Systematic review of methods for quantifying teamwork in the operating theatre

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.

Twenty-eight years of liaison psychiatry at a general hospital

Aims and method

A questionnaire was used to measure physician satisfaction with the unit and comparison of referral numbers and diagnoses with 1967, when the unit was new, and in 1985 when it was re-audited.

Results

Despite physicians' satisfaction with the service, the referral rate remains unchanged.

Clinical implications

Liaison psychiatry should not concern itself with trying to increase referral rates. Research into patient outcome should be a priority and guide its future direction.

Prediction of haematocrit in dried blood spots from the measurement of haemoglobin using commercially available sodium lauryl sulphate

Background When preparing dried blood spots (DBSs), haematocrit (Hct) can affect the ability of the blood to spread through the filter paper, thus resulting in varying quantities of sample being measured when fixed subpunches of the DBSs are taken. It may be important to predict the sample Hct to correct volume differences. Methods Blood (10  µL) was applied to Perkin Elmer 226® paper. The samples ( n = 165) were allowed to dry for 24 h, and the entire blood spots were cut out. Subpunch analysis was also performed on blood spots prepared from 75  µL EDTA blood, taking 6 mm subpunches centrally and peripherally from the spots ( n = 59). The spots were eluted with 100  µL water, and a 10  µL aliquot of lysate was added to sulfolyser reagent (80  µL) in a microtitre plate. Hb was measured at 550 nm using an ELISA plate reader. DBS samples were compared against blood samples measured on a routine Sysmex XN-9000 analyser. Results The Passing and Bablock regression showed Hct (DBS-predicted) = 0.99 Hct (Sysmex) -0.02, R²= 0.87. Intra-assay imprecision measured at Hct values of 0.27, 0.40 and 0.52, gave CVs of 4.1%, 2.8% and 4.2%, respectively. Inter-assay imprecision showed CVs of 6.2%, 5.2% and 4.2%, respectively. DBS samples were stable for up to two days at 60℃, one month at room temperature and six months at 4℃. Conclusion This method provides a simple and fast estimation of predicted Hct in dried blood spots.

Tolerability and Adherence Problems in Patients on a Stable Dose of Methotrexate: Results of a Multicentre Survey

INTRODUCTION

Methotrexate is commonly used in patients with inflammatory arthritis. The aim of the present study was to ascertain the prevalence of side effects that patients on methotrexate were tolerating and to establish their adherence to the medication.

METHOD

A questionnaire was developed for completion by the healthcare professional with the patient, and piloted in one centre. The questionnaire was then used in six other centres, with the addition of a question about the attractiveness of stopping methotrexate treatment. Efficacy and toxicities were scored for severity on a 10-cm visual analogue scale (VAS). Adherence to the drug was also explored.

RESULTS

The prevalence of 'any side effect' ranged from 57% to 86%. The most frequent side effects were fatigue (53%); nausea (38%); mouth ulcers (23%) and hair loss (23%). Efficacy averaged 6.5 cm on the VAS. Results from the combined survey revealed that toxicity averaged 5.9 cm for fatigue, 4.8 cm for nausea, 4.4 for mouth ulcers, 3.9 cm for hair loss and 5.7 cm for 'other' side effects. 13.5% of patients revealed that they had forgotten to take the drug for an average of two weeks, and 25% for an average of 2.5 weeks in the previous year. Participants were more likely to reveal this to a nurse than a doctor.

CONCLUSION

Patients put up with a considerable number of side effects in order to benefit from methotrexate therapy. Adherence to this drug merits further study. Copyright © 2015 John Wiley & Sons, Ltd.

Time Since Migration and HIV Risk Behaviors Among Puerto Ricans Who Inject Drugs in New York City

BACKGROUND

Among people who inject drugs (PWID) in the United States, those who initiated drug injection in Puerto Rico (immigrant Puerto Rican PWID) engage in more injection and sexual risk behaviors, and have higher HIV incidence than non-Hispanic whites.

OBJECTIVE

Understand the persistence of these HIV behaviors.

