Unintended harm to patients in operating theatres is common. Correlations have been demonstrated between teamwork skills and error rates in theatres. This was a single-institution uncontrolled before-after study of the effects of ''non-technical'' skills training on attitudes, teamwork, technical performance and clinical outcome in laparoscopic cholecystectomy (LC) and carotid endarterectomy (CEA) operations. The setting was the theatre suite of a UK teaching hospital. Attitudes were measured using the Safety Attitudes Questionnaire (SAQ). Teamwork was scored using the Oxford Non-Technical Skills (NOTECHS) method. Operative technical errors (OTEs), non-operative procedural errors (NOPEs), complications, operating time and length of hospital stay (LOS) were recorded. A 9 h classroom non-technical skills course based on aviation ''Crew Resource Management'' (CRM) was offered to all staff, followed by 3 months of twice-weekly coaching from CRM experts. Forty-eight procedures (26 LC and 22 CEA) were studied before intervention, and 55 (32 and 23) afterwards. Nontechnical skills and attitudes improved after training (NOTECHS increase 37.0 to 38.7, t = 22.35, p = 0.021, SAQ teamwork climate increase 64.1 to 69.2, t = 22.95, p = 0.007). OTEs declined from 1.73 to 0.98 (u = 1071, p = 0.009), and NOPEs from 8.48 to 5.16 per operation (t = 4.383, p,0.001). These effects were stronger in the LC group than in CEA procedures. The operating time was unchanged, and a non-significant reduction in LOS was observed. Non-technical skills training improved technical performance in theatre, but the effects varied between teams. Considerable cultural resistance to adoption was encountered, particularly among medical staff. Debriefing and challenging authority seemed more difficult to introduce than other parts of the training. Further studies are needed to define the optimal training package, explain variable responses and confirm clinical benefit.We studied personnel performing laparoscopic cholecystectomy (LC) and carotid endarterectomy (CEA) procedures in the theatre suites of a major UK teaching hospital. These procedures were selected to minimise difficulties in evaluating performance caused by variations in the operative procedure. All CEA operations were performed in one theatre while the LC procedures were mostly done in three others, one of which was designated a day-case theatre. All CEA operations were elective or semielective procedures performed or directly supervised by consultant vascular surgeons. About 20% of LC were performed by experienced trainees without supervision, and a similar percentage were ''hot'' procedures. There were no major differences in availability and quality of equipment between the LC theatres except that intraoperative cholangiography was difficult to perform in the day-case theatre. The consultant surgical and anaesthetic staff and senior theatre nurses were largely constant throughout the study, but junior staff turnover was relatively high, typical of UK practice. The day-case theat...

Detailed analysis of team interactions and dimensions is feasible and valuable, yielding important insights into relationships between nontechnical skills, technical performance, and operative duration. These results support the concept that interventions designed to improve teamwork and communication may have beneficial effects on technical performance and patient outcome.

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In statin-treated patients with low HDL-C, high-dose modified-release NA, compared with placebo, significantly reduces carotid atherosclerosis within 12 months. (Oxford Niaspan Study: Effects of Niaspan on Atherosclerosis and Endothelial Function; NCT00232531).

BackgroundContemporary population‐based data on age‐specific incidence and outcome from acute abdominal aortic aneurysm (AAA) events are needed to understand the impact of risk factor modification and demographic change, and to inform AAA screening policy.MethodsIn a prospective population‐based study (Oxfordshire, UK, 2002–2014), event rates, incidence, early case fatality and long‐term outcome from all acute AAA events were determined, both overall and in relation to the four main risk factors: smoking, hypertension, male sex and age.ResultsOver the 12‐year interval, 103 incident acute AAA events occurred in the study population of 92 728 (men 72·8 per cent; 59·2 per cent 30‐day case fatality rate). The incidence per 100 000 population per year was 55 in men aged 65–74 years, but increased to 112 at age 75–84 years and to 298 at age 85 years or above. Some 66·0 per cent of all events occurred in those aged 75 years or more. The incidence at 65–74 years was highest in male smokers (274 per 100 000 population per year); 27 (96 per cent) of 28 events in men aged less than 75 years occurred in ever‐smokers. Mean(s.d.) age at event was lowest in current smokers (72·2(7·2) years), compared with that in ex‐smokers (81·2(7·0) years) and never‐smokers (83·3(7·9) years) (P < 0·001). Hypertension was the predominant risk factor in women (diagnosed in 93 per cent), with 20 (71 per cent) of all 28 events in women occurring in those aged 75 years or above with hypertension. The 30‐day case fatality rate increased from 40 per cent at age below 75 years to 69 per cent at age 75 years or more (P = 0·008).ConclusionTwo‐thirds of acute AAA events occurred at age 75 years or above, and more than 25 per cent of events were in women. Taken with the strong associations with smoking and hypertension, these findings could have implications for AAA screening.