Reducing Surgery Scheduling Errors in Multihospital System.

OBJECTIVE: The purpose of this study was to assess whether bundled team training interventions for surgeons and office staff could effectively improve the accuracy of surgery scheduling, minimizing scheduling factors that may contribute to occurrence of wrong site surgery. METHODS: This quasi-experimental observational study used an interrupted time series design to explore surgery scheduling errors (SSEs) and implemented bundled team training interventions intended to reduce SSEs at a Pacific Northwest Regional Surgery Scheduling Department. Each preintervention and postintervention segment consisted of 16 weekly data points. The bundled team training interventions included disclosure of preintervention scheduling errors, a scheduling verification checklist, an updated surgery scheduling policy and procedure, and toolkit to improve office scheduling of surgeries. RESULTS: Improvements in SSEs were observed preintervention to postintervention, with decreased surgery SSE rate from 0.51% to 0.13% (P < 0.001). Reductions were observed in all SSE types. The segmented linear trend demonstrated an observed reduction of 42.70 SSE (P < 0.001). CONCLUSIONS: This is the first study conducted at a large healthcare system with a regional surgery scheduling department to demonstrate that statistically significant and clinically important reductions in SSEs can be achieved. The findings demonstrate that SSEs can be minimized and confirm that verification processes must begin in the surgeon's office once a decision has been reached to proceed with surgery. The study confirms the need for additional research targeted at understanding why SSEs occur at the time of scheduling.

Concept analysis: wrong-site surgery.

A concept analysis was conducted on the concept of wrong-site surgery (WSS) using the principle-based method by Penrod and Hupcey. It included analysis of WSS within the context of epistemological, pragmatic, linguistic, and logical principles. The analysis found that WSS is an important concept that is universally accepted, but the definition could be improved with inclusion of comprehensive labeling for types of WSS that may occur, such as wrong patient, wrong site, wrong level/part, wrong procedure, and wrong side. Wrong-site surgery falls into the domains of both nursing and medicine, and there is limited research on the topic specific to nursing interventions, perceptions, and contributions to prevent WSS.

Impact of national smokefree environments laws on teachers, schools and early childhood centres.

ISSUE ADDRESSED: New Zealand's (NZ) smokefree legislation, implemented on 1 January 2004, requires that all school and early childhood centre buildings and grounds are 100% smokefree; one aim being to prevent young people being influenced by seeing people (including teachers) smoke there. This study, conducted in 2008, investigated teachers'smoking behaviour and perceived adherence to the legislation. METHODS: A national NZ cross-sectional survey of 2,004 teachers (oversampling Maori), who were randomly selected from the electoral roll of registered voters and sent postal invitations to complete an anonymous survey. RESULTS: The response rate was 70%. Current smokers numbered 7%, and proportionately more Maori and Pacific Island teachers (12% each) smoked than European/Other teachers (7%). Of current smokers, 37% smoked non-daily. Smokers smoked less on work than non-work days. Introducing smokefree legislation was associated with teachers changing when they smoked, cutting down, quitting or trying to quit. Perceived compliance with the legislation was high, although 30% of teachers reported seeing staff smoking. Proportionately, significantly more teachers from low than from high socioeconomic schools perceived poor compliance and staff visibly smoking. CONCLUSIONS: Smokefree legislation affects people's smoking behaviour. Smoking in NZ is becoming confined to population subgroups defined by socioeconomic status and ethnicity. Our findings argue for supporting cessation among those who work with children and young people, and for targeting support at school communities in areas of low socioeconomic status or with large populations of Maori or Pacific peoples.

Impact on quit attempts of mailed general practitioner 'brief advice' letters plus nicotine replacement therapy vouchers.

AIM: To test whether a personalised letter from general practitioners advising their patients who are smokers to quit, together with an exchange card for one month of nicotine gum, prompts them to make quit attempts, is acceptable and feasible. METHODS: Non-randomised before-after ecological study involving general practices in Auckland, New Zealand. Personalised letters with exchange cards for four weeks of nicotine gum were sent to 831 patients within a single Auckland health board area who were recorded as current smokers on their general practitioners files. The comparison group was the population in another Auckland health board area. We measured calls to Quitline and vouchers redeemed at pharmacies from both areas before and after the intervention. Follow-up surveys of recipients and general practitioners assessed acceptability. RESULTS: Quitline calls from baseline to the end of the intervention from the intervention district compared with a comparison district were not significantly higher (5%, 95% CI -2-12%, p = 0.195), but nicotine replacement therapy (NRT) voucher redemptions were significantly higher (9%, 95% CI 3-16%, p = .005). Almost 9% of the exchange cards were redeemed for NRT. Despite initial difficulties in accurately identifying smokers from their records, responding GPs found the strategy very acceptable. DISCUSSION: The strategy shows potential as a simple way to increase the number of smokers making supported quit attempts through primary care. In the light of the urgent need to increase cessation rates, a randomised trial of this promising approach is warranted.

Ovine trophoblast is a primary source of TNFalpha during Chlamydophila abortus infection.

Chlamydophila abortus is a Gram-negative obligate intracellular bacterium that causes infectious abortion in sheep (ovine enzootic abortion, OEA) and humans. Infected placentas recovered from sheep that experience OEA have thickened membranes, contain dense inflammatory cellular infiltrates and show evidence of intravascular thrombosis. Despite widespread inflammation, chlamydial multiplication is restricted to the chorionic trophoblast cells. To investigate the potential role of trophoblast in the initiation and propagation of placental inflammation during OEA, the AH-1 ovine trophoblast cell line was experimentally infected with C. abortus and analysed for the release of pro-inflammatory mediators. C. abortus was found to induce the release of both tumour necrosis factor-alpha (TNFalpha) and CXCL8 (interleukin-8) from AH-1 cells in a dose- and time-dependent manner. Ultra-violet (UV)-killed organisms did not elicit this profile, indicating that intracellular multiplication of C. abortus was required for release of these pro-inflammatory mediators. Exposure of AH-1 cells to recombinant ovine TNFalpha alone resulted in the release of CXCL8, suggestive of a self-propagating inflammatory cytokine and chemokine cascade. These data indicate a primary role for trophoblast in the initiation and propagation of placental inflammation during chlamydial abortion.