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1.
Medicina (Kaunas) ; 57(2)2021 Feb 08.
Artigo em Inglês | MEDLINE | ID: mdl-33567770

RESUMO

Background and objectives: Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has spread to more than 200 countries. In light of this situation, the Japanese Government declared a state of emergency in seven regions of Japan on 7 April 2020 under the provisions of the law. The medical care delivery system has been under pressure. Although various surgical societies have published guidelines on which to base their surgical decisions, it is not clear how general anesthesia has been performed and will be performed in Japan. Materials and Methods: One of the services provided by the social network service Twitter is a voting function-Twitter Polls-through which anonymous surveys were conducted. We analyzed the results of a series of surveys 17 times over 22 weeks on Twitter on the status of operating restrictions using quadratic programming to solve the mathematical optimizing problem, and public data provided by the Japanese Government were used to estimate the current changes in the number of general anesthesia performed in Japan. Results: The minimum number of general anesthesia cases per week was estimated at 67.1% compared to 2015 on 27 April 2020. The timeseries trend was compatible with the results reported by the Japanese Society of Anesthesiologists (correlation coefficient r = 0.69, p < 0.001). Conclusions: The number of general anesthesia was reduced up to two-thirds during the pandemic of COVID-19 in Japan and was successfully quantitatively estimated using a quick questionnaire on Twitter.


Assuntos
Anestesia Geral/estatística & dados numéricos , Anestesiologia/estatística & dados numéricos , Utilização de Instalações e Serviços/estatística & dados numéricos , Mídias Sociais/estatística & dados numéricos , Humanos , Japão , Computação Matemática , Projetos de Pesquisa , Sociedades Médicas/estatística & dados numéricos , Inquéritos e Questionários
2.
Rev Esp Anestesiol Reanim ; 68(2): 114-116, 2021 02.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-33371977
3.
Bull World Health Organ ; 98(10): 671-682, 2020 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-33177757

RESUMO

Objective: To determine whether location-linked anaesthesiology calculator mobile application (app) data can serve as a qualitative proxy for global surgical case volumes and therefore monitor the impact of the coronavirus disease 2019 (COVID-19) pandemic. Methods: We collected data provided by users of the mobile app "Anesthesiologist" during 1 October 2018-30 June 2020. We analysed these using RStudio and generated 7-day moving-average app use plots. We calculated country-level reductions in app use as a percentage of baseline. We obtained data on COVID-19 case counts from the European Centre for Disease Prevention and Control. We plotted changing app use and COVID-19 case counts for several countries and regions. Findings: A total of 100 099 app users within 214 countries and territories provided data. We observed that app use was reduced during holidays, weekends and at night, correlating with expected fluctuations in surgical volume. We observed that the onset of the pandemic prompted substantial reductions in app use. We noted strong cross-correlation between COVID-19 case count and reductions in app use in low- and middle-income countries, but not in high-income countries. Of the 112 countries and territories with non-zero app use during baseline and during the pandemic, we calculated a median reduction in app use to 73.6% of baseline. Conclusion: App data provide a proxy for surgical case volumes, and can therefore be used as a real-time monitor of the impact of COVID-19 on surgical capacity. We have created a dashboard for ongoing visualization of these data, allowing policy-makers to direct resources to areas of greatest need.


Assuntos
Anestesiologia/estatística & dados numéricos , Infecções por Coronavirus/epidemiologia , Aplicativos Móveis/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Vigilância em Saúde Pública/métodos , Procedimentos Cirúrgicos Operatórios/estatística & dados numéricos , Betacoronavirus , Humanos , Estudos Longitudinais , Pandemias
4.
Anesthesiology ; 133(3): 500-509, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32788557

RESUMO

There are an increasing number of "big data" studies in anesthesia that seek to answer clinical questions by observing the care and outcomes of many patients across a variety of care settings. This Readers' Toolbox will explain how to estimate the influence of patient factors on clinical outcome, addressing bias and confounding. One approach to limit the influence of confounding is to perform a clinical trial. When such a trial is infeasible, observational studies using robust regression techniques may be able to advance knowledge. Logistic regression is used when the outcome is binary (e.g., intracranial hemorrhage: yes or no), by modeling the natural log for the odds of an outcome. Because outcomes are influenced by many factors, we commonly use multivariable logistic regression to estimate the unique influence of each factor. From this tutorial, one should acquire a clearer understanding of how to perform and assess multivariable logistic regression.


