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141. Statement on Credentialling and Defining the Scope of Clinical Practice in Anaesthesia

practitioners providing anaesthesia services, and to those Fellows acting on these credentialling committees. It is not intended to apply to Specialist Pain Medicine Physicians. 5. QUALIFICATIONS IN ANAESTHESIA Anaesthesia should be practised by specialist anaesthetists and/or trainees, or other medical staff supervised as described in Training in Anaesthesia Leading to FANZCA, and Accreditation of Facilities to Deliver this Curriculum, Regulation 37. It is recognised that in some healthcare institutions (...) physical or mental condition or substance abuse problem that could affect their ability to practise safely and competently); satisfactory references; criminal history and working with children checks. 7.8.5 processes for temporary and/or emergency credentialling. 7.8.6 re-credentialling processes, which may include any or all of the above and may also include a review of performance with evaluation by peers and other staff as determined by the committee. Submissions to the committee should

2006 Australian and New Zealand College of Anaesthetists

142. Guidelines on the Health of Specialists and Trainees

Guidelines on the Health of Specialists and Trainees AUSTRALIAN AND NEW ZEALAND COLLEGE OF ANAESTHETISTS ABN 82 055 042 852 FACULTY OF PAIN MEDICINE GUIDELINES ON THE HEALTH OF SPECIALISTS, SPECIALIST INTERNATIONAL MEDICAL GRADUATES AND TRAINEES INTRODUCTION This statement is intended to assist Fellows, trainees and specialist international medical graduates (SIMG) of the College and the Faculty of Pain Medicine with issues related to their own and their colleagues’ health. Doctors are usually (...) physically healthier than the general population but are more psychologically vulnerable, and more likely to suffer from “the three D’s” – drugs, drink and depression. 1 Performance, and ultimately patient safety, is dependent on physician well-being as well as skills and knowledge, therefore maintenance of good health is an important individual responsibility, both personally and professionally. Good health encompasses both physical and mental well-being. Proper health care includes preventative

2010 Australian and New Zealand College of Anaesthetists

143. Statement on Fatigue and the Anaesthetist

must have knowledge of fatigue related risk categories, as set out in the Australian Medical Association National Code of Practice (March 1999) (28) . Anaesthetists have a moral and ethical responsibility to consider not proceeding with clinical duties if physical or mental fatigue, stress or ill health, alone or in combination, might interfere with safe patient care. 2. When working out-of-hours results in significant disturbance to normal rest and sleep, the anaesthetist should ensure that any (...) Journal of Anaesthesia 1987; 34: 489-495. (5) Carkadon MA, Roth T. Sleep restriction. In Sleep, Sleepiness and Performance Monk TH Editor. (1991) Chichester: Wiley. 155 – 167. (6) Torsvall L, Akerstedt T. Disturbed Sleep while being on call. An EEG study of apprehension in ships engineers. Sleep 1988; 11: 35–38. (7) McCall TB. The impact of long working hours on resident physicians. New England Journal of Medicine 1988; 318: 775-778. (8) Dawson D, Reid K. Fatigue, alcohol and performance impairment

2007 Australian and New Zealand College of Anaesthetists

144. Recommendations for the Post-Anaesthesia Recovery Room

the ongoing management of the patient without the responsible anaesthetist being physically present (see 8.1.5). 4.5 Staff working in PACU must be trained for their role, and junior staff must be under the direct supervision of an experienced PACU nurse. The skills of nurses attending patients must be commensurate with the acuity of their patient. For paediatric patients, at least one nurse present must be experienced and competent in the management of post anaesthesia care complications in paediatric (...) to another appropriately skilled medical practitioner who is immediately available. 4.9 PACU staff must be able to contact the responsible anaesthetist promptly when the need arises. The anaesthetist must be physically available to attend if required unless this duty is delegated, after handover, to another medical practitioner operating within scope of practice and available promptly. 4.10 The PACU should be resourced to monitor and manage common or expected outcomes of the given procedure

