Surgery: a risky business

Wars and sweets: microbes, medicines and other moderns in and beyond the(ir) antibiotic era

Once upon a time, many of us moderns dreamt that our future was bright, squeaky clean, germ-free. Now, we increasingly fear that bacterial resistance movements and hordes of viruses are cancelling our medicated performances, and threatening life as many of us have come to know it. In order for our modern antibiotic theatre of war to go on, we pray for salvation through our intensive surveillance of microbes, crusades for more rational antibiotic wars, increased recruitment of resistance fighters and development of antibiotic armaments through greater investment in our medical-industrial-war complex. But not all of us are in favour of the promise of perpetual antimicrobial wars, no matter how careful or rational their proponents aspire to be. An increasing vocal and diverse opposition has amassed in academic journals, newspapers and other fields of practice denouncing medicalisation and pharamceuticalisation of our daily lives, as well as our modern medicine as overly militaristic. In this paper, rather than simply rehearsing many of these well-made and meaning debates to convert you to yet another cause, I enrol them in redescriptions of our modern medical performances in the hope of awakening you from your aseptic dream. What follows is my invitation for you to re-enact our mythic antibiotic era in all its martial g(l)ory. I promise that it will bring you no physically harm, yet I can't promise it will leave your beliefs unscathed, as you follow its playful redescription of how our objective scientific descriptions, clinical prescriptions, economic strategies, political mandates and military orders, not to mention our warspeak, have always been deeply entangled with triumphs and devastations of The(ir) Great anti-Microbial Wars (aka our antibiotic era).

Safe pediatric surgery: development and validation of preoperative interventions checklist

OBJECTIVES

This study was aimed at developing and validating a checklist of preoperative pediatric interventions related to the safety of surgical patients.

METHOD

Methodological study concerning the construction and validation of an instrument with safe preoperative care indicators. The checklist was subject to validation through the Delphi technique, establishing a consensus level of 80%.

RESULTS

Five professional specialists in the area conducted the validation and a consensus on the content and the construct was reached after two applications of the Delphi technique.

CONCLUSION

The "Safe Pediatric Surgery Checklist", simulating the preoperative trajectory of children, is an instrument capable of contributing to the preparation and promotion of safe surgery, as it identifies the presence or absence of measures required to promote patient safety.

A reflective study on abortions in theatre

This article discusses the concept of conscientious objection in relation to surgical terminations of pregnancy. It explores a scrub nurse's duty of care not only to the patient but to themselves. It highlights the importance of being self-aware of one's moral and emotional attitude towards abortions in theatre. Doing so enables the nurse/ODP to practice professionally and autonomously, and to deliver the highest level of perioperative care whilst respecting their personal rights.

Hide and seek, the search for a missing swab: a critical analysis

This article explores the root causes of a missing swab incident. It reinforces the scrub practitioner's responsibility for the surgical count as reflected on by a student operating department practitioner. With environmental pressures and methods upheld by the operating room culture it is recognised that mistakes do sometimes arise from human error when the stress from workload becomes apparent. Through reflection, mistakes can become learning opportunities, as sought through this critical appraisal.

Information transfer and communication in surgery: a systematic review

OBJECTIVES

We conducted a systematic review of published literature to gain a better understanding of interprofessional information transfer and communication (ITC) in hospital setting in the field of surgical and anesthetic care.

BACKGROUND

Communication breakdowns are a common cause of surgical errors and adverse events.

DATA SOURCES

Medline, Embase, PsycINFO, Cochrane Database of Systematic Reviews, and hand search of articles bibliography.

STUDY SELECTION

Of the 4027 citations identified through the initial electronic search and screened for possible inclusion, 110 articles were retained following title and abstract reviews. Of these, 38 were accepted for this review.

DATA EXTRACTION

Data were extracted from the studies about objectives, clinical domain, methodology including study design, sample population, tools for assessing communication, results, and limitations.

RESULTS

Information transfer failures are common in surgical care and are distributed across the continuum of care. They not only lead to errors in care provision but also lead to patient harm. Most of the articles have focused on ITC process in different phases especially in operating room. None of the studies have looked at whole of the surgical care process. No standard tool has been developed to capture the ITC process in different teams and to evaluate the effect of various communication interventions. Uses of standardized communication through checklist, proformas, and technology innovations have improved the ITC process, with an effect on clinical and patient outcomes.

CONCLUSIONS

ITC deficits adversely affect patient care. There is a need for standard measures to evaluate this process. Effective and standardized communication among healthcare professionals during the perioperative process facilitates surgical safety.