The provision of a trauma bed in theatre recovery and its impact on trauma theatre efficiency: experience from a high-volume trauma unit.

INTRODUCTION: Inefficiencies in the trauma setting are well known and have been further exacerbated by the COVID-19 pandemic among other factors, resulting in national guidance to aid improvements in resource utilisation. This study introduced a novel surgeon-led intervention, a trauma bed in recovery, with the aim of improving trauma theatre efficiency. METHODS: This quality improvement project was conducted using a Plan Do Study Act (PDSA) methodology and comprised multiple cycles to assess theatre performance. A multidisciplinary team (MDT) approach with relevant stakeholder input enabled intervention implementation, aimed at facilitating 'golden patient' arrival in the anaesthetic room as early as possible. The primary outcome was the time at which the first patient entered the anaesthetic room, and the secondary outcome was the number of cases performed each day. RESULTS: The study period was 1 year and encompassed three PDSA cycles. The intervention achieved its primary outcome by PDSA cycle 1 and its secondary outcome by PDSA cycle 2, demonstrating statistically significantly improved results (p < 0.001). A subanalysis assessed the specific impact of the intervention, and demonstrated a significant improvement in both outcomes when the intervention was used as intended (p < 0.0005). CONCLUSIONS: A ringfenced trauma bed significantly improved theatre start times and thereby theatre efficiency. This is a simple, pragmatic intervention that benefitted the MDT trauma team while also demonstrating a sustained impact. Given that National Health Service efficiency is at the forefront of national healthcare discourse, we recommend that this intervention is implemented in other trauma units to help provide a solution to this longstanding issue.

Radiological analysis and outcomes of isolated greater tuberosity fracture-dislocations.

BACKGROUND: The purpose of this study was to investigate different radiological characteristics for isolated greater tuberosity (GT) fracture-dislocations and their effects on complication and reoperation rates. METHODS: A two-centre, retrospective study was performed on patients with a minimum 1-year follow-up (median 4.5 years). Patients were split into two groups, Group A (<65 years old) and Group B (≥65 years old). Outcomes included initial injury characteristics (dislocation and fracture type, AC/BC ratio and distances), the reduction environment and postreduction outcomes including complications. RESULTS: A total of 55 patients were included in this study, with a reduction in the emergency department (ED) performed in 93% of patients. Complication rates (47% overall) were similar in both groups, with an overall nonunion rate of 27%. No nonunions occurred in fractures reduced in theatre compared with 29% occurring in reductions in ED (p<0.001); 11% of patients experienced surgical neck fractures, the majority of which were in Group B (p=0.003). A larger fracture fragment (i.e. higher AC/BC or AC distances) was correlated with a higher incidence of nonunion in Group B compared with Group A (p=0.003), and a higher risk of stiffness in both groups (p=0.049); 16% of patients demonstrated delayed displacement of their GT. CONCLUSIONS: This study highlights the high complication rates associated with these injuries. Age and specific radiological parameters should be taken into consideration when risk stratifying, as should reducing these fractures in a theatre setting. Interval radiographs are also advised to monitor GT displacement for at least 2-3 weeks.

Genetic Diversity, Biofilm Formation, and Antibiotic Resistance of Pseudomonas aeruginosa Isolated from Cow, Camel, and Mare with Clinical Endometritis.