2006 Australian and New Zealand College of Anaesthetists

145. Guidelines for the Perioperative Care of Patients Selected for Day Care Surgery

. ? Surgery/procedure considerations. ? Recovery (PACU) and discharge arrangements. ? Adequacy of resources, including personnel, of the DSP facility. ? Geographic location of the DSP Facility e.g. urban versus rural. ? Type of facility i.e. “free-standing” (this includes office/rooms based facilities) or co- located/in close proximity to a tertiary/quaternary hospital. 6. PATIENT SELECTION AND ANAESTHESIA FACTORS 6.1 Patients should be of ASA physical status 1 or 2 or medically stable ASA 3 or 4 patients (...) . Note that ASA physical status alone does not dictate acceptability as this will also be influenced by surgical/procedural factors and the facilities of the DSP unit. The psychosocial advantage of short duration stay in an unfamiliar environment is being increasingly recognised for the elderly but this has to be weighed up against optimal management of comorbidities. When considering whether DSP is appropriate for patients with significant medical issues, early consultation with the involved

2016 Australian and New Zealand College of Anaesthetists

146. Guidelines on Acute Pain Management

Guidelines on Acute Pain Management PS41 2013 Page 1 PS41 2013 Australian and New Zealand College of Anaesthetists (ANZCA) Faculty of Pain Medicine Guidelines on Acute Pain Management 1. INTRODUCTION 1.1 Effective treatment of acute pain is a fundamental component of quality patient care. 1.2 Education and practical experience in acute pain management are essential components of training programs for fellowships of ANZCA and FPMANZCA. 2. PRINCIPLES OF ACUTE PAIN MANAGEMENT 2.1 Adverse (...) physical therapy requirements and mobilisation. Page 3 PS41 2013 4.4 Unexpected levels of pain, or pain that suddenly increases, may signal the development of a new medical, surgical or psychiatric diagnosis. 4.5 All side effects and significant complications should be recorded, as should treatment changes resulting from these issues. 5. PHARMACOLOGICAL THERAPIES 5.1 Drugs that may be used include opioids, non-steroidal anti-inflammatory drugs and local anaesthetics, as well as adjuvant agents

2013 Australian and New Zealand College of Anaesthetists

147. Guidelines on Training and Practice of Perioperative Cardiac Ultrasound in Adults

or transthoracic route. While transoesophageal echocardiography (TOE) is largely confined to intraoperative use, transthoracic echocardiography (TTE) is useful in many aspects of perioperative medicine. There are risks associated with the technique, interpretation and reporting of findings, so this document has been developed to provide guidance for ANZCA Fellows and trainees who wish to train and practise in cardiac ultrasound. Cardiac ultrasound studies vary from limited goal-directed (focused) studies (...) , or 4.3.1.1.3 A formal qualification equivalent to the above. Page 5 PS46 2014 4.3.1.2 The formal training program should include: 4.3.1.2.1 An understanding of physics of ultrasound, and its application to sonography. 4.3.1.2.2 An understanding of relevant sonographic anatomy. 4.3.1.2.3 Ventricular filling and functional assessment. 4.3.1.2.4 Limited valve assessment for clinically relevant disease. 4.3.1.2.5 Assessment of other clinically severe disease states including cardiac tamponade and pleural

2014 Australian and New Zealand College of Anaesthetists

148. Guidelines on Infection Control in Anaesthesia

to be sterile and so might not be free from microbial contamination. Lids are intended to act as a shield for the rubber stopper and to keep dust and other physical contaminants away from it. Proper aseptic technique must be strictly followed when administering intravenous injections to a patient. This includes wiping the outer surface of the rubber stopper and its injection site with a suitable disinfectant wipe/swab and allowing it to dry before inserting any device into the vial. RELATED ANZCA DOCUMENTS (...) Perioperative Attire. From: http://www.acorn.org.au/standards Accessed: 4 February 2013 Professional documents of the Australian and New Zealand College of Anaesthetists (ANZCA) are intended to apply wherever anaesthesia is administered and perioperative medicine practised within Australia and New Zealand. It is the responsibility of each practitioner to have express regard to the particular circumstances of each case, and the application of these ANZCA documents in each case. It is recognised

