Anesthesia and analgesia
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Anesthesia and analgesia · May 2019
Concepts for the Development of Anesthesia-Related Patient Decision Aids.
Patient decision aids are educational tools used by health care providers to assist patients in choosing their treatment and care. The use of anesthesia-related patient decision aids can help practitioners provide patient-centered care by facilitating shared decision-making. The benefits of these aids have been well documented, yet a structured approach for developing patient decision aids in anesthesia has not been well established. ⋯ Using the provided developmental process and checklist, anesthesia providers can create evidence-based patient decision aids in a standardized manner. It is important to evaluate decision aids and measure their decision quality, or patient-centeredness, to further improve them and maximize their effectiveness. Moving forward, development of proper metrics for patient participation and decision quality are required.
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Anesthesia and analgesia · May 2019
Considerations for Clock Drawing Scoring Systems in Perioperative Anesthesia Settings.
The Clock Drawing Test is a cognitive screening tool gaining popularity in the perioperative setting. We compared 3 common scoring systems: (1) the Montreal Cognitive Assessment; (2) the Mini-Cog; and (3) the Libon scale. Three novice raters acquired interrater and intrarater reliability for each scoring system and then scored 738 preoperative clock drawings with each scoring system. Final scores correlated with each other but with notable discrepancies, indicating the need to attend to interrater and intrarater reliability when implementing any scoring approach in a clinical setting.
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Anesthesia and analgesia · May 2019
ReviewNarrative Review of Decision-Making Processes in Critical Care.
Several theories describing the decision-making process in the intensive care unit (ICU) have been formulated. However, none of them appreciate the complexities of the process in an eclectic way by unifying several miscellaneous variables in 1 comprehensive theory. The purpose of this review is to highlight the key intricacies associated with the decision-making process in the ICU, to describe the theoretical frameworks with a special emphasis on gaps of knowledge, and to offer some avenues for improvement. ⋯ Furthermore, it is unclear when the preferential application of reflexive, habitual, variable, and biased-prone processes results in patient and staff detriment. We suggest better matching of theoretical frameworks with strengths of the human decision-making process and balanced application computer aids, artificial intelligence, and organizational modifications. The key component of this integration is work to increase the self-awareness of decision-making processes among residents, fellows, and attending physicians.
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Medications used in anesthesiology contain both pharmacologically active compounds and additional additives that are usually regarded as being pharmacologically inactive. These additives, called excipients, serve diverse functions. ⋯ Anesthesiologists should have a clear understanding of their chemical properties and the potential for adverse reactions. This report catalogs the excipients found in drugs commonly used in anesthesiology, provides a brief description of their function, and documents examples from the literature regarding their adverse effects.