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BACKGROUND: The World Health Organization (WHO) Surgical Safety Checklist is used globally to ensure patient safety during surgery. Two years after its implementation in the University Hospital Basel's operating rooms, adherence to the protocol was evaluated. METHODS: This mixed method observational study took place in the surgical department of the University Hospital of Basel, Switzerland from April to August 2017. Data collection was via individual structured interviews with selected OR team members regarding checklist adherence and on-site non-participant observations of Team Time Out and Team Sign Out sequences in the OR. Data were subjected to thematic analysis and descriptive statistics compiled. RESULTS: Comprehensive local expert interviews indicated that individual, procedural and contextual variables influenced the application of the checklist. Facilitating factors included well-informed specialists who advocated the use of the Checklist, as well as teams focused on the checklist's intended process and on its content. In contrast, factors such as staff insecurity, a generally negative attitude towards the checklist, a lack of teamwork, and hesitance to complete the checklist, hindered its implementation.The checklist's application was evaluated in 104 on-site observations comprising of 72 Team Time Out (TTO) and 32 Team Sign Out (TSO) sections. Adherence to the protocol ranged between 96 and 100% in TTO and 22% in TSO respectively. Lack of implementation of the TSO was mainly due to the absence of one of the key OR team members, who were busy with other tasks or no longer present in the operating room. CONCLUSION: The study illustrates factors, which foster and hinder consistent application of the WHO surgical safety checklist namely individual, procedural and contextual. It also demonstrates that the TTO was consistently and correctly applied, while the unavailability of key OR team members at sign-out time was the most common reason for omission or incomplete use of the TSO.
RESUMO
We present a new paradigm to investigate cognitive processing of food cues. The study assessed if pictures of food induce prepulse inhibition (PPI) of startle eye blink, and if any such effect is sensitive to food deprivation. In a balanced cross-over design, 16 healthy male volunteers (mean age: 29 years) were tested on 2 days 1 week apart, either after a period of normal food intake (NFI) or after a 24 h period of food restriction (RFI). On each experimental day, 80 control and 20 food pictures (slides) were displayed. Noise stimuli were presented 250 ms after slide onset. Startle responses were assessed by EMG recordings of the right M. orbicularis oculi. Startle elicited during dark inter-slide periods served as control responses to calculate PPI effects. The arousing content of each picture was rated by all subjects at the end of the session. The perceived arousal effect of control slides was strongly related to their PPI effect; no impact of food access status on this association was detectable. After NFI, food slides significantly induced PPI of startle (mean: -14.5%). After RFI, arousal ratings for food pictures increased but PPI did not. These results are evidence for a pre-attentive mechanism operative in the processing of visual food cues.