2015 Australian and New Zealand College of Anaesthetists

149. Guidelines for Transport of Critically Ill Patients

Guidelines for Transport of Critically Ill Patients PS52 2015 Page 1 PS52 2015 Australasian College for Emergency Medicine (ACEM) Australian and New Zealand College of Anaesthetists (ANZCA) College of Intensive Care Medicine of Australia and New Zealand (CICM) Guidelines for Transport of Critically Ill Patients 1. INTRODUCTION Critically ill patients have life-threatening injuries or illnesses that are associated with reduced or exhausted physiological reserves. Transporting such patients (...) this, coordinating clinicians should be suitably trained in prehospital and retrieval medicine and have ongoing operational experience relevant to the type of transport undertaken. Reliable communication must be available at all times between the prehospital and retrieval team and the referring and receiving hospitals and ambulance services. At the time of first contact, clinical advice can be provided to referral staff and sought from senior specialty receiving staff as well as appropriate planning and advice

2015 Australian and New Zealand College of Anaesthetists

150. Guidelines for Major Extracorporeal Perfusion

surgery, maintain and review all protocols for ECP. 2.2.5 Ideally, conduct research into relevant aspects of ECP. 2.3 Physical facilities The major ECP service requires adequate dedicated space in close proximity and with easy access to the operating theatre and postoperative recovery/intensive care unit for: 2.3.1 Storage of hardware items. 2.3.2 Storage of adequate supplies of disposable equipment in appropriate areas, with respect to lighting and protection from humidity, moisture and temperature (...) of cardioplegia, including type, volume and route of administration. 5.4.9 Fluid outputs. 5.4.10 Notations of relevant events during ECP. RELATED ANZCA DOCUMENTS PS27 BP Guidelines for Major Extracorporeal Perfusion Background Paper Professional documents of the Australian and New Zealand College of Anaesthetists (ANZCA) are intended to apply wherever anaesthesia is administered and perioperative medicine practised within Australia and New Zealand. It is the responsibility of each practitioner to have express

2015 Australian and New Zealand College of Anaesthetists

151. Guidelines on Sedation and/or Analgesia for Diagnostic and Interventional Medical, Dental or Surgical Procedures Background Paper

Administering Local Anaesthesia and PS03 Guidelines for the Management of Major Regional Analgesia). BACKGROUND This section is intended to provide background information for the key quality and safety concepts in this professional document. Page 2 PS09 BP 2014 Personnel for sedation and/or analgesia Sedative drugs are administered to facilitate diagnostic and interventional procedures by medical practitioners from many specialties, including anaesthesia, pain medicine, surgery, emergency medicine (...) , intensive care medicine, radiology, gastroenterology and other sub- specialties of internal medicine. Dentists also engage in the practice of procedural sedation and/or analgesia. While anaesthetists are the acknowledged experts in procedural sedation and/or analgesia, it is impossible and unnecessary for anaesthetists to administer all procedural sedation and/or analgesia in Australia and New Zealand. For this reason, PS09 is designed to promote high standards of training and practice for all medical

2014 Australian and New Zealand College of Anaesthetists

152. Guidelines for the Management of Major Regional Analgesia Background paper

Guidelines for the Management of Major Regional Analgesia Background paper PS03 BP 2014 Page 1 PS03 BP 2014 Australian and New Zealand College of Anaesthetists (ANZCA) Faculty of Pain Medicine Guidelines for the Management of Major Regional Analgesia Background Paper PURPOSE OF REVIEW Major regional blocks are commonly employed for multiple purposes including postoperative analgesia, surgical anaesthesia, obstetric analgesia, and for relief of acute and chronic non- surgical pain. Including (...) of the ability to provide such feedback, for example in small children or cognitively impaired patients, tools are available to assist the assessment of pain control. Assessment is not only central to pain control but also to diagnose the development of a new physical problem, such as Compartment Syndrome. 14 Similarly the presence of indwelling catheters may lead to complications including epidural abscess, epidural haematoma, and spinal cord or nerve compression. 15,16 The generation of protocols

