British journal of anaesthesia
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Review Meta Analysis
Epidemiological, methodological, and statistical characteristics of network meta-analysis in anaesthesia: a systematic review.
Network meta-analyses (NMAs) combine direct and indirect estimates to provide mixed (or network) estimates of effect sizes. The scientific rigour of the conduct and reporting of anaesthesia NMAs is unknown. This review assessed the epidemiological, methodological, and statistical characteristics of anaesthesia NMAs. ⋯ PROSPERO CRD42021227608.
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Perioperative frailty is prevalent and requires complex management, which could be guided by clinical practice guidelines (CPGs). The objective of this systematic review was to identify and synthesise CPGs that provide perioperative recommendations specific to older adults living with frailty. ⋯ PROSPERO CRD42022320149.
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Multicenter Study
Association of sugammadex reversal of neuromuscular block and postoperative length of stay in the ambulatory care facility: a multicentre hospital registry study.
Encapsulation of rocuronium or vecuronium with sugammadex can reverse neuromuscular block faster than neostigmine reversal. This pharmacodynamic profile might facilitate patient discharge after ambulatory surgery. ⋯ Reversal with sugammadex compared with neostigmine was associated with a small decrease in postoperative length of stay in the ambulatory care unit. The effect was magnified in older and high-risk patients, and can be explained by reduced postoperative nausea and vomiting. Sugammadex reversal in ambulatory surgery may also help reduce cost of care.
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The randomised controlled trial is the foundation of clinical research; yet there is concern that many trials have flaws in design, conduct, and reporting that undermine trustworthiness. Common flaws in trials include high risk of bias, small size, outcomes irrelevant to clinical care and patient's experience, and inability to detect efficacy even if present. These flaws carry forward into systematic reviews, which can confer the label of 'high-quality evidence' on inadequate data. ⋯ Some trials have been discovered to be fabricated, the number of which is growing. The fields of anaesthesia and pain have more fabricated trials than other clinical fields, possibly because of increased vigilance. This narrative review examines these themes in depth whilst acknowledging an inescapable conclusion: that much of our clinical evidence is in trouble, and special measures are needed to bolster quality and confidence.
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Auditory interfaces play a vital role in many applications, informing users about both urgent and routine information critical to safety. Unfortunately, problems related to high alarm rates, low reliability, and sound annoyance create barriers to optimising the quality of patient care in perioperative medicine and critical care. Here, we explore how to reduce annoyance and improve detection by manipulating a sound's temporal envelope or the way its energy changes over time. ⋯ Temporal variation in amplitude envelope represents a promising path towards improving auditory interfaces for patient monitoring. By using temporally variable sounds, auditory interfaces can be more effective in alerting users. This is important for safety-critical areas, such as medical alarms, where annoyance often limits efficacy. As this manipulation can preserve the pitch and rhythm of tone sequences, it is compatible with users' pre-existing knowledge of current alarms.