Operating Room Environment Research Articles

Electronic Feedback Alone Versus Electronic Feedback Plus in-Person Debriefing for a Serious Game Designed to Teach Novice Anesthesiology Residents to Perform General Anesthesia for Cesarean Delivery: Randomized Controlled Trial.

EmergenCSim is a novel researcher-developed serious game (SG) with an embedded scoring and feedback tool that reproduces an obstetric operating room environment. The learner must perform general anesthesia for emergent cesarean delivery for umbilical cord prolapse. The game was developed as an alternative teaching tool because of diminishing real-world exposure of anesthesiology trainees to this clinical scenario. Traditional debriefing (facilitator-guided reflection) is considered to be integral to experiential learning but requires the participation of an instructor. The optimal debriefing methods for SGs have not been well studied. Electronic feedback is commonly provided at the conclusion of SGs, so we aimed to compare the effectiveness of learning when an in-person debrief is added to electronic feedback compared with using electronic feedback alone. We hypothesized that an in-person debriefing in addition to the SG-embedded electronic feedback will provide superior learning than electronic feedback alone. Novice first-year anesthesiology residents (CA-1; n=51) (1) watched a recorded lecture on general anesthesia for emergent cesarean delivery, (2) took a 26-item multiple-choice question pretest, and (3) played EmergenCSim (maximum score of 196.5). They were randomized to either the control group that experienced the electronic feedback alone (group EF, n=26) or the intervention group that experienced the SG-embedded electronic feedback and an in-person debriefing (group IPD+EF, n=25). All participants played the SG a second time, with instructions to try to increase their score, and then they took a 26-item multiple-choice question posttest. Pre- and posttests (maximum score of 26 points each) were validated parallel forms. For groups EF and IPD+EF, respectively, mean pretest scores were 18.6 (SD 2.5) and 19.4 (SD 2.3), and mean posttest scores were 22.6 (SD 2.2) and 22.1 (SD 1.6; F1,49=1.8, P=.19). SG scores for groups EF and IPD+EF, respectively, were-mean first play SG scores of 135 (SE 4.4) and 141 (SE 4.5), and mean second play SG scores of 163.1 (SE 2.9) and 173.3 (SE 2.9; F1,49=137.7, P<.001). Adding an in-person debriefing experience led to greater improvement in SG scores, emphasizing the learning benefits of this practice. Improved SG performance in both groups suggests that SGs have a role as independent, less resource-intensive educational tools.

Research on the application effect of inter-professional training program for newly enrolled medical staff in operating room based on digital information technology

BackgroundThe operating room environment demands high levels of teamwork and interprofessional collaboration, yet current training programs often lack sufficient opportunities to develop these essential skills. Few studies have explored the impact of Interprofessional Education (IPE) based on digital information technology in improving the collaboration and learning among newly enrolled medical staff in the operating room.ObjectivesThis study aimed to design, implement, and evaluate a digital information technology-based IPE training program for newly enrolled medical staff in the operating room. The evaluation focused on the effects of the program on the participants’ expertise, operational knowledge, team communication skills, and application of these skills in clinical practice.MethodsSixty-eight newly enrolled medical staff from surgical departments in a tertiary hospital in Shanxi province were included in this study from January 2021 to December 2022. The participants engaged in an IPE training curriculum that utilized digital information technology, featuring courses and case studies specifically tailored to the operating room environment. Post-training assessments included evaluation of test scores of expertise course, evaluation of surgical simulation operations (operational knowledge and communication), and the International Interprofessional Collaboration Competency Attainment Survey (ICCAS). The effectiveness of the training was assessed by evaluating improvements in communication skills, application of practical knowledge, and teamwork in surgical contexts.ResultsExpertise course evaluation and reflection revealed that the new enrolled medical staff in the operating room had a deep understanding of the knowledge. At the same time, they are better able to understand and master the nursing mode in the process of different professional surgery, and said that they would like to cooperate with surgeon and anesthesiologist during the surgical operation. The score of the Interprofessional Collaborative Competency Attainment Survey (ICCAS) increased significantly (P < 0.05), indicating that the communication and collaboration skills of the new enrolled medical staff in operating room were further improved, and that they were more familiar with the patient-centered teamwork mode.ConclusionsThis study provides a valuable reference for the design and implementation of IPE programs based on digital information technology in the operating room. It highlights the importance of such programs in enhancing the understanding and cross-disciplinary communication skills for newly enrolled medical staff, ultimately improving patient care through better teamwork.

