BJA open最新文献

{"title":"Functional coupling between chronic pain and the autonomic nervous system revealed by neuromodulation techniques. Comment on ‘Effect of neuromodulation for chronic pain on the autonomic nervous system: a systematic review’ (BJA Open 2024; 11: 100305)","authors":"Jean-Pascal Lefaucheur , Chantal Delon-Martin , Hasan Hodaj","doi":"10.1016/j.bjao.2025.100393","DOIUrl":"10.1016/j.bjao.2025.100393","url":null,"abstract":"","PeriodicalId":72418,"journal":{"name":"BJA open","volume":"14 ","pages":"Article 100393"},"PeriodicalIF":0.0,"publicationDate":"2025-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143734601","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":"The readability of online English and Spanish patient education materials on anaesthesia for orthopaedic surgery","authors":"Mariana Restrepo ,&nbsp;Brocha Z. Stern ,&nbsp;Garrett W. Burnett ,&nbsp;Chang Park ,&nbsp;Jashvant Poeran","doi":"10.1016/j.bjao.2025.100388","DOIUrl":"10.1016/j.bjao.2025.100388","url":null,"abstract":"<div><h3>Background</h3><div>With the increasing utilisation of regional anaesthesia for orthopaedic procedures, it is imperative that related online patient education materials (PEMs) be easily retrievable, comprehensive, and readable by the general population, irrespective of the language they are written in. Therefore, we compared the readability levels of online PEMs available in English and Spanish for anaesthesia related to total hip, knee, and shoulder joint replacements.</div></div><div><h3>Methods</h3><div>Six pairs (English and Spanish) of search terms were entered into Google and used to identify relevant online PEMs. Results for English search terms were analysed for readability using the Flesch Reading Ease (FRE), Fry Graph (FG), Simple Measures of Gobbledygook (SMOG) Index, and Gunning Fog Index scores, and for Spanish search terms using the Fernandez-Huerta Reading Ease (FHRE), the Gilliam-Peña-Mountain Grade Level (GPMGL), the Spanish SMOG (SOL), and Indice de Legibilidad de Flesch-Szigriszt (INFLESZ) scores. Scores were compared between languages if the Spanish-language calculator was a validated adaptation of the English one (FRE <em>vs</em> FHRE; FG <em>vs</em> GPMGL; SMOG <em>vs</em> SOL).</div></div><div><h3>Results</h3><div>Overall, 180 and 146 relevant websites were retrieved across all six English language and Spanish-language search terms, respectively. Generally, the FRE and FG scores for the English search results corresponded to college-level material and the SMOG score reflected a 10th grade reading level. In contrast, the FHRE, GPMGL, and SOL scores for Spanish search results corresponded to 10th–12th grade reading levels, and the INFLESZ to ‘Difficult’/‘Normal’ levels.</div></div><div><h3>Conclusions</h3><div>These findings reinforce past literature describing English and Spanish-language orthopaedic anaesthesia PEMs being written at far higher reading levels than the recommended 5th to 8th grade reading level. Interestingly, English PEMs were less readable than their Spanish counterparts, yet, they were more available than related Spanish PEMs overall.</div></div>","PeriodicalId":72418,"journal":{"name":"BJA open","volume":"14 ","pages":"Article 100388"},"PeriodicalIF":0.0,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143715170","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":"Beyond body mass index: exploring the role of visceral adipose tissue in intensive care unit outcomes","authors":"Maximilian R. Ralston ,&nbsp;Gordan McCreath ,&nbsp;Zoe J. Lees ,&nbsp;Ian P. Salt ,&nbsp;Malcolm A.B. Sim ,&nbsp;Malcolm J. Watson ,&nbsp;Dilys J. Freeman","doi":"10.1016/j.bjao.2025.100391","DOIUrl":"10.1016/j.bjao.2025.100391","url":null,"abstract":"<div><div>Obesity is a worldwide health crisis and poses significant challenges in critical care. Many studies suggest an ‘obesity paradox’, in which obesity, defined by body mass index (BMI), is associated with better outcomes. However, the inability of BMI to discriminate between fat and muscle or between visceral adipose tissue and subcutaneous adipose tissue, limits its prediction of metabolic ill health. We suggest that the ‘obesity paradox’ may be more reflective of the limitations of BMI than the protective effect of obesity.</div><div>We explore the biological processes leading to visceral fat accumulation, and the evidence linking it to outcomes in critical illness. In the ‘spillover’ hypothesis of adipose tissue expansion, caloric excess and impaired expansion of storage capacity in the subcutaneous adipose tissue lead to accumulation of visceral adipose tissue. This is associated with a chronic inflammatory state, which is integral to the link between visceral adiposity, type 2 diabetes mellitus, and ischaemic heart disease.