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https://www.readbyqxmd.com/read/29766033/use-of-key-performance-indicators-to-improve-milestone-assessment-in-semi-annual-clinical-competency-committee-meetings
#1
Fei Chen, Harendra Arora, Susan M Martinelli
Background: The Accreditation Council for Graduate Medical Education's Next Accreditation System requires residency programs to semiannually submit composite milestone data on each resident's performance. This report describes and evaluates a new assessment review procedure piloted in our departmental Clinical Competency Committee (CCC) semi-annual meeting in June 2016. Methods: A modified Delphi technique was utilized to develop key performance indicators (KPI) linking milestone descriptors to clinical practice...
October 2017: Journal of Education in Perioperative Medicine: JEPM
https://www.readbyqxmd.com/read/29707505/acute-airway-management
#2
Nikhil Panda, Dean M Donahue
Acute airway management has challenged clinicians for nearly four millennia. History underscores the discoveries of surgeons and anesthesiologists, whose advances in technology and surgical technique have transformed management algorithms from primarily surgical tracheostomy, to transoral endotracheal intubation under direct laryngoscopy. Despite this progress and a better understanding of airway anatomy, physiology and pathogenesis of disease, the acute airway, whether obstructed, traumatically disrupted, or externally compressed, remains a life-threatening challenge...
March 2018: Annals of Cardiothoracic Surgery
https://www.readbyqxmd.com/read/29682014/neurosurgical-interventions-for-occipital-encephalocele
#3
Lal Rehman, Ghulam Farooq, Irum Bukhari
Aims and Objectives: The aim of this study is to find the outcome of repair and resection of the occipital encephalocele. Study Design: Case series. Materials and Methods: The clinical data of fifty consecutive occipital encephalocele patients were retrieved from medical records including operative notes, postoperative follow-up visits, and postsurgical complications were noted for analysis from November 2009 to November 2013 at the Department of Neurosurgery, Jinnah Postgraduate Medical Centre, Karachi, Pakistan...
April 2018: Asian Journal of Neurosurgery
https://www.readbyqxmd.com/read/29677919/from-data-extraction-to-analysis-proposal-of-a-methodology-to-optimize-hospital-data-reuse-process
#4
Antoine Lamer, Grégoire Ficheur, Louis Rousselet, Marine van Berleere, Emmanuel Chazard, Alexandre Caron
In the Lille University Hospital (North of France), data from the Anesthesia Information Management System (Diane® are linked to the Hospital Information System and stored in a dedicated data warehouse since 2010. These electronic medical records need to be reused and analyzed for observational studies. The aim of this paper is to describe the framework developed to structure the operation of that anesthesia data warehouse for research purposes. The presented framework is structured around three meetings between clinicians, computer scientists, and statisticians...
2018: Studies in Health Technology and Informatics
https://www.readbyqxmd.com/read/29529623/can-multimodal-pain-management-in-tka-eliminate-patient-controlled-analgesia-and-femoral-nerve-blocks
#5
Stephen Yu, John Dundon, Olga Solovyova, Joseph Bosco, Richard Iorio
BACKGROUND: TKA pain management protocols vary widely with no current consensus on a standardized pain management regimen. Multimodal TKA pain management protocols aim to address pain control, facilitate functional recovery, and maintain patient satisfaction. QUESTIONS/PURPOSES: (1) Did changes to our pain management protocol, specifically adding liposomal bupivacaine, eliminating patient-controlled analgesia (PCA), and discontinuing femoral nerve blocks (FNBs), affect narcotic consumption after TKA? (2) Did these changes to our pain management protocols affect patient-reported pain scores? (3) Does the use of an immediate postoperative PCA affect rapid rehabilitation and functional recovery? (4) How did changes to our pain management regimen affect discharge disposition and pain-related Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores? METHODS: We retrospectively analyzed an institutional arthroplasty database between September 2013 and September 2015 containing 1808 patients who underwent primary TKA...
