Use of a viewdata system to collect data from a multicentre clinical trial in anaesthesia. (33/40)

The interactive electronic information storage and transmission system PRESTEL was assessed as a method of recording and collecting patient record forms from a multicentre trial in anaesthesia. PRESTEL terminals were provided in anaesthetic centres around Britain and all data handled by this public viewdata service, which connects users by telephone to a central computer. The trial was of a new analgesic supplement, alfentanil, and confirmed more rapid recovery of patients as compared with that after traditional anaesthesia with halothane. Advantages of the system were manifold and included reducing the need for the trial monitor to visit the trialist, an electronic "mailbox," confidentiality, and the ability immediately to identify violations of study protocol. No participant found the system too difficult to use, though the small keyboard was a source of complaint. Despite the initial cost of the system its utility vastly outweighs traditional methods of data collection.  (+info)

The provision of junior anaesthetic staff for the intensive care unit of a district general hospital: a workable solution? (34/40)

The problems of staffing an ICU in a District General Hospital at junior level are discussed. The needs of the Unit, the junior staff and the Anaesthetic Department and possible ways of reconciling these are outlined. A system of providing cover using pairs of junior anaesthetists is described in detail. This has been successfully in operation for 18 months and its merits are discussed.  (+info)

An analysis of major errors and equipment failures in anesthesia management: considerations for prevention and detection. (35/40)

Adaptations of the critical-incident technique were used to gather reports of anesthesia-related human error and equipment failure. A total of 139 anesthesiologists, residents, and nurse-anesthetists from four hospitals participated as subjects in directed or open-ended interviews, and 48 of them functioned as "trained observers." A total of 1,089 descriptions of preventable "critical incidents" were collected. Of these, 70 represented errors or failures that had contributed in some way to a "substantive negative outcome." From these incidents, ten potential strategies were developed for prevention or detection of incidents. Overall patterns observed in this wider study were similar to those of our earlier report. The incidents most frequently reported included breathing circuit disconnections, drug-syringe swaps, gas-flow control errors and losses of gas supply. Only 4% of the incidents with substantive negative outcomes involved equipment failure, confirming the previous impression that human error is the dominant issue in anesthesia mishaps. Among the broad categories of key strategies for mishap prevention were additional technical training, improved supervision, improved organization, equipment human-factors improvements, and use of additional monitoring instrumentation. The data also suggest that less healthy patients are more likely to be affected adversely by errors. It is suggested that, in future studies of anesthesia mortality and morbidity, untoward events should be classified according to preventive strategy rather than outcome alone as an aid to those who wish to apply the experience of others to lessen the risk in their individual practice.  (+info)

Inhalation anesthetics, anticancer drugs and sterilants as chemical hazards in hospitals. (36/40)

In recent years, there has been a considerable increase in the use of chemicals (chemical sterilants and antimicrobial agents, antineoplastic drugs, and anesthetic gases) in hospitals. The possible existence of occupational health hazards has often been overlooked in light of the great advantages provided by the use of chemical agents. It appears that certain hospital sectors, such as anesthesia units, sterilizing units and oncology units, require different degrees of caution and protective measures with respect to the handling of chemicals. The scientific evidence on which recommendations should be based is, in most cases, fairly meager; until more is known about the hazards, it would be prudent to minimize the occupational exposure to chemicals in hospitals.  (+info)

Denial of effective treatment and poor quality of clinical information in placebo controlled trials of ondansetron for postoperative nausea and vomiting: a review of published trials. (37/40)

OBJECTIVE: To determine how many patients were deprived of treatment by being given placebo as comparator in trials of ondansetron for postoperative nausea and vomiting. DESIGN: Review of published trials of ondansetron during 1991 to July 1994. SETTING: Medline search in a university department of anaesthesia. SUBJECTS: 8806 patients who had been included in 18 indexed placebo controlled trials of ondansetron as prophylaxis against or treatment of postoperative nausea and vomiting. RESULTS: Five studies (1236 patients) had been published by July 1992. All were placebo controlled trials. By July 1994, 8806 patients had been included in 18 indexed placebo controlled studies of prophylaxis or treatment. Only 462 patients had been in studies that compared ondansetron with other drugs, and there were no indexed comparative trials of treatment of nausea and vomiting. Roughly 2180 patients had been given placebo as prophylaxis and 440 had been given placebo when already experiencing postoperative nausea or vomiting. CONCLUSIONS: Around 2620 patients in the reviewed studies were denied existing drugs, which, though not completely effective or without side effects, do bring some relief from postoperative nausea and vomiting. Drug regulatory bodies should collaborate with drug companies to ensure better comparison of new with established drugs. This would avoid placebos being given to more than the fewest patients necessary to confirm effect and would allow doctors to be informed more quickly about relative efficacies.  (+info)

A pen-based system to support pre-operative data collection within an anaesthesia department. (38/40)

This paper describes the design and implementation of a pen-based computer system for remote preoperative data collection. The system is envisaged to be used by anaesthesia staff at different hospital scenarios where pre-operative data are generated. Pen-based technology offers important advantages in terms of portability and human-computer interaction, as direct manipulation interfaces by direct pointing, and "notebook user interfaces metaphors". Being the human factors analysis and user interface design a vital stage to achieve the appropriate user acceptability, a methodology that integrates the "usability" evaluation from the earlier development stages was used. Additionally, the selection of a pen-based computer system as a portable device to be used by health care personnel allows to evaluate the appropriateness of this new technology for remote data collection within the hospital environment. The work presented is currently being realised under the Research Project "TANIT: Telematics in Anaesthesia and Intensive Care", within the "A.I.M.--Telematics in Health CARE" European Research Program.  (+info)

Anaesthetic monitoring: clinical practice in anaesthetic rooms and theatres. (39/40)

Twenty anaesthetic rooms and operating theatres in Northern Ireland were visited in both 1990 and 1992. Data was collected on the availability and use of anaesthetic monitoring. In the anaesthetic rooms there were few pulse oximeters. In the theatres more monitors were available and in use. Some change in practice had occurred between 1990 and 1992, notably an increase in the monitoring of ventilation, and in the availability of printer facilities for documentation of anaesthetic records.  (+info)

General anaesthesia in accident and emergency departments. (40/40)

Potential problems with the provision of general anaesthesia in accident and emergency (A&E) departments were investigated by sending consultants in A&E a postal questionnaire asking for their views on the quality of the anaesthetic service available to their department. Of the 129 consultants replying, 31% had problems in obtaining an anaesthetist, 17% thought the first on-call anaesthetist was too inexperienced and 5% had experienced various other problems. Overall, 20% were unhappy with the service.  (+info)