were obtained from operation notes, discharge summaries and out-patient records. Operating times are routinely documented in theatre. Of the 351 operations studied, 150 were performed laparoscopically predominantly by an extraperitoneal (TEP)approach. Six required conversion to an open procedure. There was no significant difference in operating times, total theatre time or recovery room times between the two groups (51 min, 75 min and 34 min for the laparoscopic group and 53 min, 74 min and 31 min for the open repair group). Among the laparoscopic repair group there were 48 bilateral hernias and 20 recurrent hernias while 190 of the 201 open repairs were for primary unilateral hernias. Rates of overnight stay and immediate complications were similar between the groups though haematoma was more common following open repair (7 vs 2). There is no difference in theatre times, immediate complication rates or rates of overnight stay between open and laparoscopic repair of inguinal hernia. Routine laparoscopic repair of primary unilateral inguinal hernia is a viable alternative within the Day Surgery Unit.

Non-technical skills of the operating theatre scrub nurse: literature review.

PubMed

Mitchell, Lucy; Flin, Rhona

2008-07-01

This paper is a report of a review to identify the non-technical (cognitive and social) skills used by scrub nurses. Recognition that failures in non-technical skills contributed to accidents in high-risk industries led to the development of research programmes to study the role of cognition and social interactions in operational safety. Recently, psychological research in operating theatres has revealed the importance of non-technical skills in safe and efficient performance. Most of the studies to date have focused on anaesthetists and surgeons. On-line sources and university library catalogues, publications of the Association for Perioperative Practice, National Association of Theatre Nurses and Association of Peri-Operative Registered Nurses were searched in 2007. Studies were included in the review if they presented data from scrub nurses on one or more of their non-technical skills. These findings were examined in relation to an existing medical non-technical skills framework with categories of communication, teamwork, leadership, situation awareness and decision-making. Of 424 publications retrieved, 13 were reviewed in detail. Ten concerned communication and eight of those also had data on teamwork. In 11 papers teamwork was examined, and one focused on nurses' situation awareness, teamwork and communication. None of the papers we reviewed examined leadership or decision-making by scrub nurses. Further work is needed to identify formally the non-technical skills which are important to the role of scrub nurse and then to design training in the identified non-technical skills during the education and development of scrub nurses.

People's Theatre in Amerika.

ERIC Educational Resources Information Center

Taylor, Karen Malpede

A history of the people's theatre movement in this country from the early 1920s to the early 1970s, this book deals with the structural and thematic connections between the radical theatre of the twenties and thirties and current work of such revolutionary theatres as the Living Theatre, Open Theatre, Bread and Puppet Theatre, El Teatro Campesino,…

A National Vocational Qualification in the Operating Theatre: Participants' Perspectives on Its Effects on Staff Relationships.

ERIC Educational Resources Information Center

Hauxwell, Jonathan

2002-01-01

Interviews with 36 hospital employees evaluated the impact of level 3 National Vocational Qualifications in operating room practice. Most said they had a positive effect on working relationships; implementation had overcome barriers between nurses and operating department assistants/practitioners. Those who trained under earlier systems were…

Career Opportunities for Theatre Practitioners.

PubMed

Lord, Susan

2017-07-01

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.

Reduction of oxidative stress by compression stockings in standing workers.

PubMed

Flore, Roberto; Gerardino, Laura; Santoliquido, Angelo; Catananti, Cesare; Pola, Paolo; Tondi, Paolo

2007-08-01

Healthy workers who stand for prolonged periods show enhanced production of reactive oxygen species (ROS) in their systemic circulation. Oxidative stress is thought to be a risk factor for chronic venous insufficiency and other systemic diseases. To evaluate the effectiveness of compression stockings in the prevention of oxidative stress at work. ROS and venous pressure of the lower limbs were measured in 55 theatre nurses who stood in the operating theatre for >6 h, 23 industrial ironers who stood for up to 5 h during their shift and 65 outpatient department nurses and 35 laundry workers who acted as controls. Subjects and controls were examined on two consecutive days before and after work and with and without compression stockings. Without compression stockings, lower limb venous pressure increased significantly after work in all subjects and controls (P < 0.001), while only operating theatre nurses showed significantly higher mean levels of ROS (P < 0.001). There was no significant difference in venous pressures and ROS levels after work in subjects or controls when wearing compression stockings. Our data suggest a preventive role of compression stockings against oxidative stress in healthy workers with a standing occupation.

Gaze-contingent perceptually enabled interactions in the operating theatre.

PubMed

Kogkas, Alexandros A; Darzi, Ara; Mylonas, George P

2017-07-01

Improved surgical outcome and patient safety in the operating theatre are constant challenges. We hypothesise that a framework that collects and utilises information -especially perceptually enabled ones-from multiple sources, could help to meet the above goals. This paper presents some core functionalities of a wider low-cost framework under development that allows perceptually enabled interaction within the surgical environment. The synergy of wearable eye-tracking and advanced computer vision methodologies, such as SLAM, is exploited. As a demonstration of one of the framework's possible functionalities, an articulated collaborative robotic arm and laser pointer is integrated and the set-up is used to project the surgeon's fixation point in 3D space. The implementation is evaluated over 60 fixations on predefined targets, with distances between the subject and the targets of 92-212 cm and between the robot and the targets of 42-193 cm. The median overall system error is currently 3.98 cm. Its real-time potential is also highlighted. The work presented here represents an introduction and preliminary experimental validation of core functionalities of a larger framework under development. The proposed framework is geared towards a safer and more efficient surgical theatre.

Quality of surgical care in hospitals providing internship training in Kenya: a cross sectional survey.

PubMed

Mwinga, Stephen; Kulohoma, Colette; Mwaniki, Paul; Idowu, Rachel; Masasabi, John; English, Mike

2015-02-01

To evaluate services in hospitals providing internship training to graduate doctors in Kenya. A survey of 22 internship training hospitals was conducted. Availability of key resources spanning infrastructure, personnel, equipment and drugs was assessed by observation. Outcomes and process of care for pre-specified priority conditions (head injury, chest injury, fractures, burns and acute abdomen) were evaluated by auditing case records. Each hospital had at least one consultant surgeon. Scheduled surgical outpatient clinics, major ward rounds and elective (half day) theatre lists were provided once per week in 91%, 55% and 9%, respectively. In all other hospitals, these were conducted twice weekly. Basic drugs were not always available (e.g. gentamicin, morphine and pethidine in 50%, injectable antistaphylococcal penicillins in 5% hospitals). Fewer than half of hospitals had all resources needed to provide oxygen. One hundred and forty-five of 956 cases evaluated underwent operations under general or spinal anaesthesia. We found operation notes for 99% and anaesthetic records for 72%. Pre-operatively measured vital signs were recorded in 80% of cases, and evidence of consent to operation was found in 78%. Blood loss was documented in only one case and sponge and instrument counts in 7%. Evaluation of surgical services would be improved by development and dissemination of clear standards of care. This survey suggests that internship hospitals may be poorly equipped and documented care suggests inadequacies in quality and training. © 2014 The Authors. Tropical Medicine & International Health Published by John Wiley & Sons Ltd.

Training for single port video assisted thoracoscopic surgery lung resections.

PubMed

McElnay, Philip J; Lim, Eric

2015-11-01

With many surgical training programmes providing less time for training it can be challenging for trainees to acquire the necessary surgical skills to perform complex video assisted thoracoscopic surgery (VATS) lung resections. Indeed as the utilization of single port operations increases the need to approach the operating theatre with already-existing excellent hand-eye coordination skills increases. We suggest that there are a number of ways that trainees can begin to develop these necessary skills. Firstly, using computer games that involve changing horizons and orientations. Secondly, utilizing box-trainers to practice using the thoracoscopic instruments. Thirdly, learning how essential tools such as the stapler work. Trainees will then be able to progress to meaningfully assisting in theatre and indeed learning how to perform the operation themselves. At this stage is useful to observe expert surgeons whilst they operate-to watch both their technical and non-technical skills. Ultimately, surgery is a learned skill and requires implementation of these techniques over a sustained period of time.

A quick and effective method of limb preparation with health, safety and efficiency benefits.

PubMed

Naderi, N; Maw, K; Thomas, M; Boyce, D E; Shokrollahi, K

2012-03-01

Pre-operative limb preparation (PLP) usually involves lifting the limb and holding it in a fixed 'static' posture for several minutes. This is hazardous to theatre staff. Furthermore, 'painting' the limb can be time consuming and difficult areas such as between toes and fingers may remain unsterile. We demonstrate the time efficiency and asepsis achieved using the 'sterile bag' preparation technique. An additional advantage is the ability to prepare and anaesthetise a limb prior to theatre, increasing efficiency substantially for units with a large throughput of cases, such as day-case hand surgery lists. We monitored the duration of PLP in 20 patients using the 'sterile bag' technique compared to 20 patients using a conventional 'painting' method. Additionally, microbiology samples acquired from prepared upper limbs of 27 sequential patients operated on by a single surgeon over a two-month period were sent for culture immediately prior to commencement of surgery. The mean duration of the 'sterile bag' PLP was significantly lower than that of the conventional method (24 seconds vs 85 seconds, p=0.045). The technique can take as little as ten seconds (n=1). Final microbiology reports showed no growth for any of the 27 patients from whom a culture sample was taken. The sterile bag technique is effective in achieving asepsis, has the potential to increase theatre efficiency and reduces manual handling hazards compared to the conventional method. It is now taught to all theatre staff in our hospital during manual handling training. It can be undertaken in approximately ten seconds with practice for the upper limb.

Communication between anesthesiologists, patients and the anesthesia team: a descriptive study of induction and emergence.

PubMed

Smith, Andrew F; Pope, Catherine; Goodwin, Dawn; Mort, Maggie

2005-11-01

Although the importance of communication skills in anesthetic practice is increasingly recognized, formal communication skills training has hitherto dealt only with limited aspects of this professional activity. We aimed to document and analyze the informally-learned communication that takes place between anesthesia personnel and patients at induction of and emergence from general anesthesia. We adopted an ethnographic approach based principally on observation of anesthesia personnel at work in the operating theatres with subsequent analysis of observation transcripts. We noted three main styles of communication on induction, commonly combined in a single induction. In order of frequency, these were: (1) descriptive, where the anesthesiologists explained to the patient what he/she might expect to feel; (2) functional, which seemed designed to help anesthesiologists maintain physiological stability or assess the changing depth of anesthesia and (3) evocative, which referred to images or metaphors. Although the talk we have described is nominally directed at the patient, it also signifies to other members of the anesthetic team how induction is progressing. The team may also contribute to the communication behaviour depending on the context. Communication on emergence usually focused on establishing that the patient was awake. Communication at induction and emergence tends to fall into specific patterns with different emphases but similar functions. This communication work is shared across the anesthetic team. Further work could usefully explore the relationship between communication styles and team performance or indicators of patient safety or well-being.

The impact of surgery on global climate: a carbon footprinting study of operating theatres in three health systems.

PubMed

MacNeill, Andrea J; Lillywhite, Robert; Brown, Carl J

2017-12-01

Climate change is a major global public health priority. The delivery of health-care services generates considerable greenhouse gas emissions. Operating theatres are a resource-intensive subsector of health care, with high energy demands, consumable throughput, and waste volumes. The environmental impacts of these activities are generally accepted as necessary for the provision of quality care, but have not been examined in detail. In this study, we estimate the carbon footprint of operating theatres in hospitals in three health systems. Surgical suites at three academic quaternary-care hospitals were studied over a 1-year period in Canada (Vancouver General Hospital, VGH), the USA (University of Minnesota Medical Center, UMMC), and the UK (John Radcliffe Hospital, JRH). Greenhouse gas emissions were estimated using primary activity data and applicable emissions factors, and reported according to the Greenhouse Gas Protocol. Site greenhouse gas evaluations were done between Jan 1 and Dec 31, 2011. The surgical suites studied were found to have annual carbon footprints of 5 187 936 kg of CO 2 equivalents (CO 2 e) at JRH, 4 181 864 kg of CO 2 e at UMMC, and 3 218 907 kg of CO 2 e at VGH. On a per unit area basis, JRH had the lowest carbon intensity at 1702 kg CO 2 e/m 2 , compared with 1951 kg CO 2 e/m 2 at VGH and 2284 kg CO 2 e/m 2 at UMMC. Based on case volumes at all three sites, VGH had the lowest carbon intensity per operation at 146 kg CO 2 e per case compared with 173 kg CO 2 e per case at JRH and 232 kg CO 2 e per case at UMMC. Anaesthetic gases and energy consumption were the largest sources of greenhouse gas emissions. Preferential use of desflurane resulted in a ten-fold difference in anaesthetic gas emissions between hospitals. Theatres were found to be three to six times more energy-intense than the hospital as a whole, primarily due to heating, ventilation, and air conditioning requirements. Overall, the carbon footprint of surgery in the three countries studied is estimated to be 9·7 million tonnes of CO 2 e per year. Operating theatres are an appreciable source of greenhouse gas emissions. Emissions reduction strategies including avoidance of desflurane and occupancy-based ventilation have the potential to lessen the climate impact of surgical services without compromising patient safety. None. Copyright © 2017 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 license. Published by Elsevier Ltd.. All rights reserved.

Reasons for operation cancellations at a teaching hospital: prioritizing areas of improvement.

PubMed

Abeeleh, Mahmoud Abu; Tareef, Tareq M; Hani, Amjad Bani; Albsoul, Nader; Samarah, Omar Q; ElMohtaseb, M S; Alshehabat, Musa; Ismail, Zuhair Bani; Alnoubani, Omar; Obeidat, Salameh S; Halawa, Sami Abu

2017-08-01

To report rates of and reasons for operation cancellation, and to prioritize areas of improvement. Retrospective data were extracted from the monthly reports of cancelled listed operations. Data on 14 theatres were collected by the office of quality assurance at Jordan University Hospital from August 2012 to April 2016. Rates and reasons for operation cancellation were investigated. A Pareto chart was constructed to identify the reasons of highest priority. During the period of study, 6,431 cases (9.31%) were cancelled out of 69,066 listed cases. Patient no-shows accounted for 62.52% of cancellations. A Pareto analysis showed that around 80% of the known reasons for cancellation after admission were due to a lack of surgical theatre time (30%), incomplete preoperative assessment (21%), upper respiratory tract infection (19%), and high blood pressure (13%). This study identified the most common reasons for operation cancellation at a teaching hospital. Potential avoidable root causes and recommended interventions were suggested accordingly. Future research, available resources, hospital policies, and strategic measures directed to tackle these reasons should take priority.

A combined teamwork training and work standardisation intervention in operating theatres: controlled interrupted time series study.

PubMed

Morgan, Lauren; Pickering, Sharon P; Hadi, Mohammed; Robertson, Eleanor; New, Steve; Griffin, Damian; Collins, Gary; Rivero-Arias, Oliver; Catchpole, Ken; McCulloch, Peter

2015-02-01

Teamwork training and system standardisation have both been proposed to reduce error and harm in surgery. Since the approaches differ markedly, there is potential for synergy between them. Controlled interrupted time series with a 3 month intervention and observation phases before and after. Operating theatres conducting elective orthopaedic surgery in a single hospital system (UK Hospital Trust). Teamwork training based on crew resource management plus training and follow-up support in developing standardised operating procedures. Focus of subsequent standardisation efforts decided by theatre staff. Paired observers watched whole procedures together. We assessed non-technical skills using NOTECHS II, technical performance using glitch rate and compliance with WHO checklist using a simple quality tool. We measured complication and readmission rates and hospital stay using hospital administrative records. Before/after change was compared in the active and control groups using two-way ANOVA and regression models. 1121 patients were operated on before and 1100 after intervention. 44 operations were observed before and 50 afterwards. Non-technical skills (p=0.002) and WHO compliance (p<0.001) improved significantly after the intervention in the active versus the control group. Glitch count improved in both groups and there was no significant effect on clinical outcomes. Combined training in teamwork and system improvement causes marked improvements in team behaviour and WHO performance, but not technical performance or outcome. These findings are consistent with the synergistic hypothesis, but larger controlled studies with a strong implementation strategy are required to test potential outcome effects. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Effects of perioperative briefing and debriefing on patient safety: a prospective intervention study

PubMed Central

Leong, Katharina Brigitte Margarethe Siew Lan; Hanskamp-Sebregts, Mirelle; van der Wal, Raymond A; Wolff, Andre P

2017-01-01

Objectives This study was carried out to improve patient safety in the operating theatre by the introduction of perioperative briefing and debriefing, which focused on an optimal collaboration between surgical team members. Design A prospective intervention study with one pretest and two post-test measurements: 1 month before and 4 months and 2.5 years after the implementation of perioperative briefing and debriefing, respectively. Setting Operating theatres of a tertiary care hospital with 875 beds in the Netherlands. Participants All members of five surgical teams participated in the perioperative briefing and debriefing. Intervention The implementation of perioperative briefing and debriefing from July 2012 to January 2014. Primary and secondary outcomes The primary outcome was changes in the team climate, measured by the Team Climate Inventory. Secondary outcomes were the experiences of surgical teams with perioperative briefing and debriefing, measured with a structured questionnaire, and the duration of the briefings, measured by an independent observer. Results Two and a half years after the introduction of perioperative briefing and debriefing, the team climate increased statistically significant (p≤0.05). Members of the five surgical teams strongly agreed with the positive influence of perioperative briefing and debriefing on clear agreements and reminding one another of the agreements of the day. They perceived a higher efficiency of the surgical programme with more operations starting on time and less unexpectedly long operation time. The perioperative briefing took less than 4 min to conduct. Conclusions Perioperative briefing and debriefing improved the team climate of surgical teams and the efficiency of their work within the operating theatre with acceptable duration per briefing. Surgical teams with alternating team compositions have the most benefit of briefing and debriefing. PMID:29247103

A noise-reduction program in a pediatric operation theatre is associated with surgeon's benefits and a reduced rate of complications: a prospective controlled clinical trial.

PubMed

Engelmann, Carsten R; Neis, Jan Philipp; Kirschbaum, Clemens; Grote, Gudela; Ure, Benno M

2014-05-01

We assessed the impact of a noise-reduction program in a pediatric operating theatre. Adverse effects from noise pollution in theatres have been demonstrated. In 156 operations spatially resolved, sound levels were measured before and after a noise-reduction program on the basis of education, rules, and technical devices (Sound Ear). Surgical complications were recorded. The surgeon's biometric (saliva cortisol, electrodermal activity) and behavioral stress responses (questionnaires) were measured and correlated with mission protocols and individual noise sensitivity. Median noise levels in the control group versus the interventional group were reduced by -3 ± 3 dB(A) (63 vs 59 dB(A), P < 0.001) with a grossly decreased number of peaks greater than 70 dB(A) (Δn = -61/hour, P < 0.01). The intervention significantly reduced non-operation-related noise. The incidence of postoperative complications was significantly lower in patients of the intervention group (n = 10/56 vs 20/58 control; P < 0.05). "Responders," surgeons with an above-average noise sensitivity (correlation r = -0.6 for the work subscale of the NoiseQ questionnaire, P < 0.05), experienced improved intrateam communication, a decrease in disturbing conversations and sudden noise peaks (P < 0.05). Biometrically, the intervention decreased both the surgeon's pre- to postoperative rise in cortisol by approximately 20% and the surgeon's electrodermal potentials of greater than 15 μS, indicating severe stress by 60% (P > 0.05). Spontaneous noise during pediatric operations attains the magnitude of a lawn mower and peaks resemble a passing truck. The sound intensity could be reduced by 50% by specific measures. This reduction was associated with a significantly lowered number of postoperative complications. The surgeon's benefits are idiosyncratic with "responders" experiencing marked improvements.

Oxford NOTECHS II: a modified theatre team non-technical skills scoring system.

PubMed

Robertson, Eleanor R; Hadi, Mohammed; Morgan, Lauren J; Pickering, Sharon P; Collins, Gary; New, Steve; Griffin, Damian; Griffin, Damien; McCulloch, Peter; Catchpole, Ken C

2014-01-01

We previously developed and validated the Oxford NOTECHS rating system for evaluating the non-technical skills of an entire operating theatre team. Experience with the scale identified the need for greater discrimination between levels of performance within the normal range. We report here the development of a modified scale (Oxford NOTECHS II) to facilitate this. The new measure uses an eight-point instead of a four point scale to measure each dimension of non-technical skills, and begins with a default rating of 6 for each element. We evaluated this new scale in 297 operations at five NHS sites in four surgical specialities. Measures of theatre process reliability (glitch count) and compliance with the WHO surgical safety checklist were scored contemporaneously, and relationships with NOTECHS II scores explored. Mean team Oxford NOTECHS II scores was 73.39 (range 37-92). The means for surgical, anaesthetic and nursing sub-teams were 24.61 (IQR 23, 27); 24.22 (IQR 23, 26) and 24.55 (IQR 23, 26). Oxford NOTECHS II showed good inter-rater reliability between human factors and clinical observers in each of the four domains. Teams with high WHO compliance had higher mean Oxford NOTECHS II scores (74.5) than those with low compliance (71.1) (p = 0.010). We observed only a weak correlation between Oxford NOTECHS II scores and glitch count; r = -0.26 (95% CI -0.36 to -0.15). Oxford NOTECHS II scores did not vary significantly between 5 different hospital sites, but a significant difference was seen between specialities (p = 0.001). Oxford NOTECHS II provides good discrimination between teams while retaining reliability and correlation with other measures of teamwork performance, and is not confounded by technical performance. It is therefore suitable for combined use with a technical performance scale to provide a global description of operating theatre team performance.

Radiation protection for an intra-operative X-ray device

PubMed Central

Eaton, D J; Gonzalez, R; Duck, S; Keshtgar, M

2011-01-01

Objectives Therapeutic partial breast irradiation can be delivered intra-operatively using the Intrabeam 50 kVp compact X-ray device. Spherical applicators are added to the source to give an isotropic radiation dose. The low energy of this unit leads to rapid attenuation with distance, but dose rates are much greater than for diagnostic procedures. Methods To investigate the shielding requirements for this unit, attenuation measurements were carried out with manufacturer-provided tungsten–rubber sheets, lead, plasterboard and bricks. A prospective environmental dose rate survey was also conducted in the designated theatre. Results As a result of isotropic geometry, the scattered dose around shielding can be 1% of primary and thus often dominates measured dose rates compared with transmission. The absorbed dose rate of the unshielded source at 1 m was 11.6 mGy h−1 but this was reduced by 95% with the shielding sheets. Measured values for the common shielding materials were similar to reference data for the attenuation of a 50 kVp diagnostic X-ray beam. Two lead screens were constructed to shield operators remaining in the theatre and an air vent into a service corridor. A lead apron would also provide suitable attenuation, although a screen allows greater flexibility for treatment operators. With these measures, staff doses were reduced to negligible quantities. Survey measurements taken during patient treatments confirmed no additional measures were required, but the theatre should be a controlled area and access restricted. Conclusion Results from this study and reference data can be used for planning other facilities. PMID:21304003

[System of technical facilities for equipping the anesthesiologist's work place in the operating room].

PubMed

Burlakov, R I; Iurevich, V M

1981-01-01

The authors proved the advisability of complex technical provision for certain functional cycles, or parts of medical technological process. The example given is a modification of working place for anesthesiologist at the operating theatre. Principle and additional devices included in the complex are specified.

Theatre I & II Instructional Guide.

ERIC Educational Resources Information Center

Montgomery County Public Schools, Rockville, MD.

By taking a two-semester course in theatre, students in grades 10 through 12 can gain a better understanding of drama. Theatre I provides an overview of the field of theatre and serves as a prerequisite to all further theatre courses. Upon completion of the first course, students should be able to (1) respond aesthetically to theatre; (2)…

Patients with multiple traumatic amputations: An analysis of operation enduring freedom joint theatre trauma registry data.

PubMed

Godfrey, Brandon W; Martin, Ashley; Chestovich, Paul J; Lee, Gordon H; Ingalls, Nichole K; Saldanha, Vilas

2017-01-01

Improvised Explosive Devices (IED) are the primary wounding mechanism for casualties in Operation Enduring Freedom. Patients can sustain devastating traumatic amputations, which are unlike injuries seen in the civilian trauma sector. This is a database analysis of the largest patient registry of multiple traumatic amputations. The Joint Theater Trauma Registry was queried for patients with a traumatic amputation from 2009 to 2012. Data obtained included the Injury Severity Score (ISS), Glasgow Coma Score (GCS), blood products, transfer from theatre, and complications including DVT, PE, infection (Acinetobacter and fungal), acute renal failure, and rhabdomyolysis. Comparisons were made between number of major amputations (1-4) and specific outcomes using χ 2 and Pearson's rank test, and multivariable logistic regression was performed for 30-day survival. Significance was considered with p<0.05. We identified 720 military personnel with at least one traumatic amputation: 494 single, 191 double, 32 triple, and 3 quad amputees. Average age was 24.3 years (18-46), median ISS 24 (9-66), and GCS 15 (3-15). Tranexamic acid (TXA) was administered in 164 patients (23%) and tourniquets were used in 575 (80%). Both TXA and tourniquet use increased with increasing number of amputations (p<0.001). Average transfusion requirements (in units) were packed red blood cells (PRBC) 18.6 (0-142), fresh frozen plasma (FFP) 17.3 (0-128), platelets 3.6 (0-26), and cryoprecipitate 5.6 (0-130). Transfusion of all blood products increased with the number of amputations (p<0.001). All complications tested increased with the number of amputations except Acinetobacter infection, coagulopathy, and compartment syndrome. Transfer to higher acuity facilities was achieved in 676 patients (94%). Traumatic amputations from blast injuries require significant blood product transfusion, which increases with the number of amputations. Most complications also increase with the number of amputations. Despite high injury severity, 94% of traumatic amputation patients who are alive upon admission to a role II/III facility will survive to transfer to facilities with higher acuity care. Published by Elsevier Ltd.

Surgical and anaesthetic capacity of hospitals in Malawi: key insights.

PubMed

Henry, Jaymie Ang; Frenkel, Erica; Borgstein, Eric; Mkandawire, Nyengo; Goddia, Cyril

2015-10-01

Surgery is increasingly recognized as an important driver for health systems strengthening, especially in developing countries. To facilitate quality improvement initiatives, baseline knowledge of capacity for surgical, anaesthetic, emergency and obstetric care is critical. In partnership with the Malawi Ministry of Health, we quantified government hospitals' surgical capacity through workforce, infrastructure and health service delivery components. From November 2012 to January 2013, we surveyed district and mission hospital administrators and clinical staff onsite using a modified version of the Personnel, Infrastructure, Procedures, Equipment and Supplies (PIPES) tool from Surgeons OverSeas. We calculated percentage of facilities demonstrating adequacy of the assessed components, surgical case rates, operating theatre density and surgical workforce density. Twenty-seven government hospitals were surveyed (90% of the district hospitals, all central hospitals). Of the surgical workforce surveyed (n = 370), 92.7% were non-surgeons and 77% were clinical officers (COs). Of the 109 anaesthesia providers, 95.4% were non-physician anaesthetists (anaesthesia COs or ACOs). Non-surgeons and ACOs were the only providers of surgical services and anaesthetic services in 85% and 88.9% of hospitals, respectively. No specialists served the district hospitals. All of the hospitals experienced periods without external electricity. Most did not always have a functioning generator (78.3% district, 25% central) or running water (82.6%, 50%). None of the district hospitals had an Intensive Care Unit (ICU). Cricothyroidotomy, bowel resection and cholecystectomy were not done in over two-thirds of hospitals. Every hospital provided general anaesthesia but some did not always have a functioning anaesthesia machine (52.2%, 50%). Surgical rate, operating theatre density and surgical workforce density per 100 000 population was 289.48-747.38 procedures, 0.98 and 5.41 and 3.68 surgical providers, respectively. COs form the backbone of Malawi's surgical and anaesthetic workforce and should be supported with improvements in infrastructure as well as training and mentorship by specialist surgeons and anaesthetists. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2014; all rights reserved.

Surveillance of Environmental and Procedural Measures of Infection Control in the Operating Theatre Setting

PubMed Central

Raggi, Alessandra; Sanna, Tiziana; Mazzetti, Magda; Orsi, Alessandra; Zanni, Angela; Farruggia, Patrizia

2017-01-01

The microbiological contamination of operating theatres and the lack of adherence to best practices by surgical staff represent some of the factors affecting Surgical Site Infections (SSIs). The aim of the present study was to assess the microbiological quality of operating settings and the staff compliance to the SSI evidence-based control measures. Ten operating rooms were examined for microbiological contamination of air and surfaces, after cleaning procedures, in “at rest” conditions. Furthermore, 10 surgical operations were monitored to assess staff compliance to the recommended practices. None of the air samples exceeded microbiological reference standards and only six of the 200 surface samples (3.0%) were slightly above recommended levels. Potentially pathogenic bacteria and moulds were never detected. Staff compliance to best practices varied depending on the type of behaviour investigated and the role of the operator. The major not compliant behaviours were: pre-operative skin antisepsis, crowding of the operating room and hand hygiene of the anaesthetist. The good environmental microbiological quality observed is indicative of the efficacy of the cleaning-sanitization procedures adopted. The major critical point was staff compliance to recommended practices. Awareness campaigns are therefore necessary, aimed at improving the organisation of work so as to facilitate compliance to operative protocols. PMID:29283367

Thermal sensations of surgeons during work in surgical gowns.

PubMed

Zwolińska, Magdalena; Bogdan, Anna

2013-01-01

Standards for surgical procedures and medical clothing, designed for use in the operating theatre, have been gradually developed with the progress in science and technology. Standard No. EN 13795:2011, determining the requirements concerning materials for production of surgical gowns, was introduced in 2003. It concerns, e.g., resistance to microbial penetration. Little attention is given to thermal comfort, even though it is well known that thermal discomfort can have an adverse effect on the quality and efficiency of work. During a real-life test and laboratory tests, 2 male surgeons and 8 male volunteers were asked to describe their subjective sensations before and after work. The results of the real-life test and the laboratory tests are comparable. They show a clear lack of thermal comfort when medical clothing designed for the operating theatre is used.

Hybrid DynaCT-guided electromagnetic navigational bronchoscopic biopsy†.

PubMed

Ng, Calvin S H; Yu, Simon C H; Lau, Rainbow W H; Yim, Anthony P C

2016-01-01

Electromagnetic navigational bronchoscopy-guided biopsy of small pulmonary nodules can be challenging. Navigational error of the system and movement of the biopsy tool during its deployment adversely affect biopsy success. Furthermore, conventional methods to confirm navigational success such as fluoroscopy and radial endobronchial ultrasound become less useful for the biopsy of small lesions. A hybrid operating theatre can provide unparalleled real-time imaging through DynaCT scan to guide and confirm successful navigation and biopsy of difficult-to-reach or small lesions. We describe our technique for DynaCT image-guided electromagnetic navigational bronchoscopic biopsy of a small pulmonary nodule in the hybrid operating theatre. The advantages, disadvantages and special considerations in adopting this approach are discussed. © The Author 2015. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

Posttraumatic stress disorder post Iraq and Afghanistan: prevalence among military subgroups.

PubMed

Hines, Lindsey A; Sundin, Josefin; Rona, Roberto J; Wessely, Simon; Fear, Nicola T

2014-09-01

A large body of research has been produced in recent years investigating posttraumatic stress disorder (PTSD) among military personnel following deployment to Iraq and Afghanistan, resulting in apparent differences in PTSD prevalence. We compare prevalence estimates for current PTSD between military subgroups, providing insight into how groups may be differentially affected by deployment. Systematic literature searches using the terms PTSD, stress disorder, and acute stress, combined with terms relating to military personnel, identified 49 relevant papers. Studies with a sample size of less than 100 and studies based on data for treatment seeking or injured populations were excluded. Studies were categorized according to theatre of deployment (Iraq or Afghanistan), combat and noncombat deployed samples, sex, enlistment type (regular or reserve and [or] National Guard), and service branch (for example, army, navy, and air force). Meta-analysis was used to assess PTSD prevalence across subgroups. There was large variability in PTSD prevalence between studies, but, regardless of heterogeneity, prevalence rates of PTSD were higher among studies of Iraq-deployed personnel (12.9%; 95% CI 11.3% to 14.4%), compared with personnel deployed to Afghanistan (7.1%; 95% CI 4.6% to 9.6%), combat deployed personnel, and personnel serving in the Canadian, US, or UK army or the navy or marines (12.4%; 95% CI 10.9% to 13.4%), compared with the other services (4.9%; 95% CI 1.4% to 8.4%). Contrary to findings from within-study comparisons, we did not find a difference in PTSD prevalence for regular active-duty and reserve or National Guard personnel. Categorizing studies according to deployment location and branch of service identified differences among subgroups that provide further support for factors underlying the development of PTSD.

