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Annals of Cardiac Anaesthesia 2016With the growing requirement of echocardiography in the perioperative management, the anesthesiologists need to be well trained in transthoracic echocardiography (TTE).... (Review)
Review
With the growing requirement of echocardiography in the perioperative management, the anesthesiologists need to be well trained in transthoracic echocardiography (TTE). Lack of formal, structured teaching program precludes the same. The present article reviews the expanding domain of TTE, simulation-based TTE training, the advancements, current limitations, and the importance of simulation-based training for the anesthesiologists.
Topics: Anesthesiologists; Anesthesiology; Computer Simulation; Echocardiography; Humans; Manikins
PubMed: 27397457
DOI: 10.4103/0971-9784.185544 -
Anesthesiology Sep 2023
Topics: Humans; Anesthesiologists; Delivery of Health Care; Anesthesiology
PubMed: 37552097
DOI: 10.1097/ALN.0000000000004672 -
Anesthesiology Apr 2021Health care is undergoing major transformation with a shift from fee-for-service care to fee-for-value. The advent of new care delivery and payment models is serving as... (Review)
Review
Health care is undergoing major transformation with a shift from fee-for-service care to fee-for-value. The advent of new care delivery and payment models is serving as a driver for value-based care. Hospitals, payors, and patients increasingly expect physicians and healthcare systems to improve outcomes and manage costs. The impact of the coronavirus disease 2019 (COVID-19) pandemic on surgical and procedural practices further highlights the urgency and need for anesthesiologists to expand their roles in perioperative care, and to impact system improvement. While there have been substantial advances in anesthesia care, perioperative complications and mortality after surgery remain a key concern. Anesthesiologists are in a unique position to impact perioperative health care through their multitude of interactions and influences on various aspects of the perioperative domain, by using the surgical experience as the first touchpoint to reengage the patient in their own health care. Among the key interventions that are being effectively instituted by anesthesiologists include proactive engagement in preoperative optimization of patients' health; personalization and standardization of care delivery by segmenting patients based upon their complexity and risk; and implementation of best practices that are data-driven and evidence-based and provide structure that allow the patient to return to their optimal state of functional, cognitive, and psychologic health. Through collaborative relationships with other perioperative stakeholders, anesthesiologists can consolidate their role as clinical leaders driving value-based care and healthcare transformation in the best interests of patients.
Topics: Anesthesiologists; Anesthesiology; Delivery of Health Care; Humans; Perioperative Care; Physician's Role
PubMed: 33630039
DOI: 10.1097/ALN.0000000000003717 -
Brazilian Journal of Anesthesiology... 2022Self-regulated professions such as medicine are characterized by professional commitment to the public they serve and require life-long development of expected skills....
BACKGROUND
Self-regulated professions such as medicine are characterized by professional commitment to the public they serve and require life-long development of expected skills. There is a paucity of data regarding quality of training during residency in anesthesiology. The objective of this study was to create an instrument to assess the anesthesiologists' perception regarding the quality of their training during medical residency.
METHODS
An electronic questionnaire was sent to 120 anesthesiologists, assuming 15% response rate for worst case scenario, considering a number of 613 potential respondents. The answers to the questionnaire were submitted to psychometric evaluation through internal consistency analysis measured by the Cronbach's alpha coefficient, and factorial analysis by the principal components' method with varimax rotation method with Kaiser normalization. The level of Concordance (C) and Disaccord (D) of each item were compared byz tests (consensus if p < 0.05). A question asking the respondents if they would recommend their training center to a relative or a friend was added to the questionnaire and considered as a secondary outcome.
RESULTS
One hundred and one responses were obtained. The Cronbach's alpha value was 0.86, suggesting good reliability of the questionnaire. The initial analysis including all the 14 items presented on the questionnaire demonstrated that four components obeyed the Kaiser criterion, depicting 68.20% of variance. Consensus was achieved among participants regarding all items of the questionnaire. The medical residency in anesthesiology was recommended by 93% of the participants. Preceptors were considered role-models by 83% of the participants. Acquisition of practical skills was better evaluated in comparison to other areas.
