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Milam AJ, Bonner T, Burton BN, Williams B, Youssef MR, Smith RN, Cannesson M, Troianos C, Pittet JF. The Difficulty Implementing Evidence-Based Practice in the Perioperative Setting. Anesth Analg 2024; 139:874-880. [PMID: 39052524 DOI: 10.1213/ane.0000000000006916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2024]
Affiliation(s)
- Adam J Milam
- From the Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Phoenix, Arizona
| | - Timethia Bonner
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
| | - Brittany N Burton
- Department of Anesthesiology and Perioperative Medicine, UCLA David Geffen School of Medicine, Los Angeles, California
| | - Brittney Williams
- Department of Anesthesiology, University of Maryland, Baltimore, Baltimore, Maryland
| | - Mohanad R Youssef
- From the Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Phoenix, Arizona
| | - Randi N Smith
- Department of Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Maxime Cannesson
- Department of Anesthesiology and Perioperative Medicine, UCLA David Geffen School of Medicine, Los Angeles, California
| | | | - Jean-Francois Pittet
- Deparment of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, Birmingham, Alabama
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Goldstein EC, Politi MC, Baraldi JH, Elwyn G, Campos H, Feng R, Mehta S, Whatley K, Schmitz V, Neuman MD. Refining, implementing, and evaluating an anesthesia choice conversation aid for older adults with hip fracture: protocol for a stepped wedge cluster randomized trial. Implement Sci Commun 2024; 5:97. [PMID: 39267183 PMCID: PMC11396076 DOI: 10.1186/s43058-024-00635-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2024] [Accepted: 09/02/2024] [Indexed: 09/14/2024] Open
Abstract
BACKGROUND Hip fracture surgery under general or spinal anesthesia is a common procedure for older adults in the United States (US). Although spinal or general anesthesia can be appropriate for many patients, and the choice between anesthesia types is preference-sensitive, shared decision-making is not consistently used by anesthesiologists counseling patients on anesthesia for this procedure. We designed an Option Grid™-style conversation aid, My Anesthesia Choice─Hip Fracture, to promote shared decision making in this interaction. This study will refine the aid and evaluate its implementation and effectiveness in clinical practice. METHODS The study will be conducted over 2 phases: qualitative interviews with relevant clinicians and patients to refine the aid, followed by a stepped wedge cluster randomized trial of the intervention at 6 settings in the US. Primary outcomes will include the percentage of eligible patients who receive the intervention (intervention reach) and the change in quality of patient/clinician communication (intervention effectiveness). Secondary outcomes addressing other RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) domains will also be collected. Outcomes will be compared between baseline data and an active implementation period and then compared between the active implementation period and a sustainment period. Implementation strategies are guided by three constructs from the Practical, Robust Implementation and Sustainability Model (PRISM): intervention, recipients, and implementation and sustainability infrastructure. DISCUSSION This is a novel, large-scale trial evaluating and implementing a shared decision-making conversation aid for anesthesia choices. Strong buy-in from site leads and expert advisors will support both the success of implementation and the future dissemination of results and the intervention. Results from this study will inform the broader implementation of this aid for patients with hip fractures and can lead to the development and implementation of similar conversation aids for other anesthesia choices. TRIAL REGISTRATION ClinicalTrials.gov, NCT06438640.
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Affiliation(s)
- Eliana C Goldstein
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine in St. Louis, 660 S Euclid Ave, Campus MSC 8100-94-02, St. Louis, MO, 63110, USA
| | - Mary C Politi
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine in St. Louis, 660 S Euclid Ave, Campus MSC 8100-94-02, St. Louis, MO, 63110, USA
| | - James H Baraldi
- Department of Anesthesiology and Critical Care, University of Pennsylvania Perelman School of Medicine, 308 Blockley Hall, 423 Guardian Drive, Philadelphia, PA, 19104, USA
- Center for Perioperative Outcomes Research and Transformation, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Glyn Elwyn
- Dartmouth College, 74 College Street, Hanover, NH, 03755, USA
| | | | - Rui Feng
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Samir Mehta
- Orthopaedic Trauma & Fracture Service, Department of Orthopaedic Surgery, Penn Medicine, 3737 Market Street, Philadelphia, PA, 19104, USA
| | - Karah Whatley
- Department of Anesthesiology and Critical Care, University of Pennsylvania Perelman School of Medicine, 308 Blockley Hall, 423 Guardian Drive, Philadelphia, PA, 19104, USA
| | - Viktoria Schmitz
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine in St. Louis, 660 S Euclid Ave, Campus MSC 8100-94-02, St. Louis, MO, 63110, USA
| | - Mark D Neuman
- Department of Anesthesiology and Critical Care, University of Pennsylvania Perelman School of Medicine, 308 Blockley Hall, 423 Guardian Drive, Philadelphia, PA, 19104, USA.
