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https://www.readbyqxmd.com/read/29779231/specialist-perioperative-allergy-clinic-services-in-the-uk-2018-results-from-the-royal-college-of-anaesthetists-sixth-national-audit-project-nap6-investigation-of-perioperative-anaphylaxis
#1
W Egner, T M Cook, T Garcez, S Marinho, H Kemp, D N Lucas, K Floss, S Farooque, H Torevell, M Thomas, K Ferguson, S Nasser, S Karanam, K-L Kong, N McGuire, M Bellamy, A Warner, J Hitchman, L Farmer, N J N Harper
BACKGROUND: The Royal College of Anaesthetists 6th National Audit Project examined Grade 3-5 perioperative anaphylaxis for one year in the UK. OBJECTIVE: To describe the causes and investigation of anaphylaxis in the NAP6 cohort, in relation to published guidance and previous baseline survey results. METHODS: We used a secure registry to gather details of Grade 3-5 perioperative anaphylaxis. Anonymous reports were aggregated for analysis and reviewed in detail...
May 19, 2018: Clinical and Experimental Allergy: Journal of the British Society for Allergy and Clinical Immunology
https://www.readbyqxmd.com/read/29776982/variable-effectiveness-of-stepwise-implementation-of-nudge-type-interventions-to-improve-provider-compliance-with-intraoperative-low-tidal-volume-ventilation
#2
Vikas N O'Reilly-Shah, George S Easton, Craig S Jabaley, Grant C Lynde
BACKGROUND: Identifying mechanisms to improve provider compliance with quality metrics is a common goal across medical disciplines. Nudge interventions are minimally invasive strategies that can influence behavioural changes and are increasingly used within healthcare settings. We hypothesised that nudge interventions may improve provider compliance with lung-protective ventilation (LPV) strategies during general anaesthesia. METHODS: We developed an audit and feedback dashboard that included information on both provider-level and department-level compliance with LPV strategies in two academic hospitals, two non-academic hospitals and two academic surgery centres affiliated with a single healthcare system...
May 18, 2018: BMJ Quality & Safety
https://www.readbyqxmd.com/read/29769515/complications-following-general-anaesthesia-in-paediatric-patients
#3
A K Khan, S R Quddus, H K Khan, M S Ali, M Kamruzzaman, M R Hasan, M Hasan, R H Moon
Complications in paediatric anaesthesia can be conveniently classified as minor or major. Major morbidity includes cardiac arrest, brain damage and death. Minor morbidity can be assessed by clinical audits with smell patient samples. Major morbidity is rare. It is best assessed by very large clinical studies and by review of cases malpractice claims. Both minor & major complication occurs most commonly in infants and children under three especially those with severe co-morbidities. Knowledge of risk profiles in paediatric anaesthesia is a starting point for the reduction of risk complication...
April 2018: Mymensingh Medical Journal: MMJ
https://www.readbyqxmd.com/read/29582421/the-enhanced-recovery-after-surgery-eras-greenie-board-a-navy-inspired-quality-improvement-tool
#4
A J Smirk, J J Nicholson, Y L Console, N J Hunt, A Herschtal, M N H H Nguyen, B Riedel
The United States Navy uses a visual feedback system for pilots, named 'the Greenie Board', to improve flight manoeuvres on aircraft carriers. Given that increased compliance with enhanced recovery after surgery protocols reduces postoperative complications, we decided to apply a similar feedback system to our institutional enhanced recovery programme. We undertook a prospective 12-month audit of 194 patients assigned to our enhanced recovery programme and evaluated adherence to the anaesthesia-related components of our protocol, before and after implementing a Greenie Board...
March 26, 2018: Anaesthesia
https://www.readbyqxmd.com/read/29553434/pain-management-during-labour-at-the-el-emarati-hospital-a-clinical-audit
#5
Reem Y Dabbour, Tayseer A Hassan, Maha S Faqawi, Bettina Böttcher
BACKGROUND: The aim of this study was to assess the practice of pain management for women in labour at El-Emarati Hospital in Rafah, Gaza Strip, and to compare this management with the guidelines by the National Institute for Health and Care Excellence (NICE). METHODS: A data collection sheet was prepared and completed for each patient admitted to the delivery room. Patients were enrolled consecutively between Feb 1 and April 1, 2016. Data collection sheets, based on NICE guidelines, were completed by the audit team (TAH, MSF, and RYA)...
