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Experiences and outcomes of patients participating in a perioperative shared decision-making pathway. 参与围手术期共同决策途径的患者的经历和结果。
IF 1.1 4区 医学 Q3 ANESTHESIOLOGY Pub Date : 2024-11-14 DOI: 10.1177/0310057X241265725
Heidi C Omundsen, Renee L Franklin, Mark S Omundsen, Trevor R Richardson

The Complex Decision Pathway (CDP) is a novel perioperative shared decision-making pathway that was established in the Bay of Plenty, New Zealand in 2018. Unique features of the pathway include the use of a structured communication tool to facilitate a goals-of-care conversation in addition to medical assessment, and the use of a tikanga Māori framework for Māori patients. From May 2019 until May 2022, 81 patients attending the CDP clinic were recruited to a prospective study of their demographics, health status and experience at the time of presentation, along with outcomes and opinions over the subsequent 12 months. Participants were mostly elderly and frail with multiple comorbidities, and just over half of participants chose to undergo surgery. Participants who chose, or were recommended, not to undergo surgery were older, more comorbid and had worse outcomes over the subsequent 12 months. Qualitative data suggested an overall positive patient experience of the pathway, and an economic analysis demonstrated its cost-effectiveness. Overall, the data presented here suggested that the CDP assisted in risk-stratifying patients into operative and non-operative groups, provided a positive patient experience, and was a cost-effective intervention.

复杂决策路径(CDP)是一种新颖的围手术期共同决策路径,于2018年在新西兰丰盛湾建立。该路径的独特之处在于,除医疗评估外,还使用结构化交流工具促进护理目标对话,并为毛利患者使用毛利语框架(tikanga Māori)。从2019年5月到2022年5月,CDP诊所招募了81名就诊患者,对他们的人口统计学特征、健康状况、就诊时的经历以及随后12个月的治疗效果和意见进行了前瞻性研究。参与者大多年老体弱,患有多种并发症,略超过半数的参与者选择接受手术治疗。选择或被建议不接受手术的参与者年龄更大,合并症更多,在随后的12个月中治疗效果更差。定性数据表明,患者对该路径的总体体验是积极的,经济分析表明了其成本效益。总体而言,本文提供的数据表明,CDP有助于将患者分为手术组和非手术组,为患者提供了积极的体验,是一项具有成本效益的干预措施。
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引用次数: 0
Promoting behavioural change by educating anaesthetists about the environmental impact of inhalational anaesthetic agents: A systematic review. 通过教育麻醉师了解吸入麻醉剂对环境的影响来促进行为改变:系统综述。
IF 1.1 4区 医学 Q3 ANESTHESIOLOGY Pub Date : 2024-11-01 Epub Date: 2024-08-30 DOI: 10.1177/0310057X241263113
Brieana C Nolan, Michael J Hoskins, Bríd Phillips, Kiah L Evans

Of the total carbon footprint of Australia, 7% is attributed to healthcare. In the UK, inhalational agents make up 5% of the healthcare carbon footprint. This systematic review aims to determine which methods of education about the environmental impact of inhalational anaesthetic agents can be utilised to promote behaviour change, reducing the anaesthetic-related carbon footprint. This systematic review sourced records from CINAHL, EMBASE, ERIC, JBI and MEDLINE from 1970 to March 2022. The search identified 589 records, 13 of which met eligibility criteria after the screening process, in which 10 of these records were conference abstracts. Education curricula focused on inhalational agent choice (69%), lowering the fresh gas flow during maintenance anaesthesia (69%), encouraging alternatives such as total intravenous anaesthesia (23%) and/or switching off the gas on transfer (8%). The most common teaching techniques utilised in education curricula were didactic lectures (85%), visual prompts (54%), emails (46%), and conversation forums (31%). All but one study reported a positive relationship between teaching sessions and behavioural change resulting in lower inhalational anaesthetic use by participants and their organisations, reducing healthcare-associated emissions. This systematic review has demonstrated that single education sessions as well as multi-focused, multimodal education curricula on the topic of greener anaesthesia can be beneficial in promoting behavioural change.

