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5.
Br J Anaesth ; 124(3): e59-e62, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31973829

RESUMO

The Women in Anaesthesia Research Symposium (Prato, Italy; 4 June, 2019), supported by the British Journal of Anaesthesia in collaboration with Monash University, was organised to discuss challenges facing women in anaesthesia clinical practice and research. We provide an overview of institutional or departmental measures that were proposed during the symposium that may empower women in anaesthesia today.


Assuntos
Anestesiologia/organização & administração , Pesquisa Biomédica/organização & administração , Médicas , Mobilidade Ocupacional , Feminino , Humanos , Liderança , Sexismo/prevenção & controle , Assédio Sexual/prevenção & controle , Direitos da Mulher
6.
Br J Anaesth ; 124(3): e63-e69, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31980155

RESUMO

The under-representation of women in academic leadership roles, including in anaesthesiology, is a well-documented phenomenon that has persisted for decades despite more women attending medical school, participating in anaesthesiology residencies, and joining academic faculties. The percentage of female anaesthesiologists who hold senior academic ranks or leadership roles, such as chair, lags behind the percentage of female anaesthesiologists overall. Trends towards increasing the numbers of women serving in educational leadership roles, specifically residency programme directors, suggest that there are areas in which academic anaesthesiology has been, and can continue, improving gender imbalance. Continued institutional efforts to recruit women into anaesthesiology, reduce gender bias, and promote interventions that foster gender equity in hiring and promotion will continue to benefit women, academic anaesthesiology departments, and the healthcare system overall.


Assuntos
Anestesiologia/tendências , Internato e Residência/tendências , Médicas/tendências , Sexismo/tendências , Centros Médicos Acadêmicos/organização & administração , Centros Médicos Acadêmicos/tendências , Anestesiologia/educação , Anestesiologia/organização & administração , Escolha da Profissão , Mobilidade Ocupacional , Educação de Pós-Graduação em Medicina/organização & administração , Educação de Pós-Graduação em Medicina/tendências , Feminino , Humanos , Internato e Residência/organização & administração , Liderança , Médicas/estatística & dados numéricos , Faculdades de Medicina/organização & administração , Faculdades de Medicina/tendências , Sexismo/prevenção & controle , Estados Unidos
9.
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
10.
Curr Opin Anaesthesiol ; 32(4): 504-510, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31157626

RESUMO

PURPOSE OF REVIEW: To review the findings of National Transportation Safety Board-related aviation near misses and catastrophes and apply these principles to the nonoperating room anesthesia (NORA) suite. RECENT FINDINGS: NORA is a specialty that has seen tremendous growth. In 2019, NORA contributes to a larger proportion of anesthesia practice than ever before. With this growth, the NORA anesthesiologist and team are challenged to provide safe, high-quality care for more patients, often with complex comorbidities, and are forced to utilize deeper levels of sedation and anesthesia than ever before. These added pressures create new avenues for human error and adverse outcomes. SUMMARY: Safety in modern anesthesia practice often draws comparison to the aviation industry. From distinct preoperational checklists, defined courses of action, safety monitoring and the process of guiding individuals through a journey, there are many similarities between the practice of anesthesia and flying an airplane. Consistent human performance is paramount to creating safe outcomes. Although human errors are inevitable in any complex process, the goal for both the pilot and physician is to ensure the safety of their passengers and patients, respectively. As the aviation industry has had proven success at managing human error with a dramatic improvement in safety, a deeper look at several key examples will allow for comparisons of how to implement these strategies to improve NORA safety.


Assuntos
Anestesia/efeitos adversos , Anestesiologia/organização & administração , Aviação/organização & administração , Segurança do Paciente , Qualidade da Assistência à Saúde , Acidentes Aeronáuticos/prevenção & controle , Acidentes Aeronáuticos/estatística & dados numéricos , Anestesiologistas/organização & administração , Lista de Checagem , Humanos , Colaboração Intersetorial , Erros Médicos/prevenção & controle , Equipe de Assistência ao Paciente/organização & administração , Estados Unidos
11.
Anesth Analg ; 128(6): e109-e112, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31094811

RESUMO

While the literature regarding physicians' childbearing experiences is growing, there are no studies documenting those of anesthesiologists. We surveyed a convenience sample of 72 female anesthesiologists to obtain pilot data. Sixty-six women completed the survey (91.7% response rate), reporting 113 total births from before 1990 to present. Of all birth experiences, proportions of respondents reporting parental leave, lactation facilities, and lactation duration as adequate were 52.3%, 45.2%, and 58.3%, respectively. Most mothers (51.8%) gave birth to their first child while they were trainees. The majority (94.9%) favored an official statement supporting parental leave. These results may serve as groundwork for larger studies.


