Anaesthesiology

In-depth review of the anaesthetics and intensive care medicine workforce (CfWI) [UK] – 26 February 2015

Posted on March 5, 2015. Filed under: Anaesthesiology, Intensive Care, Workforce | Tags: , |

In-depth review of the anaesthetics and intensive care medicine workforce (CfWI) [UK] – 26 February 2015

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Federal pain research database launched – National Institutes of Health – 27 May 2014

Posted on May 30, 2014. Filed under: Anaesthesiology, Palliative Care | Tags: |

Federal pain research database launched – National Institutes of Health – 27 May 2014

The Interagency Pain Research Portfolio (IPRP), a database that provides information about pain research and training activities supported by the federal government, has been launched by six federal agencies.

Pain is a symptom of many disorders; chronic pain can present as a disease in of itself. The economic cost of pain is estimated to be hundreds of billions of dollars annually in lost wages and productivity.

“This database will provide the public and the research community with an important tool to learn more about the breadth and details of pain research supported across the federal government. They can search for individual research projects or sets of projects grouped by themes uniquely relevant to pain,” said Linda Porter, Ph.D., Policy Advisor for Pain at the National Institute of Neurological Disorders and Stroke (NINDS), part of the National Institutes of Health (NIH). “It also can be helpful in identifying potential collaborators by searching for topic areas of interest or for investigators.”

Users of the database easily can search over 1,200 research projects in a multi-tiered system. In Tier 1, grants are organized as basic, translational (research that can be applied to diseases), or clinical research projects. In Tier 2, grants are sorted among 29 scientific topic areas related to pain, such as biobehavioral and psychosocial mechanisms, chronic overlapping conditions, and neurobiological mechanisms.

The Tier 2 categories are also organized into nine research themes: pain mechanisms, basic to clinical, disparities, training and education, tools and instruments, risk factors and causes, surveillance and human trials, overlapping conditions, and use of services, treatments, and interventions.”

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National Hip Fracture Database: Anaesthesia Sprint Audit of Practice (ASAP) – Royal College of Physicians – 31 March 2014

Posted on April 4, 2014. Filed under: Anaesthesiology, Orthopaedics, Surgery | Tags: |

National Hip Fracture Database: Anaesthesia Sprint Audit of Practice (ASAP) – Royal College of Physicians – 31 March 2014

Media release: Professionals are divided over best care for hip fracture patients, latest audit results show

“The latest report from the Falls and Fragility Fracture Programme (FFFAP) National Hip Fracture Database (NHFD) shows that just over half of patients are receiving pain relieving anaesthetic (known as a ‘nerve block’) as part of their care for hip fracture.

The National Hip Fracture Database Anaesthesia Sprint Audit of Practice (ASAP) (PDF 2MB) results, published today, show that 56% of hip fracture patients receive a peri-operative nerve block for pain relief and 44% of patients do not. The audit recommends that this type of pain relieving anaesthetic should be offered to all hospital patients who suffer hip fracture.

The Anaesthetic Sprint Audit of Practice (ASAP) was commissioned by the Healthcare Quality Improvement Partnership (HQIP) as part of the National Clinical Audit programme. ASAP marks a successful collaboration between several professional organisations. The NHS Hip Fracture Perioperative Network (HipPen), British Orthopaedic Association (BOA), British Geriatrics Society (BGS), Royal College of Physicians (RCP) and Association of Anaesthetists of Great Britain and Ireland (AAGBI) have worked together to explore anaesthesia within hip fracture care using data collected by members of the HipPen.”

.. continues on the site

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Benefits and Harms of Routine Preoperative Testing: Comparative Effectiveness – Agency for Healthcare Research and Quality – 29 January 2014

Posted on February 5, 2014. Filed under: Anaesthesiology, Comparative Effectiveness Research, Surgery | Tags: |

Benefits and Harms of Routine Preoperative Testing: Comparative Effectiveness – Agency for Healthcare Research and Quality – 29 January 2014

Balk EM, Earley A, Hadar N, Shah N, Trikalinos TA. Benefits and Harms of Routine Preoperative Testing: Comparative Effectiveness. Comparative Effectiveness Review No. 130. (Prepared by Brown Evidence-based Practice Center under Contract No. 290-2012-0012-I.) AHRQ Publication No. 14-EHC009-EF. Rockville, MD: Agency for Healthcare Research and Quality; January 2014.

“Structured Abstract

Objectives. Preoperative testing is used to guide the action plan for patients undergoing surgical and other procedures that require anesthesia and to predict potential postoperative complications.There is uncertainty whether routine or per-protocol testing in the absence of a specific indication prevents complications and improves outcomes, or whether it causes unnecessary delays, costs, and harms due to false-positive results.

