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ABSTRACT Background Aims Materials and Methods Results Conclusion Anecdotal experience suggests that WHO Safer Surgery Checklist has become a ‘tickbox’ exercise, resulting in variable team engagement and efficacy.To observe the quality and completeness of ‘Time Out’, together with the level of team engagement during obstetrics and gynaecology procedures.Observational study where the following data were collected during ‘Time Out’: % of the 19 items correctly responded to after ‘challenge’. Type and duration of distractions. Level of team engagement. Authority gradient and likelihood of speaking up (Visual Analogue Score). Data from 70 obstetrics and gynaecology cases were collected over 8 weeks. ‘Time Out’ was clearly announced in 91.4% and was performed in all cases but not all items were communicated in the correct ‘challenge and response’ manner. Mean percentage of questions appropriately ‘challenged’ and ‘responded’ to was 92% ± 6.86%. Mean duration of ‘Time Out’ was 92.01 ± 86.9 s and observed distractions were auditory (61%), visual (26%), irrelevant chatter (22.5%) and theatre traffic (13%). In 92.8%, at least two team members were not engaged and were performing non‐essential tasks. The likelihood of a team member being able to ‘speak up’ was 8.78/10 (±0.71) and this appeared independent of whether it was led by nurses, doctors, operating department practitioners or healthcare support workers.Although performed in all cases, ‘Time Out’ is often not clearly announced or completed in the correct ‘challenge and response’ manner. It is plagued by avoidable distractions and suboptimal team engagement. Greater awareness is crucial to ensure more complete team involvement. [ABSTRACT FROM AUTHOR]

There has been a notable movement in performing procedures in the office setting. With this new shift, the utilization of proven safety measures would be beneficial to mirror. The utilization of a surgical safety checklist (SSC) has become an essential part of safety measures instituted to mitigate preventable errors in the operating room (OR). This measure is equally important to institute for non-OR procedures. The purpose of this project was to implement a SSC protocol as a standard of care at a clinic that newly adopted in-office surgical procedures with anesthesia. The project focused on developing and disseminating a SSC educational program for the procedural staff that included: three surgeons, three medical assistants, and one anesthesia provider. The staff were assessed on their ability to successfully implement the SSC over a 3-month period with a goal of 90% compliance. The result of the project was that the staff exceeded the compliance goal by successfully completing the SSC on 28 of the 29 procedures performed with anesthesia, meeting a 96% compliance. Overall, the implementation was embraced and effectively incorporated into the workflow. Comments received revealed that three staff have now adopted using the SSC beyond the project and utilize it for all procedures and injections they perform, making this implementation successful. [ABSTRACT FROM AUTHOR]

Background Globally, surgical care plays a vital role in health care. Unfortunately, complications arise in approximately 5 to 18% of surgical procedures. However, research has shown that following the surgical safety checklist provided by the World Health Organization (WHO) can significantly reduce these complications and surgery-related fatalities. The objective of this study was to assess the accuracy and completion of the WHO Surgical Safety Checklist.

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Introduction: Perioperative patient safety remains crucial in healthcare to prevent avoidable errors. The World Health Organization developed a surgical safety checklist that was implemented by the Department of Health as well as highly recommended by quality Programmes. Aim: To document the level of knowledge and practices regarding WHO recommended Surgical Safety Checklist among the Surgeons and other OT staffs. Materials and Methods: A cross-sectional study was conducted among the Operating surgeons, OT Nurses, Anesthesiologists working at HIMS. They were contacted personally to fill pre - tested Knowledge attitude and practice testing questionnaire. Approval was taken from the institutional ethical committee. Before conducting knowledge assessment a checklist was used to study the completeness of the filled surgical safety checklist form from the case sheets Results: 57% of the respondents had more than 10 years of experience. 81% were permanent employees of the institution. 66% participants had attended trainings related to the checklist. Majority mentioned their source of information about checklist was training and as well as after it was introduced in the OT booklet. Questions related to Sign in, Time out and Sign out phases were correctly answered by 28.5%, 28.5% and 38% of the participants respectively. Majority had partial knowledge (>70%) regarding the three phases. 72 % of the case sheets were complete at Medical Record Department compared to 58% at immediate post op ward. Barriers mentioned by the participants are that the time was inadequate and filling checklist was an added responsibility, number of OT staffs were inadequate, to bring the OT room to completely stand still when the checklist is read out is difficult especially to junior surgeons. Few mentioned they needed training and also one mentioned that signing the checklist each time is itself a barrier. Conclusion: The results of this study indicate that the overall application of the surgical safety checklist can be considered high, although the completeness, especially of the time out and sign out section, could be improved. Variation in use of the checklist is noted between Departments and Units. It requires training and awareness activities across the Departments. [ABSTRACT FROM AUTHOR]