Assuntos
Anestesiologistas , Anestesiologia/organização & administração , Licença Parental , Adulto , Idoso , Atitude do Pessoal de Saúde , Aleitamento Materno , Feminino , Humanos , Internato e Residência , Pessoa de Meia-Idade , Mães , Parto , Médicos , Projetos Piloto , Inquéritos e Questionários
12.
Scand J Trauma Resusc Emerg Med ; 27(1): 42, 2019 Apr 11.
Artigo em Inglês | MEDLINE | ID: mdl-30975182

RESUMO

BACKGROUND: Pre-hospital Emergency Anaesthesia (PHEA) is regarded as one of the highest risk interventions that pre-hospital providers perform. AAGBI guidance from 2017 suggests the use of Key Performance Indicators (KPIs) to audit PHEA quality. The aim of this study was to develop KPIs for use in our service and evaluate their impact. METHODS: Using the AAGBI 2017 document as a guide we developed a list of ten auditable domains. Data for each case was extracted from the Electronic Patient Record (EPR) and a score assigned to each of the domains; one if the domain is achieved and zero if the domain is not achieved or if data is missing, giving a total score out of ten. This analysis is then presented as a colour-coded matrix alongside the score. Data were analysed monthly at our case review and governance meeting. The process was refined during the year and after 12 months a formal review of the KPI process occurred. RESULTS: Eighty-two cases were analysed. Domains with the highest percentage of achievement were: Indication 96%; Tube position confirmed 94% and Full AAGBI monitoring and Grade of view < 3 both 89%. The amount of missing data declined throughout the year. The results of the clinician survey showed that almost all respondents found the TVAA PHEA review process useful. CONCLUSION: The KPI process has demonstrated areas of good quality practice and led to improvements in equipment, processes and documentation and therefore patient care. We offer suggestions to other organisations considering implementing KPIs for PHEA.


Assuntos
Anestesia/normas , Anestesiologia/organização & administração , Emergências/epidemiologia , Hospitais , Indicadores de Qualidade em Assistência à Saúde/normas , Serviços Médicos de Emergência/normas , Humanos , Incidência , Reino Unido/epidemiologia
13.
Anesth Analg ; 128(4): 789-795, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30883424

RESUMO

Work stress is an integral part of anesthetic practice and has been a subject of many studies. Persistent stress can lead to burnout. There is limited published literature from lower- and middle-income countries where job stressors may be different from high-income countries. The aim of this study was to find out the level of burnout in a cohort of anesthesiologists working in academic institutions in 2 major cities of Pakistan, a low middle income country. We conducted an anonymous survey based on the Maslach Burnout Inventory scale with 3 major components: emotional exhaustion; depersonalization; and burnout in personal achievement. The demographic and other work-related details were collected in a standardized manner. Our response rate was 74.5%. Seventy-seven percent of the participants were residents and 23% consultants. Gender distribution was 66.9% males and 33.1% females. Thirty-nine percent (95% CI, 34.8%-44.1%) showed moderate- to high-level emotional exhaustion, 68.4% (95% CI, 63.9%-72.7%) showed a moderate to high level of depersonalization, and 50.3% (95% CI, 45.6%-55.07%) showed a moderate to high level of burnout in personal achievements. On multivariable analysis, anesthesia not being the primary career choice was significantly associated with all 3-dimensional scales for the whole cohort. Factors significantly associated with emotional exhaustion were Lahore as city of work, >2 nights on call per week, and >40 h/wk work inside the operating room. Depersonalization burnout was again associated with Lahore as city of work, >40 h/wk work inside the operating room, and personal achievement burnout with >2 on-call nights per week. No association was observed for gender, marital status, or having children. In conclusion, a high rate of burnout was identified in anesthesiologists working in 2 major cities in Pakistan. Some new associated factors such as initial choice of specialty and city of work were highlighted. Based on these findings, preventive and coping strategies need to be introduced at institutional and national levels.


