Canadian journal of anaesthesia = Journal canadien d'anesthésie
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Multicenter Study
The implementation of preoperative optimization in British Columbia: a quality improvement initiative.
Surgical patient optimization is a proactive approach to improve postoperative outcomes. This article reviews the development of the Surgical Patient Optimization Collaborative, an initiative supporting preoperative optimization in British Columbia, Canada. ⋯ Preoperative optimization programs were successfully implemented across multiple sites in British Columbia. High-quality clinical outcome analyses are still needed to determine the impact of preoperative optimization on postoperative outcomes. The insight gained from the Collaborative's implementation process may help inform future multicentre preoperative optimization efforts.
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Dr. Harold R. Griffith and Richard C. ⋯ Griffith and R. Gill reveal a professional relationship heretofore not appreciated. We discuss and consider these letters in the context of curare's remarkable history.
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Northern Ontario residents experience multiple health disparities compared with those in Southern Ontario. It is unknown whether this leads to differences in surgical outcomes. We sought to compare postoperative outcomes of patients from Northern and Southern Ontario. ⋯ Northern Ontario residency was not associated with increased odds of mortality after intermediate- to high-risk elective noncardiac surgery. Overall, we found no clinically meaningful differences in postoperative outcomes between patients from Northern and Southern Ontario.
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The purpose of this Special Article is to document the evolution of the anesthesia assistant (AA) profession in Canada and summarize AA practice at Canadian institutions as it exists today, five decades after Quebec and 15 years after most other provinces formalized AA practice. ⋯ This compilation of pan-Canadian AA data shows diverse models of practice and highlights the value to patients and the health care system as a whole of incorporating these allied professionals into the anesthesia care team (ACT). The present findings allow us to offer suggestions for consideration during discussions of retention, recruitment, program expansion, and cross-country collection of metrics and other data. We conclude by making six recommendations: 1. recognize that implementation of ACTs is a key element in solving the challenge of an increasing surgical backlog; 2. develop, or facilitate the development of, metrics and increase data-sharing nationally to enable health care authorities to better understand the importance of AAs in patient safety and perioperative efficiency; 3. develop and implement funding strategies to lower the barriers to AA training such as hospital-sponsored positions, ongoing salary support, and return-of-service arrangements; 4. ensure that salaries appropriately reflect the increased level of training and added levels of responsibility of certified AAs; 5. develop long-term strategies to ensure stable funding, recruitment and retention, and a better match between the number of AA training positions and the need for newly certified AAs; and 6. engage all stakeholders to acknowledge that AAs, as knowledgeable and specifically trained assistants, not only fulfill their defined clinical role but also contribute significantly to patient safety and clinical efficiency by assuming nondirect patient care tasks.
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In Canada, three out of 17 medical schools do not mandate an anesthesia rotation in their clerkship curriculum. Understanding the effects of a mandatory anesthesiology rotation is important in determining its value to the specialty and guiding decision-making for medical educators. We sought to determine whether a mandatory anesthesia rotation affected students' understanding of anesthesiology, as well as their perspectives on anesthesia. ⋯ The results of this national survey study show the benefits of including a mandatory clerkship rotation in anesthesiology, namely on increasing positive perceptions of the specialty, while also revealing avenues for future research and insights on how to further optimize a mandatory anesthesiology rotation in clerkship.