Survey Research

Perioperative Exercise Intention and Influencing Factors: A Multi-Centered Cross-Sectional Study

Objectives: This study aimed to evaluate the level and factors affecting the perioperative exercise intention in China.

Design: This study was a cross-sectional survey in Southwest China.

Methods: Four hundred and ninety nine participants were randomly sampled in eight medical centers from November 23, 2020 to November 27, 2020. The survey included sociodemographic information and a 24-item modified questionnaire, which aimed to evaluate the attitude toward daily exercise, perception of perioperative exercise, social support and the perioperative exercise intention. A multivariable linear regression model was used to evaluate the effect of different items on the patients' intention for perioperative exercise.

Results: A total of 523 responses (95.09%) were collected and 499 (95.41%) were analyzed. The level of exercise intention of the patients during the perioperative period was: 14.83% planned to exercise every day in the hospital, 21.04% planned to exercise every other day, and 35.87% planned to exercise every week. Intensity of daily exercise (P = 0.016), positive attitude of daily exercise (P < 0.001), positive attitude of perioperative exercise (P < 0.001) and social support (P < 0.001) were positively associated with the intention for perioperative exercise. Female (P = 0.012), non-tertiary center (P = 0.011), and preoperative anxiety (P = 0.023) was negatively associated with it.

Conclusions: The intention for perioperative exercise was low in Southwest China. The authors aimed to relieve preoperative anxiety, promote the education of perioperative exercise, design perioperative exercise programs, and provide more social support from medical staff and family for inpatients undergoing elective surgery.

The impact of COVID-19 on anaesthesia and critical care services in the UK: a serial service evaluation

Between October 2020 and January 2021, we conducted three national surveys to track anaesthetic, surgical and critical care activity during the second COVID‐19 pandemic wave in the UK. We surveyed all NHS hospitals where surgery is undertaken. Response rates, by round, were 64%, 56% and 51%. Despite important regional variations, the surveys showed increasing systemic pressure on anaesthetic and peri‐operative services due to the need to support critical care pandemic demands. During Rounds 1 and 2, approximately one in eight anaesthetic staff were not available for anaesthetic work. Approximately one in five operating theatres were closed and activity fell in those that were open. Some mitigation was achieved by relocation of surgical activity to other locations. Approximately one‐quarter of all surgical activity was lost, with paediatric and non‐cancer surgery most impacted. During January 2021, the system was largely overwhelmed. Almost one‐third of anaesthesia staff were unavailable, 42% of operating theatres were closed, national surgical activity reduced to less than half, including reduced cancer and emergency surgery. Redeployed anaesthesia staff increased the critical care workforce by 125%. Three‐quarters of critical care units were so expanded that planned surgery could not be safely resumed. At all times, the greatest resource limitation was staff. Due to lower response rates from the most pressed regions and hospitals, these results may underestimate the true impact. These findings have important implications for understanding what has happened during the COVID‐19 pandemic, planning recovery and building a system that will better respond to future waves or new epidemics.

Evaluación de la investigación con encuestas en artículos publicados en revistas del área de Biblioteconomía y Documentación

Introducción y objetivo: La investigación con encuestas es un método utilizado con frecuencia en el área de Biblioteconomía y Documentación. El objetivo principal de este estudio es evaluar si los estudios realizados en el ámbito de la Biblioteconomía que utilizan encuestas como método de investigación proporcionan información completa y detallada sobre su diseño y ejecución. Métodos: Se seleccionaron de la base de datos Web of Science los artículos publicados en 2019 en revistas del área de Library Science incluidas en el Journal Citation Reports que empleaban encuestas como método de investigación cuantitativa. Para valorar el grado de cobertura informativa se creó una herramienta formada por 32 elementos utilizados en diversas guías y recomendaciones. Resultados y conclusiones: La mayoría de los artículos basados en encuestas en el área de Biblioteconomía y Documentación presentan una grave deficiencia en la información proporcionada. Es necesario mejorar y completar información sobre el procedimiento de muestreo, desarrollo y administración del cuestionario, así como sobre el análisis de sus resultados. Esta información permitirá valorar los potenciales errores cometidos y, en consecuencia, la calidad y validez de las conclusiones del estudio.