Posttraumatic Stress Disorder Post Iraq and Afghanistan: Prevalence Among Military Subgroups

PubMed Central

Hines, Lindsey A; Sundin, Josefin; Rona, Roberto J; FFPH; Wessely, Simon; FMedSci; Fear, Nicola T

2014-01-01

A large body of research has been produced in recent years investigating posttraumatic stress disorder (PTSD) among military personnel following deployment to Iraq and Afghanistan, resulting in apparent differences in PTSD prevalence. We compare prevalence estimates for current PTSD between military subgroups, providing insight into how groups may be differentially affected by deployment. Systematic literature searches using the terms PTSD, stress disorder, and acute stress, combined with terms relating to military personnel, identified 49 relevant papers. Studies with a sample size of less than 100 and studies based on data for treatment seeking or injured populations were excluded. Studies were categorized according to theatre of deployment (Iraq or Afghanistan), combat and noncombat deployed samples, sex, enlistment type (regular or reserve and [or] National Guard), and service branch (for example, army, navy, and air force). Meta-analysis was used to assess PTSD prevalence across subgroups. There was large variability in PTSD prevalence between studies, but, regardless of heterogeneity, prevalence rates of PTSD were higher among studies of Iraq-deployed personnel (12.9%; 95% CI 11.3% to 14.4%), compared with personnel deployed to Afghanistan (7.1%; 95% CI 4.6% to 9.6%), combat deployed personnel, and personnel serving in the Canadian, US, or UK army or the navy or marines (12.4%; 95% CI 10.9% to 13.4%), compared with the other services (4.9%; 95% CI 1.4% to 8.4%). Contrary to findings from within-study comparisons, we did not find a difference in PTSD prevalence for regular active-duty and reserve or National Guard personnel. Categorizing studies according to deployment location and branch of service identified differences among subgroups that provide further support for factors underlying the development of PTSD. PMID:25569079

Emergency surgery pre-operative delays - realities and economic impacts.

PubMed

O'Leary, D P; Beecher, S; McLaughlin, R

2014-12-01

A key principle of acute surgical service provision is the establishment of a distinct patient flow process and an emergency theatre. Time-to-theatre (TTT) is a key performance indicator of theatre efficiency. The combined impacts of an aging population, increasing demands and complexity associated with centralisation of emergency and oncology services has placed pressure on emergency theatre access. We examined our institution's experience with running a designated emergency theatre for acute surgical patients. A retrospective review of an electronic prospectively maintained database was performed between 1/1/12 and 31/12/13. A cost analysis was conducted to assess the economic impact of delayed TTT, with every 24hr delay incurring the cost of an additional overnight bed. Delays and the economic effects were assessed only after the first 24 h as an in-patient had elapsed. In total, 7041 procedures were performed. Overall mean TTT was 26 h, 2 min. There were significant differences between different age groups, with those aged under 16 year and over 65 having mean TTT at 6 h, 34 min (95% C.I. 0.51-2.15, p < 0.001) and 23 h, 41 min (95% C.I. 19.6-23.9, p < 0.001) respectively. 2421 (34%) waited greater than 24 h for emergency procedures. The >65 years age group had a mean TTT of 23 h, 41 min which was significantly longer than the overall mean TTT Vascular and urological emergencies are significantly disadvantaged in competition with other services for a shared emergency theatre. The economic impact of delayed TTT was calculated at €7,116,000, or €9880/day of additional costs generated from delayed TTT over a 24 month period. One third of patients waited longer than 24 h for emergency surgery, with the elderly disproportionately represented in this group. Aside from the clinical risks of delayed and out of hours surgery, such practices incur significant additional costs. New strategies must be devised to ensure efficient access to emergency theatres, investment in such services is likely to be financially and clinically beneficial. Copyright © 2014 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.

FACTORS CONTRIBUTING TO ELECTIVE THEATRE CANCELLATIONS IN THE DEPARTMENT OF SURGERY AT CHBAH.

PubMed

Mulira, M; Smith, M D; Moorman, J

2017-06-01

Elective theatre cancellations is a common experience the world over that impacts on theatre efficiency with undesirable consequences on the health care system, the patients and their families. It increases costs of running theatres, is a financial burden and emotional strain on patients and their families. A retrospective study where 300 cancellations in the Department of Surgery were randomly selected and analysed from the Morbidity and Mortality meetings held at Chris Hani Baragwanath Academic Hospital from November 2015. Of the 1554 elective cases booked during the period under review, there were 294 cancellations resulting in a cancellation rate of 18.9%. Laparoscopic Cholecystectomy was the most common procedure (31.8%) cancelled. The most common reason for cancellation (50%) was time constraints. Administrative related reasons for cancellation were the most common (85%) encountered. The majority of cancellations were judged to be the event of an Unavoidable reason. The majority of the patients cancelled were ASA II and ASA III (77%). The ASA score had no significance on medical related cancellations. We reported a comparatively high cancellation rate. Further prospective studies need to be conducted to critically evaluate the reasons behind lack of operative time as the majority of the reasons for cancellation could be potentially avoidable.

Teamwork, communication, and anaesthetic assistance in Scotland.

PubMed

Rutherford, J S; Flin, R; Mitchell, L

2012-07-01

Teamwork involves supporting others, solving conflicts, exchanging information, and co-ordinating activities. This article describes the results of interviews with anaesthetic assistants (n=22) and consultant anaesthetists (n=11), investigating the non-technical skills involved in the effective teamwork of the anaesthetic assistants in the operating theatre. Anaesthetic assistants most commonly saw themselves as either being part of a theatre team or an anaesthetic subgroup and most commonly described the senior theatre nurse as their team leader. Examples of supporting others included the following: checking equipment, providing equipment, being a second pair of eyes, providing emotional and decision support, and supporting trainee anaesthetists. Of the 19 anaesthetic assistants who were asked if they would speak up if they disagreed with a decision in theatre, only 14 said that they would voice their concerns, and the most common approach was to ask for the logic behind the decision. The WHO checklist was described as prompting some anaesthetists to describe their anaesthetic plan to the anaesthetic assistant, when previously the anaesthetist would have failed to communicate their intentions in time for equipment to be prepared. The prioritization of activities to achieve co-ordination and the anaesthetic assistants becoming familiar with the idiosyncrasies of their regular anaesthetists were also described by anaesthetic assistants.

The Salamanca Theatre Company: An Interview with Mr. Iain Lang.

ERIC Educational Resources Information Center

Secondary School Theatre Journal, 1979

1979-01-01

An actor from an Australian theatre group, touring American high schools, comments on the group's background, Australian government subsidies for "theatre-in-education," and the role of theatre arts in education. Briefly compares American and Australian students' awareness and attitudes towards theatre. (JMF)

Older Americans on Stage.

ERIC Educational Resources Information Center

Cornish, Roger, Ed.

This report describes an investigation of the recent senior adult theatre movement conducted by the American Theatre Association Senior Adult Theatre Project. Sections of the report concern: (1) the types of senior adult theatre organizations reporting, including those developed by parent theatre organizations and residential communities and those…

Long-term military work outcomes in soldiers who become mental health casualties when deployed on operations.

PubMed

Jones, Norman; Fear, Nicola T; Jones, Margaret; Wessely, Simon; Greenberg, Neil

2010-01-01

little is known about longer term military work outcomes in UK military personnel who develop mental health problems when operationally deployed. Deployed Field Mental Health Teams (FMHTs) who support them follow the principles of "Forward Psychiatry," aiming to treat psychiatric casualties close to the front line to maximize operational effectiveness and occupational retention. to examine the short- and long-term military work outcomes in soldiers deployed to Iraq between 2003 and 2007 who were referred to the FMHT. FMHT clinical records were linked to occupational records with 825 resulting matches. 71.6% of the referred soldiers with a documented short-term military work outcome returned to their operational unit, and 73.5% of those who had a documented long-term military work outcome served on for a period in excess of two years. Adjusting for potential confounders, a shorter service length and removal from the operational theatre were both strongly associated with premature discharge; however, it was not possible to determine the severity of the presenting mental health problem and assess whether this impacted outcome. the results of this study support the use of the Forward Psychiatry principles in achieving good short-term military work outcomes. Utilizing these principles, three-quarters of those referred to the FMHT were returned to their deployed unit and approximately three-quarters of those assessed by the FMHT remained in service two years after referral. We suggest that these are positive work outcomes; however, being evacuated out of the operational environment and having a short service length were both associated with premature discharge, though we were unable to examine the role of illness severity.

Soviet Counterinsurgency Operations in Afghanistan (1979-1988)

DTIC Science & Technology

2010-04-29

Soviet commitment in Afghanistan. was to be an "economy of force" mission, with the focus of Red Army combat power to remain in the European theatre ...critically for its operational and tactical resupply capability. ’’The Soviets in Afghanis4Ul,li1ce the Americansin Vietnam, discovered thai helicopters were

On the Testing of Renovations Inside Historical Opera Houses

NASA Astrophysics Data System (ADS)

Fausti, P.; Prodi, N.

2002-11-01

Due to the large number of historical opera houses in Italy, many theatres have been renovated in the past, but still more will undergo major restoration in the near future. Unfortunately in this context, the quality and protection of acoustics is rarely considered as an issue of its own. As a consequence, the renovations are hardly ever accompanied by proper scientific and technical support. In this paper, the acoustical impact of works inside the Teatro Municipale "R.Valli" in Reggio Emilia, including the restoration of the main hall and the construction of a new acoustic shell, will be dealt with. Surveys were held in the theatre before renovation and were repeated with identical procedure and instruments after its completion. By means of a comparative analysis of the architectural project and of acoustical data, the impact of major changes in the theatre can be predicted. It is shown that this approach can help in drafting an operational scheme for safeguarding the acoustics of historical opera houses.

Lunch Period Drama: An Invisible Theatre Performance with High School Students.

ERIC Educational Resources Information Center

Banaszewski, Charles

2001-01-01

Describes how two high school theatre students and the author negotiated preparation, rehearsal, performance, and reflection as they developed and performed Invisible Theatre scripts addressing their school's lunchroom (mis)behavior of excessive litter. Notes that Invisible Theatre is a public theatre which involves the public as participants in…

Bacterial Contamination of Anaesthetic and Vasopressor Drugs in the Operating Theatres

PubMed Central

Rueangchira-Urai, Rongrong; Rujirojindakul, Panthila; Geater, Alan Frederick; McNeil, Edward

2017-01-01

Objective The aim of this study was to determine the incidence of bacterial and fungal contamination in anaesthetic and vasopressor drugs before and after use in operating theatres. Methods A cross-sectional study was conducted in the operating theatres of a university hospital. We collected 945 samples of three different drugs, namely, propofol, vecuronium and ephedrine, from 20 operating rooms and refrigerators where the unused drugs were stored. Each drug was divided into two groups, the pre-use group and the post-use group. The pre-use drugs were cultured before the patient received the drug. The post-use drugs were cultured after the patient had received the drug or after the drugs had been transferred to other syringes. The culture results were reported as either positive or negative. Results Out of the 945 drug samples, 26 (2.8%, 95% confidence interval=1.8%–4.0%) gave a positive culture. Of the 317 propofol samples, 20 (6.3%) were found to have bacterial contamination, 11 in the pre-use group and 9 in the post-use group. Of the 318 ephedrine samples, 6 (1.9%) were found to be positive on culture, one in the pre-use group and five in the post-use group. Vecuronium gave no positive cultures. All organisms were non-pathogenic, and no fungal contamination was found. Conclusion The incidence of bacterial contamination in anaesthetic and vasopressor drugs was 2.8%. Anaesthetic teams must be aware of contamination issues in anaesthetic drugs that have been prepared for later use and, in order to reduce the risk of contamination, they must improve the methods of administering drugs to patients. PMID:28377840

Bacterial Contamination of Anaesthetic and Vasopressor Drugs in the Operating Theatres: Ameliyathanelerde Anestetik ve Vazopressör İlaçların Bakteriyel Kontaminasyonu.

PubMed

Rueangchira-Urai, Rongrong; Rujirojindakul, Panthila; Geater, Alan Frederick; McNeil, Edward

2017-02-01

The aim of this study was to determine the incidence of bacterial and fungal contamination in anaesthetic and vasopressor drugs before and after use in operating theatres. A cross-sectional study was conducted in the operating theatres of a university hospital. We collected 945 samples of three different drugs, namely, propofol, vecuronium and ephedrine, from 20 operating rooms and refrigerators where the unused drugs were stored. Each drug was divided into two groups, the pre-use group and the post-use group. The pre-use drugs were cultured before the patient received the drug. The post-use drugs were cultured after the patient had received the drug or after the drugs had been transferred to other syringes. The culture results were reported as either positive or negative. Out of the 945 drug samples, 26 (2.8%, 95% confidence interval=1.8%-4.0%) gave a positive culture. Of the 317 propofol samples, 20 (6.3%) were found to have bacterial contamination, 11 in the pre-use group and 9 in the post-use group. Of the 318 ephedrine samples, 6 (1.9%) were found to be positive on culture, one in the pre-use group and five in the post-use group. Vecuronium gave no positive cultures. All organisms were non-pathogenic, and no fungal contamination was found. The incidence of bacterial contamination in anaesthetic and vasopressor drugs was 2.8%. Anaesthetic teams must be aware of contamination issues in anaesthetic drugs that have been prepared for later use and, in order to reduce the risk of contamination, they must improve the methods of administering drugs to patients.

Invisible Theatre, Ethics, and the Adult Educator

ERIC Educational Resources Information Center

Burstow, Bonnie

2008-01-01

This article probes the ethics of one of the more controversial as well as exciting forms of adult education--the mode of theatre of the oppressed called "invisible theatre". Looking at claims made by practitioners--Augusto Boal's especially--and drawing on concrete theatre pieces, the author asks: What are invisible theatre's claims to…

Can patients be sure they are fully informed when representatives of surgical equipment manufacturers attend their operations?

PubMed Central

Sillender, M

2006-01-01

Objective To determine the practice in UK hospitals regarding the level of patient involvement and consent when representatives of commercial surgical device manufacturers attend and advise during operations. Methods An anonymous postal questionnaire was sent to the senior nurse in charge in all 236 UK gynaecology theatres in 2004. 79/236 (33%) replies were received. Results Operating departments were visited every 2 weeks on average by a representative of the surgical device manufacturer. Actual operations were attended every 10 weeks, although there was much variation. 33/79 (42%) units consistently obtained patient consent for visits, usually orally, whereas 40/79 (51%) units did not. 65/79 (82%) units had no guidelines for surgical device representative visits. 91% of nurses in charge believed that there should be guidelines to protect both patients and staff. 6/79 (8%) units were preparing local guidelines at the time of the survey. Conclusions Currently, patient safety, confidentiality and autonomy are being protected by a minority of NHS operating theatres when surgical device representatives attend surgery. National guidelines would hopefully ensure that fully informed patient consent is obtained and that representatives are fully trained and supervised. PMID:16816038

Explanations for the increase in mental health problems in UK reserve forces who have served in Iraq.

PubMed

Browne, Tess; Hull, Lisa; Horn, Oded; Jones, Margaret; Murphy, Dominic; Fear, Nicola T; Greenberg, Neil; French, Claire; Rona, Roberto J; Wessely, Simon; Hotopf, Matthew

2007-06-01

Deployment to the 2003 Iraq War was associated with ill health in reserve armed forces personnel. To investigate reasons for the excess of ill health in reservists. UK personnel who were deployed to the 2003 Iraq War completed a health survey about experiences on deployment to Iraq. Health status was measured using self-report of common mental disorders, post-traumatic stress disorder (PTSD), fatigue, physical symptoms and well-being. Reservists were older and of higher rank than the regular forces. They reported higher exposure to traumatic experiences, lower unit cohesion, more problems adjusting to homecoming and lower marital satisfaction. Most health outcomes could be explained by role, experience of traumatic events or unit cohesion in theatre. PTSD symptoms were the one exception and were paradoxically most powerfully affected by differences in problems at home rather than events in Iraq. The increased ill-health of reservists appears to be due to experiences on deployment and difficulties with homecoming.

Applying aviation factors to oral and maxillofacial surgery--the human element.

PubMed

Seager, Leonie; Smith, Dave W; Patel, Anish; Brunt, Howard; Brennan, Peter A

2013-01-01

There are many similarities between flying commercial aircraft and surgery, particularly in relation to minimising risk, and managing potentially fatal or catastrophic complications, or both. Since 1979, the development of Crew Resource Management (CRM) has improved air safety significantly by reducing human factors that are responsible for error. Similar developments in the operating theatre have, to a certain extent, lagged behind aviation, and it is well recognised that we can learn much from the industry. An increasing number of publications on aviation factors relate to surgery but to our knowledge there is a lack of research in our own specialty. We discuss how aviation principles related to human factors can be translated to the operating theatre to improve teamwork and safety for patients. Clinical research is clearly needed to develop this fascinating area more fully. Copyright © 2011 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

[Safer operating theatre: easier said than done].

PubMed

Kalkman, C J

2008-10-18

The Netherlands Health Care Inspectorate recently changed its approach to quality of care and patient safety from a reactive to a firmly proactive style. In two reports, the current perioperative processes in Dutch hospitals were scrutinised. Despite a highly-motivated workforce, the inspectorate detected a lack of standardisation, incomplete or inaccessible patient data, poor adherence to hygiene standards and gaps during transfer of care in both the preoperative and intraoperative stages ofsurgery. The inspectorate mandates rapid implementation of various new patient safety approaches, including the use of checklists, 'time-outs' before the start of surgery, double checking of intravenous drugs and improved compliance with hygiene standards, as well as a strict definition of roles and responsibilities of team members. Implementation will require major changes within the processes and culture of operating theatres in Dutch hospitals. Such a change is unlikely to be completed within the short timeframe allowed by the inspectorate.

The Economic Impact of Ten Cultural Institutions on the Economy of the Minneapolis-St. Paul SMSA.

ERIC Educational Resources Information Center

Cwi, David

The impact on the economy of 10 cultural institutions in the Minneapolis-St. Paul area was determined by measuring their 1978 direct and indirect fianancial effects. The institutions are the Children's Theatre Company, Chimera Theatre, Cricket Theatre, Guthrie Theatre, Minneapolis Institute of Arts, Minnesota Dance Theatre, Minnesota Orchestra,…

An Analysis of Educational Outreach by Ohio Theatres.

ERIC Educational Resources Information Center

Leptak, Jeffrey; Heimlich, Joe E.

A descriptive research study of the educational outreach activities conducted by Ohio theatres used a mail questionnaire to survey the 36 professional and large community theatres within the state. Thirty responded, for a response rate of 83.3 percent. For each theatre, the instrument sought information on the kind of theatre, the number of staff,…

Russian Drama and Theatre in Education: "Perestroika" and "Glasnost" in Moscow Theatres for Children and Youth

ERIC Educational Resources Information Center

Water, Manon van de

2004-01-01

Russian theatre for young audiences has had a long tradition of professional, state subsidised theatre, with a strong educational function specifically for young people. The primary task of the "tiuz" ("teatriunogo zritelia," theatre of the young spectator) was to contribute to the ideological and aesthetic education for future Soviet citizens. To…

Roll Damping Characterisation Program: User Guide

DTIC Science & Technology

2014-06-01

integral to conducting accurate numerical simulations of maritime platforms in support of the Australian Defence Organisation’s capability acquisition...programs and the Royal Australian Navy’s in-theatre operations and through-life capability management. This report provides detailed operational...Research Scientist with the Australian Defence Science and Technology Organisation. After graduating from the University of Tasmania with a Bachelor

A Human Factors Analysis of Technical and Team Skills Among Surgical Trainees During Procedural Simulations in a Simulated Operating Theatre

PubMed Central

Moorthy, Krishna; Munz, Yaron; Adams, Sally; Pandey, Vikas; Darzi, Ara

2005-01-01

Background: High-risk organizations such as aviation rely on simulations for the training and assessment of technical and team performance. The aim of this study was to develop a simulated environment for surgical trainees using similar principles. Methods: A total of 27 surgical trainees carried out a simulated procedure in a Simulated Operating Theatre with a standardized OR team. Observation of OR events was carried out by an unobtrusive data collection system: clinical data recorder. Assessment of performance consisted of blinded rating of technical skills, a checklist of technical events, an assessment of communication, and a global rating of team skills by a human factors expert and trained surgical research fellows. The participants underwent a debriefing session, and the face validity of the simulated environment was evaluated. Results: While technical skills rating discriminated between surgeons according to experience (P = 0.002), there were no differences in terms of the checklist and team skills (P = 0.70). While all trainees were observed to gown/glove and handle sharps correctly, low scores were observed for some key features of communication with other team members. Low scores were obtained by the entire cohort for vigilance. Interobserver reliability was 0.90 and 0.89 for technical and team skills ratings. Conclusions: The simulated operating theatre could serve as an environment for the development of surgical competence among surgical trainees. Objective, structured, and multimodal assessment of performance during simulated procedures could serve as a basis for focused feedback during training of technical and team skills. PMID:16244534

Localising People's Theatre in East Asia: Performing Hakka Women and Pear-Growers on Taiwan's Fault Line

ERIC Educational Resources Information Center

Liang, Peilin

2012-01-01

Since the 1960s and 1970s, theatre artists from around the globe initiated a wave of theatre practice that is commonly known today as People's Theatre or Theatre for Empowerment. Transforming its participants from being mere "spectactors" to "spect-actors" capable of articulating their concerns on-stage, the ultimate goal of…

Missed opportunity to screen and diagnose PTSD and depression among deploying shipboard US military personnel

PubMed Central

Hale, Braden R.; Michael, Nelson L.; Scott, Paul T.

2016-01-01

Background Depression and post-traumatic stress disorder (PTSD) are significant risks for suicide and other adverse events among US military personnel, but prevalence data among ship-assigned personnel at the onset of deployment are unknown. Aims To determine the prevalence of shipboard personnel who screen positive for PTSD and/or major depressive disorder (MDD) at the onset of deployment, and also those who reported these diagnoses made by a physician or healthcare professional in the year prior to deployment. Method Active-duty ship-assigned personnel (N = 2078) completed anonymous assessments at the beginning of deployment. Depression was measured using the Center for Epidemiologic Studies Depression Scale (CES-D; score of ≥22), and PTSD was assessed using the PTSD Checklist–Civilian Version (PCL-C; both score and symptom criteria were used). Results In total, 7.3% (n = 151 of 2076) screened positive for PTSD and 22% (n = 461 of 2078) for MDD at deployment onset. Only 6% and 15% of those who screened positive for PTSD or MDD, respectively, had been diagnosed by a healthcare professional in the past year. Conclusions Missed opportunities for mental healthcare among screen-positive shipboard personnel reduce the benefits associated with early identification and linkage to care. Improved methods of mental health screening that promote early recognition and referral to care may mitigate psychiatric events in theatre. Declaration of interest This work was performed as part of the official duties of the authors as military service members or employees of the US Government. Copyright and usage This work was prepared by military service members or employees of the US Government as part of their official duties. As such, copyright protection is not available for this work (Title 17, USC, §105). PMID:27713833

Exploring the evidence around pre-operative fasting practices.

PubMed

Hillier, Mark

Presenting a patient who is adequately fasted for theatre is still a controversial issue in contemporary nursing practice. This article will explore the evidence on fasting to allow nurses to reflect upon their own practice in this area.

Medical supply on contingency military operations: experience from Operation GRITROCK.

PubMed

Robinson, J P; Reeves, P

2015-01-01

Medical supply during military operations has the ability to affect the efficacy of the operation being undertaken, either negatively or positively. An appropriately-managed maritime platform with a robust medical supply chain during transit and on arrival in theatre is the main aim. A secure supply chain will reduce any implications that logistics may have with regard to capability, and negate the effects of deficiencies of short shelf life items occurring over time and during use in high tempo operations.

From local to global--an overview of the Croatian National Theatre in the era of globalization.

PubMed

Penjak, Ana

2012-09-01

The article offers an overview of the Croatian National Theatre research. It comes in two parts. The first examines the position theatre in the era of globalization, while the second focuses on the Croatian National Theatre, in the era of globalization, in the context of specific social and national interests, as well as within the limits of the national possibilities. What emerges in this overview is a feel for how complex the field of theatre research is in Croatia, given its specific position since there are four National Theatres in a country of approximately 4 million people. Also, local budgets and the lack of strategical plan and programme for culture in general represent a sort of limitation. The article ends with two conclusions: a) the Croatian National Theatres in the effort to go global experience primarily different economic status; b) the article draws attention to the present and future challenges that the Croatian National Theatres are faced with, posed by issues such as correlation between globalization and theatre.

We still need to operate at night!

PubMed Central

Faiz, Omar; Banerjee, Saswata; Tekkis, Paris; Papagrigoriadis, Savvas; Rennie, John; Leather, Andrew

2007-01-01

Introduction In the past the National Confidential Enquiry into Peri-operative deaths (NCEPOD) have advocated a reduction in non-essential night-time operating in NHS hospitals. In this study a retrospective analysis of the emergency general surgical operative workload at a London Teaching centre was performed. Methods All general surgical and vascular emergency operations recorded prospectively on the theatre database between 1997 and 2004 were included in the study. Operations were categorised according to whether they commenced during the daytime(08:01–18:00 hours), evening(18:01–00:00 hours) or night-time(00:01–08:00 hours). The procedure type and grade of the participating surgical personnel were also recorded. Bivariate correlation was used to analyse changing trends in the emergency workload. Results In total 5,316 emergency operations were performed over the study period. The numbers of daytime, evening and night-time emergency procedures performed were 2,963(55.7%), 1,832(34.5%), and 521(9.8%) respectively. Laparotomies and complex vascular procedures collectively accounted for half of all cases performed after midnight whereas they represented only 30% of the combined daytime and evening emergency workload. Thirty-two percent (n = 166) of all night-time operations were supervised or performed by a consultant surgeon. The annual volume of emergency cases performed increased significantly throughout the study period. Enhanced daytime (r = 0.741, p < 0.01) and evening (r = 0.548, p < 0.01) operating absorbed this increase in workload. There was no significant change in the absolute number of cases performed at night but the proportion of the emergency workload that took place after midnight decreased significantly throughout the study (r = -0.742, p < 0.01). Conclusion A small but consistent volume of complex cases require emergency surgery after midnight. Provision of an emergency general surgical service must incorporate this need. PMID:17973987

Popular Theatre: A Useful Process for Adult Educators.

ERIC Educational Resources Information Center

Bates, Reid A.

1996-01-01

Four types of theatre uses in adult education are theatre for education, for development, for conscientization, and popular theatre. The latter involves a group's interpretive study of its own social, economic, cultural, and political conditions, leading to collective action. (SK)

Fitting the Bill: Commissioned Theatre Projects on Human Rights in Pakistan--The Work of Karachi-Based Theatre Group "Tehrik e Niswan"

ERIC Educational Resources Information Center

Mundrawala, Asma

2007-01-01

Theatre practitioners in Pakistan's southern city Karachi have seen a recent surge of interest in the past two decades by donor agencies from the Western world to fund theatre companies and employ various forms of theatre for development to service their agendas and areas of interest within their target communities. This trend may have lent a…

Flexible Weaving: Investigating the Teaching and Learning Opportunities in the Practices of Theatre-Makers and Performers from Selected Townships in Cape Town

ERIC Educational Resources Information Center

Morris, Gay

2013-01-01

In 2005-2009, the author researched the theatre-making practices of young people in selected black townships near Cape Town, South Africa. Township theatre groups comprised secondary school learners and out-of-school youth who join together to learn about and make theatre, perform and watch each other. These theatre practitioners do not describe…

High-quality remote interactive imaging in the operating theatre

NASA Astrophysics Data System (ADS)

Grimstead, Ian J.; Avis, Nick J.; Evans, Peter L.; Bocca, Alan

2009-02-01

We present a high-quality display system that enables the remote access within an operating theatre of high-end medical imaging and surgical planning software. Currently, surgeons often use printouts from such software for reference during surgery; our system enables surgeons to access and review patient data in a sterile environment, viewing real-time renderings of MRI & CT data as required. Once calibrated, our system displays shades of grey in Operating Room lighting conditions (removing any gamma correction artefacts). Our system does not require any expensive display hardware, is unobtrusive to the remote workstation and works with any application without requiring additional software licenses. To extend the native 256 levels of grey supported by a standard LCD monitor, we have used the concept of "PseudoGrey" where slightly off-white shades of grey are used to extend the intensity range from 256 to 1,785 shades of grey. Remote access is facilitated by a customized version of UltraVNC, which corrects remote shades of grey for display in the Operating Room. The system is successfully deployed at Morriston Hospital, Swansea, UK, and is in daily use during Maxillofacial surgery. More formal user trials and quantitative assessments are being planned for the future.

Simulation in surgery: a review.

PubMed

Tan, Shaun Shi Yan; Sarker, Sudip K

2011-05-01

The ability to acquire surgical skills requires consistent practice, and evidence suggests that many of these technical skills can be learnt away from the operating theatre. The aim of this review article is to discuss the importance of surgical simulation today and its various types, exploring the effectiveness of simulation in the clinical setting and its challenges for the future. Surgical simulation offers the opportunity for trainees to practise their surgical skills prior to entering the operating theatre, allowing detailed feedback and objective assessment of their performance. This enables better patient safety and standards of care. Surgical simulators can be divided into organic or inorganic simulators. Organic simulators, consisting of live animal and fresh human cadaver models, are considered to be of high-fidelity. Inorganic simulators comprise virtual reality simulators and synthetic bench models. Current evidence suggests that skills acquired through training with simulators, positively transfers to the clinical setting and improves operative outcome. The major challenge for the future revolves around understanding the value of this new technology and developing an educational curriculum that can incorporate surgical simulators.

Moscow Theatre 1935 and 1970: This Is Where I Came In

ERIC Educational Resources Information Center

Houghton, Norris

1971-01-01

Compares findings of what is happening in Russian theatre today with what was being done in the 30's. Particularly discusses the work of Georgi Tovstonogov, Director of the Gorki Theatre in Leningrad, and Yuri Liubimov, Director of the Taganka Theatre in Moscow. (RB)

Theatre, Education and Performance

ERIC Educational Resources Information Center

Nicholson, Helen

2011-01-01

In the first conceptual overview of current practices and debates in theatre education, Helen Nicholson explores the contribution that professional theatre practitioners make to the education of young people. She maps the environments in which theatre and learning meet, and looks at how the educational concerns and artistic inventiveness of people…

Mental health of Canadian Forces members while on deployment to Afghanistan.

PubMed

Garber, Bryan G; Zamorski, Mark A; Jetly, Rakesh

2012-12-01

The deployed environment poses special challenges to the delivery of effective in-theatre mental health care. Our study sought to identify the prevalence and impact of symptoms of mental health problems in Canadian Forces (CF) personnel serving in Task Force Afghanistan; and, to determine the use of, and perceived need for, mental health services in CF personnel while deployed. Our study consisted of a cross-sectional survey of all 2779 CF personnel deployed to the province of Kandahar, Afghanistan, from February 15, 2010, to March 15, 2010. An important minority (8.5%) of the 1572 respondents (response rate = 57%) exceeded civilian criteria for symptoms of acute traumatic stress, major depression, or generalized anxiety. Prevalence of these 3 mental health problems increased with higher combat exposure and location in more isolated posts. A much larger fraction (31%) reported suffering a stress, emotional, alcohol, or family problem during the deployment. Only a minority of respondents with a mental health problem (26%) were currently interested in getting help. Almost one-half of respondents with a mental health problem perceived occupational dysfunction as a result, though two-thirds of respondents with occupational dysfunction were in the group without the 3 mental health problems assessed. The needs base for psychosocial support extends beyond personnel who meet conventional questionnaire criteria for traumatic stress, depression, or generalized anxiety. Future research is needed to understand what precise problems are driving this larger needs base and what precise supports (clinical or nonclinical) would be most appropriate.

