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Anesthesiology and IT

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https://www.readbyqxmd.com/read/29904607/water-in-the-human-body-an-anesthesiologist-s-perspective-on-the-connection-between-physicochemical-properties-of-water-and-physiologic-relevance
#1
REVIEW
Efraín Riveros-Perez, Ricardo Riveros
The unique structure and multifaceted physicochemical properties of the water molecule, in addition to its universal presence in body compartments, make water a key player in multiple biological processes in human physiology. Since anesthesiologists deal with physiologic processes where water molecules are critical at different levels, and administer medications whose pharmacokinetics and pharmacodynamics depend on interaction with water molecules, we consider that exploration of basic science aspects related to water and its role in physiology and pharmacology is relevant to the practice of anesthesiology...
February 2018: Annals of Medicine and Surgery
https://www.readbyqxmd.com/read/29902969/bispectral-index-to-guide-induction-of-anesthesia-a-randomized-controlled-study
#2
Dirk Rüsch, Christian Arndt, Leopold Eberhart, Scarlett Tappert, Dennis Nageldick, Hinnerk Wulf
BACKGROUND: It is unknown to what extent hypotension frequently observed following administration of propofol for induction of general anesthesia is caused by overdosing propofol. Unlike clinical signs, electroencephalon-based cerebral monitoring allows to detect and quantify an overdose of hypnotics. Therefore, we tested whether the use of an electroencephalon-based cerebral monitoring will cause less hypotension following induction with propofol. METHODS: Subjects were randomly assigned to a bispectral index (BIS)-guided (target range 40-60) or to a weight-related (2 mg...
June 15, 2018: BMC Anesthesiology
https://www.readbyqxmd.com/read/29878944/decision-support-tool-improves-real-and-perceived-anesthesiology-resident-relief-equity
#3
Monica Bhutiani, Patrick M Jablonski, Jesse M Ehrenfeld, Matthew D McEvoy, Leslie C Fowler, Jonathan P Wanderer
BACKGROUND: The Accreditation Council of Graduate Medical Education requires monitoring of resident clinical and educational hours but does not require tracking daily work patterns or duty hour equity. Lack of such monitoring may allow for inequity that affects resident morale. No defined system for resident relief of weekday operating room (OR) clinical duties existed at our institution, leaving on-call residents to independently decide daily relief order. We developed an automated decision support tool (DST) to improve equitable decision making for clinical relief and assessed its impact on real and perceived relief equity...
June 5, 2018: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/29868977/role-of-additional-organ-resection-in-adrenocortical-carcinoma-analysis-of-167-patients-from-the-u-s-adrenocortical-carcinoma-database
#4
Paula Marincola Smith, Colleen M Kiernan, Thuy B Tran, Lauren M Postlewait, Shishir K Maithel, Jason Prescott, Timothy Pawlik, Tracy S Wang, Jason Glenn, Ioannis Hatzaras, Rivka Shenoy, John Phay, Lawrence A Shirley, Ryan C Fields, Linda Jin, Sharon Weber, Ahmed Salem, Jason Sicklick, Shady Gad, Adam Yopp, John Mansour, Quan-Yang Duh, Natalie Seiser, Konstantinos Votanopoulos, Edward A Levine, George Poultsides, Carmen C Solórzano
BACKGROUND: Adrenocortical carcinoma (ACC) is a rare and aggressive cancer. This report describes factors and outcomes associated with resection of extra-adrenal organs en bloc during index adrenalectomy. METHODS: Patients who underwent ACC resection for non-metastatic disease from 1993 to 2014 at 13 participating institutions of the US-ACC Group were included in the study. Factors associated with en bloc resection were assessed by uni- and multivariate analysis...
June 4, 2018: Annals of Surgical Oncology
https://www.readbyqxmd.com/read/29802440/-patient-endangerment-due-to-device-diversity-discussion-of-a-risk-factor-based-on-the-results-of-two-surveys-of-german-hospitals
#5
K Lange, A Brinker, M Nowak, C Zöllner, W Lauer
BACKGROUND: The Federal Institute for Drugs and Medical Devices (BfArM) was notified of an event in which it was not possible to sufficiently ventilate a patient suffering a severe asthma attack. It turned out that the ventilation pressures used by the device for pressure-controlled ventilation were below the values set by the user, which the user was not aware of. The ventilation pressures chosen by the user exceeded the preset alarm limits of the ventilator. This pressure and alarm management significantly differed from that of other ventilators used in the hospital...