National survey on sedation for gastrointestinal endoscopy in 2758 Chinese hospitals

BACKGROUND

Although sedation during gastrointestinal endoscopy is widely used in China, the characteristics of sedation use, including regional distribution, personnel composition, equipment used, and drug selection, remain unclear. The present study aimed to provide insights into the current practice and regional distribution of sedation for gastrointestinal endoscopy in China.

METHODS

A questionnaire consisting of 19 items was distributed to directors of anaesthesiology departments and anaesthesiologists in charge of endoscopic sedation units in mainland China through WeChat.

RESULTS

The results from 2758 participating hospitals (36.7% of the total) showed that 9 808 182 gastroscopies (69.3%) and 4 353 950 colonoscopies (30.7%), with a gastroscopy-to-colonoscopy ratio of 2.3, were conducted from January to December 2016. Sedation was used with 4 696 648 gastroscopies (47.9%) and 2 148 316 colonoscopies (49.3%), for a ratio of 2.2. The most commonly used sedative was propofol (61.0% for gastroscopies and 60.4% for colonoscopies). Haemoglobin oxygen saturation (SpO₂) was monitored in most patients (96.1%). Supplemental oxygen was routinely administered, but the availability of other equipment was variable (anaesthesia machine in 64.9%, physiological monitor in 84.4%, suction device in 72.3%, airway equipment in 75.5%, defibrillator in 32.7%, emergency kit in 57.0%, and difficult airway kit in 20.8% of centres responding).

CONCLUSIONS

The sedation rate for gastrointestinal endoscopy is much lower in China than in the USA and in Europe. The most commonly used combination of sedatives was propofol plus an opioid (either fentanyl or sufentanil). Emergency support devices, such as difficult airway devices and defibrillators, were not usually available.

How Many Older Informal Caregivers Are There in Europe? Comparison of Estimates of Their Prevalence from Three European Surveys

Informal caregivers are people providing some type of unpaid, ongoing assistance to a person with a chronic illness or disability. Long-term care measures and policies cannot take place without taking into account the quantitatively crucial role played by informal caregivers. We use the European Health Interview Survey (EHIS), the European Quality of Life Survey (EQLS), and the Study on Health and Ageing in Europe (SHARE) to measure the prevalence of informal caregivers in the European population, and analyze associated socio-demographic factors. This rate ranges between about 13 percent in Portugal and Spain, and more than 22 percent in Luxembourg, Belgium, and Denmark. It declines in older age groups and, on average, is lower in men than in women in all countries studied, and lower among the poorly educated compared to those with higher levels of education. However, large variance was observed in the average share of informal caregivers for most countries between the three surveys. Our findings, estimated through the three surveys, reveal common trends, but also a series of disparities. Additional research will be needed to enable policy makers to access a richer and more harmonized body of data, allowing them to adopt truly evidence-based and targeted policies and interventions in this field.

An environmental scan of pharmacists supporting pre-doctoral dental education institutions

PURPOSE/OBJECTIVES

Reports have described pharmacists providing services within academic dental settings. The full scope of these activities and where they exist is unreported. This environmental scan was performed to identify and summarize the levels in which pharmacists provide support to predoctoral dental education programs.

METHODS

A survey was circulated in summer 2019 to all CODA accredited dental schools through the American Dental Education Association (ADEA) clinical dean listserv. The IRB approved survey consisted of 23 questions pertaining to the pharmacist's role in predoctoral dental education programs. Institutions were asked whether pharmacists were used and what kinds of services pharmacists provided. Pharmacist roles were classified into standard pharmacy services, clinical pharmacy services, medication inventory, education, and administration/research. Univariate analysis was performed on responses and reported using descriptive statistics.

