Anesthesia and postpartum pain management for placenta accreta spectrum: The healthcare provider perspective.

OBJECTIVE: To explore the management and experiences of healthcare providers around anesthetic care in placenta accreta spectrum (PAS). METHODS: This descriptive survey study was carried out over a 6-week period between January and March 2023. Healthcare providers, both anesthesiologists and those involved in operative care for women with PAS, were invited to participate. Questions invited both quantitative and qualitative responses. Qualitative responses were analyzed using content analysis. RESULTS: In all, 171 healthcare providers responded to the survey, the majority of whom were working in tertiary PAS referral centers (153; 89%) and 116 (70%) had more than 10 years of clinical experience. There was variation in the preferred primary mode of anesthesia for PAS cases; 69 (42%) used neuraxial only, but 58 (35%) used a combined approach of neuraxial and general anesthesia, with only 12 (8%) preferring general anesthesia. Ninety-nine (61%) were offering a routine antenatal anesthesia consultation. Content analysis of qualitative data identified three main themes, which were "variation in approach to primary mode of anesthesia", "perspectives of patient preferences", and "importance of multidisciplinary team care". These findings led to the development of a decision aid provided as part of this paper, which may assist clinicians in counseling women on their options for care to come to an informed decision. CONCLUSIONS: Approach to anesthesia for PAS varied between healthcare providers. The final decision for anesthesia should take into consideration the clinical care needs as well as the preferences of the patient.

Anesthesia and postpartum pain management for placenta accreta spectrum: The patient perspective and recommendations for care.

OBJECTIVE: Placenta accreta spectrum (PAS) is a high-risk complication of pregnancy, which often requires complex surgical intervention. There is limited literature on the patient experience during the perioperative period and postpartum pain management for PAS. Therefore, this study aims to explore the patient perspective of anesthesia care. METHODS: Ethical approval was granted by the hospital ethics committee (EC02.2023). This was a descriptive survey study, including women with a history of pregnancy complicated by PAS who were members of two patient advocacy groups. The survey, consisting of both open and closed questions, was performed over a 6-week period between January and March 2023. Content analysis was performed on qualitative data to identify themes, and recommendations for care are suggested. RESULTS: A total of 347 participants responded to the survey; 76% (n = 252) had a cesarean hysterectomy (n = 252), and general anesthesia was the most common primary mode of anesthesia (39%, n = 130). We identified two overarching themes: experiences of anesthesia and experience of postpartum pain management. Under experiences of anesthesia, three subthemes were identified, namely "communication with the anesthesiologist", "deferring to the expertise of the team", and "consequences of decision around the mode of anesthesia." Under postpartum pain management, two subthemes emerged: "support of specialist PAS team" and "poor pain management following PAS surgery". CONCLUSIONS: Women want to be involved in decisions around their care, but do not always understand the consequences of their decision-making, such as missing the birth of their child. An antenatal anesthesiology consultation is important to provide women with information, explore preferences, and develop a plan of care for the birth.

Patient safety practices in European anaesthesiology: Expert evaluation and ranking.

BACKGROUND: Patient safety is a key concern of anaesthesiology practice. However, good practices are often not widely shared between departments and hospitals, whether within or between countries. OBJECTIVE: We aimed to collect and analyse safety practices and tips from anaesthesiology departments around Europe in order to facilitate successful transfer of safety knowledge. DESIGN: Review of previously collected safety practices; allocation of numerical scores in order to rank them on 0-5 scales in terms of anticipated impact, and speed, cost, and ease of implementation; free text comment on any possible difficulties or unintended harms which might arise from adopting any of the collected practices. SETTING: Collaborative remote working of expert group. PARTICIPANTS: Nineteen experts in patient safety in anaesthesiology from nine European countries. MAIN OUTCOME MEASURES: Rankings of safety practices for anticipated practice impact, cost, speed, and ease of implementation. RESULTS: We collected 117 practices. The highest-ranked items for potential beneficial impact were: standardising the layout of drug trolleys (4.82); involving all staff in new safety initiatives in the operating theatre (4.73); ensuring patients' medical records are available at the time of surgery (4.71); running regular simulation training sessions in departments of anaesthesia (4.67); and creating a difficult airway management trolley (4.65). A major theme to emerge from the qualitative analysis of the experts' free text comments was the risk that practices aimed at enhancing patient safety might not achieve the effect intended, as introducing new safety activities can cause more mistakes during the implementation phase. CONCLUSION: Many useful practices to promote patient safety were identified, but as some practices appear to be context-dependent, we recommend that a proper, prospective risk assessment is carried out before they are introduced in a new setting. The full list of items is available online as Supplementary Digital Content, http://links.lww.com/EJA/A785 . TRIAL REGISTRATION: Not applicable.

Enhancing knowledge, skills, and comfort in providing anesthesia assistance during obstetric general anesthesia for operating room nurses: a prospective observational study.