The First Surgery Experienced Through Virtual Reality: A Knee Surgery Case Report

The decision to undergo surgery and the significance of the operating theater environment are influenced by several factors, which vary from person to person. Negative perceptions of the operating room environment can influence the decision to undergo surgery and the process of treatment. Virtual reality (VR) technology offers the potential to alter individuals' environmental encounters through the provision of diverse environmental perceptions. This case study evaluates the results of a VR simulation applied during surgery to an individual with no previous surgical experience. A male patient scheduled for arthroscopic meniscus surgery was the subject of a VR simulation. The patient's perception of the simulated environment was transmitted through VR goggles from the time he entered the operating room until he left. However, the VR application was terminated during the administration of anesthesia, and no premedication was administered to the patient. The VR application included nature walks in various regions, including forests, lakeshores, and meadows, accompanied by the sound of birds. Data were collected using a visual analog scale to assess pain levels and a walking test form. The patient, a 35-year-old male, is a high school graduate and is undergoing his first surgical procedure. The patient expressed concerns and fears regarding the decision to undergo surgery. The patient's preoperative anxiety was rated at 9 out of 10 but subsequently decreased to 1 out of 10 following the surgical procedure. The patient rated his satisfaction with the surgical experience as 9 out of 10. The patient did not require sedatives or analgesics during the intraoperative period or for the first 10 hours following the operation. The patient was successfully mobilized at the 15-hour mark following surgery. The patient was highly satisfied with the application. The utilization of VR during surgical procedures has the potential to reduce the necessity for premedication and enhance postoperative compliance among patients.

Operating room soundscape design intervention study

Noise levels in a typical Operating Room are often well beyond the recommended 45dB for a typical OR environment. Due to stringent cleanability requirements in hospitals, there are limited finishes that can be used in these rooms. Researchers from Gresham Smith and Siebein Acoustic are currently engaged in a research project to investigate how the design of the operating room environment can be acoustically optimized for staff well-being and better patient outcomes. . The study focuses on the environmental variables that can be controlled including the effects of diffusing panels, angling of the walls, and the use of special cleanable acoustic finishes on the ceiling in 3 prototypically sized Operating Rooms using 3-dimensional acoustic models. Acoustic metrics including Reverberation Time, Speech Transmission Index and clarity were compared for 11 scenarios. Results from the acoustical modeling showed that, comparing 11 different scenarios, rooms treated with absorption performed "best" on multiple metrics (Reverberation Time, Clarity, Speech Transmission Index/Intelligibility). Future research will be implemented within existing operating rooms of our hospital partner for in situ validation. Acoustical measurements will again be taken and evaluated against the initial findings and the perceptions of the users of the spaces.

Challenges With Robot-Assisted Surgery Setup for Complex Minimally Invasive Upper Gastrointestinal Surgery.

