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Journal of Laparoendoscopic & Advanced... Sep 2017As part of an effort to maximize value in the perioperative setting, a paradigm shift is underway in the way that patients are cared for preoperatively, on the day of... (Review)
Review
BACKGROUND
As part of an effort to maximize value in the perioperative setting, a paradigm shift is underway in the way that patients are cared for preoperatively, on the day of surgery, and postoperatively-a setting collectively known as the perioperative care. Enhanced Recovery After Surgery (ERAS) is an evidence-based, patient-centered team approach to delivering high-quality perioperative care to surgical patients.
METHODS
This review focuses on anesthesiologists, with their unique purview of perioperative setting, who are important drivers of change in the delivery of valuable perioperative care. ERAS care pathways begin in the preoperative setting by both preparing the patient for the psychological stress of surgery and optimizing the patient's medical and physiologic status so the body is ready for the physical demands of surgery.
RESULTS
Minimization of perioperative fasting is important to maintain volume status-decreasing reliance on intravenous fluid administration, and to reduce protein catabolism around the time of surgery. Intraoperative management in ERAS pathways relies on goal-directed fluid therapy and opioid-sparing multimodal analgesia. Postoperatively, early feeding and ambulation, as well as discontinuation of extraneous lines and catheters facilitate patients' functional recovery.
CONCLUSION
The laparoscopic approach to surgery, when possible, compliments ERAS techniques by reducing abdominal wall trauma and the resultant milieu of inflammatory, neurohumoral, and pain responses. Anesthesiologists driving change in the perioperative setting, in collaboration with surgeons and other disciplines, can improve value in healthcare and provide optimal outcomes that matter most to patients and healthcare providers alike.
Topics: Anesthesiology; Humans; Laparoscopy; Patient Care Team; Patient-Centered Care; Perioperative Care; Physician's Role; Recovery of Function
PubMed: 28829221
DOI: 10.1089/lap.2017.0239 -
Anesthesiology Jul 2023
Topics: Brain; Anesthesia; Anesthesiology
PubMed: 37279104
DOI: 10.1097/ALN.0000000000004571 -
Anaesthesia Oct 2017
Topics: Anesthesiology; Biomedical Research; Data Interpretation, Statistical; Humans; Periodicals as Topic
PubMed: 28805242
DOI: 10.1111/anae.14030 -
Anesthesia and Analgesia Mar 2022The use of large data sources such as registries and claims-based data sets to perform health services research in anesthesia has increased considerably, ultimately... (Review)
Review
The use of large data sources such as registries and claims-based data sets to perform health services research in anesthesia has increased considerably, ultimately informing clinical decisions, supporting evaluation of policy or intervention changes, and guiding further research. These observational data sources come with limitations that must be addressed to effectively examine all aspects of health care services and generate new individual- and population-level knowledge. Several statistical methods are growing in popularity to address these limitations, with the goal of mitigating confounding and other biases. In this article, we provide a brief overview of common statistical methods used in health services research when using observational data sources, guidance on their interpretation, and examples of how they have been applied to anesthesia-related health services research. Methods described involve regression, propensity scoring, instrumental variables, difference-in-differences, interrupted time series, and machine learning.
Topics: Anesthesiology; Health Services Research; Humans; Registries; Research Design
PubMed: 35180171
DOI: 10.1213/ANE.0000000000005884 -
Advances in Anesthesia Dec 2019
Review
Topics: Academic Medical Centers; Anesthesia; Anesthesiology; Humans; Practice Guidelines as Topic; Practice Patterns, Physicians'
PubMed: 31677652
DOI: 10.1016/j.aan.2019.08.004 -
Journal of Anesthesia History Dec 2019The modern human, and all progenitor species before it, evolved in a milieu of pain and suffering. Recent innovations in medicine have permitted the development of tools... (Review)
Review
The modern human, and all progenitor species before it, evolved in a milieu of pain and suffering. Recent innovations in medicine have permitted the development of tools to mitigate these powerful experiences. Anesthesiologists have been on the vanguard of developing treatments and systems to face this challenge. Pain is a heterogeneous entity that requires precise categorization, and targeted, multimodal treatment to optimally manage. Anesthesiologists have developed a system whereby analgesia permits a myriad of life-saving surgeries, and have expanded their role beyond the perioperative setting. This includes unique contributions to how the concept of pain is experienced by infants, and appropriate interventions in this population. Contemporary anesthesiologists have extended their responsibilities to include harnessing robust technologies to manage pain in outpatient clinics, and serving as pain experts within hospital systems. This article serves as a primer to the history of anesthesiologists' contributions to pain management.
