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.     

Peroxiredoxins and the Regulation of Cell Death

Cell death pathways such as apoptosis can be activated in response to oxidative stress, enabling the disposal of damaged cells. In contrast, controlled intracellular redox events are proposed to be a significant event during apoptosis signaling, regardless of the initiating stimulus. In this scenario oxidants act as second messengers, mediating the post-translational modification of specific regulatory proteins. The exact mechanism of this signaling is unclear, but increased understanding offers the potential to promote or inhibit apoptosis through modulating the redox environment of cells. Peroxiredoxins are thiol peroxidases that remove hydroperoxides, and are also emerging as important players in cellular redox signaling. This review discusses the potential role of peroxiredoxins in the regulation of apoptosis, and also their ability to act as biomarkers of redox changes during the initiation and progression of cell death.     

Community of small mammals along an elevational gradient in Biological Reserve of Serra do Japi,municipality of Jundiaí‐SP,Brazil

Studies of elevational gradients in forests are particularly interesting for the considerable differences that can be observed over short distances, such as in vegetation and temperature. Different taxonomic groups display varying types of distribution patterns along elevational gradients, with unimodal distribution being recognised as the most common pattern. The distribution of species can be affected by a range of factors that include, biotic, spatial, climatic, historic and energetic. Small mammals represent an ideal model for studies about distribution and habitat use as they can be highly abundant, tend to have different diets and use space differently. The aims of this study are to build a comprehensive understanding of the community of small mammals of the Biological Reserve of Serra do Japi and to explore its distribution pattern along elevational gradients. We investigated the influence of biomass of arthropods, fruits and seeds and percentage of ground cover, canopy cover and vertical vegetation at richness and abundance of small mammals at three different elevations. To accomplish this, we used seventy‐two pitfall traps of 63 L to capture small mammals and distributed them equally across three elevations defined as low (880–899 m), intermediate (1046–1089 m) and high (1170–1189 m). Each elevation had three lines or replicas of traps. Throughout the study, we captured one hundred and fourteen individuals belonging to eleven species of small mammals. The presence of rare and endemic species demonstrates the importance of conservation and maintenance of the Biological Reserve of Serra do Japi. In regard to the distribution of species, despite the short gradient range, we found a unimodal pattern and a positive correlation between ground cover (fallen twigs and branches up to 1 m high) and richness and abundance of small mammals. More ground cover can reduce the effects of competition and predation on small mammals’ communities. Abstract in Portuguese is available with online material.     

Message in a bottle: Inadvertent loss of seeds of native grassland species as a result of rudimentary long‐term storage

Many practitioners are likely to have collected seeds with the intention of using that seed for conservation and/or restoration plantings, but have not got around to using the seed, sometimes for many years. Currently, it is not clear what species have short‐lived or long‐lived seed when stored under rudimentary conditions such as in paper bags or in a refrigerator. We report the germinability of 12 temperate native grassland species, comprising 16 populations, whose seeds were collected with the purpose of raising seedlings to plant into the wild, but whose seeds were subsequently stored at ~2–4°C for 25+ years. We conclude that most of the grassland species that we assessed do not have viable seed after 25 years when stored in such conditions; only two species germinated despite evidence that seed germinates well for most species when first collected. Inadvertent loss of seeds of as a result of long‐term storage is most likely in readily germinable species (e.g. members of the Asteraceae). The ways in which seeds are stored by practitioners deserves consideration given the risk of seed mortality with long‐term storage under rudimentary conditions.     

Prevention of peroxynitrite-induced apoptosis of motor neurons and PC12 cells by tyrosine-containing peptides

Although peroxynitrite stimulates apoptosis in many cell types, whether peroxynitrite acts directly as an oxidant or the induction of apoptosis is because of the radicals derived from peroxynitrite decomposition remains unknown. Before undergoing apoptosis because of trophic factor deprivation, primary motor neuron cultures become immunoreactive for nitrotyrosine. We show here using tyrosine-containing peptides that free radical processes mediated by peroxynitrite decomposition products were required for triggering apoptosis in primary motor neurons and in PC12 cells cultures. The same concentrations of tyrosine-containing peptides required to prevent the nitration and apoptosis of motor neurons induced by trophic factor deprivation and of PC12 cells induced by peroxynitrite also prevented peroxynitrite-mediated nitration of motor neurons, brain homogenates, and PC12 cells. The heat shock protein 90 chaperone was nitrated in both trophic factor-deprived motor neurons and PC12 cells incubated with peroxynitrite. Tyrosine-containing peptides did not affect the induction of PC12 cell death by hydrogen peroxide. Tyrosine-containing peptides should protect by scavenging peroxynitrite-derived radicals and not by direct reactions with peroxynitrite as they neither increase the rate of peroxynitrite decomposition nor decrease the bimolecular peroxynitrite-mediated oxidation of thiols. These results reveal an important role for free radical-mediated nitration of tyrosine residues, in apoptosis induced by endogenously produced and exogenously added peroxynitrite; moreover, tyrosine-containing peptides may offer a novel strategy to neutralize the toxic effects of peroxynitrite.     

EphA4 misexpression alters tonotopic projections in the auditory brainstem

Auditory pathways contain orderly representations of frequency selectivity, which begin at the cochlea and are transmitted to the brainstem via topographically ordered axonal pathways. The mechanisms that establish these tonotopic maps are not known. Eph receptor tyrosine kinases and their ligands, the ephrins, have a demonstrated role in establishing topographic projections elsewhere in the brain, including the visual pathway. Here, we have examined the function of these proteins in the formation of auditory frequency maps. In birds, the first central auditory nucleus, n. magnocellularis (NM), projects tonotopically to n. laminaris (NL) on both sides of the brain. We previously showed that the Eph receptor EphA4 is expressed in a tonotopic gradient in the chick NL, with higher frequency regions showing greater expression than lower frequency regions. Here we misexpressed EphA4 in the developing auditory brainstem from embryonic day 2 (E2) through E10, when NM axons make synaptic contact with NL. We then evaluated topography along the frequency axis using both anterograde and retrograde labeling in both the ipsilateral and contralateral NM-NL pathways. We found that after misexpression, NM regions project to a significantly broader proportion of NL than in control embryos, and that both the ipsilateral map and the contralateral map show this increased divergence. These results support a role for EphA4 in establishing tonotopic projections in the auditory system, and further suggest a general role for Eph family proteins in establishing topographic maps in the nervous system.