Impact of a Novel Multiparameter Decision Support System on Intraoperative Processes of Care and Postoperative Outcomes

Background The authors hypothesized that a multiparameter intraoperative decision support system with real-time visualizations may improve processes of care and outcomes.Methods Electronic health record data were retrospectively compared over a 6-yr period across three groups: experimental cases, in which the decision support system was used for 75% or more of the case at sole discretion of the providers; parallel controls (system used 74% or less); and historical controls before system implementation. Inclusion criteria were adults under general anesthesia, advanced medical disease, case duration of 60  min or longer, and length of stay of two days or more. The process measures were avoidance of intraoperative hypotension, ventilator tidal volume greater than 10 ml/kg, and crystalloid administration (ml · kg–1· h–1). The secondary outcome measures were myocardial injury, acute kidney injury, mortality, length of hospital stay, and encounter charges.Results A total of 26,769 patients were evaluated: 7,954 experimental cases, 10,933 parallel controls, and 7,882 historical controls. Comparing experimental cases to parallel controls with propensity score adjustment, the data demonstrated the following medians, interquartile ranges, and effect sizes: hypotension 1 (0 to 5)versus 1 (0 to 5) min,P
Source: Anesthesiology - Category: Anesthesiology Source Type: research

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The aim of this project was to evaluate the 10-yr outcomes from the Rehabilitation Research Experience for Medical Students. A target benchmark was one high-quality output per student. Students were required to devise a research project and work full time with a mentor at an approved sponsor site for 8 wks. Longitudinal surveys were used to collect data about research outputs, match results, and decisions about whether to pursue academic careers. From 2008 to 2017, 73 (48%) of 153 applicants were awarded summer externships. Residency match results included the following: physical medicine and rehabilitation (45%), internal...
Source: American Journal of Physical Medicine and Rehabilitation - Category: Rehabilitation Tags: Education & Administration Source Type: research
We describe a case of posttraumatic chronic intercostal neuralgia, in which successful pain relief was achieved via repeated injections of local anesthetic and steroid combinations in the serratus anterior plane under ultrasonographic guidance. This novel technique is easy to administer, reliable, and warrants further investigation with regard to its use for rehabilitation of patients who are experiencing posttraumatic chronic neuropathies of the chest wall.
Source: American Journal of Physical Medicine and Rehabilitation - Category: Rehabilitation Tags: Case Report Source Type: research
Authors: Bianchi L, Schiavina R, Borghesi M, Chessa F, Casablanca C, Angiolini A, Ercolino A, Pultrone CV, Mineo Bianchi F, Barbaresi U, Piazza P, Manferrari F, Bertaccini A, Fiorentino M, Ferro M, Porreca A, Marcelli E, Brunocilla E Abstract BACKGROUND: To develop a clinical nomogram aimed to predict the achievement of trifecta in patients treated with open, laparoscopic and robotic partial nephrectomy (PN) for localized renal masses (
Source: Minerva Urologica e Nefrologica - Category: Urology & Nephrology Tags: Minerva Urol Nefrol Source Type: research
Publication date: Available online 18 October 2019Source: Brazilian Journal of Anesthesiology (English Edition)Author(s): Raul Ribeiro de Andrade, Olavo Barbosa de Oliveira-Neto, Luciano Timbó Barbosa, Isabelle Oliveira Santos, Célio Fernando de Sousa-Rodrigues, Fabiano Timbó BarbosaAbstractBackground and objectivesLow back pain is a prevalent disease in the adult population, whose quality of life is considerably affected. In order to solve this problem, several therapies have been developed, of which ozone therapy is an example. Our objective in this study was to determine the effectiveness of ozone t...
Source: Brazilian Journal of Anesthesiology - Category: Anesthesiology Source Type: research
Publication date: Available online 17 October 2019Source: Brazilian Journal of Anesthesiology (English Edition)Author(s): Marija S. Kutlesic, Gordana Kocic, Ranko M. KutlesicAbstractBackground and objectiveRemifentanil is used to attenuate maternal hemodynamic response to intubation and surgical stress during Induction-Delivery period of cesarean section. The goal was to compare the effects of two remifentanil dosing regimens on oxidative stress level, in correlation with its hemodynamic and neonatal effects.MethodsFifty-one patients, 17 per group, enrolled for elective cesarean section were randomly divided by computer-ge...
Source: Brazilian Journal of Anesthesiology - Category: Anesthesiology Source Type: research
Condition:   Regional Anesthesia, Erector Spine Plane Block, Cost Effectiveness Intervention:   Other: erector spina plane block, cost analysis Sponsor:   Kırıkkale University Recruiting
Source: ClinicalTrials.gov - Category: Research Source Type: clinical trials
This review explores the immunologic basis of pulmonary arterial hypertension, reviewing current trials targeting the immune system and the perioperative management of patients with PAH.Anesthesiology
Source: Medscape Today Headlines - Category: Consumer Health News Tags: Anesthesiology Journal Article Source Type: news
Condition:   Cerebral Oxygenation Intervention:   Diagnostic Test: NIRS open Sponsor:   Medical University of Graz Not yet recruiting
Source: ClinicalTrials.gov - Category: Research Source Type: clinical trials
Condition:   Inadvertent Perioperative Hypothermia Intervention:   Procedure: convective active warming Sponsors:   St. Marien-Hospital Düren;   Institute for Occupational, Social and Environmental Medicine, RWTH Aachen University;   Department of Anaesthesiology and Intensive Care Medicine, Hospital Düren Active, not recruiting
Source: ClinicalTrials.gov - Category: Research Source Type: clinical trials
Too many details to discuss, but essentially a known asthmatic had severe bronchospasm on induction, lungs do tight CRNA could hardly ventilate. By the time I arrived, pt blue, sats 19 and could hardly move air. Albuterol has been attempted to delivered unsuccessfully. I bolused 10mcg of epi incrementally until it cleared up. Extubated and did fine. One of my partners then asked why I didn’t give Sux to break the bronchospasm. I had never considered giving Sux unless there... Severe intraoperative bronchospasm
Source: Student Doctor Network - Category: Universities & Medical Training Authors: Tags: Anesthesiology Source Type: forums
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