- Center for Perioperative Outcomes Research and Transformation, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA.
- Department of Medicine, Division of Geriatric Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
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Jaju R, Varshney S, Bihani P, Paliwal N, Karim HMR, Bhuyan D. Enhanced perioperative communication elevates patients' understanding, perception, and satisfaction for anesthesia services: Insights from a survey study. Saudi J Anaesth 2024; 18:376-387. [PMID: 39149746 PMCID: PMC11323907 DOI: 10.4103/sja.sja_104_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 02/27/2024] [Accepted: 02/27/2024] [Indexed: 08/17/2024] Open
Abstract
Background and Aims Anesthesiologists' services extend to many critical areas of any healthcare setup. However, there needs to be more understanding among the public regarding their crucial role. Preanesthesia evaluation (PAE) visits can disseminate information about anesthesiologists and services. We aimed to evaluate patient's knowledge and the impact of interview-based surveys on increasing knowledge about anesthesiologists and anesthesia services. Methodology It was a single-center, cross-sectional survey involving 550 patients aged 18-65 undergoing elective surgeries. Pre- and postoperative interviewer-assisted questionnaires were administered to assess patients' baseline knowledge and perception of anesthesia and anesthesiologists. Statistical analysis focused on demographic, educational, and previous anesthesia exposure among subgroups; a P-value <0.05 was considered significant. Results Less than half comprehended anesthesia's role as a specialist in inducing unconsciousness. 55.3% were unaware of general anesthesia, and 69.6% were unaware of regional anesthesia as a technique. Higher education and previous anesthesia exposure correlated with better awareness with regard to the perioperative role of anesthesiologists and their fields of work (P < 0.05). The postoperative survey indicated good satisfaction with anesthesiologists' services, which might be attributable to the survey-based interaction. Conclusion A significant need for more understanding regarding anesthesia and anesthesiologists' roles still prevails. Interview-based effective communication during PAE visits, perioperative period, and shared decision-making (SDM) improves patients' knowledge, comprehension, and satisfaction.
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Affiliation(s)
- Rishabh Jaju
- Department of Anaesthesiology, All India Institute of Medical Sciences, Deoghar, Jharkhand, India
| | - Saurabh Varshney
- Executive Director and CEO, All India Institute of Medical Sciences, Deoghar, Jharkhand, India
| | - Pooja Bihani
- Department of Anaesthesiology, Dr. S.N. Medical College, Jodhpur, Rajasthan, India
| | - Naveen Paliwal
- Department of Anaesthesiology, Dr. S.N. Medical College, Jodhpur, Rajasthan, India
| | - Habib Md. R Karim
- Department of Anaesthesiology, All India Institute of Medical Sciences, Deoghar, Jharkhand, India
| | - Dipak Bhuyan
- Department of Anaesthesiology, All India Institute of Medical Sciences, Deoghar, Jharkhand, India
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Wang J, Wang S, Zeng R. Knowledge and attitude of surgical patients and their families toward anesthesia. Front Med (Lausanne) 2024; 11:1371785. [PMID: 38841590 PMCID: PMC11150525 DOI: 10.3389/fmed.2024.1371785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Accepted: 05/03/2024] [Indexed: 06/07/2024] Open
Abstract
Introduction Anesthesia plays a critical role in modern surgical procedures by ensuring patient pain management and safety. This study aimed to investigate the knowledge and attitude of surgical patients and their families toward anesthesia. Methods This prospective, cross-sectional study included patients and their families in Wenzhou, China. Data collection and the measurement of knowledge and attitude scores were administered using a self-administered questionnaire. Results 503 participants (69.98% patients, 30.02% families) were included. The mean knowledge and attitude scores were 7.93 ± 6.11 (possible range: 0-26), and 32.64 ± 2.59 (possible range: 8-40), respectively, indicating an inadequate knowledge and positive attitude. Moreover, a multivariable logistic regression analysis showed that age [odd ratio (OR) = 0.394, p = 0.018], residence (OR = 0.424, p = 0.002), household income per month (OR = 0.297 ~ 0.380, p < 0.05), gender (OR = 1.680, p = 0.017), education (OR = 2.891, p = 0.017), and experienced anesthesia (OR = 4.405, p = 0.001) were independently associated with knowledge score. Additionally, knowledge score (OR = 1.096, p < 0.001), relationship with the patient (OR = 1.902, p = 0.009), and household income per month (OR = 0.545, p < 0.031) were independently associated with attitude score. Discussion In conclusion, surgical patients and their families in Wenzhou, China had inadequate knowledge while positive attitude towards anesthesia, which might be influenced by their sociodemographic characteristics, including age, gender, residence, education, household income, relationship with patient, and experienced anesthesia. These findings emphasize the necessity of customized educational programs aimed at improving anesthesia knowledge and attitudes of patients and their families, especially among those with older age and lower socioeconomic status.