Rethinking Theatre Teacher Education: A National Think Tank for Change-Makers.

ERIC Educational Resources Information Center

Lazarus, Joan

2002-01-01

Discusses development of the American Alliance for Theatre and Education's Think Tanks on Theatre Teacher Education. Notes the think tanks were intended to probe important issues, move to a new level of thinking, and hopefully, effect change in individual and collective practice of theatre teacher education. (SG)

From Republicans to Hacktivists: Recent Inclusion Initiatives in Canadian Theatre

ERIC Educational Resources Information Center

Johnston, Kirsty

2017-01-01

Could targeted inclusion initiatives press Canada's professional theatre community to tap the vast reserve of disabled people disenfranchised by its current practices? In 2015/2016, several long-standing professional institutions dedicated to fostering Canadian theatre joined with Canadian disability theatre artists in order to mark and understand…

Towards Relevance and Professionalism: Recent Trends in Educational Theatre.

ERIC Educational Resources Information Center

Staroba, Frank

1974-01-01

During the last ten years, educational theatre has evidenced a greater relevance to and a growing involvement in contemporary life. College theatre programs have become more professional, with some universities having developed their own companies or cooperative arrangements with nearby regional theatres. The variety of performance spaces in new…

Theatre for Development: An Overview.

ERIC Educational Resources Information Center

Nogueira, Marcia Pompeo

2002-01-01

Discusses the term Theatre for Development (TFD) by addressing the theatre practice developed by a group of women in Mundemba Sub-Division, Cameroon, which was presented in Anne Tanyi-Tang's article "Theatre for Change: An Analysis of Two Performances by Women in Mundemba Sub-Division" in an earlier issue of this journal. Considers…

Museum Theatre: Telling Stories through Objects.

ERIC Educational Resources Information Center

Schindel, Dorothy Napp

2002-01-01

Explains that Museum Theatre's goal is to teach through drama by using experiential interpretive strategies that bypass the lecture format. Outlines a production of Museum Theatre which helped a museum redefine itself. Concludes that Museum Theatre helps shift the focus of programming from simple object display to an emphasis on the human…

Theatre and Cinema Architecture: A Guide to Information Sources.

ERIC Educational Resources Information Center

Stoddard, Richard

This annotated bibliography cites works related to theatres, movie houses, opera houses, and dance facilities. It is divided into three parts: general references, theatre architecture, and cinema architecture. The part on general references includes bibliographies and periodicals. The second and main part of the guide, on theatre architecture,…

Creative Inclusion in Community Theatre: A Journey with Odyssey Theatre

ERIC Educational Resources Information Center

Wooster, Roger

2009-01-01

What does "inclusion" mean in practice? This article considers the work of Odyssey Theatre, a group of learning-disabled and non-learning-disabled performers as they put together a production with the support of professional theatre workers. Working processes are examined and the balance of empowerment and professional leadership…

Using Readers' Theatre in the Classroom.

ERIC Educational Resources Information Center

Annarella, Lorie A.

Reader's Theatre can be used to combine basic literature and writing instruction with creative arts. Improvisational playmaking by students, using literature in the form of plays, prose, and poetry, forms the basis of Reader's Theatre. Use of Reader's Theatre in the classroom can: (1) foster deeper understanding of character, setting, and plot…

Clinical applicability of robot-guided contact-free laser osteotomy in cranio-maxillo-facial surgery: in-vitro simulation and in-vivo surgery in minipig mandibles.

PubMed

Baek, K-W; Deibel, W; Marinov, D; Griessen, M; Bruno, A; Zeilhofer, H-F; Cattin, Ph; Juergens, Ph

2015-12-01

Laser was being used in medicine soon after its invention. However, it has been possible to excise hard tissue with lasers only recently, and the Er:YAG laser is now established in the treatment of damaged teeth. Recently experimental studies have investigated its use in bone surgery, where its major advantages are freedom of cutting geometry and precision. However, these advantages become apparent only when the system is used with robotic guidance. The main challenge is ergonomic integration of the laser and the robot, otherwise the surgeon's space in the operating theatre is obstructed during the procedure. Here we present our first experiences with an integrated, miniaturised laser system guided by a surgical robot. An Er:YAG laser source and the corresponding optical system were integrated into a composite casing that was mounted on a surgical robotic arm. The robot-guided laser system was connected to a computer-assisted preoperative planning and intraoperative navigation system, and the laser osteotome was used in an operating theatre to create defects of different shapes in the mandibles of 6 minipigs. Similar defects were created on the opposite side with a piezoelectric (PZE) osteotome and a conventional drill guided by a surgeon. The performance was analysed from the points of view of the workflow, ergonomics, ease of use, and safety features. The integrated robot-guided laser osteotome can be ergonomically used in the operating theatre. The computer-assisted and robot-guided laser osteotome is likely to be suitable for clinical use for ostectomies that require considerable accuracy and individual shape. Copyright © 2015 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

Safety culture and the 5 steps to safer surgery: an intervention study.

PubMed

Hill, M R; Roberts, M J; Alderson, M L; Gale, T C E

2015-06-01

Improvements in safety culture have been postulated as one of the mechanisms underlying the association between the introduction of the World Health Organisation (WHO) Surgical Safety Checklist with perioperative briefings and debriefings, and enhanced patient outcomes. The 5 Steps to Safer Surgery (5SSS) incorporates pre-list briefings, the three steps of the WHO Surgical Safety Checklist (SSC) and post-list debriefings in one framework. We aimed to identify any changes in safety culture associated with the introduction of the 5SSS in orthopaedic operating theatres. We assessed the safety culture in the elective orthopaedic theatres of a large UK teaching hospital before and after introduction of the 5SSS using a modified version of the Safety Attitude Questionnaire - Operating Room (SAQ-OR). Primary outcome measures were pre-post intervention changes in the six safety culture domains of the SAQ-OR. We also analysed changes in responses to two items regarding perioperative briefings. The SAQ-OR survey response rate was 80% (60/75) at baseline and 74% (53/72) one yr later. There were significant improvements in both the reported frequency (P<0.001) and perceived importance (P=0.018) of briefings, and in five of the six safety culture domain scores (Working Conditions, Perceptions of Management, Job Satisfaction, Safety Climate and Teamwork Climate) of the SAQ-OR (P<0.001 in all cases). Scores in the sixth domain (Stress Recognition) decreased significantly (P=0.028). Implementation of the 5SSS was associated with a significant improvement in the safety culture of elective orthopaedic operating theatres. © The Author 2015. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

[Surface Cleaning and Disinfection in the Hospital. Improvement by Objective Monitoring and Intervention].

PubMed

Woltering, R; Hoffmann, G; Isermann, J; Heudorf, U

2016-11-01

Background and Objective: An assessment of cleaning and disinfection in hospitals by the use of objective surveillance and review of mandatory corrective measures was undertaken. Methods: A prospective examination of the cleaning and disinfection of surfaces scheduled for daily cleaning in 5 general care hospitals by use of an ultraviolet fluorescence targeting method (UVM) was performed, followed by structured educational and procedural interventions. The survey was conducted in hospital wards, operating theatres and intensive care units. Cleaning performance was measured by complete removal of UVM. Training courses and reinforced self-monitoring were implemented after the first evaluation. 6 months later, we repeated the assessment for confirmation of success. Results: The average cleaning performance was 34% (31/90) at base-line with significant differences between the 5 hospitals (11-67%). The best results were achieved in intensive care units (61%) and operating theatres (58%), the worst results in hospital wards (22%). The intervention significantly improved cleaning performance up to an average of 69% (65/94; +34.7%; 95% confidence interval (CI): 21.2-48.3; p<0.05), with differences between the hospitals (20-95%). The largest increase was achieved in hospital wards (+45%; CI 29.2-60.8; p<0.05). Improvements in operating theatres (+22.9%; CI 10.9-56.7) and intensive care units (+5.6%; CI 25.8-36.9) were statistically not significant. Conclusions: The monitoring of cleaning and disinfection of surfaces by fluorescence targeting is appropriate for evaluating hygiene regulations. An intervention can lead to a significant improvement of cleaning performance. As part of a strategy to improve infection control in hospitals, fluorescence targeting enables a simple inexpensive and effective surveillance of the cleaning performance and corrective measures. © Georg Thieme Verlag KG Stuttgart · New York.

Wide Awake Hand Surgery.

PubMed

Lied, Line; Borchgrevink, Grethe E; Finsen, Vilhjalmur

2017-09-01

"Wide awake hand surgery", where surgery is performed in local anaesthesia with adrenaline, without sedation or a tourniquet, has become widespread in some countries. It has a number of potential advantages and we wished to evaluate it among our patients. All 122 patients treated by this method during one year were evaluated by the surgeons and the patients on a numerical scale from 0 (best/least) to 10 (worst/most). Theatre time was compared to that recorded for a year when regional or general anaesthesia had been used. The patients' mean score for the general care they had received was 0.1 (SD 0.6), for pain during lidocaine injection 2.4 (SD 2.2), for pain during surgery 0.9 (SD 1.5), and for other discomfort during surgery 0.5 (SD 1.4). Eight reported that they would want general anaesthesia if they were to be operated again. The surgeons' mean evaluation of bleeding during surgery was 1.6 (SD 1.8), oedema during surgery 0.4 (SD 1.1), general disadvantages with the method 1.0 (SD 1.6) and general advantages 6.5 (SD 4.3). The estimation of advantages was 9.9 (DS 0.5) for tendon suture. 28 patients needed intra-operative additional anaesthesia. The proportion was lower among trained hand surgeons and fell significantly during the study period. Non-surgical theatre time was 46 (SD 15) minutes during the study period and 55 (SD 22) minutes during the regional/general period (p < 0.001). This gain was cancelled out by a longer surgery time during the wide awake period. Wide awake surgery is fully acceptable to most patients. It has a number of advantages over general or regional anaesthesia, but we feel it is unlikely to improve the efficiency of the operating theatre.

Performing Desistance: How Might Theories of Desistance From Crime Help Us Understand the Possibilities of Prison Theatre?

PubMed

Davey, Linda; Day, Andrew; Balfour, Michael

2015-07-01

Despite the ubiquity of theatre projects in prisons there has been little (published) discussion of the application of theatre to the theories of criminology or rehabilitation of offenders, and scant examination of the potential for criminological theories to inform theatre practice in criminal justice settings. This article seeks to address this deficit and argues that positioning prison theatre within the discipline of positive criminology, specifically contemporary theories of desistance from crime, provides a theoretical framework for understanding the contribution that prison theatre might be making in the correctional setting. Through a review of related literature, the article explores how prison theatre may be motivating offenders toward the construction of a more adaptive narrative identity and toward the acquisition of capabilities that might usefully assist them in the process of desisting from crime. © The Author(s) 2014.

African Theatre and the University of Leeds

ERIC Educational Resources Information Center

Banham, Martin; Plastow, Jane

2006-01-01

This paper discusses the impact that teaching and research on African theatre in the Workshop Theatre of the University of Leeds' School of English may have had in Africa and elsewhere. After surveying the productivity and influence of the Workshop Theatre to the present, the authors ask if they have contributed meaningfully to the development,…

When Theatre of the Oppressed Becomes Theatre of the Oppressor

ERIC Educational Resources Information Center

Hamel, Sonia

2013-01-01

On 6 February 2008, a deliberative theatre experiment was held at the "National Archives of Quebec". Inspired by the democratic virtues of public deliberation but preoccupied with its blind spots, Forum Theatre was used as a deliberative medium to initiate discussion about the social tensions between the homeless and other dwellers of…

Starting a Community Musical Theatre Orchestra

ERIC Educational Resources Information Center

Sorenson, Burke

2007-01-01

Musical theatre is one of the great genres of music, yet very few community theatres use live music to accompany their productions. Sadly, many community theatres that formerly employed pit orchestras are replacing them with electronic music. Some producers would welcome live music, but they worry about the potential cost. There are so many…

The "Invisible" Drama/Theatre in Education Curriculum in Kenya

ERIC Educational Resources Information Center

Joseph, Christopher Odhiambo

2016-01-01

This vignette presents the state of theatre in Education Kenya. The paper argues that though there are several theatre in education like practices, these have not been entrenched in the school curriculum. Theatre in Education finds expression and manifestations outside the mainstream school curriculum for instance in schools and colleges drama…

On Shaky Ground: The Conceptual Foundations of Theatre Historians.

ERIC Educational Resources Information Center

Zobel, Konrad; Hofmann, Juergen

Theatre historians show little inclination to reflect on the ideologies that govern their work, on the premise that "theatre is theatre" with little relationship to its socioeconomic environment. One of the causes is the historians' reliance on theatrical "facts," as they were in the same category as facts established in the natural sciences.…

The cost of open heart surgery in Nigeria.

PubMed

Falase, Bode; Sanusi, Michael; Majekodunmi, Adetinuwe; Ajose, Ifeoluwa; Idowu, Ariyo; Oke, David

2013-01-01

Open Heart Surgery (OHS) is not commonly practiced in Nigeria and most patients who require OHS are referred abroad. There has recently been a resurgence of interest in establishing OHS services in Nigeria but the cost is unknown. The aim of this study was to determine the direct cost of OHS procedures in Nigeria. The study was performed prospectively from November to December 2011. Three concurrent operations were selected as being representative of the scope of surgery offered at our institution. These procedures were Atrial Septal Defect (ASD) Repair, Off Pump Coronary Artery Bypass Grafting (OPCAB) and Mitral Valve Replacement (MVR). Cost categories contributing to direct costs of OHS (Investigations, Drugs, Perfusion, Theatre, Intensive Care, Honorarium and Hospital Stay) were tracked to determine the total direct cost for the 3 selected OHS procedures. ASD repair cost $ 6,230 (Drugs $600, Intensive Care $410, Investigations $955, Perfusion $1080, Theatre $1360, Honorarium $925, Hospital Stay $900). OPCAB cost $8,430 (Drugs $740, Intensive Care $625, Investigations $3,020, Perfusion $915, Theatre $1305, Honorarium $925, Hospital Stay $900). MVR with a bioprosthetic valve cost $11,200 (Drugs $1200, Intensive Care $500, Investigations $3040, Perfusion $1100, Theatre $3,535, Honorarium $925, Hospital Stay $900). The direct cost of OHS in Nigeria currently ranges between $6,230 and $11,200. These costs compare favorably with the cost of OHS abroad and can serve as a financial incentive to patients, sponsors and stakeholders to have OHS procedures done in Nigeria.

SMEs, IT, and the Third Space: Colonization and Creativity in the Theatre Industry

NASA Astrophysics Data System (ADS)

Kendall, Julie E.; Kendall, Kenneth E.

We examine how small and medium-sized, professional, nonprofit performing arts theatres in the US can improve the strategic use of information technology (IT), as well as other aspects of theatre management for large, commercial theatre productions in the West End of London and on Broadway in New York City. In this article we use the epistemology of the third space developed by Bhabha (1994) and extended by Frenkel (2008). Although both authors were discussing knowledge transfer, we use their conceptualizations to characterize and explore more deeply the transfer process of culture (and thereby useful practices and worthwhile lessons) from small and medium-sized professional, nonprofit theaters to large-scale commercial theatres. We include a discussion of Nonaka’s (1991) concept of ba, and how it relates to the third space. We specifically employ the metaphor of the third space developed by Bhabha (1994) to critique and understand the verbal and nonverbal cultural transmissions between small and large theatres. One of our contributions is to use the conceptualization and metaphor of the third space to understand the complex exchanges and relationships between small to medium-sized nonprofit professional theatres and large commercial theatres, and to identify what large commercial productions can learn from nonprofit theatres from these exchanges.

The effect of handover location on trauma theatre start time: An estimated cost saving of £131 000 per year.

PubMed

Nahas, Sam; Ali, Adam; Majid, Kiran; Joseph, Roshan; Huber, Chris; Babu, Victor

2018-02-08

The National Health Service was estimated to be in £2.45 billion deficit in 2015 to 2016. Trauma theatre utilization and efficiency has never been so important as it is estimated to cost £15/minute. Structured questionnaires were given to 23 members of staff at our Trust who are actively involved in the organization or delivery of orthopaedic trauma lists at least once per week. This was used to identify key factors that may improve theatre efficiency. Following focus group evaluation, the location of the preoperative theatre meeting was changed, with all staff involved being required to attend this. Our primary outcome measure was mean theatre start time (time of arrival in the anaesthetic room) during the 1 month immediately preceding the change and the month following the change. Theatre start time was improved on average 24 minutes (1 month premeeting and postmeeting change). This equates to a saving of £360 per day, or £131 040 per year. Changing the trauma meeting location to a venue adjacent to the trauma theatre can improve theatre start times, theatre efficiency, and therefore result in significant cost savings. Copyright © 2018 John Wiley & Sons, Ltd.

Vantage point.

PubMed

Shuldham, Caroline

2010-03-03

I STOOD back to allow the bed to pass as a young boy, accompanied by his mother, was wheeled into theatre. He was solemn and did not return my smile, no doubt controlling his fear. His mother, having made her decision to go ahead with the operation, was concentrating on him.

A system for the management, display and integration of pre-hospital healthcare activity in the deployed environment.

PubMed

Grant, Simon; Wheatley, R J

2014-12-01

To create and implement a system through which pre-hospital healthcare activity across an entire operational theatre could be made available in real-time to support healthcare delivery, governance and assurance activity. An IT-based system was created that could display, manage and integrate the pre-hospital healthcare activity on Op HERRICK 18. The system was based on the Defence Medical Services Common Assurance Framework and run through Microsoft Office SharePoint. Pre-hospital healthcare activity was made available and visible across an operational theatre. This supported delivery, assurance and governance at any time. Activity from each medical facility could be integrated and display automatically improving theatre wide situational awareness. The availability of information resulted in a shift towards a more continuous process of assurance and governance rather than reliance on inherently threatening and increasingly intermittent inspection regimes. The ability to review healthcare activity remotely at anytime significantly improves the validity of assurance possible for a deployed force. Governance activity can be more responsive and less reliant on the fixed timescale and datasets of reports from outlying medical facilities. However, assurance and governance authorities must not allow such a wealth of information to impact local leadership and innovation through a perception of, or actual, micro-management. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Training situational awareness to reduce surgical errors in the operating room.

PubMed

Graafland, M; Schraagen, J M C; Boermeester, M A; Bemelman, W A; Schijven, M P

2015-01-01

Surgical errors result from faulty decision-making, misperceptions and the application of suboptimal problem-solving strategies, just as often as they result from technical failure. To date, surgical training curricula have focused mainly on the acquisition of technical skills. The aim of this review was to assess the validity of methods for improving situational awareness in the surgical theatre. A search was conducted in PubMed, Embase, the Cochrane Library and PsycINFO using predefined inclusion criteria, up to June 2014. All study types were considered eligible. The primary endpoint was validity for improving situational awareness in the surgical theatre at individual or team level. Nine articles were considered eligible. These evaluated surgical team crisis training in simulated environments for minimally invasive surgery (4) and open surgery (3), and training courses focused at training non-technical skills (2). Two studies showed that simulation-based surgical team crisis training has construct validity for assessing situational awareness in surgical trainees in minimally invasive surgery. None of the studies showed effectiveness of surgical crisis training on situational awareness in open surgery, whereas one showed face validity of a 2-day non-technical skills training course. To improve safety in the operating theatre, more attention to situational awareness is needed in surgical training. Few structured curricula have been developed and validation research remains limited. Strategies to improve situational awareness can be adopted from other industries. © 2014 BJS Society Ltd. Published by John Wiley & Sons Ltd.

Optical urethrotomy under local anaesthesia is a feasible option in urethral stricture disease.

PubMed

Munks, D G; Alli, M O; Goad, E H Abdel

2010-01-01

The aim of our study was to assess the feasibility of performing optical urethrotomy for urethral stricture disease under local anaesthesia. A total of 33 patients with radiologically proven urethral stricture underwent optical urethrotomy by a single operator under local anaesthesia. Of these patients, 23 (70%) had stricture involving the corpora spongiosum and 18 (55%) of the patients were dependent on supra-pubic catheters. The procedure was successful in 30 cases (91%). The procedure was very well tolerated (average visual analogue pain score of 2/10) with an extremely low complication rate. The large number of patients with urethral stricture disease and the premium on operating time on formal theatre slates encouraged us to perform these procedures under local anaesthetic. Although most patients had severe stricture disease, the majority of cases were successful and very well tolerated. Optical urethrotomy under local anesthesia could be a viable option in the absence of formal theatre time and the facilities to perform general anaesthesia.

Theatre Safari in East Africa: An Exploration of Theatre in Kenya.

ERIC Educational Resources Information Center

Hutchinson, P. William

Six months of observation--at two universities, at a drama festival, and with several independent theatre companies--form the basis for this evaluation of theatre in Kenya, Africa. While Kenyan dramas deal with a variety of themes, the majority are topical rather than universal in their treatment of issues. In many, the emphasis is on the…

Devising and Interdisciplinary Teaching: A Case Study in Collaboration between Theatre and Humanities Courses

ERIC Educational Resources Information Center

Mahoney, Kristin; Brown, Rich

2013-01-01

We use an experimental course collaboration that occurred in the winter of 2012 as a case study for an approach to interdisciplinary collaboration between Theatre and Humanities courses, and we argue that the theatre methodology of "devising" can serve as a particularly rich locus for collaboration between Theatre students and other…

In Flesh and Bone: Bodily Image and Educational Patterns in Early Reformation Theatre

ERIC Educational Resources Information Center

Salvarani, Luana

2018-01-01

From its very beginning, the Protestant Reformation adopted the theatre as one of its educational tools. Together with choral music, visual arts, and preaching, Luther, Melanchthon, Oekolampad, and other Reformers promoted both the cultivated school theatre and the popular street theatre in order to spread the new faith, create a community ethos,…

Learning Robotics in a Science Museum Theatre Play: Investigation of Learning Outcomes, Contexts and Experiences

ERIC Educational Resources Information Center

Peleg, Ran; Baram-Tsabari, Ayelet

2017-01-01

Theatre is often introduced into science museums to enhance visitor experience. While learning in museums exhibitions received considerable research attention, learning from museum theatre has not. The goal of this exploratory study was to investigate the potential educational role of a science museum theatre play. The study aimed to investigate…

Play-Building: Creating a Documentary Theatre Performance in a High School Setting

ERIC Educational Resources Information Center

van Eyck, Philip

2013-01-01

This paper describes a high school theatre program's project in which Anna Deavere Smith's documentary theatre work serves as the foundation for play-building for students. Research in theatre arts supports the use of play-building as a way to explore major themes of relevance to students. However, there is little research addressing documentary…

A Selective Bibliography of Handbooks and Textbooks on Metalworking and Plastics Working for the Theatre Scene Shop

ERIC Educational Resources Information Center

Van Brunt, Thomas

1975-01-01

Lists books into general categories of those useful for advanced technicians, and those useful for the hobbiest or sculptor-painter. Available from: Theatre Design and Technology, Journal of the U.S. Institute for Theatre Technology, 1 Hillside Road, Newark, Delaware 19711. Subscriptions: subscription to Theatre Design and Technology is a…

The Federal Theatre Project Children's Theatre: Materials and Resources.

ERIC Educational Resources Information Center

Kerns, Ruth B.

One of the most creative, active, purposeful and successful efforts of the Federal Theatre Project (FTP), active from 1935 to 1939, was the Children's Theatre. Plays for production were selected on the basis of educational and cultural value, with special attention on sufficient realism to help children's awareness of self and place in the world.…

Pedagogies of Self-Humanization: Collaborating to Engage Trauma in the Phoenix Players Theatre Group

ERIC Educational Resources Information Center

Fesette, Nick; Levitt, Bruce

2017-01-01

The Phoenix Players Theatre Group was founded by incarcerated theatre artists located in a maximum-security prison with the aim of creating a space where they can be witnessed in order to initiate a process of personal, cultural, and sociopolitical transformation. This article integrates research from trauma theory with theatre and social justice…

The Israeli-Palestinian Conflict through Theatre: A Qualitative Study of Israeli High School Students

ERIC Educational Resources Information Center

Gesser-Edelsburg, Anat

2012-01-01

Both theatre artists and educators believe the theatre has many advantages as a vehicle for the promotion of social and political issues. This study examines how the Israeli theatre represents the Israeli-Palestinian conflict and promotes peace and tolerance among young people. The study, conducted between the years 2005 and 2007, included 26…

Reactions and Assessments: Educational Laboratory Theatre Project, 1966-70. Final Report.

ERIC Educational Resources Information Center

Hoetker, James; And Others

The general plan of the 4-year (1966-1970) Educational Laboratory Theatre Project was to have theatre companies in Rhode Island, New Orleans, and Los Angeles give five matinee performances per week for high school students and three evening performances for adults in order to (1) make extensive use of professional theatre as an integral part of…

Performing Environmental Change: MED Theatre and the Changing Face of Community-Based Performance Research

ERIC Educational Resources Information Center

Schaefer, Kerrie

2012-01-01

This article examines a programme of work produced by community-based theatre company, Manaton and East Dartmoor (MED) Theatre, addressing issues of climate change as they impact on life in rural Devon, UK. After some discussion of MED Theatre's constitution as a community-based company and the group's long-term engagement with the place, history,…

The renovation of Madison's Oscar Mayer Theater

NASA Astrophysics Data System (ADS)

Myers, Joseph W. A.; Calamia, Paul T.

2002-05-01

Originally opened in 1928 as the Capitol Theatre, the Oscar Mayer Theatre in Madison, WI underwent substantial renovation in 1980 to support its current performance program. The theatre is now home to the Madison Symphony and the Madison Opera, and is used for ballet, touring shows, and popular concerts as well. As part of the ongoing Overture Project which will transform the theatre's home, the Madison Civic Center, into the Overture Center, the Oscar Mayer Theatre will be further improved to support its new role. In this paper we will discuss the reasoning behind the upcoming renovation within the context of the Overture Project, we will describe the pending architectural modifications to the theatre, and we will discuss the intended changes in acoustics. Computer modeling results will also be presented for the existing and renovated conditions.

A brief historical review of non-anaesthetic causes of fires and explosions in the operating room.

PubMed

Macdonald, A G

1994-12-01

Fires and explosions have occurred in the operating theatre for many years. Flammable inhalation anaesthetic agents were responsible for many incidents in the past, but these are no longer available in many countries. Other causes of fires and explosions still exist in the operating theatre and, from time to time, result in serious and occasionally fatal injury. Flammable gastrointestinal gases have been the cause of injury to patients during gastric surgery, laparoscopy and during examination of the large bowel with electrical instrumentation. Gases formed in the bladder during urological procedures have ignited, causing rupture. Alcohol-based skin cleaning agents have resulted in severe burns to the skin. Equipment used for storage and delivery of oxygen to patients has caused fires in a variety of ways. Adhesive skin drapes have resulted recently in two tragic deaths. The increasing use of laser therapy, particularly in ear, nose and throat surgery, and in oral surgery, has brought about a renewed awareness of the risk of fire. The relevant factors which should be borne in mind and the precautions which should be adopted when laser therapy is to be used in the airway are discussed.

The Praxis of Theatre for Development in Curbing Social Menace in Urban Slum in Lagos State

ERIC Educational Resources Information Center

Adeyemi, Olusola Smith

2015-01-01

Theatre for Development (TfD) is a special kind of Theatre practice that creates a platform for members of a specific community to respond to, and actively participate in issues relating to their social development through an engaging process of play and acting. The sole essence of this form of theatre is to sensitize, radicalize and conscientize…

Here's Another Nice Mess: Using Video in Reflective Dialogue Research Method

ERIC Educational Resources Information Center

Hepplewhite, K.

2014-01-01

This account discusses "reflective dialogues", a process utilising video to re-examine in-action decision-making with theatre practitioners who operate in community contexts. The reflexive discussions combine with observation, text and digital documentation to offer a sometimes "messy" (from Schön 1987) dynamic to the research…

Emptiness as Material for Devised Theatre Performance

ERIC Educational Resources Information Center

Ames, Margaret

2018-01-01

The article examines the ways in which failure operated in the devising process with a colleague with learning disabilities. Themes of collaboration, co-creativity and power relations are set within the account of a process between the author and a research participant with learning and physical disabilities. The postdramatic device of failure…

Theatre as a Learning Tool.

ERIC Educational Resources Information Center

Goldman, Jeffrey

1991-01-01

Describes the Los Angeles Theatre Center's educational outreach project, "Theatre as a Learning Tool." Discusses the program, its effect on high school students, and the process of providing study guides for the teachers. (PRA)

Theatre of the Ancient Maya

ERIC Educational Resources Information Center

Klein, Maxine

1971-01-01

There is at least one Western theatre that the historians consistently overlook. This is the theatre of the Mayan Civilization, one that antedates any other in the Western world by hundreds of years. (Author)

An evaluation of a theatre production to encourage non-smoking among elementary age children: 2 Smart 2 Smoke

PubMed Central

Perry, C.; Komro, K.; Dudovitz, B.; Veblen-Mortenson, S.; Jeddeloh, R.; Koele, R.; Gallanar, I.; Farbakhsh, K.; Stigler, M.

1999-01-01

OBJECTIVE—To evaluate the impact of a theatre production on smoking-related attitudes, norms, and intentions of children in grades 1-6 (aged 6-12 years).
DESIGN—Seventeen schools were randomly selected among 160 that were participating in the implementation of the theatre production 2 Smart 2 Smoke. Schools that participated in the theatre production after 3 December 1997 were assigned as control schools. Assignment of schools to a given date for the theatre production was a random process. Students in grades 1-6 were surveyed before and after the theatre production and associated activities. The data were examined for pretest-posttest differences and intervention-control differences. The school was the unit of analysis.
SETTING—Elementary schools in the Twin Cities metropolitan area.
PARTICIPANTS—Students in grades 1-6 in 17 elementary schools.
INTERVENTION—Two plays 2 Smart 2 Smoke for grades 1-3 (6-8 year olds) and grades 4-6 (9-12 year olds), respectively, with follow-up activities for the classroom and home. A national theatre company performed the plays at the schools.
MAIN OUTCOME MEASURES—Intention to smoke in the future, normative expectations about how many people smoke, functional meanings of smoking, expected outcomes of smoking.
RESULTS—10% more students reported that they would never smoke a cigarette after the theatre production. Students in grades 4-6 showed changes in the functional meanings and expected outcomes of smoking. Students in grades 1-3 showed changes in normative expectations.
CONCLUSIONS—Further research on the impact of live theatre productions as a smoking prevention strategy is recommended.


Keywords: smoking prevention; children; theatre production PMID:10478401

[Cost recovery for the treatment of retinal and vitreal diseases by pars plana vitrectomy under the German DRG system].

PubMed

Framme, C; Franz, D; Mrosek, S; Helbig, H

2007-10-01

Since 2004 inpatient health care in Germany is paid according to calculated DRGs. Only a few university hospitals participated in distinct cost calculations of clinical treatment. It was the aim of this study to check the cost recovery at a University Eye Hospital for the surgical treatment of retinal and vitreal diseases by pars plana vitrectomy (ppV), which are included in DRGs C03Z and C17Z. The performance data for both DRGs were collected for the years 2005 and 2006 using the E1 sheets according to section 21 KHEntG. The mean duration of all procedures was collected by data from the internal controlling. Costs for single operations were calculated from fixed and variable costs for the operation theatre and the ward including costs for personnel and material. In the 2-year period of 4,721 inpatient procedures 1,307 ppVs were performed. Each ppV had fixed surgical costs of 130.60 EUR; personnel costs varied between 575 EUR (C03Z; including cataract surgery; mean OP duration: 85 min) and 510 EUR (C17Z; no cataract surgery; mean OP duration: 73 min) at a proportion between general anaesthesia and local anaesthesia of 80/20. For a pure ppV material costs were 255 EUR. Additional adjuncts such as an encircling band, perfluorcarbon, ICG, tPA, gas and silicon oil or cataract surgery led to extra costs between 51 EUR and 250 EUR per adjunct und were used in 56% (C03Z) and 74.5% (C17Z) of all procedures. Costs for hospitalisation were about 1765 EUR at a mean residence time of 6.5 days. Thus, the overall costs of a pure basic ppV amounted to 2975 EUR (C03Z) and 2661 EUR (C17Z). In consideration of the current relative DRG weights of 1.08 and 0.957 and a current base rate of 2787.19 EUR in Bavaria, cost recovery is only given for basic ppV but not for complex ppVs having higher material and personnel costs. Additionally, the costs for multiple surgeries as occur in 5.9% of cases are not compensated by the DRG system. The reimbursement for inpatient ppVs in a University environment is not covered for complex procedures requiring more cost-effective material and personnel time. To consider an adequate cost recovery for these procedures a DRG split for both DRGs (C03Z and C17Z) in basic ppVs and complex ppVs is required. We recommend this proposal for the InEK.

