المؤلفون: Stuetzle, K. V., Pavlin, B. I., Smith, N. A., Weston, K. M.

المصدر: Anaesthesia & Intensive Care; 2018, Vol. 46 Issue 4, p414-423, 10p

مصطلحات موضوعية: FATIGUE (Physiology), ANESTHESIOLOGISTS, MEDICAL errors, ANESTHESIOLOGY, MEDICINE, WORKING hours, OCCUPATIONAL diseases, SLEEP

مصطلحات جغرافية: AUSTRALIA, NEW Zealand

مستخلص: Occupational fatigue in anaesthetists is recognised as a patient safety risk. Better understanding of the issues surrounding their fatigue is needed. This study aimed to ascertain the sources and effects of occupational fatigue amongst anaesthetists in Australia and New Zealand. An anonymous online survey was sent to 979 anaesthetists. The response rate was 38.0%. Most participants reported regularly working over 40 hours per week; men reported five more hours per week than women. Stated contributors to fatigue included long work hours, mental strain at work, and personal and family demands. Fatigue-related behaviour was reported more by men (OR [odds ratio]=2.6) and less by respondents reporting eight or more hours of sleep before work (OR=0.6). Reporting at least one instance of less than five hours off between shifts was predictive of falling asleep while administering an anaesthetic (OR=1.6). More data are required to support practices and policies that promote more time off between work periods and increased time for sleep to reduce risk of fatigue. [ABSTRACT FROM AUTHOR]

: Copyright of Anaesthesia & Intensive Care is the property of Sage Publications Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

المؤلفون: Coric, D.¹, Smith, N. A.² natasmith@hotmail.com

المصدر: Anaesthesia & Intensive Care. 2017, Vol. 45 Issue 6, p683-687. 5p.

مصطلحات موضوعية: *CARDIAC patients, *TROPONIN, *POSTOPERATIVE care, *ADVERSE health care events, *CARDIAC surgery, *THERAPEUTICS, *CARDIOVASCULAR disease diagnosis, *DIAGNOSTIC errors, *SURGICAL complications, *RETROSPECTIVE studies

مستخلص: Elevated troponin levels within three days of surgery are strongly linked to major adverse cardiac events (MACE). However, the value of screening with troponin measurements is controversial. The extent to which this is done in routine practice is uncertain. We examined the medical records of all patients ≥45 years of age undergoing moderate or major non-cardiac surgery in our tertiary referral hospital over a six-month period. We determined how many patients had a troponin (TnT) measurement recorded in the first three days postoperatively, how many of these were abnormal, and the occurrence of MACE within 30 days. Two thousand and two hundred patients underwent 2,577 operations that met the study criteria. A postoperative TnT was measured after 4.5% of operations. Thirty-eight percent of patients with a recorded TnT measurement, and 44% of those with an abnormal measurement, experienced a MACE within 30 days. The sensitivity of an abnormal TnT to detect MACE was 86%. The specificity was low at 32% with a false positive rate of 56%. Patients with an abnormal TnT result had an increased risk of MACE (23%). The 'number needed to measure' to detect one patient with MACE was 4.4. In our institution, postoperative TnT levels were rarely measured and were used as a diagnostic rather than as a screening tool. The high false positive rate for MACE prediction limits its potential value as a screening tool. The test could be considered useful if it leads to further investigation, and may be best considered as one component of a multivariate approach to cardiac risk evaluation and diagnosis. [ABSTRACT FROM AUTHOR]

المؤلفون: Smith, N. A.¹ natasmith@hotmail.com, Yeow, Y. Y.²

المصدر: Anaesthesia & Intensive Care. 2016, Vol. 44 Issue 5, p581-586. 6p.

مصطلحات موضوعية: *MONTREAL Cognitive Assessment, *COGNITION disorders in old age, *MILD cognitive impairment, *ELECTIVE surgery, *DISEASE prevalence, *DIAGNOSIS, *THERAPEUTICS

مستخلص: Postoperative cognitive disorders are common in elderly patients. Pre-existing cognitive impairment including mild cognitive impairment may be an important risk factor for developing postoperative cognitive dysfunction and may not be detected in a standard preoperative interview, yet is not routinely sought. Our primary aim was to estimate the prevalence of mild cognitive impairment among elderly patients presenting to our hospital for elective surgery using a simple established screening tool: the Montreal Cognitive Assessment test. Secondarily, we wished to determine the proportion of patients with mild cognitive impairment who presented with this information available, the effect of increasing age on the prevalence of mild cognitive impairment and whether the timing and location of testing influenced results. We used the Montreal Cognitive Assessment test to screen preoperative patients aged 65 years and over. Our results suggested a potential prevalence of mild cognitive impairment of 56%, with prevalence increasing with age. No patients in the sample had a recorded diagnosis of mild cognitive impairment. Testing in either the preadmission clinic or on admission on the day of surgery yielded similar results. We found the Montreal Cognitive Assessment test to be a simple screening tool that was easily administered during the pre-admission visit. [ABSTRACT FROM AUTHOR]

المؤلفون: Smith N (AUTHOR), Koutantos A (AUTHOR), Smith, N¹ (AUTHOR), Koutantos, A (AUTHOR)

المصدر: Anaesthesia & Intensive Care. Jul2008, Vol. 36 Issue 4, p516-519. 4p.