The utilization of robot-assisted approaches to surgery has increased significantly over the last two decades. This has introduced novel complexities into the operating room environment, requiring management of new challenges and workflow adaptation. This study aimed to analyze challenges in the surgical setup for complex upper gastrointestinal robot-assisted surgery (UGI-RAS) and identify opportunities for solutions. Direct observations of surgical setup processes for UGI-RAS were performed by a trained Human Factors researcher at a non-profit academic medical center in Southern California. Setup tasks were subdivided into five phases: (1) before wheels-in; (2) patient transfer and anesthesia induction; (3) patient preparation; (4) surgery preparation; and (5) robot docking. Start/end times for each phase/task were documented along with workflow disruption (FD) narratives and timestamps. Setup tasks and FDs were analyzed using descriptive statistics. Twenty UGI-RAS setup procedures were observed between May-November 2023: sleeve gastrectomy +/- hiatal hernia repair (n = 9, 45.00%); para-esophageal hernia repair +/- fundoplication (n = 8, 40.00%); revision to Roux-en-Y gastric bypass (n = 2, 10.00%); and gastric band removal (n = 1, 5.00%). Frequent FDs included planning breakdowns (n = 20, 29.85%), equipment/supply management (n = 17, 25.37%), patient care coordination (n = 8, 11.94%), and equipment challenges (n = 8, 11.94%). Eleven of 20 observations were first-start cases, of which 10 experienced delayed starts. Interventions aimed at improving workflows during UGI-RAS setup include performing pre-operative team huddles and conducting trainings aimed at team coordination and equipment challenges. These solutions could result in improved teamwork, efficiency, and communication while reducing case start delays and turnover time.

A Familiar Working Environment Influences Surgeon's Stress in the Operating Room: A Multi-Specialty Prospective Cohort Study.

To determine the influence of operating room familiarity on surgeon stress. Regulating surgeon stress may improve patient safety. This study evaluated how assisting surgeon and operating room familiarity influence intraoperative heart rate variability among surgeons. Attending surgeons from seven specialties within four university hospitals in France were enrolled from 11/01/20-12/31/21. Vagal tone, an indicator of stress derived from heart rate variability, was assessed during the first five minutes after incision using the root mean square of successive differences (RMSSD). Higher RMSSD values indicate greater vagal tone. Team familiarity was quantified as the cumulative time the attending and assisting surgeons had operated together in the past, while operating rooms in which the surgeon conducted >10% of their operations were termed familiar. The effect of each on the RMSSD was assessed via a linear mixed-effect model adjusting for the random effect of the surgeon and possible confounders. Overall, 643 surgeries performed by 37 surgeons were included. Median surgeon age was 49 years, 29(78.4%) were male, and 22(59.5%) were professors. Surgeons spent an average of 21.2 hours with the assisting surgeon prior to surgery and conducted 585(91.0%) of their operations in a familiar operating room. For every 10 additional hours spent operating together, ln(RMSSD) significantly increased by 0.018 (95%CI: 0.003 to 0.033, P=0.016). Familiar operating rooms also tended to increase surgeon ln(RMSSD) [0.098 (95%CI: -0.007 to 0.203, P=0.068)]. Familiar assisting surgeons, and potentially operating rooms, increased surgeon vagal tone. Maintaining a stable operating room environment may improve surgeon stress and patient care.

AI 기반 서비스디자인을 통한 수술실 간호사의 업무 환경 개선 및 다학제적 융합 연구

AI 기반 서비스디자인을 통한 수술실 간호사의 업무 환경 개선 및 다학제적 융합 연구

Dry eye disease as an occupational risk factor in operating room nurses

ABSTRACT Clinical relevance Knowing occupational risks in a multifactorial disease such as dry eye disease is important for disease diagnosis and treatment. Background Dry eye disease (DED) is a multifactorial disease of the ocular surface characterised by tear film instability, adversely affecting visual function and quality of life. The operating room environment has many risk factors for DED such as air conditioning, constant humidity, constant room temperature, intense lighting, surgical smoke, anaesthetic gases and irritating chemicals, and prolonged mask use. This study investigates the ocular surface findings and blink patterns of operating room nurses at risk of DED. Methods A total of 68 nurses (operating room, n = 34; outpatient clinic, n = 34) were included in this study. The diagnosis of DED was assessed using a questionnaire, best-corrected visual acuity, tear break-up time, corneal fluorescein staining, meibomian gland assessment, Schirmer I test. All the tests were conducted in the same area. Results According to the ocular surface disease index, the rate of dry eye symptoms was significantly higher among operating room nurses than among outpatient nurses (70.5% vs 41.1%). Severe dry eye symptoms were more common in the operating room group. The meibomian gland score was higher in the operating room group (29.4% vs 5.9%). The numbers of blinks (30.91 ± 12.81 vs 21.05 ± 7.77) and incomplete blinks (8.76 ± 4.68 vs 5.76 ± 3.20) at rest were higher in operating room nurses. Conclusion The occupational risk for DED was high among operating room staff. National and international standards for the prevention and management of DED in personnel involved in health care services are needed.