RESULTS

A response rate of 59.1% from 66 institutions was achieved. Of those responding, 28.21% reported utilizing a pharmacist at their institution. Of the institutions responding positively to utilizing a pharmacist, the most common standard pharmacy services used were patient counseling regarding a disease state (50%), and medication errors/adverse event reporting (60%). Some clinical pharmacy services provided were medication history collection (70%), advising antimicrobial selection (50%), and treatment plan consultation (60%). Pharmacists were also found to be active in education, school administration, and research.

CONCLUSION

Pharmacists are utilized at just over a quarter of responding CODA accredited predoctoral dental education institutions in the United States. Where deployed, pharmacists provide a wide array of services.

Management of Acute Ischemic Stroke in the Interventional Neuroradiology Suite During the COVID-19 Pandemic: A Global Survey

BACKGROUND

According to early reports, patients affected by coronavirus disease 2019 (COVID-19) are at an increased risk of developing cerebrovascular events, including acute ischemic stroke (AIS). The COVID-19 pandemic may also impose difficulties in managing AIS patients undergoing endovascular thrombectomy (EVT), as well as concerns for the safety of health care providers. This international global survey aims to gather and summarize information from tertiary care stroke centers on periprocedural pathways and endovascular management of AIS patients during the COVID-19 pandemic.

METHODS

A cross-sectional survey-based research questionnaire was sent to 259 tertiary care stroke centers with neurointerventional facilities worldwide.

RESULTS

We received 114 responses (response rate: 44%) from 25 different countries across all 5 continents. The number of AIS patients and EVT cases were reported to have decreased during the pandemic. Most participants reported conducting COVID-19 testing before (49%) or after the procedure (31%); 20% of centers did not test at all. Only 16% of participating centers reported using a negative pressure room for the thrombectomy procedure. Strikingly, 50% of participating centers reported no changes in the anesthetic management of AIS patients undergoing EVT during the pandemic.

CONCLUSIONS

This global survey provides information on the challenges in managing AIS patients undergoing EVT during the COVID-19 pandemic. Its findings can be used to improve patient outcomes and the safety of the health care team worldwide.

Current Neurologic Assessment and Neuroprotective Strategies in Cardiac Anesthesia: A Survey to the Membership of the Society of Cardiovascular Anesthesiologists

BACKGROUND

Neurologic injury and cognitive disorder after cardiac surgery are associated with morbidity and mortality. Variability in the application of neuroprotective strategies likely exists during cardiac surgery. The Society of Cardiovascular Anesthesiologists (SCA) conducted a survey among its members on common perioperative neuroprotective strategies: assessment of aortic atheromatous burden, management of intraoperative blood pressure, and use of cerebral oximetry.

METHODS

A 15-item survey was developed by 3 members of the SCA Continuous Practice Improvement - Cerebral Protection Working Group. The questionnaire was then circulated among all working group members, adapted, and tested for face validity. On March 26, 2018, the survey was sent to members of the SCA via e-mail using the Research Electronic Data Capture system. Responses were recorded until April 16, 2018.

RESULTS

Of the 3645 surveys e-mailed, 526 members responded (14.4%). Most responders worked in academic institutions (58.3%), followed by private practices (38.7%). Epiaortic ultrasound for the assessment of aortic atheromatous burden was most commonly utilized at the surgeon's request (46.5%). Cerebral oximetry was most commonly used in patients with increased perioperative risk of cerebral injury (41.4%). Epiaortic ultrasound (1.9%) and cerebral oximetry (5.2%) were rarely part of a standardized monitoring approach. A majority of respondents (52.0%) reported no standardized management strategies for neuroprotection during cardiac surgery at their institution. A total of 55.3% stated that no standardized institutional guidelines were in place for managing a patient's blood pressure intraoperatively or during cardiopulmonary bypass. When asked about patients at risk for postoperative cerebral injury, 41.3% targeted a blood pressure goal >65 mmHg during cardiopulmonary bypass. The majority of responders (60.4%) who had access to institutional rates of postoperative stroke/cerebral injury had standard neuroprotective strategies in place.

CONCLUSIONS

Our data indicate that approximately half of the respondents to this SCA survey do not use standardized guidelines/standard operating procedures for perioperative cerebral protection. The lack of standardized neuroprotective strategies during cardiac surgery may impact postoperative neurologic outcomes. Further investigations are warranted and should assess the association of standardized neuroprotective approaches and postoperative neurological outcomes.

