Background Within our Trust we have a Day Surgery Unit located approximately 6 miles from the main hospital. The use of this building and the services provided has changed during recent years, and there has been concern over future plans. Despite no recent safety incidents, anecdotally morale has fallen, staff feel increasingly isolated and there have been questions over the future capabilities of the service. Methods We have developed a simulation based training programme to enable the entire theatre team to undertake targeted training. We have used a mobile SimMan system to run scenarios within theatre using all local equipment, staff and facilities. It has also allowed us to test the system and functioning of a remote site operating department and identify possible sources for error and potential improvements. We are measuring our progress using the Safety Attitude Questionnaire (SAQ).1 This has already been used to evaluate improvement in attitudes to safety culture and team working following intervention.2,3 Potential impact It is hoped that the use of focussed sessions specific to the needs of the individuals working in remote locations, we will improve confidence with rarely encountered emergencies as well as further developing non-technical skills. If successful we intend to expand this further to other areas of the Trust (such as ECT). Following the first session we highlighted a number of potential latent errors, including a lack of understanding regarding the process for declaring emergencies and the layout of the emergency trolley. Individual feedback has been positive, and staff feel motivated to continue participating in the sessions. We are confident that our findings will have an influence over the future provision of safe and effective care for our patients, as well as maintain skills and confidence in the workplace for the team and improve the safety culture.3 References Sexton JB, Helmreich RL, Neilands TB, Rowan K, Vella K, Boyden J, Roberts PR, Thomas EJ. The safety attitudes questionnaire: psychometric properties, benchmarking data, and emerging research. BMC Health Serv Res 2006;6:44 Wolf FA, Way LW, Stewart L. The efficacy of medical team training: improved team performance and decreased operating room delays: a detailed analysis of 4863 cases. Ann Surg 2010;252:477–485 Hill MR, Roberts MJ, Alderson ML, Gale TCE. Safety Culture and the 5 steps to safer surgery: an intervention study. Br J Anaes 2015:1–5
Cet article expose les résultats d’une recherche visant à mettre au jour les modèles auxquels se réfèrent implicitement des intervenantes et intervenants de la protection de la jeunesse dans leurs actions en situation de crise. Ces interventions visent des familles signalées en raison des troubles de comportement d’un enfant ou d’un adolescent, d’abus physique ou de négligence. Les résultats permettent de décrire, d’expliquer et de comprendre pourquoi et dans quels contextes les interventions sont mises en oeuvre. Ils révèlent que : a) les intervenants doivent faire face à trois types de crises distincts; b) le stress vécu par certains groupes d’intervenants constitue un élément central de l’intervention en situation de crise, et c) les difficultés liées à la concertation avec les nombreux partenaires du réseau provoquent des insatisfactions majeures chez les intervenants. La discussion porte sur l’impérative nécessité de mieux soutenir les intervenants et de créer une véritable concertation avec les partenaires.
Volcanic and granitic rocks of the Jack River igneous field were erupted and emplaced in the suture zone between the accreted Wrangellia composite terrane and the former margin of southern Alaska. The volcanic rocks unconformably overlie Jurassic-Cretaceous shale and sandstone of the Kahiltna assemblage and include 100–300 m of basalt, basaltic andesite, and andesite lava flows overlain by a rhyolite unit that consists of over 900 m of lava flows and pyroclastic deposits. Seven basaltic and rhyolite lava samples yield 40Ar/39Ar ages ranging from 56.0 ± 0.3 to 49.5 ± 0.3 Ma. Two granitic samples yield 40Ar/39Ar ages of 54.6 ± 0.4 and 62.7 ± 0.4 Ma. These age dates indicate that the onset of Jack River magmatism at ca. 62.7 Ma coincided with the terminal phase of terrane accretion and continued after accretion to at least 49.5 Ma.
ABSTRACT ABSTRACT The authors developed an experiment for the undergraduate analytical or forensic chemistry laboratory in which gunshot residues (GSRs) produced from toy cap guns are analyzed by laser-induced breakdown spectroscopy (LIBS). Alternatively, the experiment is readily adaptable to any emission spectroscopy technique. This project allows students to investigate the development of a forensic method while addressing proper sampling techniques used in forensic investigations. Students were able to develop a library of blank samples, establish signal detection limits to address legal considerations for determination of false-positive and -negative error rates, and optimize an emission spectrometer. KEYWORDS: forensic analysisGSRgunshot residuelaser-induced breakdown spectroscopyLIBSspectroscopy education ACKNOWLEDGMENTS This work was supported in part by the Department of Chemistry and Biochemistry at Kennesaw State University; a Kennesaw State University-Center for Excellence in Teaching and Learning-Creative Activities and Research Experiences for Teams (KSU-CETL-CARET) Grant; and an Ocean Optics, Inc. Innovation in Educational Spectroscopy Grant. The authors also thank the students in Forensic Analytical Chemistry, Spring 2008, and Instrumental Analysis, Spring 2007, and Spring 2009.
Background NICE guidelines mandates use of ultrasound guided central venous cannulation (USGCVC). This gave rise to the need for a realistic, effective and cost-effective training tool to teach this skill, as available trainers were expensive and did not survive dilation and actual cannulation. Over several years we have developed and used a simulation model that we think fulfils this function. Description of innovation We evaluated numerous venous surrogates and found latex racing cycle inner tube to have the same dimensions, ultrasonic appearance, haptic characteristics and resealability as central veins. 1 This was used initially in a gelatine substrate which was repaired after use. After developing an Ispagula husk gel based medium that was self-repairing after dilation we switched to that. 2 Both these mediums suffered from desiccation and fungal colonisation, which was solved by adding a preservative to create ADAMgel ( A queous D ietary fibre A ntifreeze M ix gel). We combined the vessel and soft tissue analogue in existing manikins or food containers under a simulated skin. Also included was a pulsatile arterial simulator. The latex tubing was connected to a reservoir of coloured fluid under the correct pressure. Cost were £5–£10 per model. Outcomes These models were then used in formal teaching on USGCVC workshops for medical students, 3 junior doctors 4 and Advanced Trauma and Life Support (ATLS) courses. They remained fully functional resealing after dilation and sonographically pristine without producing needletracts. Trainees scored them over 95% for realism, utility and models’ ability to remain fully functional without producing needletracts, with all participants recommending the model for teaching. 4 Simulated skin analogue had to be periodically replaced and probably eventually the latex inner tubing as well. Take home messages USGCVC simulation based training can be effectively provided at a reasonable cost enabling trainees to fulfil requirements for specialisation training. References Shaw C, Willers J, Bukunola B, et al . Searching for a superior central venous surrogate for ultrasound simulation. Anaesthesia 2013: 68 :43 Barnes L, Willers J, Hariharan S, et al . Gauging the gel in Fybogel. AABGI Annual Congress. Anaesthesia 2014; 69 :s4.11–88 Akrimi S, Malley T, Willers J, et al . A training day for undergraduate students using practical workshops combined with theatre sessions to teach essential skills and inspire interest in anaesthetics. Anaesthesia 2014, 69 :31 Hall A, De Barr P, Willers J, et al . Does simulation increase the familiarity of non-anaesthetists with central venous cannula insertion? Sent to AABGI Annual Congress, 2015
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