This paper we constructs the N-policy FM/FM/1 vacation queueing system with server start-up and time-out by using fuzzy control chart based on Zedeh extension law to transform fuzzy queues into family of crisp queues. Arrival rate, service rate and vacation times will all be made by fuzzy nature. We derive the membership functions of the parameters of the control chart corresponding to the expected system length L and also confirmed the parameters of the control chart for fuzzy. We have also set an numerical example. [ABSTRACT FROM AUTHOR]

Safe Surgery Saves Lives is a tool used as a quality criterion in surgical care provided to patients and is carried out through the checklist or surgical safety list, denominated as a technology tool in the management of the care process, which promotes benefits for the patient and the multidisciplinary team. The aim is to analyze the perception of health professionals in the operating room about the importance of implementing the Safe Surgery Saves Lives program in terms of the quality of care provided. This is a descriptive case study, qualitative in nature. Focal groups, direct observation, and interviews with a semi-structured script, developed from the literature on the subject, were used as data collection instruments. Fifty-five professionals from different categories were observed and interviewed in an Operating Room (OR) of a central hospital, including nurses, general surgeons, gynecologists, obstetricians, ophthalmologists, orthopedists, and anesthesiologists. The subjects have a well-founded knowledge about the importance of safe surgery in the quality of care, with clear and comprehensive information regarding the use of the checklist. Analysis of the results reveals that nurses and physicians considered it important for quality and error prevention. Benefits and advantages are recognized in its applicability, as a tool for improving quality and minimizing adverse events. Carrying out the Surgical Safety Checklist (SVSC) is an easy-to-perform procedure, with proven and recognized potential for improving the quality of care. [ABSTRACT FROM AUTHOR]

Introduction: Excessive noise in the operating room has been a topic of interest since the early 70s. It has been recognised that excessive noise can affect cognitive behavior and impair memory function which can be a health and safety issue. Though different approaches have been explored there remains a deficit in research into the application of noise modification programs within the operating room to combat the issue of noise pollution. This project aimed to identify if a discussion about appropriate noise levels and the use of a safe phrase at 'time out' would reduce noise levels in the operating room. Method: Several different approaches were used throughout this study, including a questionnaire to collect data before and after the project and two observational tools, one used to collect baseline data and the second used throughout the four-week trial period. Results: The evidence gained from this project showed an overall improvement with noise during the surgical process reduced by 26 per cent. This was done by dicsussing appropriate noise levels at 'time out' and allowing staff to speak up using the non-judgmental safe words 'below ten thousand'. Conclusion: This study aimed to see whether discussing appropriate noise levels at 'time out' could help reduce current noise levels within the operating room as, seen in other studies, reducing noise can be a challenge. Though small, the overall results of this study had a positive impact on reducing noise levels. It is, however, recommended that continued reinforcement and education about the issues surrounding noise are required. [ABSTRACT FROM AUTHOR]

Background: A team in the operating room (OR) is a hierarchically structured, gender-mixed group of people belonging to different professional categories. Disparities in the objectives of the different team members under economic pressure to perform, are sources of potential conflict in the daily work routine. This may have a negative impact on patient safety and commercial efficiency of hospital management.Objective: The aim of this summary is to sensitize the reader to the complex of problems in daily life in the OR and to increase awareness of possible approaches to solve the difficulties in an OR. Problem solutions might be approached by improvement of communication and team building.Methods: Narrative review of current literature and expert recommendations by a literature search in PubMed and Medline; keywords included teamwork, communication, operating room, team building.Results and Conclusion: Communication and teamwork in the OR are of immense importance for patient safety and the economic development of a hospital. Improvements in communication structure, among other things due to the implementation of a team time out and moderation from outside (OR manager) offer solutions to avoid conflicts in everyday clinical practice. [ABSTRACT FROM AUTHOR]

Overall, 369 responses were recorded: 318 responses came from the 1260 senior urologists of the AFU (318/1260 = 25.23%) and 51 responses (51/440 = 11.59%) came from the 440 urologists in training (AFUF). Keywords: surgical safety; checklist; time out; operating theater; urologists; surgeons; #Urology EN surgical safety checklist time out operating theater urologists surgeons #Urology 589 591 3 10/25/22 20221101 NES 221101 Abbreviations AE adverse event AFU French Association of Urology AFUF French Association of Urologists in Training HAS French National Authority for Health OR odds ratio OTCL operating theatre checklist SS surgical safety In 2010, the French National Authority for Health (HAS) implemented the operating theatre checklist (OTCL) based on the WHO report about surgical safety (SS) [1]. Checklist, time out, urologists, surgeons, surgical safety, operating theater, #Urology. [Extracted from the article]