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Affiliation(s)
- Jie Wang
- Department of Anesthesiology and Perioperative Medicine, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
- Key Laboratory of Pediatric Anesthesiology, Ministry of Education, Wenzhou Medical University, Wenzhou, Zhejiang, China
- Key Laboratory of Anesthesiology of Zhejiang Province, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Shuai Wang
- Department of Anesthesiology and Perioperative Medicine, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
- Key Laboratory of Pediatric Anesthesiology, Ministry of Education, Wenzhou Medical University, Wenzhou, Zhejiang, China
- Key Laboratory of Anesthesiology of Zhejiang Province, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Ruifeng Zeng
- Department of Anesthesiology and Perioperative Medicine, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
- Key Laboratory of Pediatric Anesthesiology, Ministry of Education, Wenzhou Medical University, Wenzhou, Zhejiang, China
- Key Laboratory of Anesthesiology of Zhejiang Province, Wenzhou Medical University, Wenzhou, Zhejiang, China
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Neuman MD, Elwyn G, Graff V, Schmitz V, Politi MC. My anesthesia Choice-HF: development and preliminary testing of a tool to facilitate conversations about anesthesia for hip fracture surgery. BMC Anesthesiol 2024; 24:165. [PMID: 38693498 PMCID: PMC11061990 DOI: 10.1186/s12871-024-02547-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 04/19/2024] [Indexed: 05/03/2024] Open
Abstract
BACKGROUND Patients often desire involvement in anesthesia decisions, yet clinicians rarely explain anesthesia options or elicit preferences. We developed My Anesthesia Choice-Hip Fracture, a conversation aid about anesthesia options for hip fracture surgery and tested its preliminary efficacy and acceptability. METHODS We developed a 1-page, tabular format, plain-language conversation aid with feedback from anesthesiologists, decision scientists, and community advisors. We conducted an online survey of English-speaking adults aged 50 and older. Participants imagined choosing between spinal and general anesthesia for hip fracture surgery. Before and after viewing the aid, participants answered a series of questions regarding key outcomes, including decisional conflict, knowledge about anesthesia options, and acceptability of the aid. RESULTS Of 364/409 valid respondents, mean age was 64 (SD 8.9) and 59% were female. The proportion indicating decisional conflict decreased after reviewing the aid (63-34%, P < 0.001). Median knowledge scores increased from 50% correct to 67% correct (P < 0.001). 83% agreed that the aid would help them discuss options and preferences. 76.4% would approve of doctors using it. CONCLUSION My Anesthesia Choice-Hip Fracture decreased decisional conflict and increased knowledge about anesthesia choices for hip fracture surgery. Respondents assessed it as acceptable for use in clinical settings. PRACTICE IMPLICATIONS Use of clinical decision aids may increase shared decision-making; further testing is warranted.
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Affiliation(s)
- Mark D Neuman
- Department of Anesthesiology and Critical Care, University of Pennsylvania Perelman School of Medicine, 308 Blockley Hall 423 Guardian Drive, Philadelphia, PA, 19106, USA.