在澳大利亚的总碳足迹中,医疗保健占 7%。在英国,吸入麻醉剂占医疗碳足迹的 5%。本系统性综述旨在确定哪些有关吸入性麻醉剂对环境影响的教育方法可用于促进行为改变,从而减少与麻醉相关的碳足迹。本系统性综述从 1970 年至 2022 年 3 月期间的 CINAHL、EMBASE、ERIC、JBI 和 MEDLINE 中检索记录。搜索共发现 589 条记录,经过筛选后有 13 条符合资格标准,其中 10 条为会议摘要。教育课程侧重于吸入剂的选择(69%)、降低维持麻醉期间的新鲜气体流量(69%)、鼓励全静脉麻醉等替代方法(23%)和/或在转运时关闭气体(8%)。教育课程中最常用的教学技巧是说教式讲座(85%)、视觉提示(54%)、电子邮件(46%)和对话论坛(31%)。除一项研究外,其他所有研究都报告了教学课程与行为改变之间的积极关系,从而降低了参与者及其组织的吸入麻醉剂使用量,减少了医疗相关排放。本系统综述表明,以绿色麻醉为主题的单一教育课程以及多重点、多模式的教育课程均有助于促进行为改变。
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引用次数: 0
Anaesthesia healthcare workers' interactions with COVID-19-positive and -suspect patients: A multi-site observational study from Queensland, Australia. 麻醉医护人员与 COVID-19 阳性和可疑患者的互动:澳大利亚昆士兰州的一项多站点观察研究。
IF 1.1 4区 医学 Q3 ANESTHESIOLOGY Pub Date : 2024-11-01 Epub Date: 2024-10-17 DOI: 10.1177/0310057X241265723
Adrian Chin, Christine Woods, Anita M Pelecanos, Angela Tognolini, Gunjan Chawla, Sheridan Bell, Ivan L Rapchuk, Jimmy Wang, Victoria A Eley

Occupationally acquired COVID-19 is a hazard for healthcare workers (HCWs). In four hospitals of the Metro North Hospitals and Health Service in Queensland, Australia, we invited HCWs to report the nature of any anaesthesia interactions with COVID-19-positive and COVID-19-suspect patients. This was to assist workforce planning in future pandemics. Data collection consisted of three phases; 1) participating HCWs recorded details of episodes of care (EOCs) with COVID-19-positive or COVID-19-suspect patients; 2) these HCWs were invited to complete a follow-up survey about their own health status regarding COVID-19 infections; 3) electronic health records were used to assess patient demographics, infectious status and outcomes. Between 21 March 2020 and 17 May 2022, 63 anaesthesia HCWs reported 90 EOCs with 67 unique patients. The median (interquartile range (IQR)) age of the HCWs was 40.5 years (34-46); 55% (34/62) were male, 62% (39/63) were consultants and 21% (13/63) were registrars. The median (IQR) age of patients was 39 (28-63) years. Personal protective equipment (PPE) was deemed to be appropriate by the HCWs in (86/88) 98% of the EOCs. Twenty-four HCWs (38%) responded to a follow-up survey. Of 12 HCWs who subsequently tested positive to COVID-19, only four had cared for a COVID-19-positive patient in the two weeks prior to their diagnosis. Most responding HCWs perceived they contracted COVID-19 in the community, experiencing mild illness. We found relatively low COVID-19 case numbers, high PPE use and low transmission of COVID-19 within the hospital setting.

职业性感染 COVID-19 对医护人员(HCWs)来说是一种危害。在澳大利亚昆士兰州北部都会区医院和卫生服务机构的四家医院中,我们邀请医护人员报告与 COVID-19 阳性和 COVID-19 可疑患者的任何麻醉互动的性质。这样做的目的是协助制定未来大流行病的劳动力规划。数据收集包括三个阶段:1)参与的医护人员记录与COVID-19阳性或COVID-19可疑患者的护理事件(EOC)详情;2)邀请这些医护人员完成关于其自身COVID-19感染健康状况的后续调查;3)使用电子健康记录评估患者的人口统计学特征、感染状况和结果。在 2020 年 3 月 21 日至 2022 年 5 月 17 日期间,63 名麻醉科医护人员共报告了 90 例 EOC,涉及 67 名患者。医护人员的年龄中位数(四分位数间距)为 40.5 岁(34-46 岁);55%(34/62)为男性,62%(39/63)为顾问,21%(13/63)为注册医师。患者年龄的中位数(IQR)为 39(28-63)岁。在(86/88)98%的平机会中,医护人员认为个人防护设备(PPE)是适当的。24 名医护人员(38%)接受了后续调查。在随后检测出 COVID-19 阳性的 12 名医务工作者中,只有 4 人在确诊前两周内护理过 COVID-19 阳性的病人。大多数接受调查的医护人员认为他们是在社区感染 COVID-19,病情较轻。我们发现,COVID-19 病例数相对较少,医院环境中个人防护设备的使用率较高,COVID-19 的传播率较低。
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引用次数: 0
Skin injury: Associations with variables related to perfusion and pressure. 皮肤损伤:与灌注和压力相关变量的联系。
IF 1.1 4区 医学 Q3 ANESTHESIOLOGY Pub Date : 2024-11-01 Epub Date: 2024-10-12 DOI: 10.1177/0310057X241264575
Christopher J Roberts, Jennifer A Popies, Abrahim N Razzak, Xi Fang, Octavio A Falcucci, Paul J Pearson, Aniko Szabo