January 2018: Clinical Orthopaedics and related Research
https://www.readbyqxmd.com/read/29525923/single-tooth-anesthesia-versus-conventional-anesthesia-a-cross-over-study
#6
Vincenzo Campanella, Antonio Libonati, Roberto Nardi, Vincenzo Angotti, Gianni Gallusi, Edoardo Montemurro, Maurizio D'Amario, Giuseppe Marzo
OBJECTIVES: The aim of the present study was to compare an electronic device, the Wand Injection System (Milestone Scientific Livingstone), with conventional anesthesia in terms of the following: pain sensation during anesthetic injection; effectiveness in achieving adequate anesthesia for a complete painless dental treatment; post-operative discomfort; and patient's anxiety toward dental treatment. MATERIALS AND METHODS: Eighty adults from 18 to 70 years were enrolled in this cross-over study...
March 10, 2018: Clinical Oral Investigations
https://www.readbyqxmd.com/read/29398993/pregabalin-did-not-improve-pain-management-after-spinal-fusions
#7
Michael K Urban, Kristy M Labib, Shane C Reid, Amanda K Goon, Valeria Rotundo, Frank P Cammisa, Federico P Girardi
Background: The treatment of postoperative pain is a challenge after posterior spinal fusions. Pain management using predominantly opioids is often associated with multiple adverse effects, while multimodal postoperative analgesia may provide adequate pain relief with fewer opioid side effects. Questions/Purposes: The purpose of this review is to determine whether addition of 150 mg pregabalin daily would reduce narcotic requirements and improve outcomes after posterior lumbar fusion (PLF)...
February 2018: HSS Journal: the Musculoskeletal Journal of Hospital for Special Surgery
https://www.readbyqxmd.com/read/29239943/achieving-milestones-as-a-prerequisite-for-proceeding-with-a-clinical-trial
#8
Angela M Mickle, Hannah R Maybrier, Anke C Winter, Sherry L McKinnon, Brian A Torres, Nan Lin, Eric J Lenze, Susan Stark, Maxwell R Muench, Eric Jacobsohn, Sharon K Inouye, Michael S Avidan, Troy S Wildes
BACKGROUND: Although the National Institutes of Health (NIH) invests $30 billion in research annually, many funded studies fail to generate results that can inform practice. The National Institutes of Health introduced a phased funding mechanism as one potential solution. Study-specific milestones are established for an initial pilot phase. We assess the utility of this phased approach through the ongoing Electroencephalography (EEG) Guidance of Anesthesia to Alleviate Geriatric Syndromes (ENGAGES) pragmatic clinical trial...
June 2018: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28922234/consensus-statement-by-the-congenital-cardiac-anesthesia-society-milestones-for-the-pediatric-cardiac-anesthesia-fellowship
#9
Viviane G Nasr, Nina A Guzzetta, Wanda C Miller-Hance, Mark Twite, Gregory J Latham, Luis Zabala, Susan C Nicolson, Emad B Mossad, James A DiNardo
Pediatric cardiac anesthesiology has evolved as a subspecialty of both pediatric and cardiac anesthesiology and is devoted to caring for individuals with congenital heart disease ranging in age from neonates to adults. Training in pediatric cardiac anesthesia is a second-year fellowship with variability in both training duration and content and is not accredited by the Accreditation Council on Graduate Medical Education. Consequently, in this article and based on the Accreditation Council on Graduate Medical Education Milestones Model, an expert panel of the Congenital Cardiac Anesthesia Society, a section of the Society of Pediatric Anesthesiology, defines 18 milestones as competency-based developmental outcomes for training in the pediatric cardiac anesthesia fellowship...
January 2018: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28816198/lingual-frenectomy-in-joubert-syndrome
#10
Vivek Gurjar, Minal Gurjar, Channaveer Pattanshetti, Banashree Sankeshwari
AIM: Our aim is to present a case of a rare disorder, such as Joubert syndrome (JS) which required oral surgical intervention under general anesthesia at a very young age to help in achieving normal developmental milestones. BACKGROUND: Ciliopathies are an emerging class of diseases of which JS is a significant member. There have been very few cases of JS with its distinguishing features which have been reported in recent literature. CASE REPORT: We herewith present a case of JS who reported to our unit with a complaint of speech abnormality...