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, USA.
- Center for Perioperative Outcomes Research and Transformation, University of Pennsylvania Perelman School of Medicine, Philadelphia, USA.
- Department of Medicine, Division of Geriatric Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, USA.
| | | | - Veena Graff
- Department of Anesthesiology and Critical Care, University of Pennsylvania Perelman School of Medicine, 308 Blockley Hall 423 Guardian Drive, Philadelphia, PA, 19106, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, USA
- Center for Perioperative Outcomes Research and Transformation, University of Pennsylvania Perelman School of Medicine, Philadelphia, USA
| | - Viktoria Schmitz
- Division of Public Health Sciences, Department of Surgery, Washington University in St. Louis, St. Louis, USA
| | - Mary C Politi
- Division of Public Health Sciences, Department of Surgery, Washington University in St. Louis, St. Louis, USA
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Ali TZ, Zil-E-Ali A, Lavanga E, Aziz F. Race-Based Variation in the Utilization of Epidural Analgesia in Addition to General Anesthesia for Open Abdominal Aortic Aneurysm Repair in the United States. Ann Vasc Surg 2024; 102:101-109. [PMID: 38307225 DOI: 10.1016/j.avsg.2023.11.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 11/20/2023] [Accepted: 11/25/2023] [Indexed: 02/04/2024]
Abstract
BACKGROUND Epidural analgesia (EA) is recommended along with general anesthesia (GA) for patients undergoing open abdominal aortic aneurysm repair (AAA) and is known to be associated with improved postoperative outcomes. This study evaluates inequities in using this superior analgesic approach and further assesses the disparities at patient and hospital levels. METHODS A retrospective analysis was performed using the Vascular Quality Initiative database of adult patients undergoing elective open AAA repair between 2003 and 2022. Patients were grouped and analyzed based on anesthesia utilization, that is, EA + GA (Group I) and GA only (Group II). Study groups were further stratified by race, and outcomes were studied. Univariate and multivariate analyses were performed to study the impact of race on the utilization of EA with GA. A subgroup analysis was also carried out to learn the EA analgesia utilization in hospitals performing open AAA with the least to most non-White patients. RESULTS A total of 8,940 patients were included in the study, of which EA + GA (Group I) comprised n = 4,247 (47.5%) patients, and GA (Group II) had n = 4,693 (52.5%) patients. Based on multivariate regression analysis, the odds ratio of non-White patients receiving both EA and GA for open AAA repair compared to White patients was 0.76 (95% confidence interval: 0.53-0.72, P < 0.001). Of the patients who received both EA + GA, non-White race was associated with increased length of intensive care unit stay and a longer total length of hospital stay compared to White patients. Hospitals with the lowest quintile of minorities had the highest utilization of EA + GA for all patients compared to the highest quintile. CONCLUSIONS Non-White patients are less likely to receive the EA + GA than White patients while undergoing elective open AAA repair, demonstrating a potential disparity. Also, this disparity persists at the hospital level, with hospitals with most non-White patients having the least EA utilization, pointing toward system-wide disparities.
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Affiliation(s)
- Tarik Z Ali
- Division of Vascular Surgery, Heart & Vascular Institute, Penn State Milton S. Hershey Medical Center, Hershey, PA
| | - Ahsan Zil-E-Ali
- Division of Vascular Surgery, Heart & Vascular Institute, Penn State Milton S. Hershey Medical Center, Hershey, PA.
