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https://www.readbyqxmd.com/read/28641321/identifying-and-acting-on-potentially-inappropriate-care-inadequacy-of-current-hospital-coding-for-this-task
#1
P David Cooper, David R Smart
INTRODUCTION: Recent Australian attempts to facilitate disinvestment in healthcare, by identifying instances of 'inappropriate' care from large Government datasets, are subject to significant methodological flaws. Amongst other criticisms has been the fact that the Government datasets utilized for this purpose correlate poorly with datasets collected by relevant professional bodies. Government data derive from official hospital coding, collected retrospectively by clerical personnel, whilst professional body data derive from unit-specific databases, collected contemporaneously with care by clinical personnel...
June 2017: Diving and Hyperbaric Medicine: the Journal of the South Pacific Underwater Medicine Society
https://www.readbyqxmd.com/read/28636738/impact-of-a-pediatric-anesthesiologist-on-operating-room-efficiency-during-pediatric-tonsillectomies-and-adenotonsillectomies
#2
Nicholas A Dewyer, Yoseph A Kram, Stephen Long, Marika D Russell
We conducted a retrospective case review to determine if the presence of an Accreditation Council for Graduate Medical Education (ACGME) fellowship-trained pediatric anesthesiologist improves efficiency during pediatric tonsillectomies and adenotonsillectomies in hospitals that do not have dedicated pediatric operating rooms and, if so, to determine which specific anesthesia practices might account for such a difference. We reviewed the charts of all patients aged 12 years and younger who had undergone a tonsillectomy or adenotonsillectomy from Jan...
June 2017: Ear, Nose, & Throat Journal
https://www.readbyqxmd.com/read/28635347/ketamine-and-international-regulations
#3
Yanhui Liao, Yi-Lang Tang, Wei Hao
BACKGROUND: Ketamine is an anesthetic commonly used in low-income countries and has recently been shown to be effective for treatment-resistant depression. However, the illicit manufacturing, trafficking, and nonmedical use of ketamine are increasing globally, and its illicit use poses major public health challenges in many countries. OBJECTIVES: To review the nonmedical use of ketamine in selected countries and its regulatory control. METHODS: We conducted a review of literature identified from searches of the China National Knowledge Infrastructure (CNKI) (1979-2016) and PubMed databases, supplemented by additional references identified by the authors...
February 13, 2017: American Journal of Drug and Alcohol Abuse
https://www.readbyqxmd.com/read/28634091/a-simple-method-associated-with-reduced-opioid-consumption-after-total-knee-arthroplasty
#4
Alfred C Kuo, Eva Grotkopp
BACKGROUND: Most patients experience moderate to severe pain after total knee arthroplasty (TKA). We hypothesized that intraoperative treatment of cut bone surfaces with local anesthetic (preimplantation immersion anesthesia, PIA) would lead to decreased postoperative pain and opioid consumption. METHODS: Records of 76 patients who underwent unilateral, cemented TKA were retrospectively reviewed. For PIA patients, surgical wounds were immersed in local anesthetic solution immediately prior to component implantation...
May 22, 2017: Journal of Arthroplasty
https://www.readbyqxmd.com/read/28633782/factors-predicting-length-of-hospital-stay-and-extended-care-facility-admission-after-hindfoot-arthrodesis-procedures
#5
Jacob Deister, Brian G Cothern, Chad Williams, Andrew W Froehle, Richard T Laughlin
Delayed identification of patients requiring admission to extended care facilities (ECFs) can lead to greater healthcare costs through an increased length of hospital stay (LOHS). Previous studies of hip and knee arthroplasty identified factors associated with a likely discharge to an ECF. These issues have not been extensively studied for major hindfoot procedures. We conducted a retrospective review of 198 cases treated during a 3-year period to identify the risk factors for an extended LOHS and ECF admission after ankle arthrodesis, triple arthrodesis, pantalar arthrodesis, and subtalar arthrodesis...