Comparison of intranasal dexmedetomidine and ketamine for paediatric premedication: A randomized study

Introduction and objectivesPaediatric patients are given premedication in order to decrease preoperative anxiety, allow smooth induction, and prevent postoperative psychological insult and behavioural changes. A child friendly method of administration is desirable.We compared intranasal administration of dexmedetomidine and ketamine in the operating room environment, to evaluate the Faces, Legs, Activity, Cry and Consolability (FLACC) score at the time of establishing intravenous access for induction of general anaesthesia. MethodsThis prospective, double-blind, randomized controlled trial was conducted at a tertiary care center. One hundred patients, 2–10 years of age, ASA physical status 1 & 2, scheduled for general anaesthesia were enrolled. Patient’s presedation behaviour was assessed by the modified Yale Preoperative Anxiety Scale Short Form (mYPAS-SF). Patients in Group D received Dexmedetomidine 1 mcg/kg intranasally, and patients in Group K received Ketamine 5 mg/kg intranasally. After 45 min, patients were transferred to the operating table where intravenous cannulation was carried out and the response to needle insertion was assessed by FLACC scale. Vital signs, including the pulse-oximetry, heart rate and respiratory rate were monitored. Side effects such as nausea, vomiting, and agitation were also recorded. ResultsA significantly higher FLACC score was seen in Group D as compared to Group K (p = 0.001). The mean heart rate between two groups was found to be significantly (p = 0.001) lower in Group D compared to Group K. However, the proportion of adverse events was 8% in patients who received ketamine. ConclusionsIntranasal ketamine in a dose of 5 mg/kg is clinically more effective as premedication in children aged 2–10 years in comparison with intranasal dexmedetomidine in a dose of 1 mcg/kg.

A Prospective Look at the Prevalence of Setup Electrode-Swap Errors Across Over 450 Intraoperative Neuromonitoring Cases

ABSTRACT Intraoperative neurophysiological monitoring (IONM) is shown to be useful in surgeries when the nervous system is at risk. Its success in part relies upon proper setup of often dozens of electrodes correctly placed and secured upon patients and inserted in specific stimulating and recording receptacles. Given the complicated setups and the demanding operating room environment, errors in setup are bound to occur. These have led to false negatives associated with new patient morbidities including, at times, paralysis. No studies quantify the prevalence of these types of setup errors. Approximately 800,000 operations annually utilize intraoperative neuromonitoring in the US alone, so even a small percentage of errors suggests clinical significance. In addition, these types of errors hinder the overall effectiveness of IONM and may result in lower reported sensitivities and lower cost-effectiveness of this important service. We sought to discover through a prospective study and verification through chart review the prevalence of “electrode-swap” errors (when recording and/or stimulating electrodes are incorrectly placed on the patient or in the IONM equipment during setup) across all procedures monitored. We found recording and/or stimulating electrode set up errors in 24 of 454 cases (5.3%). These data and examples of how errors were discovered intraoperatively are reported. We also offer techniques to help reduce this error rate. This study demonstrates a significant potential avoidable error in IONM diagnostic utility, patient outcome, and sensitivity/specificity of alert criteria. The value of identifying and correcting these errors is consequential, multifaceted, and far-reaching.

Designing and implementing a training program on surgical hand scrubbing, wearing surgical cap and surgical mask, gowning, and gloving using HMD-based virtual reality technologies for nursing students: an exploration of student perceptions.