Assuntos
Anestesiologia/métodos , Anestesiologia/estatística & dados numéricos , Adulto , Viés , Feminino , Humanos , Modelos Logísticos , Gravidez
5.
Occup Environ Med ; 77(11): 769-774, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32719018

RESUMO

OBJECTIVES: The objective of this study was to assess the influence of antioxidant gene GSTM1 and GSTT1 on DNA damage in personnel occupationally exposed to volatile anaesthetics (VA). METHODS: The study groups were composed of 50 exposed subjects (anaesthesia workers) and 49 controls. Blood samples were collected from both subjects. DNA damage was analysed through the comet assay technique. Biomarker genes GSTM1 and GSTT1 were inspected through PCR technique for polymorphism. RESULTS: The comet assay technique showed that the Total Comet Score (TCS) in exposed subjects was significantly higher (p=0.0001) than the control. Age and smoking had significant effects on TCS in the study groups (p<0.05). Duration of occupational exposure had significant positive correlation (r=0.755, p<0.001) with DNA damage. The null polymorphism in GSTM1 and GSTT1 gene showed a significant effect (p<0.001 and p<0.000) on the DNA damage. CONCLUSIONS: The polymorphism in GSTM1 and GSTT1 gene significantly damage DNA in personnel occupationally exposed to VA.


Assuntos
Anestesiologia/estatística & dados numéricos , Anestésicos Inalatórios/efeitos adversos , Dano ao DNA/genética , Glutationa Transferase/genética , Pessoal de Saúde/estatística & dados numéricos , Exposição Ocupacional/efeitos adversos , Adulto , Fatores Etários , Ensaio Cometa , Marcadores Genéticos/genética , Humanos , Masculino , Exposição Ocupacional/estatística & dados numéricos , Paquistão/epidemiologia , Polimorfismo Genético/genética , Fumar/efeitos adversos
6.
Curr Opin Anaesthesiol ; 33(4): 589-593, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32618686

RESUMO

PURPOSE OF REVIEW: The number of elderly patients receiving non-operating room anaesthesia (NORA) has substantially increased because of clinical, epidemiological, social and economic reasons. Considering the high risk of anaesthesia-related adverse events in this population, along with the limitations of NORA, more specific knowledge and skills are required. RECENT FINDINGS: Advanced age appears to be an independent risk factor for anaesthesia-related adverse events in a NORA setting, similar to the traditional operating room. As significant changes occur in the pharmacological effects of anaesthetic agents with aging, reducing dosage and carefully titrating drugs are essential. Because NORA-related injury is frequently related to airway obstruction/respiratory depression, non-invasive respiratory activity monitoring is more useful for sedation of elderly patients. Additionally, advanced age increases the risk of aspiration and cognitive complications, even during sedation. SUMMARY: Elderly patients may greatly benefit from the lower invasiveness and faster recovery offered by interventional procedures. However, as they represent a highly heterogeneous population with large variations in physiological reserves and comorbidities, anaesthesiologists should strive to maintain the same practice standards throughout all anaesthetizing locations. Knowledge of the unique hazards associated with NORA in elderly patients may further enhance patient safety.Video abstract: NORA for elderly patients.mp4: http://links.lww.com/COAN/A66.