The subject of this conversation is the 'queer seventies' as told through a heterogeneous scene of independent journalism and the burgeoning field of screen theory in Britain. Mandy Merck, who was there, and Laura Guy, who was not, explore the cultural practices coming out of the Women's and Gay Liberation Movements against a backdrop of political reform – including the Sexual Offences Act 1967, the Abortion Act of the same year, and the Equal Pay Act 1970. Turning to Merck's work as an editor and cultural critic at Time Out, the discussion foregrounds independent print and contemporary cinema as intersecting contexts through which the theoretical insights associated with screen theory emerged. Also considered is whether the British roots of queer theory can be located in this period or, indeed, if the various deviations and conversions discussed might offer directions toward a different horizon of thought and politics. [ABSTRACT FROM AUTHOR]

This article bridges a conceptual approach for understanding the sense of wellbeing, liberation, and relaxation mothers say they commonly achieve from engaging in the exercise experience, to proposing appropriate health promotion policy for practical program implementation. Mothers who engage in exercise classes may gain mental wellbeing and easing of stress levels. As it is the gaining of the actual time-out from motherhood that helps provide the means for stress reduction, it is important that the activity is offered at a convenient time and location. Supportive environments and policies that consider childminding and the busy lifestyles of mothers will ensure that individual action toward leisure is facilitated. Health policies and programs, including strategies related to settings, realistic targets, media, specificity, use of social networks, marketing, gentle exercise modes, advice and support, will do much to facilitate access and success. [ABSTRACT FROM AUTHOR]

Perioperative and procedure area nurses can encounter barriers during the time‐out process. In March 2016, a mock regulatory agency surveyor identified a gap during a time out in our cardiac catheterization laboratory. We worked with our facility's holistic nursing group to identify a solution to gain the full attention of all procedure area team members during each time out. Historically, ceremonial leaders used a gong to begin events because they thought that the sound helped participants focus on the ceremony. Because we wanted staff members to participate in a mindful practice during time outs, we decided to use a Tibetan gong to draw attention to the process. After implementing this change, staff members were more engaged during the time‐out process than they were before the change. In addition, facility leaders requested that we share our process with the staff members in the perioperative and endoscopic areas. [ABSTRACT FROM AUTHOR]

Background The older inpatient population is a particularly frail cohort with high rates of delirium, falls and immobility. These patients require skilled gerontological nursing with high levels of supervision. Despite this, restraints such as bed rails continue to be common. Tethering through intravenous drips and urinary catheters are another form of restraint. Methods We performed a chart review and a bedside observation of patients aged ≥75 on medical wards admitted for ≥72 hours. We excluded patients who were critically unwell or imminently dying. We used the open source software package PSPP to complete the statistical analysis. Results We reviewed 100 patients, of whom 25 were restrained in some way (most commonly by bed rails 80%), 10 were tethered (through intravenous drips, oxygen tubing, urinary catheters and others), 7 were in isolation for infection control reasons. Restraint was associated with greater dependence in mobility and function, reduced time out of bed (Mann Whitney, P< 0.05), delirium and incontinence (chi square, p <0.05). Isolation was associated with greater physical dependence (Mann Whitney, P< 0.05), and tethering was associated with incontinence (chi square, p <0.05). The relatively low number of isolated and tethered patients reduced the power of the study. 50% of patients with a urinary catheter did not have a clear indication and only 14% of catheterised patients had leg bags Conclusion Patients who are restrained are clearly frailer, more dependent, spend more time in bed, have higher rates of delirium and incontinence. These are particularly vulnerable patients who need high levels of attention from both medical and nursing staff. Supervision is always superior to restraint but requires investment in staff and resources. Patients who are isolated are also more physically dependent. Tethering should be minimised. Simple measures such as leg bags are underused. [ABSTRACT FROM AUTHOR]

Health care organization leaders can help prevent surgical errors by ensuring compliance with standardized preprocedure time outs that require the active participation and engagement of the entire surgical team. Some surgical department leaders have used remote video observation without audio to monitor compliance with the time out. After a sentinel event occurred, leaders at our large academic medical center initiated a quality improvement project to audit compliance with the standardized preprocedure time out. We used remote audiovisual observation to ensure that all members of the procedure team were adhering strictly to the elements of the preprocedure time out in all invasive procedure areas. Since the beginning of this remote auditing process, team member compliance with the standardized preprocedure time out has improved. [ABSTRACT FROM AUTHOR]