مستخلص: Education and expertise in airway skills are central components of anaesthesia training, yet there is no formal monitoring of the airway experience or level of competence that registrars actually obtain. An audit was performed in two phases to prospectively document the airway management experience of registrars in one teaching hospital department. Novices were studied for three months and subsequently, the whole registrar group for one month. Novice registrars performed a mean of two facemask anaesthetics, 19 laryngeal mask airways and 20 endotracheal intubations per month in their first three months of anaesthetic practice. The overall registrar group performed a mean of 18 laryngeal mask airways and 19 endotracheal intubations in the study month. Our findings indicate that the airway experience of anaesthesia trainees may be inadequate and therefore warrants further investigation. [ABSTRACT FROM AUTHOR]

المؤلفون: Chuan, A., Thillainathan, S., Graham, P. L., Jolly, B., Wong, D. M., Smith, N., Barrington, M. J.

المصدر: Anaesthesia & Intensive Care; Mar2016, Vol. 44 Issue 2, p201-209, 9p

مصطلحات موضوعية: ANESTHESIA, MEDICAL education, REPRODUCIBLE research, INTERNSHIP programs, EDUCATIONAL tests & measurements, EDUCATION

مستخلص: The Direct Observation of Procedural Skills (DOPS) form is used as a workplace-based assessment tool in the current Australian and New Zealand College of Anaesthetists curriculum. The objective of this study was to evaluate the reliability of DOPS when used to score trainees performing ultrasound-guided regional anaesthesia. Reliability of an assessment tool is defined as the reproducibility of scores given by different assessors viewing the same trainee. Forty-nine anaesthetists were recruited to score two scripted videos of trainees performing a popliteal sciatic nerve block and an axillary brachial plexus block. Reliability, as measured by intraclass correlation coefficients, was -0.01 to 0.43 for the individual items in DOPS, and 0.15 for the 'Overall Performance for this Procedure' item. Assessors demonstrated consistency of scoring within DOPS, with significant correlation of sum of individual item scores with the 'Overall Performance for this Procedure' item (r=0.78 to 0.80, P <0.001), and with "yes" versus "no" responses to the 'Was the procedure completed satisfactorily?' item (W=24, P=0.0004, Video 1, and W=65, P=0.003, Video 2). While DOPS demonstrated a good degree of internal consistency in this setting, inter-rater reliability did not reach levels generally recommended for formative assessment tools. Feasibility of the form could be improved by removing the 'Was the procedure completed satisfactorily?' item without loss of information. [ABSTRACT FROM AUTHOR]

: Copyright of Anaesthesia & Intensive Care is the property of Sage Publications Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

المؤلفون: Smith, N A (AUTHOR), Castanelli, D J (AUTHOR)

المصدر: Anaesthesia & Intensive Care. Mar2015, Vol. 43 Issue 2, p199-203. 5p.

مستخلص: The learning environment describes the way that trainees perceive the culture of their workplace. We audited the learning environment for trainees throughout Australia and New Zealand in the early stages of curriculum reform. A questionnaire was developed and sent electronically to a large random sample of Australian and New Zealand College of Anaesthetists trainees, with a 26% final response rate. This new instrument demonstrated good psychometric properties, with Cronbach's α ranging from 0.81 to 0.91 for each domain. The median score was equivalent to 78%, with the majority of trainees giving scores in the medium range. Introductory respondents scored their learning environment more highly than all other levels of respondents (P=0.001 for almost all comparisons). We present a simple questionnaire instrument that can be used to determine characteristics of the anaesthesia learning environment. The instrument can be used to help assess curricular change over time, alignment of the formal and informal curricula and strengths and weaknesses of individual departments. [ABSTRACT FROM AUTHOR]

المؤلفون: Overton, M J (AUTHOR), Smith, N A (AUTHOR)

المصدر: Anaesthesia & Intensive Care. 2015, Vol. 43 Issue 1, p51-58. 8p.

مستخلص: The role of anaesthetists has expanded and evolved to include critical care, perioperative and pain medicine and general clinical skills, as well as operating theatre-based clinical anaesthesia. Across Australia and New Zealand, these topics are taught to varying degrees, however no uniform curriculum or standardisation exists between universities. In this study, we used a Delphi technique to develop consensus-based priorities to guide medical educators when reviewing and implementing student anaesthesia curricula. A range of appropriate content has been defined, as well as details relating to duration, timing, teaching environment, faculty, feedback and assessment methods. Future enquiry to assess the efficacy of future and current teaching practices is needed to facilitate continued improvement. [ABSTRACT FROM AUTHOR]

المؤلفون: SMITH, N. A.¹ natasmith@hotmail.com, TANDEL, A.², MORRIS, R. W.²

المصدر: Anaesthesia & Intensive Care. Jul2011, Vol. 39 Issue 4, p585-589. 5p.

مصطلحات موضوعية: *INTRATRACHEAL anesthesia, *INTUBATION, *TEACHING hospitals, *OBSTETRICS

مصطلحات جغرافية: AUSTRALIA

مستخلص: The article presents an analysis of endotracheal intubations performed by anaesthesia trainees at a large Australian metropolitan teaching hospital from 1998 to 2008 to determine if numbers for trainees' caseloads in general, and endotracheal intubation in particular, had changed. Findings suggest that the Australian practice is similar to the international experience of decreasing opportunities for endotracheal intubation in obstetric anaesthesia.

المؤلفون: Smith N (AUTHOR), Martin D (AUTHOR), Smith, N A (AUTHOR), Martin, D (AUTHOR)

المصدر: Anaesthesia & Intensive Care. Mar2012, Vol. 40 Issue 2, p358-359. 2p.

المؤلفون: Smith, N (AUTHOR)

المصدر: Anaesthesia & Intensive Care. Nov2013, Vol. 41 Issue 6, p820-821. 2p.