TEAMWORK AND PATIENT SAFETY IN SURGERY

There is a growing concern that adverse events occur frequently in operating theatres. Adverse events such as wrong site surgery and surgical site infections have a severe detrimental impact on not only the patient but also the healthcare staff and the services. Institute of Medicine’s report, ‘To err is human’ highlighted that teamwork failures are a leading cause of death and suffering. Yet, in surgery, measuring teamwork and designing interventions to improve teamwork and patient safety in operating theatres remains an area of research that is largely unexplored. This thesis aims to measure and improve teamwork in operating theatres to ensure safer surgery. In this project, the WHO surgical safety checklist was evaluated for its impact on patient safety. The WHO checklist improved patient safety processes in operating theatres but its impact on teamwork, intra-operative problems and theatre efficiency was not clearly understood. Therefore, a framework was developed to measure teamwork failures, equipment problems and technical failures as surrogate markers of teamwork, patient safety and efficiency in operating theatres. Equipment failures emerged as a sensitive measure of teamwork in operating theatres. Teamwork failures were also associated with technical failures, delay in case progress and patient harm. It emerged that the WHO checklist can improve teamwork and theatre efficiency and reduce equipment problems in operating theatres when it is used in its true spirit rather than a tick-box exercise.Open Acces

Rotational spectra of interstellar N- and CN-PAHs: pyrene and coronene

The detection of benzonitrile (C6H5CN), 1- and 2-cyano-naphthalene (C10H7CN) in the cold, dark molecular cloud TMC-1 at centimetre (cm) wavelengths has opened up prospects for the detection of other N- and CN-containing polycyclic aromatic hydrocarbons (PAHs). In this light, the pure rotational spectra of N-pyrene (C15H9N), CN-pyrene (C15H9CN), N-coronene (C23H11N) and CN-coronene (C23H11CN) are reported here for the first time. The B3LYP/6-311+G(d,p) level of theory, in the Density Functional Theory (DFT) calculations, achieves the best performance for calculating the spectroscopic parameters and simulating the rotational spectra. The large permanent dipole moment of CN-PAHs makes them the most suitable PAH species for detection in the interstellar medium. Additionally, pyrene's smaller partition function makes CN-pyrene a prime candidate to be discovered in cold, dark molecular clouds such as the TMC-1. The present work sets a benchmark for theoretical rotational spectra of N- and CN-containing PAHs and may act as a guide for laboratory experiments and observational searches

How safe are clinical systems?

Th is study was commissioned by the Health Foundation to examine the extent, type and causes of failures in reliability in different healthcare systems: failures which have the potential to create risk or cause patient harm

Antilymphoid antibody preconditioning and tacrolimus monotherapy for pediatric kidney transplantation

Objective: Heavy post-transplant immunosuppression may contribute to long-term immunosuppression dependence by subverting tolerogenic mechanisms; thus, we sought to determine if this undesirable consequence could be mitigated by pretransplant lymphoid depletion and minimalistic post-transplant monotherapy. Study design: Lymphoid depletion in 17 unselected pediatric recipients of live (n = 14) or deceased donor kidneys (n = 3) was accomplished with antithymocyte globulin (ATG) (n = 8) or alemtuzumab (n = 9). Tacrolimus was begun post-transplantation with subsequent lengthening of intervals between doses (spaced weaning). Maintenance immunosuppression, morbidity, graft function, and patient/graft survival were collated. Results: Steroids were added temporarily to treat rejection in two patients (both ATG subgroup) or to treat hemolytic anemia in two others. After 16 to 31 months (mean 22), patient and graft survival was 100% and 94%, respectively. The only graft loss was in a nonweaned noncompliant recipient. In the other 16, serum creatinine was 0.85 ± 0.35 mg/dL and creatinine clearance was 90.8 ± 22.1 mL/1.73 m2. All 16 patients are on monotherapy (15 tacrolimus, one sirolimus), and 14 receive every other day or 3 times per week doses. There were no wound or other infections. Two patients developed insulin-dependent diabetes. Conclusion: The strategy of lymphoid depletion and minimum post-transplant immunosuppression appears safe and effective for pediatric kidney recipients. © 2006 Elsevier Inc. All rights reserved

How safe are clinical systems? Primary research into the reliability of systems within seven NHS organisations