2014 Australian and New Zealand College of Anaesthetists

153. Guidelines for the Management of Major Regional Analgesia

Guidelines for the Management of Major Regional Analgesia PS03 2014 Page 1 PS03 2014 Australian and New Zealand College of Anaesthetists (ANZCA) Faculty of Pain Medicine Guidelines for the Management of Major Regional Analgesia 1. OVERVIEW This document is intended to apply to central neuraxial blocks and all other techniques where a catheter is inserted and left in situ, or where a significant dose of local anaesthetic is administered, such that systemic toxicity may occur due to absorption (...) of pain intensity and the effect of interventions. Tools are also available to help assess pain in unconscious or sedated patients, cognitively impaired or young children. Where feasible, pain is best evaluated when assessed both at rest and during activity. Unexpected levels of pain, or pain that suddenly increases, may signal the development of a new physical problem such as compartment syndrome, for example, or psychological distress. In the case of epidural or intrathecal analgesia, back pain

2014 Australian and New Zealand College of Anaesthetists

154. Guidelines on Sedation and/or Analgesia for Diagnostic and Interventional Medical, Dental or Surgical Procedures

Guidelines on Sedation and/or Analgesia for Diagnostic and Interventional Medical, Dental or Surgical Procedures PS09 2014 Page 1 PS09 2014 Australian and New Zealand College of Anaesthetists (ANZCA) Faculty of Pain Medicine The following organisations have endorsed this document: Australasian College for Emergency Medicine College of Intensive Care Medicine of Australia and New Zealand Gastroenterological Society of Australia New Zealand Society for Gastroenterology Royal Australasian College (...) Guideline 58: safe sedation of children undergoing diagnostic and therapeutic procedures. Paediatr Anaesth 2008;18(1):11-2. Vargo JJ, Ahmad AS, Aslanian HR, Buscaglia JM, Das AM, Desilets DJ, et al. Training in patient monitoring and sedation and analgesia. Gastrointest Endosc 2007;66(1):7-10. Page 12 PS09 2014 APPENDIX 1: AMERICAN SOCIETY OF ANESTHESIOLOGISTS’ CLASSIFICATION OF PHYSICAL STATUS P 1 A normal healthy patient P 2 A patient with mild systemic disease P 3 A patient with severe systemic

2014 Australian and New Zealand College of Anaesthetists

155. Cognitive Impairment - Part 1: Symptoms To Diagnosis

patients presenting with cognitive concerns and manage the majority of these patients and support their caregivers. TARGET POPULATION Older adults (65 years of age and greater) EXCLUSIONS Children Younger adults ( 53 years 4 Education >10 years 0 7-9 years 2 0-6 years 3 Sex Female 0 Male 1 Systolic Blood Pressure 140 mm Hg 2 Body Mass Index 30 kg/m 2 2 Total Cholesterol 6.5 mmol/L 2 Physical Activity Active 0 Inactive 1 TOTAL PATIENT HISTORY This should focus on how the illness developed and whether (...) . A Cognitive Impairment – Part 1:Symptoms to Diagnosis | February 2017 Clinical Practice Guideline Page 13 of 21 Background collateral source is generally a more accurate source of data on function and behaviour than the patient. The interview can also be used to gauge the extent of family support. 12 PHYSICAL EXAMINATION The physical examination should include a detailed neurological examination. Observing involuntary movements could suggest rare but specific causes for dementia (e.g., Huntington’s

2017 Toward Optimized Practice

156. Environmental Exposures from Oil and Gas Emissions

Occup Environ Med. 2016 Mar;58(3):e94-e102 3. Engel C Jr, Katon W. Population and need-based prevention of unexplained symptoms in the community. In: Strategies to protect the health of deployed U.S. forces: medical surveillance, record keeping, and risk reduction (Institute of Medicine). Washington, DC: National Academy Press, 1999;173–212. 4. Kroenke K, Spitzer R, Williams J, Linzer M, Hahn S, deGruy F III, Brody D. Physical symptoms in primary care. Predictors of psychiatric disorders (...) Clinical Practice Guideline Page 5 of 14 Background FOLLOW-UP (ALL SCENARIOS) X DO NOT argue with patient or contest perceived causation of symptoms/complaints. ? Actively listen, empathize and be honest about the limitations of knowledge in this area of medicine. This can be very helpful for the patient when there are no definitive answers for their questions and concerns. ? Ensure the patient has adequate follow-up for symptom management and ask if they are satisfied with actions taken even