Risk factors for Post Traumatic Stress Disorder amongst United Kingdom Armed Forces personnel

PubMed Central

Iversen, Amy C; Fear, Nicola T; Ehlers, Anke; Hughes, Jamie Hacker; Hull, Lisa; Earnshaw, Mark; Greenberg, Neil; Rona, Roberto; Wessely, Simon; Hotopf, Matthew

2013-01-01

Background Understanding the factors which increase the risk of PTSD for military personnel is important. This study aims to investigate the relative contribution of pre-deployment, peri-deployment, and post deployment variables to the prevalence of post traumatic stress symptoms in UK Armed Forces personnel who have been deployed in Iraq since 2003. Method Data are drawn from stage 1 of a retrospective cohort study comparing a random sample of UK military personnel deployed to the 2003 Iraq War with a control group who were not deployed to the initial phase of war fighting (response rate 61%). The analyses are limited to 4762 regular service individuals who responded and who deployed to Iraq since 2003. Results Post traumatic stress symptoms were associated with lower rank, being unmarried, low educational attainment and a history of childhood adversity. Exposure to potentially traumatising events was associated with post traumatic stress symptoms. Appraisals of the experience as involving threat to life or that work in theatre was above an individual’s trade and experience were strongly associated with post traumatic stress symptoms Low morale, poor social support within the unit and non-receipt of a homecoming brief were associated with greater risk of post traumatic stress symptoms. Conclusions These results support that there are modifiable occupational factors which may influence an individual’s risk of PTSD. Personal appraisal of threat to life during the trauma emerged as the strongest predictor of symptoms, and therefore interventions focused on reinstating a sense of control are an important focus for treatment. PMID:18226287

Grafting orchids and ugly: theatre, disability and arts-based health research.

PubMed

Johnston, Kirsty

2010-12-01

Theatre-based health policy research is an emerging field, and this article investigates the work of one of its leaders. In 2005, prominent medical geneticist and playwright Jeff Nisker and his collaborators produced Orchids, his play concerning pre-implantation genetic diagnosis, to research theatre as a tool for engaging citizens in health policy development. Juxtaposing Orchids with a concurrent disability theatre production in Vancouver entitled Ugly, I argue that disability theatre suggests important means for building inclusiveness in this kind of research and complicates Nisker's own call for international guidelines to delimit how journalists, playwrights, filmmakers, physicians and other media authors share genetics-based narratives in public.

Out of hours ophthalmic surgery: a UK national survey.

PubMed

O'Colmain, U; Wright, M; Bennett, H; MacEwen, C J

2013-03-01

There have been significant changes in the management of out of hours services in ophthalmology recently. The European Working Time Directive (EWTD) and economic measures have anecdotally reduced the availability of staff and facilities outside normal working hours, and there have been various responses to the provision of emergency surgical care. There are disparate attitudes to the optimum management of the emergency surgical case. We sought to establish a nationwide picture of the management of out of hours surgery. A questionnaire was distributed to every consultant ophthalmologist working in the NHS and registered with the Royal College of Ophthalmologists (n=947). Information was requested regarding departmental and personal policies, local facilities, and personal beliefs regarding emergency surgery. A total of 440 (46.5%) questionnaires were returned from 155 units; 18.7% of the units had no out of hours services or no operating facilities. Sixty-three percent of units reported a local policy regarding a time after which patients should not be taken to theatre. For 57%, this time began between 2100 hours and midnight. The most common reasons for not operating after a certain time were 'belief that delay does not significantly affect the outcome' (41.6%), 'delayed access to theatre due to competition with other surgical specialities' (40%), and 'no specialist ophthalmic-theatre nursing input' (32.7%). We report the first nationwide study on out of hours ophthalmological surgical working practices. This demonstrates variation in work patterns. It is significant to patients and ophthalmologists that there should be units in United Kingdom without full local facilities and staff.

The quality of operative note taking: an audit using the Royal College of Surgeons Guidelines as the gold standard.

PubMed

Shayah, A; Agada, F O; Gunasekaran, S; Jassar, P; England, R J A

2007-04-01

To assess the quality of operative note keeping and compare the results with the Royal College of Surgeons (RCS) of England guidelines 'Good Surgical Practice' as the gold standard. ENT Department at Hull Royal Infirmary, University Hospital. A hundred consecutive operative notes were selected between November 2005 and January 2006. The documentation of the operative notes in each case was compared with the RCS of England guidelines. All surgeons were made aware of the results of the first cycle and the guidelines were made available in all ENT theatres in the form of a printed aide-memoir. A second audit cycle was then carried out prospectively between April and June 2006. The results demonstrated a change in practice in key areas. The 1st cycle results showed the documentation of patient identification (94%), name of surgeon (98%) and clearly written postoperative instructions (94%). However, surgeons performed suboptimally at recording the name of assistant (82%), operative diagnosis (46%), the incision type (87%) and the type of wound closure (83%). After introducing the aide-memoir, the second cycle demonstrated a change in practice with 100% documentation in most of the assessed parameters except that the time of surgery and the type of surgery (emergency or elective) were not adequately recorded. We recommend that all surgical departments should have the RCS guidelines as an aide-memoir in theatres to enhance the quality and standardise operative note recording.

Observation of behavioural markers of non-technical skills in the operating room and their relationship to intra-operative incidents.

PubMed

Siu, Joey; Maran, Nikki; Paterson-Brown, Simon

2016-06-01

The importance of non-technical skills in improving surgical safety and performance is now well recognised. Better understanding is needed of the impact that non-technical skills of the multi-disciplinary theatre team have on intra-operative incidents in the operating room (OR) using structured theatre-based assessment. The interaction of non-technical skills that influence surgical safety of the OR team will be explored and made more transparent. Between May-August 2013, a range of procedures in general and vascular surgery in the Royal Infirmary of Edinburgh were performed. Non-technical skills behavioural markers and associated intra-operative incidents were recorded using established behavioural marking systems (NOTSS, ANTS and SPLINTS). Adherence to the surgical safety checklist was also observed. A total of 51 procedures were observed, with 90 recorded incidents - 57 of which were considered avoidable. Poor situational awareness was a common area for surgeons and anaesthetists leading to most intra-operative incidents. Poor communication and teamwork across the whole OR team had a generally large impact on intra-operative incidents. Leadership was shown to be an essential set of skills for the surgeons as demonstrated by the high correlation of poor leadership with intra-operative incidents. Team-working and management skills appeared to be especially important for anaesthetists in the recovery from an intra-operative incident. A significant number of avoidable incidents occur during operative procedures. These can all be linked to failures in non-technical skills. Better training of both individual and team in non-technical skills is needed in order to improve patient safety in the operating room. Copyright © 2014 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland. Published by Elsevier Ltd. All rights reserved.

Power Dynamics in Applied Theatre: Interrogating the Power of the University-Based TfD Facilitator--the UZ Theatre and CARE Zimbabwe's Zvishavane/Mberengwa NICA Project and SSFP as Case Study

ERIC Educational Resources Information Center

Seda, Owen; Chivandikwa, Nehemiah

2014-01-01

One of the central tenets in applied theatre is the ability to confront issues of "power" and "powerlessness." Indeed, success or lack thereof in applied theatre projects is often adjudged against the ability or the extent to which these projects are, or have been able to "empower" the "powerless." In this…

Lateral bias in theatre-seat choice.

PubMed

Harms, Victoria; Reese, Miriam; Elias, Lorin J

2014-01-01

Examples of behavioural asymmetries are common in the range of human behaviour; even when faced with a symmetrical environment people demonstrate reliable asymmetries in behaviours like gesturing, cradling, and even seating. One such asymmetry is the observation that participants tend to choose seats to the right of the screen when asked to select their preferred seating location in a movie theatre. However, these results are based on seat selection using a seating chart rather than examining real seat choice behaviour in the theatre context. This study investigated the real-world seating patterns of theatre patrons during actual film screenings. Analysis of bias scores calculated using photographs of theatre patrons revealed a significant bias to choose seats on the right side of the theatre. These findings are consistent with the prior research in the area and confirm that the seating bias observed when seats are selected from a chart accurately reflects real-world seating behaviour.

Using a videogame to facilitate nursing and medical students' first visit to the operating theatre. A randomized controlled trial.

PubMed

Del Blanco, Ángel; Torrente, Javier; Fernández-Manjón, Baltasar; Ruiz, Pedro; Giner, Manuel

2017-08-01

First experiences in the operating theatre with real patients are always stressful and intimidating for students. We hypothesized that a game-like simulation could improve perceptions and performance of novices. A videogame was developed, combining pictures and short videos, by which students are interactively instructed on acting at the surgical block. Moreover, the game includes detailed descriptive information. After playing, students are given feedback on their performance. A randomized controlled trial was conducted with 132 nursing and medical students with no previous experience in surgery. Sixty two (47.0%) were allocated to a control group (CG) and 70 (53.0%) to an experimental group (EG). Subjects in EG played the game the day prior to their first experience in the theatre; CG had no access to the application. On the day after their experience at surgery, all students filled in a questionnaire in a 7-point Likert format collecting subjective data about their experience in the surgical block. Four constructs related to students' feelings, emotions and attitudes were measured through self-reported subjective scales, i.e. C1: fear to make mistakes, C2: perceived knowledge on how to behave, C3: perceived errors committed, and C4: attitude/behaviour towards patients and staff. The main research question was formulated as follows: do students show differences in constructs C1-C4 by exposure to the game? EG reported statistically significant higher scores on the four aspects measured than CG (p<0.05; Mann-Whitney U tests; Cohen's d standardized effect size d1=0.30; d2=1.05; d3=0.39; d4=0.49). Results show clear evidence that the exposure to the game-like simulation had a significant positive effect on all the constructs. After their first visit to the theatre, students in EG showed less fear (C1) and also perceived to have committed fewer errors (C3), while they showed higher perceived knowledge (C2) and a more collaborative attitude (C4). Copyright © 2017 Elsevier Ltd. All rights reserved.

[Efficacy of antiseptics in the prevention of post-operative infections of the proximal femur, hip and pelvis regions in orthopedic pediatric patients. Analysis of the first results].

PubMed

Kokavec, M; Fristáková, M

2008-04-01

In orthopedics an infected operative wound always presents a serious complication that, apart from many adverse effects on the patient, increases the costs of therapy. The aim of this study was to analyze the effectiveness of antiseptic agents in the prevention of postoperative complications associated with surgery on the proximal femur, hip and pelvis in children. This prospective randomized study included 162 patients with the following diagnoses: cerebral palsy, developmental hip dysplasia, Perthes' disease, epiphyseolysis of the femoral head, and tumors. A total of 182 surgical procedures were carried out on soft and bone tissues in the proximal femur, hip and pelvis regions. The patients were allocated to two groups according to the intra-operative conditions used. Group 1, including 89 patients, was treated with 3.5 % solution of betadine before final closing of the wound and group 2, comprising 73 patients, received no betadine irrigation during the intraoperative period. The other operative and post-operative conditions provided for the patients were identical; surgery was carried out in one operating theatre without laminar air flow. The average follow-up was 7.8 months (range, 2-14 months). No infected operative wound was observed in group 1, and two superficial wound infections were recorded in group 2. The first results of our study suggest the need of prophylactic intra-operative irrigation of wounds in the hip and pelvis region. Irrigation with a diluted betadine solution is indicated in accord with the risk factors of the patient's diagnosis and the site of surgery, and also when the operative time is longer, there is insufficient protection with single-use surgical toweling, laminar air flow is present in the operating theatre or for other reasons.

Foreign Command of US Forces in Combined Theatre Operations

DTIC Science & Technology

1994-04-01

Violence Once Chamberlain had a speech memorized from Shakespeare and gave it proudly, the old man [his father] listening but not looking, and...and women are more like Joshua Chamberlain’s "killer angels" or "craving for peace" as in the Greek comedies of Aristophanes, the dichotomy has led many

Discursive Power and Creativity in Inter-Professional Work

ERIC Educational Resources Information Center

Paloniemi, Susanna; Collin, Kaija

2012-01-01

This paper discusses how discursive power and creativity are found to be inter-related in a context not traditionally associated with creative work; the operating theatre of a hospital. Here, it is proposed that creativity relies on socio-cultural factors emphasizing the practical nature of creativity, and highlighting the fact that a large part…

Differences in Attentional Strategies by Novice and Experienced Operating Theatre Scrub Nurses

ERIC Educational Resources Information Center

Koh, Ranieri Y. I.; Park, Taezoon; Wickens, Christopher D.; Ong, Lay Teng; Chia, Soon Noi

2011-01-01

This study investigated the effect of nursing experience on attention allocation and task performance during surgery. The prevention of cases of retained foreign bodies after surgery typically depends on scrub nurses, who are responsible for performing multiple tasks that impose heavy demands on the nurses' cognitive resources. However, the…

Learning in a Simulation-OT in Heart Surgery and the Challenges of the Scientification of Work

ERIC Educational Resources Information Center

Langemeyer, Ines

2014-01-01

Enhancing competency and collaboration has become a salient topic of the professional debate on medical safety issues. The advantages of simulation-based training scenarios for team communication, routines and critical work procedures especially in operation theatres have been vigorously discussed. However, the literature on simulation-based…

Influence of changing work patterns on training in anaesthesia: an analysis of activity in a UK teaching hospital from 1996 to 2004.

PubMed

Underwood, S M; McIndoe, A K

2005-11-01

We aimed to assess the influence of reduced working hours on training in a UK teaching hospital as the specialist registrar grade was introduced in 1996, the New Deal was implemented in 2001 and the Working Time Directive (WTD) took effect for doctors in training in 2004. We analysed data from operating theatres in our hospital looking at grade of anaesthetist, time of day, emergency category, and specialty for more than 50,000 cases. Although direct supervision of trainees increased from 32 to 37 to 47%, senior house officer (SHO) and specialist registrar (SpR) caseload reduced by 20 and 21%, respectively, while that of the consultants rose. The reduction in total operating theatre cases for our trainees was evident across the epochs analysed, case numbers fell after introduction of the New Deal as well as more recently following the WTD, particularly for SHOs who are now doing a larger proportion of their work at night. SHOs and SpRs are doing more obstetric cases than in previous times but these are regional and not general anaesthetics.

Aspects on the design, implementation, and simulation of a tracked mini robot destined for special applications in theatres of operations

NASA Astrophysics Data System (ADS)

Petrişor, Silviu-Mihai; Bârsan, GhiÅ£Ä.ƒ

2013-12-01

The authors of this paper wish to highlight elements regarding the organology, functioning and simulation, in a real workspace, of a tracked mini robot structure destined for special applications in theatres of operation, a technological product which is subject to a national patent granted to our institution (patent no. RO a 2012 01051), the result of research activities undertaken under a contract won by national competition, a grant for young research teams, PN-RUTE- 2010 type. The issues outlined in this paper are aspects related to the original invention in comparison with other mini-robot structures, the inventors presenting succinctly the technological product description and its applicability both in the military and applicative area as well as in the educational one. Additionally, the advantages of using the technological product are shown in a real workspace, the constructive and functional solution before, finally, presenting, based on the modelling of the mechanical structure of the tilting module attached to the mini-robot, an application on the simulation and programming of the mini-robot under study.

25. Historic American Buildings Survey, Stevens Commercial Photographers, December 31, ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

25. Historic American Buildings Survey, Stevens Commercial Photographers, December 31, 1927 Photocopy by Lyle E. Winkle, 1969 WEATHERLY BUILDING AND ORIENTAL THEATRE, LOOKING SOUTHEAST (TAKEN EVE OF THEATRE OPENING). - Oriental Theatre, 828 Southeast Grand Avenue, Portland, Multnomah County, OR

Roles of frequency, attitudes, and multiple intelligence modality surrounding Electricity Content-Based Reader's Theatre

NASA Astrophysics Data System (ADS)

Hosier, Julie Winchester

Integration of subjects is something elementary teachers must do to insure required objectives are covered. Science-based Reader's Theatre is one way to weave reading into science. This study examined the roles of frequency, attitudes, and Multiple Intelligence modalities surrounding Electricity Content-Based Reader's Theatre. This study used quasi-experimental, repeated measures ANOVA with time as a factor design. A convenience sample of two fifth-grade classrooms participated in the study for eighteen weeks. Five Electricity Achievement Tests were given throughout the study to assess students' growth. A Student Reader's Theatre Attitudinal Survey revealed students' attitudes before and after Electricity Content-Based Reader's Theatre treatment. The Multiple Intelligence Inventory for Kids (Faris, 2007) examined whether Multiple Intelligence modality played a role in achievement on Electricity Test 4, the post-treatment test. Analysis using repeated measures ANOVA and an independent t-test found that students in the experimental group, which practiced its student-created Electricity Content-Based Reader's Theatre skits ten times versus two times for the for control group, did significantly better on Electricity Achievement Test 4, t(76) = 3.018, p = 0.003. Dependent t-tests did not find statistically significant differences between students' attitudes about Electricity Content-Based Reader's Theatre before and after treatment. A Kruskal-Wallis test found no statistically significant difference between the various Multiple Intelligence modalities score mean ranks (x2 = 5.57, df = 2, alpha = .062). Qualitative data do, however, indicate students had strong positive feelings about Electricity Content-Based Reader's Theatre after treatment. Students indicated it to be motivating, confidence-building, and a fun way to learn about science; however, they disliked writing their own scripts. Examining the frequency, attitudes, and Multiple Intelligence modalities lead to the conclusion that the role of frequency had the greatest impact on the success of Electricity Content-Based Reader's Theatre. The participating teachers, students, and research found integrating science and reading through Electricity Content-Based Reader's Theatre beneficial.

Guidelines for Theatre Safety.

ERIC Educational Resources Information Center

Texas Education Agency, Austin. Div. of Curriculum Development.

Prepared to help school administrators and theatre arts teachers establish and maintain a safe environment for the actors, technicians, and audience members who participate in educational theatre programs, this guide is divided into two major sections. The first section presents administrative guidelines covering recommended procedures, teacher…

22. Photocopy of photograph (original print in files of Theatre ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

22. Photocopy of photograph (original print in files of Theatre Historical Society, P.O. Box 101, Notre Dame, IN 46556) Photographer unknown 1938 TREMONT STREET ANNEX, LOOKING SOUTHEAST - B. F. Keith Memorial Theatre, 539 Washington Street, Boston, Suffolk County, MA

14 CFR 119.65 - Management personnel required for operations conducted under part 121 of this chapter.

Code of Federal Regulations, 2010 CFR

2010-01-01

... or Part 135 of This Chapter § 119.65 Management personnel required for operations conducted under... of management personnel due to— (1) The kind of operation involved; (2) The number and type of... 14 Aeronautics and Space 3 2010-01-01 2010-01-01 false Management personnel required for...

14 CFR 119.69 - Management personnel required for operations conducted under part 135 of this chapter.

Code of Federal Regulations, 2010 CFR

2010-01-01

... or Part 135 of This Chapter § 119.69 Management personnel required for operations conducted under... of management personnel due to— (1) The kind of operation involved; (2) The number and type of... 14 Aeronautics and Space 3 2010-01-01 2010-01-01 false Management personnel required for...

Comparing safety climate for nurses working in operating theatres, critical care and ward areas in the UK: a mixed methods study

PubMed Central

Tarling, Maggie; Jones, Anne; Murrells, Trevor; McCutcheon, Helen

2017-01-01

Objectives The main aim of the study was to explore the potential sources of variation and understand the meaning of safety climate for nursing practice in acute hospital settings in the UK. Design A sequential mixed methods design included a cross-sectional survey using the Safety Climate Questionnaire (SCQ) and thematic analysis of focus group discussions. Confirmatory factor analysis (CFA) was used to validate the factor structure of the SCQ. Factor scores were compared between nurses working in operating theatres, critical care and ward areas. Results from the survey and the thematic analysis were then compared and synthesised. Setting A London University. Participants 319 registered nurses working in acute hospital settings completed the SCQ and a further 23 nurses participated in focus groups. Results CFA indicated that there was a good model fit on some criteria (χ2=1683.699, df=824, p<0.001; χ2/df=2.04; root mean square error of approximation=0.058) but a less acceptable fit on comparative fit index which is 0.804. There was a statistically significant difference between clinical specialisms in management commitment (F (4,266)=4.66, p=0.001). Nurses working in operating theatres had lower scores compared with ward areas and they also reported negative perceptions about management in their focus group. There was significant variation in scores for communication across clinical specialism (F (4,266)=2.62, p=0.035) but none of the pairwise comparisons achieved statistical significance. Thematic analysis identified themes of human factors, clinical management and protecting patients. The system and the human side of caring was identified as a meta-theme. Conclusions The results suggest that the SCQ has some utility but requires further exploration. The findings indicate that safety in nursing practice is a complex interaction between safety systems and the social and interpersonal aspects of clinical practice. PMID:29084793

Automated Scheduling of Personnel to Staff Operations for the Mars Science Laboratory

NASA Technical Reports Server (NTRS)

Knight, Russell; Mishkin, Andrew; Allbaugh, Alicia

2014-01-01

Leveraging previous work on scheduling personnel for space mission operations, we have adapted ASPEN (Activity Scheduling and Planning Environment) [1] to the domain of scheduling personnel for operations of the Mars Science Laboratory. Automated scheduling of personnel is not new. We compare our representations to a sampling of employee scheduling systems available with respect to desired features. We described the constraints required by MSL personnel schedulers and how each is handled by the scheduling algorithm.

Narrative Power: Playback Theatre as Cultural Resistance in Occupied Palestine

ERIC Educational Resources Information Center

Rivers, Ben

2015-01-01

This paper describes The Freedom Theatre's Freedom Bus initiative and its use of Playback Theatre for community mobilisation and cultural activism within Occupied Palestine. Utilising a conflict transformation perspective, conventional dialogue-oriented initiatives are contrasted against interventions that pursue concientisation and alliance…

Unnoticed Miracles

ERIC Educational Resources Information Center

O'Connor, Peter

2009-01-01

This article examines the nature of relationships between funders and applied theatre companies. Recognising that this is a murky terrain where competing agendas and goals can jeopardise the effectiveness of applied theatre programmes, the article traces the history of the funding relationship between Applied Theatre Consultants Ltd and Child,…

Monitoring of airborne bacteria and aerosols in different wards of hospitals - Particle counting usefulness in investigation of airborne bacteria.

PubMed

Mirhoseini, Seyed Hamed; Nikaeen, Mahnaz; Khanahmd, Hossein; Hatamzadeh, Maryam; Hassanzadeh, Akbar

2015-01-01

The presence of airborne bacteria in hospital environments is of great concern because of their potential role as a source of hospital-acquired infections (HAI). The aim of this study was the determination and comparison of the concentration of airborne bacteria in different wards of four educational hospitals, and evaluation of whether particle counting could be predictive of airborne bacterial concentration in different wards of a hospital. The study was performed in an operating theatre (OT), intensive care unit (ICU), surgery ward (SW) and internal medicine (IM) ward of four educational hospitals in Isfahan, Iran. A total of 80 samples were analyzed for the presence of airborne bacteria and particle levels. The average level of bacteria ranged from 75-1194 CFU/m (3) . Mean particle levels were higher than class 100,000 cleanrooms in all wards. A significant correlation was observed between the numbers of 1-5 µm particles and levels of airborne bacteria in operating theatres and ICUs. The results showed that factors which may influence the airborne bacterial level in hospital environments should be properly managed to minimize the risk of HAIs especially in operating theaters. Microbial air contamination of hospital settings should be performed by the monitoring of airborne bacteria, but particle counting could be considered as a good operative method for the continuous monitoring of air quality in operating theaters and ICUs where higher risks of infection are suspected.

The effect of teamwork training on team performance and clinical outcome in elective orthopaedic surgery: a controlled interrupted time series study.

PubMed

Morgan, Lauren; Hadi, Mohammed; Pickering, Sharon; Robertson, Eleanor; Griffin, Damian; Collins, Gary; Rivero-Arias, Oliver; Catchpole, Ken; McCulloch, Peter; New, Steve

2015-04-20

To evaluate the effectiveness of aviation-style teamwork training in improving operating theatre team performance and clinical outcomes. 3 operating theatres in a UK district general hospital, 1 acting as a control group and the other 2 as the intervention group. 72 operations (37 intervention, 35 control) were observed in full by 2 trained observers during two 3-month observation periods, before and after the intervention period. A 1-day teamwork training course for all staff, followed by 6 weeks of weekly in-service coaching to embed learning. We measured team non-technical skills using Oxford NOTECHS II, (evaluating the whole team and the surgical, anaesthetic and nursing subteams, and evaluated technical performance using the Glitch count. We evaluated compliance with the WHO checklist by recording whether time-out (T/O) and sign-out (S/O) were attempted, and whether T/O was fully complied with. We recorded complications, re-admissions and duration of hospital stay using hospital administrative data. We compared the before-after change in the intervention and control groups using 2-way analysis of variance (ANOVA) and regression modelling. Mean NOTECHS II score increased significantly from 71.6 to 75.4 in the active group but remained static in the control group (p=0.047). Among staff subgroups, the nursing score increased significantly (p=0.006), but the anaesthetic and surgical scores did not. The attempt rate for WHO T/O procedures increased significantly in both active and control groups, but full compliance with T/O improved only in the active group (p=0.003). Mean glitch rate was unchanged in the control group but increased significantly (7.2-10.2/h, p=0.002) in the active group. Teamwork training was associated with improved non-technical skills in theatre teams but also with a rise in operative glitches. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Surgical glove perforation in cardiac surgery.

PubMed

Driever, R; Beie, M; Schmitz, E; Holland, M; Knapp, M; Reifschneider, H J; Hofmann, F; Vetter, H O

2001-12-01

Recently, concern for the protection of health care employees and health care recipients has led to increasing awareness of transmitted infections. Sterile surgical gloves were tested to determine the incidence of perforations after being worn during procedures commonly performed by cardiac surgeons. In a prospective study conducted from January 15, 2000 through February 15, 2000, 953 gloves worn during cardiac surgery were evaluated for punctures. Pairs of sterile latex surgical gloves were collected over a period of one month. Routine tasks included mainly bypass and valve surgery. Impermeability was tested by means of a water retention test according to European standard EN 455 Part 1 performed on 954 (Manufix, Hartmann, Germany) latex gloves. A control group of 50 unused gloves was also evaluated for the presence of spontaneous leakage. Gloves were separated according to whether the wearer was an operator (254 gloves), first assistant (220 gloves), second assistant (272 gloves), or theatre nurse (207 gloves). Gloves with a known perforation occurring during the procedure were not included in the study. There were no punctures in the 50 unused gloves. Punctures were detected in 66 of 254 (26.0 %) gloves used by operators, 49 of 220 (22.3 %) used by first assistants, 25 of 272 (9.2 %) used by second assistants, and 78 of 207 (37.7 %) used by theatre nurses. Some gloves had more than one puncture, accounting for the 244 holes detected (operators 75/244 = 30.7 %; first assistants 54/244 = 22.1 %; second assistants 28/244 = 11.5 %; theatre nurses 87/244 = 35.7 %). Sites of scalpel and suture needle injuries were most commonly the thumb (27.3 %) and pointer finger (42.1 %) of the non-dominant hand, followed by, in descending order: middle finger (10.2 %), other fingers (15.7 %), palm (3.8 %) and back of the hand (0.9 %). The number of punctures that occur during cardiac operations is obviously higher than has so far been assumed. Therefore, cardiac surgeons should consider the incidence of unknown glove perforations when planning surgery in patients with infectious diseases.

Reconstruction with Vertical Rectus Abdominus Myocutaneous flap in advanced pelvic malignancy.

PubMed

Creagh, Terrence A; Dixon, Liane; Frizelle, Frank A

2012-06-01

Pelvic extenuative surgery produces good long term outcomes in advanced pelvic malignancies. We evaluate the use and clinical outcomes of the Vertical Rectus Abdominus Myocutaenous (VRAM) flap as a reconstruction technique in a heterogenic cohort of patients with advanced colorectal cancer in whom neo-adjuvant chemo-radiotherapy had been performed pre-operatively. Analysis of patients having VRAM flaps for pelvic reconstruction in a tertiary referral centre from 2001 to 2010 was conducted. 37 patients (23 female, 14 male) underwent pelvic extenuative surgery of which 22 (60%) had recurrent pelvic disease. All surgical and medical complications were analysed. Major flap complications were defined as 'requiring return to the operating theatre at any stage' and these occurred in 6 (16%) patients. There were 7 (19%) minor flap complications defined as 'requiring conservative non surgical treatment' The total global re-intervention rate of patients requiring return to theatre for re-operation as a result of their exenteration and reconstruction was 6 (16%). We highlight the merits and versatility of the VRAM flap in advanced pelvic malignancy in obtaining stable and supple reconstructive cover and the relative low morbidity in this difficult group confirms out strong support for immediate VRAM reconstruction in pelvic exenterative procedures. Crown Copyright © 2011. Published by Elsevier Ltd. All rights reserved.

Conflicts in the operating theatre.

PubMed

Booij, Leo H D J

2007-04-01

Quality and safety of healthcare depend on team performance. Conflicts decrease team performance. A number of studied factors involved in the development and solution of conflicts are discussed. An operating team consists of individuals, with specific roles requiring specific expertise and skills, performing interdependent tasks with patient treatment as a common goal. Teams are prone to conflicts: a dispute, disagreement or difference of opinion related to patient management, requiring some decision or action. Many factors determine the character of the conflicts, and these vary between different countries, hospitals and teams. Factors include culture, professional social status, personality of members, etc. Conflicts can induce innovation, but can also result in job dissatisfaction. They even can affect the functioning of the hospital. On average, four conflicts can be observed per operation, which are mostly solved immediately. Communication in an open atmosphere is a major issue in dealing with conflicts. If conflicts are unresolved they grow into relationship conflicts, which are difficult to handle. Understanding the factors that contribute to the conflict is important for mediators. Most conflicts arise about theatre management, case acceptation, unexpected changes in the team or incapability of one of its members. There are many possible inductors of conflicts. Conflicts should be immediately resolved by open communication and respectful discussion.

14 CFR Appendix A to Part 372 - Overseas Military Personnel Charter Operator's Surety Bond Under Part 372 of the Special...

Code of Federal Regulations, 2014 CFR

2014-01-01

... Appendix A to Part 372—Overseas Military Personnel Charter Operator's Surety Bond Under Part 372 of the... military personnel charters to be operated subject to Part 372 of the Department's Special Regulations in... 14 Aeronautics and Space 4 2014-01-01 2014-01-01 false Overseas Military Personnel Charter...

14 CFR Appendix A to Part 372 - Overseas Military Personnel Charter Operator's Surety Bond Under Part 372 of the Special...

Code of Federal Regulations, 2010 CFR

2010-01-01

... Appendix A to Part 372—Overseas Military Personnel Charter Operator's Surety Bond Under Part 372 of the... military personnel charters to be operated subject to Part 372 of the Department's Special Regulations in... 14 Aeronautics and Space 4 2010-01-01 2010-01-01 false Overseas Military Personnel Charter...

14 CFR Appendix A to Part 372 - Overseas Military Personnel Charter Operator's Surety Bond Under Part 372 of the Special...