July 2017: Journal of Foot and Ankle Surgery: Official Publication of the American College of Foot and Ankle Surgeons
https://www.readbyqxmd.com/read/28633155/regional-anesthesia-and-pain-medicine-us-anesthesiology-resident-training-the-year-2015
#6
Joseph M Neal, Anne Gravel Sullivan, Richard W Rosenquist, Dan J Kopacz
BACKGROUND AND OBJECTIVES: The Anesthesiology Review Committee of the Accreditation Council for Graduate Medical Education sets core requirements for residency program accreditation. We periodically report and analyze the US anesthesiology residents' training experience in regional anesthesia and pain medicine. METHODS: Resident caseload, procedure, and pain medicine evaluation data were aggregated for the resident cohort who graduated in 2015. These data were analyzed for present-day experience and compared with previous reports from years 1980, 1990, and 2000 graduates...
July 2017: Regional Anesthesia and Pain Medicine
https://www.readbyqxmd.com/read/28632910/withdrawn-hypnosis-for-children-undergoing-dental-treatment
#7
REVIEW
Sharifa Al-Harasi, Paul F Ashley, David R Moles, Susan Parekh, Val Walters
BACKGROUND: Managing children is a challenge that many dentists face. Many non-pharmacological techniques have been developed to manage anxiety and behavioural problems in children, such us: 'tell, show & do', positive reinforcement, modelling and hypnosis. The use of hypnosis is generally an overlooked area, hence the need for this review. OBJECTIVES: This systematic review attempted to answer the question: What is the effectiveness of hypnosis (with or without sedation) for behaviour management of children who are receiving dental care in order to allow successful completion of treatment?Null hypothesis: Hypnosis has no effect on the outcome of dental treatment of children...
June 20, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/28632535/perioperative-surgical-home-evaluation-of-a-new-protocol-focused-on-a-multidisciplinary-approach-to-manage-children-undergoing-posterior-spinal-fusion-operation
#8
Eugene Kim, Brian Lee, Giovanni Cucchiaro
BACKGROUND: The concept of Perioperative Surgical Home has been gaining significant attention in surgical centers. This model is delivering and improving coordinated care in a cost-effective manner to patients undergoing surgical procedures. It starts with the decision for surgical intervention, continues to the intraoperative and postoperative periods, and follows into long-term recovery. Constant re-evaluation of outcomes and modifications of delivery provides a feedback loop for improvement...
June 17, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28632532/postpartum-tubal-sterilization-making-the-case-for-urgency
#9
Michael G Richardson, Sarah J Hall, Lisa C Zuckerwise
The parturient who requests postpartum sterilization has given consideration to and has made decisions regarding this aspect of her medical care long before her delivery. She arrives at parturition expecting the postpartum procedure to be performed as intended. The American Congress of Obstetricians and Gynecologists has reaffirmed its opinion that postpartum sterilization is an urgent procedure, owing to the safety and superior effectiveness of tubal sterilization via minilaparotomy in the immediate postpartum period, and the adverse consequences for mothers, babies, and society when the procedure is not actualized as desired and intended...
June 17, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28629228/use-of-provider-debriefing-to-improve-fast-track-extubation-rates-following-cardiac-surgery-at-an-academic-medical-center
#10
Jordan E Goldhammer, Jillian M Dashiell, Scott Davis, Marc C Torjman, Hitoshi Hirose
When used in appropriate patient populations, fast-track extubation (FTE) anesthetic techniques and intensive care unit (ICU) protocols safely reduce intubation times, ICU length of stay, and resource utilization. The authors hypothesized that perioperative provider debriefing on success or failure of FTE would improve FTE success. This retrospective observational study included consecutive patients undergoing elective coronary artery bypass graft (CABG), valve, or combined CABG/valve surgery between February 2015 and May 2016 (N = 313)...
June 1, 2017: American Journal of Medical Quality: the Official Journal of the American College of Medical Quality
https://www.readbyqxmd.com/read/28628578/neuraxial-anesthesia-in-obstetric-patients-receiving-thromboprophylaxis-with-unfractionated-or-low-molecular-weight-heparin-a-systematic-review-of-spinal-epidural-hematoma
#11
Lisa R Leffert, Heloise M Dubois, Alexander J Butwick, Brendan Carvalho, Timothy T Houle, Ruth Landau
Venous thromboembolism remains a major source of morbidity and mortality in obstetrics with an incidence of 29.8/100,000 vaginal delivery hospitalizations; cesarean delivery confers a 4-fold increased risk of thromboembolism when compared with vaginal delivery. Revised national guidelines now stipulate that the majority of women delivering via cesarean and women at risk for ante- or postpartum venous thromboembolism receive mechanical or pharmacological thromboprophylaxis. This practice change has important implications for obstetric anesthesiologists concerned about the risk of spinal epidural hematoma (SEH) among anticoagulated women receiving neuraxial anesthesia...