| | - Elizabeth Lavanga
- Office of Medical Education, Penn State University College of Medicine, Hershey, PA
| | - Faisal Aziz
- Division of Vascular Surgery, Heart & Vascular Institute, Penn State Milton S. Hershey Medical Center, Hershey, PA
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Gaudet JG, Levy CS, Jakus L, Goettel N, Meling TR, Quintard H. Early Extubation After Elective Infratentorial Craniotomy: Results of the International PRICE Survey. J Neurosurg Anesthesiol 2024; 36:69-73. [PMID: 36322959 DOI: 10.1097/ana.0000000000000894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 09/16/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Early extubation, defined as removal of the endotracheal tube at the end of surgery before transfer to a designated postoperative care area, is associated with better outcomes after elective infratentorial craniotomy. The Predicting Infratentorial Craniotomy Extubation (PRICE) project was an international survey designed to estimate the rate of early extubation after elective infratentorial craniotomy, as reported by neuroanesthesiologists, neurosurgeons, and neurocritical care specialists. METHODS Following research ethics board waiver, the 15-question online PRICE survey was circulated to the members of 5 international medical societies over a 15-week period. RESULTS One hundred and ninety of 5453 society members completed the survey (3.5% response rate). Respondents represented a total of 99 institutions from 92 cities, in 27 countries. While 84 of 188 (44.7%) respondents reported achieving early extubation in more than 95% of cases, 43 of 188 (22.9%) reported extubating fewer than 75% of cases early. The proportion of physicians who reported extubating at least 75% of cases early was greater in high-volume compared with low-volume institutions (73.5% vs. 50.9%, respectively; P =0.003) and among anesthesiologists compared with other specialties (75.6% vs. 45.6%, respectively; P <0.001). Preoperative bulbar dysfunction, preoperative altered consciousness and the course of surgery were the 3 factors with the biggest impact on the decision to extubate early versus late among respondents. CONCLUSIONS The reported rate of early extubation after elective infratentorial craniotomy varies widely between institutions, with respondents from high-volume institutions reporting greater rates of early extubation than those from lower-volume centers. The course of surgery, evidence of bulbar dysfunction, and altered consciousness, appear to affect the decision to extubate early more than other predictors.
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Affiliation(s)
- John G Gaudet
- Department of Anesthesiology, Lausanne University Hospital, Lausanne
| | - Camille S Levy
- Department of Anesthesiology, Riviera-Chablais Hospital, Rennaz
| | - Lien Jakus
- Division of Anesthesiology, Department of Anesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine
| | - Nicolai Goettel
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, FL
- Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Torstein R Meling
- Department of Neurosurgery, Geneva University Hospital, Geneva
- Department of Neurological Surgery Istituto Nazionale Neurologico "C. Besta" Milan, Italy
| | - Hervé Quintard
- Division of Intensive Care Medicine, Department of Anesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospital
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De Jong A, Penne C, Kapandji N, Touaibia M, Laatar C, Penne M, Carr J, Pouzeratte Y, Jaber S. Determinants of information provided by anaesthesiologists to relatives of patients during surgical procedures. BJA OPEN 2023; 7:100205. [PMID: 37638078 PMCID: PMC10457491 DOI: 10.1016/j.bjao.2023.100205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 06/07/2023] [Indexed: 08/29/2023]
Abstract
Background Data and interventions are lacking for family-centred perioperative care in adults. Perioperative information given to relatives by nurses or surgeons is associated with improved satisfaction and fewer symptoms of anxiety for relatives and the patient themselves. However, the frequency of the provision of information by anaesthesiologists to patients' relatives during surgery has never been reported. Methods A cross-sectional survey was sent to French anaesthesiologists in October 2020 to inquire how often they provided information to patients' family members during surgery and what factors led to them providing information frequently (i.e. in more than half of cases). Results Among 607 anaesthesiologists, 53% (319/607) were male, with median age 47 (36-60) yr and nearly half (43%, 260/607) reported more than 20 years of clinical experience; most responders (96%, 580/607) mainly treated adults. Forty-nine (8%) anaesthesiologists declared that they frequently provide information to relatives during surgery. After multivariate analysis, age >50 yr, female gender, and paediatric practice were associated with providing information more frequently. Reasons for not providing information included a lack of time and dedicated space to talk to relatives. Urgent surgery or surgery lasting >2 h were identified as factors associated with provision of information to relatives. Conclusions Giving information to relatives during surgery is not a common practice among anaesthesiologists. It depends on individual anaesthesiologists' personal characteristics and practice. Information during surgery could be provided systematically in situations identified as being the most important by anaesthesiologists in our survey. By creating new pathways of information, we could reduce stress and anxiety of patients and relatives.