February 21, 2018: Lancet
https://www.readbyqxmd.com/read/29455035/sustainability-of-anaesthesia-components-of-an-enhanced-recovery-program-erp-in-colorectal-and-orthopaedics-surgery
#6
Helene Beloeil, Karem Slim
BACKGROUND: Sustainability of ERP is a challenge and data are scarce on the subject. The aim of this study was to assess if application of enhanced recovery elements through the Francophone Group of Enhanced Recovery after Surgery (Grace) in the anaesthesia management was sustainable 2 years after its implementation. MATERIALS AND METHODS: We conducted a retrospective analysis of the prospective Grace database between October 2014 and October 2016. The evolution of each recommendation item over time was analysed using non-parametric Spearman correlation coefficient...
February 15, 2018: Anaesthesia, Critical Care & Pain Medicine
https://www.readbyqxmd.com/read/29452803/preoperative-fasting-in-children-review-of-existing-guidelines-and-recent-developments
#7
REVIEW
P Frykholm, E Schindler, R Sümpelmann, R Walker, M Weiss
The current guidelines for preoperative fasting recommend intervals of 6, 4, and 2 h (6-4-2) of fasting for solids, breast milk, and clear fluids, respectively. The objective is to minimize the risk of pulmonary aspiration of gastric contents, but also to prevent unnecessarily long fasting intervals. Pulmonary aspiration is rare and associated with nearly no mortality in paediatric anaesthesia. The incidence may have decreased during the last decades, judging from several audits published recently. However, several reports of very long fasting intervals have also been published, in spite of the implementation of the 6-4-2 fasting regimens...
March 2018: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/29397124/simplified-algorithm-for-the-prevention-of-postoperative-nausea-and-vomiting-a-before-and-after-study
#8
G Dewinter, W Staelens, E Veef, A Teunkens, M Van de Velde, S Rex
BACKGROUND: Poor adherence to guidelines aimed at reducing the incidence of postoperative nausea and vomiting (PONV) is well known. In a before-and-after study, we tested the effectiveness of a simplified algorithm for PONV prophylaxis on the incidence of PONV. METHODS: In the first audit, we examined the adherence to our institutional guidelines for PONV prevention. In response to the results of this audit, we introduced a simplified algorithm for PONV prevention [female patients receiving triple prophylaxis (dexamethasone and ondansetron plus either a target-controlled infusion with propofol or droperidol) and male patients receiving double prophylaxis, dexamethasone, and ondansetron]...
January 2018: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/29361259/the-establishment-of-an-anaesthetist-managed-intraoperative-neurophysiological-monitoring-service-and-initial-outcome-data
#9
B L Olesnicky, R J D'Souza, D Jayram, Omo Kim, A Rehak
Neurophysiological monitoring has been recommended to reduce the risk of neurological damage during a wide variety of surgeries. While the concept of an anaesthesia-led intraoperative neurophysiological monitoring (IONM) service is not new, the quality of this service provision has not been studied. In this article, we present our experience with the establishment of this service, and the results of our audit of 302 cases monitored over the initial four years. Our results identified that an anaesthesia-led IONM service was able to achieve a reliable signal in 95...
January 2018: Anaesthesia and Intensive Care
https://www.readbyqxmd.com/read/29242749/setting-the-research-and-implementation-agenda-for-equitable-access-to-surgical-care-in-south-africa
#10
REVIEW
Sarah Rayne, Sule Burger, Stephanie Van Straten, Bruce Biccard, Mathume Joseph Phaahla, Martin Smith
South Africa is an upper-middle-income country with widespread social and geographical inequality of surgical provision. The National Forum on Surgery and Anaesthesia in South Africa brought together various stakeholders, including government, societies, academic clinicians and the biomedical industry, to define the core strategy for a national surgical plan. During the forum, presentations and breakaway workshops explored and reported the challenges and opportunities these stakeholders may have in sustaining and improving surgical provision in South Africa...