Data sources. We searched MEDLINE® and Ovid Healthstar® (from inception to July 22, 2013), as well as Cochrane Central Trials Registry and Cochrane Database of Systematic Reviews.

Review methods. We included comparative and cohortstudies of both adults and children undergoing surgical and other procedures requiring either anesthesia or sedation (excluding local anesthesia). We included all preoperative tests that were likely to be conducted routinely (in all patients) or on a per-protocol basis(in selected patients). For comparative studies, the comparator of interest was either no testing or ad hoc testing done at the discretion of the clinician. We also looked for studies that compared routine and per-protocol testing. The outcomes of interest were mortality, perioperative events, complications, patient satisfaction, resource utilization, and harms related to testing.

Results. Fifty-seven studies (14 comparative and 43 cohort) met inclusion criteria for the review. Well-conducted randomized controlled trials (RCTs) of cataract surgeries suggested that routine testing with electrocardiography, complete blood count, and/or a basic metabolic panel did not affect procedure cancellations (2 RCTs, relative risks [RRs] of 1.00 or 0.97), and there was no clinically important difference for total complications (3 RCTs, RR = 0.99; 95% confidence interval, 0.86 to 1.14). Two RCTs and six nonrandomized comparative studies of general elective surgeries in adults varied greatly in the surgeries and patients included, along with the routine or per-protocol tests used. They also mostly had high risk of bias due to lack of adjustment for patient and clinician factors, making their results unreliable. Therefore, they yielded insufficient evidence regarding the effect of routine or per-protocol testing on complications and other outcomes. There was also insufficient evidence for patients undergoing other procedures. No studies reported on quality of life, patient satisfaction, or harms related to testing.

Conclusions. There is high strength of evidence that, for patients scheduled for cataract surgery, routine preoperative testing has no effect on total perioperative complications or procedure cancellation. There is insufficient evidence for all other procedures and insufficient evidence comparing routine and per-protocol testing. There is no evidence regarding quality of life or satisfaction, resource utilization, or harms of testing and no evidence regarding other factors that may affect the balance of benefits and harms. The findings of the cataract surgery studies are not reliably applicable to other patients undergoing other higher risk procedures. Except arguably for cataract surgery, numerous future adequately powered RCTs or well-conducted and analyzed observational comparative studies are needed to evaluate the benefits and harms of routine preoperative testing in specific groups of patients with different risk factors for surgical and anesthetic complications undergoing specific types of procedures and types of anesthesia.”

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Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research – Institute of Medicine – 29 June 2011

Posted on June 30, 2011. Filed under: Anaesthesiology, Chronic Disease Mgmt | Tags: , |

Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research – Institute of Medicine – 29 June 2011

full text 

“Chronic pain affects an estimated 116 million American adults—more than the total affected by heart disease, cancer, and diabetes combined. Pain also costs the nation up to $635 billion each year in medical treatment and lost productivity. The 2010 Patient Protection and Affordable Care Act required the Department of Health and Human Services (HHS) to enlist the IOM in examining pain as a public health problem.

In this report, the IOM offers a blueprint for action in transforming prevention, care, education, and research, with the goal of providing relief for people with pain in America. To reach the vast multitude of people with various types of pain, the nation must adopt a population-level prevention and management strategy. The IOM recommends that HHS develop a comprehensive plan with specific goals, actions, and timeframes. Better data are needed to help shape efforts, especially on the groups of people currently underdiagnosed and undertreated, and the IOM encourages federal and state agencies and private organizations to accelerate the collection of data on pain incidence, prevalence, and treatments. Because pain varies from patient to patient, healthcare providers should increasingly aim at tailoring pain care to each person’s experience, and self-management of pain should be promoted. In addition, because there are major gaps in knowledge about pain across health care and society alike, the IOM recommends that federal agencies and other stakeholders redesign education programs to bridge these gaps. Pain is a major driver for visits to physicians, a major reason for taking medications, a major cause of disability, and a key factor in quality of life and productivity. Given the burden of pain in human lives, dollars, and social consequences, relieving pain should be a national priority.”

 

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Doppler Guided Intraoperative Fluid Management: “Improving surgical outcomes, reducing hospital stay” [updated 17 January 2011] – NHS Technology Adoption Centre – How to why to guide

Posted on January 19, 2011. Filed under: Anaesthesiology | Tags: , |

Doppler Guided Intraoperative Fluid Management: “Improving surgical outcomes, reducing hospital stay” [updated 17 January 2011] – NHS Technology Adoption Centre – How to why to guide

“Optimal management of fluid balance during major surgery is considered a key factor in improving surgical outcomes. Innovative and minimally invasive monitoring of cardiac stroke volume using oesophageal Doppler technology now enables the anaesthetist to safely and accurately administer intravenous fluids during surgery. This reduces the rates of post operative complications as well as reducing the length of critical care and overall hospital stay.

