The Gap between Individual Perception and Compliance: A Qualitative Follow-Up Study of the Surgical Safety Checklist Application

Background

“The Surgical Safety Checklist (SSC) is important, but we don’t use it adequately” is a well-suited statement that reflects the SSC''s application in hospitals. Our aim was to follow up on our initial study on compliance (2014) by analysing differences between individual perception and compliance with the SSC.

Methods

We conducted a follow-up online survey to assess healthcare professionals’ individual perception of, as well as satisfaction and compliance with the SSC three years following its thorough implementation.

Results

171 (19.5%) of 875 operating team members completed the online survey. 99.4% confirmed using the SSC. Self-estimated subjective knowledge about the intention of the checklist was high, whereas objective knowledge was moderate, but improved as compared to 2014. According to an independent audit the SSC was used in 93.1% of all operations and among the SSCs used the completion rate was 57.2%. The use of the SSC was rated as rather easy [median (IQR): 7 (6–7)], familiar [7 (6–7)], generally important [7 (7–7)], and good for patients [7 (6–7)] as well as for employees [7 (7–7)]. Only comfort of use was rated lower [6 (5–7)].

Conclusion

There is a gap between individual perception and actual application of the SSC. Despite healthcare professionals confirming the importance of the SSC, compliance was moderate. The introduction of SSCs in the health care sector remains a constant challenge and requires continuous re-evaluation as well as a sensible integration into existing workflows in hospitals.     

Implementation of the Surgical Safety Checklist in Switzerland and Perceptions of Its Benefits: Cross-Sectional Survey

Objectives

To examine the implementation of the Surgical Safety Checklist (SSC) among surgeons and anaesthetists working in Swiss hospitals and clinics and their perceptions of the SSC.

Methods

Cross-sectional survey at the 97^th Annual Meeting of the Swiss Society of Surgery, Switzerland, 2010. Opinions of the SSC were assessed with a 6-item questionnaire.

Results

152 respondents answered the questionnaire (participation rate 35.1%). 64.7% respondents acknowledged having a checklist in their hospital or their clinic. Median implementation year was 2009. More than 8 out of 10 respondents reported their team applied the Sign In and the Time Out very often or quasi systematically, whereas almost half of respondents acknowledged the Sign Out was applied never or rarely. The majority of respondents agreed that the checklist improves safety and team communication, and helps to develop a safety culture. However, they were less supportive about the opinion that the checklist facilitates teamwork and eliminates social hierarchy between caregivers.

Conclusions

This survey indicates that the SSC has been largely implemented in many Swiss hospitals and clinics. Both surgeons and anaesthetists perceived the SSC as a valuable tool in improving intraoperative patient safety and communication among health care professionals, with lesser importance in facilitating teamwork (and eliminating hierarchical categories).     

Assessing Dietary and Exercise Stage of Change to Optimize Weight Loss Interventions

Objective : According to the Transtheoretical Model (TM), tailoring interventions to patients’ readiness to change can enhance patient progress and help patients use therapeutic resources more effectively. However, tailoring an intervention depends on accurate assessment of patients’ stage of change (SOC). This study describes a multi‐item algorithm of SOC (M‐SOC) for weight loss‐related behaviors that attempts to overcome some of the conceptual and methodological difficulties encountered in previously SOC assessments. Research Methods: Data were collected from participants randomly assigned to the treatment arm of a clinical trial comparing a TM‐based, cognitive‐behavioral intervention with enhanced usual care for weight loss. Results : The stair‐step relationships hypothesized by the TM between assessed SOC and key behavioral measures were found for all algorithms (p < 0.05), indicating that the M‐SOC algorithm performs as well as single item algorithms. However, 50% fewer patients were classified in action or maintenance for dietary fat intake and portion control (p < 0.05) by the multiple‐item algorithms, providing staging more consistent with the clinical presentation of obese individuals. In addition, logistic regression analyses indicated that the single‐item algorithms were not sufficient predictors of these behavioral domains. Discussion : To the extent that treatment is guided by assessed SOC, there is potential for a considerable variability in interventions with different approaches to staging. For weight‐loss interventions that target portion control and decreased fat intake, the multi‐item SOC algorithms seem to be better guides for matching treatments to SOC.     

Interventions to Increase the Uptake of Mammography amongst Low Income Women: A Systematic Review and Meta-Analysis

Background

Two previous reviews found that access-enhancing interventions were effective in increasing mammography uptake amongst low-income women. The purpose of this study was to estimate the magnitude of the effect of interventions used to increase uptake of mammography amongst low-income women.