BACKGROUND: Due to a nationwide shortage of anesthesia assistants, operating room nurses are often recruited to assist with the induction of obstetric general anesthesia (GA). We developed and administered a training program and hypothesized there would be significant improvements in knowledge and skills in anesthesia assistance during obstetric GA by operating room nurses following training with adequate retention at six months. METHODS: Following informed consent, all operating room nurses at our institution were invited to participate in the study. Baseline knowledge of participants was assessed using a 14-item multiple choice questionnaire (MCQ), and skills were assessed using a 12-item checklist scored by direct observation during simulated induction of GA. Next, a 20-min didactic lecture followed by a ten-minute hands-on skills station were delivered. Knowledge and skills were immediately reassessed after training, and again at six weeks and six months. The primary outcomes of this study were adequate knowledge and skills retention at six months, defined as achieving ≥ 80% in MCQ and ≥ 80% in skills checklist scores and analyzed using longitudinal mixed-effects linear regression. RESULTS: A total of 34 nurses completed the study at six months. The mean MCQ score at baseline was 8.9 (95% confidence interval [CI], 8.5 to 9.4) out of 14. The mean skills checklist score was 5.5 (95% CI, 4.9 to 6.1) out of 12. The mean comfort scores for assisting elective and emergency Cesarean deliveries were 3.6 (95% CI, 3.2 to 3.9) and 3.1 (95% CI, 2.7 to 3.5) out of 5, respectively. There was a significant difference in the mean MCQ and skills checklist scores across the different study periods (overall P value < 0.001). Post hoc pairwise tests suggested that, compared with baseline, there were significantly higher mean MCQ scores at all time points after the training program at six weeks (11.9; 95% CI, 11.4 to 12.4; P < 0.001) and at six months (12.0; 95% CI, 11.5 to 12.4; P < 0.001). DISCUSSION: The knowledge and skills of operating room nurses in providing anesthesia assistance during obstetric GA at our institution were low at baseline. Following a single 30-min in-house, anesthesiologist-led, structured training program, scores in both dimensions significantly improved. Although knowledge improvements were adequately retained for up to six months, skills improvements decayed rapidly, suggesting that sessions should be repeated at six-week intervals, at least initially.

RéSUMé: CONTEXTE: En raison d'une pénurie nationale d'assistants en anesthésie, le personnel infirmier de la salle d'opération est souvent sollicité pour aider à l'induction de l'anesthésie générale (AG) obstétricale. Nous avons élaboré et administré un programme de formation et émis l'hypothèse qu'il y aurait des améliorations significatives dans les connaissances et les compétences en matière d'assistance en anesthésie pendant l'anesthésie générale obstétricale par les infirmières de salle d'opération après avoir suivi une formation, avec une rétention adéquate à six mois. MéTHODE: Après avoir obtenu le consentement éclairé, tout le personnel infirmier de salle d'opération de notre établissement a été invité à participer à l'étude. Les connaissances de base des participants ont été évaluées à l'aide d'un questionnaire à choix multiples (QCM) à 14 éléments, et les compétences ont été évaluées à l'aide d'une liste de contrôle de 12 éléments notée par observation directe lors d'une simulation d'induction d'anesthésie générale. Par la suite, un cours didactique de 20 minutes suivi d'une station de compétences pratiques de dix minutes a été donné. Les connaissances et les compétences ont été réévaluées immédiatement après la formation, puis de nouveau à six semaines et six mois. Les critères d'évaluation principaux de cette étude étaient la rétention adéquate des connaissances et des compétences à six mois, définie comme l'atteinte de ≥ 80 % dans les scores du QCM et ≥ 80 % dans les scores de la liste de contrôle des compétences et analysée à l'aide d'une régression linéaire longitudinale à effets mixtes. RéSULTATS: Au total, 34 infirmières ont terminé l'étude à six mois. Au début de l'étude, le score moyen au QCM était de 8,9 (intervalle de confiance [IC] à 95 %, 8,5 à 9,4) sur 14. Le score moyen sur la liste de contrôle des compétences était de 5,5 (IC 95 %, 4,9 à 6,1) sur 12. Les scores moyens d'aisance dans l'assistance pour un accouchement par césarienne programmé et d'urgence étaient de 3,6 (IC 95 %, 3,2 à 3,9) et 3,1 (IC 95 %, 2,7 à 3,5) sur 5, respectivement. Une différence significative a été observée dans les scores moyens au QCM et sur la liste de contrôle des compétences entre les différentes périodes d'étude (valeur globale P < 0,001). Les tests appariés post-hoc ont suggéré que, par rapport aux connaissances évaluées au début de l'étude, les scores moyens au QCM étaient significativement plus élevés à tous les moments après le programme de formation, à six semaines (11,9; IC 95 %, 11,4 à 12,4; P < 0,001) et à six mois (12,0; IC 95 %, 11,5 à 12,4; P < 0,001). DISCUSSION: Les connaissances et les compétences du personnel infirmier de salle d'opération dans la prestation d'une assistance en anesthésie pendant l'AG obstétricale dans notre établissement étaient faibles au commencement de notre étude. Après un seul programme de formation structuré de 30 minutes à l'interne, dirigé par un anesthésiologiste, les scores dans les deux dimensions se sont considérablement améliorés. Bien que les améliorations des connaissances aient été retenues de manière adéquate jusqu'à six mois, les améliorations des compétences se sont rapidement détériorées, ce qui suggère que les séances devraient être répétées à des intervalles de six semaines, au moins au début.

