Can a structured checklist prevent problems with laparoscopic equipment?

BACKGROUND: A high incidence of problems with the technical equipment is known to occur during routine laparoscopic procedures. Use of a structured checklist of preparatory measures could help to prevent these problems. This study aimed to determine the extent to which a checklist reduced the number of incidents with technical laparoscopic equipment. METHODS: A 28-item checklist was developed based on frequently occurring laparoscopic equipment problems during 30 laparoscopic cholecystectomies (the control group). A further 30 procedures were conducted with the checklist (the checklist group). The number and type of incidents with the technical equipment were compared between the groups. All the procedures were recorded using a special audio-video system (black-box). RESULTS: In the checklist group, the total number of incidents per procedure was 53% lower than in the control group (23/30 versus 49/30). The checklist led to fewer incidents of wrong positioning (9/30 versus 22/30), and wrong settings and connections (7/30 versus 12/30) of the equipment. Defects or malfunctions decreased from 15/30 in the control group to 7/30 in the checklist group. One or more incidents with the equipment occurred in 47% (14/30) of the checklist procedures compared with 87% (26/30) of the control procedures. Median time taken to complete the checklist items was 3.3 min (range 1.0-8.3 min). CONCLUSIONS: Use of a checklist was feasible and helped to reduce problems with the laparoscopic equipment in the operating room. Future research should aim to implement checklists for different procedures and investigate their effects.

Infrared Astronomy After IRAS.

The 250,000 sources in the recently issued Infrared Astronomy Satellite (IRAS) all-sky infrared catalog are a challenge to astronomy. Many of these sources will be studied with existing and planned ground-based and airborne telescopes, but many others can no longer even be detected now that IRAS has ceased to operate. As anticipated by advisory panels of the National Academy of Sciences for a decade, study of the IRAS sources will require the Space Infrared Telescope Facility (SIRTF), a cooled, pointed telescope in space. This instrument may be the key to our understanding of cosmic birth-the formation of planets, stars, galaxies, active galactic nuclei, and quasars. Compared with IRAS and existing telescopes, SIRTF's power derives from a thousandfold gain in sensitivity over five octaves of the spectrum.

The behavioral side effects of the antihypertensive agents.

Most antihypertensive agents can cause behavioral side effects but only a few effects, such as delirium or severe depression, are serious enough to dictate immediate discontinuance of the offending agent. Other side effects may not even be mentioned by the patient but they can alter the quality of life and, as a result, alter compliance with treatment. For example, sexual difficulties may not be mentioned because of embarrassment. Alteration in dosage, a change in the time of administration or a change to alternative medication may alleviate these problems and help restore the patient's compliance with treatment.

Far-infrared surveys of the sky.

A series of far-infrared surveys of the sky is searching for thermal radiation from interstellar grains and for other localized sources of far-infrared radiation. A balloon-borne germanium bolometer, cooled by liquid helium, is used in association with a telescope and spectral filters. During two initial flights the response to a black-body source was mainly between 300 and 360 microns. Approximately half the celestial sphere was surveyed, including most of the northern Milky Way. The angular resolution was 2 degrees. Moon was the only source of thermal radiation detected. The upper limit on the differential flux, relative to background, from other sources was 2 x 10(-23) watt per square centimeter per hertz, corresponding to an antenna temperature of 0.6 degrees K in the Rayleigh-Jeans approximation, or 10 degrees K for a black body.