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anaesthesia audit

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https://www.readbyqxmd.com/read/27917662/validating-a-benchmarking-tool-for-audit-of-early-outcomes-after-operations-for-head-and-neck-cancer
#1
D Tighe, I Sassoon, M McGurk
INTRODUCTION In 2013 all UK surgical specialties, with the exception of head and neck surgery, published outcome data adjusted for case mix for indicator operations. This paper reports a pilot study to validate a previously published risk adjustment score on patients from separate UK cancer centres. METHODS A case note audit was performed of 1,075 patients undergoing 1,218 operations for head and neck squamous cell carcinoma under general anaesthesia in 4 surgical centres. A logistic regression equation predicting for all complications, previously validated internally at sites A-C, was tested on a fourth external validation sample (site D, 172 operations) using receiver operating characteristic curves, Hosmer-Lemeshow goodness of fit analysis and Brier scores...
December 5, 2016: Annals of the Royal College of Surgeons of England
https://www.readbyqxmd.com/read/27913269/the-structure-organisation-and-perioperative-management-of-ambulatory-surgery-and-anaesthesia-in-france-methodology-of-the-sfar-opera-study
#2
Pierre Albaladejo, Frédéric Aubrun, Charles-Marc Samama, Laurent Jouffroy, Marc Beaussier, Dan Benhamou, Pauline Romegoux, Kristina Skaare, Jean Luc Bosson, Claude Ecoffey
The organization of health care establishments and perioperative care are essential for ensuring the quality of care and safety of patients undergoing outpatient surgery. In order to correctly inventory these organizations and practices, in 2013-2014, the French Society of Anaesthesia and Intensive Care organized an extensive practical survey in French ambulatory surgery units entitled the "OPERA" study (Organisation PERiopératoire de l'anesthésie en chirurgie Ambulatoire). From among all of the ambulatory surgery centres listed by the Agences Régionales de Santé [Regional Health Agencies, France], 206 public and private centres were randomly selected...
November 29, 2016: Anaesthesia, Critical Care & Pain Medicine
https://www.readbyqxmd.com/read/27888429/inappropriateness-of-diagnostic-imaging-examinations-in-the-inpatient-setting-a-case-study-research
#3
Ettore Squillaci, Francesca Bolacchi, Jacopo Scaggiante, Francesca Ricci, Luca Pugliese, Alberto Bergamini, Francesco Garaci, Roberto Floris
OBJECTIVE: The purpose of our study was to audit the clinical appropriateness of the prescriptions of whole body CT (WB-CT), PET-CT and chest X-rays (CXRs) performed at Tor Vergata University Hospital in the inpatient setting. MATERIALS AND METHODS: WB-CT, PET-CT and CXRs examinations were retrospectively analysed in the period between January and December 2014. CXR examinations were divided into bedside CXRs and traditional CXRs. The appropriateness of the examinations was defined according the American College of Radiology Appropriateness Criteria...
November 25, 2016: La Radiologia Medica
https://www.readbyqxmd.com/read/27764047/the-future-of-postoperative-quality-of-recovery-assessment-multidimensional-dichotomous-and-directed-to-individualize-care-to-patients-after-surgery
#4
Andrea Bowyer, Colin F Royse
PURPOSE OF REVIEW: Recovery after surgery is a complex interplay of the patient, the surgery, and the perioperative anaesthesia management. Assessment of recovery should address the needs of multiple stakeholders, including the institutions and healthcare providers, but primarily should be focused on the patients and their perception of quality of recovery and return to normalcy. This review will summarize the development of assessment of recovery to a multidimensional dichotomous construct that requires a real-time assessment tool validated for repeat measures and containing cognitive assessment...