Sharing the pain: an observational analysis of Twitter and pain in Ireland.

INTRODUCTION: Studies involving Twitter and chronic pain can provide highly valuable patient-generated information. The aim of this paper was to examine pain-related tweets in Ireland over a 2-week period from 22 June 2017 to 5 July 2017 using pain-related keywords. We wished to identify Twitter user gender profile; most common discussion topics; sentiment analysis; and dissemination of tweets. METHODS: A third-party data analytics company conducted a Twitter social media analysis over a randomly chosen 14-day period between the dates 22 June and 5 July 2017. All relevant keywords were included in the search. Author group consensus yielded 24 terms. Geographical location was restricted to Ireland. A computational sentiment dictionary was used to provide a rating of the emotional properties of the text on a 9-point scale from -5 to +4 of negative to positive sentiment. Dissemination was calculated by the number of times the tweet was displayed ('impressions'). RESULTS: There were 941 tweets identified during the study from 715 contributors. These generated 2.88 million impressions. The most frequently occurring keywords were headache (n=321); migraine (n=147); back pain (n=123); cannabis (n=114); and chronic pain (n=85). There were 1.94 times as many tweets from females as males. The highest proportion of tweets from female users was in the fibromyalgia (83%) and migraine (60%) categories; and from males in the sciatica (35%), chronic pain (34%) and back pain (32%) categories. Cannabis-related tweets reflected mostly non-personal content (90%), with a highly positive sentiment, and the highest number of impressions per tweet. The largest amount of advice was offered in the back pain category. Reposting of other users' content ('retweets') was more likely to contain a positive sentiment. CONCLUSION: A substantial discussion of pain-related topics took place on Twitter during our study period. This provided real-time, dynamic information from individuals on discussion topics in pain medicine. This can be used to gain a greater understanding of the pain experience. As patients are increasingly acquiring healthcare information through online sources, high-quality information from approved sources should be promoted on such platforms.

Ten years of the Helsinki Declaration on patient safety in anaesthesiology: An expert opinion on peri-operative safety aspects.

: Patient safety is an activity to mitigate preventable patient harm that may occur during the delivery of medical care. The European Board of Anaesthesiology (EBA)/European Union of Medical Specialists had previously published safety recommendations on minimal monitoring and postanaesthesia care, but with the growing public and professional interest it was decided to produce a much more encompassing document. The EBA and the European Society of Anaesthesiology (ESA) published a consensus on what needs to be done/achieved for improvement of peri-operative patient safety. During the Euroanaesthesia meeting in Helsinki/Finland in 2010, this vision was presented to anaesthesiologists, patients, industry and others involved in health care as the 'Helsinki Declaration on Patient Safety in Anaesthesiology'. In May/June 2020, ESA and EBA are celebrating the 10th anniversary of the Helsinki Declaration on Patient Safety in Anaesthesiology; a good opportunity to look back and forward evaluating what was achieved in the recent 10 years, and what needs to be done in the upcoming years. The Patient Safety and Quality Committee (PSQC) of ESA invited experts in their fields to contribute, and these experts addressed their topic in different ways; there are classical, narrative reviews, more systematic reviews, political statements, personal opinions and also original data presentation. With this publication we hope to further stimulate implementation of the Helsinki Declaration on Patient Safety in Anaesthesiology, as well as initiating relevant research in the future.

Grief reactions and coping strategies of trainee doctors working in paediatric intensive care.

BACKGROUND: The death of a child can have significant emotional effects on doctors responsible for their care. Trainee doctors working in the paediatric intensive care unit (PICU) may be particularly vulnerable. The aim of this study was to examine the emotional impact of, and grief reactions to, a child's death in PICU trainee doctors, along with coping strategies they used. METHODS: In a prospective, cross-sectional, observational study, qualitative and quantitative data were recorded on anonymised, written questionnaires. Grief severity was assessed using the Texas Revised Inventory of Grief. Emotional impact was assessed using the shortened Impact of Event Scale. The BriefCOPE tool was used to assess coping strategies. Qualitative data was analysed using conventional content analysis. Data are presented as median (inter-quartile range) or number (%). RESULTS: All invited trainee doctors (23 anaesthetists; 5 paediatricians) completed the questionnaire (age, 30 [29-34] yr; 13/28 [46%] female). Two (7%) doctors experienced severe grief (Texas Revised Inventory of Grief score <39), with five (18%) doctors severely affected by the deaths as measured by the Impact of Event Scale. Qualitative analysis revealed prominent themes of sadness, helplessness, guilt, shock, and concern for the bereaved family. There was limited use of coping strategies. Speaking with another trainee doctor was the principal coping strategy. Requests for debriefing sessions, greater psychological support and follow-up with the patient's family were frequently suggested. CONCLUSIONS: Paediatric deaths evoke significant grief and emotional reactions in a subset of PICU trainee doctors. Trainee PICU doctors highlighted a lack of professional support and tailored debriefs.