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At least 631 records · Page 35Linked to original sources
PubMedDate not supplied

Prehospital rapid-sequence intubation: a pilot training program.

OBJECTIVE: To develop a training program enabling paramedics to use sedation and paralytic medications to facilitate endotracheal intubation in patients who otherwise could not be successfully intubated. METHODS: Paramedics underwent a training program consisting of six hours of didactic education, two four-hour mannequin labs, one four-hour animal intubation lab, and operating room experience. Rapid-sequence intubation (RSI) runs were reviewed for appropriateness in patient selection and medication use. Non-RSI runs were reviewed to determine whether appropriate patients were being missed. Intubation success rates continue to be followed. Long-term quality assurance includes monthly run reviews, periodic quizzes, and unannounced on-site practical tests. RESULTS: 101 patients have been intubated using RSI, including medical, trauma, pediatric, and adult cases. Of all patients receiving RSI drugs, 100 of 101 were successfully intubated. There were no undetected esophageal intubations. Paramedics were able to demonstrate proper patient selection and appropriately administer RSI medications. The use of sheep labs was a critical component of this training because it permitted multiple intubations in a live model possessing an airway quite similar to that of the human. The gum elastic bougie was felt to be critical in the intubation of three patients. CONCLUSION: This RSI training model can serve as a template for other agencies seeking to implement RSI. Limitations of this model include the availability of live animal labs and the expense of conducting the training. Intense medical director involvement has been key to the success of this prehospital RSI program.

Airway Obstruction↗
PubMed2006

Anesthesia for endovascular neurosurgery.

Endovascular neurosurgical procedures are complex, requiring significant planning, foresight, and coordination. The neuroanesthetist is an integral part of these procedures, organizing efforts of the technicians and nurses and responding to the needs of the neurointerventionalist. The purpose of this article is to review, in detail, the role of the neuroanesthetist in the endovascular operating room. An overview of all areas either partially or completely managed by the anesthetist is provided.

Anesthesia↗
PubMed1987

Surgical rotations: a must for nursing education.

Although more documentation is needed, the belief exists among educators that an all-RN staff in the operating room results in more productivity and quality of care. The professional nurse is seen as invaluable in the OR because of his or her flexibility in meeting the varied requirements of scrubbing and circulating. Registered nurses bring with them a broader range of skills, a lessening of costly supervision, and a decrease in ideologic conflicts about care of the surgical patient. It has been suggested that the RN, despite receiving a higher salary, is far more cost-effective than an aide or technician when compared with such factors as percentage of time ancillary staff actually work (estimated at 65%), the amount of supervision they require, and subsequent overtime frequently asked of RNs in understaffed environments. Professional nursing education should include the opportunity to learn perioperative nursing. I believe professional nurses should staff the surgical suite in both scrub and circulating positions in order to promote cost-effective operating room management and maintain quality patient care.

Clinical Clerkship↗
PubMed1964

CONVENIENT SAMPLING OF AIR BACTERIA IN OPERATING ROOMS.

A convenient arrangement for sampling air bacteria in operating rooms with a slit sampler (the Fort Detrick sampler) is described. Its purpose is to contribute as far as possible to the convenience of the surgical staff and thereby to the safety of the patient. It has the advantages of recording minute-to-minute changes in bacterial air count; it is unobtrusive and yet can be continually observed by a technician; it is not noisy and avoids the dangers of explosion and static electricity; it is inexpensive, and parts are easily replaced; and finally it provides a means of keeping permanent photographic records of bacterial counts. Results of a preliminary trial of this method appeared to be satisfactory.

Air Microbiology↗
PubMedDate not supplied

[Backache from exertion in health personnel of the Istituti Ortopedici Rizzoli in Bologna. A case-control study of the injury phenomenon in the 10-year period of 1987-1996].