December 2016: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/27738833/measuring-the-burden-of-surgical-disease-averted-by-emergency-and-essential-surgical-care-in-a-district-hospital-in-papua-new-guinea
#5
Matthew A R Stokes, Glenn D Guest, Perista Mamadi, Westin Seta, Noel Yaubihi, Grace Karawiga, Billy Naidi, David A K Watters
BACKGROUND: Timely access to emergency and essential surgical care (EESC) and anaesthesia in low- and middle-income countries (LMICs) prevents premature death, minimises lifelong disability and reduces their economic impact on families and communities. Papua New Guinea is one of the poorest countries in the Pacific region, and provides much of its surgical care at a district hospital level. We aimed to evaluate the surgical capacity of a district hospital in PNG and estimate the effectiveness of surgical interventions provided...
October 13, 2016: World Journal of Surgery
https://www.readbyqxmd.com/read/27682287/postoperative-pain-relief-and-functional-outcome-following-total-knee-arthroplasty-a-prospective-comparative-audit-of-three-analgesic-regimes
#6
A Rajeev, N Tumia, K Karn, S Kashyap, D Mayne
Pain control plays a key role in joint-replacement -surgery. As a surgeon the challenge is to reduce pain to an acceptable level in the post-operative period. The aim of the study was to assess the efficacy of bolus -local anaesthesia, infusion in to the surgical site and nerve blocks with femoral nerve catheter and its functional outcome. A prospective audit of 114 patients undergoing total knee arthroplasty were carried out.The patients were divided in to three groups : Group 1 (n = 27) received a bolus injection of 20 ml 0...
August 2016: Acta Orthopaedica Belgica
https://www.readbyqxmd.com/read/27665740/a-prospective-cohort-evaluation-of-major-and-minor-airway-management-complications-during-routine-anaesthetic-care-at-an-academic-medical-centre
#7
J M Huitink, P P Lie, I Heideman, E P Jansma, R Greif, N van Schagen, A Schauer
The aim of this study was to develop an audit tool to identify prospectively all peri-operative adverse events during airway management in a cost-effective and reproducible way. All patients at VU University Medical Center who required general anaesthesia for elective and emergency surgical procedures were included during a period of 8 weeks. Daily questionnaires and interviews were taken from anaesthesia trainees and anaesthetic department staff members. A total of 2803 patients underwent general anaesthesia, 1384 men and 1419 women, including 2232 elective patients and 571 emergency procedures, 697 paediatric and 2106 adult surgical procedures...
September 26, 2016: Anaesthesia
https://www.readbyqxmd.com/read/27608337/anaesthetic-management-of-obese-parturients-what-is-the-evidence-supporting-practice-guidelines
#8
V A Eley, A A J van Zundert, J Lipman, L K Callaway
Increasing rates of obesity in western populations present management difficulties for clinicians caring for obese pregnant women. Various governing bodies have published clinical guidelines for the care of obese parturients. These guidelines refer to two components of anaesthetic care: anaesthetic consultation in the antenatal period for women with a body mass index (BMI) ≥ 40 kg/m(2) and the provision of early epidural analgesia in labour. These recommendations are based on the increased incidence of obstetric complications and the predicted risks and difficulties in providing anaesthetic care...
September 2016: Anaesthesia and Intensive Care
https://www.readbyqxmd.com/read/27580309/quantification-of-radiation-exposure-in-the-operating-theatre-during-management-of-common-fractures-of-the-upper-extremity-in-children
#9
J F Maempel, O D Stone, A W Murray
Introduction Surgical procedures to manage trauma to the wrist, forearm and elbow in children are very common. Image intensifiers are used routinely, yet studies/guidelines that quantify expected radiation exposure in such procedures are lacking. Methods Information on demographics, injury type, surgeon grade and dose area product (DAP) of radiation exposure per procedure was collected prospectively for 248 patients undergoing manipulation/fixation of injuries to the elbow, forearm or wrist at a paediatric hospital over 1 year...
September 2016: Annals of the Royal College of Surgeons of England
https://www.readbyqxmd.com/read/27456184/a-site-check-prior-to-regional-anaesthesia-to-prevent-wrong-sided-blocks
#10
P Slocombe, S Pattullo
This paper describes the implementation of the 'Stop Before You Block' (SB4YB) initiative in an Australian teaching hospital. This process, which began in the UK in 2010, is a pre-procedure pause to confirm the correct side of a regional anaesthetic block. A change in practice was implemented with the formal roll out of a SB4YB educational program. Use of the initiative was then audited over a subsequent three-month period. It was hoped that after implementing the initiative, at least 80% of blocks would have a site check performed...
