Understanding Barriers and Facilitators to Behavior Change After Implementation of an Interdisciplinary Surgical Non-Technical Skills Training Program in Rwanda.

Objective: Nontechnical skills, such as situation awareness, decision making, leadership, communication, and teamwork play a crucial role on the quality of care and patient safety in the operating room (OR). In our previous work, we developed an interdisciplinary training program, based on the NOTSS (Non-Technical Skills for Surgeons) taxonomy. The aim of this study was to understand the challenges faced by Rwandan surgical providers, who had undergone NOTSS training, to apply these nontechnical skills during subsequent operative surgery.

Best Buy in Public Health or Luxury Expense?: The Cost-effectiveness of a Pediatric Operating Room in Uganda From the Societal Perspective.

Objective: To determine the cost-effectiveness of building and maintaining a dedicated pediatric operating room (OR) in Uganda from the societal perspective.

Background: Despite the heavy burden of pediatric surgical disease in low-income countries, definitive treatment is limited as surgical infrastructure is inadequate to meet the need, leading to preventable morbidity and mortality in children.

Methods: In this economic model, we used a decision tree template to compare the intervention of a dedicated pediatric OR in Uganda for a year versus the absence of a pediatric OR.

Global paediatric surgery: meeting an unmet need-the response of the British Association of Paediatric Surgeons.

Aim: Outline the response from an organisation regarding the unmet needs in global children's surgery METHOD: The burden of global surgical disease, whilst daunting, is becoming increasingly better defined as agencies, surgical colleges and professional specialty associations all attempt to increase capacity in terms of manpower, support education and find sustainable solutions to the deficit of health in treating women and children. However, definition of the problem does not in itself create change and similarly, humanitarian activities including volunteering by established surgical practitioners and other non-governmental organisations (NGOs) make only marginal improvement in the standards of care on offer at a global level.

Results: The International Affairs Committee, British Association of Paediatric Surgeons (BAPS) has had its target firmly set on investing in potential leaders within paediatric surgery in low- and middle-income countries (LMICs), and sharing elements of the educational programme made available for training within the UK and Ireland with the aim of contributing to the solutions of inequity in the surgical standards available to the world's children.

A Cost-Effectiveness Analysis of a Pediatric Operating Room in Uganda.

Unlabelled: This study examines the cost-effectiveness of constructing a dedicated pediatric operating room (OR) in Uganda, a country where access to surgical care is limited to 4 pediatric surgeons serving a population of over 20 million children under 15 years of age.

Methods: A simulation model using a decision tree template was developed to project the cost and disability-adjusted life-years saved by a pediatric OR in a low-income setting. Parameters are informed by patient outcomes of the surgical procedures performed.

Construct and criterion validity testing of the Non-Technical Skills for Surgeons (NOTSS) behaviour assessment tool using videos of simulated operations.

Background: Surgeons' non-technical skills are an important part of surgical performance and surgical education. The most widely adopted assessment tool is the Non-Technical Skills for Surgeons (NOTSS) behaviour rating system. Psychometric analysis of this tool to date has focused on inter-rater reliability and feasibility rather than validation.

Introduction of the non-technical skills for surgeons (NOTSS) system in a Japanese cancer center.

Purpose: Non-technical skills rating systems, which are designed to support surgical performance, have been introduced worldwide, but not officially in Japan. We performed a pilot study to evaluate the "non-technical skills for surgeons" (NOTSS) rating system in a major Japanese cancer center.

Methods: Upper gastrointestinal surgeons were selected as trainers or trainees.

Nontechnical skills in pediatric surgery: Factors influencing operative performance.

Technical competence is an essential aspect of intraoperative performance but is in itself insufficient to ensure an optimal surgical outcome. A list of other skills complement technical ability and these relate, among others, to surgical judgment and intraoperative decision-making processes as well as the role of the operating surgeon as leader of the surgical team. This article outlines the composite set of nontechnical skills (NTS) and the factors which influence surgical performance by virtue of this skill set.

Competence assurance - who cares?

The provision of clinical care in the United Kingdom now requires the acquisition of a licence to practise from the regulatory authority. A review process-revalidation has been put in place to ensure that standards of care are maintained by the medical workforce, and that all doctors remain up-to-date and fit for purpose so that this licence can be retained. This article outlines how this new statutory requirement pertains to paediatric surgery and highlights those areas where adjudication of competence remains imprecise and where progress in this process of revalidation needs to be made.

Medical error and disclosure - a view from the U.K.

Whilst the steps for reacting to and communicating following a surgical error should be clear to all, actual practice is punctuated by a range of failures which lead to the harm done by the error being compounded by inadequacies in the disclosure and subsequent processes. This article outlines best practice at the current time within the United Kingdom when responding to a surgical error and it also reports the type of behaviours which result in poor levels of satisfaction from the patients' perspective - often resulting in litigation being invoked.

The risk of failure after primary orchidopexy: an 18 year review.

Objective: To review the primary orchidopexy failure rate and outcome of repeat orchidopexy in a tertiary paediatric surgical centre and identify risk factors.

Methods: A prospectively collected and validated audits system was used to identify all boys having a repeat orchidopexy from August 1990 to December 2008 (18 years).