Code of Federal Regulations, 2013 CFR

2013-01-01

... Appendix A to Part 372—Overseas Military Personnel Charter Operator's Surety Bond Under Part 372 of the... military personnel charters to be operated subject to Part 372 of the Department's Special Regulations in... 14 Aeronautics and Space 4 2013-01-01 2013-01-01 false Overseas Military Personnel Charter...

14 CFR Appendix A to Part 372 - Overseas Military Personnel Charter Operator's Surety Bond Under Part 372 of the Special...

Code of Federal Regulations, 2011 CFR

2011-01-01

... Appendix A to Part 372—Overseas Military Personnel Charter Operator's Surety Bond Under Part 372 of the... military personnel charters to be operated subject to Part 372 of the Department's Special Regulations in... 14 Aeronautics and Space 4 2011-01-01 2011-01-01 false Overseas Military Personnel Charter...

14 CFR Appendix A to Part 372 - Overseas Military Personnel Charter Operator's Surety Bond Under Part 372 of the Special...

Code of Federal Regulations, 2012 CFR

2012-01-01

... Appendix A to Part 372—Overseas Military Personnel Charter Operator's Surety Bond Under Part 372 of the... military personnel charters to be operated subject to Part 372 of the Department's Special Regulations in... 14 Aeronautics and Space 4 2012-01-01 2012-01-01 false Overseas Military Personnel Charter...

Theatre and the Human Animal.

ERIC Educational Resources Information Center

Tiger, Lionel

1983-01-01

Theatre is that art form most dramatically akin to life before electricity and the mechanical tools that now characterize most other modes of communication. We are still mammalian and still concerned with basic principles of reciprocity and interaction; theatre permits people to display emotions in front of others. (Author/GC)

[Essays on Teaching Drama.

ERIC Educational Resources Information Center

Parret, Margaret; And Others

1972-01-01

The Fall 1972 issue of this publication focuses on oral interpretation, readers theatre, and creative dramatics. The lead article is on the subject of readers theatre for teaching interpretation to elementary school children. Two articles discuss the roles of creative dramatics and readers theatre in the high school curriculum. Relationships…

Readers Theatre plus Comprehension and Word Study

ERIC Educational Resources Information Center

Young, Chase; Stokes, Faida; Rasinski, Timothy

2017-01-01

Readers Theatre has been used to introduce critical issues, promote fluency among English learners and non-English learners, teach vocabulary, and integrate content in the classroom. Previous studies of Readers Theatre application have demonstrated an increase in student reading fluency, motivation, and confidence. The focus of this systemic…

"Kindergarten Truck": Participatory Play in Public

ERIC Educational Resources Information Center

Gaines, Andrew M.

2015-01-01

As a licensed dramatherapist, experienced teacher, applied theatre artist and doctoral candidate in educational theatre, the centre of my research and practice has revolved around the intersection of activism, education, healing and performance aesthetics for the last 20 years. My latest street theatre project, "Kindergarten Truck" (KT),…

A Brechtian Theatre Pedagogy for Intercultural Education Research

ERIC Educational Resources Information Center

Frimberger, Katja

2016-01-01

The following article explores the potential of Bertolt Brecht's theatre pedagogy for intercultural education research. It is argued that Brecht's pedagogical views on theatre connect to those interculturalists who prioritise the embodied dimensions of intercultural encounters over a competence-driven orientation. Both share a love for aesthetic…

Error, stress, and teamwork in medicine and aviation: cross sectional surveys

NASA Technical Reports Server (NTRS)

Sexton, J. B.; Thomas, E. J.; Helmreich, R. L.

2000-01-01

OBJECTIVES: To survey operating theatre and intensive care unit staff about attitudes concerning error, stress, and teamwork and to compare these attitudes with those of airline cockpit crew. DESIGN:: Cross sectional surveys. SETTING:: Urban teaching and non-teaching hospitals in the United States, Israel, Germany, Switzerland, and Italy. Major airlines around the world. PARTICIPANTS:: 1033 doctors, nurses, fellows, and residents working in operating theatres and intensive care units and over 30 000 cockpit crew members (captains, first officers, and second officers). MAIN OUTCOME MEASURES:: Perceptions of error, stress, and teamwork. RESULTS:: Pilots were least likely to deny the effects of fatigue on performance (26% v 70% of consultant surgeons and 47% of consultant anaesthetists). Most pilots (97%) and intensive care staff (94%) rejected steep hierarchies (in which senior team members are not open to input from junior members), but only 55% of consultant surgeons rejected such hierarchies. High levels of teamwork with consultant surgeons were reported by 73% of surgical residents, 64% of consultant surgeons, 39% of anaesthesia consultants, 28% of surgical nurses, 25% of anaesthetic nurses, and 10% of anaesthetic residents. Only a third of staff reported that errors are handled appropriately at their hospital. A third of intensive care staff did not acknowledge that they make errors. Over half of intensive care staff reported that they find it difficult to discuss mistakes. CONCLUSIONS: Medical staff reported that error is important but difficult to discuss and not handled well in their hospital. Barriers to discussing error are more important since medical staff seem to deny the effect of stress and fatigue on performance. Further problems include differing perceptions of teamwork among team members and reluctance of senior theatre staff to accept input from junior members.

Error, stress, and teamwork in medicine and aviation: cross sectional surveys

PubMed Central

Sexton, J Bryan; Thomas, Eric J; Helmreich, Robert L

2000-01-01

Objectives: To survey operating theatre and intensive care unit staff about attitudes concerning error, stress, and teamwork and to compare these attitudes with those of airline cockpit crew. Design: Cross sectional surveys. Setting: Urban teaching and non-teaching hospitals in the United States, Israel, Germany, Switzerland, and Italy. Major airlines around the world. Participants: 1033 doctors, nurses, fellows, and residents working in operating theatres and intensive care units and over 30 000 cockpit crew members (captains, first officers, and second officers). Main outcome measures: Perceptions of error, stress, and teamwork. Results: Pilots were least likely to deny the effects of fatigue on performance (26% v 70% of consultant surgeons and 47% of consultant anaesthetists). Most pilots (97%) and intensive care staff (94%) rejected steep hierarchies (in which senior team members are not open to input from junior members), but only 55% of consultant surgeons rejected such hierarchies. High levels of teamwork with consultant surgeons were reported by 73% of surgical residents, 64% of consultant surgeons, 39% of anaesthesia consultants, 28% of surgical nurses, 25% of anaesthetic nurses, and 10% of anaesthetic residents. Only a third of staff reported that errors are handled appropriately at their hospital. A third of intensive care staff did not acknowledge that they make errors. Over half of intensive care staff reported that they find it difficult to discuss mistakes. Conclusions: Medical staff reported that error is important but difficult to discuss and not handled well in their hospital. Barriers to discussing error are more important since medical staff seem to deny the effect of stress and fatigue on performance. Further problems include differing perceptions of teamwork among team members and reluctance of senior theatre staff to accept input from junior members. PMID:10720356

Replacing the Sofa with the Spotlight: Interrogating the Therapeutic Value of Personal Testimony within Community-Based Theatre

ERIC Educational Resources Information Center

Leffler, Elliot

2012-01-01

Julie Salverson, a Canadian scholar-practitioner, has long challenged the assumption that personal storytelling within Community-Based Theatre is necessarily therapeutic. Salverson critiques an "aesthetic of injury," arguing that theatre practitioners have foregrounded personal narratives in a way that reinscribes a "victim…

Curriculum: The Contradictions in Theatre Education in Brazil

ERIC Educational Resources Information Center

Pompeo Nogueira, Marcia; de Medeiros Pereira, Diego

2016-01-01

The history of arts education in Brazil is summarised, based on its contradictions. Some aspects of the Brazilian educational system and the National Curriculum Parameters are presented, in order to identify the predominant approach to theatre education. Three situations of the theatre education landscape in the state of Santa Catarina, southern…

Women in Theatre Administration: A Dean's View.

ERIC Educational Resources Information Center

Wills, J. Robert

Statistics reveal that only 11% of the 1,500 theatre administrators on United States college campuses are women. On the other hand, recent surveys have indicated that few women are actively seeking administrative positions. The situation is unfortunate since campus theatres and institutions of higher education need highly qualified, capable…

Mosaic: Re-Imagining the Monolingual Classroom through Theatre-in-Education

ERIC Educational Resources Information Center

Pakkar-Hulla, D.

2014-01-01

This article is a study of "Mosaic"--a piece of multilingual theatre-in-education designed to promote linguistically diverse practices in primary schools in Birmingham, United Kingdom. Focusing on the relatively uncharted territory of applied theatre as a means of promoting multilingualism, and challenging a culture of monolingual…

Live Theatre: A Dynamic Medium for Engaging with Intercultural Education Research

ERIC Educational Resources Information Center

Nelson, Cynthia D.

2013-01-01

In this paper, I discuss live theatre as a highly effective and dynamic medium for facilitating meaningful engagement with research on intercultural education. I make the case that ethnographic, or research-based, theatre can productively showcase challenging social issues and the sometimes confusing, poignant and humorous complexities of…

Popular Theatre and Participatory Research. Bosele Tshwaraganang Publications No. 12.

ERIC Educational Resources Information Center

Kraai, Ziki; And Others

The use of popular theatre to overcome community development problems in underdeveloped countries through adult education is introduced and its relationship to the concept of participatory research is explored. Material is arranged in four sections. The first of these presents an introduction to popular theatre and participatory research. Stemming…

Enacting Democracy: Using Forum Theatre to Confront Bullying

ERIC Educational Resources Information Center

Gourd, Karen M.; Gourd, Tina Y.

2011-01-01

This article describes a curriculum project designed to create opportunities for transformative educational experiences in relation to democratic and social justice ideals. The project used an empowering interactive art form, Forum Theatre, to explore the topic of bullying. Through the development of Forum Theatre scenes by eighth grade students…

The Undergraduate Curriculum in Theatre History.

ERIC Educational Resources Information Center

Elwood, William R.

Theatre history programs in the medium sized or large university need to be reorganized at the undergraduate level for relevancy in the twentieth century. One possible curriculum would require that 80 percent of the courses taken be in dramatic literature, theatre history, theory, and criticism, while the remaining 20 percent consist of courses…

The "Not Knowns": Memory, Narrative and Applied Theatre

ERIC Educational Resources Information Center

Conroy, Colette; Dickenson, Sarah Jane; Mazzoni, Giuliana

2018-01-01

This is an attempt to articulate and explore the relationship between the science of memory and the applied theatre project, "The Not Knowns." The project was a collaboration between theatre practitioners and a psychologist who worked together with a group of young people known, problematically, as the "not knowns" throughout…

Thematic Issue: Italian Theatre.

ERIC Educational Resources Information Center

Kirby, Michael, Ed.

1978-01-01

In 1964, when the "living" theatre appeared to be dying in New York, theater in Italy began changing from an author-oriented to a performance-oriented, nonliterary form. The articles in this document trace the historical development of Italian theatre and analyze current dramas which demonstrate the diversity of approaches and the energy…

Marginal Experiments: Peter Brook and Stepping out Theatre Company

ERIC Educational Resources Information Center

Harpin, Anna

2010-01-01

This article juxtaposes the recent work of Peter Brook with a Bristol-based mental health service-user collective--Stepping Out Theatre Company. Informed by field-work with the company, this chapter explores the aesthetic and political relationship between professional, experimental theatre work and community-based performance practice. Drawing…

Family Life Education through Teen Theatre.

ERIC Educational Resources Information Center

Burdyshaw, Cynthia; Fowler, Marilyn

This paper describes how to create a teenage theatre project and explains why such a project is effective in educating teenagers. New Image Teen Theatre is a project which has combined peer education and improvisational theater since 1981 to reach teenagers with accurate family planning information, encourage communication, and promote responsible…

Wishing for a World without "Theatre for Development": Demystifying the Case of Bangladesh.

ERIC Educational Resources Information Center

Ahmed, Syed Jamil

2002-01-01

Argues that Theatre for Development in Bangladesh practiced by Non-Governmental Organizations, which is almost entirely funded by international donor organizations, serves globalization in the name of poverty alleviation. Concludes by advocating for the necessity of exploring alternatives by which indigenous theatre performers may access directly…

Determining Audience Profile and Effectiveness of Publicity.

ERIC Educational Resources Information Center

Klinzing, Dennis

This report of two audience analyses at the University of Delaware Theatre was prepared as a guide for other university theatres that may need an understanding of the people who attend their dramatic presentations. Such analyses can provide information about who is attending the theatre, how performances are evaluated, what influences audience…

"Physics and Theatre," College of William and Mary

ERIC Educational Resources Information Center

Wasley, Paula

2008-01-01

This article describes the "Physics and Theatre," a seminar developed by Rosa Alejandra Lukaszew. Lukaszew developed this seminar to merge students majoring in theatre and physics and let them find out what they have in common. Lukaszew's seminar aims to integrate these students' different viewpoints through discussions of the role of…

Physical Theatre Education: Beyond Knowledge Transfer

ERIC Educational Resources Information Center

Gaines, Andrew M.

2016-01-01

Teaching physical theatre successfully relies on a reverence for the human soul in order to cultivate risk-forward embodiment while demanding technical precision. In an effort to illuminate such praxis, this article documents and analyzes the experiences of novice physical theatre performers guided by master teaching artist and performer, Dr.…

The Black Presence in London Theatre, 1974-1979.

ERIC Educational Resources Information Center

Stanback, T.W.

1983-01-01

Based on studies conducted by the Afro-Asian Committee of British Actors Equity and others, discusses the limited opportunities for minority actors in British theatre. Identifies plays in which Black performers were cast during the late 1970s and describes a number of fringe theatre groups which employ Black actors. (GC)

Origins of the Restoration Playhouse.

ERIC Educational Resources Information Center

Wilson, Dennis D.

Contrary to the popular theory that the proscenium type of playhouse was imported from France by the Court of Charles II in 1660, the Restoration playhouse in fact developed from Elizabethan theatres and court masques. These Elizabethan theatres were the private theatres, and were generally small, rectangular, roofed structures where aristocratic…

"Playlinks": A Theatre-for-Young Audiences Artist-in-the-Classroom Project

ERIC Educational Resources Information Center

McLauchlan, Debra

2017-01-01

"Playlinks," the project documented in this paper, contributed a theatre-based artist-in-the-classroom study to the Community Arts Zone initiative. "Playlinks" involved 248 elementary school classrooms in pre- and post-production workshops connected to live theatre that visited their schools. Data sources included researcher…

Theatre for Development as a Model for Transformative Change in Nigeria

ERIC Educational Resources Information Center

Okpadah, Stephen Ogheneruro

2017-01-01

This study examines the role of "theatre for development" (TFD) as a model for social transformation in Nigeria, historicizing its relationship to "community theatre" while illuminating significant innovations in authorship and participation. In addition, the article explores TFD as a relational and performative process in…

Popular theatre and nonformal education in the Third World: Five strands of experience

NASA Astrophysics Data System (ADS)

Kidd, Ross

1985-09-01

Popular theatre is gaining increasing attention in the Third World as a tool for popular education and community organizing. It finds expression in a number of forms including drama, music dance, puppetry and poetry and is performed for — and often by — ordinary peasants and workers. Popular theatre is used as a means of bringing people together, building confidence and solidarity, stimulating discussion, exploring alternative options for action, and building a collective commitment to change: starting with people's urgent concerns and issues, it encourages reflection on these issues and possible strategies for change. Popular theatre, however, is not a unified discipline. It is used by different groups for different interests, ranging from a technocratic, message-oriented `domestication theatre' at one end of the spectrum to a process of consciousness-raising, organization-building and struggle at the other end. Five main strands of popular theatre can be distinguished: (a) the struggle for national liberation; (b) mass education and rural extension; (c) community or participatory development; (d) `conscientization' or popular education; and (e) popular education and organizing. At its best, popular theatre is not an isolated performance or a cathartic experience, but part of an ongoing process of education and organizing, aimed at overcoming oppression and dependence, and at securing basic rights.

Using Augusto Boal-based theatre for development methods to mediate the introduction of fuel-efficient cook stoves in Chajul, Guatemala: provoking action through an ethical intervention

NASA Astrophysics Data System (ADS)

Bisping, Jason

2011-12-01

This dissertation examines how theatre for development methods, developed and influenced by Augusto Boal, were employed to provide energy-oppressed people with opportunities to reflect and take action to improve their lives. Specifically, this research study examines two theatre for development interventions conducted in Chajul, Guatemala, where I worked with indigenous citizens of Chajul and a host nongovernmental organization, Limitless Horizons Ixil, to create theatre pieces that confronted people's home energy-use habits, focusing, specifically, on the dangers of indoor air pollution caused by the use of open fires in homes. The first intervention occurred during a seven-day trip to Chajul in July 2009, and involved devising and staging an original play, "Life with a Cookstove/Life without a Cookstove," that was presented to more than 300 community members. The second intervention, which took place over ten days in June 2010, consisted of staging original theatre pieces in people's homes around their open fires. In addition to using theatre as an educational tool, information was collected about people's attitudes and behaviors related to indoor air pollution and cookstoves. Additionally, the theatre interventions gave people the opportunity to practice taking action to reduce dangers associated with indoor air pollution in their homes through the proposed use of cookstoves. This investigation provides insight into common theatre for development practices that can be used in Latin America, a portion of the world that has been significantly understudied, and with other underrepresented populations around the world that are not accustomed to using theatre to reflect on their home energy use or other significant issues of concern in need of action. Additionally, this research assisted Limitless Horizons Ixil to achieve its development goals of reducing indoor air pollution in Chajul through the introduction of cookstoves in an ethical and sustainable way. As the only study on using theatre for development methods to introduce, investigate, and promote cookstoves as an appropriate and sustainable energy technology, this research serves as an example of employing participatory and ethical theatre for energy justice methods to provide people with opportunities to reflect on and take action to solve their energy needs.

49 CFR 236.1047 - Training specific to locomotive engineers and other operating personnel.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 49 Transportation 4 2012-10-01 2012-10-01 false Training specific to locomotive engineers and... engineers and other operating personnel. (a) Operating personnel. Training provided under this subpart for any locomotive engineer or other person who participates in the operation of a train in train control...

49 CFR 236.1047 - Training specific to locomotive engineers and other operating personnel.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 49 Transportation 4 2010-10-01 2010-10-01 false Training specific to locomotive engineers and... engineers and other operating personnel. (a) Operating personnel. Training provided under this subpart for any locomotive engineer or other person who participates in the operation of a train in train control...

49 CFR 236.1047 - Training specific to locomotive engineers and other operating personnel.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 49 Transportation 4 2014-10-01 2014-10-01 false Training specific to locomotive engineers and... engineers and other operating personnel. (a) Operating personnel. Training provided under this subpart for any locomotive engineer or other person who participates in the operation of a train in train control...

49 CFR 236.1047 - Training specific to locomotive engineers and other operating personnel.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 49 Transportation 4 2013-10-01 2013-10-01 false Training specific to locomotive engineers and... engineers and other operating personnel. (a) Operating personnel. Training provided under this subpart for any locomotive engineer or other person who participates in the operation of a train in train control...

The british military hospitals in macedonia during the first world war.

PubMed

Cvetkovski, Vladimir

The paper focusses its attention to the medical work of the British Military hospitals stationed in Macedonia during the First World War, the surgical work carried out under very heavy conditions in improvised operating theatres as well as the treatment of the wounded and sick solders brought from the battlefields on the Macedonian Front.

Improving operating theatre efficiency: an intervention to significantly reduce changeover time.

PubMed

Soliman, Bishoy A B; Stanton, Raymond; Sowter, Steven; Rozen, Warren Matthew; Shahbaz, Shekib

2013-07-01

Operating theatre inefficiency and changeover delays are not only a significant source of wasted resources, but also a familiar source of frustration to patients and health-care providers. This study aimed to prove that the surgical registrar through active involvement in patient changeover can significantly improve operating room efficiency and minimize delays. A two-phase prospective cohort study was undertaken, conducted over the course of 4 weeks at a single institution. The only inclusion criteria comprised patients to undertake endoscopic urological day surgery cases and require general anaesthesia. There were no exclusions. In the first phase (observational, with no intervention), changeover times between cases were documented. The second phase followed a structured intervention, involving the surgical registrar being actively involved in the patient's operative journey. Outcome measures were qualitative measures of operative efficiency. Statistical analysis was undertaken. There were 42 patients included in this study, with 21 patients in each of its arms. A 48% (P-value < 0.01) reduction in overall case changeover times was demonstrated with the utilization of a structured intervention from 27.7 min (95% confidence interval (CI) 22.8-32.7%) to 15.7 min (95% CI 13.2-18.2%). The intervention results were statistically significant (P-value < 0.05) for all markers of efficiency except for the waiting time in the anaesthetic holding bay (P-value 0.13). The surgical registrar can improve operating room efficiency by using a structured intervention, ultimately reducing patient changeover times. © 2012 The Authors. ANZ Journal of Surgery © 2012 Royal Australasian College of Surgeons.

Firework-related injury in the Top End: a 16-year review.

PubMed

Read, David J; Bradbury, Richard; Yeboah, Edward

2017-12-01

On July 1st on 'Territory Day', the public in the Northern Territory are permitted to purchase and operate consumer fireworks without a licence. Serious permanent injuries from fireworks are well described, leading to their banning in many other jurisdictions. This study describes those seriously injured by fireworks in the Top End of the Northern Territory, with the aim of identifying opportunities for prevention and harm minimization. This is a retrospective audit of all admitted patients with an injury from fireworks at the Royal Darwin Hospital between 2000 and 2015. The variables collected included demographic data and the circumstances around injury (operator versus bystander, alcohol involvement and day of device operation). The consequences such as injuries, operating theatre visits, length of stay and outpatient visits are described. Fifty-five patients (including 17 children) suffered 67 injuries over the study period, resulting in 68 operating theatre visits, 322 hospital days and 380 outpatient appointments. Burns, hand and eye injuries predominate. Females (P = 0.000) and children (P = 0.029) were more likely to be injured as bystanders. Injuries on a day other than Territory Day were more likely to have alcohol involvement (P = 0.01), and occur in the operator (P = 0.017). Consumer firework usage results in a small number of life altering injuries annually. Previous prevention campaigns focusing on device user safety should be expanded to include the safety of bystanders and children and reduce firework usage outside of the Territory Day. © 2017 Royal Australasian College of Surgeons.

Personnel Recovery: Using Game Theory to Model Strategic Decision Making in the Contemporary Operating Environment

DTIC Science & Technology

2005-06-17

conventional military superiority of the U.S. presents significant operational challenges. Recovery forces are vulnerable conducting personnel recovery... forced to evade. In this strategic context, the military’s decision-making process with regard to personnel recovery is completely rational. 15...superiority of the U.S. presents significant operational challenges. Recovery forces are vulnerable conducting personnel recovery because the situation

Network Enabled Operations: The Experiences of Senior Canadian Commanders

DTIC Science & Technology

2006-03-31

d’opérations par réseaux dans ce pays, qu’il n’y a pas de solution universelle car, selon les commandants interrogés, les besoins en réseaux...was provide by Lerhe who said that the commander must understand his communications systems sufficiently to appreciate the allocation of bandwidth...alter bandwidth allocation as he moves from the operational theatre (at sea) to port and vice versa. More specifically, this officer felt that a task

Anaesthesia machine: checklist, hazards, scavenging.

PubMed

Goneppanavar, Umesh; Prabhu, Manjunath

2013-09-01

From a simple pneumatic device of the early 20(th) century, the anaesthesia machine has evolved to incorporate various mechanical, electrical and electronic components to be more appropriately called anaesthesia workstation. Modern machines have overcome many drawbacks associated with the older machines. However, addition of several mechanical, electronic and electric components has contributed to recurrence of some of the older problems such as leak or obstruction attributable to newer gadgets and development of newer problems. No single checklist can satisfactorily test the integrity and safety of all existing anaesthesia machines due to their complex nature as well as variations in design among manufacturers. Human factors have contributed to greater complications than machine faults. Therefore, better understanding of the basics of anaesthesia machine and checking each component of the machine for proper functioning prior to use is essential to minimise these hazards. Clear documentation of regular and appropriate servicing of the anaesthesia machine, its components and their satisfactory functioning following servicing and repair is also equally important. Trace anaesthetic gases polluting the theatre atmosphere can have several adverse effects on the health of theatre personnel. Therefore, safe disposal of these gases away from the workplace with efficiently functioning scavenging system is necessary. Other ways of minimising atmospheric pollution such as gas delivery equipment with negligible leaks, low flow anaesthesia, minimal leak around the airway equipment (facemask, tracheal tube, laryngeal mask airway, etc.) more than 15 air changes/hour and total intravenous anaesthesia should also be considered.

Anaesthesia Machine: Checklist, Hazards, Scavenging

PubMed Central

Goneppanavar, Umesh; Prabhu, Manjunath

2013-01-01

From a simple pneumatic device of the early 20th century, the anaesthesia machine has evolved to incorporate various mechanical, electrical and electronic components to be more appropriately called anaesthesia workstation. Modern machines have overcome many drawbacks associated with the older machines. However, addition of several mechanical, electronic and electric components has contributed to recurrence of some of the older problems such as leak or obstruction attributable to newer gadgets and development of newer problems. No single checklist can satisfactorily test the integrity and safety of all existing anaesthesia machines due to their complex nature as well as variations in design among manufacturers. Human factors have contributed to greater complications than machine faults. Therefore, better understanding of the basics of anaesthesia machine and checking each component of the machine for proper functioning prior to use is essential to minimise these hazards. Clear documentation of regular and appropriate servicing of the anaesthesia machine, its components and their satisfactory functioning following servicing and repair is also equally important. Trace anaesthetic gases polluting the theatre atmosphere can have several adverse effects on the health of theatre personnel. Therefore, safe disposal of these gases away from the workplace with efficiently functioning scavenging system is necessary. Other ways of minimising atmospheric pollution such as gas delivery equipment with negligible leaks, low flow anaesthesia, minimal leak around the airway equipment (facemask, tracheal tube, laryngeal mask airway, etc.) more than 15 air changes/hour and total intravenous anaesthesia should also be considered. PMID:24249887

Family Matters: An Approach to the Theatre and to Theatre Research.

ERIC Educational Resources Information Center

Addington, David W.

The relational concepts developed in mathematics and psychology are used in this paper to explicate the needs and responsibilities of dramatic acting and theatre research. A parallel is constructed between the emergence of the mathematical concept of function, the awakening of psychology to the concept of relationship (especially regarding family…

Secondary School Students' Opinions about Readers' Theatre

ERIC Educational Resources Information Center

Karabag, S. Gulin

2015-01-01

In this article, a teaching strategy which not only blends yesterday and today in a meaningful way but also powerfully integrates literacy and history will be examined. Firstly Readers' Theatre as a technique will be introduced. Secondly, the usage guidelines of Readers' Theatre will be presented. Finally the opinions of secondary school students…

Devices for Deviling Classes in Theatre History.

ERIC Educational Resources Information Center

Bryan, George B.

In addition to the use of the lecture-discussion method of teaching theatre history, the author contends that this approach can be augmented by the process of "deviling" (adding spice to) the learning situation. At the University of Vermont, theatre history courses have been taught with a variety of deviling exercises, which include: (1)…

The Subversive Practices of Reminiscence Theatre in Taiwan

ERIC Educational Resources Information Center

Wang, Wan-Jung

2006-01-01

Founded in 1995, the Taiwanese Uhan Shii Theatre Group has created 12 distinctive reminiscence theatre productions and has performed locally in Taiwan as well as globally around the world. The company has developed its own theatrical aesthetics of memory, and their work not only represents the traditions of Taiwanese culture and habitus, but it…

Student Success and Satisfaction: Analysis of Students' Perception of a Theatre Conservatory Program

ERIC Educational Resources Information Center

Anton, Anita

2010-01-01

All theatre programs are not created equal. This qualitative study set out to determine the graduating students' perception of satisfaction and success after attending a four year conservatory theatre program. I conducted two interviews with seven of the twelve graduating seniors. The initial interview was conducted after graduation, and the…

Theatre for Re-Education: Experimenting with Documentary Form in Kerala

ERIC Educational Resources Information Center

Eldhose, Adakkaravayalil; Das, Neethu

2015-01-01

This paper is a study of a Malayalam documentary play "Not Just the Victims" staged by Abhinaya Theatre Research Centre Trivandrum. Along with analyzing the documentary method of the play this study looks at how the theatre group employed the play for "re-educating" the people regarding certain existing norms. The play…

Exploring Professionalism in Undergraduate Medical and Dental Education through Forum Theatre

ERIC Educational Resources Information Center

Brett-MacLean, Pamela; Yiu, Verna; Farooq, Ameer

2012-01-01

Forum Theatre (FT) was created by Brazilian theatre director Augusto Boal (1985) as an approach for promoting dialogue between the audience and those performing on stage for his "Theater for the Oppressed." FT offers an accessible, interactive approach to exploring challenging topics and situations. In FT, a short scene is performed. It…

Group Theatre.

ERIC Educational Resources Information Center

Clark, Brian

The group interpretation approach to theatre production is defined as a method that will lead to production of plays that will appeal to "all the layers of the conscious and unconscious mind." In practice, it means that the group will develop and use resources of the theatre that orthodox companies too often ignore. The first two chapters of this…

Roles of Frequency, Attitudes, and Multiple Intelligence Modality Surrounding Electricity Content-Based Reader's Theatre

ERIC Educational Resources Information Center

Hosier, Julie Winchester

2009-01-01

Integration of subjects is something elementary teachers must do to insure required objectives are covered. Science-based Reader's Theatre is one way to weave reading into science. This study examined the roles of frequency, attitudes, and Multiple Intelligence modalities surrounding Electricity Content-Based Reader's Theatre. This study used…

Theatre as a Vehicle for Mobilizing Knowledge in Education

ERIC Educational Resources Information Center

Segedin, Lauren

2017-01-01

In the field of education, there has been an increased emphasis on evidence-based practice. Yet, traditional dissemination methods continue to be used. Using more creative and innovative strategies to disseminate research are needed. Theatre is one such method. Stemming from the research on knowledge mobilization and theatre as a method for social…

Myths and Metaphors from the Mall: Critical Teaching and Everyday Life in Undergraduate Theatre Studies.

ERIC Educational Resources Information Center

Berkeley, Anne

2001-01-01

Offers a theoretical basis for undergraduate theatre studies that stresses the participation, democratization, and popularization that are necessary to sustain the arts in American society. Argues that the curriculum should be reoriented to emphasize theatre's functional value by building on students' already acquired and practiced aesthetic…

"Drama for Schools": Teacher Change in an Applied Theatre Professional Development Model

ERIC Educational Resources Information Center

Dawson, Kathryn; Cawthon, Stephanie W.; Baker, Sally

2011-01-01

Applied theatre often draws upon critical pedagogy and constructivist methodology as a way to bring participants into direct engagement with their own learning experiences. As learners, adults bring a wealth of perspectives that further affect how they interact with an applied theatre experience. "Drama for Schools" (DFS) is a…

Theatre Arts Standards of Learning for Virginia Public Schools

ERIC Educational Resources Information Center

Virginia Department of Education, 2006

2006-01-01

The Theatre Arts Standards of Learning identify the essential content and skills required in the theatre arts curriculum for the middle school and core high school courses in Virginia's public schools. The standards are designed to be cumulative and progress in complexity by course from the middle school through the secondary level. Throughout…

Over the Ramp: Building Bridges

ERIC Educational Resources Information Center

Sutton, Mary

2007-01-01

TheatreWorks is the third largest theatre in the San Francisco bay area. Through the usual educational programs that $6 million companies tend to offer, it has reached over 100,000 students of all ages in the past 8 years. The TheatreWorks Bridges Projects, however, are special. They are intricate and expansive, work with multiple community…

Stagecoach Theatre Schools: England's Franchised Musical Theatre Training.

ERIC Educational Resources Information Center

Heinig, Ruth Beall

2001-01-01

Describes how a student at Stagecoach (a private arts school), by securing the lead role in the film "Billy Elliot," encouraged other British boys to enroll in ballet and dance classes as well as Stagecoach Theatre Arts Schools. Present locations and international links for Stagecoach schools. Describes how the Stagecoach schools are run…

Teaching the Total Language with Readers Theatre.