Assuntos
Anestesia/efeitos adversos , Anestesiologia/estatística & dados numéricos , Anestésicos/efeitos adversos , Assistência ao Paciente/métodos , Fatores Etários , Idoso , Instituições de Assistência Ambulatorial/estatística & dados numéricos , Anestesia/métodos , Anestesia/tendências , Anestesiologistas , Anestésicos/farmacologia , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Humanos , Assistência ao Paciente/tendências , Segurança do Paciente
7.
J Anesth Hist ; 6(2): 84-89, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32593382

RESUMO

PURPOSE: One of the most interesting signs of growth in a medical specialty is the addition of pain medicine as a clinical subspecialty to it. The aim of this study was to analyze publication-based academic interest in pain medicine among clinical specialties with long-standing involvement in pain management. METHODS: We assessed the activity within several specialties in the development of an academic foundation for pain medicine by measuring the frequency of the most common pain topics (1998-2017) in academic journals representing such specialties. The selection of materials for the analysis of publication-based academic interest associated with the development of pain medicine followed a three-step process: (1) Medical specialties, limited to those with accredited fellowship training in pain medicine for more than 20 years - anesthesiology, neurology, physiatry, and psychiatry; (2) Pain topics, based on the degree of topic association with the work of pain clinics - a total of 34 topics; (3) Specialty journals, mostly official journals of societies publishing articles representing all aspects of a specialty - four journals per specialty. Specialty-related academic interest was characterized in two dimensions: its breadth (the number of different topics of interest with distinctly high shares of publications) and its intensity (maximal number of publications on a particular topic). RESULTS: According to the number of topics with a distinctly high share of articles per topic (≥ 5%), the rank order of specialties was as follows (of 34 topics): anesthesiology (22), physiatry (20), neurology (10), and psychiatry (0). Regarding comparative intensity of interest, anesthesiology has prevailing interest in 16 topics (especially in postoperative pain and pharmacologic pain treatment), physiatry in 13 topics (especially in physical methods of pain therapy), and neurology in one topic (headache disorders). CONCLUSION: Publication-based academic interest in pain management was most intensive in two specialties, anesthesiology and physiatry, with anesthesiology being somewhat more multifaceted, especially in the methods of pain treatment.


Assuntos
Anestesiologia/estatística & dados numéricos , Neurologia/estatística & dados numéricos , Manejo da Dor , Medicina Física e Reabilitação/estatística & dados numéricos , Psiquiatria/estatística & dados numéricos , Publicações/estatística & dados numéricos , Bibliometria , Humanos
8.
Diagn Interv Imaging ; 101(6): 347-353, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32360351

RESUMO

The COVID-19 pandemic has deeply impacted the activity of interventional oncology in hospitals and cancer centers. In this review based on official recommendations of different international societies, but also on local solutions found in different expert large-volume centers, we discuss the changes that need to be done for the organization, safety, and patient management in interventional oncology. A literature review of potential solutions in a context of scarce anesthesiologic resources, limited staff and limited access to hospital beds are proposed and discussed based on the literature data.


Assuntos
Betacoronavirus , Institutos de Câncer/organização & administração , Infecções por Coronavirus/epidemiologia , Neoplasias/terapia , Pandemias , Pneumonia Viral/epidemiologia , Aerossóis , Fatores Etários , Anestesia Geral , Anestesiologia/estatística & dados numéricos , Biópsia/efeitos adversos , Biópsia/métodos , Carcinoma Hepatocelular/terapia , Carcinoma de Células Renais/terapia , Quimioembolização Terapêutica/métodos , Técnicas de Laboratório Clínico/métodos , Neoplasias do Colo/patologia , Infecções por Coronavirus/complicações , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/transmissão , Bases de Dados Factuais , Pessoal de Saúde/estatística & dados numéricos , Recursos em Saúde/organização & administração , Recursos em Saúde/provisão & distribução , Número de Leitos em Hospital/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Humanos , Hipertermia Induzida/métodos , Neoplasias Renais/terapia , Neoplasias Hepáticas/terapia , Neoplasias Pulmonares/secundário , Neoplasias Pulmonares/terapia , Neoplasias/complicações , Cuidados Paliativos/métodos , Pneumonia Viral/complicações , Pneumonia Viral/diagnóstico , Pneumonia Viral/transmissão , Triagem
9.
Ann R Coll Surg Engl ; 102(5): 343-347, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32233651

