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41. Impact of race and sex on pain management by medical trainees: a mixed methods pilot study of decision making and awareness of influence. Full Text available with Trip Pro

Impact of race and sex on pain management by medical trainees: a mixed methods pilot study of decision making and awareness of influence. Previous research suggests female and black patients receive less optimal treatment for their chronic pain compared with male and white patients. Provider-related factors are hypothesized to contribute to unequal treatment, but these factors have not been examined extensively. This mixed methods investigation examined the influence of patients' demographic (...) characteristics on providers' treatment decisions and providers' awareness of these influences on their treatment decisions.Twenty medical trainees made treatment decisions (opioid, antidepressant, physical therapy) for 16 virtual patients with chronic low back pain; patient sex and race were manipulated across patients. Participants then indicated from a provided list the factors that influenced their treatment decisions, including patient demographics. Finally, individual interviews were conducted

2015 Pain Medicine

42. Intraoperative awareness: controversies and non-controversies. Full Text available with Trip Pro

Intraoperative awareness: controversies and non-controversies. Intraoperative awareness, with or without recall, continues to be a topic of clinical significance and neurobiological interest. In this article, we review evidence pertaining to the incidence, sequelae, and prevention of intraoperative awareness. We also assess which aspects of the complication are well understood (i.e. non-controversial) and which require further research for clarification (i.e. controversial). © The Author 2015

2015 British Journal of Anaesthesia

43. Awareness during emergence from anaesthesia: significance of neuromuscular monitoring in patients with butyrylcholinesterase deficiency†. Full Text available with Trip Pro

Awareness during emergence from anaesthesia: significance of neuromuscular monitoring in patients with butyrylcholinesterase deficiency†. Butyrylcholinesterase deficiency can result in prolonged paralysis after administration of succinylcholine or mivacurium. We conducted an interview study to assess whether patients with butyrylcholinesterase deficiency were more likely to have experienced awareness during emergence from anaesthesia if neuromuscular monitoring had not been applied.Patients (...) referred during 2004-2012 were included. Data on the use of neuromuscular monitoring were available from a previous study. Interviews, conducted by telephone, included questions about awareness and screening for post-traumatic stress disorder. Reports of panic, hopelessness, suffocation, or a feeling of being dead or dying resulted in the experience being classified further as distressful. Patients were categorized as aware or unaware by investigators blinded to use of neuromuscular monitoring.Ninety

2015 British Journal of Anaesthesia

44. Modern Palliative Treatments for Metastatic Bone Disease: Awareness of Merits, Demerits and Guidance. (Abstract)

Modern Palliative Treatments for Metastatic Bone Disease: Awareness of Merits, Demerits and Guidance. Metastatic disease is the most common malignancy of the bone. Prostate, breast, lung, kidney, and thyroid cancer account for 80% of skeletal metastases. Bone metastases are associated with significant skeletal morbidity including severe bone pain, pathologic fractures, spinal cord or nerve roots compression, and malignant hypercalcemia. These events compromise greatly the quality of life

2015 Clinical Journal of Pain

45. Is the Level of Sedation Depth in the Early Postintubation Period Associated With Worse Patient Outcomes? Full Text available with Trip Pro

crowding have led to increased management of these patients in the ED setting, it is important to be aware of the risks of light versus deep sedation in their early management. The authors of this study identified that light sedation in the early period (defined as within 48 hours) was associated with reduced mortality, length of ICU stay, and number of days of mechanical ventilation. From a practical standpoint, providers could achieve this by using standardized protocols with sedation goals based

2019 Annals of Emergency Medicine Systematic Review Snapshots

46. Perioperative

this communicated to the surgical and anesthesiology team and the patient made aware this may increase the surgical risk. Consensus Chung, 2016 (Guideline); Gross, 2014 (Guideline) Nicotine Cessation Low Smoking cessation intervention (brief or intensive) should be initiated before elective surgery. Strong Bayfield, 2018 (Meta- Analysis); Nolan, 2017 (Observational Study); Nolan, 2015 (Systematic Review); Thomsen, 2014 (Systematic Review) Return to Table of Contents Recommendations Tablewww.icsi.org Institute (...) the recovery from anesthesia or sedation. 3. Patients with suspected sleep apnea in the perioperative period should have a follow-up evaluation, typically in concert with the patient’s primary provider (if one is available), and/or referral to sleep center. 4. Patients with known sleep apnea or suspected sleep apnea at a preoperative evaluation should have this communicated to the surgical and anesthesiology team, and the patient made aware this may increase the surgical risk. Benefit: Targeted screening

2020 Institute for Clinical Systems Improvement

47. Checklist for draw-over anaesthetic equipment

for all users. Common pitfalls • Awareness of anaesthetic agent levels in vaporiser due to rapid use • Multiple connections within the breathing system means there is a high risk of disconnection • Heavy valve/?lter arrangement at patient end of circuit • Putting supplementary oxygen connection distal to the vaporiser in the circuit can lead to dilution of the volatile • Ensure vaporiser cap is ?tted properly • Failed removal of expired gases - especially when using PEEP • Lack of temperature (...) public awareness and are at the forefront of safer anaesthesia across the world. Published by Association of Anaesthetists 21 Portland Place, London, W1B 1PY Telephone 020 7631 1650 Fax 020 7631 4352 info@anaesthetists.org www.anaesthetists.org Association of Anaesthetists is the brand name used to refer to both the Association of Anaesthetists of Great Britain & Ireland and its related charity, AAGBI Foundation (England & Wales no. 293575 and in Scotland no. SC040697).