August 1, 2017: Journal of Contemporary Dental Practice
https://www.readbyqxmd.com/read/28576279/-atypical-reaction-to-anesthesia-in-duchenne-becker-muscular-dystrophy
#11
Helga Cristina Almeida da Silva, Marcia Hiray, Mariz Vainzof, Beny Schmidt, Acary Souza Bulle Oliveira, José Luiz Gomes do Amaral
BACKGROUND AND OBJECTIVES: Duchenne/Becker muscular dystrophy affects skeletal muscles and leads to progressive muscle weakness and risk of atypical anesthetic reactions following exposure to succinylcholine or halogenated agents. The aim of this report is to describe the investigation and diagnosis of a patient with Becker muscular dystrophy and review the care required in anesthesia. CASE REPORT: Male patient, 14 years old, referred for hyperCKemia (chronic increase of serum creatine kinase levels - CK), with CK values of 7,779-29,040IU...
May 30, 2017: Revista Brasileira de Anestesiologia
https://www.readbyqxmd.com/read/28367396/comparing-anesthesiology-residency-training-structure-and-requirements-in-seven-different-countries-on-three-continents
#12
Satoshi Yamamoto, Pedro Tanaka, Matias V Madsen, Alex Macario
Little has been published comparing the graduate medical education training structure and requirements across multiple countries. The goal of this study was to summarize and compare the characteristics of anesthesiology training programs in the USA, UK, Canada, Japan, Brazil, Denmark, and Switzerland as a way to better understand efforts to train anesthesiologists in different countries. Two physicians trained in each of the seven countries (convenience sample) were interviewed using a semi-structured approach...
February 26, 2017: Curēus
https://www.readbyqxmd.com/read/28306681/anesthesia-in-adults-with-congenital-heart-disease
#13
REVIEW
Torsten Baehner, Richard K Ellerkmann
PURPOSE OF REVIEW: The current review focuses on patients with congenital heart disease (CHD) with regard to recent trends in global demographics, healthcare provision for noncardiac surgery, as well as anesthetic and perioperative care for these patients. RECENT FINDINGS: About 40 years after milestones of surgical innovation in CHD, the number of adults with CHD (ACHD) now surpasses those of children with CHD. This development leads to the fact that even patients with complex CHD managed for noncardiac surgery are not restricted to highly specialized centers...
June 2017: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/28099326/implementation-of-a-needs-based-online-feedback-tool-for-anesthesia-residents-with-subsequent-mapping-of-the-feedback-to-the-acgme-milestones
#14
Pedro Tanaka, Sylvia Bereknyei Merrell, Kim Walker, Jennifer Zocca, Lena Scotto, Alyssa L Bogetz, Alex Macario
BACKGROUND: Optimizing feedback that residents receive from faculty is important for learning. The goals of this study were to (1) conduct focus groups of anesthesia residents to define what constitutes optimal feedback; (2) develop, test, and implement a web-based feedback tool; and (3) then map the contents of the written comments collected on the feedback tool to the Accreditation Council for Graduate Medical Education (ACGME) anesthesiology milestones. METHODS: All 72 anesthesia residents in the program were invited to participate in 1 of 5 focus groups scheduled over a 2-month period...
February 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28079776/enhanced-recovery-program-and-length-of-stay-after-laparotomy-on-a-gynecologic-oncology-service-a-randomized-controlled-trial
#15
RANDOMIZED CONTROLLED TRIAL
Elizabeth L Dickson, Erica Stockwell, Melissa A Geller, Rachel Isaksson Vogel, Sally A Mullany, Rahel Ghebre, Boris J N Witherhoff, Levi S Downs, Linda F Carson, Deanna Teoh, Michelle Glasgow, Matt Gerber, Colleen Rivard, Britt K Erickson, Jacob Hutchins, Peter A Argenta
OBJECTIVE: To estimate whether a rapid recovery program would reduce length of stay among patients undergoing laparotomy on a gynecologic oncology service. METHODS: We conducted a prospective, randomized, controlled trial comparing an enhanced recovery after surgery protocol with routine postoperative care among women undergoing laparotomy on the gynecologic oncology service. Protocol elements included: preoperative counseling, regional anesthesia, intraoperative fluid restriction, and early postoperative ambulation and feeding...
