Surgical checklist for cataract surgery:progress with the initiative by the Royal College of Ophthalmologists to improve patient safety

PurposeThe World Health Organisation (WHO) identified patient safety in surgery as an important public health matter and advised the adoption of a universal peri-operative surgical checklist. An adapted version of the WHO checklist has been mandatory in the National Health Service since 2010. Wrong intraocular lens (IOL) implantation is a particular safety concern in ophthalmology. The Royal College of Ophthalmologists launched a bespoke checklist for cataract surgery in 2010 to reduce the likelihood of preventable errors. We sought to ascertain the use of checklists in cataract surgery in 2012.Patients and methodsA survey of members of the Royal College of Ophthalmologists seeking views on the use of checklists in cataract surgery. Four hundred and sixty-nine completed responses were received (18% response rate).ResultsRespondents worked in England (75%), Scotland (11%), Wales (5%), Northern Ireland (2%), the Republic of Ireland (1%), and overseas (6%). Ninety-four per cent of respondents support the use of a checklist for cataract surgery and 85% say that they always use a checklist before cataract surgery. Sixty-seven per cent of cataract surgeons stated they undertake a pre-operative team brief. Thirty-six per cent use a cataract surgery checklist developed locally, 18% use the college's bespoke cataract surgery checklist, 39% use a generic surgical checklist, and 4% reported that they do not use a checklist.ConclusionNinety-three per cent of cataract surgeons responding to the questionnaire report using a surgical checklist and 67% use a team brief. However, only 54% use a checklist, which addresses the selection of the correct intraocular implant. We recommend wider adoption of checklists, which address risks relevant to cataract surgery, in particular the possibility of selection of an incorrect IOL.Eye advance online publication, 24 May 2013; doi:10.1038/eye.2013.101.

Spectacles of military urbanism in online representations of the Elite Squad of the military police of Rio de Janeiro: a multimodal approach

This paper presents a multimodal analysis of online self-representations of the Elite Squad of the military police of Rio de Janeiro, the Special Police Operations Battalion BOPE. The analysis is placed within the wider context of a “new military urbanism”, which is evidenced in the ongoing “Pacification” of many of the city’s favelas, in which BOPE plays an active interventionist as well as a symbolic role, and is a kind of solution which clearly fails to address the root causes of violence which lie in poverty and social inequality. The paper first provides a sociocultural account of BOPE’s role in Rio’s public security and then looks at some of the mainly visual mediated discourses the Squad employs in constructing a public image of itself as a modern and efficient, yet at the same time “magical” police force.

Exodus? The training paths and plans of postgraduate medical trainees, under the Royal College of Physicians of Ireland

Background: In 2006, the Buttimer report highlighted the paucity of demographic data on those applying for and entering postgraduate medical education and training (PGMET) in Ireland. Today, concerns that there is an "exodus" of graduates of Irish medical schools are at the forefront of national discussion, however, published data on PGMET remains inadequate.

Aims: The objectives of this study were to collate existing data relating to trainees and training programmes at three stages of training and to examine the career plans of junior trainees.

Methods: Data from application forms for training programmes, commencing July 2012, under the Royal College of Physicians of Ireland (n = 870), were integrated with data from other existing sources. Candidates entering basic specialist training were surveyed with regard to career plans. Descriptive and comparative analysis was performed in SPSS version 18.

Results: Graduates of Irish medical schools made up over 70 % of appointees. Over 80 % of BST trainees aspired to work as consultants in Ireland, but 92.5 % planned to spend time working abroad (response rate 77 %). Decisions to leave the Irish system were linked to lifestyle, but also to failure to be appointed to higher specialist training. Significant numbers of trainees return to Ireland after a period abroad.

Conclusions: The trainee "exodus" is more complex than is often portrayed. The desire to spend time working outside Ireland must be accounted for in workforce planning and configuration of training programmes. Expansion of HST is a potential solution to reduce the numbers of graduates leaving Ireland post-BST.

Biogeochemistry of the shelf sediments of south eastern Arabian sea: Effect on benthic bacterial heterotrophs

The composition and variability of heterotrophic bacteria along the shelf sediments of south west coast of India and its relationship with the sediment biogeochemistry was investigated. The bacterial abundance ranged from 1.12 x 103 – 1.88 x 106 CFU g-1 dry wt. of sediment. The population showed significant positive correlation with silt (r = 0.529, p< 0.05), organic carbon (OC) (r = 0.679, p< 0.05), total nitrogen (TN) (r = 0.638, p< 0.05), total protein (TPRT) (r = 0.615, p< 0.05) and total carbohydrate (TCHO) (r = 0.675, p< 0.05) and significant negative correlation with sand (r = -0.488, p< 0.05). Community was mainly composed of Bacillus, Alteromonas, Vibrio, Coryneforms, Micrococcus, Planococcus, Staphylococcus, Moraxella, Alcaligenes, Enterobacteriaceae, Pseudomonas, Acinetobacter, Flavobacterium and Aeromonas. BIOENV analysis explained the best possible environmental parameters i.e., carbohydrate, total nitrogen, temperature, pH and sand at 50m depth and organic matter, BPC, protein, lipid and temperature at 200m depth controlling the distribution pattern of heterotrophic bacterial population in shelf sediments. The Principal Component Analysis (PCA) of the environmental variables showed that the first and second principal component accounted for 65% and 30.6% of the data variance respectively. Canonical Correspondence Analysis (CCA) revealed a strong correspondence between bacterial distribution and environmental variables in the study area. Moreover, non-metric MDS (Multidimensional Scaling) analysis demarcated the northern and southern latitudes of the study area based on the bioavailable organic matter

