Suture needle handling in the operating theatre; what is the safest method? A survey of surgical nursing opinion.

INTRODUCTION: Suture needle handling methods vary extensively between units. Securing the needle tip by locking it against the shaft of the needle holder prior to transfer (protected method) has been suggested to improve safety, although this is not evidence based. Some teams prefer to transfer the needle mounted perpendicularly to the needle holders with the tip exposed (unprotected method). We investigated scrub nurses' preferred method of needle transfer, and noted the safety of each by investigating their experience of needlestick injuries (NSIs). METHOD: Scrub nurses from Oxford University Hospitals Trust, Chelsea and Westminster and Wexham Park Hospitals were surveyed anonymously between November 2013 and August 2014. Nurses selected their preferred method (protected, unprotected or either), and indicated previous NSIs with either technique. Multinomial regression analysis and χ(2) with Yates correction were used to assess associations. RESULTS: One hundred and seven scrub nurses from 12 specialities were interviewed. 80/107 (75%) preferred protected transfer, 20/107 (19%) preferred unprotected transfer and 7/107 (6%) expressed no preference. There was no significant association between needle-mounting preference and years of scrub experience or speciality. Significant differences between preferences and four of the six hospitals were observed. Nine (9/107, 8%) scrub nurses reported NSIs with the protected method compared with 40 (40/107, 37%) in the unprotected group, this difference being statistically significant (p<0.001, χ(2)=25.17). Five (5/107, 5%) reported NSIs with both methods. CONCLUSIONS: Protected needle transfer seems safer than the unprotected method. Needle-handling guidelines and appropriate training are required to help prevent the occurrence of NSIs in the operating theatre.

Fraud and deceit in medical research.

Publication of medical research is the cornerstone for the propagation and dissemination of medical knowledge, culminating in significant effects on the health of the world's population. However, instances of individuals and institutions subverting the ethos of honesty and integrity on which medical research is built in order to advance personal ambitions have been well documented. Many definitions to describe this unethical behavior have been postulated, although the most descriptive is the "FFP" (fabrication, falsification, and plagiarism) model put forward by the United States' Office of Research Integrity. Research misconduct has many ramifications of which the world's media are all too keen to demonstrate. Many high-profile cases the world over have demonstrated this lack of ethics when performing medical research. Many esteemed professionals and highly regarded world institutions have succumbed to the ambitions of a few, who for personal gains, have behaved unethically in pursuit of their own ideals. Although institutions have been set up to directly confront these issues, it would appear that a lot more is still required on the part of journals and their editors to combat this behavioral pattern. Individuals starting out at very junior positions in medical research ought to be taught the basics of medical research ethics so that populations are not failed by the very people they are turning to for assistance at times of need. This article provides a review of many of the issues of research misconduct and allows the reader to reflect and think through their own experiences of research. This hopefully will allow individuals to start asking questions on, what is an often, a poorly discussed topic in medical research.

A historical analysis of surgery performed between 1941 and 1942 at the Bangour Maxillofacial and Plastic Surgery Unit, Scotland.

In 1939, Bangour Emergency Medical Services Hospital was built as an annexe to Edinburgh War Hospital. The Maxillofacial and Plastic Surgery Unit opened in 1941, one of the several set-ups built with the support of Sir Harold Gillies, to ensure a service with specialist skills throughout Great Britain. The unit was led by Alexander Burns Wallace, who had to rapidly adapt the service to reflect the patterns of injury reflected by the more modern warfare practiced in the Second World War, while also incorporating techniques that were, at the time, revolutionary. Although much has been written about other units, Bangour's activity revealed through its case histories' highlights that plastic surgery was developing in parallel throughout Britain. The influence of Sir Harold Gillies was clear, and his input to support the fledgling service serves as an important aspect of the newly developing specialty of plastic surgery: collaboration and sharing of knowledge. This paper analyses the work of the Maxillofacial and Plastic Surgery Unit at Bangour General Hospital in Scotland between 1941 and 1942 and demonstrates its historical significance, as well as its relevance to current practice. Ninety-two case notes from the unit recently became accessible. These were analysed and four were selected for review in this study. These cases were selected as they were well-documented with photographs and good examples of the work performed at the unit in order to highlight the innovative, creative and complicated work carried out at the Unit.

A simple, inexpensive and non-microscope based model for microsurgical training.

In this manuscript we present a simple, inexpensive, non-microscope training model for microsurgery.

HMM assessment of quality of movement trajectory in laparoscopic surgery.

Laparoscopic surgery poses many different constraints for the operating surgeon, resulting in a slow uptake of advanced laparoscopic procedures. Traditional approaches to the assessment of surgical performance rely on prior classification of a cohort of surgeons' technical skills for validation, which may introduce subjective bias to the outcome. In this study, Hidden Markov Models (HMMs) are used to learn surgical maneuvers from 11 subjects with mixed abilities. By using the leave-one-out method, the HMMs are trained without prior clustering of subjects into different skill levels, and the output likelihood indicates the similarity of a particular subject's motion trajectories to those of the group. The results show that after a short period of training, the novices become more similar to the group when compared to the initial pre-training assessment. The study demonstrates the strength of the proposed method in ranking the quality of trajectories of the subjects, highlighting its value in minimizing the subjective bias in skills assessment for minimally invasive surgery.