</div><div>We review the current evidence on visceral adiposity and critical illness outcomes. In COVID-19, increased visceral adipose tissue, irrespective of BMI, is associated with more severe disease. This is mirrored in acute pancreatitis, suggesting visceral adiposity is linked to poorer outcomes in some hyperinflammatory conditions. We suggest that visceral adiposity's chronic inflammatory state may potentiate acute inflammation in conditions such as COVID-19 and acute pancreatitis. Further work is required to investigate other critical illnesses, especially sepsis and acute respiratory distress syndrome, in which current evidence is scarce. This may give further insights into pathophysiology and inform tailored treatment and nutrition strategies based on body fat distribution.</div></div>","PeriodicalId":72418,"journal":{"name":"BJA open","volume":"14 ","pages":"Article 100391"},"PeriodicalIF":0.0,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143706352","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":"Strategies to reduce the risk of unrecognised oesophageal intubation: a survey of Difficult Airway Society members","authors":"Moon-Moon Majumdar ,&nbsp;Natalie Silvey ,&nbsp;Abhijoy Chakladar ,&nbsp;Barry McGuire ,&nbsp;Ellen O’Sullivan ,&nbsp;Alistair F. McNarry","doi":"10.1016/j.bjao.2025.100390","DOIUrl":"10.1016/j.bjao.2025.100390","url":null,"abstract":"<div><h3>Background</h3><div>Despite multiple initiatives and consensus guidelines, preventable deaths from unrecognised oesophageal intubation continue worldwide. We aimed to establish what different organisations are doing to reduce the risk of unrecognised oesophageal intubation.</div></div><div><h3>Methods</h3><div>This was a cross-sectional survey of Difficult Airway Society (DAS) members using an internet-based survey platform. Members were invited to participate via e-mail over a period of 10 weeks (28 March to 07 June 2023). Results were reported according to the CROSS checklist.</div></div><div><h3>Results</h3><div>The response rate was 39% (819/2125). About 50% (402/799) of respondents were providing training to reduce the risk of unrecognised oesophageal intubation and 9% (69/799) were planning to. Most of the training (69%; 310/449) is multidisciplinary. However, almost one-third of respondents (31%; 246/799) were from departments that were not planning any training. Non-training-related strategies (including but not limited to increased use of videolaryngoscopy, increased use or improving the interpretability of waveform capnography) were implemented in 39% (297/765) of respondents' departments and planned in 8% (60/765). Nearly one-third (31%; 237/765) were not planning any non-training interventions to reduce risk. Of those who responded, 17% (130/765) were from departments not planning <em>any</em> strategies to reduce the risk of unrecognised oesophageal intubation. <em>Two-person verbal confirmation of capnography</em> was considered ‘extremely’ or ‘very’ helpful by 59% (411/702) of respondents.</div></div><div><h3>Conclusions</h3><div>Our study suggests that uptake of preventative strategies to reduce the risk of unrecognised oesophageal intubation remains inadequate. The authors suggest it is now time for the Royal College of Anaesthetists, DAS, and the General Medical Council to mandate strategies to reduce the risk of unrecognised oesophageal intubation.</div></div>","PeriodicalId":72418,"journal":{"name":"BJA open","volume":"14 ","pages":"Article 100390"},"PeriodicalIF":0.0,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143685750","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":"Analgesia using intrathecal morphine to improve quality of recovery after minimally invasive major abdominal surgery (AIM Trial): study protocol for a multicentre randomised controlled trial","authors":"Katrina Pirie ,&nbsp;Emily Traer ,&nbsp;Noam Winter ,&nbsp;Wendy Brown ,&nbsp;Bernhard Riedel ,&nbsp;Paul S. Myles","doi":"10.1016/j.bjao.2025.100386","DOIUrl":"10.1016/j.bjao.2025.100386","url":null,"abstract":"<div><h3>Background</h3><div>Evidence to support the effectiveness of intrathecal morphine in patients undergoing minimally invasive abdominal surgery is largely based on small, single-centre studies. We therefore designed a large, multi-centre clinical trial to investigate the effect of intrathecal morphine with local anaesthetic on patient postoperative quality of recovery. The primary objective is to compare quality of recovery on postoperative Day 1. The secondary objectives are to compare opioid consumption, pain scores, and opioid-related adverse events.