Diversity, local uses and availability of medicinal plants and wild yams in the Mahafaly region of south-western Madagascar

Short summary: This study was undertaken to assess the diversity of plant resources utilized by the local population in south-western Madagascar, the social, ecological and biophysical conditions that drive their uses and availability, and possible alternative strategies for their sustainable use in the region. The study region, ‘Mahafaly region’, located in south-western Madagascar, is one of the country’s most economically, educationally and climatically disadvantaged regions. With an arid steppe climate, the agricultural production is limited by low water availability and a low level of soil nutrients and soil organic carbon. The region comprises the recently extended Tsimanampetsotsa National Park, with numerous sacred and communities forests, which are threatened by slash and burn agriculture and overexploitation of forests resources. The present study analyzed the availability of wild yams and medicinal plants, and their importance for the livelihood of the local population in this region. An ethnobotanical survey was conducted recording the diversity, local knowledge and use of wild yams and medicinal plants utilized by the local communities in five villages in the Mahafaly region. 250 households were randomly selected followed by semi-structured interviews on the socio-economic characteristics of the households. Data allowed us to characterize sociocultural and socioeconomic factors that determine the local use of wild yams and medicinal plants, and to identify their role in the livelihoods of local people. Species-environment relationships and the current spatial distribution of the wild yams were investigated and predicted using ordination methods and a niche based habitat modelling approach. Species response curves along edaphic gradients allowed us to understand the species requirements on habitat conditions. We thus investigated various alternative methods to enhance the wild yam regeneration for their local conservation and their sustainable use in the Mahafaly region. Altogether, six species of wild yams and a total of 214 medicinal plants species from 68 families and 163 genera were identified in the study region. Results of the cluster and discriminant analysis indicated a clear pattern on resource, resulted in two groups of household and characterized by differences in livestock numbers, off-farm activities, agricultural land and harvests. A generalized linear model highlighted that economic factors significantly affect the collection intensity of wild yams, while the use of medicinal plants depends to a higher degree on socio-cultural factors. The gradient analysis on the distribution of the wild yam species revealed a clear pattern for species habitats. Species models based on NPMR (Nonparametric Multiplicative Regression analysis) indicated the importance of vegetation structure, human interventions, and soil characteristics to determine wild yam species distribution. The prediction of the current availability of wild yam resources showed that abundant wild yam resources are scarce and face high harvest intensity. Experiments on yams cultivation revealed that germination of seeds was enhanced by using pre-germination treatments before planting, vegetative regeneration performed better with the upper part of the tubers (corms) rather than the sets of tubers. In-situ regeneration was possible for the upper parts of the wild tubers but the success depended significantly on the type of soil. The use of manure (10-20 t ha¹) increased the yield of the D. alata and D. alatipes by 40%. We thus suggest the promotion of other cultivated varieties of D. alata found regions neighbouring as the Mahafaly Plateau.

Strategies, effectiveness and rationale of vector-borne disease control in the pastoralist system of south-western Uganda

In Uganda, control of vector-borne diseases is mainly in form of vector control, and chemotherapy. There have been reports that acaricides are being misused in the pastoralist systems in Uganda. This is because of the belief by scientists that intensive application of acaricide is uneconomical and unsustainable particularly in the indigenous cattle. The objective of this study was to investigate the strategies, rationale and effectiveness of vector-borne disease control by pastoralists. To systematically carry out these investigations, a combination of qualitative and quantitative research methods was used, in both the collection and the analysis of data. Cattle keepers were found to control tick-borne diseases (TBDs) mainly through spraying, in contrast with the control of trypanosomosis for which the main method of control was by chemotherapy. The majority of herders applied acaricides weekly and used an acaricide of lower strength than recommended by the manufacturers. They used very little acaricide wash, and spraying was preferred to dipping. Furthermore, pastoralists either treated sick animals themselves or did nothing at all, rather than using veterinary personnel. Oxytetracycline (OTC) was the drug commonly used in the treatment of TBDs. Nevertheless, although pastoralists may not have been following recommended practices in their control of ticks and tick-borne diseases, they were neither wasteful nor uneconomical and their methods appeared to be effective. Trypanosomosis was not a problem either in Sembabule or Mbarara district. Those who used trypanocides were found to use more drugs than were necessary.