A review of physician anaesthesia prescribing practices in an abortion clinic in British Columbia.

OBJECTIVE: The primary purpose of this study was to review the standard prescribing practices of physicians providing local anaesthesia in a major abortion clinic in British Columbia. METHODS: We conducted a retrospective review of patients who underwent a first trimester surgical abortion at the Comprehensive Abortion and Reproductive Education (CARE) Program at BC Women's Hospital and Health Centre during 2004 (n = 1546). Patients' demographics and reproductive history including age, weight, gestational age, and gravidity were recorded. Main outcomes recorded were dosage of lidocaine administered and amount of conscious sedation (midazolam and fentanyl) administered for pain management. Incidence of toxicity was also recorded. RESULTS: Almost one half (49.9%) of the patients received 20 mL of 0.5% lidocaine, and the remainder received 20 mL of 1.0% lidocaine. The volume of conscious sedation did not differ between groups. There was a positive correlation computed between midazolam and fentanyl dosages (r = 0.583, P < 0.01). Neither was significantly associated with gravidity. Gestational age was associated with both midazolam and fentanyl dose (r = 0.05, P = 0.047; r = 0.06, P = 0.024). There was no reported incidence of toxicity. CONCLUSION: Similar doses of midazolam and fentanyl were administered to patients regardless of the amount of lidocaine given (20 mL of either 0.5% or 1.0%). Further investigation is required to assess whether fentanyl and midazolam doses used during procedures can be used as surrogate measurements of pain. Our findings suggest it would be reasonable to consider using a lower dose of local anaesthetic for first trimester abortions to further reduce the risk of toxicity.

Treatment of recurrent miscarriage and antiphospholipid syndrome with low-dose enoxaparin and aspirin.

The aim of this retrospective, observational study was to determine the impact of low-dose enoxaparin (20 mg) in conjunction with low-dose aspirin on the pregnancy outcome of women with antiphospholipid syndrome and recurrent miscarriage. The study was conducted in a tertiary referral teaching hospital. A total of 35 women with antiphospholipid syndrome were treated with low-dose enoxaparin and aspirin as soon as pregnancy was confirmed. The outcome of pregnancy was analysed. The miscarriage rate was 7/35 (20%) whereas the live birth rate was 28/35 (80%). In conclusion, low-dose (20 mg) enoxaparin in conjunction with low-dose aspirin treatment produced encouraging results. The findings in this study suggest that there is a case for randomized controlled trials to compare low-dose (20 mg) enoxaparin with higher doses.

The Preferred Attributes of a Trauma Team Leader: Evidence From a Discrete Choice Experiment.

OBJECTIVE: Leaders of a pediatric trauma team are tasked with managing rapidly changing diagnostic and treatment challenges, while ensuring the entire team functions effectively to produce optimal patient outcomes. An effective trauma team leader is often thought to be self-evident, and there is little formal literature identifying the leadership characteristics and attributes associated with optimal trauma team performance. The purpose of this study was to elicit the trauma team leader traits and characteristics deemed of greatest utility by members of the pediatric trauma team. DESIGN, SETTING, PARTICIPANTS: Members of the pediatric trauma team at British Columbia Children's Hospital were asked to participate in a semistructured interview to identify trauma team leader attributes associated with maximal team performance. Using the attributes, we constructed a discrete choice experiment (DCE). DCEs, developed in the economics and market research setting, allow participants to express preferences among finite alternatives, with subsequent statistical analysis that allows quantitative comparison of the utility of selected attributes. RESULTS: After interviewing 21 trauma team practitioners, 6 themes were identified as being most important for trauma team leadership. The developed DCE was administered to 64 members of the trauma team. Analysis of the DCE revealed the most important attributes were collaboration, strong communication, and decisiveness. The attribute of least utility was experience. The specific leadership qualities that provided the most utility to the trauma team included "actively involves input for team" (mean utility [MU]: 0.70; standard error [SE]: 0.11) and "concise communication, at times closed-loop" (MU: 0.52; SE: 0.09). "Hesitant and unclear communication" (MU: -0.88; SE: 0.09) and "often indecisive" (MU: -0.68; SE: 0.10) were deemed most detrimental (negative utility) to the team's function. CONCLUSIONS: This study is novel in applying a strategy to identify and quantify the relative value of trauma team leader attributes. When designing education initiatives for pediatric trauma care teams, defining trauma team quality metrics, and providing continuing medical education for the team leader, it is essential to incorporate preferred leadership characteristics. Crisis resource management skills benefit greatly from an understanding of the preferred attributes, as defined and evaluated by other trauma team members.