</div></div><div><h3>Methods</h3><div>This multi-centre, prospective, randomised controlled trial will recruit 280 adult patients undergoing minimally invasive major abdominal surgery. The intervention group will receive 200 mcg of intrathecal morphine with local anaesthetic, as part of a multimodal analgesic strategy. Following safety analysis after the first 100 patients the dose of ITM will increase to 300 mcg. The control group will receive non-neuraxial multimodal analgesia.</div></div><div><h3>Conclusions</h3><div>This trial is expected to provide evidence on the effectiveness and the safety of two different ITM doses with local anaesthetic in major minimally invasive abdominal surgery.</div></div><div><h3>Clinical trial registration</h3><div>ACTRN12623001347651 (ANZCTR Registry Number).</div></div><div><h3>Protocol version number and date</h3><div>1.0, May 2, 2024.</div></div>","PeriodicalId":72418,"journal":{"name":"BJA open","volume":"14 ","pages":"Article 100386"},"PeriodicalIF":0.0,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143685749","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":"The use of intrathecal morphine in non-abdominal surgery: a scoping review","authors":"Aart Jan W. Teunissen ,&nbsp;Lieke van Gastel ,&nbsp;Robert J. Stolker ,&nbsp;Seppe A. Koopman","doi":"10.1016/j.bjao.2025.100387","DOIUrl":"10.1016/j.bjao.2025.100387","url":null,"abstract":"<div><h3>Background</h3><div>Intrathecal morphine can reduce pain and opioid requirements needed for postoperative pain relief. It can potentially aid in the effectiveness of enhanced recovery protocols in non-abdominal surgery. However, concerns about side-effects may have hindered its use. This scoping review evaluates the effectiveness, appropriate dosage, and adverse effects of intrathecal morphine in non-abdominal surgery.</div></div><div><h3>Methods</h3><div>We systematically searched for randomised controlled trials examining the use of intrathecal morphine in non-abdominal surgery.</div></div><div><h3>Results</h3><div>The search identified 75 trials involving 4685 patients. We undertook a scoping review of these randomised controlled trials, including bias assessments, to comprehensively analyse the effectiveness and side-effects of intrathecal morphine. The findings indicate that intrathecal morphine reduced postoperative pain and opioid consumption after spinal surgery, thoracic surgery, and orthopaedic lower extremity surgery. However, it was associated with an increased incidence of itching, postoperative nausea and vomiting, and urinary retention, particularly in orthopaedic procedures. Delayed respiratory depression was absent with low to moderate doses (&lt;500 μg) in the reviewed studies.</div></div><div><h3>Conclusions</h3><div>This review supports the effectiveness of intrathecal morphine in non-abdominal surgery. However, the benefits must be carefully weighed against potential side-effects that could lead to prolonged hospital stays.</div></div><div><h3>Clinical trial registration</h3><div>PROSPERO-registry CRD42021233936.</div></div>","PeriodicalId":72418,"journal":{"name":"BJA open","volume":"14 ","pages":"Article 100387"},"PeriodicalIF":0.0,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143685748","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":"Adductor canal block in total knee arthroplasty: a scoping review of the literature","authors":"Nikhil Agarwal ,&nbsp;Robert Kay ,&nbsp;Andrew D. Duckworth ,&nbsp;Nicholas D. Clement ,&nbsp;David M. Griffith","doi":"10.1016/j.bjao.2025.100381","DOIUrl":"10.1016/j.bjao.2025.100381","url":null,"abstract":"<div><h3>Background</h3><div>An adductor canal block is commonly used to reduce pain after total knee arthroplasty. Practice varies in terms of site of injection, local anaesthetic, and adjuncts used, with poor consensus in relation to the best approach. The aim of this scoping review was to assess the evidence for efficacy and safety of adductor canal block, determine variation in the technique used, type and dose of medication, and compare the efficacy of adductor canal block with other nerve block techniques.</div></div><div><h3>Methods</h3><div>Four databases were searched to identify relevant studies (Medline, Embase, Cochrane, and <span><span>ClinicalTrials.gov</span><svg><path></path></svg></span>). A total of 285 articles were found, and data was extracted from 130 randomised controlled trials.