July 2016: Anaesthesia and Intensive Care
https://www.readbyqxmd.com/read/27443946/increasing-the-availability-and-quality-of-caesarean-section-in-tanzania
#11
A Nyamtema, N Mwakatundu, S Dominico, H Mohamed, A Shayo, R Rumanyika, C Kairuki, C Nzabuhakwa, O Issa, C Lyimo, I Kasiga, J van Roosmalen
OBJECTIVE: To describe the results of increasing availability and quality of caesarean deliveries and anaesthesia in rural Tanzania. DESIGN: Before-after intervention study design. SETTINGS: Rural Tanzania. METHODS: Ten health centres located in rural areas were upgraded to provide comprehensive emergency obstetric care (CEmOC) and the four related district hospitals were supported. Upgrading entailed constructing and equipping maternity blocks, operation rooms and laboratories; installing solar systems, backup generators and water supply systems...
September 2016: BJOG: An International Journal of Obstetrics and Gynaecology
https://www.readbyqxmd.com/read/27440629/a-national-survey-of-the-impact-of-nap4-on-airway-management-practice-in-united-kingdom-hospitals-closing-the-safety-gap-in-anaesthesia-intensive-care-and-the-emergency-department
#12
T M Cook, N Woodall, C Frerk
BACKGROUND: The 4th National Audit Project of the Royal College of Anaesthetists' and Difficult Airway Society (NAP4) made recommendations to improve reliability and safety of airway management in hospitals. This survey examines its impact. METHODS: A survey was sent to all UK National Health Service hospitals to examine changes in practice in response to NAP4. We performed a 'gap analysis' to determine whether NAP4 had reduced the 'safety gap' between actual and ideal practice...
August 2016: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/27239298/care-of-elderly-patients-a-prospective-audit-of-the-prevalence-of-hypotension-and-the-use-of-bis-intraoperatively-in-25-hospitals-in-london
#13
Alex Wickham, David Highton, Daniel Martin
BACKGROUND: Anaesthesia is frequently complicated by intraoperative hypotension (IOH) in the elderly, and this is associated with adverse outcome. The definition of IOH is controversial, and although management guidelines for IOH in the elderly exist, the frequency of IOH and typical clinically applied treatment thresholds are largely unknown in the UK. METHODS: We audited frequency of intraoperative blood pressure against national guidelines in elderly patients undergoing surgery...
2016: Perioperative Medicine
https://www.readbyqxmd.com/read/27208604/decreasing-diagnostic-hysteroscopy-performed-in-the-operating-room-a-quality-improvement-initiative
#14
Stephanie Leung, Nicholas Leyland, Ally Murji
OBJECTIVES: At our institution, diagnostic hysteroscopy (DH), often combined with uterine curettage, commonly has been performed in the main OR with the patient under general anaesthesia. Our objective was to create targeted interventions aimed at decreasing the number of DHs performed in the OR by 75% over one year. METHODS: This quality improvement initiative had a quasi-experimental (time-series) design. To obtain baseline numbers of DHs performed each month, we conducted a retrospective chart audit at a university teaching hospital...
April 2016: Journal of Obstetrics and Gynaecology Canada: JOGC, Journal D'obstétrique et Gynécologie du Canada: JOGC
https://www.readbyqxmd.com/read/27182507/accreditation-of-training-programmes-by-the-west-african-college-of-surgeons
#15
C O Bode, J O Olatosi, A Ademuyiwa
The establishment of surgical training programmes of the West African College of Surgeons started in six teaching hospitals the early 1970s in Nigeria and Ghana; it was championed by College Fellows, surgeons who had returned to the sub-region after having trained in Europe and America. Surgical programmes accreditation, captured in the College's constitution and mission statement, uses objective guidelines in the identification and encouragement of suitable institutions for surgical training through periodic peer-review audits of installed manpower, facilities, clinical services and academic programmes...