May 25, 2018: Der Anaesthesist
https://www.readbyqxmd.com/read/29796968/recommendations-for-the-use-of-ect-in-pregnancy-literature-review-and-proposed-clinical-protocol
#6
Heather Burrell-Ward, John A Fromson, Joseph J Cooper, Gildasio De Oliveira, Marcela Almeida
Psychiatric disorders are common in pregnancy, affecting 15-29% of pregnant women. Untreated depression has negative health consequences for mother and fetus. Electroconvulsive therapy (ECT) is an effective option for the treatment of severe depression, high suicide risk, catatonia, medication-resistant illness, psychotic agitation, severe physical decline, and other life-threatening conditions. To our knowledge, however, there is no literature that consolidates all the evidence on maternal and fetal risks associated with untreated depression, medications, and ECT then translating it into one cohesive protocol that could serve as a management guide and a source of reassurance to health-care providers involved in such practice...
May 23, 2018: Archives of Women's Mental Health
https://www.readbyqxmd.com/read/29772984/pain-upon-inserting-a-peripheral-intravenous-catheter-size-does-not-matter
#7
Fredericus Hj van Loon, Lisette Apm Puijn, Wesly H van Aarle, Angelique Tm Dierick-van Daele, Arthur Ra Bouwman
BACKGROUND: Approximately 1.2 billion peripheral intravenous catheters are inserted across the world annually. It is known that intravenous cannulation may be a painful procedure, which affects cognitive abilities by increasing anxiety and discomfort. AIM: We hypothesized that inserting a smaller sized peripheral intravenous catheter has a lower level of pain sensation compared to a larger sized catheter. METHODS: This observational, cross-sectional study was conducted between May and October 2016, in which surgical patients, aged 18 years or older, were eligible to participate...
May 2018: Journal of Vascular Access
https://www.readbyqxmd.com/read/29767825/-palliative-sedation-development-and-consensus-of-a-german-language-documentation-template
#8
C Klein, C Wittmann, K N Wendt, C Ostgathe, S Stiel
BACKGROUND: Palliative sedation (PS) serves as a therapeutic option in cases of otherwise intractable suffering. As the use of sedative and hypnotic medication in many diverse situations is a core competency of anesthesiology, anesthesiologists are confronted with questions of sedative therapy at the end of life in institutions for specialized palliative care, in intensive care units and intermediate care wards. In recent years a number of guidelines have been published internationally but so far no official guidelines exist in Germany...
May 16, 2018: Der Anaesthesist
https://www.readbyqxmd.com/read/29762462/the-safety-and-utility-of-fiberoptic-bronchoscopy-in-the-very-elderly
#9
Cameron W McLaughlin, Andrew J Skabelund, Ellis R Easterling, Michael J Morris
BACKGROUND: Flexible bronchoscopy (FB) is a common modality for diagnostic sampling within the thorax. It is utilized often in the elderly population, but there is limited data on the safety and utility of the procedure in the very elderly. METHODS: FBs performed outside the intensive care unit in the San Antonio Military Health System on patients 85 years and older were reviewed. Outcomes including indications, complications, diagnostic yield, and final diagnosis were compared with a control group consisting of patients' ages of 65 to 79 years old...
May 14, 2018: Journal of Bronchology & Interventional Pulmonology
https://www.readbyqxmd.com/read/29759290/anesthesiology-s-future-with-specialists-in-population-health
#10
REVIEW
Mike Schweitzer
In population health medicine, often it is not primary care, but rather the specialists' care teams that are responsible for the most overall spending for health care. Engaging specialists in population health medicine is a prerequisite to be successful in improving the quality of care by reducing complications, unnecessary utilization, avoidable Emergency Department visits/readmissions, and total cost of care. Creating patient-centric, physician-lead, interdisciplinary care teams to redesign the delivery of care across the continuum of the episode of care (eg, shadow bundle) is a successful approach to commercial or Centers for Medicare and Medicaid Services value-based payments...