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Affiliation(s)
- Audrey De Jong
- PhyMedExp, University of Montpellier, INSERM, CNRS, CHU Montpellier, France
- Département d’Anesthésie-Réanimation, Hôpital Saint-Eloi, Montpellier, France
| | - Clara Penne
- Département d’Anesthésie-Réanimation, Hôpital Saint-Eloi, Montpellier, France
| | - Natacha Kapandji
- GRC 29, AP-HP, DMU DREAM, Department of Anesthesiology and Critical Care, Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France
| | - Maha Touaibia
- Département d’Anesthésie-Réanimation, Hôpital Saint-Eloi, Montpellier, France
| | - Chahir Laatar
- Département d’Anesthésie-Réanimation, Hôpital Saint-Eloi, Montpellier, France
| | - Michaela Penne
- Département d’Anesthésie-Réanimation, Hôpital Saint-Eloi, Montpellier, France
| | - Julie Carr
- Département d’Anesthésie-Réanimation, Hôpital Saint-Eloi, Montpellier, France
| | - Yvan Pouzeratte
- Département d’Anesthésie-Réanimation, Hôpital Saint-Eloi, Montpellier, France
| | - Samir Jaber
- PhyMedExp, University of Montpellier, INSERM, CNRS, CHU Montpellier, France
- Département d’Anesthésie-Réanimation, Hôpital Saint-Eloi, Montpellier, France
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El-Jack K, Henderson K, Andy AU, Southwick L. Reddit Users' Questions and Concerns about Anesthesia. INTERNATIONAL JOURNAL OF MEDICAL STUDENTS 2023. [DOI: 10.5195/ijms.2022.1687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023] Open
Abstract
Background: Patients utilize social media in search of support networks. Reddit is one of the most popular social media sites and allows users to anonymously connect. Anesthesia patients are actively using Reddit to discuss their treatment options and experiences within the medical system.
Methods: Posts published on an active Reddit forum on Anesthesia (i.e., /r/Anesthesia) were used. Big Query was used to collect posts from /r/Anesthesia. We collected 3,288 posts published between December 2015 and August 2019. We collected a control group of 3,288 posts from a Reddit forum not related to Anesthesia. Using latent Dirichlet allocation (LDA) we extracted 20 topics from our data set. The LDA topic themes most associated with posts in /r/Anesthesia compared to the control group were determined.
Results: LDA analysis of posts in /r/Anesthesia relative to a control group produced 6 distinct categories of posts (Table 1). The posts most associated with /r/Anesthesia when compared to a control group were posts belonging to the “Physician-Patient Experience” category (Cohen’s d= 0.389) while the posts least associated with /r/Anesthesia were from the “Uncertainties” category of posts (Cohen’s d= 0.147). Example experiences from members of the /r/Anesthesia forum highlight subjective experiences of patients undergoing anesthesia.
Conclusions: The language used on social media can provide insights into an individual's experience with anesthesia and inform physicians about patient concerns. Anesthesiologists are poised to address these concerns and prevent anonymous misinformation by providing verified physician insights on the forum /r/Anesthesia.
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Berlin JA, Rubenfeld GD, O'Cearbhaill RE, Shah AS, Fihn SD. Keeping Meta-analyses Fresh. JAMA Netw Open 2022; 5:e2228541. [PMID: 36001322 DOI: 10.1001/jamanetworkopen.2022.28541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Jesse A Berlin
- Center for Pharmacoepidemiology and Treatment Science, Rutgers University, New Brunswick, New Jersey
- JAMA Network Open , Chicago, Illinois
| | - Gordon D Rubenfeld
- JAMA Network Open , Chicago, Illinois
- Sunnybrook Health Sciences Center, Program in Trauma, Emergency, and Critical Care, Interdepartmental Division of Critical Care Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Roisin E O'Cearbhaill
- JAMA Network Open , Chicago, Illinois
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Amy Sanghavi Shah
- JAMA Network Open , Chicago, Illinois
- University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Stephan D Fihn
- JAMA Network Open , Chicago, Illinois
- Department of Medicine, University of Washington, Seattle, Seattle
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Demchenko I, Blumberger DM, Flint AJ, Anderson M, Daskalakis ZJ, Foley K, Karkouti K, Kennedy SH, Ladha KS, Robertson J, Vaisman A, Koczerginski D, Parikh SV, Bhat V. Electroconvulsive Therapy in Canada During the First Wave of COVID-19: Results of the "What Happened" National Survey. J ECT 2022; 38:52-59. [PMID: 34519681 PMCID: PMC8875437 DOI: 10.1097/yct.0000000000000801] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 06/21/2021] [Indexed: 01/09/2023]
Abstract
