Anesthesia and analgesia
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Anesthesia and analgesia · Aug 2011
Automatic notifications mediated by anesthesia information management systems reduce the frequency of prolonged gaps in blood pressure documentation.
Arterial blood pressure (BP) measurement at least every 5 minutes is part of the American Society of Anesthesiologists' monitoring standard, but prolonged BP gaps in electronic anesthesia records have been noted. We undertook multicenter studies to determine the frequency of cases with at least 1 interval ≥10 minutes between successive BP measurements and then to ascertain whether educational feedback via an electronic, near real-time notification system alerting providers to the presence of such gaps would reduce their incidence. ⋯ BP gaps of ≥10 minutes were common in electronic anesthesia records, and their incidence was reduced but not eliminated by near real-time feedback to providers. The American Society of Anesthesiologists' standard for BP documentation every 5 minutes might not be achievable with current practices and technology. Anesthesia information management systems users need to be cognizant of the potential for gaps in BP measurement, take steps to minimize their occurrence, and document an explanation when such failures occur.
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Anesthesia and analgesia · Aug 2011
Mean arterial pressures bracketing prolonged monitoring interruptions have negligible systematic differences from matched controls without such gaps.
Comparing intraoperative hemodynamic data from anesthesia information management systems (AIMS) among hospitals involves handling missing or edited values. There routinely are periods >5 minutes ("gaps") in recorded blood pressure in AIMS records. Previous studies showed the importance of monitoring the incidences of unexplained gaps, because providers interpolate when charting vital signs in gaps. We studied whether ignoring missing vital signs during gaps systematically biases monitoring results. ⋯ Our results show that when comparing hospitals using mean MAP data from hundreds of AIMS cases, statistical issues related to gaps are of minor importance. The more important issues when comparing hospitals are the incidences of gaps themselves and/or the manual editing of automatically recorded vital signs. Nevertheless, when quantifying hemodynamic variability (e.g., brief periods with rapid changes in MAP), gaps cannot be ignored. Furthermore, none of our results apply to individual patients (i.e., it is best not to have gaps in blood pressure during anesthesia).
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After submission of a manuscript to a peer-reviewed anesthesia journal, several authors were asked to cite additional references from the journal to which they submitted. We hypothesized that there were differences among the anesthesiology journals in both the total number of self-citations and the proportion of self-citations to the total number of references in each manuscript for the years 2005 and 2010. ⋯ Although the number and rate of self-citations differed among anesthesia journals, the contribution of self-citation to IF has declined over time for most anesthesia journals. These results suggest periodic reassessment may be important to ensure that the publication process remains transparent and impartial to bias.