Adaptive strategies used by surgical teams under pressure: an interview study among senior healthcare professionals in four major hospitals in the United Kingdom.

Background: Healthcare systems are operating under substantial pressures, and often simply cannot provide the standard of care they aspire to within the available resources. Organisations, managers, and individual clinicians make constant adaptations in response to these pressures, which are typically improvised, highly variable and not coordinated across clinical teams. The purpose of this study was to identify and describe the types of everyday pressures experienced by surgical teams and the adaptive strategies they use to respond to these pressures.

Development of a high fidelity, multidisciplinary, crisis simulation model for robotic surgical teams.

Immediate access to the patient in crisis situations, such as cardiac arrest during robotic surgery, can be challenging. We aimed to present a full immersion simulation module to train robotic surgical teams to manage a crisis scenario, enhance teamwork, establish clear lines of communication, improve coordination and speed of response. Start time of cardiopulmonary resuscitation (CPR), first defibrillator shock and robotic de-docking time from the first 'cardiac arrest call' were recorded.

A BURST-BAUS consensus document for best practice in the conduct of scrotal exploration for suspected testicular torsion: the Finding consensus for orchIdopeXy In Torsion (FIX-IT) study.

Objectives: To produce a best practice consensus guideline for the conduct of scrotal exploration for suspected testicular torsion using formal consensus methodology.

Materials And Methods: A panel of 16 expert urologists, representing adult, paediatric, general, and andrological urology used the RAND/UCLA Appropriateness Consensus Methodology to score a 184 statement pre-meeting questionnaire on the conduct of scrotal exploration for suspected testicular torsion. The collated responses were presented at a face-to-face online meeting and each item was rescored anonymously after a group discussion, facilitated by an independent chair with expertise in consensus methodology.

EAU-ESPU guidelines recommendations for daytime lower urinary tract conditions in children.

The objective is to review the literature related to lower urinary tract (LUT) conditions in children to conceptualize general practice guidelines for the general practitioner, pediatrician, pediatric urologist, and urologist. PubMed was searched for the last 15-year literature by the committee. All articles in peer-review journal-related LUT conditions (343) have been retrieved and 76 have been reviewed extensively.

Practical recommendations of the EAU-ESPU guidelines committee for monosymptomatic enuresis-Bedwetting.

Background And Aims: The objective of this update of the EAU-ESPU guidelines recommendations for nocturnal enuresis was to review the recent published literature of studies, reviews, guidelines regarding the etiology, diagnosis and treatment options of nocturnal enuresis and transform the information into a practical recommendation strategy for the general practitioner, pediatrician, pediatric urologist and urologist.

Material And Methods: Since 2012 a monthly literature search using Scopus® was performed and the relevant literature was reviewed and prospectively registered on the European Urology bedwetting enuresis resource center (http://bedwetting.europeanurology.

Treatment of Varicocele in Children and Adolescents: A Systematic Review and Meta-analysis from the European Association of Urology/European Society for Paediatric Urology Guidelines Panel.

Context: The benefits and harms of intervention (surgical or radiological) versus observation in children and adolescents with varicocele are controversial.

Objective: To systematically evaluate the evidence regarding the short- and long-term outcomes of varicocele treatment in children and adolescents.

Evidence Acquisition: A systematic review and meta-analysis was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) statement.

Role of antibiotic prophylaxis in antenatal hydronephrosis: A systematic review from the European Association of Urology/European Society for Paediatric Urology Guidelines Panel.

Background: The benefits and harms of continuous antibiotic prophylaxis (CAP) versus observation in patients with antenatal hydronephrosis (ANH) are controversial.

Objective: The aim was to determine the effectiveness of CAP for ANH, and if beneficial to determine the best type and regimen of antibiotic and the most harmful to provide guidance for clinical practice.

Methods: A systematic literature search was performed in databases including Medline, Embase, and Cochrane in June 2015.

Management of undescended testes: European Association of Urology/European Society for Paediatric Urology Guidelines.

Context: Undescended testis is the most common endocrinological disease in the male newborn period. Incidence varies between 1.0% and 4.

Single incision prone retroperitoneoscopic paediatric nephrectomy.

Objective: We have previously reported our early experience (2 patients) of single-incision nephrectomy via the retroperitoneal prone route using an advanced access platform (GelPOINT Mini). Here, we review our series to date and also present a detailed video demonstrating the technique.

Method: In the prone position, a single transverse incision was made at the midpoint on a line along the lateral border of erector spinae bounded by the lower border of the 12th rib and iliac crest.

Impact of intraoperative distractions on patient safety: a prospective descriptive study using validated instruments.

Background: There is emerging evidence indicating that distractions in the operating room (OR) are prevalent. Studies have shown a negative impact of distractions, but they have been conducted mostly with residents in simulated environments. We tested the hypothesis that intraoperative distractions are associated with deterioration in patient safety checks in the OR.

"An Unusual Urological Tumour": Above the Collar and below the Belt.