2017: BMJ Global Health
https://www.readbyqxmd.com/read/29210043/accidental-awareness-during-general-anaesthesia-a-narrative-review
#11
REVIEW
S R Tasbihgou, M F Vogels, A R Absalom
Unintended accidental awareness during general anaesthesia represents failure of successful anaesthesia, and so has been the subject of numerous studies during the past decades. As return to consciousness is both difficult to describe and identify, the reported incidence rates vary widely. Similarly, a wide range of techniques have been employed to identify cases of accidental awareness. Studies which have used the isolated forearm technique to identify responsiveness to command during intended anaesthesia have shown remarkably high incidences of awareness...
January 2018: Anaesthesia
https://www.readbyqxmd.com/read/29161401/the-evolution-of-airway-management-new-concepts-and-conflicts-with-traditional-practice
#12
A F McNarry, A Patel
In the last 25 yr, there have been several advances in the safe management of the airway. Videolaryngoscopes and supraglottic airways, now in routine use by new trainees in anaesthesia, have had their genesis in the recent past. The 4th National Audit Project of the Royal College of Anaesthetists and the Difficult Airway Society published in 2011 a seminal report that has influenced airway management worldwide . Understanding how the report's recommendations were constructed and how clinical guidelines compliment rather than contradict them is important in understanding the tenets of safe airway management...
December 1, 2017: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/29137582/the-effectiveness-of-regional-anaesthesia-before-and-after-the-introduction-of-a-dedicated-regional-anaesthesia-service-incorporating-a-block-room
#13
A Chin, L Heywood, P Iu, A M Pelecanos, M J Barrington
Dedicated regional anaesthesia services incorporating block rooms and/or block teams may facilitate theatre efficiency and improve training in regional anaesthesia. Currently, it is unknown if a dedicated regional anaesthesia service improves the effectiveness of regional anaesthesia. In November 2013, the Royal Brisbane and Women's Hospital established a dedicated regional anaesthesia service comprising a block team and a block room. Pre-intervention (conventional model of care) registry data was retrospectively compared with post-intervention (dedicated regional anaesthesia service) audit data, with regard to pain and opioid requirement in the post-anaesthesia care unit (PACU)...
November 2017: Anaesthesia and Intensive Care
https://www.readbyqxmd.com/read/28893748/effect-of-individual-patient-risk-centre-surgeon-and-anaesthetist-on-length-of-stay-in-hospital-after-cardiac-surgery-association-of-cardiothoracic-anaesthesia-and-critical-care-actacc-consecutive-cases-series-study-of-10-uk-specialist-centres
#14
Olympia Papachristofi, Andrew A Klein, John Mackay, Samer Nashef, Nick Fletcher, Linda D Sharples
OBJECTIVES: To determine the relative contributions of patient risk profile, local and individual clinical practice on length of hospital stay after cardiac surgery. DESIGN: Ten-year audit of prospectively collected consecutive cardiac surgical cases. Case-mix adjusted outcomes were analysed in models that included random effects for centre, surgeon and anaesthetist. SETTING: UK centres providing adult cardiac surgery. PARTICIPANTS: 10 of 36 UK specialist centres agreed to provide outcomes for all major cardiac operations over 10 years...
September 11, 2017: BMJ Open
https://www.readbyqxmd.com/read/28803651/using-national-hip-fracture-registries-and-audit-databases-to-develop-an-international-perspective
#15
Antony Johansen, David Golding, Louise Brent, Jacqueline Close, Jan-Erik Gjertsen, Graeme Holt, Ami Hommel, Alma B Pedersen, Niels Dieter Röck, Karl-Göran Thorngren
Hip fracture is the commonest reason for older people to need emergency anaesthesia and surgery, and leads to prolonged dependence for many of those who survive. People with this injury are usually identified very early in their hospital care, so hip fracture is an ideal marker condition with which to audit the care offered to older people by health services around the world. We have reviewed the reports of eight national audit programmes, to examine the approach used in each, and highlight differences in case mix, management and outcomes in different countries...