METHODS

In a cross-sectional study conducted in New York City (NYC) in 2012 (National HIV Behavioral Surveillance), PWID aged ≥18 years were recruited using Respondent-Driven Sampling, interviewed, and tested for HIV. Participants were categorized into 5 different groups: (1) US-born non-Hispanic PWID, (2) US-born Puerto Rican PWID, (3) recent immigrant Puerto Rican PWID (≤3 years in NYC), (4) medium-term immigrant Puerto Rican PWID (>3 and ≤10 years in NYC), and (5) long-term immigrant Puerto Rican PWID (>10 years in NYC). We examined the relationship between time since migrating on sexual and injection risk behaviors among immigrant Puerto Rican PWID, compared with U.S.-born Puerto Rican PWID and US-born non-Hispanic PWID. Adjusted odds ratios (aOR) and 95% confidence intervals (95% CI) were estimated using logistic regression.

RESULTS

A total of 481 PWID were recruited. In adjusted analyses using US-born non-Hispanic PWID as the comparison group, syringe sharing was significantly more likely among medium-term immigrants; and unprotected sex with casual partners was more likely among recent and long-term immigrants.

CONCLUSIONS

The risk-acculturation process for immigrant Puerto Rican PWID may be nonlinear and may not necessarily lead to risk reduction over time. Research is needed to better understand this process.

Label-free monitoring of the nanoparticle surface modification effects on cellular uptake, trafficking and toxicity

Real-time label-free techniques combining cell electric sensing supported by inorganic analysis are employed to determine the biological impact of zinc oxide nanoparticles on the selected cell model.

Nurses' experiences providing palliative care to individuals living in rural communities: aspects of the physical residential setting

INTRODUCTION

Efforts are needed to improve palliative care in rural communities, given the unique characteristics and inherent challenges with respect to working within the physical aspects of residential settings. Nurses who work in rural communities play a key role in the delivery of palliative care services. Hence, the purpose of this study was to explore nurses' experiences of providing palliative care in rural communities, with a particular focus on the impact of the physical residential setting.

METHODS

This study was grounded in a qualitative approach utilizing an exploratory descriptive design. Individual telephone interviews were conducted with 21 community nurses. Data were analyzed by thematic content analysis.

RESULTS

Nurses described the characteristics of working in a rural community and how it influences their perception of their role, highlighting the strong sense of community that exists but how system changes over the past decade have changed the way they provide care. They also described the key role that they play, which was often termed a 'jack of all trades', but focused on providing emotional, physical, and spiritual care while trying to manage many challenges related to transitioning and working with other healthcare providers. Finally, nurses described how the challenges of working within the physical constraints of a rural residential setting impeded their care provision to clients who are dying in the community, specifically related to the long distances that they travel while dealing with bad weather.

CONCLUSIONS

These study findings contribute to our understanding of the experiences of nurses working in rural communities in terms of the provision of palliative care and the influence of the physical residential setting that surrounds them. These findings are important since nurses play a major role in caring for community-dwelling clients who are dying, but they are confronted with many obstacles. As such, these results may help inform future decisions about how to best improve access to important services and ways to support them while providing palliative care to rural individuals.

Improving accuracy and efficiency of mutual information for multi-modal retinal image registration using adaptive probability density estimation

Mutual information (MI) is a popular similarity measure for performing image registration between different modalities. MI makes a statistical comparison between two images by computing the entropy from the probability distribution of the data. Therefore, to obtain an accurate registration it is important to have an accurate estimation of the true underlying probability distribution. Within the statistics literature, many methods have been proposed for finding the 'optimal' probability density, with the aim of improving the estimation by means of optimal histogram bin size selection. This provokes the common question of how many bins should actually be used when constructing a histogram. There is no definitive answer to this. This question itself has received little attention in the MI literature, and yet this issue is critical to the effectiveness of the algorithm. The purpose of this paper is to highlight this fundamental element of the MI algorithm. We present a comprehensive study that introduces methods from statistics literature and incorporates these for image registration. We demonstrate this work for registration of multi-modal retinal images: colour fundus photographs and scanning laser ophthalmoscope images. The registration of these modalities offers significant enhancement to early glaucoma detection, however traditional registration techniques fail to perform sufficiently well. We find that adaptive probability density estimation heavily impacts on registration accuracy and runtime, improving over traditional binning techniques.