June 2018: Anesthesiology Clinics
https://www.readbyqxmd.com/read/29759285/value-proposition-and-anesthesiology
#11
REVIEW
Joseph W Szokol, Keith J Chamberlin
Health care in general and anesthesia in particular have seen dramatic changes in the economic landscape. It is vital if anesthesia groups wish to survive and prosper in this new environment to understand the changes occurring in health care and be flexible and proactive in taking on these challenges. More than ever anesthesia groups must be good corporate citizens and seek ways in which to enhance their value to the organization, whether in the operating room or out of operating room locations, and be a proactive partner with the hospital...
June 2018: Anesthesiology Clinics
https://www.readbyqxmd.com/read/29750321/improved-outcomes-of-enhanced-recovery-after-surgery-eras-protocol-for-radical-cystectomy-with-addition-of-a-multidisciplinary-care-process-in-a-us-comprehensive-cancer-care-center
#12
Sephalie Y Patel, Rosemarie E Garcia Getting, Brandon Alford, Karim Hussein, Braydon J Schaible, David Boulware, Jae K Lee, Scott M Gilbert, Julio M Powsang, Wade J Sexton, Philippe E Spiess, Michael A Poch
INTRODUCTION: Although enhanced recovery after surgery (ERAS) components include both anesthesia and surgical care processes, it is unclear whether a multidisciplinary approach to implementing ERAS care processes improves clinical outcomes. The addition of multidisciplinary care with anesthesiology-related components to an existing ERAS protocol for radical cystectomy at a US comprehensive cancer center provided an opportunity to compare short- and long-term outcomes. METHODS: We retrospectively compared the outcomes of 116 consecutive patients who underwent cystectomy after implementation of a multidisciplinary ERAS protocol with those of a historical control group of 143 consecutive patients who had been treated with a surgical ERAS protocol...
May 10, 2018: World Journal of Surgery
https://www.readbyqxmd.com/read/29736556/-correct-positioning-of-central-venous-catheters-in-pediatrics-are-current-formulae-really-useful
#13
REVIEW
C Cleff, M Boensch, F Eifinger, J Hinkelbein
BACKGROUND: Correct positioning of a central venous catheter (CVC) tip in pediatric patients is very important. Malpositioning may lead to direct complications, such as arrhythmia and increase the risk of thrombosis, infections, valve failures or pericardial tamponade. OBJECTIVE: The aim of this review was to identify and summarize published formulae for the correct positioning of the CVC tip in children and to discuss the benefits of these formulae for the daily routine...
May 7, 2018: Der Anaesthesist
https://www.readbyqxmd.com/read/29732201/robot-assisted-radical-cystectomy-first-polish-clinical-outcomes
#14
Przemysław Adamczyk, Kajetan Juszczak, Pawel Poblocki, Witold Mikolajczak, Tomasz Drewa
Introduction: Urothelial cell carcinoma is the most common neoplasm of the genito-urinary tract, which, in advanced stages, is treated with radical cystectomy with pelvic lymphadenectomy. It can be performed by an open or minimally invasive approach (laparoscopic and robot-assisted radical cystectomy).Large meta-analyses showed a significantly lower complication rate in the RARC (robot-assisted radical cystectomy) group compared to ORC (open radical cystectomy) in thirty and ninety days after surgery, with similar oncological and functional outcomes...
2018: Central European Journal of Urology
https://www.readbyqxmd.com/read/29725565/the-use-of-simulation-to-improve-family-understanding-and-support-of-anesthesia-providers
#15
Susan M Martinelli, Fei Chen, Gene Hobbs, Brooke A Chidgey, Lacey E Straube, David Zvara, Robert Isaak
Introduction  Burnout in medical providers is associated with work dissatisfaction, reduction in patient safety, and provider depression. Simulation is a tool effectively used for specific task training but has not been broadly used as a means to combat medical professional stress and enhance wellness. The authors created a medical simulation program targeted at those involved in the social support of medical providers. The hypothesis was that education of non-medical persons involved in social support would translate into an enhanced understanding of the demands among medical providers in anesthesiology...