Objective: To determine what factors affect paediatric trainee confidence on return to work after maternity leave.Design: Information was collected anonymously via an online survey from trainees who had taken maternity leave.Setting: The survey was distributed centrally to each UK deanery.Main Outcome Measures: Trainee confidence was rated retrospectively using self-assessment.Results: 146 paediatric trainees from 12 out of 13 deaneries completed the survey. 96% of trainees experienced an initial lack of confidence, with 36% requiring 3 months or longer for their confidence to return. Prolonged lack of confidence was associated with longer time out of training, training stage, returning part-time, less frequent engagement with educational activities and lack of recognition by supervising consultant.Conclusion: We propose a scoring system using the above risk factors, the MoTHER score (Months out, Training stage, Hours worked on return, Educational activities, Recognition by consultant), which can be used to identify trainees who are at higher probability of experiencing reduced confidence on return to work. [ABSTRACT FROM AUTHOR]

Abstract: The perioperative environment is fast paced and complex. Competing responsibilities, noise and distractions, and reluctance of team members to speak up when they are aware of a potential patient safety issue are all barriers to effective communication in the perioperative setting. Communication breakdowns among health care providers can lead to medical errors and patient harm. Accurate and complete communication about the patient and the patient's care can contribute to improved efficiency, better patient outcomes, and fewer adverse events. The new AORN “Guideline for team communication” provides guidance on using standardized processes and tools to improve the quality of team communication. The key points address hand overs between phases of perioperative care; a briefing to share the surgical plan; a time out to verify the correct patient, procedure, site, and side; and a debriefing to discuss what was learned and how to improve. Perioperative RNs should review the complete guideline for additional information and for guidance when writing and updating policies and procedures. [ABSTRACT FROM AUTHOR]

An enhanced time out is an improved communication process initiated to prevent such surgical errors as wrong-site, wrong-procedure, or wrong-patient surgery. The enhanced time out at my facility mandates participation from all members of the surgical team and requires designated members to respond to specified time out elements on the surgical safety checklist. The enhanced time out incorporated at my facility expands upon the safety measures from the World Health Organization’s surgical safety checklist and ensures that all personnel involved in a surgical intervention perform a final check of relevant information. Initiating the enhanced time out at my facility was intended to improve communication and teamwork among surgical team members and provide a highly reliable safety process to prevent wrong-site, wrong-procedure, and wrong-patient surgery. [ABSTRACT FROM AUTHOR]

The surgical time out is an integral component of patient safety in OR settings. At The Center for Outpatient Surgery (TCOPS), a team of nurses and plastic and breast surgeons evaluated discrepancies, wrong-site surgeries, near misses, team communication, and patient satisfaction to develop and implement a surgical checklist that would help improve efficiency and patient safety and reduce near misses. This checklist involves the surgical team and patient, and it includes preoperative, preincision, and postoperative time outs. Since 2011, 4,453 procedures have used the preoperative and preincision timeouts. Of those, 998 have used all three when we added the postoperative component. Since the implementation of the checklist, there have been zero discrepancies and zero wrong-site surgeries. Patients have expressed satisfaction with their inclusion in the preoperative time out. Staff members at TCOPS have noted excellent results, and the checklist can be adopted by other specialties. [ABSTRACT FROM AUTHOR]

The successful and safe transfer of the patient from one phase of care to another is contingent on optimal communication by all team members. Nurses are often in a natural leadership position to improve safe practices during hand overs. A holistic understanding of the patient allows the perioperative nurse the opportunity to identify issues and choose a nursing diagnosis based on key elements of a patient’s needs and goals—information that should be relayed during patient transfers. This article reviews best practices in transfer-of-care communication to enable perioperative RNs to take an active, leading role in hand-over processes. [ABSTRACT FROM AUTHOR]

Rationale: The relatively weak reinforcing effects of nicotine in experimental studies have been attributed to possible aversive effects or the need to space nicotine administrations over time to expose reinforcing effects. Objective: This study was designed to determine if the response-maintaining effects of nicotine are increased when availability is spaced through time, and whether nicotine is an effective punisher of remifentanil-maintained responding. Methods: Compared to a cocaine reference dose, nicotine dose and timeout (TO) value were varied in eight rhesus monkeys responding for intravenous (i.v.) nicotine on varying fixed-ratio (FR) schedules of reinforcement.The aversive effects of nicotine were evaluated in four animals choosing between a standard dose of remifentanil alone or in combination with one of several doses of nicotine. Results: In three of eight self-administration monkeys, 0.01 mg/kg/inj nicotine did not maintain responding at any FR value. In the other five animals, nicotine-maintained response rates increased with either FR or TO values to a certain point, and then slowed. Maximum nicotine-maintained response rates were much slower than those maintained by cocaine, and demand for nicotine was less than demand for cocaine. Nicotine was an effective punisher of remifentanil-maintained responding at doses ranging from 0.01 to 0.3 mg/kg/inj. Lower punishing dose seemed to be related to the absence of reinforcing effects within subject. Conclusion: There are an order of magnitude individual differences in sensitivity to both the reinforcing and punishing effects of nicotine, and this drug may be unique in being a weak positive reinforcer in small doses and aversive in large doses. [ABSTRACT FROM AUTHOR]