2017 Toward Optimized Practice

157. Consolidated guidelines on person-centred HIV patient monitoring and case surveillance

Guarainieri, Ed Ngoskin – Global Fund to Fight AIDS, Tuberculosis and Malaria; Priscilla Idele, Lori Thorell – United Nations Children’s Fund (UNICEF); Sandy Schwarcz – University of California, San Francisco (UCSF); Katherine Hildebrand – University of Cape Town, South Africa; Olga Varetska – AIDS Alliance; Whitney Ewing, Sharon Weir – University of North Carolina, USA; Ruth Macklin, Stefan Baral – Johns Hopkins University (JHU), USA; Calum Davery – London School of Hygiene and Tropical Medicine (LSH&TM (...) related to the physical, electronic and procedural aspects of protecting information collected as part of the scale up of HIV services. Security must address both protection of data from inadvertent or malicious inappropriate disclosure, ensure availability of data even when there is system failure or user errors, and protect data from unauthorized alteration. Sentinel event refers to a predefined event in the context of case surveillance for which relevant data are transmitted to the public health

2017 World Health Organisation HIV Guidelines

158. Cardiac rehabilitation

Intercollegiate Guidelines Network (SIGN) and the Scottish Medicines Consortium are key components of our organisation. www.healthcareimprovementscotland.org Edinburgh Office | Gyle Square |1 South Gyle Crescent | Edinburgh | EH12 9EB Telephone 0131 623 4300 Fax 0131 623 4299 Glasgow Office | Delta House | 50 West Nile Street | Glasgow | G1 2NP Telephone 0141 225 6999 Fax 0141 248 3776 The Healthcare Environment Inspectorate, the Scottish Health Council, the Scottish Health Technologies Group, the Scottish (...) Intercollegiate Guidelines Network (SIGN) and the Scottish Medicines Consortium are key components of our organisation. KEY TO EVIDENCE STATEMENTS AND RECOMMENDATIONS LEVELS OF EVIDENCE 1 ++ High-quality meta-analyses, systematic reviews of RCTs, or RCTs with a very low risk of bias 1 + Well-conducted meta-analyses, systematic reviews, or RCTs with a low risk of bias 1 - Meta-analyses, systematic reviews, or RCTs with a high risk of bias 2 ++ High-quality systematic reviews of case-control or cohort studies

2017 SIGN

159. CHIVA Guidance on Transition for adolescents living with HIV

/vocational needs of adolescents and young adults with chronic physical and medical conditions as they move from child-centred to adult- orientated health care systems.” 31 The UK National Service Framework (NSF) sets clear recommendations for transitional care supported by a wealth of Department of Health (DOH) guidance and resources. 31-33 In contrast, transfer is the physical event of the young person moving from paediatric to adult services and if unsupported by the process of transition has been (...) and / or family ! Adult consultant ! GP ! Social Services if in Foster care ! Medical Notes 13 Conclusion Transition from paediatric to adult services occurs at a time when adolescents living with HIV are managing the wide spectrum of change associated with later adolescence and particularly influencing independence and autonomy, sexuality and personal identity. Education and employment, relationships with families and peers are also in transition and will be affected by emotional as well as physical health

2017 The Children's HIV Association

160. Staff and Associate Specialist Grade Handbook (Third Edition)

• Moodiness, anxiety, depression • Memory loss, indecision • Increasing personal and professional isolation • Physical changes – weight loss, less effort made with clothing and general appearance • Inappropriate prescription of large narcotic doses • Heavy ‘wastage’ of drugs • Dropping/breaking an already empty ampoule to get a full replacement • Insistence on personal administration of parenteral opioids to patients in pain despite high doses of opioids charted as given • Preference for working alone

2017 Association of Anaesthetists of GB and Ireland

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