Assuntos
Anestesiologistas/psicologia , Anestesiologia/organização & administração , Esgotamento Profissional , Estresse Ocupacional , Centros Médicos Acadêmicos , Adulto , Anestesiologia/métodos , Cidades , Estudos Transversais , Feminino , Humanos , Satisfação no Emprego , Masculino , Pessoa de Meia-Idade , Paquistão , Classe Social , Inquéritos e Questionários , Universidades , Carga de Trabalho/psicologia , Adulto Jovem
14.
Int J Med Educ ; 10: 62-67, 2019 Mar 29.
Artigo em Inglês | MEDLINE | ID: mdl-30927542

RESUMO

Objectives: To assess the correlation between perception of the learning environment and the approach to learning adopted by anesthesiology residents throughout training in an academic institution in the United States. Methods: This is a cross-sectional study involving forty-one anesthesiology residents who completed electronic forms of the Revised Two-Factor Study Process Questionnaire to assess learning approaches, and the Dundee Ready Educational Environment Measure questionnaire to assess learning environment. Convenience sampling was used with the current anesthesiology residents. Learning approaches were analyzed with a multiple regression model for correlation between total score, domains, and training level. Analysis of variance was used to assess differences in perception of the learning environment based on training level. Multivariate logistic regression was used to assess the correlation between domains of learning the environment and approaches questionnaires. Cronbach α was used to evaluate the internal consistency of responses within each domain of both questionnaires. Results: Forty-one residents completed the questionnaires. Cronbach α varied between 0.604 and 0.76 among the domains in the Study Process Questionnaire and was greater than 0.60 for the Dundee questionnaire. There was a moderate correlation between total deep approach scores and the total subjective perception of teachers scores (R2= - 0.507, p <0.01). There was no significant association between specific domains of Dundee and study process questionnaires and resident year of training. Conclusions: The learning approaches adopted by anesthesiology residents and the perception of the educational environment are not correlated with years of training. The DREEM and R-SPQ-2F questionnaires should not be recommended for evaluation of anesthesiology residents.


Assuntos
Anestesiologia/educação , Atitude do Pessoal de Saúde , Avaliação Educacional , Internato e Residência/métodos , Aprendizagem/fisiologia , Meio Social , Estudantes de Medicina , Adulto , Anestesiologia/métodos , Anestesiologia/organização & administração , Anestesiologia/normas , Estudos Transversais , Avaliação Educacional/métodos , Avaliação Educacional/normas , Feminino , Humanos , Internato e Residência/tendências , Masculino , Pessoa de Meia-Idade , Percepção/fisiologia , Estudantes de Medicina/psicologia , Estudantes de Medicina/estatística & dados numéricos , Inquéritos e Questionários , Estados Unidos/epidemiologia
15.
Curr Opin Anaesthesiol ; 32(2): 123-128, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30817383

RESUMO

PURPOSE OF REVIEW: Many hospitals, particularly large academic centers, have begun to provide 24-h in-house intensive care attending coverage. Proposed advantages for this model include improved patient care, greater provider, nursing and patient satisfaction, better communication, and greater cost-effectiveness. This review will evaluate current evidence with respect to 24/7 coverage, including patient outcomes, cost-effectiveness, and impact on training/education. RECENT FINDINGS: Evidence surrounding 24-h intensivist staffing has been mixed. Although a subset of studies suggest a possible benefit to 24-h intensivist coverage, recent prospective studies have shown no difference in major patient outcomes, including mortality and ICU length of stay between patients in ICUs with and those without 24-h intensivist coverage. SUMMARY: Although some studies cite increased caregiver and patient satisfaction, outcome studies find no consistent effect on patient-centered outcomes such as mortality or length of stay. Downsides to in-house nighttime attending staffing include physician burnout, adverse effects on physician health, decreased trainee autonomy, and effects on trainee specialty choices because of undesirable lifestyle considerations. Tele-ICU and other novel approaches may allow for attending supervision without physical presence.