Skin injuries are a major healthcare problem that are not well understood or prevented in the critically ill, suggesting that underappreciated variables are contributing. This pilot study tested the hypothesis that perfusion-related factors contribute to skin injuries diagnosed as hospital-acquired pressure injuries (HAPIs). A total of 533 adult patients were followed over 2574 critical care days (mean age 62.4, standard deviation (SD) 14.3 years, mean body mass index 30.4 (SD 7.4) kg/m2, 36.4% female). This was a secondary analysis of prospective, non-randomised clinical data from an intensive care unit at a large urban teaching hospital. Factors related to perfusion, specifically two or more infusions of vasopressors/inotropes, temporary mechanical circulatory support (MCS), extracorporeal membrane oxygenation, and durable MCS, were analysed to determine whether they were more strongly associated with HAPIs than immobility due to prolonged mechanical ventilation (>72 h) or operating room time (>6 h). Patients diagnosed with a HAPI had a statistically significant higher risk of being exposed to variables related to perfusion and immobility (P < 0.05 for each variable). Perfusion-related variables, except durable MCS, had a larger effect on skin breakdown (number needed to harm (NNH) 4-10) than immobility-associated variables (NNH 12-17). The finding that perfusion-related variables predicted HAPIs may warrant consideration of alternative diagnoses, such as skin failure due to impaired perfusion as a pathophysiological process that occurs concurrently with multisystem organ failure. Differentiation of skin injuries primarily from circulatory malfunction, rather than external pressure, may guide the development of more effective treatment and prevention protocols. This pilot study suggests that the contribution of perfusion to skin injuries should be explored further.

皮肤损伤是一个主要的医疗保健问题,但人们对重症患者的皮肤损伤并不十分了解,也不能很好地预防皮肤损伤,这表明造成皮肤损伤的因素中存在一些未被充分重视的变量。这项试验性研究检验了这样一个假设,即灌注相关因素会导致皮肤损伤被诊断为医院获得性压力损伤(HAPIs)。共对 533 名成年患者进行了为期 2574 天的重症监护随访(平均年龄 62.4 岁,标准差 (SD) 14.3 岁,平均体重指数 30.4 (SD 7.4) kg/m2,36.4% 为女性)。这是对一家大型城市教学医院重症监护室的前瞻性、非随机临床数据进行的二次分析。分析了与灌注相关的因素,特别是两次或两次以上输注血管加压素/肌注、临时机械循环支持(MCS)、体外膜氧合和持久机械循环支持,以确定这些因素是否比因机械通气时间过长(>72小时)或手术室时间过长(>6小时)而导致的不活动与HAPIs有更密切的关系。被诊断为 HAPI 的患者暴露于与灌注和不活动相关的变量的风险具有显著的统计学意义(P
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引用次数: 0
Dr Gilbert Reynolds Troup: A founder of the Australian Society of Anaesthetists. 吉尔伯特-雷诺兹-特鲁普博士:澳大利亚麻醉师协会创始人。
IF 1.1 4区 医学 Q3 ANESTHESIOLOGY Pub Date : 2024-11-01 DOI: 10.1177/0310057X241267928
Michael G Cooper
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引用次数: 0
Survival in hostile environments: The fight to understand and protect against acceleration-induced visual disturbance and loss of consciousness in pilots of powered, heavier-than-air aircraft. 在恶劣环境中生存:努力了解和防止动力重于空气的飞机飞行员因加速度引起的视觉干扰和意识丧失。
IF 1.1 4区 医学 Q3 ANESTHESIOLOGY Pub Date : 2024-11-01 DOI: 10.1177/0310057X241286298
Peter J Featherstone, Christine M Ball
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引用次数: 0
A comprehensive audit of difficult airway trolleys in selected Victorian hospitals. 对维多利亚州部分医院的困难气道推车进行全面审计。
IF 1.1 4区 医学 Q3 ANESTHESIOLOGY Pub Date : 2024-11-01 Epub Date: 2024-09-23 DOI: 10.1177/0310057X241265722
Yaodong Tang, Teresa Pham, William Pl Bradley, Fiona M Brewster, David J Brewster

