RESUMEN
Pulse oximetry is mandatory during anaesthesia in many countries, a standard endorsed by the World Health Organization 'Safe Surgery Saves Lives' initiative. The Association of Anaesthetists of Great Britain and Ireland, the World Federation of Societies of Anaesthesiologists and GE Healthcare collaborated in a quality improvement project over a 15-month period to investigate pulse oximetry in four pilot sites in Uganda, Vietnam, India and the Philippines, using 84 donated pulse oximeters. A substantial gap in oximeter provision was demonstrated at the start of the project. Formal training was essential for oximeter-naïve practitioners. After introduction of oximeters, logbook data were collected from over 8000 anaesthetics, and responses to desaturation were judged appropriate. Anaesthesia providers believed pulse oximeters were essential for patient safety and defined characteristics of the ideal oximeter for their setting. Robust systems for supply and maintenance of low-cost oximeters are required for sustained uptake of pulse oximetry in low- and middle-income countries.
Asunto(s)
Monitoreo Intraoperatorio/métodos , Oximetría/estadística & datos numéricos , Calidad de la Atención de Salud , Adulto , Anestesia General/normas , Anestesiología/educación , Actitud Frente a la Salud , Niño , Países en Desarrollo , Educación Médica Continua/métodos , Diseño de Equipo , Humanos , Lactante , Cooperación Internacional , Área sin Atención Médica , Persona de Mediana Edad , Monitoreo Intraoperatorio/instrumentación , Monitoreo Intraoperatorio/normas , Oximetría/instrumentación , Oximetría/normas , Proyectos Piloto , Administración de la Seguridad/métodos , Adulto JovenRESUMEN
Global Oximetry (GO) is an initiative launched recently in Uganda, India, the Philippines and Vietnam. The overall aims are to promote oximetry utilisation and reduce oximetry costs in lower income countries. Research objectives include studying the feasibility of cost reduction; overcoming non-cost barriers to global oximetry including issues of prioritization; education and guidelines; servicing and access to parts. Promotional objectives include creating new policy, influencing oximetry design, and setting new global standards for safer monitoring.
Asunto(s)
Países en Desarrollo , Cooperación Internacional , Monitoreo Intraoperatorio/métodos , Oximetría/estadística & datos numéricos , Costos y Análisis de Costo/estadística & datos numéricos , Humanos , Oximetría/economía , Oximetría/instrumentaciónRESUMEN
BACKGROUND: The Royal College of Anaesthetists audited consultant supervision and responsibility in anaesthesia in the UK during 2003. METHODS: Consultants (supervising) and non-consultants (supervised) were surveyed on their attitudes to supervision, experience of their own hospital system for supervision and of induction for new starters. Local coordination was achieved through anaesthesia audit coordinators who provided information on local policies, induction programmes and anaesthesia charts. Supervision was audited over a 5-day period. RESULTS: 135 departments of anaesthesia took part (43% of 315 departments), questionnaires being returned by 2297 anaesthetists. Anaesthesia record charts in use do not meet criteria considered desirable locally. Most trainees, but less than half staff grade/associate specialists, received an induction programme, often not supported by written documentation. Consultants find conflicting demands of service and supervision difficult. Many work in systems which do not permit providing direct, immediate support to those supervised. Most anaesthetists think supervision is very important. Around half disagree with national guidance that every NHS patient should have a named consultant. Two per cent of non-consultants during the audit period reported assistance from consultants not being obtainable soon enough. CONCLUSIONS: This audit found departure from standards and the potential for risk and failure. New standards may be needed regarding anaesthesia record sheets, induction, accountability, when to seek help and care of sick patients. Supervision systems in over 40% of hospitals need review to ensure they provide a named consultant and immediate direct support for elective lists.
