Effect of noise on tasks in operating theatres: a survey of the perceptions of healthcare staff.

Noise in the operating theatre has an adverse impact on healthcare professionals, both physically and psychologically. It can be distracting, make communication difficult, and contribute to a perceived increase in stress. Staff in theatre must deliver high quality care, and overlook noise as a potentially damaging influence. The aim of this survey was to obtain further information about the perspective of healthcare professionals on how noise can affect their practice and whether it affects their work in theatre. We distributed six closed-ended questions in the form of a Survey Monkey® questionnaire to about 50 hospitals across the UK and target groups such as medical students, the Leeds Advanced Trauma Life Support faculty group, the Court of Examiners of the Royal College of Surgeons of England, and surgical trainees sitting the Member of the Royal College of Surgeons examination. We received 519 responses of which 415 respondents (83%) thought that noise contributed to human errors. A total of 282 participants (57%) thought that the theatre was the noisiest area within the theatre suite. Both communication among staff (n=400, 80%) and concentration (n=384, 77%) were thought to be adversely affected by noise. However, 385 (78%) did not feel that music adversely affected their performance. The results provide insights into the interplay of noise and its effect on people. Although the role of music remains contentious, our results suggest that it might have a calming influence.

Epidural analgesia for labour in a patient with Ebstein's anomaly.

Ebstein's anomaly is an uncommon congenital cardiac defect which is associated with cyanosis and arrhythmias. There have been very few previous reported cases of successful outcome in pregnancy in women with this disorder. We describe the successful analgesic management of an obstetric patient who had been known to have Ebstein's anomaly since childhood. Her first pregnancy was uneventful and analgesia during labour was provided by an epidural. During her second pregnancy she presented to our hospital as her condition had deteriorated. Symptomatic control was achieved with digoxin. Despite this, several episodes of hospitalization were needed pre-partum for rest and oxygen therapy. After the onset of spontaneous labour, analgesia was managed by an epidural using bupivacaine. Invasive monitoring was not deemed appropriate due to increased risk and questionable usefulness. Vaginal delivery was managed with elective lift-out forceps to minimize the stress of pushing. When reviewed two months post-partum she still required digoxin although her symptoms had improved considerably. The successful management of Ebstein's anomaly in pregnancy should include team management from early in pregnancy.

Psychoactive-drug use among adolescents with psychiatric disorders.

Demographic and medical data and data on the use of prescribed and illicit psychoactive drugs were collected retrospectively from medical records of patients admitted for the first time to the adolescent unit of a psychiatric hospital between July 1974 and June 1984. The frequency with which adolescents used prescribed and illicit drugs before admission, during hospitalization, and at discharge from the facility was examined. Data were analyzed for the entire study period and for three time intervals within the 10-year period. Of 204 adolescents between the ages of 11 and 17, 52% were male and 86% were white. The percentage of patients using prescribed psychoactive agents increased during the study period, with the third time interval (1982-84) accounting for the majority of the increase. The use of antidepressants significantly increased over the 10-year period while the use of neuroleptic agents remained fairly constant. Use of at least one illicit drug before admission to the psychiatric facility was reported by 45% of the patient population studied; marijuana was the most frequently used illicit drug. The prescribing patterns reported may be related primarily to individual variation among prescribers. Other factors possibly influencing these prescribing patterns include improved history-taking over the time period studied and less resistance to taking psychoactive medications.