Determination of the 5-HT receptor subtype involved in 8-OH-DPAT-induced hyperlocomotion: potential difficulties arising from inadequate pharmacological tools

Selective 5-HT1A receptor agonists such as 8-OH-DPAT (8-hydroxy-2-(di-n-propylamino)tetralin), flesinoxan, 5-methylurapidil and others, increased locomotor behaviour in rats following s.c. injection. Unfortunately, all available 5-HT1A receptor antagonists are non-selective, a fact which severely hampers their use. The inhibitory effects of (+)- and (-)-pindolol (1-10 mg/kg, -45 min s.c.) on locomotion induced by 8-OH-DPAT were investigated in rats pretreated with the beta-adrenoceptor antagonists, ICI 118,551 and betaxolol (both 1 mg/kg, -45 min s.c.). ICI 118,551 and betaxolol significantly enhanced the response to 8-OH-DPAT. Co-administration of (-)-pindolol (2-10 mg/kg) dose dependently antagonised the hyperlocomotion whereas (+)-pindolol was weakly effective at 10 mg/kg. The partial agonists ipsapirone (1-10 mg/kg, -45 min s.c.) and buspirone (0.1-1 mg/kg, -45 min) antagonised the effects of 8-OH-DPAT. This inhibition may, however, be due to alpha 1-adrenoceptor blockade and DA receptor antagonism, respectively. Finally, although spiroxatrine (0.1 and 1 mg/kg, -45 min s.c.) inhibited the response to 8-OH-DPAT, this inhibition may also be non-specific since spiroxatrine strongly reduced spontaneous locomotor activity. In conclusion, whilst much of our data is consistent with 8-OH-DPAT-induced locomotion being mediated by 5-HT1A receptors, only the data obtained with the pindolol enantiomers provide direct evidence for this. The results also suggest that, under normal circumstances, the 5-HT1A receptor antagonist effect of pindolol may be masked by the facilitating effect of beta-adrenoceptor blockade.     

Assessment of spinal cord ischemia by means of evoked potential monitoring during thoracoabdominal aortic surgery

Besides renal failure and mesenteric infarction, spinal cord ischemia is the most dreaded complication after thoracoabdominal aortic surgery. Several techniques have been developed to improve neurologic outcome of these massive surgical procedures, including pharmacologic adjuncts, epidural cooling, distal aortic perfusion, cerebrospinal fluid drainage, and reattachment of segmental arteries. The authors developed a technique to assess spinal cord integrity as part of the surgical protocol, dictating operative strategies to restore blood supply to the endangered grey matter. Monitoring motor evoked potentials (MEPs) was performed in experimental studies and in 170 patients with a thoracoabdominal aortic aneurysm. The surgical protocol included left heart bypass and cerebrospinal fluid drainage, and MEP monitoring was applied to identify critical intercostal and lumbar arteries. Based on MEPs, the aggressive surgical approach resulted in a significant reduction of neurologic complications (2.3%).     

Non-invasive bladder volume measurement for the prevention of postoperative urinary retention: validation of two ultrasound devices in a clinical setting

Ultrasound scanning of bladder volume is used for prevention of postoperative urinary retention (POUR). Accurate assessment of bladder volume is needed to allow clinical decision-making regarding the need for postoperative catheterization. Two commonly used ultrasound devices, the BladderScan® BVI 9400 and the newly released Prime® (Verathon Medical®, Bothell, WA, USA), with or without the ‘pre-scan’ option, have not been validated in clinical practice. The aim of this study was to assess the performance of these devices in daily clinical practice. Between June and September 2016 a prospective observational study was conducted in 318 surgical patients (18 years or older) who needed a urinary catheter perioperatively for clinical reasons. For acceptable performance, we required that the volume as estimated by the BladderScan® differs by no more than 5% from the actual urine volume after catheterization. The Schuirmann’s two one-sided test was performed to assess equivalence between the BladderScan® estimate and catheterization. The BVI 9400® overestimated the actual bladder volume by +?17.5% (95% CI +?8.8 to +?26.3%). The Prime® without pre-scan underestimated by ? 4.1% (95% CI ? 8.8 to +?0.5%) and the Prime® with pre-scan underestimated by ? 6.3% (95% CI ? 11.6 to ? 1.1%). This study shows that while both ultrasound devices were able to approximate current bladder volume, both BVI 9400® and Prime®—with and without pre-scan—were not able to measure the actual bladder volume within our predefined limit of ±?5%. Using the pre-scan feature of the Prime® did not further improve accuracy.     

Concept analysis: Role ambiguity in senior nursing students

Role ambiguity is a lack of clarity or uncertainty related to one's position or role. Role ambiguity has been documented in the literature in relationship to athletics, industry, business, education, and nursing. However, a concept analysis has not been performed. Therefore, the process of concept analysis outlined by Walker and Avant is now used to look at the concept of role ambiguity and its relevance to senior nursing students’ socialization and education into the profession of nursing. Attributes, antecedents, consequences, and empiric referents are discussed and theories commonly associated with role ambiguity are presented. At the end of the analysis, an operational definition is provided for use in exploring the concept of role ambiguity as it relates to senior nursing students’ articulation of the role of the professional nurse.     

The influence of anesthesia-controlled time on operating room scheduling in Dutch university medical centres

Background

Predicting total procedure time (TPT) entails several elements subject to variability, including the two main components: surgeon-controlled time (SCT) and anesthesia-controlled time (ACT). This study explores the effect of ACT on TPT as a proportion of TPT as opposed to a fixed number of minutes. The goal is to enhance the prediction of TPT and improve operating room scheduling.

Methods

Data from six university medical centres (UMCs) over seven consecutive years (2005-2011) were included, comprising 330,258 inpatient elective surgical cases. Based on the actual ACT and SCT, the revised prediction of TPT was determined as SCT × 1.33. Differences between actual and predicted total procedure times were calculated for the two methods of prediction.

Results

The predictability of TPT improved when the scheduling of procedures was based on predicting ACT as a proportion of SCT.

Conclusions

Efficient operating room (OR) management demands the accurate prediction of the times needed for all components of care, including SCT and ACT, for each surgical procedure. Supported by an extensive dataset from six UMCs, we advise grossing up the SCT by 33% to account for ACT (revised prediction of TPT = SCT × 1.33), rather than employing a methodology for predicting ACT based on a fixed number of minutes. This recommendation will improve OR scheduling, which could result in reducing overutilized OR time and the number of case cancellations and could lead to more efficient use of limited OR resources.     

Successful interventions to reduce first-case tardiness in Dutch university medical centers: Results of a nationwide operating room benchmark study

Background

First-case tardiness is still a common source of frustration. In this study, a nationwide operating room (OR) Benchmark database was used to assess the effectiveness of interventions implemented to reduce tardiness and calculate its economic impact.

Methods

Data from 8 University Medical Centers over 7 years were included: 190,295 elective inpatient first cases. Data were analyzed with SPSS statistics and multidisciplinary focus-group study meetings. Analysis of variance with contrast analysis measured the influence of interventions.

Results

Seven thousand ninety-four hours were lost annually to first-case tardiness, which has a considerable economic impact. Four University Medical Centers implemented interventions and effectuated a significant reduction in tardiness, eg providing feedbacks directly when ORs started too late, new agreements between OR and intensive care unit departments concerning “intensive care unit bed release” policy, and a shift in responsibilities regarding transport of patients to the OR.

Conclusions

Nationwide benchmarking can be applied to identify and measure the effectiveness of interventions to reduce first-case tardiness in a university hospital OR environment. The implemented interventions in 4 centers were successful in significantly reducing first-case tardiness.