Photorealistic modeling of tissue reflectance properties.

OBJECTIVE: For Minimally Invasive Surgery (MIS) procedures, specular highlights constitute important visual cues for gauging tissue deformation as well as perceiving depth and orientation. This paper describes a novel reflectance modeling technique that is particularly suitable for simulating light interaction behavior with mucus-covered tissue surfaces. METHODS: The complex and largely random tissue-light interaction behavior is modeled with a noise-based approach. In the proposed technique, Perlin noise is used to modulate the shape of specular highlights and imitate the effects of the complex tissue structure on reflected lighting. For efficient execution, the noise texture is generated in pre-processing and stored in an image-based representation, i.e., a reflectance map. At run-time, the graphics hardware is used to attain per-pixel control and achieve realistic tissue appearance. RESULTS: The reflectance modeling technique has been used to replicate light-tissue reflection in surgical simulation. By comparing the results acquired against those obtained from conventional per-vertex Phong lighting and OpenGL multi-texturing, it is observed that the noise-based approach achieves improved tissue appearance similar to that observed in real procedures. Detailed user evaluation demonstrates the quality and practical value of the technique for increased perception of photorealism. CONCLUSION: The proposed technique presents a practical strategy for surface reflectance modeling that is suitable for real-time interactive surgical simulation. The use of graphics hardware further enhances the practical value of the technique.

HMM assessment of quality of movement trajectory in laparoscopic surgery.

Laparoscopic surgery poses many different constraints to the operating surgeon, this has resulted in a slow uptake of advanced laparoscopic procedures. Traditional approaches to the assessment of surgical performance rely on prior classification of a cohort of surgeons' technical skills for validation, which may introduce subjective bias to the outcome. In this study, Hidden Markov Models (HMMs) are used to learn surgical maneuvers from 11 subjects with mixed abilities. By using the leave-one-out method, the HMMs are trained without prior clustering subjects into different skills levels, and the output likelihood indicates the similarity of a particular subject's motion trajectories to the group. The experimental results demonstrate the strength of the method in ranking the quality of trajectories of the subjects, highlighting its value in minimizing the subjective bias in skills assessment for minimally invasive surgery.

Photo-realistic tissue reflectance modelling for minimally invasive surgical simulation.

Computer-based simulation is an important tool for surgical skills training and assessment. In general, the degree of realism experienced by the trainees is determined by the visual and biomechanical fidelity of the simulator. In minimally invasive surgery, specular reflections provide an important visual cue for tissue deformation, depth and orientation. This paper describes a novel image-based lighting technique that is particularly suitable for modeling mucous-covered tissue surfaces. We describe how noise functions can be used to control the shape of the specular highlights, and how texture noise is generated and encoded in image-based structure at a pre-processing stage. The proposed technique can be implemented at run-time by using the graphics processor to efficiently attain pixel-level control and photo-realism. The practical value of the technique is assessed with detailed visual scoring and cross comparison experiments by two groups of observers.

Invisible shadow for navigation and planning in minimal invasive surgery.

Depth estimation is one of the most fundamental challenges for performing minimally invasive surgical (MIS) procedures. The requirement of accurate 3D instrument navigation using limited visual depth cues makes such tasks even more difficult. With the constant expectation of improving safety for MIS, there is a growing requirement for overcoming such constraints during MIS. We present in this paper a method of improving the surgeon's perception of depth by introducing an "invisible shadow" in the operative field cast by an endoscopic instrument. Although, the shadow is invisible to human perception, it can be digitally detected, enhanced and re-displayed. Initial results from our study suggest that this method improves depth perception especially when the endoscopic instrument is in close proximity to the surface. Experiment results have shown that the method could potentially be used as an instrument navigation aid allowing accurate maneuvering of the instruments whilst minimizing tissue trauma.

Is the internet the best resource for blushers?

Blushing can be a disabling condition that causes sufferers great distress. It causes patients to become socially isolated, frequently being labelled as "shy". Any referral to their condition is embarrassing; even a discussion with a health care professional requires a great deal of courage. Even then, the information from non-specialists is often inaccurate and inadequate and fails to inform patients of the possible treatment options available. In today's era the internet has become an important information medium. This information on almost any subject is widely available to the general public and can be accessed at any time. It is available to blushers and health care professionals alike. It offers a non-embarrassing method of seeking help for an embarrassing condition. It is a medium for specialists to inform sufferers incognito about such a condition. We report our experience from our website: a generalised hyperhidrosis, blushing and sympathectomy information web site (www.sympathectomy.co.uk) by analysing the number of hits and requests for information. We discuss the statistics of internet access to our website including the "hit rate" and enquiry rate. Paradoxically 75% of all enquiries have been from blushers with only 25% coming from patients with hyperhidrosis.A properly designed, accurate and dynamic web site tailored towards users' needs can be used to effectively educate an information hungry but shy group.