Canadian Journal of Anesthesia-Journal Canadien D Anesthesie最新文献

{"title":"Squats, spinach, and soul: considering disparities in prehabilitation medicine before programmatic implementation.","authors":"Gianni R Lorello, Su-Yin MacDonell","doi":"10.1007/s12630-024-02876-1","DOIUrl":"10.1007/s12630-024-02876-1","url":null,"abstract":"","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":"1606-1611"},"PeriodicalIF":3.4,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142677905","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trends in characteristics, interventions, and outcomes of hospitalized patients with COVID-19 in Canada: a multicentre prospective cohort study.","authors":"Divyajot Sadana, David Granton, Neill K J Adhikari, Ruxandra Pinto, Srinivas Murthy, Robert A Fowler","doi":"10.1007/s12630-024-02826-x","DOIUrl":"10.1007/s12630-024-02826-x","url":null,"abstract":"<p><strong>Purpose: </strong>Our objective was to investigate the temporal trends in baseline characteristics, interventions, and clinical outcomes in patients hospitalized with COVID-19 in Canada over five pandemic waves.</p><p><strong>Methods: </strong>We conducted a multicentre prospective cohort study enrolling adults and children admitted with COVID-19 from 47 Canadian hospitals. We compared characteristics, interventions, and outcomes of patients across five distinct pandemic waves.</p><p><strong>Results: </strong>We enrolled 5,285 patients between 2 January 2020 and 8 February 2022. The mean (standard deviation) age was 62.6 (21.0) yr; 41.2% (n = 2,176) were female, and 48% (n = 2,539) required admission to an intensive care unit (ICU), of whom 60.3% (n = 1,530) underwent invasive mechanical ventilation. The proportion of vaccinated patients increased over time. The proportion of vaccinated hospitalized patients progressing to require ICU admission fell over pandemic waves while the proportion of unvaccinated hospitalized patients progressing to require ICU admission did not. Patients were most commonly treated with corticosteroids (48.7%; n = 2,575); use of corticosteroids and other evidence-based treatments increased over time. Hospital mortality was 22.1% (n = 1,166) among all patients, 30.2% (n = 766) among those admitted to an ICU, and 37.9% (n = 580) among those requiring invasive mechanical ventilation. Younger age, absence of chronic cardiac or pulmonary disease, severity of illness at admission, and prior vaccination was associated with a lower mortality; however, pandemic wave itself was not.</p><p><strong>Conclusion: </strong>Among patients hospitalized in Canada with COVID-19, several clinical factors including prior vaccination were associated with lower mortality, but pandemic wave was not.</p>","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":"1745-1754"},"PeriodicalIF":3.4,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11666781/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142134611","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An anesthesiology-led perioperative outreach service: experience from a Canadian centre and a focused narrative literature review.","authors":"Michele Homsy, Julius Dale-Gandar, Stephan K W Schwarz, Alana M Flexman, Su-Yin MacDonell","doi":"10.1007/s12630-024-02884-1","DOIUrl":"10.1007/s12630-024-02884-1","url":null,"abstract":"<p><p>Approximately 320 million surgeries occur annually worldwide, increasingly performed on an ageing, comorbid population in whom postoperative complications contribute significantly to mortality. While anesthesiologists have led advances in perioperative care, the optimal structure of the provision of postoperative care has lacked discourse. In this article, we describe the implementation, structure, role, and benefits of an Anesthesiology Perioperative Outreach Service (APOS) at a Canadian tertiary hospital, providing proactive daily review and management of high-risk surgical patients. The APOS involves routine reviews and care on surgical wards, emphasizing collaboration among anesthesiology, internal medicine, surgery, and geriatric medicine teams, with a specific screening pathway to identify patients experiencing myocardial injury after noncardiac surgery. We discuss case vignettes to illustrate common examples of how the APOS enabled early detection and treatment escalation for deteriorating patients and provide a focused narrative literature review. The anesthesiology-led perioperative outreach model described herein could provide an implementable framework for institutions seeking to enhance their quality of postoperative care-particularly among complex, comorbid patients at risk of postoperative morbidity.