Low-back (lumbosacral) injuries are known as one of more important occupational health problems in health care workers, because of high prevalence and impact of socioeconomic costs. To investigate the risk of low-back pain in hospital workers into the Istituti Ortopedici Rizzoli in Bologna (Italy), a retrospective study was carried out. The adapted study design was the matched (1:1 for age) case-control, enlisting the first injuries occurred in the hospital staff like cases, and personnel in force, matched for age and year of happened case, like controls. Information about diagnoses and occupational data was obtained from the current informative systems. Comparison with a control group suggests the validity of the work-relatedness of low-back pain in nursing and health aides (OR: 21.67; LC: 4.69-196.56), in nurses (OR: 20.21; LC: 4.81-177.95), in therapists (OR: 16.36; LC: 2.80-163.54) and in X-ray technicians (OR: 13.64; LC: 2.25-138.99). The risk of occupational injury is not homogeneously allocated into the hospital, and significatively prevails in the orthopaedic wards, in the plaster-rooms, in the operating blocks and in the sterilization plants. Specific manual handling were associated with an increased risk of back pain, while some non occupational factors like cigarette smoking, previous trauma leading to hospital admission, and number of children in female, were resulted weakly associated.

Adult↗
PubMed1992

Keeping an OR supply system with '90s reimbursement.

1. Operating rooms need to be run as efficient businesses. The supply costs are major expenses; OR directors must have systems that provide information on usage, costs, and inventory of all supplies. 2. The following goals were developed: decrease outages; increase revenue; identify appropriate ordering personnel; provide information for decision-making; control supplies; maintain supplies in good condition; control the budget; develop an overall supply system; and reduce inventory. 3. The inventory control technicians are responsible for the dollars in their accounts, ordering, maintaining pars, receiving, and planning for ways to cut costs. They work closely with OR teams, giving nurses more time to assess, plan, implement, and evaluate the OR cases in their rooms.

Documentation↗
PubMed1995

Instrumentation and setup for endoscopic plastic surgery.

The use of endoscopic techniques mandates the need for basic understanding of endoscopic instrumentation and operating room setup in order to avoid procedural delays and surgeon frustration. The electronic systems for endoscopic surgery-cameras, light sources, monitors, and so on-have been well developed for other specialties and are fully adaptable to endoscopic plastic surgical procedures. Hand instruments, however, are in the early phases of refinement for subcutaneous plastic surgical procedures and will undoubtedly improve over the next several years. Adaptation of existing instrumentation and development of new operating tools continue and promise to make endoscopic plastic surgical procedures of the future more ergonomic and efficient. Similarly, while operating room setup for endoscopic plastic surgical procedures varies depending on individual circumstances, application of a few basic principles will help in making this step quick and simple. The knowledge and experience of scrub technicians and nurses experienced in endoscopic techniques can be invaluable to the surgeon just beginning to use endoscopic techniques in plastic and reconstructive surgery.

Endoscopy↗
PubMed1994

The Role of the "O.R. Personnel" for Operative Gynecologic Endoscopy

The role of the operating room personnel in gynecologic surgery has changed dramatically during the past decade. This change has been a result of the development of gynecologic endoscopy, and more importantly, due to the addition of the videocamera to the laparoscope and hysteroscope. The attachment of the videocamera to the laparoscope and hysteroscope during surgery so that everyone present can follow the procedure on the videomonitor and appropriately anticipate the surgeon's needs has created an entirely new involvement for operating room personnel. This has made the contribution by personnel so important that many hospitals have recognized the need for an "endoscopy team." The "endoscopy team" generally refers to the surgeon, surgical assistant, scrub nurse or technician, nurse circulator, and laser nurse. Our purpose is to outline in detail the responsibilities of the "endoscopy team" specific to the O.R. personnel involved in these procedures. It is essential for these members of the team to be aware of their role to enable them to provide the appropriate assistance before, during, and after surgery.

Journal Article↗
PubMed2001

A new distal targeting device for closed interlocking nailing.

A new, image-intensifier mounted target device for closed interlocking nailing is described. The aim of locating the distal holes with the least radiation exposure is achieved. The proposed device has been designed to be mounted on the image-intensifier, is absolutely stable, eliminates the need for a specialised X-ray technician and allows the surgeon to be away from the radiation beam (direct or scattered). It also permits image intensification in the anteroposterior view, without losing the target. The device has proved its reliability in the operating room during closed interlocking nailing procedures.

Bone Nails↗
PubMed1981

Comparative aspects of chronic pain in the head and neck versus trunk and appendages: experiences of the Multidisciplinary University of North Carolina Pain Clinic.