July 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28627724/comparative-echogenicity-of-an-epidural-catheter-and-2-new-catheters-designed-for-ultrasound-guided-continuous-peripheral-nerve-blocks
#12
Daniel M Moy, T Edward Kim, T Kyle Harrison, Jody C Leng, Brendan Carvalho, Steven K Howard, Cynthia Shum, Alex Kou, Edward R Mariano
Visualization of the catheter during ultrasound-guided continuous nerve block performance may be difficult but is an essential skill for regional anesthesiologists. The objective of this in vitro study was to evaluate 2 newer catheters designed for enhanced echogenicity and compare them to a widely used catheter not purposely designed for ultrasound guidance. Outcomes were the numbers of first-place rankings among all 3 catheters and scores on individual echogenicity criteria as assessed by 2 blinded reviewers...
June 19, 2017: Journal of Ultrasound in Medicine: Official Journal of the American Institute of Ultrasound in Medicine
https://www.readbyqxmd.com/read/28625750/postoperative-delirium-in-patients-undergoing-off-pump-coronary-artery-bypass-grafting-according-to-the-anesthetic-agent-a-retrospective-study
#13
Chung-Sik Oh, Sewon Park, Seung Wan Hong, Woon-Seok Kang, Tae-Gyoon Yoon, Seong-Hyop Kim
OBJECTIVE: To evaluate the effect of two anesthetic agents (sevoflurane or propofol) on postoperative delirium (POD) in patients undergoing off-pump coronary artery bypass grafting (CABG). DESIGN: Retrospective observational design. SETTING: University hospital. PARTICIPANTS: Two hundred ninety-two patients undergoing off-pump CABG who were anesthetized with sevoflurane or propofol. METHODS: Incidence of POD, laboratory data, and pre-, intra-, and 24-hour postoperative clinical variables were reviewed retrospectively...
February 12, 2017: Journal of Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/28625460/perioperative-use-of-angiotensin-converting-enzyme-inhibitors-and-angiotensin-receptor-antagonists
#14
REVIEW
Luis Mario Vaquero Roncero, David Sánchez Poveda, Joaquín José Valdunciel García, María Elisa Sánchez Barrado, José María Calvo Vecino
STUDY OBJECTIVE: Clinical repercussions of perioperative treatment with ACEIs/ARBs. DESIGN: Systematic review according to PRISMA statement. SETTING: Perioperative period. PATIENTS: 29 studies 11 cases/cases series, 12 observational studies and 6 randomized studies. MEASUREMENTS: Arterial blood pressure differences, refractory hypotension, other comorbidities. MAIN RESULTS: The studies show different results regarding the topics measured...
August 2017: Journal of Clinical Anesthesia
https://www.readbyqxmd.com/read/28625450/vasoplegic-syndrome-an-update-on-perioperative-considerations
#15
REVIEW
Henry Liu, Ling Yu, Longqiu Yang, Michael S Green
Vasoplegic syndrome (VS) is increasingly recognized as an important clinical entity in perioperative medicine. VS is characterized by significant arterial hypotension, normal or high cardiac output, low systemic vascular resistance, and increased requirements for intravenous volume and vasopressors. Tremendous variations exist regarding incidence reported in the literature and management at different institutions; and the incidence of VS is likely significantly higher than many anesthesiologists believe. Thus the aims of this article are to review the pertinent aspects related to VS and alert clinical anesthesiologists to this under-recognized yet very challenging clinical condition...