Surgery is complex and technically demanding for all team members. Surgical checklists have been implemented with different degrees of success in the perioperative setting. There is a wealth of evidence that they are effective at preventing patient safety events and helping team members master the complexities of modern health care. Implementation is key to successful use of the surgical checklist in all invasive procedural settings. Key strategies for successful checklist implementation include establishing a multidisciplinary team to implement the checklist, involving surgeon leaders, pilot testing the checklist, incorporating feedback from team members to improve the process, recognizing and addressing barriers to implementation, and offering coaching and continuous feedback to team members who use the checklist. Using these strategies will give the perioperative nurse, department leaders, and surgeons the tools to implement a successful checklist. [ABSTRACT FROM AUTHOR]

BACKGROUND: Wrong site confusions are among the most common mistakes in operations of twosome organs. PURPOSE: To examine the frequency of wrong sided confusions that could theoretically occur in various surgeries in the absence of preoperative verification. METHODS: Ten cataract surgeons, twelve orthopedic surgeons and 6 ENT surgeons participated in the study. The surgeons were asked to fill a questionnaire that included their demographic data, occupational habits and their approach to and handling of patients preoperatively. On the day of operation the surgeons were asked to recognize the side of the operation from the patient's name only. At the second stage of the study, surgeons were asked to recognize the side of the operation while standing a two meter distance from the patient's face. Surgeons' answers were compared to the actual operation side. Patients then underwent a full 'time out' procedure, which included side marking before the operation. RESULTS: Of a total of 67 ophthalmic patients, 52 orthopedic patients and 26 ENT patients the surgeons correctly identified the operated side in 111 (76.5%) by name and in 126 (87%) by looking at patients' faces. Wrong side identification correlated with the time lapsed from the last preoperative examination (p = 0.034). The number of cataract surgeries performed by the same surgeon (on the same day) also correlated to the number of wrong identifications (p = 0.001) in ophthalmology. Orthopedic surgeons were more accurate in identifying the operated site Surgeon seniority or age did not correlate to the number of wrong identifications. CONCLUSIONS: This study illustrates the high error that can result in the absence of side marking prior to cataract surgery, as well as in operations on other twosome organs. [ABSTRACT FROM AUTHOR]

Objective: Because wrong-site confusion is among the most common mistakes in the operations of paired organs, we have examined the frequency of wrong-sided confusions that could theoretically occur in cataract surgeries in the absence of preoperative verification. Methods: Ten cataract surgeons participated in the study. The surgeons were asked to complete a questionnaire that included their demographic data, occupational habits, and their approach to and the handling of patients preoperatively. On the day of operation, the surgeons were asked to recognize the side of the operation from the patient's name only. At the second stage of the study, surgeons were asked to recognize the side of the operation while standing a 2-meter distance from the patient's face. The surgeons' answers were compared to the actual operation side. Patients then underwent a full time-out procedure, which included side marking before the operation. Results: Of the total 67 patients, the surgeons correctly identified the operated side of the eye in 49 (73%) by name and in 56 (83%) by looking at patients' faces. Wrong-side identification correlated with the time lapsed from the last preoperative examination (P=0.034). The number of cataract surgeries performed by the same surgeon (on the same day) also correlated to the number of wrong identifications (P=0.000). Surgeon seniority or age did not correlate to the number of wrong identifications. Conclusion: This study illustrates the high error rate that can result in the absence of side marking prior to cataract surgery, as well as in operations on other paired organs. [ABSTRACT FROM AUTHOR]

Time out has been widely advocated as an effective parental discipline practice to reduce disruptive and oppositional child behaviour in young children. Despite evidence showing that the procedure is effective when used as part of a comprehensive positive parenting strategy it has not been uniformly accepted and critics have questioned its effectiveness and potentially adverse effects on the parent-child relationship. This paper examines the controversy surrounding the use of time out, discusses the criticisms levelled against it, and concludes that its judicious use in parent training programs is justified and is of benefit to many children with conduct problems. Factors that influence the effectiveness of time out and some contraindications are also discussed. [ABSTRACT FROM AUTHOR]

Communication and collaboration in patient care settings is vital for promoting the best possible patient outcomes. The counting of sponges, sharps, and instruments, and the surgical time out before the start of any surgical procedure are opportunities for the surgical team to address patient safety risks. Personnel in the surgical services department at St Luke's Episcopal Hospital, Houston, Texas, implemented the use of a hanging, magnetic, dry-erase board that includes the elements of a time out (eg, patient name and identifiers, procedure, site, allergies) and provides a means to document countable items. The board promotes team awareness of this time out and count information at all times during a procedure. Specific magnets on the count board identify items intentionally packed inside the patient to remind the team of the location of these items when the count is reconciled at the end of the procedure. In addition, a process of obtaining an radiograph of items similar to any missing items assists radiologists in identifying the location of retained surgical items. As a result of implementing both changes, our ability to locate missing items has significantly increased. AORN J 92 (October 2010) 420-424. © AORN, Inc, 2010. [ABSTRACT FROM AUTHOR]

