Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Dec 2023
In control or along for the ride? Lessons for anesthesiologists from air traffic control.
Anesthesia professionals work in an unpredictable, rapidly changing environment in which they are quickly diagnose and manage uncommon and life-threatening critical events. The perioperative environment has traditionally been viewed as a deterministic system in which outcomes can be predicted, but recent studies suggest that the operating room behaves more like a complex adaptive system, in which events can interact and connect with each other in unpredictable and unplanned ways. ⋯ A better understanding of automation, complexity, and resilience in a changing environment are essential steps toward the safe practice of anesthesia.
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Curr Opin Anaesthesiol · Dec 2023
Can we nudge to reduce the perioperative low value care? Decision making factors influencing safe practice implementation.
Highlight sources of low-value care (LVC) during the perioperative period help understanding the decision making behind its persistence, the barriers for change, and the potential implementation strategies to reduce it. ⋯ LVC, such as unneeded surgeries, or preanaesthesia tests for low-risk surgeries in low-risk patients, is a relevant source of waste and preventable harm, most especially in the perioperative period. Despite the international focus on it, initial efforts to reduce it in the last decade have not clearly shown a sustainable improvement. Understanding the shared decision-making process and the barriers to be expected when tackling LVC is the first step to build the change. Applying a structured strategy based on the behavioural science principles may be the path to increasing high value care in an effective an efficient way. It is time to foster nudge units at different healthcare system levels.
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Curr Opin Anaesthesiol · Oct 2023
ReviewMaking chronic pain count: empirical support for the ICD-11 classification of chronic pain.
The purpose is to review the evidence that has been collected with regard to the new classification of chronic pain. In 2022, the World Health Assembly endorsed the 11 th revision of the International Classification of Diseases and Related Health Problems (ICD-11), and with it a new classification of chronic pain. ⋯ The evidence supports the use of the new classification and highlights its informational gains - using it will contribute to making chronic pain count in many contexts.