March 2, 2018: Curēus
https://www.readbyqxmd.com/read/29690755/perioperative-surgical-home-a-new-scope-for-future-anesthesiology
#16
Min A Kwon
The health care system is changing from 'pay for volume' to 'pay for value.' These changes are turning health care delivery into a more cost-effective and coordinated care setup that drives hospitals to lower costs and greater quality gains. The present perioperative care service in Korea has proven to be costly, fragmented, and neither evidence-based nor patient- centered. Recently, a new concept of a perioperative care model termed perioperative surgical home (PSH) has been proposed. The PSH is a patient-centered, team-based, and coordinated perioperative care setup, composed of the head anesthesiologist-perioperativist in tandem with dedicated nurse practitioners and other PSH team doctors...
April 25, 2018: Korean Journal of Anesthesiology
https://www.readbyqxmd.com/read/29688921/development-of-an-objective-structured-clinical-examination-using-the-american-board-of-anesthesiology-content-outline-for-the-objective-structured-clinical-examination-component-of-the-applied-certification-examination
#17
Pedro Tanaka, Aileen Adriano, Lynn Ngai, Yoon Soo Park, Adrian Marty, Shin Wakatsuki, Carlos Brun, Kyle Harrison, Erin Bushell, Jakob Louis Demant Thomsen, Louise Wen, Christopher Painter, Marianne Chen, Alex Macario
The goal of this study was to use the American Board of Anesthesiology Objective Structured Clinical Examination (OSCE) content outline as a blueprint to develop and administer a 9-station mock OSCE with station-specific checklists to senior residents (n = 14). The G- and Ф-coefficient reliability estimates were 0.76 and 0.61, respectively. Residents judged the scenarios as either extremely or somewhat realistic (88%). It is feasible to develop and administer a mock OSCE with rigorous psychometric characteristics...
April 23, 2018: A&A practice
https://www.readbyqxmd.com/read/29687674/intubation-through-2-supraglottic-airway-device-in-cervical-spine-immobilization-a-randomized-trial-of-residents-use-of-the-intubating-laryngeal-mask-airway-and-the-intubating-laryngeal-tube-in-manikins
#18
Dawid Aleksandrowicz, Tomasz Gaszyński
OBJECTIVES: The aim of this study was to compare the intubating laryngeal mask (iLM) airway and the new intubating laryngeal tube (iLTS-D) in use by residents with minimal previous intubation experience during simulated conditions of reduced cervical spine mobility. MATERIAL AND METHODS: Thirty first-year residents in anesthesiology participated in the study (18 women). All participants had minimal intubation experience (fewer than 10 previously performed intubations) and were novices in the specialty...
June 2018: Emergencias: revista de la Sociedad Española de Medicina de Emergencias
https://www.readbyqxmd.com/read/29686578/anesthesiology-automation-and-artificial-intelligence
#19
John C Alexander, Girish P Joshi
There have been many attempts to incorporate automation into the practice of anesthesiology, though none have been successful. Fundamentally, these failures are due to the underlying complexity of anesthesia practice and the inability of rule-based feedback loops to fully master it. Recent innovations in artificial intelligence, especially machine learning, may usher in a new era of automation across many industries, including anesthesiology. It would be wise to consider the implications of such potential changes before they have been fully realized...
January 2018: Proceedings of the Baylor University Medical Center
https://www.readbyqxmd.com/read/29683833/gender-distribution-of-the-american-board-of-anesthesiology-diplomates-examiners-and-directors-1985-2015
#20
Brenda G Fahy, Deborah J Culley, Huaping Sun, Rupa Dainer, Benjamin P Lutkoski, Cynthia A Lien
To understand the potential role of women in leadership positions, data from the American Board of Anesthesiology (ABA) were analyzed to explore the impact of women in the specialty of anesthesiology. The number of newly certified ABA diplomates, oral examiners, and directors from 1985 to 2015 was obtained from the ABA database. The percentages of women in each group were calculated for each year. Because it took an average of 10 years for a diplomate to become an oral examiner and an average of 7 years for an oral examiner to be elected as a director during the study period, the following percentages were compared: women oral examiners versus newly certified women diplomates 10 years prior and women directors versus women oral examiners 7 years prior...
April 19, 2018: Anesthesia and Analgesia
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