October 2017: Injury
https://www.readbyqxmd.com/read/28801130/prospective-implementation-of-enhanced-recovery-after-surgery-protocols-to-radical-cystectomy
#16
Karl H Pang, Ruth Groves, Suresh Venugopal, Aidan P Noon, James W F Catto
BACKGROUND: Multimodal enhanced recovery after surgery (ERAS) regimens have improved outcomes from colorectal surgery. OBJECTIVE: We report the application of ERAS to patients undergoing radical cystectomy (RC). DESIGN, SETTING, AND PARTICIPANTS: Prospective collection of outcomes from consecutive patients undergoing RC at a single institution. INTERVENTION: Twenty-six components including prehabilitation exercise, same day admission, carbohydrate fluid loading, targeted intraoperative fluid resuscitation, regional local anaesthesia, cessation of nasogastric tubes, omitting oral bowel preparation, avoiding drain use, early mobilisation, chewing gum use, and audit...
August 8, 2017: European Urology
https://www.readbyqxmd.com/read/28728520/in-and-out-hospital-mortality-rate-in-surgical-patients
#17
Philippe Dony, Magali Pirson, Jean G Boogaerts
BACKGROUND: Death rates after surgery are increasingly analysed for clinical audit and quality assessment. Many studies commonly provide information only on deaths that occur during hospital stay, known as in-hospital death rates. By using hospital data set linked to death certificate registry, we recorded in- and out-hospital deaths within 30 and 60 post-operative days. METHODS: The study included all consecutive surgical procedures (denominator) under general or locoregional anaesthesia in adult patients admitted for elective or non-elective inpatient surgery...
February 2018: Acta Chirurgica Belgica
https://www.readbyqxmd.com/read/28629668/underestimating-the-size-of-the-problem-uk-anaesthesia-for-patients-with-obesity
#18
James Palmer, Mike Sury, Claire Nightingale, Jaideep Pandit, Tim Cook
We analysed data from 14,000 patients in the 2013 United Kingdom Anaesthesia Activity Survey of the Fifth National Audit Project of the Royal College of Anaesthetists and Association of Anaesthetists of Great Britain and Ireland to examine anaesthetic, organisational and clinical practice for patients with obesity. We compared practice then with current guidance on management of this patient group. Obesity was reported in 22%, mainly Black, Afro-Caribbean and White Caucasian patients. There was minimal variation in surgical timing, anaesthetic seniority, induction location or day-case procedure rates...
June 16, 2017: Obesity Research & Clinical Practice
https://www.readbyqxmd.com/read/28267948/a-clinical-audit-to-assess-the-efficacy-of-the-coolsense%C3%A2-pain-numbing-applicator-for-intravenous-cannulation-in-children
#19
P G Ragg, G Cahoon, A Yeo, G Chalkiadis
The Coolsense® device is a topical applicator that is used to anaesthetise the skin before a painful procedure. It is a handheld device with a temperature-controlled head that acts on application, without chemicals, to cool and anaesthetise the site of injection. This prospective observational audit of 100 children and adolescents aged six to 18 years studied the analgesic efficacy and patient and carer satisfaction rating of the device during intravenous cannulation and complications arising from its use...
March 2017: Anaesthesia and Intensive Care
https://www.readbyqxmd.com/read/28249602/relating-professionalism-and-conscientiousness-to-develop-an-objective-scalar-proxy-measure-of-professionalism-in-anaesthetic-trainees
#20
M A Sawdon, K Whitehouse, G M Finn, J C McLachlan, D Murray
BACKGROUND: The concept of professionalism is complex and subjective and relies on expert judgements. Currently, there are no existing objective measures of professionalism in anaesthesia. However, it is possible that at least some elements of professionalism may be indicated by objective measures. A number of studies have suggested that conscientiousness as a trait is a significant contributor to professionalism. METHODS: A 'Conscientiousness Index' (CI) was developed by collation of routinely collected data from tasks expected to be carried out by anaesthetic trainees such as punctual submission of holiday and 'not-on-call' requests, attendance at audit meetings, timely submission of completed appraisal documentation and sickness/absence notifications...
March 1, 2017: BMC Medical Education
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