Striving towards access to essential medicines for human and animal health; a situational analysis of access to and use of antifungal medications for histoplasmosis in Ethiopia.

Antifungal medications are vital in combatting fungal diseases that affect over a billion people annually. Antifungal medications for people and equids are scarce in Ethiopia, where lack of resources to treat fungal infection, in particular histoplasmosis, is a major health challenge. Histoplasmosis is endemic within the equine population in Ethiopia, where it is estimated that one in five horses are infected.

Metal-citrate complex transport in Kineococcus radiotolerans.

The growth of an organism is highly dependent on the acquisition of carbon and metals, and availability of these nutrients in the environment affects its survival. Organisms can obtain both nutrients simultaneously through proteins of the CitMHS superfamily. Bioinformatic studies suggested a CitMHS gene (Accession number ABS03965.

Intentional Rounding: a staff-led quality improvement intervention in the prevention of patient falls.

Aims And Objectives: This study designed and evaluated the use of a specific implementation strategy to deliver a nursing staff-led Intentional Rounding intervention to reduce inpatient falls.

Background: Patient falls are a common cause of harm during hospital treatment. Intentional Rounding has been proposed as a potential strategy for prevention, but has not received much objective evaluation.

Lean Participative Process Improvement: Outcomes and Obstacles in Trauma Orthopaedics.

Objectives: To examine the effectiveness of a "systems" approach using Lean methodology to improve surgical care, as part of a programme of studies investigating possible synergy between improvement approaches.

Setting: A controlled before-after study using the orthopaedic trauma theatre of a UK Trust hospital as the active site and an elective orthopaedic theatre in the same Trust as control.

Participants: All staff involved in surgical procedures in both theatres.

Assessing the Nontechnical Skills of Surgical Trainees: Views of the Theater Team.

Objective: This study aims to explore the views of members of theater teams regarding the proposed introduction of a workplace-based assessment of nontechnical skills of surgeons (NOTSS) into the Intercollegiate Surgical Curriculum Programme in the United Kingdom. In addition, the previous training and familiarity of the members of the surgical theater team with the concept and assessment of NOTSS would be evaluated.

Design: A regional survey of members of theater teams (consultant surgeons, anesthetists, scrub nurses, and trainees) was performed at 1 teaching and 2 district general hospitals in South Yorkshire.

The Safer Delivery of Surgical Services Program (S3): Explaining Its Differential Effectiveness and Exploring Implications for Improving Quality in Complex Systems.

Objective: To analyze the challenges encountered during surgical quality improvement interventions, and explain the relative success of different intervention strategies.

Summary Background Data: Understanding why and how interventions work is vital for developing improvement science. The S3 Program of studies tested whether combining interventions addressing culture and system was more likely to result in improvement than either approach alone.

Quality Improvement in Surgery Combining Lean Improvement Methods with Teamwork Training: A Controlled Before-After Study.

Background: To investigate the effectiveness of combining teamwork training and lean process improvement, two distinct approaches to improving surgical safety. We conducted a controlled interrupted time series study in a specialist UK Orthopaedic hospital incorporating a plastic surgery team (which received the intervention) and an Orthopaedic theatre team acting as a control.

Study Design: We used a 3 month intervention with 3 months data collection period before and after it.

The effect of teamwork training on team performance and clinical outcome in elective orthopaedic surgery: a controlled interrupted time series study.

Objectives: To evaluate the effectiveness of aviation-style teamwork training in improving operating theatre team performance and clinical outcomes.

Setting: 3 operating theatres in a UK district general hospital, 1 acting as a control group and the other 2 as the intervention group.

Participants: 72 operations (37 intervention, 35 control) were observed in full by 2 trained observers during two 3-month observation periods, before and after the intervention period.

Effectiveness of facilitated introduction of a standard operating procedure into routine processes in the operating theatre: a controlled interrupted time series.

Background: Standard operating procedures (SOPs) should improve safety in the operating theatre, but controlled studies evaluating the effect of staff-led implementation are needed.

Methods: In a controlled interrupted time series, we evaluated three team process measures (compliance with WHO surgical safety checklist, non-technical skills and technical performance) and three clinical outcome measures (length of hospital stay, complications and readmissions) before and after a 3-month staff-led development of SOPs. Process measures were evaluated by direct observation, using Oxford Non-Technical Skills II for non-technical skills and the 'glitch count' for technical performance.

A combined teamwork training and work standardisation intervention in operating theatres: controlled interrupted time series study.

Background: Teamwork training and system standardisation have both been proposed to reduce error and harm in surgery. Since the approaches differ markedly, there is potential for synergy between them.

Design: Controlled interrupted time series with a 3 month intervention and observation phases before and after.

Interventions employed to improve intrahospital handover: a systematic review.

Background: Modern medical care requires numerous patient handovers/handoffs. Handover error is recognised as a potential hazard in patient care, and the information error rate has been estimated at 13%. While accurate, reliable handover is essential to high quality care, uncertainty exists as to how intrahospital handover can be improved.

Oxford NOTECHS II: a modified theatre team non-technical skills scoring system.

Background: We previously developed and validated the Oxford NOTECHS rating system for evaluating the non-technical skills of an entire operating theatre team. Experience with the scale identified the need for greater discrimination between levels of performance within the normal range. We report here the development of a modified scale (Oxford NOTECHS II) to facilitate this.

Capturing intraoperative process deviations using a direct observational approach: the glitch method.

Objectives: To develop a sensitive, reliable tool for enumerating and evaluating technical process imperfections during surgical operations.

Design: Prospective cohort study with direct observation.

Setting: Operating theatres on five sites in three National Health Service Trusts.