</p>","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":"1653-1663"},"PeriodicalIF":3.4,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142866536","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"John Matthew Cowan, MBChB, FRCPC.","authors":"Homer Yang","doi":"10.1007/s12630-024-02856-5","DOIUrl":"10.1007/s12630-024-02856-5","url":null,"abstract":"","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":"1792-1793"},"PeriodicalIF":3.4,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142395577","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A survey of Canadian perioperative medicine practices regarding surveillance for myocardial injury after noncardiac surgery.","authors":"Julius Dale-Gandar, Anthony Chau, Su-Yin MacDonell, Alana M Flexman","doi":"10.1007/s12630-024-02850-x","DOIUrl":"10.1007/s12630-024-02850-x","url":null,"abstract":"","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":"1783-1785"},"PeriodicalIF":3.4,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142513721","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Medical students' perspectives on and understanding of anesthesiology: a Canadian cross-sectional survey.","authors":"Michael Nixon, Monica Brundage, Ligia Cordovani, Adrienne Carr, Joycelyne Ewusie, Daniel Cordovani","doi":"10.1007/s12630-024-02751-z","DOIUrl":"10.1007/s12630-024-02751-z","url":null,"abstract":"<p><strong>Purpose: </strong>In Canada, three out of 17 medical schools do not mandate an anesthesia rotation in their clerkship curriculum. Understanding the effects of a mandatory anesthesiology rotation is important in determining its value to the specialty and guiding decision-making for medical educators. We sought to determine whether a mandatory anesthesia rotation affected students' understanding of anesthesiology, as well as their perspectives on anesthesia.</p><p><strong>Methods: </strong>We conducted an anonymous cross-sectional survey of Canadian medical students graduating in 2021. Our survey consisted of 46 questions related to student's perspectives of anesthesiology, understanding of anesthesia, their interest in the specialty, and participant's demographics. This included 16 Likert-scale questions, 19 quiz-style questions, four free-text response questions, and seven demographics questions. The survey was hosted by SurveyMonkey^® (SurveyMonkey Inc., San Mateo, CA, USA) and distributed to the participants by each individual institution.</p><p><strong>Results: </strong>We collected a total of 331 responses across 13 different Canadian medical schools, representing a 17.3% response rate of students surveyed and 11.7% of all graduating medical Canadian students in 2021. A mandatory rotation in anesthesiology was associated with a more positive perspective (P = 0.01) but not understanding (P = 0.07) of the specialty. A mandatory rotation was not related to students' application to anesthesiology at a statistically significant level (P = 0.06).</p><p><strong>Conclusions: </strong>The results of this national survey study show the benefits of including a mandatory clerkship rotation in anesthesiology, namely on increasing positive perceptions of the specialty, while also revealing avenues for future research and insights on how to further optimize a mandatory anesthesiology rotation in clerkship.</p>","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":"1716-1724"},"PeriodicalIF":3.4,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140295387","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Douglas Booth Craig, MD, FRCPC.","authors":"Judith Littleford","doi":"10.1007/s12630-024-02867-2","DOIUrl":"10.1007/s12630-024-02867-2","url":null,"abstract":"","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":"1789-1791"},"PeriodicalIF":3.4,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142605594","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Postoperative outcomes among Northern versus Southern Ontario patients undergoing common intermediate- to high-risk elective surgeries: a population-based cohort study.","authors":"Max Chen, Kaitlin Duncan, Robert Talarico, Sarah McIsaac, Daniel I McIsaac","doi":"10.1007/s12630-024-02860-9","DOIUrl":"10.1007/s12630-024-02860-9","url":null,"abstract":"<p><strong>Purpose: </strong>Northern Ontario residents experience multiple health disparities compared with those in Southern Ontario. It is unknown whether this leads to differences in surgical outcomes. We sought to compare postoperative outcomes of patients from Northern and Southern Ontario.</p><p><strong>Methods: </strong>We conducted a retrospective population-based cohort study using linked administrative health care data to identify all adult patients undergoing selected elective intermediate- to high-risk noncardiac surgeries in Ontario, Canada between 2009 and 2022. The primary outcome was 30-day mortality following surgery. The secondary outcomes were number of days alive at home, hospital length of stay, total health care system costs, discharge disposition, and readmissions. We used regression models to estimate the adjusted association between the exposure and outcomes.