February 2017: Obstetrics and Gynecology
https://www.readbyqxmd.com/read/27765179/from-the-laboratory-bench-to-the-operating-room-the-role-of-the-surgeon-in-cancer-prevention
#16
Terry C Lairmore
BACKGROUND: The last 200 years have seen remarkable achievements in the art and clinical practice of surgery. These advances include the introduction of antisepsis, anesthesia, vascular anastomosis, antimicrobials, organ transplantation, and the widespread application of minimally invasive operative procedures. Very recently, a surgical procedure has been shown to cure diabetes, representing the most effective treatment of a metabolic disorder by surgeons. METHODS: The author reviewed the major surgical milestones in the modern surgical era and prepared this monograph for presentation as the Claude H...
December 2016: American Journal of Surgery
https://www.readbyqxmd.com/read/27416639/focalyx-dx-bx-tx-et-apps-a-novel-contemporary-fusion-paradigm-for-the-management-of-prostate-cancer
#17
REVIEW
F J Bianco, J I Martínez-Salamanca
FocalyxTM conceived as a response to emerging evidence data across numerous cancer lesions that questions current standard treatment approaches that too often lead to detrimental quality of life yet delivering limited survival benefit, especially in-lieu of advances in imaging technology applicable to cancer patients. The Focalyx paradigm aims to control cancer with improvement in quality of life. We initially devised 5 milestones: 1- Consistently optimize Prostate MRI imaging using the novel published protocols adopted as guidelines by societies such as the European Society of Urology and Radiology; 2- Evaluate fusion platform software solutions that existed; 3- Determine best fusión platform for Focalyx on practicality, precision, and workflow premises; 4- Evaluate commercially available FDA approved ablative technologies to implement our treatment vision; 5- Design a treatment option that can be performed in the office setting under local anesthesia, which would not impact negatively QOL outcomes of Prostate Cancer patients and seamless constant nonintrusive practical patient-physician interaction by the Focalyx app that facilitates follow up and provides early warning signals shall any change in the disease dynamics emerge...
July 2016: Archivos Españoles de Urología
https://www.readbyqxmd.com/read/26883652/pain-control-and-functional-milestones-in-total-knee-arthroplasty-liposomal-bupivacaine-versus-femoral-nerve-block
#18
COMPARATIVE STUDY
Stephen Yu, Alessandra Szulc, Sharon Walton, Joseph Bosco, Richard Iorio
BACKGROUND: Although pain management after total knee arthroplasty (TKA) affects rehabilitation, length of stay, and functional outcomes, pain management for patients undergoing TKA has yet to be standardized. Femoral nerve blocks (FNBs) are commonly used as an adjunct; however, these can result in transient quadriceps weakness and have been associated with in-hospital falls. Periarticular infiltration of liposomal bupivacaine has been recently introduced as a long-acting analgesic that can be administered without affecting motor function...
January 2017: Clinical Orthopaedics and related Research
https://www.readbyqxmd.com/read/26841351/perioperative-management-of-children-with-giant-encephalocele-a-clinical-report-of-29-cases
#19
Charu Mahajan, Girija P Rath, Parmod K Bithal, Ashok K Mahapatra
BACKGROUND: Giant encephalocele, a rare entity, makes anesthesiologists wary of challenging anesthetic course. Apart from inherent challenges of pediatric anesthesia, the anesthesiologist has to deal with unusual positioning, difficult tracheal intubation, and associated anomalies during the perioperative course. MATERIALS AND METHODS: Medical records of 29 children with giant encephalocele, who underwent excision and repair, during a period of 13 years, were retrospectively analyzed...
July 2017: Journal of Neurosurgical Anesthesiology
https://www.readbyqxmd.com/read/26434871/epidemiological-study-of-laryngeal-carcinoma-in-western-nepal
#20
Krishna Koirala
BACKGROUND: Laryngeal malignancy is a common malignancy of the head and neck region. Affected patients usually present with features that are characteristic of certain subsites. The larynx is oncologically divided into three: supraglottis, glottis and subglottis. Studies from Western countries have shown that the glottis is the commonest subsite to harbour laryngeal malignancy. However, the supraglottis has been reported to be the commonest subsite in developing countries, including examples in the Indian subcontinent...
2015: Asian Pacific Journal of Cancer Prevention: APJCP
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