The value of guided operating theatre experience for undergradaute nurses

Not all undergraduate nurses visit the operating theatre. Does this impact on care provided pre and post-operatively? Knowledge testing revealed a 76% pass rate for guided compared to 56% for non-guided learners at graduation and a 100% pass rate for guided compared to 53% of non-guided after their Graduate Nurse Year.

Measuring nursing competencies in the operating theatre: instrument development and psychometric analysis using Item Response Theory

BACKGROUND: Concern about the process of identifying underlying competencies that contribute to effective nursing performance has been debated with a lack of consensus surrounding an approved measurement instrument for assessing clinical performance. Although a number of methodologies are noted in the development of competency-based assessment measures, these studies are not without criticism. RESEARCH AIM: The primary aim of the study was to develop and validate a Performance Based Scoring Rubric, which included both analytical and holistic scales. The aim included examining the validity and reliability of the rubric, which was designed to measure clinical competencies in the operating theatre. RESEARCH METHOD: The fieldwork observations of 32 nurse educators and preceptors assessing the performance of 95 instrument nurses in the operating theatre were used in the calibration of the rubric. The Rasch model, a particular model among Item Response Models, was used in the calibration of each item in the rubric in an attempt at improving the measurement properties of the scale. This is done by establishing the 'fit' of the data to the conditions demanded by the Rasch model. RESULTS: Acceptable reliability estimates, specifically a high Cronbach's alpha reliability coefficient (0.940), as well as empirical support for construct and criterion validity for the rubric were achieved. Calibration of the Performance Based Scoring Rubric using Rasch model revealed that the fit statistics for most items were acceptable. CONCLUSION: The use of the Rasch model offers a number of features in developing and refining healthcare competency-based assessments, improving confidence in measuring clinical performance. The Rasch model was shown to be useful in developing and validating a competency-based assessment for measuring the competence of the instrument nurse in the operating theatre with implications for use in other areas of nursing practice.

The effect of surgical timing on the outcome of patients with neck of femur fracture

Aims: To investigate the effect of surgical timing (in hours versus after hours and weekdays versus weekends) on the outcome of patients with neck of femur fracture. Methods: Patients who were admitted to a single tertiary referral hospital for surgical management of femoral neck fractures over a continuous period from 1/11/2002 to 12/7/2012 were identified from medical records and the operating theatre database. Results: A consecutive series of 2334 patients were included in the study. Of the patients who underwent surgery during the weekday and during usual hours, 18 % (207/1135) experienced an adverse event, compared to 16 % (193/1199) outside of these times. The difference between the two groups was not significant (p = 0.17). The same conclusion was made for the comparison between those who had surgery during the week with those who had surgery on the weekend (17 %, 267/1546 and 17 %, 133/788, respectively, p > 0.05). The proportion of patients who underwent surgery during hours that experienced an adverse event was significantly higher than those undergoing surgery out of hours (18 %, 327/1789 and 13 %, 73/545, respectively, p = 0.0081). When adjusted for age, ASA score and pre-operative stay, there was no statistical difference between those different sub-groups. Conclusions: There was no difference in the rates of adverse events between patients who had surgery during hours and weekdays with those who had surgery after hours or weekends. The careful selection of patients with appropriate hospital staff, resources and adequate theatre access, surgery during after hours and weekends may be safely considered to prevent a delay in surgical treatment for patient with neck of femur fracture.

Monitoring and evaluating surgical care: defining perioperative mortality rate and standardising data collection

