Socioeconomic Deprivation and Utilization of Anesthetic Care During Pregnancy and Delivery

Socioeconomic deprivation is associated with reduced use of antenatal resources and poor maternal outcomes with pregnancy | Anesthesia & Analgesia

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Background: Research examining the association between socioeconomic deprivation and use of obstetric anesthesia care in a country providing universal health coverage is scarce. We hypothesized that in a country providing universal health coverage, France, socioeconomic deprivation is not associated with reduced use of anesthetic care during pregnancy and delivery. This study aimed to examine the association between socioeconomic deprivation and (1) completion of a mandatory preanesthetic evaluation during pregnancy and (2) use of neuraxial analgesia during labor.

Conclusions: In a country providing universal health care coverage, women who were socioeconomically deprived showed reduced completion of preanesthetic evaluation during pregnancy but not reduced use of neuraxial labor analgesia. Interventions should be targeted to socioeconomically deprived women to increase the completion of the preanesthetic evaluation.

Full reference: Kantor, E. et al. (2017) Socioeconomic Deprivation and Utilization of Anesthetic Care During Pregnancy and Delivery: A French Retrospective, Multicenter, Cohort Study. Anesthesia & Analgesia. Post Author Corrections: 13 July 2017

Referral From One Surgeon to Another to Reduce Maximum Waiting Time

Studies of shared (patient-provider) decision making for elective surgical care have examined both the decision whether to have surgery and patients’ understanding of treatment options | Anesthesia & Analgesia

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Background: We consider shared decision making applied to case scheduling, since implementation would reduce labor costs.

Methods: Study questions were presented in sequence of waiting times, starting with 4 workdays. “Assume the consultant surgeon (ie, the surgeon in charge) you met in clinic did not have time available to do your surgery within the next 4 workdays, but his/her colleague would have had time to do your surgery within the next 4 workdays. Would you have wanted to discuss with a member of the surgical team (eg, the scheduler or the surgeon) the availability of surgery with a different, equally qualified surgeon at Mayo Clinic who had time available within the next 4 workdays, on a date of your choosing?” There were 980 invited patients who underwent lung resection or cholecystectomy between 2011 and 2016; 135 respondents completed the study and 6 respondents dropped out after the study questions were displayed.

Results: The percentages of patients whose response to the study questions was “4 days” were 58.8% (40/68) among lung resection patients and 58.2% (39/67) among cholecystectomy patients. The 97.5% 2-sided confidence interval for the median maximum wait was 4 days to 4 days. Patients’ choices for the waiting time sufficient to discuss having another surgeon perform the procedure did not differ between procedures (P = .91). Results were insensitive to patients’ sex, age, travel time to hospital, or number of office visits before surgery (all P >= .20).

Conclusion: Our results indicate that bringing up the option with the patient of changing surgeons when a colleague is available and has the operating room time to perform the procedure sooner is being respectful of most patients’ individual preferences (ie, patient-centered).

Full reference: Logvinov, I. I. et al. (2017) Patient Survey of Referral From One Surgeon to Another to Reduce Maximum Waiting Time for Elective Surgery and Hours of Overutilized Operating Room Time. Anesthesia & Analgesia: Post Author Corrections: July 10, 2017

Nurse-led intervention helps carers’ manage medication and cancer pain

The potential benefits of a new nurse-led intervention in supporting carers to manage pain medication in people with terminal cancer are explored in this article | ScienceDaily

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Image source: frankieleon – Flickr // CC BY 2.0

A study funded by Marie Curie and Dimbleby Cancer Care published today shows the potential benefits of a new nurse-led intervention in supporting carers to manage pain medication in people with terminal cancer. Researchers from the University of Southampton, Cardiff University and University of Leeds have developed a nurse-led intervention to help carers with medication management, and evaluated its use in routine practice.

The Cancer Carers’ Medicines Management (CCMM) intervention addresses carers’ beliefs, knowledge and skills and promotes self-evaluation of competence. It centres on a structured conversational process between a nurse and carer. It is the first time that a study has attempted to integrate an intervention developed using input from carers and nurses into routine palliative care. The research showed that the CCMM intervention compared favourably with current practice as it offered a more systematic and comprehensive approach to supporting carer management of pain medicines.

Early Antibiotics & Fluids Key in Sepsis Management

Sepsis and septic shock are medical emergencies that require immediate action | Anesthesiology News

Early resuscitation should begin with early antibiotics and fluids, as well as the identification of the source of infection, according to new guidelines that were released at the Society of Critical Care Medicine’s (SCCM) 2017 Critical Care Congress.

In addition, the new guidelines say a health care provider who is trained and skilled in the management of sepsis should reassess the patient frequently at the bedside. “It is not the initial assessment, but the frequent reassessment that will make a difference,” said Andrew Rhodes, MD, FRCP, FRCA, FFICM, the co-chair of the guidelines committee.

Read the full news story here

Management of major trauma

Trauma remains one of the leading causes of mortality and morbidity in the UK | Anaesthesia and Intensive Care Medicine

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Trauma is the primary cause of mortality in the first four decades of life and has a significant impact on the economy of the nation. In recent years the structure of trauma care has undergone significant restructuring. This article will review the reports that led to these changes, discuss the changes that have occurred and describe some of the anaesthetic management of this important group of patients.

Full reference: pearson, J. et al. (2017) Management of major trauma. Anaesthesia and Intensive Care Medicine. Published online: June 24, 2017

 

Anesthesiology: July 2017 Podcast

New Issue of Anesthesiology
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Image source: Anesthesiology

On the cover:
Management of perioperative fluid impacts gastrointestinal function. In this issue of Anesthesiology, Gómez-Izquierdo et al. randomized patients undergoing laparoscopic colorectal surgery within an Enhanced Recovery After Surgery program to receive intraoperative goaldirected fluid therapy or fluid therapy based on traditional principles and assessed the impact on postoperative ileus. Intraoperative goal-directed fluid therapy did not reduce postoperative ileus, suggesting that previously demonstrated benefits might have been offset by advancements in perioperative care.