RESUMO

INTRODUCTION: Tracheostomy is a common surgical procedure used to create a secure airway in patients, now performed by a variety of specialties, with a notable rise in critical care environments. It is unclear whether this rise is seen in units with large head and neck surgery departments, and how practice in such units compares with the rest of the UK. METHODS: A three-year retrospective audit was carried out between anaesthetic, surgical and critical care departments. All tracheostomy procedures were recorded anonymously. RESULTS: A total of 523 tracheostomies were performed, 66% of which were in men. The mean patient age was 60 years. The majority (83%) were elective, performed for various indications, while the remaining 17% were emergency tracheostomies performed for pending airway obstruction. A fifth of the tracheostomies were percutaneous procedures. Most emergency tracheostomies (78%) were performed by otolaryngology. Three cricothyroidotomies were performed within critical care and theatres. Complications related to tracheostomy occurred in 47 cases (9%), most commonly lower respiratory tract infection. The mean time to decannulation was 12.8 days. CONCLUSIONS: This paper discusses the findings of a comprehensive, multispecialty audit of tracheostomy experience in a large health board, with over 150 tracheostomies performed annually. Elective cases form the majority although there is a significant case series of emergency tracheostomies performed for a range of pathologies. Around a quarter of those requiring tracheostomy ultimately died, mostly as a result of advanced cancer.


Assuntos
Auditoria Médica/estatística & dados numéricos , Traqueostomia/estatística & dados numéricos , Idoso , Anestesiologia/métodos , Anestesiologia/estatística & dados numéricos , Cuidados Críticos/métodos , Cuidados Críticos/estatística & dados numéricos , Procedimentos Cirúrgicos Eletivos/métodos , Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Otolaringologia/métodos , Otolaringologia/estatística & dados numéricos , Estudos Retrospectivos , Escócia , Traqueostomia/efeitos adversos
10.
Anaesthesia ; 75(5): 648-653, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32012219

RESUMO

Which journals cite work published in anaesthetic journals is of potential interest to authors, editors and publishers. We analysed citations made in 2017-2018 for articles, reviews, editorials and letters published by 12 anaesthetic journals in 2016, using the Web of Science™ citation index platform. We analysed 12,544 citations made for 3518 items. Citations were most often made by specialist anaesthesia journals and critical care journals, and occurred most commonly in articles, followed by reviews, editorials and letters. The median (IQR [range]) number of citations made per item was 3.3 (2.6-4.1 [1.6-5.1]). The median (IQR [range]) number of journals that cited the 12 source journals was 302 (236-449 [139-671]). The median (IQR [range]) proportion of citations made by the same journal that published the items (i.e. 'self-citations') was 15% (11-17% [5-32%]). There were 1305/1932 (68%) citations made by North American journals for items published in North American journals and 1712/2063 (83%) citations made by European journals for items published in European journals, p < 0.0001. Our analysis may inform authors, editors and publishers where to submit work, what editorial policy to pursue and what journal strategy to follow, respectively.


Assuntos
Anestesiologia/estatística & dados numéricos , Bibliometria , Publicações Periódicas como Assunto/estatística & dados numéricos , Cuidados Críticos , Políticas Editoriais , Europa (Continente) , Humanos , América do Norte , Políticas
11.
Anesth Analg ; 130(5): 1296-1302, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-31923001