ERIC Educational Resources Information Center

Goodman, Jess A., Jr.

Reading, writing, speech assignments for special education classes, English as a second language and many other classroom projects can be taught through the involvement created by Readers Theatre. Readers Theatre is the presentation of dialogue-type material in play form. The actors hold the script as they move through it and a narrator's voice…

Improvisational Theatre as Public Pedagogy: A Case Study of "Aesthetic" Pedagogy in Leadership Development

ERIC Educational Resources Information Center

Katz-Buonincontro, Jen

2011-01-01

How does improvisational theatre promote aesthetic learning in leaders, emphasizing emotion and somatic, or sensory, knowledge? While improvisational theatre has been used in organizational settings, there is little empirical research describing the aesthetic learning process geared towards preparing educational leaders. Based on a case study of…

Performing That Which Exceeds Us: Aesthetics of Sincerity and Obscenity during 'The Refugee Crisis'

ERIC Educational Resources Information Center

Zaroulia, Marilena

2018-01-01

Focusing on examples from theatre ("On the Move" festival, London International Festival of Theatre/Royal Court Theatre, London 2016), film (Gianfranco Rosi's "Fuoccoamare," 2016) and the visual arts (Ai Weiwei's "Safe Passage," Berlin 2016), this article proposes that in order to think through questions of efficacy…

Between the Frames: Youth Spectatorship and Theatre as Curated, "Unruly" Pedagogical Space

ERIC Educational Resources Information Center

Gallagher, Kathleen; Wessels, Anne

2013-01-01

In this article, we consider the aesthetic, political and pedagogical strengths of a verbatim theatre performance, "The Middle Place" by Project: Humanity, a play that explores the experiences of shelter youth in Toronto, Canada. This ethnographic study moved from drama classrooms into theatres and charted audience responses to the…

Children's Theatre Review, Volume XXX, Number 2, Spring 1981. Research Edition.

ERIC Educational Resources Information Center

Ritch, Pamela, Ed.

1981-01-01

This special journal edition contains research reports on children and the theatre. The seven articles discuss the following subjects: (1) how audiences function in participation plays for young people, (2) creative dramatics and handicapped children, (3) the effect of advance organizers on children's responses to theatre viewing, (4) a Piagetian…

Political Conscientisation through Street Theatre: A Study with Reference to "Kalyanasaugadhikam"

ERIC Educational Resources Information Center

Eldhose, Adakkaravayalil Yoyakky

2014-01-01

Theatre occupies a significant place in any revolutionary political strategy that has as its objective a radical transformation of society. This paper attempts to make a thematic and structural analysis of the Malayalam street play "Kalyanasaugadhikam" written by Anil Nadakavu in 2009 and performed by Manisha Theatres, Thadiyankovil,…

The Ignorant Facilitator: Education, Politics and Theatre in Co-Communities

ERIC Educational Resources Information Center

Lev-Aladgem, Shulamith

2015-01-01

This article discusses the book "The Ignorant Schoolmaster: Five Lessons in Intellectual Emancipation" by the French philosopher, Jacques Rancière. Its intention is to study the potential contribution of this text to the discourse of applied theatre (theatre in co-communities) in general, and the role of the facilitator in particular. It…

A Silent Revolution: "Image Theatre" as a System of Decolonisation

ERIC Educational Resources Information Center

Perry, J. Adam

2012-01-01

This article summarises the ways in which Image Theatre, a practice originally developed by Augusto Boal which continues to be developed in the hands of applied theatre practitioners and critical arts educators worldwide, can be used as a pedagogical and dramaturgical system of decolonisation at the level of communities and individuals. Through…

Shaping Networked Theatre: Experience Architectures, Behaviours and Creative Pedagogies

ERIC Educational Resources Information Center

Sutton, Paul

2012-01-01

Since 2006 the UK based applied theatre company C&T has been using its experience and expertise in mixing drama, learning and digital media to create a new online utility for shaping collaborative educational drama experiences. C&T describes this practice as "Networked Theatre". This article describes both the motivations for…

Training the Peer Facilitator: Using Participatory Theatre to Promote Engagement in Peer Education

ERIC Educational Resources Information Center

Orr, Sarah Hunter

2015-01-01

"Training the peer facilitator: using participatory theatre to promote engagement in peer education" examines the role of participatory theatre in a peer education setting in relation to the goal of young people engaging and empowering their peers to create new knowledge together. Extending research about the use of applied theatre…

Primal Theatre

ERIC Educational Resources Information Center

Rubin, Alec

1976-01-01

Defines primal therapy as an approach to growth and change the goal of which is to rediscover the real self, the natural child. Relates this concept to primal theatre where an effort is made to express on stage what rarely occurs in life and what is usually hidden. Basic processes for primal theatre workshops are discussed. For availability see CS…

Enhancing Correctional Education through Community Theatre: The Benin Prison Experience

ERIC Educational Resources Information Center

Okhakhu, Marcel; Evawoma-Enuku, Usiwoma

2011-01-01

This paper seeks to establish the relationship between Popular Theatre and Correctional Education. The Benin Prison experiment is the springboard for this laudable and valuable link. The paper strives stridently to show the value of Popular Theatre as a vehicle for achieving correctional values in a Correction centre. More than anything else, it…

From Children's Perspectives: A Model of Aesthetic Processing in Theatre

ERIC Educational Resources Information Center

Klein, Jeanne

2005-01-01

While several developmental models of aesthetic understanding, experience, and appreciation exist in the realms of visual art and music education, few examples have been proposed in regard to theatre, particularly for child audiences. This author argues that children gaze upon theatre in differential ways by including age as a variable…

Low-Achieving Readers, High Expectations: Image Theatre Encourages Critical Literacy

ERIC Educational Resources Information Center

Rozansky, Carol Lloyd; Aagesen, Colleen

2010-01-01

Students in an eighth-grade, urban, low-achieving reading class were introduced to critical literacy through engagement in Image Theatre. Developed by liberatory dramatist Augusto Boal, Image Theatre gives participants the opportunity to examine texts in the triple role of interpreter, artist, and sculptor (i.e., image creator). The researchers…

‘Tails’ – A fairy tale on furry tails: A 15-year theatre experience for hospitalized children created by health professionals

PubMed Central

Rokach, Ami; Matalon, Raan

2007-01-01

OVERVIEW The present article describes an innovative theatre production that has been running in The Hospital for Sick Children in Toronto, Ontario, for the past 15 years. It is directed at, and created for, hospitalized children and their families. The effects of hospitalization on children and their families are reviewed, and the benefits of humour and support during the stressful time the children have to spend in the hospital is highlighted. The play and its message, as well as possible health benefits, are also described. PRACTICAL IMPLICATIONS Theatre productions may help ease the anxiety felt by children and their families concerning illness, hospitalization and the associated medical procedures. Theatre may also assist in increasing patients’ compliance with medical procedures and follow-up. ORIGINALITY The play described is the first regular children’s theatre created by medical staff for hospitalized children. It is valuable because it may result in other hospitals following this example, and because it may generate research on the effects of theatre on patients and their families. PMID:19030374

Virtual reality training for improving the skills needed for performing surgery of the ear, nose or throat.

PubMed

Piromchai, Patorn; Avery, Alex; Laopaiboon, Malinee; Kennedy, Gregor; O'Leary, Stephen

2015-09-09

Virtual reality simulation uses computer-generated imagery to present a simulated training environment for learners. This review seeks to examine whether there is evidence to support the introduction of virtual reality surgical simulation into ear, nose and throat surgical training programmes. 1. To assess whether surgeons undertaking virtual reality simulation-based training achieve surgical ('patient') outcomes that are at least as good as, or better than, those achieved through conventional training methods.2. To assess whether there is evidence from either the operating theatre, or from controlled (simulation centre-based) environments, that virtual reality-based surgical training leads to surgical skills that are comparable to, or better than, those achieved through conventional training. The Cochrane Ear, Nose and Throat Disorders Group (CENTDG) Trials Search Co-ordinator searched the CENTDG Trials Register; Central Register of Controlled Trials (CENTRAL 2015, Issue 6); PubMed; EMBASE; ERIC; CINAHL; Web of Science; ClinicalTrials.gov; ICTRP and additional sources for published and unpublished trials. The date of the search was 27 July 2015. We included all randomised controlled trials and controlled trials comparing virtual reality training and any other method of training in ear, nose or throat surgery. We used the standard methodological procedures expected by The Cochrane Collaboration. We evaluated both technical and non-technical aspects of skill competency. We included nine studies involving 210 participants. Out of these, four studies (involving 61 residents) assessed technical skills in the operating theatre (primary outcomes). Five studies (comprising 149 residents and medical students) assessed technical skills in controlled environments (secondary outcomes). The majority of the trials were at high risk of bias. We assessed the GRADE quality of evidence for most outcomes across studies as 'low'. Operating theatre environment (primary outcomes) In the operating theatre, there were no studies that examined two of three primary outcomes: real world patient outcomes and acquisition of non-technical skills. The third primary outcome (technical skills in the operating theatre) was evaluated in two studies comparing virtual reality endoscopic sinus surgery training with conventional training. In one study, psychomotor skill (which relates to operative technique or the physical co-ordination associated with instrument handling) was assessed on a 10-point scale. A second study evaluated the procedural outcome of time-on-task. The virtual reality group performance was significantly better, with a better psychomotor score (mean difference (MD) 1.66, 95% CI 0.52 to 2.81; 10-point scale) and a shorter time taken to complete the operation (MD -5.50 minutes, 95% CI -9.97 to -1.03). Controlled training environments (secondary outcomes) In a controlled environment five studies evaluated the technical skills of surgical trainees (one study) and medical students (three studies). One study was excluded from the analysis. Surgical trainees: One study (80 participants) evaluated the technical performance of surgical trainees during temporal bone surgery, where the outcome was the quality of the final dissection. There was no difference in the end-product scores between virtual reality and cadaveric temporal bone training. Medical students: Two other studies (40 participants) evaluated technical skills achieved by medical students in the temporal bone laboratory. Learners' knowledge of the flow of the operative procedure (procedural score) was better after virtual reality than conventional training (SMD 1.11, 95% CI 0.44 to 1.79). There was also a significant difference in end-product score between the virtual reality and conventional training groups (SMD 2.60, 95% CI 1.71 to 3.49). One study (17 participants) revealed that medical students acquired anatomical knowledge (on a scale of 0 to 10) better during virtual reality than during conventional training (MD 4.3, 95% CI 2.05 to 6.55). No studies in a controlled training environment assessed non-technical skills. There is limited evidence to support the inclusion of virtual reality surgical simulation into surgical training programmes, on the basis that it can allow trainees to develop technical skills that are at least as good as those achieved through conventional training. Further investigations are required to determine whether virtual reality training is associated with better real world outcomes for patients and the development of non-technical skills. Virtual reality simulation may be considered as an additional learning tool for medical students.

49 CFR 1544.217 - Law enforcement personnel.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 49 Transportation 9 2010-10-01 2010-10-01 false Law enforcement personnel. 1544.217 Section 1544... AND COMMERCIAL OPERATORS Operations § 1544.217 Law enforcement personnel. (a) The following applies to... for law enforcement personnel meeting the qualifications and standards specified in §§ 1542.215 and...

Oxford Optronix MPM 3S: a clinical assessment of a microvascular perfusion monitor.

PubMed

Dryden, C M; Gray, W M; Asbury, A J

1992-01-01

The Oxford Optronix MPM 3S is a new microvascular perfusion monitor which is promoted as a device for use in the operating theatre. It uses a semiconductor laser diode and applies the Doppler principle to derive a semi-quantitative estimation of microvascular flow. We assessed this instrument with eight healthy volunteers who each performed eight different orthostatic arm manoeuvres while forearm skin blood flow was monitored. The different manoeuvres caused statistically significant changes in the instrument's reading which generally were consistent with expected changes in blood flow. The monitor also was assessed in the theatre environment with four anaesthetized patients. It proved easy to use, and was not subject to electrical interference from other equipment including short-wave diathermy. The major practical limitation of the technique is the semi-quantitative nature of the measurement. The instrument appears to have potential clinical uses in plastic and vascular surgery.

Surgical Burn Care by Médecins Sans Frontières-Operations Center Brussels: 2008 to 2014.

PubMed

Stewart, Barclay T; Trelles, Miguel; Dominguez, Lynette; Wong, Evan; Fiozounam, Hervé Tribunal; Hassani, Ghulam Hiadar; Akemani, Clemence; Naseer, Aemer; Ntawukiruwabo, Innocent Bagura; Kushner, Adam L

Humanitarian organizations care for burns during crisis and while supporting healthcare facilities in low-income and middle-income countries. This study aimed to define the epidemiology of burn-related procedures to aid humanitarian response. In addition, operational data collected from humanitarian organizations are useful for describing surgical need otherwise unmet by national health systems. Procedures performed in operating theatres run by Médecins Sans Frontières-Operations Centre Brussels (MSF-OCB) from July 2008 through June 2014 were reviewed. Surgical specialist missions were excluded. Burn procedures were quantified, related to demographics and reason for humanitarian response, and described. A total of 96,239 operations were performed at 27 MSF-OCB projects in 15 countries between 2008 and 2014. Of the 33,947 general surgical operations, 4,280 (11%) were for burns. This proportion steadily increased from 3% in 2008 to 24% in 2014. People receiving surgical care from conflict relief missions had nearly twice the odds of having a burn operation compared with people requiring surgery in communities affected by natural disaster (adjusted odds ratio, 1.94; 95% confidence interval, 1.46-2.58). Nearly 70% of burn procedures were planned serial visits to the theatre. A diverse skill set was required. Unmet humanitarian assistance needs increased US$400 million dollars in 2013 in the face of an increasing number of individuals affected by crisis and a growing surgical burden. Given the high volume of burn procedures performed at MSF-OCB projects and the resource intensive nature of burn management, requisite planning and reliable funding are necessary to ensure quality for burn care in humanitarian settings.

Putting Role 1 first: the Role 1 capability review.

PubMed

Hodgetts, T J; Findlay, S

2012-09-01

To quantify the risk for delivering care at Role 1 in the Land Environment (point of wounding to hospital care) on current operations and set the conditions for systematic change to enhance future capability. UK, US and Danish Army Role 1 Subject Matter Experts (SMEs) (1) Questionnaire study ofUK SMEs to determine capability gaps; (2) Questionnaire study of US and Danish SMEs to benchmark UK capability; (3) Semi-structured interviews of UK SMEs; (4) In-theatre evaluation of deployed Role 1. Thirty two SMEs completed the questionnaire (68% response rate), comprising 25 medical officers (20 in clinical appointments; five in command and staff appointments), six nurses and one medical support officer. Results of the entire review were collated as a cross-Defence Lines of Development analysis, separating the specific experience of 1 Medical Regiment's Hybrid Foundation Training (HFT), Mission Specific Training (MST) and deployment cycle from the analysis gained from questionnaire studies, SME consultation and documentary evidence. The review generated 77 recommendations and 38 sub-recommendations. The top six messages of the review were (1) To balance the expressed desire to increase the ratio of trained Team Medics with the reality of generating credible instructors with clinical experience; (2) To recognise that inadequate experience for Combat Medical Technicians in Primary Healthcare in the Firm Base undermines their operational preparedness; (3) To recognise that Current Regimental Aid Post (RAP) at contingency without power lacks the rudimentary infrastructure of a modern Medical Treatment Facility; (4) To recognise that inappropriate deployment of personnel with chronic disease or acutely limiting conditions is a consistent trend for 20 years that highlights continuing system weaknesses in applying protective medical grading; (5) To accept that General Practitioner manning requires re-evaluating as an Operational Pinch Point, reviewing all options to maintain operational effectiveness including, but not focusing on, incentives; and (6) To recognise that a best practice template for Role 1 Healthcare Governance has been created that must endure.

21 CFR 111.12 - What personnel qualification requirements apply?

Code of Federal Regulations, 2014 CFR

2014-04-01

..., PACKAGING, LABELING, OR HOLDING OPERATIONS FOR DIETARY SUPPLEMENTS Personnel § 111.12 What personnel... dietary supplements. (b) You must identify who is responsible for your quality control operations. Each...

21 CFR 111.12 - What personnel qualification requirements apply?

Code of Federal Regulations, 2012 CFR

2012-04-01

..., PACKAGING, LABELING, OR HOLDING OPERATIONS FOR DIETARY SUPPLEMENTS Personnel § 111.12 What personnel... dietary supplements. (b) You must identify who is responsible for your quality control operations. Each...

49 CFR 236.927 - Training specific to locomotive engineers and other operating personnel.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 49 Transportation 4 2010-10-01 2010-10-01 false Training specific to locomotive engineers and... Training specific to locomotive engineers and other operating personnel. (a) What elements apply to operating personnel? Training provided under this subpart for any locomotive engineer or other person who...

49 CFR 236.927 - Training specific to locomotive engineers and other operating personnel.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 49 Transportation 4 2012-10-01 2012-10-01 false Training specific to locomotive engineers and... Training specific to locomotive engineers and other operating personnel. (a) What elements apply to operating personnel? Training provided under this subpart for any locomotive engineer or other person who...

49 CFR 236.927 - Training specific to locomotive engineers and other operating personnel.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 49 Transportation 4 2013-10-01 2013-10-01 false Training specific to locomotive engineers and... Training specific to locomotive engineers and other operating personnel. (a) What elements apply to operating personnel? Training provided under this subpart for any locomotive engineer or other person who...

49 CFR 236.927 - Training specific to locomotive engineers and other operating personnel.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 49 Transportation 4 2014-10-01 2014-10-01 false Training specific to locomotive engineers and... Training specific to locomotive engineers and other operating personnel. (a) What elements apply to operating personnel? Training provided under this subpart for any locomotive engineer or other person who...

49 CFR 1544.231 - Airport-approved and exclusive area personnel identification systems.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 49 Transportation 9 2012-10-01 2012-10-01 false Airport-approved and exclusive area personnel... AIRCRAFT OPERATOR SECURITY: AIR CARRIERS AND COMMERCIAL OPERATORS Operations § 1544.231 Airport-approved... carry out a personnel identification system for identification media that are airport-approved, or...

49 CFR 1544.231 - Airport-approved and exclusive area personnel identification systems.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 49 Transportation 9 2011-10-01 2011-10-01 false Airport-approved and exclusive area personnel... AIRCRAFT OPERATOR SECURITY: AIR CARRIERS AND COMMERCIAL OPERATORS Operations § 1544.231 Airport-approved... carry out a personnel identification system for identification media that are airport-approved, or...

49 CFR 1544.231 - Airport-approved and exclusive area personnel identification systems.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 49 Transportation 9 2014-10-01 2014-10-01 false Airport-approved and exclusive area personnel... AIRCRAFT OPERATOR SECURITY: AIR CARRIERS AND COMMERCIAL OPERATORS Operations § 1544.231 Airport-approved... carry out a personnel identification system for identification media that are airport-approved, or...

It's Not Always Good For You: Theatre Is Not Supposed To Be Medicine.

ERIC Educational Resources Information Center

Gregg, Stephen

2002-01-01

Suggests that theatre's capacity to educate is often overstated. Notes theatre created by and for teenagers is especially guilty of proselytizing. Argues the real danger is that the cumulative, subliminal message is that theater is medicine. Suggests that playwrights, directors, and artistic directors leave the education for the classroom and take…

Engaging Learners' Comprehension, Interest and Motivation to Learn Literature Using the Reader's Theatre

ERIC Educational Resources Information Center

Kabilan, Muhammad Kamarul; Kamarudin, Fadzliyati

2010-01-01

This article reports on a teacher's experiment with Reader's Theatre (RT), an interactive play reading activity with elements of reading aloud, drama and theatre, for her 20 unmotivated learners of literature in a premier school in Malaysia. Using RT, the students staged Angela Wright's "Potato People". The procedures and design of the…

Teaching Note--Theatre of the Oppressed and Social Work Education: Radicalizing the Practice Classroom

ERIC Educational Resources Information Center

Giesler, Mark A.

2017-01-01

Augusto Boal's Theatre of the Oppressed has been the basis for radical performance techniques practiced around the world. Widely a staple for theatre performance syllabi, it also has an innovative application for the social work classroom. This article designates Boal's four stages of his poetics of the oppressed and concomitant theatrical…

Drama and Theatre in the Junior High/Middle School...Striving for New Heights and Insight.

ERIC Educational Resources Information Center

Schindel, Dorothy Napp

1989-01-01

Outlines the mission of the American Alliance for Theatre and Education's Committee on Junior High/Middle School Theatre Programs. Describes the committee's seminars and workshop activities, and mentions ideas under consideration for future projects. Invites readers to join the network of Junior High/Middle School teachers, and calls for articles…

A State of Health? Constructive Dialogue and the Rhythms of International Youth Theatre

ERIC Educational Resources Information Center

Parry, Simon

2014-01-01

This article examines youth theatre as a mode of promoting public dialogue within situations of political tension or conflict. It reflects on the author's own experience of trying unsuccessfully to find a framework to evaluate an European Union supported theatre project, youth/art/peace/network, which took place in Austria, Israel and Palestine in…

Theatre Curriculum in the US: A Great Tasting Sandwich on Stale Bread

ERIC Educational Resources Information Center

Duffy, Peter

2016-01-01

This essay considers the role that local control, poverty, access and policy play in providing drama/theatre education opportunities to students in the US. It examines how state and federal initiatives shape and determine the curriculum. While there are studies that suggest robust theatre education in the US, these findings are complicated when…

Theatre for Change: An Analysis of Two Performances by Women in Mundemba Sub-Division.

ERIC Educational Resources Information Center

Tanyi-Tang, Anne

2001-01-01

Contends that theatre has the power to induce oppressors to change their attitudes permanently towards the groups they oppress. Describes theatrical performances by women in Mundemba Sub-Division, Cameroon, which created lasting changes in men's attitudes. Concludes that theatre calls for sociocultural and economic changes and it has the power to…

Online "iDentity" Formation and the High School Theatre Trip

ERIC Educational Resources Information Center

Richardson, John M.

2016-01-01

Over the years that I have taken secondary school students to the theatre, the the digital revolution has moved through schools, classrooms, and even theatres, calling into question my goal of contributing positively to students' identity formation through exposure to live plays. Responding to calls to examine the ways in which young people's…

TheatreLink: Wired to Make Plays Together at a Distance

ERIC Educational Resources Information Center

Shookhoff, David

2004-01-01

Now entering its eighth year, TheatreLink, Manhattan Theater Club's Internet-based distance-learning project remains the most exciting and most challenging initiative. MTC's Education Program had existed for seven years (since 1989 to be exact) before it started TheatreLink. During that early period MTC created an array of programs, all of them…

Implementing and Assessing the Effects of Theatre Infused Reading Instruction in Sixth, Seventh, and Eighth Grade Middle School English Classrooms

ERIC Educational Resources Information Center

Eyerly, William J., Jr.

2017-01-01

Theatre instructional techniques, including reader's theatre and process drama teaching strategies, have been employed as instructional strategies in classrooms to enhance reading comprehension and vocabulary learning in students. In this era of increasing accountability for educational outcomes, quantifying what, if any, impact such instructional…

Translation between Academic Research, Community and Practice: A Forum Theatre Process

ERIC Educational Resources Information Center

Hamel, Sonia

2015-01-01

On 6 February 2008, a deliberative theatre experiment was held at the National Archives of Quebec. Inspired by the democratic virtues of public deliberation but preoccupied with its blind spots, Forum Theatre was used to initiate discussion about the social tensions between the homeless and other dwellers of public space in downtown Montreal.…

A Search for the Sources of Excellence: Applying Contemporary Management Theory to Theatre Research.

ERIC Educational Resources Information Center

Jones, Tom; White, Donald D.

A study was conducted to learn about the effective practice of theatre through the application of research methods developed in studies involving other types of organizations. Successful and unsuccessful play directors, as determined by evaluations of their plays in the Southwest Region of the American College Theatre Festival, were surveyed to…

The Dialogic and the Aesthetic: Some Reflections on Theatre as a Learning Medium

ERIC Educational Resources Information Center

Jackson, Anthony

2005-01-01

In this article, the author suggests that the dichotomy that so frequently plagues debates about theatre for young people and whether or not it should have an educational or "interventionist" agenda may be misconceived. He suggests that the use of theatre in "applied contexts" (whether schools, museums, young offender institutions, prisons, or…

CLICK: Arts Education and Critical Social Dialogue within Global Youth Work Practice

ERIC Educational Resources Information Center

Aubrey, Meg

2015-01-01

This article discusses CLICK, a collaborative theatre project between the Mess Up The Mess Theatre Company in Wales, the Hong Kong Academy for Performing Arts, the Australian Theatre for Young People, and Inspired Productions in New Zealand. This case study demonstrates the value of using arts education to bring together young people from multiple…

Efficacy of a computerized system applied to central operating theatre for medical records collection.

PubMed

Yamamoto, K; Ogura, H; Furutani, H; Kitazoe, Y; Takeda, Y; Hirakawa, M

1986-01-01

A computer system operation is introduced, which has been in use since October 1981 at Kochi medical school as one of the integral sub-systems of the total hospital information system called IMIS. The system was designed from the beginning with the main purposes of obtaining better management of operations, and detailed medical records are included for before, during and after operations. It is shown that almost all operations except emergencies were managed using the computer system rather than the paper system. After presenting some of the results of the accumulated records we will discuss the reason for this high frequency of use of the computer system.

Evolution of the anatomical theatre in Padova.

PubMed

Macchi, Veronica; Porzionato, Andrea; Stecco, Carla; De Caro, Raffaele

2014-01-01

The anatomical theatre played a pivotal role in the evolution of medical education, allowing students to directly observe and participate in the process of dissection. Due to the increase of training programs in clinical anatomy, the Institute of Human Anatomy at the University of Padova has renovated its dissecting room. The main guidelines in planning a new anatomical theatre included: (1), the placement of the teacher and students on the same level in a horizontal anatomical theatre where it is possible to see (theatre) and to perform (dissecting room); (2), in the past, dissection activities were concentrated at the center of the theatre, while in the new anatomical theatre, such activities have been moved to the periphery through projection on surrounding screens-thus, students occupy the center of the theatre between the demonstration table, where the dissection can be seen in real time, and the wall screens, where particular aspects are magnified; (3), three groups of tables are placed with one in front with two lateral flanking tables in regards to the demonstration table, in a semicircular arrangement, and not attached to the floor, which makes the room multifunctional for surgical education, medical students and physician's continued professional development courses; (4), a learning station to introduce the students to the subject of the laboratory; (5), cooperation between anatomists and architects in order to combine the practical needs of a dissection laboratory with new technologies; (6), involvement of the students, representing the clients' needs; and (7), creation of a dissecting room of wide measurements with large windows, since a well-illuminated space could reduce the potentially negative psychological impact of the dissection laboratory on student morale. © 2014 American Association of Anatomists.

[Theatre as communication method in psychogeriatric care: effects on behaviour, mood and quality of life of people with dementia ].

PubMed

van Dijk, A M; van Weert, J C M; Dröes, R M

2012-12-01

Recently, a new communication method was introduced in nursing homes for people with dementia. This so-called Veder Method, developed by professional actors with former educational background in care,combines proven effective emotion-oriented care methods, like reminiscence,with theatrical stimuli like songs and poetry. The method is applied during theatre shows and living room theatre activities. In this exploratory study the surplus value of a living room theatre activity according to the Veder method compared to a reminiscence group activity was evaluated. Within a quasi experimental design, three groups of nursing home residents with dementia were compared: Experimental group 1 (E1; N=64)joined a 'living room theatre activity' offered by trained caregivers. Experimental group 2 (E2; N=31) joined a 'living room theatre activity' offered by professional actors. The control group (N=52) received a reminiscence group activity. Behaviour, mood and quality of life were measured using standardized observation scales at three points in time: (T1) pretest; (T2)during the intervention and; (T3) posttest, two hours after the intervention. During and after the intervention, positive effects were found in favour of E2 on behaviour (i.e. laughing, recalled memories), mood (i.e. happy/content) and quality of life (i.e. social involvement, feeling at home). A living room theatre activity according to the Veder Method has more positive effect on nursing home residents compared to a normal reminiscence group activity, if offered by professional actors.This article is a slightly edited translation of Does theatre improve the quality of life of people with dementia? International Psychogeriatrics2012;24: 36r381 by the same authors.

Forced-air patient warming blankets disrupt unidirectional airflow.

PubMed

Legg, A J; Hamer, A J

2013-03-01

We have recently shown that waste heat from forced-air warming blankets can increase the temperature and concentration of airborne particles over the surgical site. The mechanism for the increased concentration of particles and their site of origin remained unclear. We therefore attempted to visualise the airflow in theatre over a simulated total knee replacement using neutral-buoyancy helium bubbles. Particles were created using a Rocket PS23 smoke machine positioned below the operating table, a potential area of contamination. The same theatre set-up, warming devices and controls were used as in our previous study. This demonstrated that waste heat from the poorly insulated forced-air warming blanket increased the air temperature on the surgical side of the drape by > 5°C. This created convection currents that rose against the downward unidirectional airflow, causing turbulence over the patient. The convection currents increased the particle concentration 1000-fold (2 174 000 particles/m(3) for forced-air warming vs 1000 particles/m(3) for radiant warming and 2000 particles/m(3) for the control) by drawing potentially contaminated particles from below the operating table into the surgical site. Cite this article: Bone Joint J 2013;95-B:407-10.

Ventilation performance in the operating theatre against airborne infection: numerical study on an ultra-clean system.

PubMed

Chow, T T; Yang, X Y

2005-02-01

A laminar airflow study was performed in a standard operating theatre in Hong Kong, the design of which followed the requirements of the UK Health Technical Memorandum. The study of the ultra-clean ventilation system investigated the effectiveness of the laminar flow in: (i) preventing bioaerosols released by the surgical staff from causing postoperative infection of the patient; and (ii) protecting the surgical team against infection by bacteria from the wound site. Seven cases of computer simulation are presented and the sensitivity of individual cases is discussed. Air velocity at the supply diffuser has been identified as one of the most important factors in governing the dispersion of airborne infectious particles. Higher velocity within the laminar regime is advantageous in minimizing the heat-dissipation effect, and to ensure an adequate washing effect against particulate settlement. Inappropriate positioning of the medical lamps can be detrimental. Omission of a partial wall may increase the infection risk of the surgical team due to the ingression of room air at the supply diffuser periphery. This paper stresses that a successful outcome in preventing airborne infection depends as much on resolving human factors as on overcoming technical obstacles.

TRADITIONAL CANISTER-BASED OPEN WASTE MANAGEMENT SYSTEM VERSUS CLOSED SYSTEM: HAZARDOUS EXPOSURE PREVENTION AND OPERATING THEATRE STAFF SATISFACTION.

PubMed

Horn, M; Patel, N; MacLellan, D M; Millard, N

2016-06-01

Exposure to blood and body fluids is a major concern to health care professionals working in operating rooms (ORs). Thus, it is essential that hospitals use fluid waste management systems that minimise risk to staff, while maximising efficiency. The current study compared the utility of a 'closed' system with a traditional canister-based 'open' system in the OR in a private hospital setting. A total of 30 arthroscopy, urology, and orthopaedic cases were observed. The closed system was used in five, four, and six cases, respectively and the open system was used in nine, two, and four cases, respectively. The average number of opportunities for staff to be exposed to hazardous fluids were fewer for the closed system when compared to the open during arthroscopy and urology procedures. The open system required nearly 3.5 times as much staff time for set-up, maintenance during procedures, and post-procedure disposal of waste. Theatre staff expressed greater satisfaction with the closed system than with the open. In conclusion, compared with the open system, the closed system offers a less hazardous and more efficient method of disposing of fluid waste generated in the OR.

Promoting patient safety through prospective risk identification: example from peri-operative care.