The aim of this study is to determine the steps of a training program utilizing Head-Mounted Display (HMD) based Virtual Reality Technology to enhance nursing students' skills in surgical hand scrubbing, wearing surgical cap and surgical mask, gowning and gloving, and to evaluate students' perceptions toward the program. The study aimed to investigate the potential applications of HMD-Based Virtual Reality Technology in Surgical Hand Scrubbing, Wearing Surgical Cap and Surgical Mask, Gowning and Gloving Program for nursing students, as well as students' perceptions toward this technology. The research was conducted with a focus group consisting of second-year nursing students in Osmaniye/Turkey, between January and June 2022, and the training program was implemented in five stages: Analysis, Design, Development, Implementation, and Evaluation. The program was evaluated with a focus group of nursing students. Focus group discussions were conducted to provide insights into students' experiences, feedback, and perceptions of the program. A vast majority of participants (92.5%) reported feeling fully immersed in the operating room environment during the virtual reality (VR) experience. Notably, all students acknowledged the potential of HMD-Based Virtual Reality Technology to enrich their understanding of surgical hand scrubbing, wearing surgical cap and surgical mask, gowning and gloving procedures, surpassing conventional instructional models. While many participants found the experience exhilarating (85.1%), a considerable portion reported a decline in engagement after repeated exposures (88.8%). Overall, participants welcomed the integration of VR technology into education, expressing optimism about its capacity to facilitate additional instructional modules (74.4%). Moreover, they conveyed satisfaction with the opportunity to engage with the VR application, emphasizing its significant educational value (81.4%). Based on these findings, we can suggest that virtual reality technology has the potential to have an impact on nursing students' education. The majority of students expressing a sense of presence in the operating room highlights the value of this method in education. However, the reported boredom after repeated experiences by most participants underscores the importance of diversifying the program and introducing innovative approaches to keep students engaged.

Perceptions about perioperative communication among anesthesiologists and surgeons and the impact of perceived status hierarchies on teamwork in the operating room

ObjectivesThis exploratory study examines anesthesiologists' and surgeons' perceptions regarding perioperative communication and the extent to which any differences or barriers to effective communication are a function of a perceived power dynamic and/or occupational status hierarchies between them. MethodsSemi-structured interviews were conducted with 11 attending anesthesiologists and 10 attending surgeons actively practicing clinically in the United States to explore their perceptions about perioperative communication, status hierarchies in the medical profession, and effective teamwork. The interviews were analyzed using Interpretative Phenomenological Analysis to identify recurrent and overarching themes. ResultsBoth groups acknowledged the role of effective perioperative communication in ensuring optimal surgical outcomes and identified factors such as team inconsistencies and lack of familiarity with the team as major barriers to effective teamwork. Multiple other occupational and institutional barriers were identified. Both clinician groups alluded to a perceived hierarchy in certain contexts, which can impact expectations and communication dynamics within the operating room environment. This appears to be a nuanced and complex relationship which is manifested via several indirect pathways. ConclusionThere are multiple cultural, occupational, and institutional factors that impact the quality of perioperative communication between anesthesiologists and surgeons. The mechanisms by which perceptions around occupational status hierarchies act as a barrier to effective communication appear to be indirect, complex, and warrant further exploration.

Surgical Procedures for the Non-Surgeon: A Rheumatology Perspective

Each specialty of medicine (and surgery) employs certain technical procedures appropriate to their specialty. Occasionally, those procedures require performance in an operating room environment. With the O.R. considered the province of the surgeon, such trespass by non-surgeons is not always well accepted. Rheumatologists seeking to develop arthroscopy as a tool for arthritis patients encountered such resistance but were able to persist and now perform any arthroscopy exclusively in a clinic or procedure room setting. Other procedures now performed by rheumatologists - arthrocentesis, joint washout, synovial biopsy, and labial salivary gland biopsy (lip biopsy) -all had their beginnings in the operating room, but no longer require such an environment. Non-surgeons - including rheumatologists - seeking to develop new invasive procedures may continue to utilize the O.R. in early stages when caution and safety concerns demand high level support, and sterile technique. The history of development of these procedures shows a common path to bedside performance. Any O.R. turf touched by a non-surgeon is only temporary.