RESUMO

BACKGROUND: The proportion of women medical school graduates in the United States has grown substantially; however, representation of women in anesthesiology lags behind. We sought to investigate factors associated with women recommending against a career in anesthesiology due to obstacles related to motherhood. METHODS: We surveyed 9525 women anesthesiologist members of the American Society of Anesthesiologists (ASA) with a web-based survey distributed via e-mail. Associations between whether women would counsel against anesthesiology due to obstacles related to motherhood and 34 related categorical variables were estimated. Fisher exact test was used for categorical binary variables, and Wilcoxon-Mann-Whitney test was used for ranked variables. RESULTS: The response rate for the primary question was 19.2%. Among the 1827 respondents to the primary question, 11.6% would counsel a female medical student against a career in anesthesiology due to obstacles pertaining to motherhood. Counseling against an anesthesiology career was not associated with ever being pregnant (P = .16), or whether a woman was pregnant during residency or fellowship training (P = .41) or during practice (P = .16). No association was found between counseling against anesthesiology and training factors: total number of weeks of maternity leave (P = .18), the percentage of women faculty (P = .96) or residents (P = .34), or the number of pregnant coresidents (P = .66). Counseling against a career in anesthesiology was significantly associated with whether respondents' desired age of childbearing/motherhood and desired number of children were adversely affected by work demands (with Bonferroni adjustment for the 34 comparisons, both P < .0001). The risk ratio of respondents whose desired childbearing age and desired number of children were affected by work demands counseling against a career in anesthesiology was 5.1 compared to women whose desired childbearing age and desired number of children were not affected (99% confidence interval [CI], 3.3-7.9; P < .0001; odds ratio, 6.2). CONCLUSIONS: In this study of 1827 women anesthesiologists, approximately 1 in 10 would counsel a student against a career in anesthesiology due to obstacles pertaining to motherhood, and this was associated with altering one's timing and number of children due to job demands. Further research is needed to understand how women's perception of a career in anesthesiology is related to factors influencing personal choices. Understanding women's perceptions of motherhood in anesthesiology may help leaders support career longevity and personal satisfaction in this growing cohort of anesthesiologists.


Assuntos
Anestesiologia , Escolha da Profissão , Internato e Residência , Mães/psicologia , Sociedades Médicas , Inquéritos e Questionários , Anestesiologia/estatística & dados numéricos , Feminino , Humanos , Internato e Residência/estatística & dados numéricos , Satisfação no Emprego , Gravidez , Sociedades Médicas/estatística & dados numéricos , Inquéritos e Questionários/estatística & dados numéricos
13.
Anaesthesia ; 75(2): 247-253, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31472021

RESUMO

Pilot and feasibility studies are preliminary investigations undertaken before a larger study. We hypothesised that only a small proportion of pilot or feasibility studies published in anaesthesia journals were correctly labelled as such. We searched for papers published between 2007 and 2017 in six anaesthesia journals using the text words 'pilot' OR 'feasibility' and included 266 original articles with 26,682 human participants. Only 34 (12.8%) were correctly labelled as a pilot or feasibility study. They were more likely to: have more median (IQR [range]) participants, 73 (40-130 [4-2716]) vs. 27 (15-60 [2-3305], p < 0.001; report feasibility outcomes, 82.4% vs. 4.3%, p < 0.001; and report an intention to convert, 100% vs. 39.7%, p < 0.001. They were less likely to test the efficacy of the primary outcome, 50% vs. 72.8%, p = 0.009; and report firm clinical conclusions 41.2% vs. 67.7%, p = 0.004. Of the studies published more than 5 years ago, correctly labelled pilot or feasibility studies were more likely to precede a published conversion study, 53.8% vs. 16%, p = 0.004. There was no difference between the number of citations 18 (9-44 [2-216]) vs. 20 (7-47 [0-251]), p = 0.865. These results have important consequences for patients, trialists, researchers and funders. We argue that correctly labelled pilot studies enhance the quality of scientific research by encouraging methodological rigour, ensuring scientific validity and reducing research waste. Authors, reviewers, editors and publishers should ensure they adhere to the contents of the 2016 CONSORT extension for pilot and feasibility studies.


