Use of Simulation to Visualize Healthcare Worker Exposure to Aerosol in the Operating Room

SUMMARY STATEMENT

Simulation resources offer an opportunity to highlight aerosol dispersion within the operating room environment. We demonstrate our methodology with a supporting video that can offer operating room teams support in their practical understanding of aerosol exposure and the importance of personal protective equipment.

Making the invisible visible: New perspectives on the intersection of human-environment interactions of clinical teams in intensive care

Understanding human behaviour is essential to the successful adoption of new technologies, and for the promotion of safer care. This requires capturing the detail of clinical workflows to inform the design of new human-technology interactions. We are interested particularly in the possibilities for touchless technologies that can decipher human speech, gesture and motion and allow for interactions that are free of contact. Here, we employ a new approach by installing a single 360° camera into a clinical environment to analyse touch patterns and human-environment interactions across a clinical team to recommend design considerations for new technologies with the potential to reduce avoidable touch.

175 Embracing a System-Based Approach to Simulation – The Experience of a Paediatric Hospital During a Global Pandemic

The GOSH Clinical Simulation Centre (CSC) delivers an established paediatric

The aim of the study was to expand the applications of our pan-trust

Over the course of 18 months, simulation exercises were designed to focus on rehearsal and refinement of processes and systems, towards uncovering latent safety threats or gaps in practice. A reporting tool was developed; to capture risks and identify mitigating actions. In addition to this, an established reporting structure enabled faculty to share findings and escalate risks to the local patient safety team. The COVID-19 pandemic presented healthcare workers with many new or unfamiliar working practices. This context further shifted our focus towards systems safety simulations (SSS) with the aim of enabling teams to focus on rehearsing and preparing for new ways of working.

Ten different exercises were delivered with clinical teams across the trust: successfully informing the development of five new clinical guidelines relating to COVID-19-specific practices. In one exercise alone, 11 latent safety threats (LSTs) were captured and managed with the appropriate teams (

Themes from LSTs captured during COVID-19 CT transfer simulation

SSS fire evacuation exercise in the IMRI suite

SSS fire evacuation exercise in the new sight and sound building

These exercises demonstrate the potential applications of simulation to support process and system improvement. Beyond the pandemic, we aim to continue to deliver SSS exercises to help make clinical systems and spaces safer for patients and teams. Following in the footsteps of successful simulation teams in the USA, we aim to advance this work to deliver SSS at the preconstruction level in future to inform the design of new clinical spaces.

Examining the cost of community-based tuberculosis treatment in South Africa

SETTING: While South Africa has improved access to tuberculosis (TB) treatment and care, the 2015 treatment success rate for multidrug-resistant TB (MDR-TB) remains low, at 55%. Community-based TB treatment and care improves patient retention compared to the standard of care alone.OBJECTIVE: To assess the cost of a USAID-funded community-based TB model in Nelson Mandela Bay Health District (NMBHD), Eastern Cape Province, South Africa compared to the national standard of care alone.DESIGN: We estimated the cost of community-based DR-TB treatment and adherence support compared to the standard of care alone.RESULTS: Average overall costs were US$2827 lower per patient on the community-based model than the standard of care alone.CONCLUSION: The per-patient cost of the community-based model is lower than the standard of care alone. Assuming the costs and effects of a community-based model implemented in NMBHD were observed at a larger scale, implementing the model could reduce overall health system costs.

The uninsured and Medicaid Oregon tobacco user experience in a real world, phone based cessation programme

OBJECTIVE

To describe the experience of uninsured and Medicaid Oregon tobacco users who registered in Free & Clear (F&C), a telephone based cessation programme including five scheduled outbound calls.

DESIGN AND SETTING

Using a retrospective cohort design, 1334 (423 uninsured, 806 Medicaid, and 105 commercially insured) Oregon tobacco users who registered in F&C between 18 November 1998 and 28 February 2000 were identified and followed for 12 months post-registration; 648 (48.6%) were successfully contacted at 12 months. Information was collected from the F&C database. Unconditional logistic regression, adjusted for race and education, was used.