Assuntos
Cuidados Críticos/organização & administração , Unidades de Terapia Intensiva/organização & administração , Admissão e Escalonamento de Pessoal/estatística & dados numéricos , Recursos Humanos/organização & administração , Anestesiologia/educação , Anestesiologia/organização & administração , Anestesiologia/estatística & dados numéricos , Análise Custo-Benefício , Cuidados Críticos/economia , Cuidados Críticos/estatística & dados numéricos , Hospitais/estatística & dados numéricos , Humanos , Unidades de Terapia Intensiva/economia , Unidades de Terapia Intensiva/estatística & dados numéricos , Satisfação do Paciente/estatística & dados numéricos , Recursos Humanos/economia , Recursos Humanos/estatística & dados numéricos
19.
J Clin Monit Comput ; 33(3): 541-542, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29956063

RESUMO

Following introduction of an Anesthesia Information Management System (AIMS) at a tertiary care, academic health sciences centre, a quality assurance initiative was conducted to assess staff opinions of the AIMS using a previously published, anonymous survey tool at 1 and 5 years following AIMS introduction. At 5 years compared to 1 year after implementation of AIMS, the majority (18 of 24, 75%) of responses to the survey questions had a statistically significant change (P < 0.05) in the proportion of respondents favoring AIMS compared to the 1 year survey. Domains noted to be more favorable 5 years compared to 1 year after AIMS introduction included patient safety in the Operating Rooms and Post-Anesthesia Care Unit, quality of handover and overall documentation, and communication amongst healthcare workers. The ideal time period at which to assess AIMS after introduction is not clear.


Assuntos
Anestesia Dentária , Anestesiologia/instrumentação , Anestesiologia/métodos , Atitude do Pessoal de Saúde , Sistemas Computadorizados de Registros Médicos/estatística & dados numéricos , Salas Cirúrgicas , Anestesiologistas , Anestesiologia/organização & administração , Comunicação , Documentação , Humanos , Gestão da Informação , Segurança do Paciente , Inquéritos e Questionários
20.
World J Surg ; 43(1): 24-35, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30128771

RESUMO

BACKGROUND: Improvement in the surgical system requires intersectoral coordination. To achieve this, the development of National Surgical, Obstetric, and Anaesthesia Plans (NSOAPS) has been recommended. One of the first steps of NSOAP development is situational analysis. On the ground situational analyses can be resource intensive and often duplicative. In 2016, the Ministry of Health of Tanzania issued a directive for the creation of an NSOAP. This systematic review aimed to assess if a comprehensive situational analysis could be achieved with existing data. These data would be used for evidence-based priority setting for NSOAP development and streamline any additional data collection needed. METHODS: A systematic literature review of scientific literature, grey literature, and policy documents was performed as per PRISMA. Extraction was performed for all articles relating to the five NSOAPS domains: infrastructure, service delivery, workforce, information management, and financing. RESULTS: 1819 unique articles were generated. Full-text screening produced 135 eligible articles; 46 were relevant to surgical infrastructure, 53 to workforce, 81 to service delivery, 11 to finance, and 15 to information management. Rich qualitative and quantitative data were available for each domain. CONCLUSIONS: Despite little systematic data collection around SOA, a thorough literature review provides significant evidence which often have a broader scope, longer timeline and better coverage than can be achieved through snapshot-stratified samples of directed on the ground assessments. Evidence from the review was used during stakeholder discussion to directly inform the NSOAP priorities in Tanzania.


Assuntos
Anestesiologia/organização & administração , Assistência à Saúde/organização & administração , Obstetrícia/organização & administração , Anestesiologia/estatística & dados numéricos , Assistência à Saúde/economia , Assistência à Saúde/estatística & dados numéricos , Instalações de Saúde , Mão de Obra em Saúde , Humanos , Gestão da Informação , Obstetrícia/estatística & dados numéricos , Segurança do Paciente , Tanzânia
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