Assuntos
Anestesiologia/estatística & dados numéricos , Bibliometria , Publicações Periódicas como Assunto , Pesquisa/estatística & dados numéricos , Humanos , Projetos Piloto
14.
J Comp Eff Res ; 8(16): 1417-1423, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31789050

RESUMO

Aim: We assessed reporting of data on sex/gender and race/ethnicity in randomized controlled trials of interventions published in the highest-ranking anesthesiology journals from 2014 to 2017. Methods: We extracted data regarding terminology for sex/gender, proportion of participants according to the race/gender and race/ethnicity, and results shown for the race/gender and race/ethnicity. Results: Among the analyzed 732 trials, few stratified allocation of participants on the basis of sex/gender and race/ethnicity, few reported results for sex/gender or race/ethnicity and the outcomes reported may be influenced by one or both. Conclusion: In conclusion, outcomes of anesthesiology trials could be vulnerable to an important and avoidable source of bias; trialists need to pay more attention to sex and race/ethnicity when designing and reporting their studies.


Assuntos
Anestesiologia/estatística & dados numéricos , Grupos Étnicos/estatística & dados numéricos , Publicações Periódicas como Assunto/estatística & dados numéricos , Ensaios Clínicos Controlados Aleatórios como Assunto/estatística & dados numéricos , Feminino , Humanos , Masculino , Publicações/estatística & dados numéricos , Projetos de Pesquisa/estatística & dados numéricos , Distribuição por Sexo
15.
Br J Anaesth ; 123(5): 679-687, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31561883

RESUMO

BACKGROUND: While increased surgical-provider volume has been associated with improved outcomes, research regarding volume-outcome relationships within high-volume institutions and the role of anaesthesiologists is limited. Further, the effect of anaesthesia-care-team composition remains understudied. This analysis aimed to identify the impact of anaesthesiologist and surgeon volume on adverse events after total joint arthroplasties. METHODS: We retrospectively identified 40 437 patients who underwent total joint arthroplasties at a high-volume institution from 2005 to 2014. The main effects of interest were anaesthesiologist and surgeon volume and experience along with anaesthesia-care-team composition. Multivariable logistic regression models were used to evaluate three outcomes: any complication, cardiopulmonary complication, and length of stay (>5 days). Odds ratios (ORs) and 99.75% confidence intervals (CIs) were reported. RESULTS: Across all three models, anaesthesiologist volume and experience, and anaesthesia-care-team composition were not significant predictors. Surgeon annual case volume >50 was associated with significantly reduced odds of any complication (annual case volume: 50-149; OR: 0.80; CI: 0.66-0.98) and prolonged length of stay (OR: 0.69; CI: 0.60-0.80). Surgeon experience >20 yr was associated with significantly reduced odds of prolonged length of stay (OR: 0.85; CI: 0.75-0.95). CONCLUSIONS: Anaesthesiologist volume and experience, and anaesthesia-care-team composition did not impact the odds of an adverse outcome, although a higher surgeon volume was associated with decreased odds of complications and prolonged length of stay. Further study is necessary to determine if these findings can be extrapolated to less specialised, lower volume surgical settings.


Assuntos
Anestesiologia/estatística & dados numéricos , Artroplastia de Quadril/normas , Artroplastia do Joelho/normas , Competência Clínica/estatística & dados numéricos , Carga de Trabalho/estatística & dados numéricos , Idoso , Anestesia/métodos , Anestesia/normas , Anestesia/estatística & dados numéricos , Anestesiologia/organização & administração , Anestesiologia/normas , Artroplastia de Quadril/efeitos adversos , Artroplastia do Joelho/efeitos adversos , Comorbidade , Feminino , Hospitais com Alto Volume de Atendimentos/normas , Hospitais com Alto Volume de Atendimentos/estatística & dados numéricos , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , New York/epidemiologia , Equipe de Assistência ao Paciente/organização & administração , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Resultado do Tratamento
16.
Perspect Med Educ ; 8(4): 253-260, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31347032