Perioperative patient safety indicators-A Delphi study.

To identify, define and achieve consensus on perioperative patient safety indicators within a Swedish context. A modified Delphi method. A purposeful sample of 22 experts, all experienced operating room nurse specialists, was recruited for this study. A questionnaire was constructed incorporating statements derived from a preceding study. The experts were asked to rate the importance of each statement concerning patient safety during the perioperative phase. The data collection occurred through an online survey platform between November 2022 and April 2023. The CREDES checklist guided the reporting of this study. The three-round Delphi study resulted in consensus on 73 statements out of 103, encompassing 74% process indicators and 26% structure indicators. Key areas of consensus included the use of the Surgical Safety Checklist and optimizing the operating room environment. Consensus was reached on perioperative safety indicators, underscoring the intricate challenges involved in ensuring patient safety in the operating room. It emphasizes the important integration of both structure and process indicators for comprehensive safety assessment during surgical procedures. Recognizing the difficulty in measuring factors like teamwork and communication, essential for patient safety, the study offers practical guidance. It underlines a balanced approach and specific consensus areas applicable in clinical practice to enhance perioperative patient safety. This study provides concrete practice guidance and establishes a structured framework for evaluating perioperative care processes. It emphasizes the critical role of professionals having the necessary skills and being present during surgical procedures. Additionally, the study underscores the paramount importance of effective communication and teamwork within the operating room team, substantively contributing to overall patient safety enhancement. The study focused on addressing the challenge of ensuring patient safety in operating rooms, acknowledging the persistent complications related to surgery despite global efforts to eliminate avoidable harm in healthcare. Consensus was reached on 73 crucial indicators for perioperative patient safety, emphasizing a balanced approach integrating both process and structure indicators for a comprehensive assessment of safety during surgical procedures. The study has a broad impact on professionals and healthcare systems, providing concrete guidance for practice and offering a structured process for evaluating perioperative care. The study is reported informed by 'Guidance on Conducting and REporting DElphi Studies (CREDES) in palliative care: Recommendations derived from a methodological systematic review'. No patient or public contribution.

Safe usage of Mini 'C'-arm in operating room environment: Implications for clinical practice.

Mini 'C'-arm machine is an advanced medical imaging device used primarily for intraoperative imaging during surgical, orthopaedic and emergency care procedures. Since the technology is based on ionising radiation, safe usage of Mini 'C'-arm machine is mandatory to protect patients and operating personnel. The main objective is to describe the various components related to patients, operator and equipment to ensure safe usage of Mini 'C'-arm machine. A comprehensive search strategy using the PEO (Population, Exposure, Outcome) framework was conducted using Embase, PubMed, Google Scholar and ResearchGate databases to identify suitable literature. The keywords used for the search included 'Fluoroscopy', 'Ionising Radiation' and 'surgical safety'. Safe usage of Mini 'C'-arm equipment involves components of operator training, operator safety, patient safety, radiation dose, operating room logistics, handling of images and auditing of Mini 'C'-arm use. Mini 'C'-arm provides an invaluable, portable imaging tool in a spectrum of general surgical and orthopaedic interventional procedures. However, safe usage of Mini 'C'-arm machine requires a multifaceted approach including operator responsibility and safety, patient protection, equipment maintenance, radiation dose awareness, documentation and sound reporting mechanisms.