OBJECTIVES The COVID-19 pandemic has disrupted the provision of essential and potentially life-saving procedural treatments such as electroconvulsive therapy (ECT). We surveyed ECT providers across Canada to understand how the first wave of the pandemic affected ECT delivery between mid-March 2020 and mid-May 2020. METHODS The survey was administered to ECT team members and decision makers at 107 Canadian health care centers with a focus on 5 domains: operations, decision-making, hospital resources, ECT procedure, and patient impact. Responses were obtained from 72 institutions, and collected answers were used to derive representative responses reflecting the situation at each ECT center. For specific domains, responses were split into 2 databases representing the perspective of psychiatrists (n = 67 centers) and anesthesiologists (n = 24 centers). RESULTS Provision of ECT decreased in 64% centers and was completely suspended in 27% of centers after the onset of the pandemic. Outpatient and maintenance ECT were more affected than inpatient and acute ECT. Programs reported a high level of collaboration between psychiatry and hospital leadership (59%) but a limited input from clinical ethicists (18%). Decisions were mostly made ad hoc leading to variability across institutions in adopted resource allocation, physical location of ECT delivery, and triaging frameworks. The majority of centers considered ECT to be aerosol-generating and incorporated changes to airway management. CONCLUSIONS Electroconvulsive therapy services in Canada were markedly disrupted by the COVID-19 pandemic. The variability in decision-making across centers warrants the development of a rational approach toward offering ECT in pandemic contexts.
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Affiliation(s)
- Ilya Demchenko
- From the Interventional Psychiatry Program, Mental Health and Addictions Service, St Michael's Hospital
| | - Daniel M. Blumberger
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health
- Department of Psychiatry, University of Toronto
- Institute of Medical Science, University of Toronto
| | - Alastair J. Flint
- Department of Psychiatry, University of Toronto
- Institute of Medical Science, University of Toronto
- Centre for Mental Health, University Health Network
| | - Melanie Anderson
- Library and Information Services, University Health Network, Toronto, Ontario, Canada
| | | | - Karen Foley
- Department of Anesthesia and Pain Management, University Health Network
- Department of Anesthesiology and Pain Medicine
| | - Keyvan Karkouti
- Department of Anesthesia and Pain Management, University Health Network
- Department of Anesthesiology and Pain Medicine
- Institute of Health Policy, Management, and Evaluation, University of Toronto
| | - Sidney H. Kennedy
- From the Interventional Psychiatry Program, Mental Health and Addictions Service, St Michael's Hospital
- Department of Psychiatry, University of Toronto
- Institute of Medical Science, University of Toronto
| | - Karim S. Ladha
- Department of Anesthesiology and Pain Medicine
- Institute of Health Policy, Management, and Evaluation, University of Toronto
- Department of Anesthesia
| | - Jamie Robertson
- Centre for Clinical Ethics, St Michael's Hospital
- Dalla Lana School of Public Health, University of Toronto
| | - Alon Vaisman
- Department of Infection Prevention and Control, University Health Network
| | - David Koczerginski
- Department of Psychiatry, North York General Hospital, Toronto, Ontario, Canada
| | - Sagar V. Parikh
- Department of Psychiatry, University of Michigan, Ann Arbor, MI
| | - Venkat Bhat
- From the Interventional Psychiatry Program, Mental Health and Addictions Service, St Michael's Hospital
- Department of Psychiatry, University of Toronto
- Institute of Medical Science, University of Toronto
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Yefimova M, Aslakson RA. Preoperative Conversations About Postoperative Risks, Outcomes, and Quality of Life-Time to Start Thinking Outside the Box. JAMA Netw Open 2020; 3:e2024048. [PMID: 33180125 DOI: 10.1001/jamanetworkopen.2020.24048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Maria Yefimova
- Office of Research, Patient Care Services, Stanford Healthcare, Stanford, California
- Department of Medicine and Division of Primary Care and Population Health, Section of Palliative Care, Stanford University, Stanford, California
| | - Rebecca A Aslakson
- Department of Medicine and Division of Primary Care and Population Health, Section of Palliative Care, Stanford University, Stanford, California
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, California
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