PubMed

Smith, A; Boult, M; Woods, I; Johnson, S

2010-02-01

Investigation of patient safety incidents has focused on retrospective analyses once incidents have occurred. Prospective risk analysis techniques complement this but have not been widely used in healthcare. Prospective risk identification of non-operative risks associated with adult elective surgery under general anaesthesia using a customised structured "what if" checklist and development of risk matrix. Prioritisation of recommendations arising by cost, ease and likely speed of implementation. Groups totalling 20 clinical and administrative healthcare staff involved in peri-operative care and risk experts convened by the UK National Patient Safety Agency. 102 risks were identified and 95 recommendations made. The top 20 recommendations together were judged to encompass about 75% of the total estimated risk attributable to the processes considered. Staffing and organisational issues (21% of total estimated risk) included recommendations for removing distractions from the operating theatre, ensuring the availability of senior anaesthetists and promoting standards and flexible working among theatre staff. Devices and equipment (19% of total estimated risk) could be improved by training and standardisation; airway control and temperature monitoring were identified as two specific areas. Pre-assessment of patients before admission to hospital (12% of estimated risk) could be improved by defining a data set for adequate pre-assessment and making this available throughout the NHS. This technique can be successfully applied by healthcare staff but expert facilitation of groups is advisable. Such wider-ranging processes can potentially lead to more comprehensive risk reduction than "single-issue" risk alerts.

33 CFR 150.620 - What are the requirements for protecting personnel from machinery?

Code of Federal Regulations, 2012 CFR

2012-07-01

... protecting personnel from machinery? 150.620 Section 150.620 Navigation and Navigable Waters COAST GUARD... Health Machine Guards § 150.620 What are the requirements for protecting personnel from machinery? The deepwater port operator must ensure that all personnel are protected from the risks created by operating...

33 CFR 150.620 - What are the requirements for protecting personnel from machinery?

Code of Federal Regulations, 2014 CFR

2014-07-01

... protecting personnel from machinery? 150.620 Section 150.620 Navigation and Navigable Waters COAST GUARD... Health Machine Guards § 150.620 What are the requirements for protecting personnel from machinery? The deepwater port operator must ensure that all personnel are protected from the risks created by operating...

33 CFR 150.620 - What are the requirements for protecting personnel from machinery?

Code of Federal Regulations, 2011 CFR

2011-07-01

... protecting personnel from machinery? 150.620 Section 150.620 Navigation and Navigable Waters COAST GUARD... Health Machine Guards § 150.620 What are the requirements for protecting personnel from machinery? The deepwater port operator must ensure that all personnel are protected from the risks created by operating...

33 CFR 150.620 - What are the requirements for protecting personnel from machinery?

Code of Federal Regulations, 2013 CFR

2013-07-01

... protecting personnel from machinery? 150.620 Section 150.620 Navigation and Navigable Waters COAST GUARD... Health Machine Guards § 150.620 What are the requirements for protecting personnel from machinery? The deepwater port operator must ensure that all personnel are protected from the risks created by operating...

Between Home and Homeland: Facilitating Theatre with Ethiopian Youth

ERIC Educational Resources Information Center

Lev-Aladgem, Shulamith

2008-01-01

The article discusses a community-based theatre project facilitated with a group of Jewish Ethiopian youth in a boarding school in Israel. The intention is to investigate how far a specific group of black immigrants are able to use theatre for their own needs in such a location. It begins with the presentation of the Jewish Ethiopians as a…

"It Makes Me Feel Alive": The Socio-Motivational Impact of Drama and Theatre on Marginalised Young People

ERIC Educational Resources Information Center

Hanrahan, Fidelma; Banerjee, Robin

2017-01-01

An in-depth, longitudinal, idiographic study examined the impact of theatre and drama involvement on marginalised young people. Semi-structured interviews, at three separate time points over 2 years, were conducted with four young people (15-21 years of age) involved in a theatre project. Interpretative phenomenological analysis suggested that…

The Economic Impact of Ten Cultural Institutions on the Economy of the Salt Lake SMSA.

ERIC Educational Resources Information Center

Cwi, David

The impact of 10 cultural institutions on the Salt Lake City economy was determined by measuring their 1978 direct and indirect financial effects. The institutions are Ballet West, Pioneer Memorial Theatre, Repertory Dance Theatre, Salt Lake City Art Center, Theatre 138, Tiffany's Attic, Utah Museum of Fine Arts, Utah Symphony, Utah Opera Company,…

The School Theatre as a Place of Cultural Learning: The Case of Soviet Latvia (1960s-1980s)

ERIC Educational Resources Information Center

Kestere, Iveta

2017-01-01

The goal of this article is to reveal how through school theatre activities under authoritarian rule, changes took place in pupil knowledge, skills, attitudes, and behaviour regarding culture, namely, how the process of cultural learning occurs. I use a historical case study, specifically the case of the Valmiera School Theatre, which was the…

A Comprehensive Guide to Readers Theatre: Enhancing Fluency and Comprehension in Middle School and Beyond

ERIC Educational Resources Information Center

Black, Alison; Stave, Anna M.

2007-01-01

With the current education climate so focused on accountability, teachers need to ensure that their teaching practices are supported by today's content-specific standards. To meet this need, "A Comprehensive Guide to Readers Theatre" shows not only how to implement Readers Theatre in the classroom but also how to use it to meet current literacy…

Digital Culture, and the Viewing/Participating Pre-Service Teacher: (Re)envisioning Theatre Teacher Training for a Social Media Culture

ERIC Educational Resources Information Center

Jensen, Amy

2012-01-01

This paper explores how our "digital world" shapes the ways that young people want to be engaged and how those desires subsequently shape academic theatre spaces. The paper uses artefacts developed in a university classroom to demonstrate that pre-service theatre educators can create educational materials that interrogate and deploy multiple media…

High School Dinner Theatre: A Fun Way to Raise Funds.

ERIC Educational Resources Information Center

Robert, Harvey

Citing the success of commercial dinner theatres, this guide is designed to persuade high school drama teachers to try the idea and also to answer questions and help solve problems for those producing a dinner theatre for the first time. The six chapters cover choosing the place, the menu, and the play; ticket sales; advertising and publicity; and…

Finding a Concrete Utopia in the Dystopia of a "Sub-City"

ERIC Educational Resources Information Center

Busby, Selina

2017-01-01

This article examines a 10-year long series of annual short-term interventions with young people living in Dharavi (India) that has led to a number of public theatre events. The partnership offers a unique training experience to students from the UK in theatre facilitation, and a regular opportunity to participate in theatre for young people in…

"I Learned to Accept Every Part of Myself": The Transformative Impact of a Theatre-Based Sexual Health and HIV Prevention Programme

ERIC Educational Resources Information Center

Grewe, Mary E.; Taboada, Arianna; Dennis, Alexis; Chen, Elizabeth; Stein, Kathryn; Watson, Sable; Barrington, Clare; Lightfoot, Alexandra F.

2015-01-01

Theatre-based interventions have been used in health promotion with young people to address HIV and sexual health. In this study, we explored the experience of undergraduate student performers participating in a theatre-based HIV prevention and sexual health education intervention for high school students in the USA. Undergraduate students…

Asian Theatre: A Study Guide and Annotated Bibliography. "Theatre Perspectives" No. 1.

ERIC Educational Resources Information Center

Brandon, James R., Ed.; Wichmann, Elizabeth, Ed.

This study guide/bibliography is intended to help the English language reader find materials for the study of Asian theatre. Containing 1,348 entries, the guide is the most extensive bibliography published to date. The guide is organized by geographical area: an initial chapter on Asia is followed by chapters on each of 16 countries: Burma,…

Interdisciplinary Teaching of Theatre and Human Rights in Honors

ERIC Educational Resources Information Center

Szasz, Maria

2017-01-01

Since spring 2012, the author has taught a 300-level Theatre and Human Rights class in the University of New Mexico Honors College. One of the centerpieces of honors education is careful research and thorough analysis of what is taught and why it is taught. In creating the honors class Theatre and Human Rights, the author explored how she would…

Can Mimetics, a Theatre-Based Practice, Open Possibilities for Young People with Learning Disabilities? A Capability Approach

ERIC Educational Resources Information Center

Trowsdale, Jo; Hayhow, Richard

2013-01-01

While the significance of the social model of disability for articulating inclusive approaches in education is recognised, the application of capability theory to education is less well developed. This article by Jo Trowsdale of the University of Warwick and Richard Hayhow of Open Theatre considers how a particular theatre-based practice, here…

Family Life Theatre and youth health services.

PubMed Central

Boria, M C; Welch, E J; Vargas, A M

1981-01-01

The Family Life Theatre, integrated into the Youth Health Services of a medical institution in a large urban community, has achieved rather unusual success. After seven years of experience marked by a constant quest for improvements, what was started in 1973 as a very modest health education program, through the medium of improvisational theatre, has now become a pilot project, duplicated by many groups and institutions throughout the country. The experiences of the Family Life Theatre, and its multiple ramifications leading to a comprehensive approach to the adolescent health problems, are presented and analyzed in a public health perspective. Images p151-a p152-a p153-a PMID:7457684

49 CFR 1542.217 - Law enforcement personnel.

Code of Federal Regulations, 2014 CFR

2014-10-01

....217 Transportation Other Regulations Relating to Transportation (Continued) TRANSPORTATION SECURITY ADMINISTRATION, DEPARTMENT OF HOMELAND SECURITY CIVIL AVIATION SECURITY AIRPORT SECURITY Operations § 1542.217 Law enforcement personnel. (a) Each airport operator must ensure that law enforcement personnel used...

49 CFR 1542.217 - Law enforcement personnel.

Code of Federal Regulations, 2013 CFR

2013-10-01

....217 Transportation Other Regulations Relating to Transportation (Continued) TRANSPORTATION SECURITY ADMINISTRATION, DEPARTMENT OF HOMELAND SECURITY CIVIL AVIATION SECURITY AIRPORT SECURITY Operations § 1542.217 Law enforcement personnel. (a) Each airport operator must ensure that law enforcement personnel used...

49 CFR 1542.217 - Law enforcement personnel.

Code of Federal Regulations, 2011 CFR

2011-10-01

....217 Transportation Other Regulations Relating to Transportation (Continued) TRANSPORTATION SECURITY ADMINISTRATION, DEPARTMENT OF HOMELAND SECURITY CIVIL AVIATION SECURITY AIRPORT SECURITY Operations § 1542.217 Law enforcement personnel. (a) Each airport operator must ensure that law enforcement personnel used...

49 CFR 1542.217 - Law enforcement personnel.

Code of Federal Regulations, 2012 CFR

2012-10-01

....217 Transportation Other Regulations Relating to Transportation (Continued) TRANSPORTATION SECURITY ADMINISTRATION, DEPARTMENT OF HOMELAND SECURITY CIVIL AVIATION SECURITY AIRPORT SECURITY Operations § 1542.217 Law enforcement personnel. (a) Each airport operator must ensure that law enforcement personnel used...

A break-even analysis of major ear surgery.

PubMed

Wasson, J D; Phillips, J S

2015-10-01

To determine variables which affect cost and profit for major ear surgery and perform a break-even analysis. Retrospective financial analysis. UK teaching hospital. Patients who underwent major ear surgery under general anaesthesia performed by the senior author in main theatre over a 2-year period between dates of 07 September 2010 and 07 September 2012. Income, cost and profit for each major ear patient spell. Variables that affect major ear surgery profitability. Seventy-six patients met inclusion criteria. Wide variation in earnings, with a median net loss of £-1345.50 was observed. Income was relatively uniform across all patient spells; however, theatre time of major ear surgery at a cost of £953.24 per hour varied between patients and was the main determinant of cost and profit for the patient spell. Bivariate linear regression of earnings on theatre time identified 94% of variation in earnings was due to variation in theatre time (r = -0.969; P < 0.0001) and derived a break-even time for major ear surgery of 110.6 min. Theatre time was dependent on complexity of procedure and number of OPCS4 procedures performed, with a significant increase in theatre time when three or more procedures were performed during major ear surgery (P = 0.015). For major ear surgery to either break-even or return a profit, total theatre time should not exceed 110 min and 36 s. © 2015 John Wiley & Sons Ltd.

Study Results on Knowledge Requirements for Entry-Level Airport Operations and Management Personnel

NASA Technical Reports Server (NTRS)

Quilty, Stephen M.

2005-01-01

This paper identifies important topical knowledge areas required of individuals employed in airport operations and management positions. A total of 116 airport managers and airfield operations personnel responded to a survey that sought to identify the importance of various subject matter for entry level airport operations personnel. The results from this study add to the body of research on aviation management curriculum development and can be used to better develop university curriculum and supplemental training focused on airport management and operations. Recommendations are made for specialized airport courses within aviation management programs. Further, this study identifies for job seekers or individuals employed in entry level positions those knowledge requirements deemed important by airport managers and operations personnel at different sized airports.

The razor's edge: Australian rock music impairs men's performance when pretending to be a surgeon.

PubMed

Fancourt, Daisy; Burton, Thomas Mw; Williamon, Aaron

2016-12-12

Over the past few decades there has been interest in the role of music in the operating theatre. However, despite many reported benefits, a number of potentially harmful effects of music have been identified. This study aimed to explore the effects of rock and classical music on surgical speed, accuracy and perceived distraction when performing multiorgan resection in the board game Operation. Single-blind, three-arm, randomised controlled trial. Imperial Festival, London, May 2016. Members of the public (n = 352) aged ≥ 16 years with no previous formal surgical training or hearing impairments. Participants were randomised to listen through noise-cancelling headphones to either the sound of an operating theatre, rock music or classical music. Participants were then invited to remove three organs from the board game patient, Cavity Sam, using surgical tweezers. Time taken (seconds) to remove three organs from Cavity Sam; the number of mistakes made in performing the surgery; and perceived distraction, rated on a five-point Likert-type scale from 1 (not at all distracting) to 5 (very distracting). Rock music impairs the performance of men but not women when undertaking complex surgical procedures in the board game Operation, increasing the time taken to operate and showing a trend towards more surgical mistakes. In addition, classical music was associated with lower perceived distraction during the game, but this effect was attenuated when factoring in how much people liked the music, with suggestions that only people who particularly liked the music of Mozart found it beneficial. Rock music (specifically Australian rock music) appears to have detrimental effects on surgical performance. Men are advised not to listen to rock music when either operating or playing board games.

The development and validation of a scoring tool to predict the operative duration of elective laparoscopic cholecystectomy.

PubMed

Bharamgoudar, Reshma; Sonsale, Aniket; Hodson, James; Griffiths, Ewen

2018-07-01

The ability to accurately predict operative duration has the potential to optimise theatre efficiency and utilisation, thus reducing costs and increasing staff and patient satisfaction. With laparoscopic cholecystectomy being one of the most commonly performed procedures worldwide, a tool to predict operative duration could be extremely beneficial to healthcare organisations. Data collected from the CholeS study on patients undergoing cholecystectomy in UK and Irish hospitals between 04/2014 and 05/2014 were used to study operative duration. A multivariable binary logistic regression model was produced in order to identify significant independent predictors of long (> 90 min) operations. The resulting model was converted to a risk score, which was subsequently validated on second cohort of patients using ROC curves. After exclusions, data were available for 7227 patients in the derivation (CholeS) cohort. The median operative duration was 60 min (interquartile range 45-85), with 17.7% of operations lasting longer than 90 min. Ten factors were found to be significant independent predictors of operative durations > 90 min, including ASA, age, previous surgical admissions, BMI, gallbladder wall thickness and CBD diameter. A risk score was then produced from these factors, and applied to a cohort of 2405 patients from a tertiary centre for external validation. This returned an area under the ROC curve of 0.708 (SE = 0.013, p < 0.001), with the proportions of operations lasting > 90 min increasing more than eightfold from 5.1 to 41.8% in the extremes of the score. The scoring tool produced in this study was found to be significantly predictive of long operative durations on validation in an external cohort. As such, the tool may have the potential to enable organisations to better organise theatre lists and deliver greater efficiencies in care.

14 CFR 119.67 - Management personnel: Qualifications for operations conducted under part 121 of this chapter.

Code of Federal Regulations, 2010 CFR

2010-01-01

... or Part 135 of This Chapter § 119.67 Management personnel: Qualifications for operations conducted... 14 Aeronautics and Space 3 2010-01-01 2010-01-01 false Management personnel: Qualifications for operations conducted under part 121 of this chapter. 119.67 Section 119.67 Aeronautics and Space FEDERAL...

14 CFR 119.71 - Management personnel: Qualifications for operations conducted under part 135 of this chapter.

Code of Federal Regulations, 2010 CFR

2010-01-01

... or Part 135 of This Chapter § 119.71 Management personnel: Qualifications for operations conducted... 14 Aeronautics and Space 3 2010-01-01 2010-01-01 false Management personnel: Qualifications for operations conducted under part 135 of this chapter. 119.71 Section 119.71 Aeronautics and Space FEDERAL...

The Use of Film/Television Techniques in Teaching the Craft of Acting in the Community College.

ERIC Educational Resources Information Center

Bellais, Will

The theatre curriculum at Montgomery College in Rockville, Maryland teaches acting techniques used in film and television in order to take students into the world of performance via the media they appreciate first. While a large number of students do not attend the theatre and have learned little about the cultural heritage of the theatre in their…

Popular Theatre for Science Engagement: Audience Engagement with Human Cloning Following a Production of Caryl Churchill's "A Number"

ERIC Educational Resources Information Center

Donkers, Martina; Orthia, Lindy A.

2016-01-01

Research into the role of fiction in engaging people with science is a growing area, but a little studied medium in this respect is "popular theatre," or non-pedagogic theatre that exists primarily as a work of art. This study investigated audience engagement with human cloning issues after seeing a performance of Caryl Churchill's 2002…

Black Theatre: Ideas That Matter in the Pursuit of Human Dignity.

ERIC Educational Resources Information Center

Sandle, Floyd L.

Black theatre has come a long way from the major stereotypes of black people established by white playwrights, but it is still trying to convey the fact that blacks remain in a kind of prison. The slow pace of black theatre in becoming art is obviously due to the long degradation of blacks, the tolerated injustice of whites, and the belated…

Theatre and Oral Interpretation: Abstracts of Doctoral Dissertations Published in "Dissertation Abstracts International," July through December 1982 (Vol. 43 Nos. 1 through 6).

ERIC Educational Resources Information Center

ERIC Clearinghouse on Reading and Communication Skills, Urbana, IL.

This collection of abstracts is part of a continuing series providing information on recent doctoral dissertations. The 16 titles deal with the following topics: (1) children's theatre activities at Karamu House in Cleveland, Ohio; (2) the development, implementation, and significance of story theatre as a theatrical art form and performance…

As They Liked It: The Tragical-Comical-Pastoral Drama of Elizabethan Theatre. Curriculum Projects. The Huntington Theatre Company's Master Works Study in Shakespeare.

ERIC Educational Resources Information Center

Huntington Theatre Co., Boston, MA.

Developed by the participants of the Huntington Theatre Company's Master Works Study in Shakespeare, this collection presents single lesson plans and unit plans for teaching Elizabethan drama. The collection presents 12 lesson plans (spanning one or a few days of instruction) and 15 unit plans (ranging over several weeks) suitable for secondary…

Summaries, Conclusions, Recommendations from a Survey of the Status of Secondary School Theatre in Maine.

ERIC Educational Resources Information Center

Sawyer, Richard W.

This study is a quantitative descriptive survey of the character and scope of Maine high school curricular and cocurricular theatre education. A two-part questionnaire was mailed to the principal and the teacher most directly concerned with programs in theatre of all Maine public and private high schools in the fall of 1972. Sixty-one percent of…

An Allegory of Addiction Recovery: Exploring the Performance of "Eumenides" by Aeschylus, as Adapted by 18 ANO Theatre Group

ERIC Educational Resources Information Center

Zontou, Zoe

2013-01-01

This paper examines the performance of the "Eumenides," as adapted and performed by 18 ANO theatre group. 18 ANO is the theatre group of the Drug dependence treatment unit 18 ANO of Attica's Psychiatric Hospital, which is based in Athens, Greece. Each year 18 ANO organises performances in the wider community with the aim of promoting…

From Corporate Social Responsibility, through Entrepreneurial Orientation, to Knowledge Sharing: A Study in Cai Luong (Renovated Theatre) Theatre Companies

ERIC Educational Resources Information Center

Tuan, Luu Trong

2015-01-01

Purpose: This paper aims to examine the role of antecedents such as corporate social responsibility (CSR) and entrepreneurial orientation in the chain effect to knowledge sharing among members of Cai Luong theatre companies in the Vietnamese context. Knowledge sharing contributes to the depth of the knowledge pool of both the individuals and the…

Pioneer surgeon drove ultra clean technology.

PubMed

Parkin, Amanda

2013-04-01

On the 50th anniversary of the development of his ground-breaking hip replacement surgical technique, Amanda Parkin, communications consultant with clean air technology specialist, Howorth Air Technology, examines Professor Sir John Charnley's influence on orthopaedic surgery, and explains how his realisation that any subsequent infection may not appear until long after the operation, and that keeping bacteria away from the wound during the procedure is the the key to minimising the risk, led to the emergence of 'ultra clean' operating theatre technology - within which Howorth was an early pioneer.

Cost Effective Regional Ballistic Missile Defense

DTIC Science & Technology

2016-02-16

deploying advanced air defense systems18, such as the Russian S-300 and S-500, and concealing them in hardened, camouflaged sites, such as extensive... Russian objections to the European Phased Adaptive Approach (EPAA) and fund homeland defense priorities.39 Furthermore, the PTSS system was also... Theatre Ballistic Missile Defence Capability Becomes Operational,” Jane’s Missiles & Rockets, 1 February 2011. 55 Joseph W. Kirschbaum, REGIONAL MISSILE

Tactical Unit Data and Decision Requirements for Urban Operations

DTIC Science & Technology

2008-10-01

maneuverability, sensor optimization, weapon effects, terrain), and develop rich but lightweight information structures and architecture . Specifically, the goal...tion structure and systemic architecture that enable sharing common data in near real-time, and mission planning and analysis software for U-BE...Building Function Verify mosque and identify possi- ble schools or meeting places Identify types of cinema (stage/theatre) or other similar nearby

Overseas Contingency Operations: Observations on the Use of Force Management Levels in Afghanistan, Iraq, and Syria

DTIC Science & Technology

2016-12-01

relating to security force assistance activities and readiness of U.S. Special Operations Forces. • Increased Use of Contractors and Personnel on...Temporary Duty. DOD relies on contractors to support a wide range of military operations and free up uniformed personnel to directly support mission...needs. During operations in Afghanistan and Iraq contractor personnel played a critical role in supporting U.S. troops and sometimes exceeded the

"Living theatre, theatre of life".

PubMed

Wenzel, E

1987-09-01

Young people love to play theatre--in one way or another. They like to play with behaviours, costumes, words, communication patterns, etc.; they like to disguise themselves, to create certain spheres and scenes of drama and tragedy, excitement and extacy, satire and irony, morals and decadence. Due to the particular uncertainties of the adolescent passage, youth oscillates between taking life both, too seriously and easy. Searching for identity and integration, they tend to experiment with styles of behaviour and culturally defined patterns of lifestyles conductive to well-being. Sometimes, life is perceived as pure entertainment, and sometimes as pure drama. It's living theatre and theatre of life. On the one hand it is "acting out", on the other hand it is playing precisely defined roles. And, in-between, it is always the question: Who am I? They tend to slip into roles in order to check out whether they are willing to accept their implications with regard to the priorities they have set so far.

Acquisition of 3d Information for Vanished Structure by Using Only AN Ancient Picture

NASA Astrophysics Data System (ADS)

Kunii, Y.; Sakamoto, R.

2016-06-01

In order to acquire 3D information for reconstruction of vanished historical structure, grasp of 3D shape of such structure was attempted by using an ancient picture. Generally, 3D information of a structure is acquired by photogrammetric theory which requires two or more pictures. This paper clarifies that the geometrical information of the structure was obtained only from an ancient picture, and 3D information was acquired. This kind of method was applied for an ancient picture of the Old Imperial Theatre. The Old Imperial Theatre in the picture is constituted by two-point perspective. Therefore, estimated value of focal length of camera, length of camera to the Old Imperial Theatre and some parameters were calculated by estimation of field angle, using body height as an index of length and some geometrical information. Consequently, 3D coordinate of 120 measurement points on the surface of the Old Imperial Theatre were calculated respectively, and 3DCG modeling of the Old Imperial Theatre was realized.

Use of applied theatre in health research dissemination and data validation: a pilot study from South Africa

PubMed Central

Stuttaford, Maria; Bryanston, Claudette; Hundt, Gillian Lewando; Connor, Myles; Thorogood, Margaret; Tollman, Steve

2010-01-01

This article reports on a pilot study of the use of applied theatre in the dissemination of health research findings and validation of data. The study took place in South Africa, as part of the Southern Africa Stroke Prevention Initiative (SASPI) and was based at the University/Medical Research Council Rural Public Health and Health Transitions Research Unit (also known as the Agincourt Unit). The aim of SASPI was to investigate the prevalence of stroke and understand the social context of stroke. It was decided to use an applied theatre approach for validating the data and disseminating findings from the anthropological component of the study. The pilot study found that applied theatre worked better in smaller community groups. It allowed data validation and it elicited ideas for future interventions resulting from the health research findings. Evaluation methods of the impact of applied theatre as a vehicle for the dissemination and communication of research findings require further development. PMID:16322042

Acoustics of Chinese traditional theatres

NASA Astrophysics Data System (ADS)

Wang, J. Q.

2002-11-01

Chinese traditional theatre is unique in the world as an architectural form. The Chinese opera evolved into maturity as early as the Song and Yuan Dynasties, 11th-14th centuries, and Chinese theatrical buildings developed accordingly. As the Chinese opera plays on the principle of imaginary actions, no realistic stage settings are required. But Chinese audiences have placed great demands on vocal performance since ancient times. Pavilion stages that are small in area, open on three sides, and thrusting into the audience area are commonly found in traditional theatres, both the courtyard type and auditorium type. The pavilion stage is backed with a wall and a low ceiling (flat or domed). The stage functions as a reflecting shell, which enhances the sound to the audience and provides self-support to the singer. Numerous theatres of this kind exist and function in good condition to the present time. Acoustical measurements show that the sound strength and clarity in audience areas is satisfactory in moderate size courtyard traditional theatres. [Work supported by NSF.

29 CFR 1917.27 - Personnel.

Code of Federal Regulations, 2013 CFR

2013-07-01

...) MARINE TERMINALS Marine Terminal Operations § 1917.27 Personnel. (a) Qualifications of machinery... code in use shall be permitted to operate a crane, winch or other power operated cargo handling apparatus, or any power operated vehicle, or give signals to the operator of any hoisting apparatus...

29 CFR 1917.27 - Personnel.

Code of Federal Regulations, 2012 CFR

2012-07-01

...) MARINE TERMINALS Marine Terminal Operations § 1917.27 Personnel. (a) Qualifications of machinery... code in use shall be permitted to operate a crane, winch or other power operated cargo handling apparatus, or any power operated vehicle, or give signals to the operator of any hoisting apparatus...

29 CFR 1917.27 - Personnel.

Code of Federal Regulations, 2014 CFR

2014-07-01

...) MARINE TERMINALS Marine Terminal Operations § 1917.27 Personnel. (a) Qualifications of machinery... code in use shall be permitted to operate a crane, winch or other power operated cargo handling apparatus, or any power operated vehicle, or give signals to the operator of any hoisting apparatus...

Observations on personnel dosimetry for radiotherapy personnel operating high-energy LINACs.

PubMed

Glasgow, G P; Eichling, J; Yoder, R C

1986-06-01

A series of measurements were conducted to determine the cause of a sudden increase in personnel radiation exposures. One objective of the measurements was to determine if the increases were related to changing from film dosimeters exchanged monthly to TLD-100 dosimeters exchanged quarterly. While small increases were observed in the dose equivalents of most employees, the dose equivalents of personnel operating medical electron linear accelerators with energies greater than 20 MV doubled coincidentally with the change in the personnel dosimeter program. The measurements indicated a small thermal neutron radiation component around the accelerators operated by these personnel. This component caused the doses measured with the TLD-100 dosimeters to be overstated. Therefore, the increase in these personnel dose equivalents was not due to changes in work habits or radiation environments. Either film or TLD-700 dosimeters would be suitable for personnel monitoring around high-energy linear accelerators. The final choice would depend on economics and personal preference.

The Mortality Peer Review Panel: a report on the deaths on operations of UK Service personnel 2002-2013.

PubMed

Russell, Robert; Hunt, N; Delaney, R

2014-06-01

Review of adverse outcomes is an essential element of healthcare governance. For each operational death, the post-mortem is attended by a member of Academic Department of Military Emergency Medicine and the case is assessed by a Mortality Peer Review Panel comprised of Defence Professors and other clinical and technical experts. A search was conducted of the Joint Theatre Trauma Registry (JTTR) for all UK military death reviews held from January 2002 to November 2013 and the judgement made by the Mortality Peer Review panel. Cases are awarded a 'salvageability' rating between S1 (salvageable) and S4 (not salvageable). Cases graded S1-3 are then assessed further for tactical, clinical or equipment factors that affected the outcome. There were 621 deaths recorded on the JTTR and 517 (83.3%) were due to hostile action. The Killed in Action to Died of Wounds ratio is 6.28 : 1. Explosive mechanisms of injury were responsible for 55.65% of combat deaths and penetrating mechanisms 28.71%. An average of 10.56 injuries was recorded per casualty and the mean number of body regions affected was 3.34. The Peer Review Panel decided that 91.1% cases were not salvageable (S4); this figure is 93.5% if the deaths due to hostile action are considered separately. The severity of modern military trauma is overwhelming in nature and, along with trauma scoring systems, clinical peer review is an essential part of healthcare governance. The process also helps inform and direct research within clinical and force protection fields. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Applying cost accounting to operating room staffing in otolaryngology: time-driven activity-based costing and outpatient adenotonsillectomy.

PubMed

Balakrishnan, Karthik; Goico, Brian; Arjmand, Ellis M

2015-04-01

(1) To describe the application of a detailed cost-accounting method (time-driven activity-cased costing) to operating room personnel costs, avoiding the proxy use of hospital and provider charges. (2) To model potential cost efficiencies using different staffing models with the case study of outpatient adenotonsillectomy. Prospective cost analysis case study. Tertiary pediatric hospital. All otolaryngology providers and otolaryngology operating room staff at our institution. Time-driven activity-based costing demonstrated precise per-case and per-minute calculation of personnel costs. We identified several areas of unused personnel capacity in a basic staffing model. Per-case personnel costs decreased by 23.2% by allowing a surgeon to run 2 operating rooms, despite doubling all other staff. Further cost reductions up to a total of 26.4% were predicted with additional staffing rearrangements. Time-driven activity-based costing allows detailed understanding of not only personnel costs but also how personnel time is used. This in turn allows testing of alternative staffing models to decrease unused personnel capacity and increase efficiency. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2015.

Selected Readings in Drama and Theatre Education: The IDEA '95 Papers (2nd, Brisbane, Australia, July 1995). NADIE Research Monograph Series, 3.

ERIC Educational Resources Information Center

Taylor, Philip, Ed.; Hoepper, Christine, Ed.

Documenting some of the myriad of voices assembled in Brisbane, Australia in July 1995 for the Second World Congress of the International Drama/Theatre and Education Association, the essays in this book address the central question of the Congress: What can be the role of drama/theatre and education in a rapidly changing world entering a new…

"It's a Bit like Flying": Developing Participatory Theatre with the Under-Twos--A Case Study of Oily Cart

ERIC Educational Resources Information Center

Young, Susan

2004-01-01

This article describes a case study of a new venture by the children's theatre company Oily Cart to develop a participatory theatre piece for carers and their under-two-year-olds, entitled Clouds. Given what little is known about how to design and conduct arts events with this age phase, a case study offered the opportunity to identify features…

An Integrated Theatre Production for School Nutrition Promotion Program

PubMed Central

Bush, Robert; Box, Selina; McCallum, David; Khalil, Stephanie

2018-01-01

In the context of stubbornly high childhood obesity rates, health promotion activities in schools provide a potential avenue to improve children’s nutritional behaviours. Theatre production has a rich history as a health behaviour promotion strategy but lacks sound, outcome-based evaluation. This study evaluated the effect of an integrated, two-part, place-based theatre performance program with 212 students in five schools in a regional urban and semi-rural area. The program included a theatre performance and a healthy eating competition. A brief survey assessed student healthy eating knowledge and attitudes at three time points. Nutrition behaviour was measured by scoring the contents of children’s lunch boxes before, during and up to six weeks after the intervention. Statistical analysis tested change over time on five variables (Knowledge, Attitude, Sometimes foods, Everyday foods, Overall lunch box score). Results showed that both components of the integrated program improved nutrition knowledge and that the theatre performance improved children’s healthy eating attitudes. All three lunch box scores peaked after the integrated program and remained significantly higher than baseline at 4–6 weeks follow-up. Interaction effects were identified for school catchment area on four of the five dependent variables. Evaluation of this integrated theatre production program indicates the potential benefit of taking a “super-setting” approach. It demonstrates an effect from students taking home information they had learned and incorporating it into lunch box preparation. It also showed consistent effects for school geographical catchment. This study suggests that, with careful, theory-based design, theatre productions in schools can improve student nutritional activities. PMID:29498690

An Integrated Theatre Production for School Nutrition Promotion Program.