</div></div><div><h3>Results</h3><div>Adductor canal block is a safe and potentially effective peripheral nerve block for reducing postoperative pain after total knee arthroplasty while preserving motor function. Of all adjuncts to adductor canal block assessed, either dexamethasone or dexmedetomidine provide additional analgesic benefit. Adductor canal block combined with peri-articular local anaesthetic injection provides the best outcomes. Continuous infusion of local anaesthetic through a catheter placed in the adductor canal provides no additional benefit over a single injection. The site of injection used for adductor canal block does not seem to affect efficacy. There was no evidence to support the superiority of any single local anaesthetic agent.</div></div><div><h3>Conclusion</h3><div>This scoping review has identified variation in the use of medications, doses, techniques, and adjuncts for adductor canal block. As such, definitive conclusions regarding the most effective practice for adductor canal block cannot be made.</div></div>","PeriodicalId":72418,"journal":{"name":"BJA open","volume":"14 ","pages":"Article 100381"},"PeriodicalIF":0.0,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143643122","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":"Impact of perioperative dexmedetomidine treatment on 1-year mortality in patients undergoing orthotopic heart transplantation","authors":"Carolin Torregroza ,&nbsp;Carla L. Endreß ,&nbsp;René M'Pembele ,&nbsp;Sebastian Roth ,&nbsp;Alexandra Stroda ,&nbsp;Hug Aubin ,&nbsp;Artur Lichtenberg ,&nbsp;Giovanna Lurati Buse ,&nbsp;Ragnar Huhn ,&nbsp;Udo Boeken","doi":"10.1016/j.bjao.2025.100389","DOIUrl":"10.1016/j.bjao.2025.100389","url":null,"abstract":"<div><h3>Background</h3><div>Heart transplantation remains the gold standard treatment of end stage heart failure. The prognosis of heart transplantation has continuously improved, with a 10-yr survival of 53%. Dexmedetomidine is commonly used as a sedative in cardiac patients. Recently its clinical use has been limited because it was associated with increased mortality in the SPICE 3 trial. The impact of perioperative dexmedetomidine treatment on patients undergoing heart transplantation has not been examined yet. Therefore, this study investigated the influence of dexmedetomidine treatment on 1-yr mortality in patients undergoing heart transplantation.</div></div><div><h3>Methods</h3><div>This retrospective cohort study included patients who underwent heart transplantation at the University Hospital Duesseldorf between 2011 and 2021. The main exposure was perioperative dexmedetomidine treatment. The primary endpoint was 1-yr mortality after surgery. Kaplan–Meier analysis and multivariate cox regression with adjustment for risk index for mortality prediction after cardiac transplantation (IMPACT) and packed red blood cells were performed.</div></div><div><h3>Results</h3><div>A total of 267 patients were screened. To avoid a potential selection bias, patients who needed postoperative treatment with extracorporeal life support system were excluded, leaving 169 patients included in the analysis. Out of 169 patients, 85 received perioperative dexmedetomidine treatment and 84 were not treated with dexmedetomidine. Overall, 1-yr mortality was 10.3% (dexmedetomidine 4.9% <em>vs</em> no dexmedetomidine 15.5%, <em>P</em>=0.025). After adjustment for IMPACT score and packed red blood cells, dexmedetomidine treatment was independently associated with lower 1-yr mortality after heart transplantation (hazard ratio: 0.25, 95% confidence interval 0.07–0.93, <em>P</em>=0.03).</div></div><div><h3>Conclusion</h3><div>Perioperative dexmedetomidine treatment appears to be safe regarding 1-yr mortality in patients undergoing orthotopic heart transplantation.</div></div>","PeriodicalId":72418,"journal":{"name":"BJA open","volume":"14 ","pages":"Article 100389"},"PeriodicalIF":0.0,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143628922","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":"The ED95 of lidocaine and prilocaine for ultrasound-guided brachial plexus blocks for surgical anaesthesia: a randomised controlled clinical trial","authors":"Anurag Vats ,&nbsp;Pawan K. Gupta ,&nbsp;Andrew Berrill ,&nbsp;Sarah Zohar ,&nbsp;Philip M. Hopkins","doi":"10.1016/j.bjao.2025.100385","DOIUrl":"10.1016/j.bjao.2025.100385","url":null,"abstract":"<div><h3>Background</h3><div>Our trial addresses the gaps in the current literature by directly estimating the ED₉₅ of short-acting local anaesthetics for ultrasound-guided axillary and supraclavicular brachial plexus blocks for surgical anaesthesia.