RESULTS

The seven day quit rate at 12 months, assuming non-respondents were smokers, was 14.8% (95% confidence interval (CI) 13.0 to 16.9). This rate was significantly higher among commercially insured participants (v Medicaid but not uninsured) and among participants who completed > or = 5 calls (v < 5 calls). The quit rate for those contacted at 12 months was 30.6% (95% CI 27.0% to 34.3%) and varied, however not significantly, by insurance and number of calls. After adjustment, respondents who completed > or = 5 calls were 60% more likely to quit tobacco (odds ratio (OR) 1.6, 95% CI 0.9 to 3.1), and uninsured respondents who completed > or = 5 calls were 70% more likely to quit tobacco (OR 1.7, 95% CI 0.9 to 3.5), relative to those who completed < 5 calls, but the difference was not significant.

CONCLUSIONS

The quit rates are similar to those reported in efficacy trials. The observed variation in quitting tobacco for respondents by number of calls completed and by insurance merits further investigation concentrating on increasing compliance with the call schedule, particularly for the uninsured.

Transferrin variation in caribou (Rangifer tarandus L.) on the Canadian Arctic islands

Polyacrylamide gel electrophoresis was used to analyse transferrin variation in caribou from the Canadian Arctic islands. Sixteen alleles were detected in Peary caribou (Rangifer tarandus pearyi). The most common allele was TfG2, which increased in frequency from 0.167 at the Boothia Peninsula to 0.236 in the Peel population and 0.340 in the Parry population. The presence of this allele, which is the most common allele in Svalbard reindeer (R. t. platyrhynchus) and not detected in Norwegian reindeer (R. t. tarandus), suggests a common origin for the Peary caribou and the Svalbard reindeer. The large genetic distance in the transferrin locus between continental and island populations suggests the isolation of a High Arctic population in a northern refugium during the Wisconsin glaciation.

Use of yohimbine hydrochloride to reverse immobilization of polar bears by ketamine hydrochloride and xylazine hydrochloride

Yohimbine hydrochloride (YH) effectively reversed the immobilizing effects of ketamine hydrochloride (KH) combined with xylazine hydrochloride (XH) in 48 wild polar bears (Ursus maritimus) handled in the summer. Single intravenous doses of YH ranging between 0.029 and 0.198 mg/kg resulted in a median time of 10 min (range: 1-123 min) to post-injection recovery from KH-XH immobilization. Convulsions and muscle twitching were observed in some bears after YH was administered and one death occurred. Median respiratory rate and heartbeat rate increased from 5 br/min to 12 br/min and 51 BPM to 79 BPM, respectively, soon after yohimbine was administered. The median time to recovery after KH-XH administration, including processing and handling time, was 113 min for bears administered yohimbine and 202 min for bears not administered YH. After YH-induced recovery, polar bears showed signs of reduced awareness and many remained recumbent for undetermined periods although they could coordinate movements, stand, and walk or run if disturbed. YH proved to be a useful antagonist to immobilization induced by KH-XH in a field situation.

Immobilization of polar bears (Ursus maritimus Phipps) with a mixture of tiletamine hydrochloride and zolazepam hydrochloride

A 1:1 mixture of tiletamine hydrochloride and zolazepam hydrochloride was tested on 39 polar bears in and near Churchill, Manitoba, Canada during October 1983. The mean dose for satisfactory immobilization with a single injection was 5.1 mg/kg. Bears showed signs of ataxia from 1-3 min following injection and were usually sitting within 4 min. The mean induction time, taken as the adoption of sternal recumbency, was 5.1 min. Maximum relaxation was usually seen by about 20 min post-injection. The duration of immobilization appeared to be related to the dose of drug received. In bears that received a dose near the mean, recumbency lasted about 2 hr. Cubs of the year recovered more quickly than adults. Preliminary results indicated that the bears did not suffer respiratory depression and were able to thermoregulate while immobilized. Bears could be handled safely while under the effects of the drug and workers could readily evaluate the state of their sedation by their reactions. The drug did not appear to provide good analgesia at the doses tested.

