JCA Advances最新文献

{"title":"Intraoperative pain management shared decision making with a patient with a complex pain and mental health history: A case report.","authors":"Aubrey Samost-Williams, Jerry Wang, Casey Horani, Eric J Thomas, Robert J Volk","doi":"10.1016/j.jcadva.2025.100156","DOIUrl":"10.1016/j.jcadva.2025.100156","url":null,"abstract":"<p><p>Shared decision making is where the patient and clinician come together to decide on the appropriate course of action in a patient's medical care based on their goals, preferences, and values. Typically, decision making in anesthesia remains more paternalistic, with clinicians making decisions for patients. However, there is a move towards embracing a shared decision making model. We present here a case report of using shared decision making principles to develop a pain and anxiety management plan in a patient with chronic pain and a complex mental health history. A 40-year-old female with a history of chronic pain, bipolar disorder, generalized anxiety disorder, and postural orthostatic tachycardic syndrome presented for elective temporomandibular joint replacement. Exploration of her prior anesthetic and pain experiences led us to co-create a tailored pain and anxiety management plan drawing on our clinical knowledge and her preferences and experiences. She expressed a high level of satisfaction with pain management and overall anesthetic care. Shared decision making can be a powerful tool in creating perioperative pain management plans. While there are calls for increased use of shared decision making in anesthesia care, most research is in the space of high-risk patients and decisions around anesthetic technique. However, in applying the principles of shared decision making to a lower risk patient's pain management plan, we were able to better balance pain management, perioperative anxiety, and medication side effects according to her preferences. More research is needed to promote shared decision making throughout anesthesia care.</p>","PeriodicalId":520424,"journal":{"name":"JCA Advances","volume":"2 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12439104/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145083273","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementation Mapping to Guide Adoption of a Semi-Structured Intraoperative Anesthesia Handoff Tool.","authors":"Aubrey Samost-Williams, Reed Richter, Naveen Vanga, Spandana Mandaloju, Adlai Arandela, Srikanth Sridhar, Eric J Thomas","doi":"10.1016/j.jcadva.2025.100099","DOIUrl":"10.1016/j.jcadva.2025.100099","url":null,"abstract":"<p><p>There frequently exists a gap between known best practices and real-world methods. Closing this gap involves thoughtful implementation, typically involving multiple implementation strategies. Implementation mapping is a technique that links the innovation being implemented with potential barriers to implementation and connects these barriers to the strategies that form the implementation plan. This study demonstrates the application of implementation mapping to guide the adoption of the Epic Health Systems Intraoperative Anesthesia Handoff Report. The objective is to create a comprehensive implementation plan tailored to the anticipated challenges of the local environment. There are five steps in implementation mapping: (1) performing a needs assessment, (2) creating a matrix of change, (3) identifying the mechanisms of change and strategies for change, (4) creating implementation materials, and (5) measuring implementation outcomes. Through the creation of this map, a multi-pronged implementation strategy was created and executed. This implementation plan resulted in high acceptability, appropriateness, and feasibility scores among frontline anesthesia clinicians adopting the intraoperative anesthesia tool. The logical connections between the barriers and the implementation strategies further facilitated changes to the implementation plan as new challenges arose during the implementation process. This study addresses a critical gap in clinical practice by providing a structured approach to implementing best practices in anesthesiology. Implementation mapping can potentially be a valuable technique for guiding quality improvement projects involving implementing new clinical practices in anesthesiology.