BACKGROUND: Case volume per 100 000 population and perioperative mortality rate (POMR) are key indicators to monitor and strengthen surgical services. However, comparisons of POMR have been restricted by absence of standardised approaches to when it is measured, the ideal denominator, need for risk adjustment, and whether data are available. We aimed to address these issues and recommend a minimum dataset by analysing four large mixed surgical datasets, two from well-resourced settings with sophisticated electronic patient information systems and two from resource-limited settings where clinicians maintain locally developed databases. METHODS: We obtained data from the New Zealand (NZ) National Minimum Dataset, the Geelong Hospital patient management system in Australia, and purpose-built surgical databases in Pietermaritzburg, South Africa (PMZ) and Port Moresby, Papua New Guinea (PNG). Information was sought on inclusion and exclusion criteria, coding criteria, and completeness of patient identifiers, admission, procedure, discharge and death dates, operation details, urgency of admission, and American Society of Anesthesiologists (ASA) score. Date-related errors were defined as missing dates and impossible discrepancies. For every site, we then calculated the POMR, the effect of admission episodes or procedures as denominator, and the difference between in-hospital POMR and 30-day POMR. To determine the need for risk adjustment, we used univariate and multivariate logistic regression to assess the effect on relative POMR for each site of age, admission urgency, ASA score, and procedure type. FINDINGS: 1 365 773 patient admissions involving 1 514 242 procedures were included, among which 8655 deaths were recorded within 30 days. Database inclusion and exclusion criteria differed substantially. NZ and Geelong records had less than 0·1% date-related errors and greater than 99·9% completeness. PMZ databases had 99·9% or greater completeness of all data except date-related items (94·0%). PNG had 99·9% or greater completeness for date of birth or age and admission date and operative procedure, but 80-83% completeness of patient identifiers and date related items. Coding of procedures was not standardised, and only NZ recorded ASA status and complete post-discharge mortality. In-hospital POMR range was 0·38% in NZ to 3·44% in PMZ, and in NZ it underestimated 30-day POMR by roughly a third. The difference in POMR by procedures instead of admission episodes as denominator ranged from 10% to 70%. Age older than 65 years and emergency admission had large independent effects on POMR, but relatively little effect in multivariate analysis on the relative odds of in-hospital death at each site. INTERPRETATION: Hospitals can collect and provide data for case volume and POMR without sophisticated electronic information systems. POMR should initially be defined by in-hospital mortality because post-discharge deaths are not usually recorded, and with procedures as denominator because details allowing linkage of several operations within one patient's admission are not always present. Although age and admission urgency are independently associated with POMR, and ASA and case mix were not included, risk adjustment might not be essential because the relative odds between sites persisted. Standardisation of inclusion criteria and definitions is needed, as is attention to accuracy and completeness of dates of procedures, discharge and death. A one-page, paper-based form, or alternatively a simple electronic data collection form, containing a minimum dataset commenced in the operating theatre could facilitate this process. FUNDING: None.

A real-time abnormality detection system for intensive care management

Detecting abnormalities from multiple correlated time series is valuable to those applications where a credible realtime event prediction system will minimize economic losses (e.g. stock market crash) and save lives (e.g. medical surveillance in the operating theatre). For example, in an intensive care scenario, anesthetists perform a vital role in monitoring the patient and adjusting the flow and type of anesthetics to the patient during an operation. An early awareness of possible complications is vital for an anesthetist to correctly react to a given situation. In this demonstration, we provide a comprehensive medical surveillance system to effectively detect abnormalities from multiple physiological data streams for assisting online intensive care management. Particularly, a novel online support vector regression (OSVR) algorithm is developed to approach the problem of discovering the abnormalities from multiple correlated time series for accuracy and real-time efficiency. We also utilize historical data streams to optimize the precision of the OSVR algorithm. Moreover, this system comprises a friendly user interface by integrating multiple physiological data streams and visualizing alarms of abnormalities. © 2013 IEEE.

A cluster operating system supporting parallel computing

The single factor limiting the harnessing of the enormous computing power of clusters for parallel computing is the lack of appropriate software. Present cluster operating systems are not built to support parallel computing – they do not provide services to manage parallelism. The cluster operating environments that are used to assist the execution of parallel applications do not provide support for both Message Passing (MP) or Distributed Shared Memory (DSM) paradigms. They are only offered as separate components implemented at the user level as library and independent servers. Due to poor operating systems users must deal with computers of a cluster rather than to see this cluster as a single powerful computer. A Single System Image of the cluster is not offered to users. There is a need for an operating system for clusters. We claim and demonstrate that it is possible to develop a cluster operating system that is
able to efficiently manage parallelism, support Message Passing and DSM and offer the Single System Image. In order to substantiate the claim the first version of a cluster operating system, called GENESIS, that manages parallelism and offers the Single System Image has been developed.

