Team perception of the radiation safety climate in the hybrid angiography suite : a cross-sectional study

Background: Good radiation safety practice in the angiosuite is essential to protect patients and healthcare workers. Most strategies aim to advance radiation safety through technological upgrades and educational initiatives. However, safety literature suggests that additional ways to improve radiation safety in the angiosuite do exist. The safety climate reflects the way team members perceive various key characteristics of their work environment and is closely related to relevant safety outcomes. A specific ‘radiation safety climate’ has not been described nor studied in the hybrid angiosuite. This study explores the radiation safety climate in the hybrid angiosuite and its relation to team members' radiation safety behavior, knowledge and motivation. Materials and Methods: Vascular surgeons, fellows/trainees and operating room nurses active in the angiosuite at five hospitals were invited to complete an online self-report questionnaire assessing the radiation safety climate (28 items); radiation safety behavior; radiation safety knowledge and radiation safety motivation. Relations between climate scores and behavior were investigated using Pearson correlations. Mediation was analyzed using the Baron and Kenny analysis. P-Values < 0.05 were considered statistically significant. Results: No major differences were identified in total radiation safety climate scores between centers or team member functions. Scale reliability for radiation safety climate was good to excellent (α > 0.663). Total radiation safety climate scores were positively related to the radiation safety behavior score (r=0.403; p=0.015). This relation was partially mediated by radiation safety knowledge (β=0.1730; 95% CI: [0.0475; 0.3512]), while radiation safety motivation did not act as a mediator: (β=0.010; 95% CI: [-0.0561; 0.0998]). Conclusion: A well-developed radiation safety climate in the hybrid angiosuite fosters positive radiation safety behaviors, which may partially be explained through improved radiation safety knowledge transfer. Further research on (radiation) safety climate and its impact on radiation safety-related outcome measures for patients is recommended

Evolution of surgical treatment of carotid artery stenosis : a single center observational study

Background: In 2009 and 2011 respectively ESVS and AHA/ASA guidelines recommended to operate patients with a symptomatic carotid artery stenosis within 14 days. This study aimed primarily to determine if an academic hospital has implemented these international guidelines about indication and timing of surgical treatment of carotid stenosis. Second, the influence of referral from another hospital on time from symptoms to surgery and the influence of time between neurological event and surgery on 30-day complication rate was studied. Third, the number of asymptomatic carotid artery lesions treated surgically was also evaluated in both periods. Methods: Retrospective study to compare patients with significant atherosclerotic carotid stenosis who underwent carotid endarterectomy (CEA) or carotid artery stenting (CAS) in 2005-2006 versus patients treated in 2014-2016. Demographic data, treatment characteristics, interval between symptom and surgery and 30-day outcomes were collected. Results: In 2005-2006 38.1% (59/155) of the patients were treated for symptomatic carotid artery stenosis, in 2014-2016 this increased to 66.5% (121/182) (p < .001, 95% CI: 0.179-0.383). Median time from neurological symptom to surgery in symptomatic patients decreased from 30 to 13 d (p <.001, 95% CI: 1.476-2.763). Early surgery did not increase the 30-day postoperative complications (p = .19, 95% CI: 0.987-1.003). Referral from another hospital almost doubled the time interval between symptoms and surgery in 2014-2016 (p <.001, 95% CI: 1.386-2.827). Conclusions: Since the publication of the international guidelines, patients with symptomatic carotid artery stenosis were preferably surgically treated within 2 weeks at an academic institution. The number of treated asymptomatic carotid stenoses was drastically reduced

Distributed endovascular training improves performance compared to massed practice but increases the risk of drop-out

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