Methods

Searches were conducted in MEDLINE and EMBASE (2002–April 2012) using relevant MeSH terms and keywords. Randomised controlled trials which aimed to increase mammography use in an asymptomatic low-income population and which had as an outcome receipt of a mammogram, were eligible for inclusion. The primary outcome was the post-intervention difference in the proportion of women who had a mammogram in the intervention and control groups. The quality of the studies was assessed using the Cochrane risk of bias tool. We calculated summary estimates using random effects meta-analyses. Possible reasons for heterogeneity were investigated using sub-group analyses and meta-regression. Publication bias was assessed using Egger''s test.

Results

Twenty-one studies met the inclusion criteria, including 33 comparisons. Interventions increased the uptake of mammography in low income women by an additional 8.9% (95% CI 7.3 to 10.4%) compared to the control group. There was some evidence that interventions with multiple strategies were more effective than those with single strategies (p  = 0.03). There was some suggestion of publication bias. The quality of the included studies was often unclear. Omitting those with high risk of bias has little effect on the results.

Conclusions

Interventions can increase mammography uptake among low-income women, multiple interventions being the most effective strategy. Given the robustness of the results to sensitivity analyses, the results are likely to be reliable. The generalisability of the results beyond the US is unclear.     

Simulating Strategic Implementation of the CRP to Increase Greater Prairie-Chicken Abundance

The Conservation Reserve Program (CRP) has the potential to influence the distribution and abundance of grasslands in many agricultural landscapes, and thereby provide habitat for grassland-dependent wildlife. Greater prairie-chickens (Tympanuchus cupido pinnatus) are a grassland-dependent species with large area requirements and have been used as an indicator of grassland ecosystem function; they are also a species of conservation concern across much of their range. Greater prairie-chicken populations respond to the amount and configuration of grasslands and wetlands in agriculturally dominated landscapes, which in turn can be influenced by the CRP; however, CRP enrollments and enrollment caps have declined from previous highs. Therefore, prioritizing CRP reenrollments and new enrollments to achieve the greatest benefit for grassland-dependent wildlife seems prudent. We used models relating either lek density or the number of males at leks to CRP enrollments and the resulting landscape structure to predict changes in greater prairie-chicken abundance related to changes in CRP enrollments. We simulated 3 land-cover scenarios: expiration of existing CRP enrollments, random, small-parcel (4,040 m²) addition of CRP grasslands, and strategic, large-parcel (80,000 m²) addition of CRP grasslands. Large-parcel additions were the average enrollment size in northwestern Minnesota, USA, within the context of a regional prairie restoration plan. In our simulations of CRP enrollment expirations, the abundance of greater prairie-chickens declined when grassland landscape contiguity declined with loss of CRP enrollments. Simulations of strategic CRP enrollment with large parcels to increase grassland contiguity more often increased greater prairie-chicken abundance than random additions of the same area in small parcels that did not increase grassland contiguity. In some cases, CRP enrollments had no or a negative predicted change in greater prairie-chicken abundance because they provided insufficient grassland contiguity on the landscape, or increased cover-type fragmentation. Predicted greater prairie-chicken abundance increased under large-parcel and small-parcel scenarios of addition of CRP grassland; the greatest increases were associated with large-parcel additions. We suggest that strategic application of the CRP to improve grassland contiguity can benefit greater prairie-chicken populations more than an opportunistic approach lacking consideration of the larger landscape context. Strategic implementation of the CRP can benefit greater prairie-chicken populations in northwestern Minnesota, and likely elsewhere in landscapes where grassland continuity may be a limiting factor. © 2020 The Wildlife Society.     

响应面分析法对甘蔗渣中木聚糖提取条件的优化

以甘蔗渣为原料,通过单因素实验选取因素和水平,在此基础上,综合考虑各因素对木聚糖提取率的影响,根据Box-Benhnken实验设计原理,用Design-Expert软件进行响应面分析(RSA),得出甘蔗渣木聚糖的最佳提取工艺条件:室温条件下,抽提时间3 h,固液比1∶30,NaOH浓度8.56%.经验证,实际测得的木聚糖提取率为28.84%,比单因素实验的最高提取率25.57%高出3.27%.在误差允许的范围内,与模型的预测值28.17%基本相符.     