Asunto(s)
Servicio de Anestesia en Hospital/organización & administración , Anestesiología/normas , Auditoría Médica , Anestesiología/educación , Actitud del Personal de Salud , Educación Médica Continua/normas , Adhesión a Directriz , Humanos , Cuerpo Médico de Hospitales/educación , Sociedades Médicas , Medicina Estatal/normas , Encuestas y Cuestionarios , Reino UnidoRESUMEN
We compared the cost-effectiveness of general anaesthetic agents in adult and paediatric day surgery populations. We randomly assigned 1063 adult and 322 paediatric elective patients to one of four (adult) or two (paediatric) anaesthesia groups. Total costs were calculated from individual patient resource use to 7 days post discharge. Incremental cost-effectiveness ratios were expressed as cost per episode of postoperative nausea and vomiting (PONV) avoided. In adults, variable secondary care costs were higher for propofol induction and propofol maintenance (propofol/propofol; p < 0.01) than other groups and lower in propofol induction and isoflurane maintenance (propofol/isoflurane; p < 0.01). In both studies, predischarge PONV was higher if sevoflurane/sevoflurane (p < 0.01) was used compared with use of propofol for induction. In both studies, there was no difference in postdischarge outcomes at Day 7. Sevoflurane/sevoflurane was more costly with higher PONV rates in both studies. In adults, the cost per extra episode of PONV avoided was pound 296 (propofol/propofol vs. propofol/ sevoflurane) and pound 333 (propofol/sevoflurane vs. propofol/isoflurane).
Asunto(s)
Procedimientos Quirúrgicos Ambulatorios/economía , Anestesia General/economía , Costos de la Atención en Salud , Náusea y Vómito Posoperatorios/economía , Adolescente , Adulto , Anciano , Anestesia General/efectos adversos , Anestesia General/métodos , Anestésicos por Inhalación/efectos adversos , Anestésicos por Inhalación/economía , Anestésicos Intravenosos/efectos adversos , Anestésicos Intravenosos/economía , Niño , Preescolar , Inglaterra , Humanos , Isoflurano/economía , Éteres Metílicos/economía , Persona de Mediana Edad , Náusea y Vómito Posoperatorios/inducido químicamente , Propofol/economía , Estudios Prospectivos , SevofluranoRESUMEN
BACKGROUND: Information on anaesthesia interventions, plans and risks is needed by patients and carers alike and is a key component of the Good Practice In Consent initiative. Existing information materials may under-represent what patients are able to contribute. METHOD: UK anaesthetic departments were surveyed on provision of written patient information. The response rate was 66% (177/267). RESULTS: Fifty-five per cent of respondents reported providing patient information materials for planned surgical admission, mainly on general anaesthesia, regional analgesia and pain. A minority provided information for children and for critical care patients. Few (32%) had sought feedback from patients, and few used existing sources of guidance. Most (85%) wanted improvements, with a four-to-one majority favouring central resources developed by The Royal College of Anaesthetists. CONCLUSIONS: Working in parallel does not give our hospitals excellent, effective patient information materials. Demand exists for The Royal College of Anaesthetists to lead in this area. Working in partnership with patients and taking into account existing written guidance is important but has often been overlooked.
Asunto(s)
Anestesia , Anestesiología , Educación del Paciente como Asunto/métodos , Niño , Comunicación , Humanos , Participación del Paciente , Relaciones Médico-Paciente , Reino UnidoRESUMEN
The object of this study was to assess patients' experience of pain management following day surgery. One hundred and two patients agreed to take part in a telephone survey, 2 and 4 days following day surgery. The majority of patients (73%) were broadly satisfied with the quality of pain management they received, however, there was room for improvement. Despite modern anaesthesia and surgery, 17% of patients surveyed reported having severe pain immediately following day-case surgery. The majority (82%) of patients left the day-case ward in pain and an even higher proportion (88%) had pain at some time between 2 and 4 days postoperatively. Severe levels of pain following discharge from hospital were a concern for 21% of patients. It was reported that day-case staff did not always ask patients whether they were in pain. Communication with patients is vital in the delivery of optimal care. More support and more information are needed to manage patients' pain effectively, whilst in the day-case wards and also following discharge, at home.