CONCLUSION
The questionnaire effectively characterized the perception of anesthesiologists regarding the quality of their training during medical residency. The information produced by this instrument could provide interesting clues on the quality of residency programs, pointing out areas of education that need more attention.
Topics: Anesthesiologists; Clinical Competence; Humans; Internship and Residency; Perception; Reproducibility of Results; Surveys and Questionnaires
PubMed: 34216702
DOI: 10.1016/j.bjane.2021.06.004 -
Current Opinion in Anaesthesiology Aug 2019Nonoperating room anesthesia (NORA) is the fastest growing segment of anesthetic practice. This review provides an overview of knowledge and trends that will need to be... (Review)
Review
PURPOSE OF REVIEW
Nonoperating room anesthesia (NORA) is the fastest growing segment of anesthetic practice. This review provides an overview of knowledge and trends that will need to be introduced to residents as part of their education.
RECENT FINDINGS
Topics for the future include, but are not limited to, new medications, artificial intelligence and big data, monitoring depth of hypnosis, translational innovation and collaboration, demographic changes, financial driving forces, destination hubs, medical tourism, and new approaches to education training and self-management.
SUMMARY
Implementing new medical technologies for anesthesia outside the operating room will help to successfully master this ever evolving subspecialty. Anesthesiologists require specific preparation for the diverse settings that they will encounter during their training. In this rapidly changing field, cognitive fitness must be factored into teaching and evaluation of residents. We describe the most important topics to consider when educating anesthesiology residents, and highlight research that addresses upcoming challenges.
Topics: Anesthesia; Anesthesiologists; Anesthesiology; Anesthetics; Biomedical Technology; Diffusion of Innovation; Forecasting; Humans; Internship and Residency
PubMed: 31021895
DOI: 10.1097/ACO.0000000000000743 -
BMC Anesthesiology Jun 2023Critical incident reporting and analysis is one of the key components of patient safety in anesthesiology. The aim of this study was to determine the frequency and...
BACKGROUND
Critical incident reporting and analysis is one of the key components of patient safety in anesthesiology. The aim of this study was to determine the frequency and characteristics of critical incidents during anesthesia, main causes and factors involved, influence on patient outcomes, prevalence of incident reporting and further analysis.
METHODS
A multicenter prospective audit was conducted at the clinical departments of the Bogomolets National Medical University during the period from 1 to 2021 to 1 December 2021. 13 hospitals from different Ukrainian regions took part in the study. Anesthesiologists voluntarily submitted critical incident reports into a Google form as they occurred during the working shifts, reporting the details of the incident, and the incident registration routine in their hospital. The study design was approved by the Bogomolets National Medical University (NMU) ethics committee, protocol #148, 07.09.2021.
RESULTS
The incidence of critical incidents was 9.35 cases per 1000 anesthetic procedures. Most common incidents were related to the respiratory system: difficult airway (26.8%), reintubation (6.4%), oxygen desaturation (13.8%); cardiovascular system: hypotension (14.9%), tachycardia (6.4%), bradycardia (11.7%), hypertension (5.3%), collapse (3.2%); massive hemorrhage (17%). Factors associated with critical incidents were elective surgery (OR 4.8 [3.1-7.5]), age from 45 to 75 years (OR 1.67 [1.1-2.5]), ASA II (OR 38 [13-106]}, III (OR 34 [12-98]) or IV (3.7 [1.2-11]) compared to ASA I; regional anesthesia (OR 0.67 95 CI 0.5-0.9) or general anesthesia (GA) and regional anesthesia combination (OR 0.55 95 CI 0.3-0.9] decreased the risk of incidents compared to GA alone. Procedural sedation was associated with increased risk of a critical incident, compared to GA (OR 0.55 95 CI 0.3-0.9). The incidents occurred most commonly during the maintenance phase (75/113, 40%, OR compared to extubation phase 20 95 CI 8-48) or the induction phases of anesthesia (70/118, 37%, OR compared to extubation phase 18 95 CI 7-43). Among common reasons that could lead to the incident, the physicians have identified: individual patient features (47%), surgical tactics (18%), anesthesia technique (16%) and human factor (12%). The most frequent failings contributing to the incident occurrence were: insufficient preoperative assessment (44%), incorrect interpretation of the patients' state (33%), faulty manipulation technique (14%), miscommunication with a surgical team (13%) and delay in emergency care (10%). Furthermore, 48% of cases, as judged by participating physicians, were preventable and the consequences of another 18% could be minimized. The consequences of the incidents were insignificant in over a half of the cases, but in 24.5% have led to prolonged hospital stay, in 16% patients required an urgent transfer to the ICU and 3% of patients died during their hospital stay. The majority of the critical incidents (84%) were reported through the hospital reporting system, using mostly paper forms (65%), oral reports (15%) and an electronic database (4%).
