British journal of anaesthesia
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Commercial aviation practices including the role of the pilot monitoring, the sterile flight deck rule, and computerised checklists have direct applicability to anaesthesia care. The pilot monitoring performs specific tasks that complement the pilot flying who is directly controlling the aircraft flight path. The anaesthesia care team, with two providers, can be organised in a manner that is analogous to the two-pilot flight deck. ⋯ Checklists are commonly used in the operating room, especially the World Health Organization surgical safety checklist. However, the use of aviation-style computerised checklists offers additional benefits. Here we discuss how these commercial aviation practices may be applied in the operating room.
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In the UK more women than men are practicing medicine, and for the first time in the history of the Royal College of Anaesthetists (RCoA), the president of the RCoA, Dean of the Faculty of Pain Medicine, and Dean of the Faculty of Intensive Care Medicine are all women. However, within the subspecialty of pain medicine, there are significantly more men practicing than women, with the most recent UK estimates identifying that only 26.7% of current pain physicians are women. ⋯ We discuss current trends in pain medicine recruitment within the UK, where most pain physicians are recruited from anaesthesia training programs, including the barriers to women's representation and reasons women enter the subspecialty. We advocate for speaker gender quotas at conferences, diversity considerate workforce planning, peer support groups, adjustments to training programs, and further research to help narrow the gender gap.
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Editorial Review
Propensity score methods in observational research: brief review and guide for authors.
Causal inference in observational research requires a careful approach to adjustment for confounding. One such approach is the use of propensity score analyses. In this editorial, we focus on the role of propensity score-based methods in estimating causal effects from non-randomised observational data. We highlight the details, assumptions, and limitations of these methods and provide authors with guidelines for the conduct and reporting of propensity score analyses.
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Retrospective observational studies have reported a significant association between intraoperative hypotension and postoperative morbidity. However, association does not imply causation, and whether preventing intraoperative hypotension can improve patient outcome remains to be demonstrated. ⋯ In contrast, they reported a statistically significant (but not clinically relevant) reduction in postoperative cardiac arrhythmia and hospital length of stay when targeting mean arterial pressure ≤60 mm Hg. These findings suggest that during most surgical cases, intraoperative hypotension is a marker of the severity, frailty, or both rather than a mediator of postoperative complications.
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Airway-related articles have featured heavily in the British Journal of Anaesthesia since it was founded in 1923. In the 100 years thereafter, 1102 airway-related articles have been published in the journal, written by 2955 unique authors from 55 different countries. In this editorial, we highlight some of the major publications in airway management and their impact on the specialty. Summaries of the most cited articles are contained within online supplementary material as well as links to all airway-related articles for readers who wish to delve deeper into this body of work.