Beyond the self: a novel framework to enhance non-technical team skills for anesthesiologists.

Human factors and non-technical skills (NTS) have been identified as essential contributors to both the propagation and prevention of medical errors in the operating room. Despite extensive study and interventions to nurture and enhance NTS in anesthesiologists, gaps to effective team practice and patient safety remain. Furthermore, the link between added NTS training and clinically significant improved outcomes has not yet been demonstrated. We performed a narrative review to summarize the literature on existing systems and initiatives used to measure and nurture NTS in the clinical operating room setting. Controlled interventions performed to nurture NTS (N.=13) were identified and compared. We comment on the body of current evidence and highlight the achievements and limitations of interventions published thus far. We then propose a novel education and training framework to further develop and enhance non-technical skills in both individual anesthesiologists and operating room teams. We use the cardiac anesthesiology environment as a starting point to illustrate its use, with clinical examples. NTS is a key component of enhancing patient safety. Effective framing of its concepts is central to apply individual characteristics and skills in team environments in the OR and achieve tangible, beneficial patient outcomes.

The effectiveness of the Safety in Interventional Radiology (SIR) Shield in reducing droplet transmission and its effect on image quality and radiation dose.

OBJECTIVE: To evaluate the efficacy of a barrier shield in reducing droplet transmission and its effect on image quality and radiation dose in an interventional suite. METHODS: A human cough droplet visualisation model in a supine position was developed to assess efficacy of barrier shield in reducing environmental contamination. Its effect on image quality (resolution and contrast) was evaluated via image quality test phantom. Changes in the radiation dose to patient post-shield utilisation was measured. RESULTS: Use of the shield prevented escape of visible fluorescent cough droplets from the containment area. No subjective change in line-pair resolution was observed. No significant difference in contrast-to-noise ratio was measured. Radiation dosage to patient was increased; this is predominantly attributed to the increased air gap and not the physical properties of the shield. CONCLUSION: Use of the barrier shield provided an effective added layer of personal protection in the interventional radiology theatre for aerosol generating procedures. ADVANCES IN KNOWLEDGE: This is the first time a human supine cough droplet visualisation has been developed. While multiple types of barrier shields have been described, this is the first systematic practical evaluation of a barrier shield designed for use in the interventional radiology theatre.

Management of orocutaneous fistulas using a vacuum-assisted closure system.

BACKGROUND: The vacuum-assisted closure (VAC) system has been used to manage complicated wounds. The purpose of this study was to describe a novel technique in using the VAC system for orocutaneous fistulas. METHODS: A retrospective study was performed on 10 patients treated at the National Cancer Centre, Singapore, who developed postoperative orocutaneous fistulas. Hydrogum dental paste was used as a sealant together with the VAC system to close the fistulas. We used either the RENASYS or VAC ATS system with 50 mm Hg to 125 mm Hg continuous suction. RESULTS: The 10 patients developed 11 fistulas. The median age of this cohort was 67 years (range, 33-80 years). Nine patients had successful closure of their fistulas with VAC therapy whereas 1 patient had unsuccessful VAC therapy and required flap reconstruction. The median time to fistula closure was 19 days (range, 6-36 days). The median time to radiotherapy after surgery was 46 days (range, 26-62 days). CONCLUSION: VAC therapy is an effective treatment option for orocutaneous fistulas.

Phasing-out tobacco: proposal to deny access to tobacco for those born from 2000.

As a contribution to worldwide efforts towards a tobacco-free society, this paper considers the possibility of a long-term phasing-in of a total ban, by proposing that individuals born in or after the year 2000 have their supply of tobacco restricted. In conjunction, a survey that we have conducted in Singapore indicates strong public support (even among current smokers) for the proposal.

Global air monitoring study: a multi-country comparison of levels of indoor air pollution in different workplaces.

INTRODUCTION: A local study completed in Singapore, which was part of an international multi-country study that aims to develop a global assessment of exposure to second-hand smoke in indoor workplaces, gathered data regarding the indoor air quality of public areas. It was hypothesised that air would be less polluted in non-smoking venues compared to places where smoking occurred. MATERIALS AND METHODS: A TSI SidePak AM510 Personal Aerosol Monitor was used to sample and record the levels of respirable suspended particles (RSP) in the air. A broad range of venues were sampled in Singapore. The primary goal of data analysis was to assess the difference in the average levels of RSP in smoke-free and non smoke-free venues. Data was assessed at 3 levels: (a) the mean RSP across all venues sampled compared with the mean levels of smoke-free and non smoke-free venues, (b) levels in venues where smoking occurred compared with similar venues in Ireland, and (c) comparison between smoke-free and non smoke-free areas according to the type of venue. Statistical significance was assessed using the Mann-Whitney U-test. RESULTS: The level of indoor air pollution was 96% lower in smoke-free venues compared to non smoke-free venues. Averaged across each type of venue, the lowest levels of indoor air pollution were found in restaurants (17 microg/m3) and the highest in bars (622 microg/m3); both well above the US EPA Air Quality Index hazardous level of >or=251 ug/m3. CONCLUSIONS: This study demonstrates that workers and patrons are exposed to harmful levels of a known carcinogen and toxin. Policies that prohibit smoking in public areas dramatically reduce exposure and improve worker and patron health.