Asunto(s)
Procedimientos Quirúrgicos Ambulatorios/efectos adversos , Analgesia/normas , Dolor Postoperatorio/tratamiento farmacológico , Adolescente , Adulto , Anciano , Analgésicos/administración & dosificación , Analgésicos/provisión & distribución , Anestesia General , Comunicación , Esquema de Medicación , Medicina Familiar y Comunitaria , Femenino , Encuestas de Atención de la Salud , Humanos , Masculino , Persona de Mediana Edad , Dimensión del Dolor , Dolor Postoperatorio/epidemiología , Satisfacción del Paciente , Prevalencia , Relaciones Profesional-Paciente , Reino Unido/epidemiologíaAsunto(s)
Procedimientos Quirúrgicos Ambulatorios/efectos adversos , Anestésicos/efectos adversos , Anestésicos/economía , Análisis Costo-Beneficio , Resultado del Tratamiento , Adulto , Procedimientos Quirúrgicos Ambulatorios/economía , Procedimientos Quirúrgicos Ambulatorios/normas , Anestésicos/administración & dosificación , Anestésicos/clasificación , Anestésicos por Inhalación/administración & dosificación , Anestésicos por Inhalación/efectos adversos , Anestésicos por Inhalación/economía , Anestésicos Intravenosos/administración & dosificación , Anestésicos Intravenosos/efectos adversos , Anestésicos Intravenosos/economía , Niño , Costos de los Medicamentos , Femenino , Humanos , Isoflurano/administración & dosificación , Isoflurano/efectos adversos , Isoflurano/economía , Tiempo de Internación , Masculino , Éteres Metílicos/administración & dosificación , Éteres Metílicos/efectos adversos , Éteres Metílicos/economía , Persona de Mediana Edad , Náusea y Vómito Posoperatorios/inducido químicamente , Náusea y Vómito Posoperatorios/epidemiología , Propofol/administración & dosificación , Propofol/efectos adversos , Propofol/economía , Ensayos Clínicos Controlados Aleatorios como Asunto , Sevoflurano , Medicina Estatal/economía , Reino UnidoRESUMEN
AIM: The aim of this study is to investigate patients' perceptions and experiences of chronic pain management before and after attending pain services. METHOD: A sample of 245 patients with chronic pain, who attended specialist pain services in 11 UK hospitals, were interviewed using a structured questionnaire. Patients' ages ranged between 23 and 86 years (median 51 years), and the duration of pain ranged between six months and 57 years (median five years). RESULTS: Patients reported that pain had had a profound effect on their lives, restricting daily living and leisure activities. 33 per cent (81) were classified as medically disabled. Patients' perceptions and attitudes to the management of chronic pain varied. Their main concern was that, although they wanted a specific diagnosis, they were often not given a reason for their chronic pain. CONCLUSION: Pain management requires a significant amount of input by health professionals. Patients wanted advice on the best techniques to help them cope with chronic pain. Most patients had previously tried many different pain treatments to obtain short-term pain relief. One third of patients had waited up to four months for their initial pain assessment at the pain service. Once referred to specialist pain services, patients were satisfied with their care. Almost half (47 per cent, 115) of the interviewees reported that their pain had improved. As chronic pain has a profound effect on patients' lives, it is important that early diagnosis, treatment and referral to appropriate specialists is given high priority. This study has raised the awareness and understanding of an important, but often misunderstood area.
Asunto(s)
Adaptación Psicológica , Actitud Frente a la Salud , Dolor/prevención & control , Dolor/psicología , Autocuidado/psicología , Actividades Cotidianas , Adulto , Anciano , Anciano de 80 o más Años , Enfermedad Crónica , Femenino , Humanos , Actividades Recreativas , Masculino , Persona de Mediana Edad , Investigación Metodológica en Enfermería , Dolor/diagnóstico , Dolor/etiología , Dimensión del Dolor , Educación del Paciente como Asunto , Calidad de Vida , Derivación y Consulta , Autocuidado/métodos , Encuestas y CuestionariosRESUMEN
BACKGROUND: This article describes the use of focus groups in research, including the advantages and disadvantages of using this type of research methodology. Using an example of a focus group of patients who experienced chronic pain, the authors discuss the planning, organisation, conduct and analysis of focus groups. CONCLUSION: Focus groups enabled an exploration of the topics in-depth including obtaining insight from a patient's perspective of the management of their chronic pain. It was important and of value to take into account the experiences and expectations of health service delivery from a consumer's perspective.
Asunto(s)
Grupos Focales/métodos , Investigación Metodológica en Enfermería/métodos , Dolor/prevención & control , Dolor/psicología , Satisfacción del Paciente , Adaptación Psicológica , Enfermedad Crónica , Comunicación , Análisis Costo-Beneficio , Humanos , Proyectos de Investigación , Grupos de AutoayudaAsunto(s)
Anestesiología/organización & administración , Ejecutivos Médicos , Sociedades Médicas , Servicio de Anestesia en Hospital/organización & administración , Anestesiología/legislación & jurisprudencia , Eficiencia Organizacional , Humanos , Cooperación Internacional , Sociedades Médicas/organización & administración , Reino Unido , Estados UnidosRESUMEN
A postal survey of all 269 acute hospital trusts identified in the United Kingdom was carried out to study the work of Clinical Directors of anaesthesia. Initial responses from 163 Clinical Directors and 129 completed questionnaires were analysed. Four main areas of concern revealed by the survey were contracts and objectives, funding of managerial sessions, access to information and perceived need for support. Most Clinical Directors had no job description and most had no formal written objectives, despite a substantial body of advice that these should be provided. There was generally substantial underfunding of managerial hours compared with those actually worked and approximately 20% of Clinical Directors surveyed had no funding for managerial duties. Clinical Directors' ratings of the information available to assist their decision making were also a cause of concern. Clinical Directors perceived that they need better networking, more training particularly on human resource management and improved management information.