The purpose of this study was to determine the current state of knowledge concerning the implementation of the Joint Commission's Universal Protocol. We conducted an integrative review of the literature through a systematic search of the National Library of Medicine (ie, PubMed) database to identify empirical and theoretical documents that discussed the implementation process for the Universal Protocol. The current state of knowledge varies from facility to facility, and we noted significant trends, gaps, and areas of concern in the implementation process. Successful implementation of the Universal Protocol has the following elements: a multidisciplinary team approach, active staff/ patient participation, supportive hospital administration/leadership, and active communication that promotes a healthy work environment. [ABSTRACT FROM AUTHOR]

Under coordination by the Patient Safety Authority, staff members in facilities across Pennsylvania analyzed 97 wrong site surgery near misses and 44 actual occurrences using a common analysis form from August 2007 to August 2008. These assessments were aggregated and compared by the Patient Safety Authority. Assessments in which near misses were identified that did not advance to actual wrong site occurrences were significantly more likely to report compliance with patient identification and preoperative reconciliation protocols, accurate scheduling, notation of the surgical site on the consent form, participation of the surgeon in preoperative verification, participation of all surgical team members in the time out, time outs performed with the site marking visible after draping, and the surgeon explicitly empowering team members to speak up if concerned and acknowledging concerns when expressed. [ABSTRACT FROM AUTHOR]

Abstract: This paper provides an overview of behavioral strategies used for reducing hand-related stereotypies (i.e., hand/finger mouthing, eye poking, self-slapping, and other hand-to-head/body responses) of persons with severe to profound intellectual and multiple disabilities. Computerized and manual searches were conducted to identify the studies carried out in this area between 1995 and 2007. Forty-one studies were identified which used five main strategies: (1) mechanical restraints employed alone or together with other intervention variables, (2) response blocking alone or together with other intervention variables, (3) noncontingent stimulation (environmental enrichment) with or without prompting or contingent reinforcement events, (4) contingency manipulations differing from those relied upon by the other strategies, and (5) programs based on microswitch clusters. The outcomes of the studies tended to be positive but occasional failures also occurred. Outcomes were discussed in terms of the characteristics of the strategies employed, the implications of the strategies for the participants’ overall stimulation and occupational situation, and the overall practicality, applicability, affordability and potential of the strategies in the short and long term. Issues for future research were also examined. [Copyright &y& Elsevier]

Background A core element of the Centers for Disease Control and Prevention Antimicrobial Stewardship standard for the inpatient setting includes a 48-hour antibiotic time-out (ATO) process to reassess antibiotic indication. We implemented an automated alert in the electronic health record (EHR) that identifies patients that have received >=48hours of antibiotic therapy. The alert requires the clinician (physician or pharmacist) to note an indication for continuation or plan for discontinuation. Within the alert, a dashboard was developed to include relevant patient information (e.g. temperature, white blood cell count, microbiology, etc). We sought to evaluate the impact of the ATO alert on the duration of therapy (DOT) of cefepime (CFP), ceftazidime (CTZ) and vancomycin (VAN), for the treatment of pneumonia (PNA) and urinary tract infections (UTI) for adult and pediatric patients. Methods This quasi-experimental, retrospective analysis included adult and pediatric patients that received ≥48 hours of CFP, CTZ, or VAN for UTI or PNA between April 1, 2017 and July 31, 2017 (pre-48H ATO) and October 1, 2018–December 31, 2018 (post-48H ATO). Fields at order-entry to specify an antibiotic indication were not available prior to our EHR interventions. A randomized subset from the Pre-48Hr ATO group was selected for detailed analysis. The primary endpoint was to evaluate the average DOT of CFP/CTZ combined, VAN alone, and the combination of CFP/CTZ/VAN. We also evaluated length of stay (LOS), all-cause inpatient mortality, and 30-day readmissions. Results A total of 157 antibiotic orders (n = 94 patients) were evaluated in the pre-48h ATO group, and 2093 antibiotic orders (n = 521 patients) post-48H ATO group. Pre-48H ATO, 85 patients received CFP/CTZ and 72 VAN. Post-48H ATO, 322 patients received CFP/CTZ and 198 VAN. PNA was the most common indication pre- and post-48H ATO. DOT significantly decreased pre- vs. post-48H ATO (Figure 1). LOS was 2 days shorter (P = 0.01) in the post-48H ATO group, mortality and 30-day readmissions was similar between groups (Table 1). Conclusion Average antibiotic DOT for CFP/CTZ, and VAN significantly decreased following the implementation of the 48H ATO at our medical center. LOS was reduced by 2 days, while mortality and 30-day readmissions were similar before and after. Disclosures All authors: No reported disclosures. [ABSTRACT FROM AUTHOR]