The results of this implementation project demonstrate that encouraging research data can be reproduced in routine NHS clinical and operational practice with a three day reduction in hospital stay and fewer postoperative complications for patients.

Our “How To, Why To Guide” provides a comprehensive introduction to the technology, the supporting clinical evidence and practical, useful information to support its implementation. Our “How to Why To” Guides has been specifically designed to save you time, improve patient outcomes and productivity.”

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Doppler Guided Intraoperative Fluid Management – NHS Technology Adoption Centre – How to why to guide – January 2010

Posted on January 15, 2010. Filed under: Anaesthesiology | Tags: |

Doppler Guided Intraoperative Fluid Management – NHS Technology Adoption Centre – How to why to guide – January 2010

“Optimal management of fluid balance during major surgery is considered a key factor in improving surgical outcomes. Innovative and minimally invasive monitoring of cardiac stroke volume using oesophageal Doppler technology now enables the anaesthetist to safely and accurately administer intravenous fluids during surgery. This reduces both the rates of post operative complications and mortality, as well as reducing the length of critical care and overall hospital stay.

The results of this implementation project demonstrate that encouraging research data can be reproduced in routine NHS clinical and operational practice with a three day reduction in hospital stay and fewer postoperative complications for patients.

Our “How To, Why To Guide” provides a comprehensive introduction to the technology, the supporting clinical evidence and practical, useful information to support its implementation. Our “How to Why To” Guides has been specifically designed to save you time, improve patient outcomes and productivity.

Our Guide explains the barriers to adoption, how they were overcome, together with the benefits this technology can bring to your organisation from the lessons learnt at our three clinical implementation sites. The guide provides comprehensive, relevant and practical information for clinicians, managers and other stakeholders on how to implement this technology. There’s detailed information on procurement and key policy areas that this technology may impact on, a full business case, and costing model that can be tailored to your Trust’s requirements.”

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Guide to good practice in clinical perfusion – UK – 22 July 2009

Posted on July 23, 2009. Filed under: Anaesthesiology, Cardiol / Cardiothor Surg |

Guide to good practice in clinical perfusion

Document type:      Guidance
Author:   UK  Department of Health
Published date:      22 July 2009
Pages:      52

“In order to assure safe and high quality clinical perfusion services, a new guide to good practice in clinical perfusion has been developed in response to a critical incident in 2005 which led to the publication of the Gritten report. The Guide to Good Practice in Clinical Perfusion provides a Quality Management System and a Framework for the Administration of Named Medicines to form the basis of patient-specific directions which are recorded in the patient’s notes and clinical perfusion record. This guidance and the recommended frameworks should assist in the assurance of safe and high quality clinical perfusion services provided by the NHS.”

Download Guide to good practice in clinical perfusion (PDF, 873K)

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Royal College of Anaesthetists launches elearning resource

Posted on June 19, 2009. Filed under: Anaesthesiology, Educ for Hlth Professions |

Royal College of Anaesthetists launches elearning resource

“e-LA is a web-based educational resource produced by the Royal College of Anaesthetists in partnership with e-Learning for Healthcare (e-LfH).

Available for free to all UK anaesthetists practising in the NHS, e-LA delivers the knowledge and key concepts that underpin the anaesthetic curriculum and will help trainees prepare for the FRCA examination.”

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Supply and Demand for Anaesthesia Services 2009

Posted on April 17, 2009. Filed under: Anaesthesiology, Workforce | Tags: |

Australia will have a significant shortage of anaesthetists by 2028.  A major workforce study jointly commissioned by the Australian and New Zealand College of Anaesthetists (ANZCA) and the Australian Society of Anaesthetists (ASA) projects a shortage of 2287 anaesthetists in Australia by 2028.

The workforce study “Supply and Demand for Anaesthesia Services” by economics consultants, Access Economics, examines the supply of, and demand for, anaesthesia services and identifies gaps in service provision over the next 20 years. The projections suggest a widening gap between demand and supply, rising from a very small shortage of four full-time equivalent (FTE) anaesthetists in 2008 to a short fall of 2287 practitioners in 2028.

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Safety guidelines on pre-hospital anaesthesia and interhospital transfer – Association of Anaesthetists

Posted on April 17, 2009. Filed under: Anaesthesiology | Tags: |

The Association of Anaesthetists has published two safety guidelines: one on pre-hospital anaesthesia and another on interhospital transfer.

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