Pseudomonas aeruginosa is a ubiquitous opportunistic bacterium that causes diseases in animals and humans. This study aimed to investigate the genetic diversity, antimicrobial resistance, biofilm formation, and virulence and antibiotic resistance genes of P. aeruginosa isolated from the uterus of cow, camel, and mare with clinical endometritis and their drinking water. Among the 180 uterine swabs and 90 drinking water samples analysed, 54 (20%) P. aeruginosa isolates were recovered. Isolates were identified biochemically to the genus level by the automated Vitek 2 system and genetically by the amplification of the gyrB gene and the sequencing of the 16S rRNA gene. Multilocus sequence typing identified ten different sequence types for the P. aeruginosa isolates. The identification of ST2012 was significantly (p ≤ 0.05) higher than that of ST296, ST308, ST111, and ST241. The isolates exhibited significantly (p ≤ 0.05) increased resistance to piperacillin (77.8%), ciprofloxacin (59.3%), gentamicin (50%), and ceftazidime (38.9%). Eight (14.8%) isolates showed resistance to imipenem; however, none of the isolates showed resistance to colistin. Multidrug resistance (MDR) was observed in 24 isolates (44.4%) with a multiple antibiotic resistance index ranging from 0.44 to 0.77. MDR was identified in 30 (33.3%) isolates. Furthermore, 38.8% and 9.2% of the isolates exhibited a positive extended-spectrum-ß-lactamase (ESBL) and metallo-ß-lactamase (MBL) phenotype, respectively. The most prevalent ß-lactamase encoding genes were blaTEM and blaCTX-M, however, the blaIPM gene was not detected in any of the isolates. Biofilm formation was observed in 49 (90.7%) isolates classified as: 11.1% weak biofilm producers; 38.9% moderate biofilm producers; 40.7% strong biofilm producers. A positive correlation was observed between the MAR index and biofilm formation. In conclusion, the results highlighted that farm animals with clinical endometritis could act as a reservoir for MDR and virulent P. aeruginosa. The emergence of ESBLs and MBLs producing P. aeruginosa in different farm animals is a public health concern. Therefore, surveillance programs to monitor and control MDR P. aeruginosa in animals are required.

Genotyping and Antimicrobial Susceptibility of Clostridium perfringens and Clostridioides difficile in Camel Minced Meat.

The present study aimed to determine the occurrence, genotypes, and antimicrobial resistance of Clostridium perfringens (C. perfringens) and Clostridioides difficile (C. difficile) in camel minced meat samples collected from small butcher shops and supermarkets in Al-Ahsa Governorate, Saudi Arabia. A total of 100 camel minced meat samples were randomly collected from small butcher's shops (n = 50) and supermarkets (n = 50) in Al-Ahsa Governorate, Saudi Arabia. C. perfringens and C. difficile were isolated and identified using the VITEK-2 compact system and 16S rRNA gene amplification. Genotypes, toxin genes, and antimicrobial susceptibility of the isolates were determined. Moreover, ELISA was used to detect C. perfringens and C. difficile toxins. C. perfringens and C. difficile were isolated from 14% and 4% of the tested minced meat samples, respectively. Out of the 14 C. perfringens isolates, type A (64.3%), type B (7.1%), type C (21.5%), and type D (7.1%) were detected. However, out of the four C. difficile isolates, three (75%) were type A+B+ and one (25%) was type A-B+. None of the C. perfringens or C. difficile toxins were identified using ELISA. C. perfringens and C. difficile isolates exhibited a high rate of resistance to tetracycline (56% and 75%, respectively). However, all isolates were susceptible to amoxicillin-clavulanate. Multidrug resistance was observed in three (21.4%) C. perfringens and one (25%) C. difficile isolates. In conclusion, camel minced meat was contaminated with C. perfringens and C. difficile, which present a potential risk of food poisoning. The majority of the isolates were resistant to at least one antimicrobial, and some isolates were multidrug-resistant. Therefore, food safety standards and frequent inspections of abattoirs, small butcher shops, and supermarkets should be enforced.

Coexistence of superconductivity and charge-density wave in the quasi-one-dimensional material HfTe3.

We present the first experimental evidence for metallicity, superconductivity (SC) and the co-existence of charge density waves (CDW) in the quasi-one-dimensional material HfTe3. The existence of such phenomena is a typical characteristic of the transition metal chalcogenides however, without the application of hydrostatic pressure/chemical doping, it is rare for a material to exhibit the co-existence of both states. Materials such as HfTe3 can therefore provide us with a unique insight into the relationship between these multiple ordered states. By improving on the original synthesis conditions, we have successfully synthesised single phase HfTe3 and confirmed the resultant structure by performing Rietveld refinement. Using low temperature resistivity measurements, we provide the first experimental evidence of SC at ~1.4 K as well as a resistive anomaly indicative of a CDW formation at ~82 K. By the application of hydrostatic-pressure, the resistivity anomaly shifts to higher temperature. The results show that HfTe3 is a promising new material to help study the relationship between SC and CDW.

Experiences of person-centred care - patients' perceptions: qualitative study.