</div></div><div><h3>Methods</h3><div>Four double-blind prospective studies were organized in two separate arms. Patients were randomised between studies A (lidocaine 1% with adrenaline) and B (lidocaine 2% with adrenaline) for axillary blocks and between studies C (prilocaine 1%) and D (lidocaine 1% with adrenaline) for supraclavicular blocks. All statistical modelling and analysis were performed using the modified continual reassessment method. The primary endpoint of the studies was the loss of cold and pin-prick sensations in the sensory distributions of the median, musculocutaneous, radial, and ulnar nerves.</div></div><div><h3>Results</h3><div>For axillary blocks, the estimated ED₉₅ of lidocaine 1% with adrenaline was 40 ml (95% credibility interval: 89.5–99.2%), and lidocaine 2% with adrenaline was 15 ml (95% credibility interval: 87.4–97.5%) (studies A and B: 41 and 40 patients, respectively). The ED₉₅ could not be determined for supraclavicular blocks as it fell outside the dose range considered in the studies (studies C and D: 31 and 42 patients, respectively).</div></div><div><h3>Conclusions</h3><div>We achieved a 95% success rate for axillary blocks using lidocaine (1% and 2%) with adrenaline within our dosing limits. For supraclavicular blocks, &gt;40 ml of prilocaine 1% or lidocaine 1% with adrenaline may be required to consistently achieve a 95% success rate. Our studies highlight the continual reassessment method as a credible methodology for dose-finding studies in regional anaesthesia.</div></div><div><h3>Clinical trial registration</h3><div>EudraCT ref: 2010-018466-22.</div></div>","PeriodicalId":72418,"journal":{"name":"BJA open","volume":"14 ","pages":"Article 100385"},"PeriodicalIF":0.0,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143621486","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":"Improved pointer in auditory alarms enhances response accuracy","authors":"Michelle Shin ,&nbsp;Ian Grant ,&nbsp;Ramez Mikhail ,&nbsp;Alexandra Lee ,&nbsp;Tiffany-Chau Le ,&nbsp;Alexandra Bruder ,&nbsp;Judy Edworthy ,&nbsp;Joshua Shive ,&nbsp;Joseph J. Schlesinger","doi":"10.1016/j.bjao.2025.100379","DOIUrl":"10.1016/j.bjao.2025.100379","url":null,"abstract":"<div><h3>Background</h3><div>Auditory alarms are crucial in clinical settings, alerting clinicians to events requiring immediate attention. However, multitasking can lead to missed alarms and disrupt patient care. Enhancing auditory alarms can improve patient safety and clinician satisfaction.</div></div><div><h3>Methods</h3><div>In a controlled laboratory study, we recruited 26 clinicians (residents, fellows, advanced practice providers) and 19 non-clinicians (undergraduate students) to compare our previously validated alarm with an improved design. The improved alarm incorporates a ‘pointer’ (a short sound burst indicating acuity levels) enriched with harmony, intervallic change, roughness, and glissando to provide additional information to users. We measured response accuracy (correct alarm identification) and response time (seconds to respond).</div></div><div><h3>Results</h3><div>A total of 26 clinicians and 19 non-clinicians were recruited and all participants met inclusion criteria for analysis. A mixed analysis of variance revealed a large main effect of the pointer on response accuracy (F(1,44)=9.11, <em>P</em>=0.004, η²_<em>p</em>=0.17). Accuracy was higher for our improved pointer (M=0.90, 95% confidence interval [CI; 0.84–0.95]) than for our previous design (M=0.80, 95% CI [0.74–0.87]). Ascending alarms representing hypertension yielded a mean response accuracy of 0.89 (95% CI 0.84–0.94) and descending alarms representing hypotension yielded a mean response accuracy of 0.81 (95% CI 0.75–0.88). Low acuity ascending alarms resulted in slower response times compared with other combinations, where acuity of change was conveyed through intervallic difference of two-note harmonies.</div></div><div><h3>Conclusions</h3><div>Improved pointers demonstrated statistically significant accuracy improvement for clinicians and non-clinicians without compromising response time—a design advantage that can influence the revision of the international alarm standard and improve patient safety.</div></div>","PeriodicalId":72418,"journal":{"name":"BJA open","volume":"14 ","pages":"Article 100379"},"PeriodicalIF":0.0,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143621487","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}