The knowledge that poor systems can cause harm is not new, but the size of this problem has not been established systematically. This report provides groundbreaking evidence of the extent to which important clinical systems and processes fail, and the potential these failings have to harm patients. This study forms part of the Health Foundation’s work to help healthcare organisations improve the quality of services they offer. Our Safer Patients Initiative has highlighted the need to take a clinical systems approach to improving safety, since it is failings in these systems that often contribute to breakdowns in patient safety

Renal transplantation in children managed with lymphocyte depleting agents and low-dose maintenance tacrolimus monotherapy

OBJECTIVE. Describe the safety and efficacy of antithymocyte globulin or alemtuzumab preconditioning, steroid avoidance and reduced calcineurin inhibitor (CNI) immunosuppression in 34 children undergoing renal transplantation. METHODS. ATG (n=8) or alemtuzumab (n=26) were infused at the time of transplantation. This was followed by low-dose twice a day tacrolimus monotherapy with consolidation to once daily dosing by 6 months and once every other day dosing by 12 months. Follow-up ranged from 0.5-2.9 years (mean 1.33 years), with a minimum of 6 months. RESULTS. Both ATG and alemtuzumab were well tolerated. Lymphopenia occurred routinely and resolved after 3-6 months. Acute cellular rejection occurred in 9%; it was related to medical nonadherence in two patients and resulted in one graft loss at 1.5 years. Important adverse events included transient neutropenia in 10 children (none with serious infection), and autoimmune hemolytic anemia in two (resolved with a steroid course in both and conversion to sirolimus in one). Estimated glomerular filtration rate (e-GFR) was stable and averaged 88 mL/min/1.73 m at latest follow-up. Fifteen preadolescents had a greater increase in height Z-score at 1 year (1.3 vs. 0.5, P=0.001), and a higher e-GFR (94.8±21 vs. 76.6±20 ml/min/1.73 m, P<0.05), when compared to case-matched historical controls who were weaned off steroids by 6 months after transplantation and received twice daily tacrolimus monotherapy. CONCLUSION. This simple regimen appears safe, has a low risk for acute cellular rejection or other adverse effects, and is associated with excellent growth and renal function. Such a regimen may also improve compliance and limit CNI nephrotoxicity. © 2007 Lippincott Williams & Wilkins, Inc

Derivation of Chondrogenically-Committed Cells from Human Embryonic Cells for Cartilage Tissue Regeneration

Background: Heterogeneous and uncontrolled differentiation of human embryonic stem cells (hESCs) in embryoid bodies (EBs) limits the potential use of hESCs for cell-based therapies. More efficient strategies are needed for the commitment and differentiation of hESCs to produce a homogeneous population of specific cell types for tissue regeneration applications. Methodology/Principal Findings: We report here that significant chondrocytic commitment of feeder-free cultured human embryonic stem cells (FF-hESCs), as determined by gene expression and immunostaining analysis, was induced by coculture with primary chondrocytes. Furthermore, a dynamic expression profile of chondrocyte-specific genes was observed during monolayer expansion of the chondrogenically-committed cells. Chondrogenically-committed cells synergistically responded to transforming growth factor-b1 (TGF-b1) and b1-integrin activating antibody by increasing tissue mass in pellet culture. In addition, when encapsulated in hydrogels, these cells formed cartilage tissue both in vitro and in vivo. In contrast, the absence of chondrocyte co-culture did not result in an expandable cell population from FF-hESCs. Conclusions/Significance: The direct chondrocytic commitment of FF-hESCs can be induced by morphogenetic factor

The International Natural Product Sciences Taskforce (INPST) and the power of Twitter networking exemplified through #INPST hashtag analysis

Background: The development of digital technologies and the evolution of open innovation approaches have enabled the creation of diverse virtual organizations and enterprises coordinating their activities primarily online. The open innovation platform titled "International Natural Product Sciences Taskforce" (INPST) was established in 2018, to bring together in collaborative environment individuals and organizations interested in natural product scientific research, and to empower their interactions by using digital communication tools. Methods: In this work, we present a general overview of INPST activities and showcase the specific use of Twitter as a powerful networking tool that was used to host a one-week "2021 INPST Twitter Networking Event" (spanning from 31st May 2021 to 6th June 2021) based on the application of the Twitter hashtag #INPST. Results and Conclusion: The use of this hashtag during the networking event period was analyzed with Symplur Signals (https://www.symplur.com/), revealing a total of 6,036 tweets, shared by 686 users, which generated a total of 65,004,773 impressions (views of the respective tweets). This networking event's achieved high visibility and participation rate showcases a convincing example of how this social media platform can be used as a highly effective tool to host virtual Twitter-based international biomedical research events