Understanding patient and family experiences of critical care in Bangladesh and India: What are the priority actions to promote person-centred care?

Patients' experiences in the intensive care unit (ICU) can enhance or impair their subsequent recovery. Improving patient and family experiences on the ICU is an important part of providing high quality care. There is little evidence to guide how to do this in a South Asian critical care context. This study addresses this gap by exploring the experiences of critically ill patients and their families in ICUs in Bangladesh and India. We elicit suggestions for improvements from patients, families and staff and highlight examples of practices that support person-centred care. This multi-site hospital ethnography was carried out in five ICUs in government hospitals in Bangladesh and India, selected using purposive sampling. Qualitative data were collected using non-participant observation and semi-structured interviews and analysed using reflexive thematic analysis. A total of 108 interviews were conducted with patients, families, and ICU staff. Over 1000 hours of observation were carried out across the five study sites. We identified important mediators of patient and family experience that span many different aspects of care. Factors that promote person-centred care include access to ICU for families, support for family involvement in care delivery, clear communication with patients and families, good symptom management for patients, support for rehabilitation, and measures to address the physical, environmental and financial needs of the family. This study has generated a list of recommendations that can be used by policy makers and practitioners who wish to implement person-centred principles in the ICU.

Comparison of McCoy, Macintosh, and Truview laryngoscope for bougie-aided naso-tracheal intubation: A randomized controlled study.

Background: Video laryngoscopes are commonly used along with Macintosh and McCoy laryngoscopes for Nasotracheal intubation (NTI). The purpose of this study was to evaluate the performance of McCoy, Macintosh, and Truview laryngoscopes during bougie-aided NTI with respect to intubation time, success rate, and hemodynamic changes during the procedure. Methods: Forty-five American Society of Anesthesiologists (ASA) I-II adult patients, with Mallampati grade 1-4, requiring NTI, were enrolled after taking written informed consent. ASA III/IV, restricted mouth opening, and body mass index >30 were excluded from the study. Patients were randomly allocated to intubate with one of the three laryngoscopes (McCoy, Macintosh, and Truview) and the anesthesiologists were well experienced with all of them. The primary outcome was intubation time and secondary outcomes included first attempt success rate, external laryngeal manipulation, Cormack-Lehane (CL) grade, and hemodynamic responses. Results: The intubation time of McCoy, Macintosh, and Truview, was 86.87 ± 15.92, 82.87 ± 16.46, and 79.93 ± 14.53 (mean ± standard deviation) seconds, respectively, which is comparable with Truview being the shortest. CL grade 1 was obtained more in the Truview group (53.3%) compared to the other two groups, while CL grade 3 was obtained in 20% each in McCoy and Macintosh groups. Conclusions: McCoy, Macintosh, and Truview laryngoscopes were comparable in performance during bougie-aided NTI, with Truview having the shortest intubation time and better visualization.

Analysis of publication speed of anesthesiology journals: a cross-sectional study.

BACKGROUND: Publication speed is one of the critical factors affecting authors' preference to a journal for manuscript submission. The publication time of submitted manuscripts varies across journals and specialty. OBJECTIVES: Several bibliometric studies in various fields of medicine, except in anesthesiology, have addressed the issue of publication speed and factors that influence the publication speed. We aimed to identify factors affecting the publication speed of indexed anesthesiology journals. METHOD: Overall, 25 anesthesiology journals indexed in MEDLINE database were retrospectively analyzed for the time required during different stages of publication process. A total of 12 original articles published in the year 2018 were randomly selected from each journal based on the number of issues. Time periods from submission to acceptance and from submission to publication were noted, and their association with impact factor (IF), advanced online publication (AOP), and article processing charges (APCs) were evaluated. RESULTS: The median time from submission to acceptance and from submission to publication for the selected journals were 120 (IQR [83-167]) days and 186 (IQR [126-246]) days, respectively. Publication speed was not found to have any correlation with IF and APC. However, journals with AOP required significantly lesser time for publication than those without AOP 138.5 and 240 days, respectively, (p =  0.011). Moreover, the IF of journals with AOP was significantly higher than that of journals without AOP (p =  0.002). CONCLUSION: The study provides an overview of total time required for peer review, acceptance, and publication in indexed anesthesiology journals. Researchers should focus on journals with AOP for expediting the publication process and avoiding publication delays.

Management of a parturient with uncorrected tetralogy of Fallot in shock: an anesthetic challenge.

Tetralogy of Fallot (TOF) is the most common form of cyanotic congenital heart disease. The survival of patients with uncorrected TOF till the fourth decade of life is rare (around 3%). Pregnancy in a patient with uncorrected TOF requires a multidisciplinary approach. A confluence of pregnancy, uncorrected TOF and shock is infrequent. The state of hypovolaemia and a decrease in systemic vascular resistance due to anaesthetic agents increase the right to left shunt. The decrease in pulmonary blood flow provokes a 'hypercyanotic spell'. We report the successful management of 30-year-old pregnant (G3P2A2L0) with uncorrected TOF, presenting to the emergency department with incomplete abortion in shock.

Effectiveness of Different Techniques of Ethyl Chloride Spray for Venepuncture-Induced Pain: A Randomised Controlled Trial.

BACKGROUND: Venepuncture is an essential component of anaesthesia services. However, this invites pain generating the first negative experience with anaesthesia. Hence, relief of this pain carries considerable importance. Efficacy of ethyl chloride spray although studied, there is no consensus for the best way of application. OBJECTIVES: The present study was conducted to find an effective technique/method of ethyl chloride spray application to reduce venepuncture pain. METHODS: Adult patients posted for different anaesthesia procedures were randomised into three groups. Venepuncture was done either after installation of distilled water or spray of ethyl chloride either once to twice. Venepuncture pain was assessed with a 0-100 Numeric Rating Scale. RESULTS: The analysis showed significant differences among the groups (F [2,96] = 66.27, P < 0.05). The twice sprayed group experienced the least pain ([mean ± standard deviation [SD]] 16.67 ± 10.21), lower in the once spray group ([mean ± SD] 27.58 ± 13.24), and the controls had the highest pain score ([mean ± SD] 49.09 ± 11.28). Post hoc Tukey's tests showed all the three groups differed significantly. The effect size was large, and the variability of the spray on the reduction of pain scores is 58% (η2 = 57.99). CONCLUSION: Ethyl chloride spray effectively reduces the pain on venepuncture, especially when the vapocoolant is sprayed twice each over 5 s, and from a distance of 5 cm perpendicular to the skin.