PubMed

Bush, Robert; Capra, Sandra; Box, Selina; McCallum, David; Khalil, Stephanie; Ostini, Remo

2018-03-02

In the context of stubbornly high childhood obesity rates, health promotion activities in schools provide a potential avenue to improve children's nutritional behaviours. Theatre production has a rich history as a health behaviour promotion strategy but lacks sound, outcome-based evaluation. This study evaluated the effect of an integrated, two-part, place-based theatre performance program with 212 students in five schools in a regional urban and semi-rural area. The program included a theatre performance and a healthy eating competition. A brief survey assessed student healthy eating knowledge and attitudes at three time points. Nutrition behaviour was measured by scoring the contents of children's lunch boxes before, during and up to six weeks after the intervention. Statistical analysis tested change over time on five variables (Knowledge, Attitude, Sometimes foods, Everyday foods, Overall lunch box score). Results showed that both components of the integrated program improved nutrition knowledge and that the theatre performance improved children's healthy eating attitudes. All three lunch box scores peaked after the integrated program and remained significantly higher than baseline at 4-6 weeks follow-up. Interaction effects were identified for school catchment area on four of the five dependent variables. Evaluation of this integrated theatre production program indicates the potential benefit of taking a "super-setting" approach. It demonstrates an effect from students taking home information they had learned and incorporating it into lunch box preparation. It also showed consistent effects for school geographical catchment. This study suggests that, with careful, theory-based design, theatre productions in schools can improve student nutritional activities.

Spatial analysis of the etiology of amyotrophic lateral sclerosis among 1991 Gulf War veterans.

PubMed

Miranda, Marie Lynn; Alicia Overstreet Galeano, M; Tassone, Eric; Allen, Kelli D; Horner, Ronnie D

2008-11-01

Veterans of the 1991 Gulf War have an increased risk of amyotrophic lateral sclerosis (ALS), but the etiology is unknown. This study sought to identify geographic areas with elevated risk for the later development of ALS among military personnel who served in the first Gulf War. A unified geographic information system (GIS) was constructed to allow analysis of secondary data on troop movements in the 1991 Gulf War theatre in the Persian Gulf region including Iraq, northern Saudi Arabia, and Kuwait. We fit Bayesian Poisson regression models to adjust for potential risk factors, including one relatively discrete environmental exposure, and to identify areas associated with elevated risk of ALS. We found that service in particular locations of the Gulf was associated with an elevated risk for later developing ALS, both before and after adjustment for branch of service and potential of exposure to chemical warfare agents in and around Khamisiyah, Iraq. Specific geographic locations of troop units within the 1991 Gulf War theatre are associated with an increased risk for the subsequent development of ALS among members of those units. The identified spatial locations represent the logical starting points in the search for potential etiologic factors of ALS among Gulf War veterans. Of note, for locations where the relative odds of subsequently developing ALS are among the highest, specific risk factors, whether environmental or occupationally related, have not been identified. The results of spatial models can be used to subsequently look for risk factors that follow the spatial pattern of elevated risk.

Effects of System Timing Parameters on Operator Performance in a Personnel Records Task

DTIC Science & Technology

1981-03-01

work sampling, embedded performance measures, and operator satisfaction ratings) are needed to provide a complete analysis of the effects of the four...HFL-8 l-l/NPRDC-8 1-1 March 1981 EFFECTS OF SYSTEM TIMING PARAMETERS ON OPERATOR PERFORMANCE IN A PERSONNEL RECORDS TASK Robert C. Williges Beverly H...and Subtitle) S. TYPE OF REPORT & PERIOD COVERED EFFECTS OF SYSTEM TIMING PARAMETERS ON OPERATOR PERFORMANCE IN A PERSONNEL RECORDS TASK Final

Interventional Radiologists: a Necessary Evaluation of Technical, Protective and Technological Operation.

PubMed

Rahimi, Sayed Ali; Pourkaveh, Maryam

2016-02-01

To present the results of occupational radiation doses investigated through a Hospitals of Mazandaran Medical Science Universities in north of Iran. Radiology unit has an important role in diagnosis of many disorders with providing suitable and high quality pictures. A good picture was provided using correct technical criteria and suitable circumstance of patient. Finally, operation and knowledge of radiology personnel directly has a primary role in determining quality of radiography. This study was done in order to determine personnel operation in the units of hospitals radiologist related to University of Mazandaran Medical Science. Data collection tools are made of a researcher check list that was used after obtaining suitable letter and validity indexes. All of the 73 personnel of radiology unit related to Mazandaran Medical Science were studied. 35 operations (in technical, protective and technological fields) of any personnel, in three distinct shifts were observed and recorded. All of them were tested regarding these three fields with a total of 40 questions. The total scores received from personnel in technical part in the morning, evening and night shift were 66.4, 53.9 and 60.2 percent respectively. Received scores from personnel in the protective fields were 68.1, 59.5 and 60.2 percent. Moreover, received scores from personnel in the technological operation fields were 47.8, 39.95 and 43.65 percent respectively. Comparison of these three scores in technical, protective and technological operation fields showed a meaningful difference (p<0.05). The overall quality of personnel operations were nearly desirable and in need of continuous education, supervision and evaluation. Emphasizing protection to beams, accessibility of necessary tools, continuous supervision regarding the usage of these equipments and respecting the other security points have an important role in decreasing patients absorbed doses.

"You Know the Homophobic Stuff Is Not in Me, Like Us, It's Out There". Using Participatory Theatre to Challenge Heterosexism and Heteronormativity in a South African School

ERIC Educational Resources Information Center

Francis, Dennis

2013-01-01

Forum Theatre (FT), a participatory improvised theatre form, raises consciousness, enables debate and critical reflection, and encourages a democratic form of knowledge production that engages the audience in their own learning and unlearning. I used FT as a platform to understand how 15- to 18-year-old learners, in a co-educational school in the…

[Nursing professionals and health care assistants' perception of patient safety culture in the operating room].

PubMed

Bernalte-Martí, Vicente; Orts-Cortés, María Isabel; Maciá-Soler, Loreto

2015-01-01

To assess nursing professionals and health care assistants' perceptions, opinions and behaviours on patient safety culture in the operating room of a public hospital of the Spanish National Health Service. To describe strengths and weaknesses or opportunities for improvement according to the Agency for Healthcare Research and Quality criteria, as well as to determine the number of events reported. A descriptive, cross-sectional study was conducted using the Spanish version of the questionnaire Hospital Survey on Patient Safety Culture. The sample consisted of nursing professionals, who agreed to participate voluntarily in this study and met the selection criteria. A descriptive and inferential analysis was performed depending on the nature of the variables and the application conditions of statistical tests. Significance if p < .05. In total, 74 nursing professionals responded (63.2%). No strengths were found in the operating theatre, and improvements are needed concerning staffing (64.0%), and hospital management support for patient safety (52.9%). A total of 52.3% (n = 65) gave patient safety a score from 7 to 8.99 (on a 10 point scale); 79.7% (n = 72) reported no events last year. The total variance explained by the regression model was 0.56 for "Frequency of incident reporting" and 0.26 for "Overall perception of safety". There was a more positive perception of patient safety culture at unit level. Weaknesses have been identified, and they can be used to design specific intervention activities to improve patient safety culture in other nearby operating theatres. Copyright © 2014 Elsevier España, S.L.U. All rights reserved.

Impact of same day vs day before pre-operative lymphoscintigraphy for sentinel lymph node biopsy for early breast cancer (local Australian experience).

PubMed

Huang, Yang Yang; Maurel, Amelie; Hamza, Saud; Jackson, Lee; Al-Ogaili, Zeyad

2018-06-01

To assess the impact of delayed vs immediate pre-operative lymphoscintigraphy (LSG) for sentinel lymph node biopsy in a single Australian tertiary breast cancer centre. Retrospective cohort study analysing patients with breast cancer or DCIS who underwent lumpectomy or mastectomy with pre-operative LSG and intra-operative sentinel lymph node biopsy from January 2015 to June 2016. A total of 182 LSG were performed. Group A patients had day before pre-operative LSG mapping (n = 79) and Group B had LSG mapping on the day of surgery (n = 103). The overall LSG localisation rate was 97.3% and no statistical difference was detected between the two groups. The overall sentinel lymph node biopsies (SLN) were identified in 99.6% of patients. The number of nodes excised was slightly higher in Group A (1.90 vs 1.72); however, this was not statistically significant. In addition, the number of nodes on histopathology and the incidence of second echelon nodal detection were also similar between the two groups without statistical significance. In conclusion, the 2-day LSG protocol had no impact on overall SLNB and LSG detection rates although slightly higher second tier nodes but this did not translate to any difference between the number of harvest nodes between the two groups. The 2-day LSG allows for greater flexibility in theatre planning and more efficient use of theatre time. We recommend a dose of 40 Mbq of Tc99 m pertechnetate-labelled colloid be given day prior to surgery within a 24-hour timeframe. © 2017 The Royal Australian and New Zealand College of Radiologists.

Relationship between intraoperative non-technical performance and technical events in bariatric surgery.

PubMed

Fecso, A B; Kuzulugil, S S; Babaoglu, C; Bener, A B; Grantcharov, T P

2018-03-30

The operating theatre is a unique environment with complex team interactions, where technical and non-technical performance affect patient outcomes. The correlation between technical and non-technical performance, however, remains underinvestigated. The purpose of this study was to explore these interactions in the operating theatre. A prospective single-centre observational study was conducted at a tertiary academic medical centre. One surgeon and three fellows participated as main operators. All patients who underwent a laparoscopic Roux-en-Y gastric bypass and had the procedures captured using the Operating Room Black Box ® platform were included. Technical assessment was performed using the Objective Structured Assessment of Technical Skills and Generic Error Rating Tool instruments. For non-technical assessment, the Non-Technical Skills for Surgeons (NOTSS) and Scrub Practitioners' List of Intraoperative Non-Technical Skills (SPLINTS) tools were used. Spearman rank-order correlation and N-gram statistics were conducted. Fifty-six patients were included in the study and 90 procedural steps (gastrojejunostomy and jejunojejunostomy) were analysed. There was a moderate to strong correlation between technical adverse events (r s  = 0·417-0·687), rectifications (r s  = 0·380-0·768) and non-technical performance of the surgical and nursing teams (NOTSS and SPLINTS). N-gram statistics showed that after technical errors, events and prior rectifications, the staff surgeon and the scrub nurse exhibited the most positive non-technical behaviours, irrespective of operator (staff surgeon or fellow). This study demonstrated that technical and non-technical performances are related, on both an individual and a team level. Valuable data can be obtained around intraoperative errors, events and rectifications. © 2018 BJS Society Ltd Published by John Wiley & Sons Ltd.

[Endovascular surgery in the war].

PubMed

Reva, V A; Samokhvalov, I M

2015-01-01

Rapid growth of medical technologies has led to implementation of endovascular methods of diagnosis and treatment into rapidly developing battlefield surgery. This work based on analysing all available current publications generalizes the data on using endovascular surgery in combat vascular injury. During the Korean war (1950-1953) American surgeons for the first time performed endovascular balloon occlusion of the aorta - the first intravascular intervention carried out in a zone of combat operations. Half a century thereafter, with the beginning of the war in Afghanistan (2001) and in Iraq (2003) surgeons of central hospitals of the USA Armed Forces began performing delayed endovascular operations to the wounded. The development of technologies, advent of mobile angiographs made it possible to later on implement high-tech endovascular interventions in a zone of combat operations. At first, more often they performed implantation of cava filters, somewhat afterward - angioembolization of damaged accessory vessels, stenting and endovascular repair of major arteries. The first in the theatre of war endovascular prosthetic repair of the thoracic aorta for severe closed injury was performed in 2008. Russian experience of using endovascular surgery in combat injuries is limited to diagnostic angiography and regional intraarterial perfusion. Despite the advent of stationary angiographs in large hospitals of the RF Ministry of Defence in the early 1990s, endovascular operations for combat vascular injury are casuistic. Foreign experience in active implementation of endovascular technologies to treatment of war-time injuries has substantiated feasibility of using intravascular interventions in tertiary care military hospitals. Carrying out basic training courses on endovascular surgery should become an organic part of preparing multimodality general battlefield surgeons rendering care on the theatre of combat operations.

Operating Room Traffic as a Modifiable Risk Factor for Surgical Site Infection.

PubMed

Wanta, Brendan T; Glasgow, Amy E; Habermann, Elizabeth B; Kor, Daryl J; Cima, Robert R; Berbari, Elie F; Curry, Timothy B; Brown, Michael J; Hyder, Joseph A

2016-12-01

Surgical site infections (SSI) contribute to surgical patients' morbidity and costs. Operating room traffic may be a modifiable risk factor for SSI. We investigated the impact of additional operating room personnel on the risk of superficial SSI (sSSI). In this matched case-control study, cases included patients in whom sSSI developed in clean surgical incisions after elective, daytime operations. Control subjects were matched by age, gender, and procedure. Operating room personnel were classified as (1) surgical scrubbed, (2) surgical non-scrubbed, or (3) anesthesia. We used conditional logistic regression to test the extent to which additional personnel overall and from each work group were associated with infection. In total, 474 patients and 803 control subjects were identified. Each additional person among total personnel and personnel from each work group was significantly associated with greater odds of infection (all personnel, odds ratio [OR] = 1.082, 95% confidence interval [CI] 1.031-1.134, p = 0.0013; surgical scrubbed OR = 1.132, 95% CI 1.029-1.245, p = 0.0105; surgical non-scrubbed OR = 1.123, 95% CI 1.008-1.251, p = 0.0357; anesthesia OR = 1.153, 95% CI 1.031-1.290, p = 0.0127). After adjusting for operative duration, body mass index, diabetes mellitus, and vascular disease, additional personnel and sSSI were no longer associated overall or for any work groups (total personnel OR = 1.033, 95% CI 0.974-1.095, p = 0.2746; surgical scrubbed OR = 1.060, 95% CI 0.952-1.179, p = 0.2893; surgical non-scrubbed OR = 1.023 95% CI 0.907-1.154, p = 0.7129; anesthesia OR = 1.051, 95% CI 0.926-1.193, p = 0.4442). The presence of additional operating room personnel was not independently associated with increased odds of sSSI. Efforts dedicated to sSSI reduction should focus on other modifiable risk factors.

Experience of head and neck theatre staff and attitudes to human factors using an aviation-based analysis and classification system--a pilot survey.

PubMed

Konieczny, Katarzyna M; Seager, Leonie; Scott, Jim; Colbert, Serryth; Dale, Trevor; Brennan, Peter A

2014-01-01

The role that human factors have in contributing to air crashes is well known and is included as an essential part of training. Awareness of human factors in surgery is increasingly being recognised but surprisingly few papers have come from head and neck specialties. We circulated a questionnaire on human factors based on an aviation model to 140 head and neck medical and ancillary staff who work in operating theatres in 3 large UK hospitals. Most positive responses were found in the consultant group followed by trainee doctors and support staff. A significant difference was found in the subcategories of Unsafe Supervision (p=0.002) and Preconditions to Unsafe Acts (p=0.001). This work will help to identify multi-system deficiencies that can be corrected, and highlights aspects that may yield the greatest reduction in surgical errors. Copyright © 2013 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

Distractions during critical phases of anaesthesia for caesarean section: an observational study.

PubMed

Jenkins, A; Wilkinson, J V; Akeroyd, M A; Broom, M A

2015-05-01

Aviation's 'sterile cockpit' rule holds that distractions on the flight deck should be kept at a minimum during critical phases of flight. To assess current practice at comparable points during obstetric regional anaesthesia, we measured ambient noise and distracting events during 30 caesarean sections in three phases: during establishment of regional anaesthesia; during testing of regional blockade; and after delivery of the fetal head. Mean (SD) noise levels were 62.5 (3.9) dB during establishment of blockade, 63.9 (4.1) dB during testing and 66.8 (5.0) dB after delivery (p < 0.001). The median rates of sudden, loud (> 70 dB) noises, non-clinical conversations and numbers of staff present in the operating theatre increased during each of the three phases. Conversely, entrances into, and exits from, theatre per minute were highest during establishment of regional anaesthesia and decreased over the subsequent two time periods (p < 0.001). © 2014 The Association of Anaesthetists of Great Britain and Ireland.

Hot off the Press for Perioperative Nurses.

PubMed

Fisher, Mona Guckian

2017-06-01

I am delighted to bring you the Perioperative Care Collaborative (PCC) National Core Curriculum for Perioperative Nursing 2017, whose purpose is 'influencing and supporting clinical policies into perioperative practice'. This is a very important document for nurses working within operating theatre settings. Since the dissolution of the English National Board (ENB), perioperative nurses have not had access to appropriate professional courses in line with what had been previously available.

First multiphoton tomography of brain in man

NASA Astrophysics Data System (ADS)

König, Karsten; Kantelhardt, Sven R.; Kalasauskas, Darius; Kim, Ella; Giese, Alf

2016-03-01

We report on the first two-photon in vivo brain tissue imaging study in man. High resolution in vivo histology by multiphoton tomography (MPT) including two-photon FLIM was performed in the operation theatre during neurosurgery to evaluate the feasibility to detect label-free tumor borders with subcellular resolution. This feasibility study demonstrates, that MPT has the potential to identify tumor borders on a cellular level in nearly real-time.

33 CFR 150.620 - What are the requirements for protecting personnel from machinery?

Code of Federal Regulations, 2010 CFR

2010-07-01

... deepwater port operator must ensure that all personnel are protected from the risks created by operating..., DEPARTMENT OF HOMELAND SECURITY (CONTINUED) DEEPWATER PORTS DEEPWATER PORTS: OPERATIONS Workplace Safety and...

"Who's on the team today?" The status of briefing amongst operating theatre practitioners in one UK hospital.

PubMed

Allard, Jon; Bleakley, Alan; Hobbs, Adrian; Vinnell, Tina

2007-03-01

Accidents in health care are mainly due to systemic communication errors. Errors occur more frequently in the operating theatre (OT) than other clinical settings. Hence, it is important that preventive communication practices are adopted in OT teams. Formal team pre-briefing has been shown to improve safety in high risk settings such as aviation, but such briefing is not common practice in OT teams. This paper reviews key literature demonstrating the value of briefing in high-risk practices; presents and analyses the results of a questionnaire survey on the status of briefing after its introduction to OT teams in one UK hospital; and analyses processes that frustrate widespread adoption of briefing. In comparison with other OT practitioners, surgeons generally reported differing perceptions of the meaning and value of briefing, often holding broad notions of what constitutes a "brief", but also showing scepticism towards briefing. However, surgeons who had introduced briefing reported positive results such as greater efficiency, shared understanding, and increased team morale. Collaborative briefing that extends beyond the technical to include the interpersonal could be initiated in principle by any member of the OT team, but a number of factors inhibit this, and surgeons play a pivotal role in establishing briefing.

Clean and Green: Saving Water in the Operating Theatre

PubMed Central

Jehle, Karlheinz; Jarrett, Nick; Matthews, Shaun

2008-01-01

INTRODUCTION There is a growing trend to use alcohol-based hand disinfectants in clinical practice. In addition to their antibacterial efficacy, these disinfectants offer an alternative to traditional surgical hand disinfection agents that can save water in the operating theatre. MATERIALS AND METHODS The amounts of water and soap used during traditional surgical hand disinfection with antiseptic soap preparations were measured and water usage over a 1-year period was estimated. Costs of traditional disinfection agents were compared with alcohol-based agents. RESULTS One surgical hand disinfection episode with traditional agents used 18.5 l of water. During 15,500 procedures performed at our institution over a 1-year period, 931,938 l of water were used which could have been saved had alcohol-based agents been used. Cost per episode of hand disinfection depends on the amounts used and is not higher compared to traditional agents. CONCLUSIONS The benefits of using an alcohol-based surgical hand disinfectant may include significant water savings, in addition to previously published advantages of improved efficacy. When deciding on the method of surgical hand disinfection, careful thought should be given to the use of water as a resource. Surgeons should be aware of the environmental impact of their profession. PMID:18201493

A new mechatronic assistance system for the neurosurgical operating theatre: implementation, assessment of accuracy and application concepts.

PubMed

Rachinger, Jens; Bumm, Klaus; Wurm, Jochen; Bohr, Christopher; Nissen, Urs; Dannenmann, Tim; Buchfelder, Michael; Iro, Heinrich; Nimsky, Christopher

2007-01-01

To introduce a new robotic system to the field of neurosurgery and report on a preliminary assessment of accuracy as well as on envisioned application concepts. Based on experience with another system (Evolution 1, URS Inc., Schwerin, Germany), technical advancements are discussed. The basic module is an industrial 6 degrees of freedom robotic arm with a modified control element. The system combines frameless stereotaxy, robotics, and endoscopy. The robotic reproducibility error and the overall error were evaluated. For accuracy testing CT markers were placed on a cadaveric head and pinpointed with the robot's tool tip, both fully automated and telemanipulatory. Applicability in a clinical setting, user friendliness, safety and flexibility were assessed. The new system is suitable for use in the neurosurgical operating theatre. Hard- and software are user-friendly and flexible. The mean reproducibility error was 0.052-0.062 mm, the mean overall error was 0.816 mm. The system is less cumbersome and much easier to use than the Evolution 1. With its user-friendly interface and reliable safety features, its high application accuracy and flexibility, the new system is a versatile robotic platform for various neurosurgical applications. Adaptations for different applications are currently being realized. Copyright (c) 2007 S. Karger AG, Basel.

Surgical specimen handover from the operating theatre to laboratory-Can we improve patient safety by learning from aviation and other high-risk organisations?

PubMed

Brennan, Peter A; Brands, Marieke T; Caldwell, Lucy; Fonseca, Felipe Paiva; Turley, Nic; Foley, Susie; Rahimi, Siavash

2018-02-01

Essential communication between healthcare staff is considered one of the key requirements for both safety and quality care when patients are handed over from one clinical area to other. This is particularly important in environments such as the operating theatre and intensive care where mistakes can be devastating. Health care has learned from other high-risk organisations (HRO) such as aviation where the use of checklists and human factors awareness has virtually eliminated human error and mistakes. To our knowledge, little has been published around ways to improve pathology specimen handover following surgery, with pathology request forms often conveying the bare minimum of information to assist the laboratory staff. Furthermore, the request form might not warn staff about potential hazards. In this article, we provide a brief summary of the factors involved in human error and introduce a novel checklist that can be readily completed at the same time as the routine pathology request form. This additional measure enhances safety, can help to reduce processing and mislabelling errors and provides essential information in a structured way assisting both laboratory staff and pathologists when handling head and neck surgical specimens. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Surgical skills simulation in trauma and orthopaedic training.

PubMed

Stirling, Euan R B; Lewis, Thomas L; Ferran, Nicholas A

2014-12-19

Changing patterns of health care delivery and the rapid evolution of orthopaedic surgical techniques have made it increasingly difficult for trainees to develop expertise in their craft. Working hour restrictions and a drive towards senior led care demands that proficiency be gained in a shorter period of time whilst requiring a greater skill set than that in the past. The resulting conflict between service provision and training has necessitated the development of alternative methods in order to compensate for the reduction in 'hands-on' experience. Simulation training provides the opportunity to develop surgical skills in a controlled environment whilst minimising risks to patient safety, operating theatre usage and financial expenditure. Many options for simulation exist within orthopaedics from cadaveric or prosthetic models, to arthroscopic simulators, to advanced virtual reality and three-dimensional software tools. There are limitations to this form of training, but it has significant potential for trainees to achieve competence in procedures prior to real-life practice. The evidence for its direct transferability to operating theatre performance is limited but there are clear benefits such as increasing trainee confidence and familiarity with equipment. With progressively improving methods of simulation available, it is likely to become more important in the ongoing and future training and assessment of orthopaedic surgeons.

Is the Army Communicating Effectively in Today’s Information Environment

DTIC Science & Technology

2013-03-01

to undertake a rapid and fundamental shift in the education, training, and resourcing of its Public Affairs career field, personnel and operations to...rapid and fundamental shift in the education, training, and resourcing of its Public Affairs career field, personnel and operations to effectively...rapid and fundamental shift in the education, training, and resourcing of its Public Affairs career field, personnel and operations to effectively

Inside ‘Inside View’: reflections on stimulating debate and engagement through a multimedia live theatre production on the dilemmas and issues of pre‐natal screening policy and practice

PubMed Central

Hundt, Gillian Lewando; Bryanston, Claudette; Lowe, Pam; Cross, Saul; Sandall, Jane; Spencer, Kevin

2010-01-01

Abstract Background  The role of applied theatre in engaging both lay and professional publics with debate on health policy and practice is an emergent field. This paper discusses the development, production performance and discussion of ‘Inside View’. 1 Objectives  The objectives were to produce applied theatre from research findings of a completed study on genetic prenatal screening, exploring the dilemmas for women and health professionals of prenatal genetic screening, and to engage audiences in debate and reflection on the dilemmas of prenatal genetic screening. Methods  ‘Inside View’ was developed from a multidisciplinary research study through identification of emergent themes from qualitative interviews, and development of these by the writer, theatre producer and media technologist with input from the researchers. Findings  Inside View was performed in London and the Midlands to varied audiences with a panel discussion and evaluation post performance. The audiences were engaged in debate that was relevant to them professionally and personally. Knowledge translation through applied theatre is an effective tool for engaging the public but the impact subsequently is unclear. There are ethical issues of unexpected disclosure during discussion post performance and the process of transforming research findings into applied theatre requires time and trust within the multidisciplinary team as well as adequate resourcing. PMID:20550593

Trends in musical theatre voice: an analysis of audition requirements for singers.

PubMed

Green, Kathryn; Freeman, Warren; Edwards, Matthew; Meyer, David

2014-05-01

The American musical theatre industry is a multibillion dollar business in which the requirements for singers are varied and complex. This study identifies the musical genres and voice requirements that are currently most requested at professional auditions to help voice teachers, pedagogues, and physicians who work with musical theatre singers understand the demands of their clients' business. Frequency count. One thousand two thirty-eight professional musical theatre audition listings were gathered over a 6-month period, and information from each listing was categorized and entered into a spreadsheet for analysis. The results indicate that four main genres of music were requested over a wide variety of styles, with more than half of auditions requesting genre categories that may not be served by traditional or classical voice technique alone. To adequately prepare young musical theatre performers for the current job market and keep the performers healthily making the sounds required by the industry, new singing styles may need to be studied and integrated into voice training that only teaches classical styles. Copyright © 2014 The Voice Foundation. Published by Mosby, Inc. All rights reserved.

Exploring the benefits of an optional theatre module on medical student well-being.

PubMed

Nagji, Alim; Brett-MacLean, Pamela; Breault, Lorraine

2013-01-01

Medical students struggle with varied stressors and developing adequate coping mechanisms is essential. This study examined medical student perceptions of the well-being impact of a theatre-based course. Eighteen 1st-year medical students at the University of Alberta participated in 3 focus groups following the conclusion of a theatre-based module that was piloted in the first quarter of 2010. A semistructured protocol was used to guide the focus groups, which were audiotaped and transcribed. Along with general feedback, impact on personal development and student well-being were discussed. Thematic aspects of these discussions were qualitatively analyzed. During the focus groups, medical students identified three aspects of the theatre-based module that contributed to their sense of overall well-being. These included (a) fun/relaxation, (b) enhanced relationships with each other, and (c) personal growth/resilience. Our findings suggest that participating in an optional theatre module can enhance medical student well-being. Our analysis suggests the need to consider novel, humanities-based curriculum offerings in relation to personal development and well- being.

The viewpoint-specific failure of modern 3D displays in laparoscopic surgery.

PubMed

Sakata, Shinichiro; Grove, Philip M; Hill, Andrew; Watson, Marcus O; Stevenson, Andrew R L

2016-11-01

Surgeons conventionally assume the optimal viewing position during 3D laparoscopic surgery and may not be aware of the potential hazards to team members positioned across different suboptimal viewing positions. The first aim of this study was to map the viewing positions within a standard operating theatre where individuals may experience visual ghosting (i.e. double vision images) from crosstalk. The second aim was to characterize the standard viewing positions adopted by instrument nurses and surgical assistants during laparoscopic pelvic surgery and report the associated levels of visual ghosting and discomfort. In experiment 1, 15 participants viewed a laparoscopic 3D display from 176 different viewing positions around the screen. In experiment 2, 12 participants (randomly assigned to four clinically relevant viewing positions) viewed laparoscopic suturing in a simulation laboratory. In both experiments, we measured the intensity of visual ghosting. In experiment 2, participants also completed the Simulator Sickness Questionnaire. We mapped locations within the dimensions of a standard operating theatre at which visual ghosting may result during 3D laparoscopy. Head height relative to the bottom of the image and large horizontal eccentricities away from the surface normal were important contributors to high levels of visual ghosting. Conventional viewing positions adopted by instrument nurses yielded high levels of visual ghosting and severe discomfort. The conventional viewing positions adopted by surgical team members during laparoscopic pelvic operations are suboptimal for viewing 3D laparoscopic displays, and even short periods of viewing can yield high levels of discomfort.

10 CFR 72.190 - Operator requirements.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 10 Energy 2 2010-01-01 2010-01-01 false Operator requirements. 72.190 Section 72.190 Energy... and certified personnel or be under the direct visual supervision of an individual with training and certification in the operation. Supervisory personnel who personally direct the operation of equipment and...

Theatre in the Curriculum.

ERIC Educational Resources Information Center

Teaching Theatre, 1990

1990-01-01

Relates the text of the Educational Theatre Association-National Association of Secondary School Principals brochure. Discusses theater's place in the high school curriculum and the qualities of a good high school curriculum. (PRA)

Alarm upgrade meets new standards.

PubMed

2004-11-01

When Bedford Hospital NHS Trust decided to replace its ageing and increasingly unreliable fire detection and alarm system, it was looking to achieve more than just compliance with the latest regulations. It wanted a flexible, state-of-the-art system that would not only meet its current requirements but would also be easy to adapt and inexpensive to maintain. The pound 1 million Gent Vigilon fire system now operating across the site has given it just that. The 15-month long project to install the system was completed without a single ward or operating theatre having to be shut down.

[Theatre as a form of physical mediation].

PubMed

Ostermeyer, Monique

2016-01-01

In psychiatric care, the specific physical relationship that the nursing staff have with people in distress must be taken into account. In a workshop, this physical relationship extends to the group. In a theatre workshop, it is even more complex as the body is engaged in play, in character and sometimes in front of an audience. This article describes the experience of participants and nurses with regard to the particularity of the body within the theatre setting. Copyright © 2016. Published by Elsevier Masson SAS.

The fluorescence theatre: a cost-effective device using theatre gels for fluorescent protein and dye screening.

PubMed

Heil, John R; Nordeste, Ricardo F; Charles, Trevor C

2011-04-01

Here we report a simple cost-effective device for screening colonies on plates for expression of the monomeric red fluorescent protein mRFP1 and the fluorescent dye Nile red. This device can be built from any simple light source, in our case a Quebec Colony Counter, and cost-effective theatre gels. The device can be assembled in as little as 20 min, and it produces excellent results when screening a large number of colonies.