2020 Association of Anaesthetists of GB and Ireland

48. Perioperative interventions in pelvic organ prolapse surgery. Full Text available with Trip Pro

to attend six perioperative consultations in the three months surrounding prolapse surgery. Trial results provided no clear evidence of a difference between groups in objective failure at any site at 12 to 24 months (odds ratio (OR) 0.93, 95% confidence interval (CI) 0.56 to 1.54; two RCTs, 327 women; moderate-quality evidence). With respect to awareness of prolapse, findings were inconsistent. One RCT found no evidence of a difference between groups at 24 months (OR 1.07, 95% CI 0.61 to 1.87; one RCT

2018 Cochrane

49. Intravenous versus inhalational maintenance of anaesthesia for postoperative cognitive outcomes in elderly people undergoing non-cardiac surgery. Full Text available with Trip Pro

Intravenous versus inhalational maintenance of anaesthesia for postoperative cognitive outcomes in elderly people undergoing non-cardiac surgery. The use of anaesthetics in the elderly surgical population (more than 60 years of age) is increasing. Postoperative delirium, an acute condition characterized by reduced awareness of the environment and a disturbance in attention, typically occurs between 24 and 72 hours after surgery and can affect up to 60% of elderly surgical patients (...) . Postoperative cognitive dysfunction (POCD) is a new-onset of cognitive impairment which may persist for weeks or months after surgery.Traditionally, surgical anaesthesia has been maintained with inhalational agents. End-tidal concentrations require adjustment to balance the risks of accidental awareness and excessive dosing in elderly people. As an alternative, propofol-based total intravenous anaesthesia (TIVA) offers a more rapid recovery and reduces postoperative nausea and vomiting. Using TIVA

2018 Cochrane

50. Bair Hugger for measuring core temperature during perioperative care

recommends that adjustments may need to be made to indirect minimally invasive recorded temperature to obtain the core temperature, and that indirect estimates of core temperature should not be used during surgery. In 2010, the national patient safety agency (now NHS Improvement) released guidance stating that the method used for taking the temperature should be clearly identified and recorded. NICE is not aware of any CE-marked devices that appear to fulfil a similar function as the Bair Hugger (...) , but that it could make health care professionals more aware of inadvertent perioperative hypothermia. This would help ensure hypothermia is treated appropriately, potentially reducing costs by reducing complications. Specialist commentators Specialist commentators The following clinicians contributed to this briefing: Mr Tim Baker, practice educator, Adult Intensive Care Unit, University Hospital of South Manchester NHS Foundation Trust. No conflicts of interest. Bair Hugger for measuring core temperature

2017 National Institute for Health and Clinical Excellence - Advice

51. Canadian Urological Association guideline: Perioperative thromboprophylaxis and management of anticoagulation

and, as a result, a continuing professional development teaching program was created. This program is available to CUA members on the member portal. Regarding existing clinical guidance, the panel is aware of a number of medical, oncological, and surgical VTE guide- lines, which are not urology-specific and generally do not weigh the tradeoff between VTE prevention and bleeding explicitly. 12 Most recently, the European Association of Urology (EAU) published a VTE guideline that is current and urology

2019 Canadian Urological Association

52. Anesthesia

of this page. But if you still have questions please contact us via jon.brassey@tripdatabase.com Anesthesia Clinical anesthesia is used to induce a temporary medical state of controlled unconsciousness, inducing a loss of sensation or awareness. There are three main types of anesthesia: Local and Regional General Sedation Anesthesia is primarily used during surgical procedures to block pain. While unconscious, blood flow and heart rate is monitored. Research and development in the use of anesthesia has

2018 Trip Latest and Greatest

53. Anaesthesia

. But if you still have questions please contact us via jon.brassey@tripdatabase.com Anaesthesia Clinical Anaesthesia is used to induce a temporary medical state of controlled unconsciousness, inducing a loss of sensation or awareness. There are three main types of Anaesthesia: Local and Regional General Sedation Anaesthesia is primarily used during surgical procedures to block pain. While unconscious, blood flow and heart rate is monitored. Research and development in the use of Anaesthesia has helped

2018 Trip Latest and Greatest

54. Home mechanical ventilation for patients with Amyotrophic Lateral Sclerosis: A CTS Clinical Practice Guideline

centres, it will be challenging to monitor adoption of the guideline. The most reliable data collection at present is by ALS clinics and by the Canadian ALS Research network and it is for this reason that a survey of awareness and compli- ance will be done through ALS clinics and the Canadian ALS Research network. At 12–24months post publication and dis- tribution, ALS clinics across Canada will be surveyed to assess their knowledge of and compliance with recommendations. Review and approval process

