Immobilisation of enzymes for alkaloid production

Imperial Users onl

Development and validation of the Surgical Outcome Risk Tool (SORT).

Existing risk stratification tools have limitations and clinical experience suggests they are not used routinely. The aim of this study was to develop and validate a preoperative risk stratification tool to predict 30-day mortality after non-cardiac surgery in adults by analysis of data from the observational National Confidential Enquiry into Patient Outcome and Death (NCEPOD) Knowing the Risk study

Editorial: ASA Physical Status Score: has its time passed?

No Abstrac

Primum Non Nocere: is shared decision-making the answer?

Surgical ambition is rising, with the Royal College of Surgeons reporting an increase in the number of procedures by a million over the past decade (Royal College of Surgeons. Surgery and the NHS in Numbers. Available from https://www.rcseng.ac.uk). Underpinning, this is a rapidly growing population, especially those in the over 85 age group, coupled with rising perioperative expertise; options for surgery are now present where conditions were once managed conservatively. Matching the right patient to the right procedure has never been so pertinent (Bader, Am Soc Anesthesiol 78(6), 2014). At the heart of these increasingly complex decisions, which may prove fatal or result in serious morbidity, lies the aspiration of shared decision-making (SDM) (Glance et al., N Engl J Med 370:1379–81, 2014). Shared decision-making is a patient-centred approach taking into account the beliefs, preferences and views of the patient as an expert in what is right for them, supported by clinicians who are the experts in diagnostics and valid therapeutic options (Coulter and Collins, Making shared decision-making a reality: no decision about me, without me, 2011). It has been described as the pinnacle of patient-centred care (Barry et al., N Engl J Med 366:780–1, 2012). In this commentary, we explore further the concept of shared decision-making, supported by a recent article which highlights critical deficits in current perioperative practice (Ankuda et al., Patient Educ Couns 94(3):328–33, 2014). This article was chosen for the purposes of this commentary as it is a large study across several surgical specialties investigating preoperative shared decision-making, and to our knowledge, the only of this kind

Publishing quality improvement studies: learning to share and sharing to learn

This editorial welcomes the decision of BJA Open to publish quality improvement (QI) studies. It summarises the current problems with conducting, evaluating, and publishing QI studies. It highlights existing guidance for prospective authors to follow regarding the reporting of QI interventions, their context(s), underlying theories, and evaluation. In so doing, we hope to encourage the publication of more QI studies of sufficient quality to facilitate learning or replication elsewhere

Survival after postoperative morbidity: a longitudinal observational cohort study

Prolonged morbidity after surgery is associated with a risk of premature death for a longer duration than perhaps is commonly thought; however, this risk falls with time. We suggest that prolonged postoperative morbidity measured in this way may be a valid indicator of the quality of surgical healthcare. Our findings reinforce the importance of research and quality improvement initiatives aimed at reducing the duration and severity of postoperative complication

Improvement Science in Anaesthesia

PURPOSE OF REVIEW: This article offers an overview of the history and features of Improvement Science in general and some of its applications to Anaesthesia in particular. RECENT FINDINGS: Improvement Science is an evolving discipline aiming to generate learning from quality improvement interventions. An increasingly common approach to improving Anaesthesia services is to employ large-scale perioperative data measurement and feedback programmes. Improvement Science offers important insights on questions such as which indicators to collect data for; how to capture that data; how it can be presented in engaging visual formats; how it could/should be fed back to frontline staff and how they can be supported in their use of data to generate improvement. SUMMARY: Data measurement and feedback systems represent opportunities for anaesthetists to work with multidisciplinary colleagues to help improve services and outcomes for surgical patients. Improvement Science can help evaluate which approaches work, and in which contexts, and is therefore of value to healthcare commissioners, providers and patients

What does 'learning' and 'organisational learning' mean in the context of patient safety? Protocol for a systematic hermeneutic conceptual review

Introduction: Learning is essential for improving patient safety and is often cited as necessary following a patient safety incident (PSI). Both individual and organisational learning are needed to enable improvements in health systems. However, there is no clear consensus on what ‘learning’ or ‘organisational learning’ actually means in the context of a PSI. Learning theories can be applied to healthcare in order to improve patient safety interventions. In this systematic hermeneutic conceptual review, we aim to define learning and organisational learning in the context of patient safety and to identify the theoretical approaches to learning and interventions utilised. / Methods and analysis: This review will be undertaken in two phases, utilising a systematic hermeneutic approach. Phase one will focus on ascertaining taxonomy domains through identification of the concept and theoretical frameworks of ‘learning’ and ‘organisational learning’ from the literature. These taxonomy domains and the World Health Organisation’s World Alliance for Patient Safety International Classification for Patient Safety will inform a thematic framework for phase two. Phase two will be a more detailed search and focus on learning and related applied interventions in the context of patient safety incidents utilising the thematic framework from phase one. Data will be analysed using framework method analysis. / Ethics and dissemination: This review does not require ethical approval. The results will be published in a peer-reviewed journal

Good intra-operative anaesthesia is more than an “ABCD with a three, two and a one".

The adoption of checklists within healthcare leads to improvements in patient safety. Perioperative management of patients with comorbidity and polypharmacy is complex and whilst physical checklists, aviation style computerised checklists, and mnemonics can all be used to make anaesthesia safer, these cannot cover the entirety or the complexity of perioperative care, and in particular, the principles by which anaesthetists work to promote restoration of function. Restoration of function is increasingly being seen as the marker of good anaesthetic care.Wellcome Trus

Racial and Ethnic Disparities in Post-neonatal Mortality in Florida

This policy-related study examines primary care delivery methods in reducing population health disparities. We use post- neonatal mortality as an indicator ofpopulation health within counties to study the effects ofusing contracted service providers compared to direct provision of primary care by county health departments in improving health equity. We analyzed post- neonatal mortality data collected annually between 1997 and 2006 from ten ofFlorida’s most populous counties (\u3e500,000). Using Poisson regression analyses with generalized estimating equations (GEE), we examined differences in post-neonatal mortality among racial and ethnic groups; and among counties and groups over time. The results show significant differences in post-neonatal mortality between Black and White groups in both counties that outsource county health department primary care services and also counties that do not outsource these services. After adjusting for low birth weight and age ofthe mother (\u3c 20 years), the post-neonatal mortality rate for black infants remains higher in outsourced counties but not in non- outsourced counties. The increase in disparity in post-neonatal mortality rates between black and white infants in outsourced counties compared to non-outsourced counties is also significant. Contracted service providers are being used with greater frequency to expand access to health services with the idea that they can improve health outcomes; however, these data show that all groups may not benefit equally under this mechanism ofservice delivery