The interdisciplinary University of North Carolina Pain Clinic, in existence since 1973, is a coordination center for research, pre and postdoctoral and resident training, and clinical services. It functions primarily as a tertiary care center for outpatients as a component of the North Carolina Memorial Hospital. Inpatient consultations and therapy direction are carried out on request. Approximately 400 new patient visits and 1,200 consults and return visits are made yearly. The clinic is administered by codirectors from the Departments of Oral and Maxillofacial Surgery and Anesthesiology. Consultants to the clinic include the disciplines of psychiatry, neurosurgery, family medicine, pathology-oral pathology, dentistry, physical therapy, social work and nursing. Support staff includes a head nurse, half-time transcription and half-time general secretary and a financial technician. Facilities consist of an 8-room clinic dual equipped for patient care and clinical research. An adjacent conference room is used for research and patient presentation conferences. In addition to routine examining and interview rooms, a minor procedure operating room is equipped with resuscitation equipment, suction, oxygen, anesthesia machine, a physiologic monitoring system with polygraph, a cryosurgical unit and a radiofrequency lesion generator. A second room is equipped for neurosensory studies of peripheral nerve functions including a battery of tactile-mechanical and thermal threshold stimuli tests, as well as nerve conduction and EMG. A system for psychophysical testing is available through tie-in with a computer, which is located in an adjacent laboratory used for data analysis and also subhuman primate experiments. Another room is equipped with psychophysiologic training equipment, particularly EMG biofeedback. A computer terminal on line to the University IBM 360 is located in the Pain Clinic for use in entering patient-research data. A library with dictating space is available for use by consultants, postdoctoral trainees, and residents.

Chronic Disease↗
PubMed1980

Qaulity-control plan for intravenous admixture programs. II: Validation of operator technique.

A plan for the validation of aseptic-operator technique in i.v. admixture programs and two test methods for evaluating the plan are proposed. After a new operator has been trained, the plan involves qualification of the operator through the preparation of statistically valid samples, to be followed by the random selection of samples for in-process monitoring. To test the plan, trypticase soy broth transfers were used in one hospital and Addi-Chek (Millipore Corp.) filtrations were used in another. The participants, all trained operators, initially prepared 40 test samples as a validation step. The finding of no microbial growth in these test samples permitted continuation into the monitoring phase, during which test samples were prepared randomly, one test sample out of every 25 i.v. admixtures prepared for patient use. All samples were negative for microbial growth, indicating that the operators maintained aseptic technique. These findings give evidence that the proposed testing plan is valid. The authors propose the plan as a phase of a quality control program, based on valid statistical principles, to give assurance that i.v. room operators are qualified to prepare sterile parenteral medications.

Drug Combinations↗
PubMedDate not supplied

Prioritizing verification checks and preventive maintenance.

The role of the equipment technician has not changed in 30 years, but the equipment and the staff using it has. It is clearly time to update our procedures and methodology. Some of these time-consuming PM tasks yield no measurable benefit to neither our industry nor to our customers. All of the additional requirements placed onto us recently indicate that our customers' needs have changed and negates our obsession to place inspection stickers all over the place. We need to adapt to the changing environment and become the technicians of the 21st century by abandoning long, outdated practices such as mindless monthly inspections. We are valuable to our customers and our employers for what we know--not what we do. Not just anyone can walk into anactive operating room theater and find a bad patient cableon the spot. We alone can control the work that we do. We are the pinnacle of all electronics repair with the duties and responsibilities that go along with it. Isn't it abouttime we acted like it?

Biomedical Engineering↗
PubMed2006

Patient safety in surgery.