This study aimed to assess the availability, design, and contents of difficult airway trolleys in hospitals in Victoria, Australia. A survey audit was conducted with a 92.3% reply rate, and the responses from 22 major Victorian hospitals were analysed. The results showed that difficult airway trolleys were available in 100% of operating theatres, emergency departments and intensive care units, and the rate of standardisation was high. Compliance with recommended design features and resources was on average 68.3%. There was no significant difference in the compliance rate of major tertiary centres compared with other hospitals. The carriage of non-essential items was reduced compared with earlier audits. However, there was heterogeneity in the brands of supraglottic airway devices, videolaryngoscopes and cognitive aids used. The study highlights the need for ongoing improvement to the organization and content of difficult airway trolleys, and for further discussion regarding the safety of equipment variation across institutions.

本研究旨在评估澳大利亚维多利亚州医院中困难气道推车的可用性、设计和内容。研究对维多利亚州 22 家主要医院的回复进行了分析。结果显示,100% 的手术室、急诊科和重症监护室都配备了困难气道推车,而且标准化率很高。对推荐设计特征和资源的符合率平均为 68.3%。与其他医院相比,大型三级医疗中心的达标率没有明显差异。与早期的审核相比,非必要项目的携带量有所减少。不过,所使用的声门上气道装置、视频喉镜和认知辅助设备的品牌存在差异。这项研究强调了持续改进困难气道手推车的组织和内容的必要性,以及进一步讨论各机构设备差异安全性的必要性。
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引用次数: 0
MET call prevention. 防止 MET 呼叫。
IF 1.1 4区 医学 Q3 ANESTHESIOLOGY Pub Date : 2024-11-01 Epub Date: 2024-09-03 DOI: 10.1177/0310057X241261392
William Pl Bradley, Simon Reilly, Alexander D Smith
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引用次数: 0
A case of cardiorespiratory collapse following bilateral sub-Tenon's blocks from brainstem anaesthesia. 一例脑干麻醉后双侧腱膜下阻滞后心肺功能衰竭的病例。
IF 1.1 4区 医学 Q3 ANESTHESIOLOGY Pub Date : 2024-11-01 Epub Date: 2024-09-23 DOI: 10.1177/0310057X241265729
Steven C Cai, Anne-Marie Amie W Dempster, Alfred Wy Chua

Sub-Tenon's block has a superior safety profile and life-threatening complications such as cardiovascular collapse and brainstem anaesthesia are extremely rare. We report a case of cardiorespiratory collapse following bilateral sub-Tenon's blocks at the conclusion of a laser photocoagulation procedure under general anaesthesia. The cause was most likely brainstem anaesthesia. We explore and discuss the likely mechanisms and other potential differential diagnoses. It highlights the importance of maintaining vigilance following an eye block. Attention should not falter upon completing a block or at the conclusion of a case, regardless of its type or safety profile. This case also illustrates how the presence of general anaesthesia may obscure and delay the diagnosis of brainstem anaesthesia.

腱膜下阻滞具有卓越的安全性,心血管衰竭和脑干麻醉等危及生命的并发症极为罕见。我们报告了一例在全身麻醉下完成激光光凝手术后进行双侧腱膜下阻滞后出现心肺功能衰竭的病例。病因很可能是脑干麻醉。我们探讨并讨论了可能的机制和其他潜在的鉴别诊断。这凸显了眼阻滞术后保持警惕的重要性。在完成阻滞后或病例结束时,无论其类型或安全性如何,都不应放松警惕。本病例还说明了全身麻醉的存在会如何掩盖和延迟脑干麻醉的诊断。
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引用次数: 0
A comment on the clinical experience of cardiothoracic anaesthesia trainees in a tertiary Australian hospital. 对澳大利亚一家三级医院心胸麻醉实习生临床经验的评论。
IF 1.1 4区 医学 Q3 ANESTHESIOLOGY Pub Date : 2024-11-01 Epub Date: 2024-10-17 DOI: 10.1177/0310057X241272109
Lay Teng Tan, Ivan L Rapchuk
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引用次数: 0
期刊
Anaesthesia and Intensive Care
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