August 2017: Journal of Clinical Anesthesia
https://www.readbyqxmd.com/read/28625438/efficacy-of-prophylactic-doses-of-intravenous-nitroglycerin-in-preventing-myocardial-ischemia-under-general-anesthesia-a-systematic-review-and-meta-analysis-with-trial-sequential-analysis
#16
REVIEW
Hiroshi Hoshijima, Yohei Denawa, Takahiro Mihara, Risa Takeuchi, Norifumi Kuratani, Tsutomu Mieda, Yoshinori Iwase, Toshiya Shiga, Zen'ichiro Wajima, Hiroshi Nagasaka
STUDY OBJECTIVE: To evaluate the efficacy of intravenous nitroglycerin (TNG) in preventing intraoperative myocardial ischemia (MI) under general anesthesia. Moreover, we analyzed the hemodynamic changes in heart rate (HR), mean blood pressure (MBP), and pulmonary capillary wedge pressure (PCWP) associated with TNG administration both before and after the induction of anesthesia. DESIGN: Meta-analysis. SETTING: Operating room, cardiac surgery or non-cardiac surgery, all surgeries were elective measurements...
August 2017: Journal of Clinical Anesthesia
https://www.readbyqxmd.com/read/28625437/inhalation-versus-intravenous-anaesthesia-for-adults-undergoing-on-pump-or-off-pump-coronary-artery-bypass-grafting-a-systematic-review-and-meta-analysis-of-randomized-controlled-trials
#17
REVIEW
Regina El Dib, José E Guimarães Pereira, Arnav Agarwal, Huda Gomaa, Ana Patricia Ayala, Andresa Graciutti Botan, Leandro Gobbo Braz, Luciane Dias de Oliveira, Luciane Cruz Lopes, Preethy J Mathew
STUDY OBJECTIVE: To compare the use of inhalation versus intravenous anaesthesia for adults undergoing on-pump or off-pump coronary artery bypass grafting. DESIGN: A systematic review. SETTING: A hospital-affiliated university. MEASUREMENTS: The following databases were searched: the Cochrane Central Register of Controlled Trials (CENTRAL 2016, Issue 10), MEDLINE, EMBASE, and LILACS (from inception to October 2016). We used the GRADE approach to rate overall certainty of the evidence...
August 2017: Journal of Clinical Anesthesia
https://www.readbyqxmd.com/read/28625309/maternal-mortality-and-the-role-of-the-obstetric-anesthesiologist
#18
REVIEW
Gillian Abir, Jill Mhyre
Maternal mortality is increasing in the United States and remains unacceptably high in many parts of the world. Pre-existing conditions and social determinants of health frequently contribute to maternal death. General solutions to enhance maternal safety focus on systems to identify women at high risk and to tailor the management before, during, and after pregnancy. This review highlights condition-specific solutions for the leading etiologies of maternal death, including cardiac disease, sepsis, hemorrhage, venous thromboembolism, hypertensive disorders of pregnancy, and amniotic fluid embolism...
March 2017: Best Practice & Research. Clinical Anaesthesiology
https://www.readbyqxmd.com/read/28625306/spinal-induced-hypotension-incidence-mechanisms-prophylaxis-and-management-summarizing-20-years-of-research
#19
REVIEW
Jennifer E Lee, Ronald B George, Ashraf S Habib
Hypotension commonly occurs in parturients undergoing cesarean delivery under spinal anesthesia. This leads to maternal and neonatal adverse outcomes, including maternal nausea and vomiting and fetal acidosis, and might even lead to cardiovascular collapse if not treated. Arterial dilatation and reduction in systemic vascular resistance are the major contributors to spinal-induced hypotension. Therefore, strategies aimed at expanding the intravascular volume with fluid loading or increasing venous return with lower extremities mechanical compression and lateral tilt have had limited effectiveness in the management of spinal-induced hypotension...
March 2017: Best Practice & Research. Clinical Anaesthesiology
https://www.readbyqxmd.com/read/28625301/maintenance-of-epidural-labour-analgesia-the-old-the-new-and-the-future
#20
REVIEW
Ban Leong Sng, Alex Tiong Heng Sia
Neuraxial analgesia is considered the gold standard in labour analgesia, providing the most effective pain relief during childbirth. Improvements have enhanced the efficacy and safety of epidural analgesia through better drugs, techniques and delivery systems. This review describes the history of epidural labour analgesia and recent improvements in labour epidural analgesia. We discuss the role of the combined spinal epidural technique, low-concentration local anaesthetic-opioid epidural solutions, patient-controlled epidural analgesia, and programmed intermittent or automated mandatory boluses in the maintenance of epidural labour analgesia...
March 2017: Best Practice & Research. Clinical Anaesthesiology
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