BACKGROUND: Patient care models have been implemented and documented worldwide. Many studies have focused on features that hinder and facilitate the shift to such models, including the implementation process, staff involvement, resistance to new models and cultural dimensions. However, few studies have identified the potential effects of such new care models from a patient perspective. The aim of the present study was to investigate whether patients did in fact perceive the intentions of partnership in the new care model 1 year after its implementation. METHODS: Sixteen participants were interviewed, selected from two wards in a medical department where a new care model had been implemented 1 year earlier. A directed deductive content analysis was selected. The aim of the directed approach to content analysis was to investigate to what extent the new care model had been implemented, using patients' perspectives to describe the level of implementation. A coding framework was developed based on a theoretical paper that described the key features of the new care model. RESULTS: The implementation of person-centred care had clearly occurred to a large degree, even if some patients appeared not to have been exposed to the model at all. Aspects of the newly implemented care model were obvious; however, it was also clear that implementation was not complete. The analysis showed that patients felt listened to and that their own perception of the situation had been noted. Patients spontaneously expressed that they felt that the staff saw them as persons and did not solely focus on their disease. It was also stated that not every ailment or aspect of a patient's illness needed to be addressed or resolved for open listening to be perceived as a positive experience. CONCLUSIONS: The findings indicate that even though some patients were not interested in participating and playing an active role in their own care, this might relate to a lack of understanding on how to invite them to do so and to increase their confidence. To change healthcare from a paternalistic system to care where patients are seen as partners may require pedagogical skills.

Organizational culture and the implementation of person centered care: results from a change process in Swedish hospital care.

Sweden has one of the oldest, most coherent and stable healthcare systems in the world. The culture has been described as conservative, mechanistic and increasingly standardized. In order to provide a care adjusted to the patient, person centered care (PCC) has been developed and implemented into some parts of the health care industry. The model has proven to decrease patient uncertainty. However, the impact of PCC has been limited in some clinics and hospital wards. An assumption is that organizational culture has an impact on desired outcomes of PCC, such as patient uncertainty. Therefore, in this study we identify the impact of organizational culture on patient uncertainty in five hospital wards during the implementation of PCC. Data from 220 hospitalized patients who completed the uncertainty cardiovascular population scale (UCPS) and 117 nurses who completed the organizational values questionnaire (OVQ) were investigated with regression analysis. The results seemed to indicate that in hospitals where the culture promotes stability, control and goal setting, patient uncertainty is reduced. In contrast to previous studies suggesting that a culture of flexibility, cohesion and trust is positive, a culture of stability can better sustain a desired outcome of reform or implementation of new care models such as person centered care. It is essential for health managers to be aware of what characterizes their organizational culture before attempting to implement any sort of new healthcare model. The organizational values questionnaire has the potential to be used as a tool to aid health managers in reaching that understanding.

Current challenges and opportunities for better integration of human factors research with development of clinical information systems.

OBJECTIVES: Clinical information system (CIS) developers and implementers have begun to look to other scientific disciplines for new methods, tools, and techniques to help them better understand clinicians and their organizational structures, clinical work environments, capabilities of clinical information and communications technology, and the way these structures and processes interact. The goal of this article is to help CIS researchers, developers, implementers, and evaluators better understand the methods, tools, techniques, and literature of the field of human factors. METHODS: We developed a framework that explains how six key human factors topics relate to the design, implementation, and evaluation of CISs. RESULTS: Using this framework we discuss the following six topics: 1) informatics and patient safety; 2) user interface design and evaluation; 3) workflow and task analysis; 4) clinical decision making and decision support; 5) distributed cognition; and 6) mental workload and situation awareness. CONCLUSIONS: Integrating the methods, tools, and lessons learned from each of these six areas of human factors research early in CIS design and incorporating them iteratively during development can improve user performance, user satisfaction, and integration into clinical workflow. Ultimately, this approach will improve clinical information systems and healthcare delivery.

Adults who are mentally handicapped and living with their parents: satisfaction and perceptions regarding their lives and circumstances.

This study describes the circumstances of 12 adults who are mentally handicapped who are residing with their parents. The results are derived from a content analysis of interviews. The analysis explores the reliability of a procedure for rating people's satisfaction. It also investigates people's views regarding the following: money, cooking, laundry, shopping, cleaning, home, neighbours, friends, support, interests and the ATC.