Perspectives from Transgender and Gender Diverse People on How to Ask About Gender

Purpose: When inquiring about the gender of research participants, most studies use self-generated questions about gender or questions prepared by researchers that have been evaluated for comprehension by transgender and gender diverse (TGD) and cisgender individuals. However, many gaps still exist in this area, including identifying how TGD people would like to see their gender represented in questions about gender identity. To address this issue, we explored the perspectives of TGD people regarding the construction of questions about gender. Methods: In this online study of 695 TGD people (Mage = 25.52), participants provided written suggestions for how to ask about gender and these responses were analyzed thematically. Data were collected between fall 2015 and summer 2017. Results: Three broad categories of responses emerged: (1) specific identities to include in response options; (2) specific questions to ask about gender; and (3) qualifiers/nuanced considerations. Conclusion: Participants provided a variety of suggestions for how to ask about gender and future research is needed to explore the implementation of these suggestions. Recommendations are provided for options that researchers can explore for how to ask about gender. These findings highlight the ways that TGD people would like their gender to be asked about, which is necessary information to ensure that questions about gender reflect TGD people's identities accurately.

Assessing the Quality of Published Surveys in Ophthalmology

PURPOSE

Surveys are an important research modality in ophthalmology, but their quality has not been rigorously assessed. This study evaluated the quality of published ophthalmic surveys.

METHODS

Three survey methodologists, three senior ophthalmologists, and two research assistants developed a survey evaluation instrument focused on survey development and testing; sampling frame; response bias; results reporting; and ethics. Two investigators used the instrument to assess the quality of all ophthalmic surveys that were published between January 1, 2018 and December 31, 2018; indexed in MEDLINE/PubMed, Embase, and/or Web of Science; contained the search terms "ophthalmology" and "survey" or "questionnaire" in the title and/or abstract; and were available in English.

RESULTS

The search identified 626 articles; 60 met the eligibility criteria and were assessed with the survey evaluation instrument. Most surveys (93%; 56/60) defined the study population; 48% (29/60) described how question items were chosen; 30% (18/60) provided the survey for review or described the questions in sufficient detail; 30% (18/60) were pre-tested or piloted; 25% (15/60) reported validity/clinical sensibility testing; 15% (9/60) described techniques used to assess non-response bias; and 63% (38/60) documented review by an institutional review board (IRB).

CONCLUSION

The quality of published ophthalmic surveys can be improved by focusing on survey development, pilot testing, non-response bias and institutional review board review. The survey evaluation instrument can help guide researchers in conducting quality ophthalmic surveys and assist journal editors in evaluating surveys submitted for publication.

Anticoagulation Management and Antithrombin Supplementation Practice during Veno-venous Extracorporeal Membrane Oxygenation

Background

There is a lack of consensus on how to manage anticoagulation during veno-venous extracorporeal membrane oxygenation, including antithrombin monitoring and supplementation. The authors’ aim was to determine current practice in a large number of extracorporeal membrane oxygenation centers around the world.

Methods

This was an electronic survey disseminated in 2018 to directors and coordinators of extracorporeal membrane oxygenation centers as well as to extracorporeal membrane oxygenation experts. Participating centers were classified according to some covariates that may affect practice, including 2017 gross national income per capita, primary patient population, and annual extracorporeal membrane oxygenation patient volume.

Results

The authors analyzed 273 unique responses from 50 countries. Systemic anticoagulation was routinely prescribed in 264 (96.7%) centers, with unfractionated heparin being the drug of choice in 255 (96.6%) of them. The preferred method to monitor anticoagulation was activated partial thromboplastin time in 114 (41.8%) centers, activated clotting time in 82 (30.0%) centers, and anti-factor Xa activity in 62 (22.7%) centers. Circulating antithrombin activity was routinely monitored in 133 (48.7%) centers. Antithrombin supplementation was routinely prescribed in 104 (38.1%) centers. At multivariable analyzes, routine antithrombin supplementation was associated with national income, being less likely in lower- than in higher-income countries (odds ratio, 0.099 [95% CI, 0.022 to 0.45]; P = 0.003); with primary patient population being more frequent in mixed (odds ratio, 2.73 [1.23 to 6.0]; P = 0.013) and pediatric-only centers (odds ratio, 6.3 [2.98 to 13.2]; P &lt; 0.001) than in adult-only centers; but not with annual volume of extracorporeal membrane oxygenation cases, being similarly common in smaller and larger centers (odds ratio, 1.00 [0.48 to 2.08]; P = 0.997).