Asunto(s)
Servicio de Anestesia en Hospital/organización & administración , Actitud del Personal de Salud , Ejecutivos Médicos/estadística & datos numéricos , Adulto , Servicio de Anestesia en Hospital/economía , Presupuestos , Recolección de Datos , Educación Médica Continua , Femenino , Hospitales Públicos/organización & administración , Humanos , Servicios de Información/normas , Práctica Institucional/estadística & datos numéricos , Perfil Laboral , Masculino , Persona de Mediana Edad , Objetivos Organizacionales , Admisión y Programación de Personal/estadística & datos numéricos , Ejecutivos Médicos/educación , Ejecutivos Médicos/psicología , Reino Unido , Recursos HumanosRESUMEN
Our aim was to locate brain regions projecting to all cranial motor nuclei involved in phonation simultaneously, that is, the ambiguus, trigeminal motor, facial, and hypoglossal nuclei. For this purpose, four squirrel monkeys (Saimiri sciureus) were injected with horseradish peroxidase, each of the four nuclei in a different animal. Those regions retrogradely labeled in all four cases then were injected in another 29 animals with [3H]leucine for anterograde tracing. We found that the only region connected directly with all phonatory motor nuclei is a restricted portion of the pontine and medullary reticular formation, including the nucl. subceruleus ventralis, nucl. parvocellularis and nucl. centralis myelencephali. It is assumed that these nuclei are involved in the integration of vocal fold adduction, articulation, and respiration during vocal utterances.
Asunto(s)
Encéfalo/anatomía & histología , Nervios Craneales/anatomía & histología , Vocalización Animal , Animales , Vías Eferentes/anatomía & histología , Peroxidasa de Rábano Silvestre , Leucina , Bulbo Raquídeo/anatomía & histología , SaimiriAsunto(s)
Enfermedades de la Mama/patología , Mama/metabolismo , Mamografía/métodos , Adulto , Anciano , Mama/patología , Femenino , Humanos , Métodos , Persona de Mediana EdadAsunto(s)
Ropa de Cama y Ropa Blanca , Regulación de la Temperatura Corporal , Craneotomía , Adulto , Anciano , Anestesia General , Temperatura Corporal , Femenino , Humanos , Periodo Intraoperatorio , Masculino , Metales , Persona de Mediana Edad , Plásticos , Recto , Temperatura Cutánea , Factores de TiempoRESUMEN
Plasma levels of acebutolol and its major human metabolite, diacetolol, were determined before, during and after aortocoronary bypass grafting in 10 patients who had received a chronic oral regimen of acebutolol 200 mg t.d.s. for at least 6 days before surgery, a 200 mg dose with the premedication and 5-10 mg intravenously immediately before intubation. It was found that this regimen produced beta-adrenoceptor antagonist levels which were within the range in which attenuation of hypertension and tachydysrhythmia occurs. These effective plasma levels were sustained throughout surgery and persisted into the early recovery period.
Asunto(s)
Acebutolol/uso terapéutico , Puente de Arteria Coronaria , Premedicación , Acebutolol/administración & dosificación , Acebutolol/análogos & derivados , Acebutolol/sangre , Adulto , Humanos , Periodo Intraoperatorio , Masculino , Persona de Mediana Edad , Periodo Posoperatorio , Factores de TiempoRESUMEN
The relevance of social relationships to the phenomena of depression among the aged was examined. The study was based on the reduced reinforcement hypothesis which predicts a low rate of social relationships (i.e. the loss of positive reinforcement) for those individuals who are prone to depression. This hypothesis was both tested and confirmed among the residents in homes for the aged in Berlin. The senior citizens who reported a low rate of social activities had higher depression scores than those reporting a higher rate of such social involvement. These results were confirmed for various indicators of social participation. A further variable influencing the rate of depression was identified as the self-rating of personal health. The results are discussed within both a behavioral and a cognitive framework.