2019 Canadian Thoracic Society

55. Increased Risk of Intraoperative Awareness in Patients with a History of Awareness. Full Text available with Trip Pro

Increased Risk of Intraoperative Awareness in Patients with a History of Awareness. Patients with a history of intraoperative awareness with explicit recall (AWR) are hypothesized to be at higher risk for AWR than the general surgical population. In this study, the authors assessed whether patients with a history of AWR (1) are actually at higher risk for AWR; (2) receive different anesthetic management; and (3) are relatively resistant to the hypnotic actions of volatile anesthetics.Patients

2013 Anesthesiology Controlled trial quality: uncertain

56. Perioperative Anaphylaxis Management Guidelines

monitoring of cardiovascular responses. 2.3 Because adrenaline has a narrow therapeutic window clinicians need to be aware of the potential for toxicity including accidental overdose, particularly during crisis management. 2.4 Intramuscular (I.M.) adrenaline into the lateral thigh should be considered in the initial management of perioperative anaphylaxis where I.V. access is not yet established or is lost, where haemodynamic monitoring is not in-situ at the start of the reaction, or while awaiting

2019 Australian and New Zealand College of Anaesthetists

57. Guidelines for crises in anaesthesia - Quick Reference Handbook

and APL valve (Box E) 100 bpm sinus rhythm, treat as hypovolaemia: give i.v fluid bolus. • If heart rate >100 bpm and non-sinus ? 2-7 Tachycardia. ? Depth • Ensure correct depth of anaesthesia AND analgesia (consider risk of awareness). ? Exclude potential surgical causes (Box D) – discuss with surgical team. ? Consider causes in Box E and call for help if problem not resolving quickly. 2-4 The Association of Anaesthetists of Great Britain & Ireland 2018. www.aagbi.org/qrh Subject to Creative Commons (...) up to max 30 mg (tachyphylaxis limits further usefulness) Box C: CRITICAL CHANGES • Cardiac arrest ? 2-1 • Hypotension ? 2-4 • Bradycardia ? 2-6 • Local anaesthetic toxicity ? 3-10 START. ? Reassure the patient – remember that they may be fully aware. • Plan to ensure hypnosis as soon as clinical situation permits. ? Call for help and inform theatre team of the problem. ? Treat airway and breathing: • Give 100% oxygen. • Chin lift / jaw thrust may suffice. • Consider supraglottic airway

2019 Association of Anaesthetists of GB and Ireland

58. Guidelines for Monitoring and Management of Pediatric Patients Before, During, and After Sedation for Diagnostic and Therapeutic Procedures

surgical procedures performed on pediatric patients outside of the traditional operating room setting has increased in the past several decades. As a consequence of this change and the increased awareness of the importance of providing analgesia and anxiolysis, the need for sedation for procedures in physicians’ offices, dental offices, subspecialty procedure suites, imaging facilities, emergency departments, other inpatient hospital settings, and ambulatory surgery centers also has increased markedly (...) recommendations are proffered with the awareness that, regardless of the intended level of sedation or route of drug administration, the sedation of a pediatric patient represents a continuum and may result in respiratory depression, laryngospasm, impaired airway patency, apnea, loss of the patient’s protective airway reflexes, and cardiovascular instability. Procedural sedation of pediatric patients has serious associated risks. These adverse responses during and after sedation for a diagnostic

2019 American Academy of Pediatrics

59. Practice Advisory for Perioperative Visual Loss Associated with Spine Surgery 2019 Full Text available with Trip Pro

of the Advisory The purpose of this Advisory is to enhance awareness and reduce the frequency of perioperative visual loss during and after spine surgery. Focus of the Advisory This Advisory focuses on the perioperative management of patients who are undergoing spine procedures while they are positioned prone and receiving general anesthesia. This Advisory does not address the perioperative management of patients who receive regional anesthesia or sedation. This Advisory also does not include other causes

2019 American Society of Anesthesiologists

60. Anaesthetic practice in the independent sector

and guidelines adopted by the independent hospital. The independent hospital has the responsibility for ensuring that the Medical Advisory Committee has approved these regulations and guidelines, and that all anaesthetists are informed of the regulations and guidelines relevant to them. The hospital should make the anaesthetist aware of its disciplinary procedures. The anaesthetist should be prepared to share their appraisal documentation with the independent hospital. Some hospitals request a summary, while (...) and the Association is aware of local disputes about such remuneration arrangements. As stated previously, the Association is unable to suggest fee schedules but proposes that local arrangements are negotiated and made clear prior to undertaking NHS work in the independent sector. It is worth noting that in the NHS all consultants, regardless of specialty, are paid identical rates per session. This should be considered when negotiating fees for NHS patients cared for in the independent sector. The independent

2019 Association of Anaesthetists of GB and Ireland

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