British journal of anaesthesia
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An organizational approach is proposed as an immediate solution for improving postoperative pain (POP) management. The aim was to evaluate the clinical effectiveness of a quality management system (QMS), based on procedure-specific, multimodal analgesic protocols, modified to meet the individual patients' requirements. ⋯ The implementation of QMS allowed the reduction in POP intensity with a simultaneous decrease in analgesia-related side-effects. This has led to an increased quality of life and patient satisfaction.
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Prehospital oligoanalgesia is prevalent among trauma victims, even when the emergency medical services team includes a physician. We investigated if not only patients' characteristics but physicians' practice variations contributed to prehospital oligoanalgesia. ⋯ Physicians' practice variations contributed to oligoanalgesia, a factor often overlooked in analyses of prehospital pain management. Further exploration of the sources of these variations may provide innovative targets for quality improvement programmes to achieve consistent pain relief for trauma victims.
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Current thinking about patient safety emphasizes the relationship between organizational factors, that is, latent risk factors (LRFs) and patient safety. This study explores the influence of the operating theatre (OT), intensive care unit (ICU), and disciplines on ratings of LRFs. If we have an understanding of the contribution made by these factors, we can identify significant points from which we can promote a safe environment. ⋯ As healthcare focuses its safety efforts towards system issues rather than towards the individual provider of care, attention has turned to organizational factors, known as LRFs. Understanding how LRFs affect safety should enable us to design more effective measures that will improve overall safety. Strategies for improving patient safety should be tailored specifically for various clinical areas and disciplines.
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This study was conducted to provide preliminary data regarding current Internet use practices for information about anaesthesia in patients undergoing elective surgical procedures at a major academic institution. ⋯ Of the patients coming for elective surgery who responded (30%), the majority did not use the Internet to seek information regarding anaesthesia. Respondents indicated a high degree of interest in being directed to appropriate websites for further information. These results suggest that it may be beneficial to include information regarding reliable web-based resources to interested patients at preoperative visits.
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There are few national figures on the incidence of failed tracheal intubation during general anaesthesia in obstetrics. Recent small studies have quoted a rate of one in 250 general anaesthetics (GAs). The aim of this UK national study was to estimate this rate and identify factors that may be predictors. ⋯ We received 57 completed reports (100% response). The incidence using a unit-based estimation approach was one in 224 (95% confidence interval 179-281). Univariate analyses showed the index cases to be significantly older, heavier, with higher BMI, with Mallampati score recorded and score >1. Multivariate analyses showed that age, BMI, and a recorded Mallampati score were significant independent predictors of failed tracheal intubation. The classical laryngeal mask airway was the most commonly used rescue airway (39/57 cases). There was one emergency surgical airway but no deaths or hypoxic brain injuries. Gastric aspiration occurred in four (8%) index cases. Index cases were more likely to have maternal morbidities (P=0.026) and many babies in both groups were admitted to the neonatal intensive care unit: 21 (37%) vs 29 (27%) (NS). Three babies died--all in the control group.