Legal and Ethical Recommendations for Video Recording in the Operating Room: A Review of Literature

Background: One of the legal and ethical issues related to the medical profession and health centers is patients’ uncertainty regarding the type and quality of clinical care provided and the extent to which the health care providers comply with the necessary criteria in delivering health care. This study investigated the civil, criminal, and ethical aspects of using cameras in the operating room by describing a case that a legal complaint had filed regarding this issue and a review of the literature.Methods: The study was a case report and narrative review. First, we introduce a case that found out that the patient admitted for brain tumor surgery did not operate on him and requested to review the videos of the operating room. Then, we investigated this issue in the literature. Results: The purpose and outcome of using Closed-Circuit Television (CCTV) in the Operating Room (OR), may vary depending on the goals, needs, and expectations of different stakeholders. Some countries may use CCTV in the OR primarily for educational, research, or quality improvement purposes. In contrast, others may use CCTV in the OR mainly for security, surveillance, or legal purposes. Conclusion: The suggestion of recording the events done in the operating room environment using a CCTV can be an acceptable solution and as a legal document and evidence.

Nanopore-based metagenomics analysis reveals microbial presence in amniotic fluid: A prospective study

BackgroundCurrent research on amniotic fluid (AF) microbiota yields contradictory data, necessitating an accurate, comprehensive, and scientifically rigorous evaluation. ObjectiveThis study aimed to characterise the microbial features of AF and explore the correlation between microbial information and clinical parameters. Methods76 AF samples were collected in this prospective cohort study. Fourteen samples were utilised to establish the nanopore metagenomic sequencing methodology, whereas the remaining 62 samples underwent a final statistical analysis along with clinical information. Negative controls included the operating room environment (OE), surgical instruments (SI), and laboratory experimental processes (EP) to elucidate the background contamination at each step. Simultaneously, levels of five cytokines (IL-1β, IL-6, IL-8, TNF-α, MMP-8) in AF were assessed. ResultsAmong the 62 AF samples, microbial analysis identified seven without microbes and 55 with low microbial diversity and abundance. No significant clinical differences were observed between AF samples with and without microbes. The correlation between microbes and clinical parameters in AF with normal chromosomal structure revealed noteworthy findings. In particular, the third trimester exhibited richer microbial diversity. Pseudomonas demonstrated higher detection rates and relative abundance in the second trimester and Preterm Birth (PTB) groups. S. yanoikuyae in the PTB group exhibited elevated detection frequencies and relative abundance. Notably, Pseudomonas negatively correlated with activated partial thromboplastin time (APTT) (r = −0.329, P = 0.016), while Staphylococcus showed positive correlations with APTT (r = 0.395, P = 0.003). Furthermore, Staphylococcus negatively correlated with birth weight (r = −0.297, P = 0.034). ConclusionMost AF samples exhibited low microbial diversity and abundance. Certain microbes in AF may correlate with clinical parameters such as gestational age and PTB. However, these associations require further investigation. It is essential to expand the sample size and undertake more comprehensive research to elucidate the clinical implications of microbial presence in AF.

Nurse anaesthetists’ experiences of student nurse anaesthetist learning during clinical practice: a qualitative interview study

BackgroundThe professional role of a nurse anaesthetist involves taking a pedagogical approach towards students, including supervision during clinical practice. Although supervisors are facilitators of student learning, they are offered little training in adult learning principles. The aim of this study was to describe supervisors’ experience of student nurse anaesthetist learning during clinical practice in the operating room.MethodIn this qualitative interview study, 12 semi-structured individual interviews were carried out with clinical supervising nurse anaesthetists. The data were analysed inductively using thematic analysis.ResultsThe results are illustrated with one theme and five sub-themes. The clinical learning situation of student nurse anaesthetists is described as a reflection of different cultures coming together. The operating room environment is a new context to students, and students enter with different clinical background and experiences. There is tension in facilitating student learning due to demands for productivity; supervisors suggest the use of separate operating rooms with a special focus on learning in the future.ConclusionClinical practice facilitates student learning and is a parallel process to routine care. Thus, it requires the cultures of higher education and healthcare organizations to co-exist. This is illustrated with the theme “Contributing to students’ future professional roles by bridging the hospital and university cultures”. In the operating room, student learning is challenged by a new context and time pressure as shown by subthemes. To overcome challenges and support student learning in the operating room from a supervisors’ perspective, interprofessional student teams are suggested as a future approach and need to be further investigated.

