Airway management in patients with suspected or confirmed cervical spine injury

Summary: Background: There are concerns that airway management in patients with suspected or confirmed cervical spine injury may exacerbate an existing neurological deficit, cause a new spinal cord injury or be hazardous due to precautions to avoid neurological injury. However, there are no evidence‐based guidelines for practicing clinicians to support safe and effective airway management in this setting. Methods: An expert multidisciplinary, multi‐society working party conducted a systematic review of contemporary literature (January 2012–June 2022), followed by a three‐round Delphi process to produce guidelines to improve airway management for patients with suspected or confirmed cervical spine injury. Results: We included 67 articles in the systematic review, and successfully agreed 23 recommendations. Evidence supporting recommendations was generally modest, and only one moderate and two strong recommendations were made. Overall, recommendations highlight key principles and techniques for pre‐oxygenation and facemask ventilation; supraglottic airway device use; tracheal intubation; adjuncts during tracheal intubation; cricoid force and external laryngeal manipulation; emergency front‐of‐neck airway access; awake tracheal intubation; and cervical spine immobilisation. We also signpost to recommendations on pre‐hospital care, military settings and principles in human factors. Conclusions: It is hoped that the pragmatic approach to airway management made within these guidelines will improve the safety and efficacy of airway management in adult patients with suspected or confirmed cervical spine injury

Greener Operations: a James Lind Alliance Priority Setting Partnership to define research priorities in environmentally sustainable perioperative practice through a structured consensus approach

Objectives: To agree on the ‘top 10’ research priorities for environmentally sustainable perioperative practice. Design: Surveys and literature review; final consensus workshop using a nominal group technique. Setting: UK-based setting. Participants: Healthcare professionals, patients, carers and the public. Outcome measures: Initial survey—suggested research questions; interim survey—shortlist of ‘indicative’ questions (the 20 most frequently nominated by patients, carers and the public, and healthcare professionals); final workshop—ranked research priorities. Results: Initial survey—1926 suggestions by 296 respondents, refined into 60 indicative questions. Interim survey—325 respondents. Final workshop—21 participants agreed the ‘top 10’: (1) How can more sustainable reusable equipment safely be used during and around the time of an operation? (2) How can healthcare organisations more sustainably procure (obtain) medicines, equipment and items used during and around the time of an operation? (3) How can healthcare professionals who deliver care during and around the time of an operation be encouraged to adopt sustainable actions in practice? (4) Can more efficient use of operating theatres and associated practices reduce the environmental impact of operations? (5) How can the amount of waste generated during and around the time of an operation be minimised? (6) How do we measure and compare the short-term and long-term environmental impacts of surgical and non-surgical treatments for the same condition? (7) What is the environmental impact of different anaesthetic techniques (eg, different types of general, regional and local anaesthesia) used for the same operation? (8) How should the environmental impact of an operation be weighed against its clinical outcomes and financial costs? (9) How can environmental sustainability be incorporated into the organisational management of operating theatres? (10) What are the most sustainable forms of effective infection prevention and control used around the time of an operation (eg, personal protective equipment, drapes, clean air ventilation)? Conclusions: A broad range of ‘end-users’ have identified research priorities for sustainable perioperative care

Team work in context : institutional mediation in the public-service professional bureaucracy

This paper examines how context shapes team work within the public-service professional bureaucracy. We examine the effects of an interaction between both macro-institutional and local-organizational context upon the micro-negotiation of team work. Specifically, we consider how features of local context mediate professional-institutional effects. Drawing upon neo-institutionalism (Lawrence and Suddaby 2006; Powell and DiMaggio 1991), we view team members as ‘institutional agents’ (Scott 2008), shaping team work in ways that either reproduce or transform professional structures within particular local conditions. Exemplary of international government transformative efforts for public-service enhancement (Newman 2001; Osborne and Gaebler 1992), we focus upon a UK government initiative to reconfigure professional relationships through introducing team work in National Health Service genetic care. Findings from two qualitative, comparative case studies reveal contrasting outcomes: reproduction or transformation of the professional institution, respectively. Specific local conditions — organizational, and human and social in particular — combine to produce these divergent mediating effects towards inertia or change. This highlights the importance of antecedents to team work and taking a historical perspective to understand the influence of context. While the challenges of reconfiguring professional structures through team work are shown, our analysis also suggests optimism regarding possibilities for change, albeit within certain local conditions. The challenge for management and policy-makers becomes the extent to which — and indeed, if at all — such facilitative local environments might be supported