Topics: Anesthesiology; History, 19th Century; Humans; Pain Management
PubMed: 31735278
DOI: 10.1016/j.janh.2018.10.005 -
Best Practice & Research. Clinical... 2018
Topics: Anesthesiology; Humans; Patient-Centered Care; Recovery of Function
PubMed: 30522714
DOI: 10.1016/j.bpa.2018.11.001 -
BMC Medical Education Apr 2023Healthcare systems often face shortages of certain medical specialists due to lack of interest among medical students. We questioned a common "one solution fits all"...
BACKGROUND
Healthcare systems often face shortages of certain medical specialists due to lack of interest among medical students. We questioned a common "one solution fits all" approach to this problem which involves monetary incentives to lure students to these specialties. Instead, we used the marketing principle the "consumer knows best" to explore ways of elucidating the reasons and proposing solutions for such shortages.
METHODS
A convenience sample of Israeli 6th-year medical students and interns completed questionnaires to determine why they thought three specialties (geriatrics, anesthesiology, emergency medicine) were unpopular and their ideas on increasing their appeal.
RESULTS
119 6th-year students and 84 interns completed questionnaires. Geriatrics was reported having a problematic patient population; not being interesting and challenging; and not considered prestigious by colleagues and the populace. This contrasts with emergency medicine which, although considered prestigious, has difficult working conditions both during and after residency accompanied by much pressure at work. Although, improvements in lifestyle and remuneration were thought by students and interns as possibly making these specialties more attractive, reducing the pressure at work and decreasing on-call obligations were designated by the students/interns as ways to increase emergency medicine's and anesthesiology's appeal. Half the students replied that anesthesiology would be more appealing if work was in shifts (< 16 h), while 60% replied so for emergency medicine and only 18% for geriatrics. 90% of students reported that control over lifestyle would make emergency medicine more attractive while 55% and 48% replied positively for anesthesiology and geriatrics, respectively.
CONCLUSIONS
Using the concept "consumer knows best" provided additional insight into the specialty selection process. Students/interns have specialty-specific opinions as to why some specialties are unpopular. Their ideas about attracting more students to these specialties were also specialty-dependent, i.e. "one solution does not fit all". These observations render problematic a single solution aimed at ameliorating the workforce shortages of multiple specialties. Instead, these results advocate a differential approach wherein the lack of appeal of each unpopular specialty is analyzed individually and the students'/interns' (the "consumers") ideas sought resulting in solutions tailored to address each specialty's lack of attractiveness.
TRIAL REGISTRATION
None.
Topics: Humans; Career Choice; Anesthesiology; Emergency Medicine; Surveys and Questionnaires; Students, Medical; Internship and Residency
PubMed: 37081461
DOI: 10.1186/s12909-023-04241-0 -
Annals of Cardiac Anaesthesia 2022
Topics: Anesthesiology; Cardiology; Heart; Humans
PubMed: 35799550
DOI: 10.4103/aca.aca_103_22 -
British Journal of Anaesthesia May 2019
Topics: Anesthesiology; Clinical Competence; Cognition; Education, Medical; Evidence-Based Medicine; Feedback, Psychological; Humans; Models, Educational; Professional Practice; Quality Improvement
PubMed: 30916027
DOI: 10.1016/j.bja.2019.02.006