</p><p><strong>Results: </strong>This study identified 562,115 patients, including 41,191 (7.3%) from Northern Ontario. We did not find strong evidence that mortality rates were higher for Northern vs Southern Ontario residents (adjusted odds ratio, 1.04; 95% confidence interval [CI], 0.85 to 1.27). Health system costs were lower for Northern Ontario residents at 30 days [adjusted ratio of mean (RoM), 0.92; 95% CI, 0.89 to 0.96] and at 365 days (adjusted RoM, 0.93; 95% CI, 0.90 to 0.96). Hospital length of stay was longer for Northern Ontario residents (adjusted RoM, 1.06; 95% CI, 1.01 to 1.11). The number of days alive at home and rate of readmission were not statistically different between the two groups.</p><p><strong>Conclusion: </strong>Northern Ontario residency was not associated with increased odds of mortality after intermediate- to high-risk elective noncardiac surgery. Overall, we found no clinically meaningful differences in postoperative outcomes between patients from Northern and Southern Ontario.</p>","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":"1705-1715"},"PeriodicalIF":3.4,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11666767/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142577351","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Developing a toolkit for building a community hospital clinical research program.","authors":"Kian Rego, Elaina Orlando, Patrick Archambault, Anna Geagea, Anish R Mitra, Gloria Vazquez-Grande, Rosa M Marticorena, Lisa Patterson, Giulio DiDiodato, Oleksa G Rewa, Janek Senaratne, Madelyn Law, Alexandra Binnie, Jennifer Tsang","doi":"10.1007/s12630-024-02883-2","DOIUrl":"10.1007/s12630-024-02883-2","url":null,"abstract":"<p><strong>Purpose: </strong>Although health research in Canada is primarily conducted in academic hospitals, most patients receive their care in community hospitals. The benefits of increasing research capacity in community hospitals include improved study recruitment, increased generalizability of results, broader patient access to novel therapies, better patient outcomes, enhanced staff satisfaction, and improved organizational efficiency. Nevertheless, building research programs in community hospitals remains challenging because of a lack of support and expertise. To address this gap, we developed a toolkit to help community hospital professionals build and sustain their community hospital research programs.</p><p><strong>Source: </strong>The toolkit was developed by the Canadian Community Intensive Care Unit Research Network (CCIRNet), a group of clinician-researchers and research staff from community hospitals across Canada who have experience building community hospital research programs. Feedback from a concurrent qualitative study of Canadian community critical care professionals informed the toolkit's design.</p><p><strong>Principal findings: </strong>The CCIRNet toolkit outlines five stages of community hospital clinical research program development: 1) building a research team and gaining support, 2) developing a new research program, 3) choosing a first research study, 4) getting the study up and running, and 5) sustaining a research program. Feedback from qualitative interviews emphasized the need for a step-by-step approach, frequently asked questions, and essential resources. Accordingly, each stage is structured in a question-and-answer format and includes relevant resources for each section.</p><p><strong>Conclusion: </strong>The CCIRNet toolkit is a practical resource for establishing research programs in community hospitals. The toolkit may increase research participation and support clinical research capacity building in community hospitals.</p>","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":"1646-1652"},"PeriodicalIF":3.4,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11666650/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142848548","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safe use of a 5:1 coverage model for anesthesia assistants performing conscious sedation in an independent health facility.","authors":"Marcus Salvatori, Serena Shum, Ana Lopez Filici, Laura Noble, Gerry O'Leary, Keyvan Karkouti, Sharon Peacock","doi":"10.1007/s12630-024-02827-w","DOIUrl":"10.1007/s12630-024-02827-w","url":null,"abstract":"","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":"1769-1771"},"PeriodicalIF":3.4,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142115335","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}