Conclusions

There is large practice variation among institutions regarding anticoagulation management and antithrombin supplementation during veno-venous extracorporeal membrane oxygenation. The paucity of prospective studies and differences across institutions based on national income and primary patient population may contribute to these findings.

Editor’s Perspective

What We Already Know about This Topic

What This Article Tells Us That Is New

Gender effects in anaesthesia training in Australia and New Zealand

BACKGROUND

Women face gender-based challenges in their medical education and career. Inequitable access to procedural training, a confidence gap, and professional identity deficit have been shown. We made a gender comparison of procedural case volume, confidence for independent practice, perceived gender and ethnic bias, and professional identity in Australasian anaesthesia trainees.

METHODS

An online, voluntary, anonymous survey using SurveyMonkey® was delivered to Australasian anaesthesia trainees. Information collected included demographics, experience and confidence in 12 anaesthetic procedures, assessments relating to confidence and professional identity, and perceived gender and ethnic bias. Gender differences were evaluated.

RESULTS

Three hundred and fifty-six trainees (22.2%) of the Australian and New Zealand College of Anaesthetists (ANZCA) responded. Male trainees reported a higher number (standard deviation) of procedures performed greater than 10 times (men 4.45 [2.55], women 3.78 [1.95]; P<0.001 adjusted for training level). Men were more likely to rate themselves at a training competency above their actual training level (men 18.6%, women 7.8%; P=0.004) and exaggerate procedural experience to supervisors (men 30.8%, women 11.8%; P<0.001). Final-year male trainees felt significantly more prepared for independent practice (P=0.021, trend across ordered responses). Women reported significantly higher levels of gender bias exhibited by patients (men 1.1%, women 84.5%; P<0.001) and in training overall (men 10.3%, women 55.3%; P<0.001), which was compounded in women with an ethnic minority background.

CONCLUSIONS

A discrepancy exists between the number of procedures performed by male and female anaesthesia trainees in Australia and New Zealand. Relative male overconfidence may be a major contributing factor to the gender confidence gap.

Health care professionals’ knowledge of commonly used sedative, analgesic and neuromuscular drugs: A single center (Rambam Health Care Campus), prospective, observational survey

Background

Methods

Results

Conclusion

Post-surgical opioid stewardship programs across Australia and New Zealand: Current situation and future directions

Community harm associated with prescription opioids is causing global concern, and post-hospital discharge prescribing is contributing to the problem. We surveyed anaesthetists in Australia and New Zealand to determine which opioid stewardship measures are currently in place, and to gauge interest in participating in future health services research on introducing an opioid stewardship bundle of care. A total of 87 anaesthetists from 87 hospitals were invited to participate, and 45 (52%) responded. The extent of nine current opioid stewardship measures reported was highly variable. One respondent (2%) reported no measures introduced at their hospital; 12 (27%) one to two measures; 16 (36%) three or four measures; 13 (29%) five to seven measures; and 3 (7%), all nine measures were in place. Respondents were often interested in being contacted about future trial participation ( n = 33, 73%); however, concerns regarding feasibility of introducing an opioid stewardship bundle of care were widespread ( n = 22, 49%). It is possible that the variability in Australian and New Zealand opioid stewardship practice is due, in part, to the current limited evidence base for the individual measures, in addition to challenges in research translation. We have found that interest in further research on opioid stewardship is high. Comprehensive, locally adapted, evidence-based opioid stewardship measures may increase the safety of patients and the community following opioid therapy.