An investigation of barriers to the use of the World Health Organization Surgical Safety Checklist in theatres

Background. The World Health Organization (WHO) has implemented the Surgical Safety Checklist (SSCL) as part of the Safe Surgery Saves Lives campaign. This is aimed at improving surgical safety worldwide. Despite many perceived benefits of the SSCL, compliance and acceptance in many areas remain poor.Objectives. To investigate perceptions of theatre staff regarding the checklist and to identify reasons and barriers for poor compliance and implementation. Methods. Questionnaires were handed out to theatre teams across all surgical disciplines at two large hospitals in Durban, South Africa, over a 2-week period. Data collected included role in theatre, intention of the SSCL, training received, as well as questions regarding previously identified barriers and staff perceptions.Results. Questionnaires were distributed to 225 practitioners, with a response rate of 81.7% from 51 nurses, 54 anaesthetists and 79 surgeons. Rank of medical staff included 52 seniors (consultants) and 81 juniors (registrars and medical officers). The majority (95%) of respondents perceived the SSCL as intended to improve safety, prevent errors or reduce morbidity and mortality. A total of 146 respondents (79.3%) received no SSCL training. No new barriers were identified, but previously identified barriers were confirmed. Our key factors were time-related issues and lack of buy-in from team members. Surgeons were perceived as being supportive by 45.1% of respondents, in contrast to nurses (62.5%), anaesthetists (70.1%) and management (68.5%). When compared with junior staff, senior staff were 5-fold more likely to feel that staff did not need to be trained and 8-fold more likely to indicate that the checklist did not improve patient safety.Conclusions. The WHO SSCL is an important tool in the operating room environment. The barriers in our setting are similar to those identified in other settings. There needs to be widespread training in the use of the SSCL, including adaptation of the checklist to make it fit for purpose in our setting. Improving use of the checklist will allow theatre staff to work together towards ensuring a safer theatre environment for both patients and staff

Litotripsia extracorpórea con ondas de choque con el tripter XI / Extracorporeal lithotripsy shockwave with tripter XI

Desde septiembre de 1989 se ha empleado Litotripsia Extracorpórea en 18 pacientes portadores de litiasis renal o ureteral alta. El equipo empleado es un Tripter X 1; se ha conseguido fragmentación en el 100% de los casos y eliminación completa antes del mes en el 78%. 1 paciente que formó steinstrasse ureteral requirió manipulación endoureteral. Esta es la primera experiencia nacional con litotripsia extracorpórea

Veloplastia primaria: técnica quirúrgica / Surgery of velum platinum: surgical technic

La importancia del músculo elevador del velo del paladar en la función de la trompa de Eustaquio en la hendidura palatina, ha sido manifestada por algunos autores, mientras otros creen en la relación del músculo tensor del velo del paladar. Como quiera que el cierre quirúrgico del paladar blando puede beneficiar su función, nosotros elegimos realizar la veloplastia a la edad de tres meses. la técnica quirúrgica implica el cierre del paladar blando por capas, dejando el hamulus intacto y la mitad lateral de la inserción ósea del músculo tensor del velo del paladar también intacta para evitar la disfunción de este músculo. Doce niños fueron operados a la edad de tres meses y seguidos por más de dos años por el especialista de la audición y del lenguaje, y todos ellos tienen buena función auditiva. Conservativamente, la veloplastia primaria puede ser realizada a los tres meses de edad como una ayuda al difícil problema de la otitis media y sus secuelas

Tips of the trade #11. A technique for tendon and capsule separation in shoulder surgery.

Difficulty is frequently encountered in separating the rotator cuff tendons, particularly the subscapularis tendon, from the underlying and often adherent capsule. A safe and quick method of dissecting the tendon from the capsule using a Cobb elevator has proven effective without causing capsular penetration in well over 100 consecutive primary shoulder stabilizations.

Suturas automáticas en cirugía torácica: experiencia-clinica; IVSS 1981-1987 / Automatic sutures in throracic surgery: clinical-experience; IVSS 1981-1987

El objeto del presente trabajo es hacer una revisión del tema de las suturas mecánicas y del empleo del engrapado en los diferentes tipos de operaciones que se efectúan en la "Cirugía Torácica" (pulmón-esófago). Se presenta el material clínico, obtenido de la práctica diaria en los quirófanos de la sección de "cirugía del Tórax" en el Hospital "Dr. Miguel Pérez Carreño" en el lapso de seis años (1981-1987). La cirugía realizada mediante el empleo del instrumental y técnicas de autosutura, fue realizada por los integrantes del Servicio de Cirugía General N-1. Se han intervenido con estos instrumentos a 97 pacientes realizado 129 procedimientos. Podemos establecer que las suturas mecánicas, son tan seguras, y que se efectúan con mayor rapidez que las realizadas en forma manual, también han hecho progresar la cirugía. El instrumento de autosutura es eficiente y fácil de aplicar con porcentaje bajo de fracaso

[Surgical treatment of axillary hyperhidrosis]. / Zur operativen Behandlung der Hyperhidrosis axillaris.

Surgical treatment of hyperhidrosis axillaris is described using a housed razor blade to remove subcutaneous sweat glands.

[Use of fiber-optic elements in ophthalmological instruments and light sources]. / Primenenie volokonno-opticheskikh élementov v oftal'mologicheskikh instrumentakh i osvetitel'nykh ustroistvakh.

Application of flexible light guides in ophthalmological devices and light sources permits to develop the tools for illumination of surgical field, transilluminators for eyes, combinations of instruments with tools for intraocular manipulations. An eye transilluminator has been produced and tested with a set of attachments comprising fiver-optic light-guiding elements. This instrument allows to reveal foreign particles in the eye's vitreous body and in the surrounding tissues, and to diagnose some pathological changes.

[The "martin-arm" system for abdominal wall fixation for many applications - experience from its use of gynaecology (author's transl)]. / Erfahrungen mit dem neuen vielseitig verwendbaren Bauchdeckenhalter "martin-Arm"-System in der Gynäkologie.

The "martin-arm"-System meets the demand for optimal fixation of outer edges of the wound cavity and exact positioning of organs in a three dimensional manner at abdominal operations. The four joints of each arm individually connected to the Op-table make this possible. They are fixed in position by a central joint with a lever which can be tightened. An adequate assortment of exchangeable retractors, specula and spatulas offers the possibility of a clear view of the operation. All instruments are ready for use even without the "martin-Arm". This system is especially suitable for emergency surgery, for small gynaecology wards or during staff shortages e.g. at night. The operation setting, according to requirements, remains in position for the duration of the whole operation. In the case of long operations, fatigue symptoms of the assistant are no longer present with this instrumentation.