Healthcare service provider perceptions of organisational communication across the perioperative pathway: a questionnaire survey.

AIMS AND OBJECTIVES: To gain understandings into service providers' perceptions of organisational communication and identify areas for improvement across the perioperative pathway. BACKGROUND: Effective communication among healthcare service providers is vital to the delivery of safe and quality patient care. Locally and internationally, research into sentinel and adverse events consistently demonstrate the perioperative environment and communication breakdown as recurring constituents in the generation of sentinel and adverse patient events. DESIGN: Prospective cross-sectional survey design. METHODS: Using a whole population sampling method all service providers from across the perioperative pathway including surgeons, nurses, anaesthetists, theatre technicians, patient service assistants and receptionists were surveyed using the International Communication Association survey. Responses were analysed using descriptive statistics, univariate analysis of variance and independent samples t-tests. RESULTS: In total, 281 service providers from the perioperative pathway of three Australian public hospitals completed the survey. Respondents were dissatisfied with communication from top management and service providers employed in an operating room or postanaesthetic care unit perceived the communication of information to be inadequate. Further, analysis by service providers' occupation revealed nurses were less satisfied with channels of information than surgeons and anaesthetists were less satisfied with the timeliness of information than nurses. CONCLUSIONS: Restricted communication flow was evident as many areas of organisational communication were reported to be insufficient for the transmission of information. This research highlights the need for improved communication flow between service providers, and between management and service providers, working across the perioperative pathway. RELEVANCE TO CLINICAL PRACTICE: Areas identified for communication improvement can be used to prevent communication failures and promote effective communication strategies such as meetings, education, providing time for open communication and developing organisational policy and procedures.

Respiratory function in rats restrained for extended periods: assessment of the effects of bethanecol.

INTRODUCTION: The ICH guideline S7A recommends that the effects of drugs on the respiratory system are evaluated in laboratory mammals prior to administration in man. Previously, animals have been placed in plethysmography chambers for short durations. This study investigates the possibility of restraining animals in chambers for a longer duration to assess respiratory function over extended periods. METHODS: Respiratory function in conscious rats was assessed using plethysmography chambers where the rat body was enclosed in a sealed chamber while the head was free. Thoracic movements were measured by pressure transducers linked to a Buxco amplifier system and respiratory parameters were captured and analyzed by the Notocord HEM data acquisition system. Each animal was subjected to 5 acclimatization sessions of escalating duration (1, 2, 4, 5, and 6 hours (h)) over 5 days prior to testing, with a baseline recording session conducted the day prior to dosing. Animals (8 males/group) were dosed subcutaneously with saline or bethanecol (3, 10, or 30 mg/kg) and placed in the chambers for 6 h of continuous recording. Additionally, a recording session was conducted at 24 h post-dose. RESULTS: Subcutaneous administration of 30 mg/kg bethanecol decreased respiration rate by up to 33% during the first 1.5 h post-dose and increased tidal volume by up to 46% from 0.25 to 1.25 h post-dose when compared to vehicle group data. A decrease in minute volume of up to 33% was observed 0.25 h following administration of the 10 and 30 mg/kg doses. DISCUSSION: These data show a respiratory depression caused by the cholinergic agonist bethanecol, an effect partially compensated for by an increase in tidal volume. This also demonstrates the ability to continuously restrain and record respiratory parameters in conscious rats for up to 6 h without any negative impact on the quality of the data.

Leading the charge--pioneering treatments in the fight against neuropathic pain.

Neuropathic pain, arising from nerve injury, results in a chronic and debilitating form of pain that in the past has been poorly diagnosed and treated. During the past few years, intensive research has resulted in major progress towards understanding the basic mechanisms that contribute to this condition, and the renewed possibility of safe and effective medicines. Indeed, the next few years should see the first fruits of this labour reaching the market place and, with them, the opportunity to assess whether the scientific advances achieved have resulted in significant clinical improvement. In this article, some of the key compounds that will lead this charge and the clinical results obtained so far are discussed.