Preoperative Virtual Reality to Expose Patients With Breast Cancer to the Operating Room Environment: Feasibility and Pilot Case Series Study.

Clinically elevated preoperative distress and anxiety are common among patients undergoing cancer surgery. Preoperative interventions have been developed to mitigate this distress and anxiety but are inconsistent in efficacy and feasibility for broad implementation. This preliminary pilot study aims to assess the feasibility and utility of a newly developed virtual reality (VR) intervention to expose patients awaiting breast cancer surgery to the operating room environment and a simulation of anesthetic induction. Patients undergoing breast cancer surgery (N=7) were assigned to the VR intervention or control (treatment as usual) group and completed self-report measures of distress and anxiety before surgery, on the day of surgery, and after surgery (5 and 30 d postoperatively). Those in the intervention group trialed the VR simulation 1 to 2 weeks preoperatively and provided qualitative and quantitative feedback. We assessed the feasibility of recruitment capability and study design and evaluated participants' impressions of the intervention using self-report rating scales and open-ended questions. We also descriptively examined distress and anxiety levels throughout the duration of the study. Recruitment occurred between December 2021 and December 2022 and progressed slowly (rate: 1 participant/7 wk on average; some hesitancy because of stress and being overwhelmed). All participants who consented to participate completed the entire study. All participants were female and aged 56 (SD 10.56) years on average. In total, 57% (4/7) of the participants were assigned to the intervention group. On average, intervention participants spent 12 minutes engaged in the VR simulation. In general, the intervention was rated favorably (eg, clear information, enjoyable, and attractive presentation; mean% agreement 95.00-96.25, SD 4.79-10.00) and as helpful (mean% agreement 87.50, SD 25.00). Participants described the intervention as realistic (eg, "It was realistic to my past surgical experiences"), impacting their degree of preparedness and expectations for surgery (eg, "The sounds and sights and procedures give you a test run; they prepare you for the actual day"), and having a calming or relaxing effect (eg, "You feel more relaxed for the surgery"). This preoperative VR intervention demonstrated preliminary feasibility among a sample of patients undergoing breast cancer surgery. Results and participant feedback will inform modifications to the VR intervention and the study design of a large-scale randomized controlled trial to examine the efficacy of this intervention. ClinicalTrials.gov NCT04544618; https://clinicaltrials.gov/study/NCT04544618.

Comparison of the different operation room environmental exposures on tear film function before and after operation

1.2 Previous studies have confirmed that air and light pollution can cause damage to a number of systems throughout the body, including the ocular surface and retina. However, the exact effect of air pollution and light pollution on tear film function is not clear. This study explored the different operation room environmental exposures on tear film function before and after operation. Sixty medical staff in the operating room were selected and divided into 4 groups according to different surgical methods to evaluate the tear film function before and after operation: Da Vinci surgery group (DVSS), Laparoscopic surgery group (LS), Traditional surgery group (TS), and Ophthalmic microsurgery group (OM). The results showed that the levels of light and air pollution were elevated in operating rooms during the operation and the changes of tear film function in the other three groups were statistically significant except for DVSS group. In TS group, particulate matter (pm) 1 (R = 0.61, p < 0.01), pm2.5 (R = 0.63, p < 0.01), and pm10 (R = 0.67, p < 0.01) were positively correlated with eye redness index, and first and average noninvasive tear film break-up times were positively correlated with illuminance (R = 0.54, p < 0.05; R = 0.97, p < 0.01). In OM group, there was a positive correlation between the operation time and the first (R = 0.69, p < 0.01) and average (R = 0.89, p < 0.01) noninvasive tear film break-up times. Our research found that exposure to different operating room environment will lead to damage of tear film function, but also provide a theoretical basis for the improvement of surgical environment.