Bladder lymphomas are rarely primary tumours and more commonly associated with systemic lymphoma, either as nonlocalised bladder lymphoma or as secondary bladder lymphoma. Primary bladder lymphomas (PBL) tend to be low-grade mucosa-associated lymphoid tissue (MALT) type, contrasting with diffuse large cell or follicular centre cell types more commonly seen in secondary bladder lymphoma. Bladder involvement by systemic lymphoma infers poor prognosis and patients often have no localising symptoms (typically a postmortem diagnosis).

Using manual dexterity to predict the quality of the final product in the small bowel anastomosis after a period of training.

Objective: The use of aptitude tests in the selection of surgeons has gained recent attention. Few have described its relevance in predicting the acquisition of surgical techniques. We aim to show whether assessing manual dexterity can predict the quality of the final product after a period of training.

Differences in final product of a bowel anastomosis of male and female novice surgeons.

Introduction: There is a disproportionate ratio of male to female surgeons when compared with the ratio at medical school. Although gender differences in surgical technical ability is not known, studies have shown gender differences in visuospatial ability and manual dexterity. We devised a study to assess objectively the quality of final product of small bowel anastomosis in male and female novice surgeons to explore differences in surgical technical ability.

Framework for incorporating simulation into urology training.

Objectives: • Changes to working hours, new technologies and increased accountability have rendered the need for alternative training environments for urologists. • Simulation offers a promising arena for learning to take place in a safe, realistic setting. • Despite its benefits, the incorporation of simulation into urological training programmes remains minimal.

Observational teamwork assessment for surgery: construct validation with expert versus novice raters.

Objective: To test the construct validity of the Observational Teamwork Assessment for Surgery (OTAS) tool.

Summary Background Data: Poor teamwork in surgical teams has been implicated in adverse events to patients. The OTAS is a tool that assesses teamwork in real time for the entire surgical team.

Development, initial reliability and validity testing of an observational tool for assessing technical skills of operating room nurses.

Background: The recent emergence of the Systems Approach to the safety and quality of surgical care has triggered individual and team skills training modules for surgeons and anaesthetists and relevant observational assessment tools have been developed.

Objective: To develop an observational tool that captures operating room (OR) nurses' technical skill and can be used for assessment and training.

Methods: The Imperial College Assessment of Technical Skills for Nurses (ICATS-N) assesses (i) gowning and gloving, (ii) setting up instrumentation, (iii) draping, and (iv) maintaining sterility.

Reliability of a revised NOTECHS scale for use in surgical teams.

Background: Recent developments in the surgical literature highlight the need for assessment of nontechnical skills in surgery. We report a revision of the NOn-TECHnical Skills (NOTECHS) scale of the aviation industry for use in surgery and detailed analysis on its reliability.

Methods: The original NOTECHS scale assesses (1) Cooperation, (2) Leadership and Managerial Skills, (3) Situation Awareness and Vigilance, and (4) Decision Making.

Annoyances, disruptions, and interruptions in surgery: the Disruptions in Surgery Index (DiSI).

Background: Recent studies have investigated disruptions to surgical process via observation. We developed the Disruptions in Surgery Index (DiSI) to assess operating room professionals' self-perceptions of disruptions that affect surgical processes.

Materials: The DiSI assesses individual issues, operating room environment, communication, coordination/situational awareness, patient-related disruptions, team cohesion, and organizational issues.

Multidisciplinary crisis simulations: the way forward for training surgical teams.

Background: High-reliability organizations have stressed the importance of non-technical skills for safety and of regularly providing such training to their teams. Recently safety skills training has been applied in the practice of medicine. In this study, we developed and piloted a module using multidisciplinary crisis scenarios in a simulated operating theatre to train entire surgical teams.

Observational teamwork assessment for surgery (OTAS): refinement and application in urological surgery.

Background: Teamwork in surgical teams is at the forefront of good practice guidelines and empirical research as an important aspect of safe surgery. We have developed a comprehensive assessment for teamwork in surgery-the Observational Teamwork Assessment for Surgery (OTAS)-and we have tested it for general surgical procedures. The aim of the research reported here was to extend the assessment to urology procedures.

Laparoscopy simulators.

To reduce the complication rate associated with laparoscopic surgery and to improve training, several simulators have been incorporated into training curricula and skills courses. We discuss the advantages and disadvantages and compare the different types of simulators available. We also reviewed the literature to assess the acquisition of skills using these simulators and their transfer to real operations.

Recording of drug allergies: are we doing enough?

Objective: To assess the implementation of local and national guidelines concerning documentation of drug/clinical hypersensitivities.

Design: Audit with retrospective and prospective components used to assess the process of drug hypersensitivity documentation.

Patients: Fifty surgical inpatients' notes were retrospectively analysed followed by 63 patients prospectively.

The complexity of measuring interprofessional teamwork in the operating theatre.

Surgery depends on interprofessional teamwork, which is becoming increasingly specialized. If surgery is to become a highly reliable system, it must adapt and professionals must learn from, and share, tested models of interprofessional teamwork. Trainers also need valid measures of teamwork to assess individual and team performance.