RESUMO

INTRODUCTION: This paper reports on the development of a scale to measure intrapersonal factors (IPF) that may influence speaking up behaviour in the operating room. METHODS: Participants were postgraduate year 2, 3, and 4 anaesthesiology residents and practising faculty anaesthesiologists at a large quaternary care academic hospital. Based on a literature review, the authors constructed the initial scale. Exploratory factor analysis was conducted to identify the underlying factor structure for the scale. A set of one-way ANOVAs and multiple ordinal regressions were carried out to provide additional validity evidence for the new scale. RESULTS: Exploratory factor analysis indicated a three-factor solution accounting for 73% of the variance. The self-efficacy subscale included four items (Cronbach's α = 0.86), and the social outcome expectations (Cronbach's α = 0.86) and assertive attitude (Cronbach's α = 0.67) subscales contained three items each. The effect of training level was significantly associated with self-efficacy (p < 0.001) and assertive attitude subscale scores (p < 0.001). Multiple ordinal regressions indicated that IPF predicted participants' likelihood of speaking up in various hypothetical scenarios. DISCUSSION: Our analyses provided initial evidence for the validity and reliability of a 10-item IPF scale. This instrument needs to be validated in other cohorts.


Assuntos
Anestesiologia/estatística & dados numéricos , Assertividade , Internato e Residência/estatística & dados numéricos , Relações Interpessoais , Salas Cirúrgicas/estatística & dados numéricos , Psicometria/normas , Adulto , Análise de Variância , Análise Fatorial , Feminino , Humanos , Masculino , Reprodutibilidade dos Testes
17.
World J Surg ; 43(11): 2934-2944, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31297580

RESUMO

BACKGROUND: Existing data suggest a large burden of surgical conditions in low- and middle-income countries (LMICs). However, surgical care for children in LMICs remains poorly understood. Our goal was to define the hospital infrastructure, workforce, and delivery of surgical care for children across Somaliland and provide policy guidance to improve care. METHODS: We used two established hospital assessment tools to assess infrastructure, workforce, and capacity at all hospitals providing surgical care for children across Somaliland. We collected data on all surgical procedures performed in children in Somaliland between August 2016 and July 2017 using operative logbooks. RESULTS: Data were collected from 15 hospitals, including eight government, five for-profit, and two not-for-profit hospitals. Children represented 15.9% of all admitted patients, and pediatric surgical interventions comprised 8.8% of total operations. There were 0.6 surgical providers and 1.2 anesthesia providers per 100,000 population. A total of 1255 surgical procedures were performed in children in all hospitals in Somaliland over 1 year, at a rate of 62.4 surgical procedures annually per 100,000 children. Care was concentrated at private hospitals within urban areas, with a limited number of procedures for many high-burden pediatric surgical conditions. CONCLUSIONS: We found a profound lack of surgical capacity for children in Somaliland. Hospital-level surgical infrastructure, workforce, and care delivery reflects a severely resource-constrained health system. Targeted policy to improved essential surgical care at local, regional, and national levels is essential to improve the health of children in Somaliland.


Assuntos
Assistência à Saúde/estatística & dados numéricos , Países em Desenvolvimento , Mão de Obra em Saúde/estatística & dados numéricos , Hospitais/estatística & dados numéricos , Procedimentos Cirúrgicos Operatórios/estatística & dados numéricos , Anestesiologistas/provisão & distribução , Anestesiologia/estatística & dados numéricos , Criança , Pré-Escolar , Feminino , Política de Saúde , Hospitais Privados/estatística & dados numéricos , Hospitais Públicos/estatística & dados numéricos , Hospitais Urbanos/estatística & dados numéricos , Hospitais Filantrópicos/estatística & dados numéricos , Humanos , Lactente , Recém-Nascido , Masculino , Somália , Cirurgiões/provisão & distribução
18.
Ann Card Anaesth ; 22(2): 199-203, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30971603