Background The Infectious Diseases Society of America's guideline for implementing antibiotic (abx) stewardship recommends routine review of abx use. Several studies demonstrate antibiotic time out (ATO) programs result in de-escalation, but there is limited evidence of improved outcomes. The aim of this study was to evaluate the clinical impact of ATO. Methods This retrospective study included hospitalized patients at The Ohio State University Wexner Medical Center receiving abx and a documented ATO from 7/1/2017 to 6/30/2018. ATO patients were matched by infection type to abx-treated patients lacking an ATO note. Patients were excluded if they were identified as a protected population, were in the ICU at the time of ATO, had an ATO within 48 hours of discharge, cystic fibrosis, or febrile neutropenia. The primary objective was to evaluate abx optimization in patients with documented ATO vs. those without ATO. Abx optimization was defined as the selection of ideal abx based on guidelines, culture and susceptibility results, or expert opinion when undefined. Secondary outcomes included vancomycin-associated acute kidney injury (VAN-AKI), infection-related length of stay (LOS), all-cause 30-day readmission or mortality, abx days, and nosocomial C. difficile infection (CDI) rates. The Student t-test/Fisher's exact test and Wilcoxon-rank sum were utilized as appropriate. Results One hundred ATO patients were compared with 100 non-ATO patients. Baseline characteristics and infection types were similar between groups. ATO resulted in improved optimization of abx selection (P = 0.05) and duration (P < 0.01), and reduced piperacillin/tazobactam (P/T) and vancomycin (VAN) utilization. No difference was observed in VAN-AKI (22 vs. 20%, P = 0.73), 30-day readmission (28 vs. 27%, P = 0.87), mortality (5 vs. 5%, P = 1), or CDI rates (6 vs. 5%, p = 0.76) in the ATO vs. non-ATO group. However, inpatient abx days (12 vs. 8, P = 0.004) and infection-related LOS (10 vs. 8, P = 0.0006) were shorter in the non-ATO group. Conclusion ATO improved optimization of abx selection and duration, and reduced P/T and VAN use. Despite this, clinical outcomes were not improved. Disclosures All authors: No reported disclosures. [ABSTRACT FROM AUTHOR]

Background In an effort to minimize complications associated with over-utilization of antibiotics, many antimicrobial stewardship programs have incorporated an antibiotic time out (ATO). Despite the increasing adoption of the ATO, limited data are available to support its effectiveness. This study was designed to assess the impact of an automated ATO integrated into the electronic medical record (EMR) on the rate of antibiotic modification in patients receiving broad-spectrum antibiotic(s) for Gram-negative bacteremia (GNB). Methods This was a single-center retrospective cohort study of inpatients from January 2017 to June 2018 conducted at a large academic medical center. ATO was implemented on October 31, 2017. Adult patients with GNB who received at least 72 hours of a systemic antibiotic were included. Patients with neutropenia or polymicrobial infections were excluded. The primary outcome was the proportion of patients who received a modification of therapy within 24 hours of final culture results. Secondary outcomes included modification at any point in therapy, time to modification of therapy, time to de-escalation, and days of therapy of broad-spectrum antibiotics. Results There was a total of 88 patients who met inclusion criteria, 37 patients pre-ATO and 51 patients post-ATO. The primary outcome of modification of therapy within 24 hours of final culture results was not significantly different for patients in the pre-ATO and post-ATO groups (19% vs. 20%, P = 0.94, respectively). The secondary outcome of modification of therapy at any point in therapy was not significantly different between the two groups (62% vs. 66%, P = 0.67). Of the 47 patients who received a modification of therapy, the mean time to modification was significantly shorter in the post-ATO group (52.8 hours vs. 45.26 hours, P < 0.05,). All other secondary outcomes were not significantly different between study groups. Conclusion The ATO alert was not associated with a higher rate of antibiotic modification within 24 hours of culture results in patients with GNB, although there was a significant reduction in the time to antibiotic modification. Further efforts are needed to improve the time to modification and optimize antibiotic prescribing practices. Disclosures All authors: No reported disclosures. [ABSTRACT FROM AUTHOR]