Results: In total, 1538 boys underwent orchidopexy with 1886 testicles operated on.

Development of a behavioural marker system for scrub practitioners' non-technical skills (SPLINTS system).

Rationale, Aims And Objectives: Adverse events still occur despite ongoing efforts to reduce harm to patients. Contributory factors to adverse events are often due to limitations in clinicians' non-technical skills (e.g.

Evaluation of the Scrub Practitioners' List of Intraoperative Non-Technical Skills system.

Background: The Scrub Practitioners' List of Intraoperative Non-Technical Skills (SPLINTS) system is a new tool for training and assessing scrub practitioner (nurse, technician) behaviours during surgical operations.

Objectives: The aim of the study was to test the psychometric properties including inter-rater reliability of the prototype SPLINTS behavioural rating system.

Methods: Experienced scrub practitioners (n=34) attended a one-day session where they received background training in human factors and non-technical skills and were also trained to use the SPLINTS system.

Teaching and assessing non-technical skills.

The terms human factors and non-technical skills have recently been introduced to the language of surgical education. Both tend to be used interchangeably and yet each has a specific definition. More importantly, however, is the fact that the attributes and qualities contained within these headings relate to behaviours, attitudes and cognitive skills.

Surgeons' intraoperative decision making and risk management.

Background: Surgical research on decision making and risk management usually focuses on perioperative care, despite the magnitude and frequency of intraoperative risks. The aim of this study was to examine surgeons' intraoperative decisions and risk management strategies to explore differences in cognitive processes.

Method: Critical decision method interviews were conducted with 24 consultant surgeons who recalled cases and selected important decisions during the operations.

Thinking ahead of the surgeon. An interview study to identify scrub nurses' non-technical skills.

Background: Efforts to reduce adverse event rates in healthcare have revealed the importance of identifying the essential non-technical (cognitive and social) skills for safe and effective performance. Previous research on non-technical skills for operating theatre staff has concentrated on doctors rather than nursing professionals.

Objectives: The aim of the study was to identify the critical non-technical skills that are essential for safe and effective performance as an operating theatre scrub nurse.

Patient safety in surgery: non-technical aspects of safe surgical performance.

The performance of operative surgery has an understandable focus placed on dexterity, technical precision, as well as the choice of procedure. There is less appreciation of the cognitive and social skills of the individual surgeon and the effect that these have on the surgical team and on patient outcome. This article highlights that impact and explores the contribution of non-technical skills to safe practice within the operating room.

The UK proposals for revalidation of physicians: Implications for the recertification of surgeons.

The editorial titled "For the Protection of the Public and the Good of the Specialty: Maintenance of Certification" (published in the February 2009 issue of the Archives of Surgery) has prompted us to offer the following article to inform the debate about how assessing surgical care and sorting out the variables to be included in maintenance of certification may develop worldwide. The proposals for revalidation of UK physicians involve the relicensing of all physicians and recertification of all specialists on the specialist register of the General Medical Council. The process will be on a 5-year cycle and is currently under development by the General Medical Council.

Therapeutic intussusception in necrotizing enterocolitis: a novel surgical strategy.

The optimal operative management of babies with necrotizing enterocolitis (NEC) remains uncertain. We report the case of a premature neonate with advanced NEC where areas of necrotic small bowel were successfully managed by intussusception into adjacent distal intestine and we discuss the merits of therapeutic intussusception as an option in the surgical management of advanced NEC.

Experience matters: comparing novice and expert ratings of non-technical skills using the NOTSS system.

There is growing evidence that non-technical skills (NTS) are related to surgical outcomes and patient safety. The aim of this study was to further evaluate a behaviour rating system (NOTSS: Non-Technical Skills for Surgeons) which can be used for workplace assessment of the cognitive and social skills which are essential components of NTS. A novice group composed of consultant surgeons (n = 44) from five Scottish hospitals attended one of six experimental sessions and were trained to use the NOTSS system.

Operative management of testicular torsion: current practice within the UK and Ireland.

Several methods have been described and are currently used for fixation of testes in the operative treatment of testicular torsion. Although recurrence of torsion is generally viewed as a technical failure, the factors contributing to this failure remain unclear. This survey was conducted to establish current practice amongst paediatric surgeons in the UK and Ireland, in relation to testicular fixation, in an attempt to reflect the level of concern over the potential for recurrence as expressed in choice of procedure.

The changing epidemiology of infantile hypertrophic pyloric stenosis in Scotland.

Background: The aetiology of infantile hypertrophic pyloric stenosis (IHPS) has not been fully elucidated. Since the 1990s, a sharp decline in IHPS has been reported in various countries. Recent research from Sweden reported a correlation between falling rates of IHPS and of sudden infant death syndrome (SIDS).

Surgeons' non-technical skills in the operating room: reliability testing of the NOTSS behavior rating system.

Background: Previous research has shown that surgeons' intraoperative non-technical skills are related to surgical outcomes. The aim of this study was to evaluate the reliability of the NOTSS (Non-technical Skills for Surgeons) behavior rating system. Based on task analysis, the system incorporates five categories of skills for safe surgical practice (Situation Awareness, Decision Making, Task Management, Communication & Teamwork, and Leadership).