Comparative Study for Efficacy and Safety of Adenoidectomy according to the Surgical Method: A Prospective Multicenter Study

Background/Objective

There have been several operative techniques for adenoidectomy and their efficacy and morbidity are different according to the technique. This prospective multicenter study was aimed to compare the efficacy and morbidity of coblation adenoidectomy (CA) with those of power-assisted adenoidectomy.

Study Design

Prospective multi-institutional study.

Methods

Children who underwent CA, power-assisted adenoidectomy with cauterization (PAA+C) or without cauterization (PAA-C) due to adenoid hypertrophy were enrolled from 13 hospitals between July 2013 and June 2014. Mean operation time, degree of intraoperative bleeding and postoperative bleeding rate were evaluated.

Results

A total of 388 children (mean age ± standard deviation = 6.6 ± 2.5 years; 245 males and 143 females) were included. According to the adenoidectomy technique, the children were classified into 3 groups: (1) CA (n = 116); (2) PAA+C (n = 153); and (3) PAA-C (n = 119). Significant differences were not found in age and sex among three groups. In the CA group, mean operation time was significantly shorter (P < 0.001) and degree of intraoperative bleeding was significantly less (P < 0.001) compared to PAA+C or PAA-C group. Delayed postoperative bleeding rate of PAA-C group was significantly higher than that of CA or PAA+C group (P = 0.016).

Conclusions

This prospective multicenter study showed that CA was superior to PAA in terms of mean operation time and degree of intraoperative bleeding.     

Adapting Management of Marine Environments to a Changing Climate: A Checklist to Guide Reform and Assess Progress

Documented impacts of climate change on marine systems indicate widespread changes in many geographic regions and throughout all levels of the ocean’s food webs. Oceans provide the main source of animal protein for over a billion people, and contribute significantly to food security for billions more. Clearly, if we are to continue to derive these benefits, then the rate of adaptation in our human systems needs to at least keep pace with the rate of ecological change for these benefits to continue. An Australia-wide program of research into marine biodiversity and fisheries explored the opportunities for policy and management to respond to a changing climate. The research program spanned all Australian estuarine-nearshore and marine environments—tropical, subtropical, and temperate—and focused on two key marine sectors: biodiversity conservation and fisheries (commercial, recreational, and aquaculture). Key findings from across this strategic and extensive research investment were the need to foster resilience through habitat repair and protection, improve resource allocation strategies, fine-tune fisheries management systems, and enhance whole of government approaches and policies. Building on these findings, from a climate adaptation perspective, we generated a checklist of thirteen elements encompassing all project findings to assess and steer progress towards improving marine policy and management. These elements are grouped in three broad areas: preconditioning; future proofing; and transformational changes and opportunities. Arising from these elements is a suite of priority strategies that provide guidance for marine managers, policy practitioners, and stakeholders as they prepare for a future under climate change. As the research program encompassed a wide range of habitats and ecosystems, spanned a latitudinal range of over 30°, and considered a diversity of management systems and approaches, many of these elements and strategies will be applicable in a global context.     

Impact of Multidisciplinary Process Improvement Interventions on Glucometrics in a Noncritically Ill Setting

Objective: This study aimed to assess the impact of multidisciplinary process improvement interventions on glycemic control in the inpatient setting of an urban community hospital, utilizing the daily simple average as the primary glucometric measure.Methods: From 2010–2014, five process of care interventions were implemented in the noncritical care inpatient units of the study hospital. Interventions included education of medical staff, implementation of hyperglycemia and hypoglycemia protocols, computerized insulin order entry, and coordination of meal tray delivery with finger stick and insulin administration. Unpaired t tests compared pre- and postintervention process measures. Simple average daily glucose measure was the primary glucometric outcome. Secondary outcome measures included frequency of hyperglycemia and hypoglycemia. Glucose outcomes were compared with an in-network hospital that did not implement the respective interventions.Results: A total of 180,431 glucose measurements were reported from 4,705 and 4,238 patients from the intervention and comparison hospitals, respectively. The time between bolus-insulin administration and breakfast tray delivery was significantly reduced by 81.7 minutes (P<.00005). The use of sliding scale insulin was sustainably reduced. Average daily glucose was reduced at both hospitals, and overall rates of hypoglycemia were low.Conclusion: A multidisciplinary approach at an urban community hospital with limited resources was effective in improving and sustaining processes of care for improved glycemic control in the noncritical care, inpatient setting.Abbreviations: IQR = interquartile range; JMC = Jacobi Medical Center; NCBH = North Central Bronx Hospital     

Implementation of Non-Pharmaceutical Interventions by New York City Public Schools to Prevent 2009 Influenza A

Introduction

Children are important transmitters of influenza in the community and a number of non-pharmaceutical interventions (NPIs), including hand washing and use of hand sanitizer, have been recommended to mitigate the transmission of influenza, but limited information is available regarding schools'' ability to implement these NPIs during an influenza outbreak. We evaluated implementation of NPIs during fall 2009 in response to H1N1 pandemic influenza (pH1N1) by New York City (NYC) public schools.