</p>","PeriodicalId":520424,"journal":{"name":"JCA Advances","volume":"2 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12136501/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144228370","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sudden cardiac death during anesthesia in non-cardiac surgery and its link to possible cardiac channelopathies: A case series.","authors":"Samadhi Dandeniya Arachchi, Joseph Westaby, Mary N Sheppard","doi":"10.1016/j.jcadva.2024.100083","DOIUrl":"10.1016/j.jcadva.2024.100083","url":null,"abstract":"<p><p>Cardiac arrest with induction of anesthesia in those who appear healthy with no apparent cardiovascular disease is rare and the autopsy is essential to identify any underlying cardiac pathology. A retrospective analysis of the database of sudden cardiac deaths referred to the CRY Centre, St. Georges University of London identified 7 cases in which death occurred during anesthesia. We found 3 cases with explained causes; peripartum cardiomyopathy, myocarditis and ischemic heart disease where the risk of sudden cardiac death in anesthesia is well known and helps anesthetists and surgeons explain the cardiac arrest. More importantly there were 4 cases with morphologically normal hearts with no apparent cardiovascular disease who developed bradycardia and cardiac arrest with the induction of anesthesia. This raises the possibility of cardiac ion channelopathies when nothing else is found at autopsy and there is no aesthetic cause. The negative autopsy has major implications for the families requiring detailed cardiovascular screening of the immediate family to prevent future sudden deaths. All surgical teams need to be aware of this and advise the families accordingly in these traumatic situations.</p>","PeriodicalId":520424,"journal":{"name":"JCA Advances","volume":"2 1","pages":"None"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11841371/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143470446","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diversity engagement is associated with lower burnout among anesthesia providers.","authors":"Julia C Whiteleather, Beda Rosario-Rivera, Aminat Haruna, Alejandro Munoz-Valencia, Kristin Ondecko-Ligda, Keith M Vogt, Andrea J Ibarra","doi":"10.1016/j.jcadva.2024.100027","DOIUrl":"10.1016/j.jcadva.2024.100027","url":null,"abstract":"<p><strong>Study objective: </strong>The high prevalence of burnout among anesthesia providers is a well-established, multifactorial problem that deserves systematic attention and action. This study aimed to identify how perceptions of institutional diversity engagement are associated with burnout and perceived stress among anesthesia personnel.</p><p><strong>Design: </strong>Survey-based prospective cross-sectional study.</p><p><strong>Setting: </strong>Anesthesiology department that encompasses community and academic hospitals in a large healthcare system.</p><p><strong>Participants: </strong>One-hundred and sixty anesthesiology department employees over 18 years of age (i.e. attending physicians, trainees, advanced practice providers and others).</p><p><strong>Measurements: </strong>A web-based survey with 39 questions measured: demographics, diversity engagement, burnout, and perceived stress. The primary objective was to assess the association of burnout and diversity engagement and the mediating effect of perceived stress in this relationship. Our secondary objective was to measure the prevalence of burnout, diversity engagement, and perceived stress. Burnout, diversity engagement, and perceived stress were measured using a validated two-item survey developed from the Maslach Burnout Inventory-Human Services Survey, the 22-item Diversity Engagement Survey (DES), and the Perceived Stress Scale (PSS-4), respectively.</p><p><strong>Main results: </strong>Mean scores were 4.4 (SD 3.2) for burnout, 78.3 (SD 14.3) for DES, and 4.8 (SD 2.6) for perceived stress. Higher DES score predicted lower burnout (β = -0.11 [95% CI -0.14, -0.08], <i>P</i> < 0.001) and lower perceived stress (β = -0.05 [95% CI -0.08, -0.03], <i>P</i> < 0.001). Mediation analysis estimated the total effect of burnout (β = -0.10, <i>P</i> < 0.001), which comprised the direct effect of diversity engagement (β = -0.08, P < 0.001) and indirect effect of perceived stress (β = -0.02, <i>P</i> = 0.0048).</p><p><strong>Conclusions: </strong>The perception of increased institutional diversity engagement is associated with reduced burnout among anesthesia providers, in part due to a reduction in perceived stress. Implementing interventions at the leadership level that improve diversity engagement may reduce the negative effects of perceived stress and burnout, potentially improving patient care.</p>","PeriodicalId":520424,"journal":{"name":"JCA Advances","volume":"1 3-4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12810883/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146000291","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}