April 2012: Journal of the West African College of Surgeons
https://www.readbyqxmd.com/read/27145563/prospective-study-on-dental-extractions-carried-out-for-paediatric-patients-under-general-anaesthetic-in-a-district-general-hospital
#16
Tom Friend, Paul Allen
BACKGROUND: The first line approach to managing healthy anxious children requiring dental extractions should include behavioural management and treatment under local anaesthetic. This can be coupled with conscious sedation. AIM: To evaluate alternative methods attempted prior to treatment under general anaesthesia (GA), to establish the incidence of repeat GA procedures. METHOD: Paediatric cases requiring dental extractions under GA were audited from October 2014 - December 2014 in the Oral and Maxillofacial Department, Great Western Hospital, Swindon...
January 2016: SAAD Digest
https://www.readbyqxmd.com/read/27145559/short-report-audit-of-conscious-sedation-provision-in-a-salaried-dental-service
#17
Stephen G Jones
Clinical audit is a tool that may be used to improve the quality of care and outcomes for patients in a health care setting as well as a mechanism for clinicians to reflect on their performance. The audit described in this short report involved the collection and analysis of data related to the administration of 1,756 conscious sedations, categorised as standard techniques, by clinicians employed by an NHS Trust-based dental service during the year 2014. Data collected included gender, age and medical status of subject, the type of care delivered, the dose of drug administered and the quality of the achieved sedation and any sedation-related complications...
January 2016: SAAD Digest
https://www.readbyqxmd.com/read/27145558/the-state-of-uk-dental-anaesthesia-results-from-the-nap5-activity-survey-a-national-survey-by-the-5th-national-audit-project-of-the-royal-college-of-anaesthetists-and-the-association-of-anaesthetists-of-great-britain-and-ireland
#18
COMPARATIVE STUDY
Michael R J Sury, James H MacG Palmer, Tim M Cook, Jaideep J Pandit
The National Health Service anaesthesia annual activity (2013) was recently reported by the Fifth National Audit Program of the Royal College of Anaesthetists and the Association of Anaesthetists of Great Britain and Ireland. Within a large dataset were 620 dental cases. Here, we describe this data subset. The estimated annual dental caseload was 111,600:60% were children (< 16 y), 38.5% adults (16 - 65y) and 1.5% the elderly (> 65y). Almost all were elective day procedures (97%) and ASA 1 or 2 patients (95%)...
January 2016: SAAD Digest
https://www.readbyqxmd.com/read/27145556/is-propofol-safe-for-food-allergy-patients-a-review-of-the-evidence
#19
REVIEW
Arkadiusz Dziedzic
Allergic cross-reactivity between propofol and food is frequently considered as a risk factor for perioperative allergic hypersensitivity reactions and anaphylaxis during dental anaesthesia and sedation. Better understanding of of this cross-reactivity is important to providing safe care. There are, however, conflicting assumptions about anaphylactic reactions to propofol in patients reporting allergy to certain type of the food. Egg and/or soya allergy are often cited as contraindications to propofol administration but the evidence remains unclear...
January 2016: SAAD Digest
https://www.readbyqxmd.com/read/27131418/evaluation-of-a-continuous-improvement-programme-of-enhanced-recovery-after-caesarean-delivery-under-neuraxial-anaesthesia
#20
Benjamin Deniau, Nacima Bouhadjari, Valentina Faitot, Antoine Mortazavi, Gilles Kayem, Laurent Mandelbrot, Hawa Keita
OBJECTIVE: To assess the performance of a multidisciplinary programme for enhanced recovery after caesarean delivery under neuraxial anaesthesia. STUDY DESIGN: Prospective single-centre study. METHODS: Programme in 6 steps including 3 professional practice audits based on clinical records and questioning patients: audit T0, first "existing state", creation of a working group, drafting and implementation of a multidisciplinary rehabilitation procedure, second audit (T0+4 months), information about and implementation of corrective measures and a third audit (T0+8 months)...
April 27, 2016: Anaesthesia, Critical Care & Pain Medicine
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