Methods

From January 25 through February 9, 2010, an online survey was sent to all the 1,632 NYC public schools and principals were asked to participate in the survey or to designate a school nurse or other school official with knowledge of school policies and characteristics to do so.

Results

Of 1,633 schools, 376(23%) accessed and completed the survey. Nearly all respondents (99%) implemented at least two NPIs. Schools that had a Flu Response Team (FRT) as a part of school emergency preparedness plan were more likely to implement the NPI guidelines recommended by NYC public health officials than schools that did not have a FRT. Designation of a room for isolating ill students, for example, was more common in schools with a FRT (72%) than those without (53%) (p<0.001).

Conclusions

Implementing an NPI program in a large school system to mitigate the effects of an influenza outbreak is feasible, but there is potential need for additional resources in some schools to increase capacity and adherence to all recommendations. Public health influenza-preparedness plans should include school preparedness planning and FRTs.     

Implementation of a Bundle of Care to Reduce Surgical Site Infections in Patients Undergoing Vascular Surgery

Background

Surgical site infections (SSI’s) are associated with severe morbidity, mortality and increased health care costs in vascular surgery.

Objective

To implement a bundle of care in vascular surgery and measure the effects on the overall and deep-SSI’s rates.

Design

Prospective, quasi-experimental, cohort study.

Methods

A prospective surveillance for SSI’s after vascular surgery was performed in the Amphia hospital in Breda, from 2009 through 2011. A bundle developed by the Dutch hospital patient safety program (DHPSP) was introduced in 2009. The elements of the bundle were (1) perioperative normothermia, (2) hair removal before surgery, (3) the use of perioperative antibiotic prophylaxis and (4) discipline in the operating room. Bundle compliance was measured every 3 months in a random sample of surgical procedures and this was used for feedback.

Results

Bundle compliance improved significantly from an average of 10% in 2009 to 60% in 2011. In total, 720 vascular procedures were performed during the study period and 75 (10.4%) SSI were observed. Deep SSI occurred in 25 (3.5%) patients. Patients with SSI’s (28,5±29.3 vs 10.8±11.3, p<0.001) and deep-SSI’s (48.3±39.4 vs 11.4±11.8, p<0.001) had a significantly longer length of hospital stay after surgery than patients without an infection. A significantly higher mortality was observed in patients who developed a deep SSI (Adjusted OR: 2.96, 95% confidence interval 1.32–6.63). Multivariate analysis showed a significant and independent decrease of the SSI-rate over time that paralleled the introduction of the bundle. The SSI-rate was 51% lower in 2011 compared to 2009.

Conclusion

The implementation of the bundle was associated with improved compliance over time and a 51% reduction of the SSI-rate in vascular procedures. The bundle did not require expensive or potentially harmful interventions and is therefore an important tool to improve patient safety and reduce SSI’s in patients undergoing vascular surgery.     

Safety Risk Assessment and Improvement in a Food Production Process

The food industry is under pressure to improve food safety, implement efficient risk management, and control quality “from farm to fork.” During processing of raw materials into packaged consumable products, food may be influenced by biological and chemical pollution and other various environmental factors. Risk assessment of a food production process was studied in this work. The novelty of this work lies in analyzing the development laws of food safety risk in serial and parallel modes, and developing a heuristic algorithm of polynomial time to minimize safety risks in food production with a constant budget. This algorithm was validated by a numerical example of peanut milk production. The primary procedures in peanut milk production were found and the advice on investment allocation was given to improve production.     

Intraocular Lens-Shell Technique: Adjustment of the Surgical Procedure Leads to Greater Safety When Treating Dense Nuclear Cataracts

Objective

To compare the efficacy and safety of the intraocular lens (IOL)-shell procedure versus conventional phacoemulsification for the surgical treatment of dense cataracts.