CONCLUSION
Critical incidents during anesthesia occur rather often, mainly during the induction or maintenance phases of anesthesia, and could lead to prolonged hospital stay, unplanned transfer to the ICU or death. Reporting and further analysis of the incident are crucial, so we should continue to develop the web-based reporting systems on both local and national levels.
STUDY REGISTRATION
NCT05435287, clinicaltrials.gov, 23/6/2022.
Topics: Humans; Middle Aged; Aged; Anesthesiology; Anesthesia, General; Anesthesia, Conduction; Anesthesiologists; Airway Extubation
PubMed: 37316789
DOI: 10.1186/s12871-023-02171-4 -
Anesthesia and Analgesia Feb 2022
Topics: Anesthesiologists; Anesthesiology; Humans; United States
PubMed: 35030116
DOI: 10.1213/ANE.0000000000005852 -
Journal of Cardiothoracic and Vascular... May 2021Anesthesiologists have a high risk of infection with COVID-19 during perioperative care and as first responders to airway emergencies. The potential of becoming infected... (Review)
Review
Anesthesiologists have a high risk of infection with COVID-19 during perioperative care and as first responders to airway emergencies. The potential of becoming infected can be reduced by a systematic and integrated approach that assesses infection risk. The latter leads to an acceptable choice of materials and techniques for personal protection and prevention of cross-contamination to other patients and staff. The authors have presented a protocolized approach that uses diagnostic criteria to clearly define benchmarks from the medical history along with clinical symptoms and laboratory tests. Patients can then be rapidly assigned into 1 of 3 risk categories that direct the choice of protective materials and/or techniques. Each hospital can adapt this approach to develop a system that fits its individual resources. Educating medical staff about the proper use of high-risk areas for containment serves to protect staff and patients.
Topics: Anesthesia; Anesthesiologists; COVID-19; Humans; Infection Control; SARS-CoV-2
PubMed: 32279934
DOI: 10.1053/j.jvca.2020.03.035 -
British Journal of Anaesthesia Oct 2022Thirty-day mortality is widely used in medical and surgical outcomes research as a quality indicator, and as an endpoint in perioperative clinical trials. However, the...
Thirty-day mortality is widely used in medical and surgical outcomes research as a quality indicator, and as an endpoint in perioperative clinical trials. However, the validity of this metric has recently been questioned. In this issue of the British Journal of Anaesthesia, Fowler and colleagues quantify, update, and put into perspective the looming suspicion that perioperative adverse events cast a 'long shadow' of increased mortality, far beyond the 30-day time frame. Their work not only raises important questions on how we should think about, analyse, and report 'perioperative' complications and mortality, but also stresses anaesthesiologist and surgeon roles as key stakeholders in patient long-term survival.
Topics: Anesthesia; Anesthesiologists; Anesthesiology; Humans; Outcome Assessment, Health Care; Postoperative Complications
PubMed: 35410788
DOI: 10.1016/j.bja.2022.03.014 -
Anesthesiology Dec 2021
Topics: Anesthesiologists; Burnout, Professional; Burnout, Psychological; Humans
PubMed: 34402857
DOI: 10.1097/ALN.0000000000003930