RESUMO

Background: Electronic monitoring of physiologic variables has gained widespread support over the past decade for critical patients in the intensive care setting. Specifically, anesthesiologists have increased the emphasis and practice of hemodynamic control through monitoring cardiac output (CO). However, these physicians are presented with several options in terms of how they wish to study the trend of this physiologic parameter. Materials and Methods: A survey was distributed to 250 general and subspecialty-trained anesthesiologists. A series of questions were presented in terms of preference of patient monitoring methods requiring yes or no answers. Anesthesiologists were asked about subspecialty training, years since residency graduation, and preferences toward specific hemodynamic monitoring tools. Nonparametric statistical analysis and Chi-squared tests were used to analyze both normal and nonnormally distributed data. Results: CO monitoring devices were implemented by 106 out of 133 anesthesiologists, with 98 of these physicians utilizing CO monitoring for fluid and vasopressors response. Of the physicians implementing a monitoring device, 48 out of 107 physicians preferred pulmonary artery catheter, while pulse contour analysis was preferred by 17 anesthesiologists. An echocardiography unit was available to the department for 90 anesthesiologists, and 77 anesthesiologists were trained to use this technology for monitoring cardiac function. Conclusion: Many anesthesiologists have placed emphasis on the importance of CO monitoring within the intensive care setting. However, physicians are still faced with multiple options in terms of how they wish to specifically monitor this hemodynamic variable. Factors that influence such decisions include the time of physician's residency training along with patient and clinical case characteristics.


Assuntos
Anestesiologia/estatística & dados numéricos , Débito Cardíaco , Pesquisas sobre Serviços de Saúde/estatística & dados numéricos , Monitorização Fisiológica/instrumentação , Monitorização Fisiológica/métodos , Serviços de Saúde para Veteranos Militares/estatística & dados numéricos , Anestesiologistas/estatística & dados numéricos , Técnica Delfos , Feminino , Humanos , Masculino , Estados Unidos
20.
Int J Surg ; 66: 72-78, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31029875

RESUMO

BACKGROUND: The Operating Theatre (OT) is the largest cost centre as well as the main revenue generator in most hospitals. One of the common problems affecting optimal OT utilization is the cancellation of scheduled surgeries. The goal of this study was to identify factors associated with cancellation within 24 h of scheduled surgeries in a tertiary hospital. METHODS: All elective surgeries performed on adults 18 years and above between June 2015 and December 2016 were included. Cancellations ≤24 h from the scheduled start time of the surgery were recorded, with their reasons for cancellation. Data relating to the patient, surgeon and planned surgery were obtained from the hospital operational database. Univariate analysis and multivariable analysis were conducted using logistic regression. RESULTS: A total of 4060 scheduled surgeries were included, of which 398 (9.8%) were cancelled within 24 h of surgery. On multivariate analysis, cancellation within 24 h of surgery was associated with history of heart failure (Adjusted odds ratio, AOR1.65; 95%CI 1.08-2.50), advanced chronic kidney disease (AOR2.33; 95%CI 1.58-3.39), or a history of hip fracture (AOR2.29; 95%CI 1.33-3.80), low socio-economic status (on Medifund financing, AOR3.16; 95%CI 1.37-6.72), history of ≥4 cancelled surgeries in the past 3 years (AOR2.38; 95%CI 1.30-4.19), and scheduled time in the afternoon (AOR1.83; 95%CI 1.44-2.32) and evening (AOR2.09; 95%CI0.73-5.13), compared to the morning. Attendance at preoperative anaesthesia assessment clinic was associated with reduced likelihood of cancellation (AOR0.55; 95%CI0.43-0.72). CONCLUSIONS: Several patient and system factors can be used to identify scheduled surgeries that are at high likelihood of cancellation within 24 h of surgery, which may inform strategies to improve the efficiency of OT utilization, including having a dedicated preoperative anaesthesia assessment clinic.


Assuntos
Centros Médicos Acadêmicos/estatística & dados numéricos , Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Pacientes não Comparecentes/estatística & dados numéricos , Salas Cirúrgicas/estatística & dados numéricos , Adulto , Anestesiologia/estatística & dados numéricos , Agendamento de Consultas , Estudos de Coortes , Comorbidade , Feminino , Pesquisa sobre Serviços de Saúde/métodos , Humanos , Masculino , Cuidados Pré-Operatórios/métodos , Fatores de Risco , Singapura , Classe Social , Centros de Atenção Terciária/estatística & dados numéricos , Fatores de Tempo
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