Methods

Eighty eyes with dense nuclear cataracts were enrolled in a prospective, randomized controlled study. Patients were assigned to two groups. In Group I, the IOL was traditionally implanted after all nuclear fragments were completely removed, and in Group II, the IOL was innovatively implanted in the bag before the last residual nuclear fragment was removed. This novel adjusted surgical procedure, named the “IOL-shell technique”, features use of the IOL as a protective barrier rather than simply as a refractive alternative, and it is conceptually different from the traditional step-by-step procedure. Clinical examinations, including uncorrected visual acuity, central corneal thickness (CCT), temporal clear corneal incision thickness and corneal endothelial cell density, were carried out.

Results

The inter-group difference in temporal corneal thickness was found to be of no statistical significance at any of the visits. Compared to eyes in Group I, those in Group II were shown to have significantly less corneal endothelial cell loss on both the 7th and 30th day following surgery. At 7 days after surgery, the mean corneal endothelial cell loss in Group II was 10.29%, compared to 14.37% in Group I (P<0.05). The mean endothelial cell loss measured on postoperative day 30 was 16.88% in Group II compared to 23.32% in Group I (P<0.05). On the 1st day after surgery, the mean CCT of eyes in Group II was significantly smaller compared to Group I (Group I vs. Group II: 19.42% vs. 13.50%, P<0.05).

Conclusions

Compared to conventional phacoemulsification, the IOL-shell technique was shown to be a relatively safer procedure without compromised efficiency for dense cataracts, and it caused less corneal endothelial cell loss and milder postoperative corneal edema (Clinical Trials Identifier: {"type":"clinical-trial","attrs":{"text":"NCT02138123","term_id":"NCT02138123"}}NCT02138123).

Trial Registration

ClinicalTrials.gov {"type":"clinical-trial","attrs":{"text":"NCT02138123","term_id":"NCT02138123"}}NCT02138123     

Dissection of a Single Rat Muscle-Tendon Complex Changes Joint Moments Exerted by Neighboring Muscles: Implications for Invasive Surgical Interventions

The aim of this paper is to investigate mechanical functioning of a single skeletal muscle, active within a group of (previously) synergistic muscles. For this purpose, we assessed wrist angle-active moment characteristics exerted by a group of wrist flexion muscles in the rat for three conditions: (i) after resection of the upper arm skin; (ii) after subsequent distal tenotomy of flexor carpi ulnaris muscle (FCU); and (iii) after subsequent freeing of FCU distal tendon and muscle belly from surrounding tissues (MT dissection). Measurements were performed for a control group and for an experimental group after recovery (5 weeks) from tendon transfer of FCU to extensor carpi radialis (ECR) insertion. To assess if FCU tenotomy and MT dissection affects FCU contributions to wrist moments exclusively or also those of neighboring wrist flexion muscles, these data were compared to wrist angle-moment characteristics of selectively activated FCU. FCU tenotomy and MT dissection decreased wrist moments of the control group at all wrist angles tested, including also angles for which no or minimal wrist moments were measured when activating FCU exclusively. For the tendon transfer group, wrist flexion moment increased after FCU tenotomy, but to a greater extent than can be expected based on wrist extension moments exerted by selectively excited transferred FCU. We conclude that dissection of a single muscle in any surgical treatment does not only affect mechanical characteristics of the target muscle, but also those of other muscles within the same compartment. Our results demonstrate also that even after agonistic-to-antagonistic tendon transfer, mechanical interactions with previously synergistic muscles do remain present.     

喉癌患者术后感染的危险因素分析及干预对策探讨

目的:探讨喉癌患者手术部位发生感染(Surgical site infection,SSI)的相关危险因素及干预对策,为临床预防提供参考。方法:回顾性分析2012年7月-2013年11月因喉癌而在我院行喉切除术的83例患者的临床资料,根据术后是否发生SSI将患者分为感染组(n=12例)和非感染组(n=71例)。分析两组患者术后SSI的危险因素,并提出相应护理对策。结果:83例患者中,12例术后发生SSI,发生率为14.46%;单因素分析显示,感染组和非感染组在临床III期以上、术前气管切开、手术时间4 h、全喉切除等方面存在显著差异性(P0.05);多因素回归分析显示:患者的临床分期、术前气管是否切开、手术时间及手术切除方式是术后发生SSI的独立危险因素(P0.05)。结论:喉癌术后感染与临床分期、手术时间及切除方式等因素有关,采取有效的干预对策可减少术后SSI的发生率。