GENESIS: an efficient, transparent and easy to use cluster operating system

Present operating systems are not built to support parallel computing––they do not provide services to manage parallelism, i.e., to globally manage parallel processes and computational resources. The cluster operating environments that are used to assist the execution of parallel applications do not provide support for both programming paradigms, message passing (MP) or distributed shared memory (DSM)––they are mainly offered as separate components implemented at the user level as library and independent server processes. Due to poor operating systems users must deal with clusters as a set of independent computers rather than to see this cluster as a single powerful computer. A single system image (SSI) of the cluster is not offered to users. There is a need for an operating system for clusters. We claim and demonstrate in this paper that it is possible to develop a cluster operating system that is able to efficiently manage parallelism; use cluster resources efficiently; support MP in the form of standard MP and PVM, and DSM; offer SSI; and make it easy to use. We show that to achieve these aims this operating system should inherit many features of a distributed operating system and provide new services which address the needs of parallel processes, cluster's resources, and application developers. In order to substantiate the claim the first version of a cluster operating system managing parallelism and offering SSI, called GENESIS, has been developed.

The development of an efficient checkpointing facility exploiting operating systems services of the GENESIS cluster operating system

Recent research efforts of parallel processing on non-dedicated clusters have focused on high execution performance, parallelism management, transparent access to resources, and making clusters easy to use. However, as a collection of independent computers used by multiple users, clusters are susceptible to failure. This paper shows the development of a coordinated checkpointing facility for the GENESIS cluster operating system. This facility was developed by exploiting existing operating system services. High performance and low overheads are achieved by allowing the processes of a parallel application to continue executing during the creation of checkpoints, while maintaining low demands on cluster resources by using coordinated checkpointing.

Operating experiences with an advanced fabric energy storage system in Australia

Despite their proven track record in the cold climate countries of northern Europe, there are no reports in the research literature of experiences using advanced fabric energy storage (FES) systems in countries where cooling rather than heating is the main priority. This paper reports some of the experiences with the first known advanced FES system in Australia made over the first full calendar .year of operation. It is located in a three storey building on a university campus in Victoria and has been in operation since mid-2002. Temperature, energy use and operational mode data were recorded during 2003. Airflow measurements through the FES have been made in five areas of the building. On-going operating problems still exist with the system and this has prevented a conclusive evaluation of its suitability for the southern Australian climate.

Recent indigenous theatre in Australia:the politics of autobiography

Over the past decade Australian theatre has seen an increased profile for works written and created by Indigenous artists. This paper looks at the development of Indigenous theatre in Australia and considers how increased mainstream production opportunities have facilitated this expansion of Indigenous theatre practice. Based on the textual analysis of a number of key works, this paper looks at the development of the one-person show as the dominant genre for Indigenous theatre practices, and investigates the relationship between autobiography and the celebration of ‘otherness’. This study argues that this theatre work represents a shift away from conventional representations of Aboriginality towards a more self-determined expression of political identity.

The play, of blessed memory : the Dybbuk as imagined and reconstructed Jewishness in the Gilgul Theatre's 'Exile Trilogy'

I have quite distinct memories of my first encounters with people I identified as Jews. In the 1970's, when I was in my teens, I made friends with a group of Jewish girls, and was invited to their homes, most of which were in the Melbourne (Australia) suburb of Caulfield, which had one of the highest proportions of Jewish inhabitants in the city. I was growing up opposite a golf-course in an increasingly affluent, beachside, bleached-blonde outer suburb whose micro-culture epitomised entrenched Anglo-Australian values; good manners, regular hours, discreet display of wealth, restrained emotion, mid-week tennis, weekends on the beach. Entree to the homes of these Jewish families provided my fairly romantic and uncritical eye with a glimpse of another world....

Building audiences for Indigenous theatre : a case study of Kooemba Jdarra

This paper uses audience research data to examine the positioning of Indigenous theatre in the Australian theatre environment. Kooemba Jdarra is an Aboriginal theatre company in Brisbane, Australia, with a distinguished history of developing Aboriginal artists, writers and directors. However, it has struggled to maintain its positioning because of the perceived risks of participation by audiences who prefer to see Indigenous theatre within the program of the mainstream state theatre company. The paper concludes with strategies for decreasing risk for audiences and for greater advocacy by the company in positioning itself in the mainstream Australia theatre environment.