Characterization of antigens in SSV nonproducer cells

An autologous antiserum against simian sarcoma virus (SSV) nonproducer cells (SSV-NP cells) was characterized by radioimmunoprecipitation. It reacts specifically with two different molecules in SSV-NP cells, a SSV transformation-specific glycoprotein (SSV TrS-gp) and p65, which probably represents a modified gag-precursor.

Parasites and diseases of bison in Canada IV. Serologic survey for brucellosis in bison in northern Canada

Serum samples collected from 2,365 free-roaming hybrid bison (Bison bison bison x Bison bison athabascae) in Wood Buffalo National Park and adjacent areas in the Northwest Territories were tested for brucellosis during the period 1959 to 1974. A positive reaction was obtained in 739 (31.2%) of the animals tested. The overall effect of brucellosis on this free-roaming bison population is unknown. The authors also dealt with some of the actual and possible consequences of the disease in this population.

Radiographic examination of mandibular lesions in barren-ground caribou

Dental anomalies were observed in 43 of 1,226 barren-ground caribou (Rangifer tarandus groenlandicus) taken between 1966 and 1968. In five of these 43 animals, the mandibles had deformities which radiography showed to be the result of dental abscesses in four cases and probably of a trauma in the other. The absence of actinomycotic lesions of the jaw bones of these 1,226 animals, and of more than 500 examined previously, indicates that "lumpy jaw" is rare in barren-ground caribou. The authors suggest the use of radiography to determine the nature of bone growth on skeletal remains, in the absence of soft tissues for examination for Actinomyces, either microscopically or by cultural methods.

Schistosomatium douthitti (Cort, 1914) Price, 1929 in a porcupine (Erethizon dorsatum) in eastern Ontario, Canada

Schistosomatium douthitti (Cort, 1914) Price, 1929 was found in the portal system of a new host, the porcupine, Erethizon dorsatum (L.), from eastern Ontario. Histological examination of the conspicuously mottled liver revealed eggs of the parasite throughout the parenchyma. Many of the eggs had induced extensive granulomatous inflammatory reactions with necrosis of adjacent hepatic cells.

Waterfowl mortality caused by Cyathocotyle bushiensis Khan, 1962 (Trematoda: Cyathocotylidae), St. Lawrence River, Quebec

In St. Lawrence River marshes, fatal sporadic and epizootic typhlitis in breeding populations of black ducks, Anas rubripes; blue-winged teal, A. discors; and migrant green-winged teal, A. carolinensis, is attributed to Cyathocotyle bushiensis Khan, 1962. This is the first report of C. bushiensis in natural definitive hosts, and the first record of the genus Cyathocotyle in North America. Pathogenicity of C. bushiensis was confirmed experimentally by using metacercariae from the most abundant local gastropod, Bythinia tentaculata, to produce cyathocotyliasis in Pekin ducklings.

Brucellosis in reindeer, Rangifer tarandus L., and the migratory barren-ground caribou, Rangifer tarandus groenlandicus (L.), in Canada

Serum samples from 1692 reindeer slaughtered in the Mackenzie River Delta in the last decade and from 320 Kaminuriak barren-ground caribou killed between June 1966 and July 1968 were tested for brucellosis. All sera yielding titers of 1:25 or higher were considered to be positive. A positive reaction was obtained in 148 of the 1692 reindeer and 14 of the 320 barren-ground caribou tested, giving an overall reactor percentage of 8.74 in reindeer and 4.37 in caribou.Orchitis, epididymitis, bursitis, metritis, abortion, and placental retention—conditions associated with brucellosis in reindeer in the U.S.S.R. and caribou in Alaska—were not noted in the autopsy of the 1692 reindeer and of 500 sexually mature barren-ground caribou. Three possible records of bursitis, of unknown nature, in barren-ground caribou are discussed. Seemingly, brucellosis does not represent a serious threat to either the Mackenzie River Delta reindeer or the Kaminuriak barren-ground caribou population, but its detection in these animal populations is of interest from a public health standpoint.

Besnoitiosis in barren-ground caribou in Northern Canada

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