BACKGROUND: Improving patient safety is an increasing priority for surgeons and hospitals since sentinel events can be catastrophic for patients, caregivers, and institutions. Patient safety initiatives aimed at creating a safe operating room (OR) culture are increasingly being adopted, but a reliable means of measuring their impact on front-line providers does not exist. METHODS: We developed a surgery-specific safety questionnaire (SAQ) and administered it to 2769 eligible caregivers at 60 hospitals. Survey questions included the appropriateness of handling medical errors, knowledge of reporting systems, and perceptions of safety in the operating room. MANOVA and ANOVA were performed to compare safety results by hospital and by an individual's position in the OR using a composite score. Multilevel confirmatory factor analysis was performed to validate the structure of the scale at the operating room level of analysis. RESULTS: The overall response rate was 77.1% (2135 of 2769), with a range of 57% to 100%. Factor analysis of the survey items demonstrated high face validity and internal consistency (alpha = 0.76). The safety climate scale was robust and internally consistent overall and across positions. Scores varied widely by hospital [MANOVA omnibus F (59, 1910) = 3.85, P < 0.001], but not position [ANOVA F (4, 1910) = 1.64, P = 0.16], surgeon (mean = 73.91), technician (mean = 70.26), anesthesiologist (mean = 71.57), CRNA (mean = 71.03), and nurse (mean = 70.40). The percent of respondents reporting good safety climate in each hospital ranged from 16.3% to 100%. CONCLUSIONS: Safety climate in surgical departments can be validly measured and varies widely among hospitals, providing the opportunity to benchmark performance. Scores on the SAQ can serve to evaluate interventions to improve patient safety.

Analysis of Variance↗
PubMed1976

Patient monitoring in the operating theatre.

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.

Anesthesia↗
PubMed2000

Cost comparison of radical prostatectomy and transperineal brachytherapy for localized prostate cancer.

OBJECTIVES: To compare perioperative costs associated with radical retropubic prostatectomy (RRP) to transperineal brachytherapy (BXRT) with iodine-125 (125I) seeds in the treatment of localized prostate cancer. METHODS: Actual costs per case for the perioperative period were compiled prospectively for 583 consecutive patients undergoing RRP or BXRT between January 1, 1997 and October 30, 1998 using a hospital-wide cost accounting system. The total cost per case included both technical and professional components. The technical costs included those incurred for anesthesiology, laboratory medicine, medicine, pharmacy, nursing, radiology, 125I seeds, and BXRT technicians. Professional costs included fees from anesthesiology, laboratory, medicine, urology, radiation oncology, and physics. Cases were divided into three groups for analysis: group 1, RRP (n = 404); group 2, BXRT with planning ultrasound performed in the office setting before implantation (n = 107); and group 3, BXRT with planning ultrasound performed in the operating room at the time of implantation (n = 72). Results are reported as relative cost ratios, with RRP assigned a relative cost of 1.0. RESULTS: The total relative perioperative cost for BXRT exceeded that for RRP by 85% to 105%. Technical cost, exclusive of 125I seeds, was substantially lower for BXRT (relative cost 0.36 to 0.42) but was more than offset by the cost of the seeds when comparing total cost with RRP. Performance of the planning ultrasound in the operating room (group 3) increased the total cost by 20%. The categorical technical costs for both BXRT groups were significantly lower for anesthesiology, laboratory medicine, medicine, pharmacy, and nursing but were significantly higher for radiology. The total professional costs were similar for all groups. CONCLUSIONS: Perioperative costs of BXRT with 125I seeds are substantially higher than RRP in the treatment of localized prostate cancer, primarily because of the cost of the seeds.

Brachytherapy↗
PubMed2004

Mirror-image reversal of coronal computed tomography scans.

OBJECTIVES/HYPOTHESIS: Mirror-image reversal of coronal computed tomography (CT) scans can be a significant problem in patient care, potentially leading to wrong-sided surgery and malpractice suits. There is no literature describing the problem of mirror-image reversal of coronal CT scans. Generally, medical errors are not widely published: however, with the emphasis on reduction of errors in medicine, this topic should be openly discussed. STUDY DESIGN: Retrospective review of patient care and an assessment of current methods. METHODS: Two cases of mirror-image reversal of coronal CT scans were reviewed, and the authors found that each case represented a different type of error. In the first case, the error was recognized in the operating room. The second case resulted in wrong-sided surgery, and a lawsuit was filed. These two separate occurrences led to a review of the methods for determining right versus left side for orienting and labeling of CT scans. Orientation of coronal scans depends on whether the patient is prone or supine. Thus, technician input is required. If a labeling mistake is made, radiologists may not readily catch the mistake because of the symmetry of the head and neck anatomy. RESULTS: A review of the markings on each scan should provide the otolaryngologist with enough information to determine whether the scan is mislabeled. CONCLUSION: The incidence of mislabeled coronal CT scans is unknown. This error can result in inappropriate patient care and lawsuits for wrong-sided surgery. Awareness of the potential problem and open discussion of interpretation and prevention are necessary.

Adult↗