• Post-ejaculatory interval strongly correlates with mean time out duration in rats. • This effect is persistent across ejaculation series and copulation sessions. • Stimulation magnitude in a mount bout predicts duration of the following time out. • These results are consistent in three different cohorts of two different strains. • Mount bout-based analysis of copulation should be standard in male rats. The assessment of sexual behavior in male rats with the aim of unraveling underlying neurobiological mechanisms has in the recent decades been reduced to the annotation of mounts, intromissions and ejaculations. To provide a better understanding of the structure and patterns of copulation, it is necessary to extend and tailor the analysis to the natural organization of male rat copulation. This will lead to better formulation of hypotheses about neurobiological underpinnings of behavior. Mounts and intromissions are naturally organized in mount bouts consisting of one or more copulatory behaviors and are interspersed with time outs. We hypothesized that time outs and the post-ejaculatory interval (inter-copulatory intervals) are related and possibly under the control of a common copulatory inhibition mechanism that is the result of penile sensory stimulation. To test this hypothesis, we analyzed sexual behavior in male rats of three different cohorts from three different laboratories. Results showed that the post-ejaculatory interval and mean time out duration are strongly correlated in all cohorts analyzed. In addition, we showed that individual time out duration is at least partially predicted by the sum of sensory stimulation of copulatory components in the preceding mount bout, with more penile stimulation associated with longer time outs. These findings suggest that both time out and post-ejaculatory interval duration may be determined by the magnitude of sensory stimulation, which inhibits copulation. Whether the same neural pathways are involved in the central orchestration of both time outs and the post-ejaculatory interval should be subject to future studies. [ABSTRACT FROM AUTHOR]

Background: Parent-Child Interaction Therapy (PCIT) is an effective parent training approach for a commonly occurring and disabling condition, namely conduct problems in young children. Yet, despite ongoing efforts to train clinicians in PCIT, the intervention is not widely available in New Zealand and Australia., Methods: We undertook a cross-sectional online survey of clinicians in New Zealand and Australia who had completed at least the 40-h initial PCIT training, to understand the barriers they encountered in their implementation efforts, and the extent to which attitudes toward time-out influenced implementation. The overall response rate was 47.5% (NZ: 60%; Australia: 31.4%)., Results: Responses suggested that participants generally viewed PCIT as both acceptable and effective. Australian participants reported seeing significantly more clients for PCIT per week than those in NZ (Medians 0 and 2, respectively; χ 2 (1) = 14.08, p < 0.001) and tended to view PCIT as more effective in treating disruptive and oppositional behaviour (95% CI: -0.70, -0.13, p = 0.005). Participants currently seeing PCIT clients described it as more enjoyable to implement than those not using PCIT (95% CI: -0.85, -0.10, p = 0.01). Thirty-eight percent of participants indicated that they adapt or tailor the standardised protocol, primarily by adding in content relating to emotion regulation, and removing content relating to time-out. Participants generally felt that they had fewer skills, less knowledge, and less confidence relating to the Parent-Directed Interaction phase of PCIT (which involves time-out), compared with the Child-Directed Interaction phase., Conclusion: While we had hypothesised that time-out represented an intra-intervention component that detracted from implementation success, results suggested that clinician concern over the use of time-out was present but not prominent. Rather, the lack of access to suitable equipment (i.e., one-way mirror and ear-piece) and difficulties associated with clients attending clinic-based sessions were barriers most commonly reported by clinicians. We suggest that future research might consider whether and how PCIT might be "re-implemented" by already-trained clinicians, moving beyond simply training more clinicians in the approach.

Embedding effective parent training programmes for the treatment of childhood conduct problems into routine clinical practice does not happen spontaneously. Despite the known influence of contextual factors on implementation success, and the centrality of the therapist as a key implementation stakeholder, studies into the therapist experience of receiving training in, and implementing evidence-based manualised parent training programmes are relatively rare. This study sought to understand the training and post-training implementation experiences of Parent-Child Interaction Therapy (PCIT) therapists in New Zealand, and to compare and contrast these with existing research into the experiences of PCIT trainees in the Netherlands (i.e., Niec et al., 2018) Fifty-six therapists (a response rate of 67%) completed an anonymous online survey of their experiences of training in, and subsequently implementing Parent-Child Interaction Therapy (PCIT) in New Zealand. Qualitative and quantitative analyses indicated that therapists experienced barriers to implementation, both internal ("burdened") and external ("blocked") yet typically persisted with implementation efforts. Therapist (and other stakeholder) attitudes towards the use of time out with young children was a common barrier to implementation. Therapists described drawing from other - at times incompatible – treatment approaches for children with conduct problems, and in some cases reported using only components of the manualised PCIT protocol. Direct international comparison of New Zealand and Dutch PCIT therapists' responses demonstrated remarkably similar (and positive) attitudes towards PCIT, and the experience of similar barriers internationally. Implications for implementation success are discussed. [ABSTRACT FROM AUTHOR]