Jason Williams-James, RCoA Patients Voices member with personal experience of surgery and anaesthesia, discusses the importance of DrEaMing with Eleanor Warwick, ST6 Anaesthetist and Perioperative Quality Improvement Programme (PQIP) Fellow. They discuss why patients, the surgical multidisciplinary team (MDT), and organisations should be interested in this quality improvement metric.
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It is safe to say that the laryngoscope is one of the most recognisable tools within anaesthesia. A piece of equipment that has evolved throughout the years to be used by airway specialists, the humble laryngoscope allows us to perform one of the fundamentals of anaesthesia: to intubate an airway.
It is safe to say that the laryngoscope is one of the most recognisable tools within anaesthesia. A piece of equipment that has evolved throughout the years to be used by airway specialists, the humble laryngoscope allows us to perform one of the fundamentals of anaesthesia: to intubate an airway.
The COVID-19 pandemic has accelerated a trend within anaesthesia – a move away from direct laryngoscopy (DL) towards video laryngoscopy (VL) as the primary method of intubating the airway.1 Indeed, from recent conversations with my colleagues about their choice of airway tool, I’ve noted a general theme: DL is fast becoming an unfavoured and unfamiliar technique for management of a patient’s airway. This sentiment was reflected in the updated Difficult Airway Society (DAS) guidelines in 2015: laryngoscopy as part of Plan A can now comprise either DL or VL attempts.2
With such a minimal amount of time in the undergraduate curriculum allocated to anaesthesia, it is crucial that we maximise learning opportunities to inspire and develop future clinicians. Here is how we revolutionised the undergraduate anaesthetic placement at Northwick Park Hospital.
Authors:
- Dr Chima Oti, Consultant Anaesthetist, London North West University Healthcare NHS Trust; Anaesthetic Lead for Undergraduate Medicine
- Dr Kimberley Hodge, Squadron Leader, RAF ST6 Anaesthesia and Intensive Care Medicine, Kimberley.hodge@nhs.net
- Dr Cara Lewis, ST5 Anaesthetics, London North West School of Anaesthesia
- Dr Aynkaran Dharmarajah, Consultant Anaesthetist, London North West University Healthcare NHS Trust
With such a minimal amount of time in the undergraduate curriculum allocated to anaesthesia, it is crucial that we maximise learning opportunities to inspire and develop future clinicians. Here is how we revolutionised the undergraduate anaesthetic placement at Northwick Park Hospital.
Why do medical students spend so little time on clinical placement with anaesthetics? As a foundation doctor one must be knowledgeable about a broad collection of topics; these include practical skills such as phlebotomy and cannulation, acute- pain management, and recognition and treatment of an acutely deteriorating patient. All of these are skills found within an anaesthetist’s armamentarium, placing us in the privileged position of being able to impart our knowledge to the next generation of doctors. As anaesthetics is a postgraduate specialty, our primary opportunity to help develop these skills for our colleagues is during their undergraduate attachment.
Perioperative Journal Watch is written by TRIPOM (trainees with an interest in perioperative medicine – tripom.org) and is a brief distillation of recent important papers and articles on perioperative medicine from across the spectrum of medical publications.
Author: Dr Stuart Connal, ST5, North Central London Deanery
Perioperative Journal Watch is written by TRIPOM (trainees with an interest in perioperative medicine – tripom.org) and is a brief distillation of recent important papers and articles on perioperative medicine from across the spectrum of medical publications.
In this article, Dr Passi and Dr Oliver seek to highlight the resulting increased potential for contraceptive failure and propose methods to better inform and protect patients.
It has both a favourable side-effect profile compared with traditional anticholinesterases and allows for emergency reversal.
With the expiry of its original patent last year, high cost is no longer a factor prohibiting its use, which will invariably further increase. In this article, we seek to highlight the resulting increased potential for contraceptive failure and propose methods to better inform and protect patients.
The risk of contraceptive failure
Due to its ability to encapsulate progesterone – present in contraceptive pills, vaginal rings, implants and intra-uterine devices – the administration of sugammadex may reduce their biological effect and cause contraceptive failure. This was identified in in-vitro studies, using isothermal microcalorimetry, performed as part of the drug’s development. While in-vivo studies to quantify the reduction in serum progesterone concentration following sugammadex administration have not been performed, these results have shaped current manufacturer guidance.
Dr Liu and Dr Taylor, Junior Clinical Fellows at Guys' and St Thomas' Hospitals discuss the challenges and opportunities of implementing perioperative medicine services for patients living with frailty.
It's also associated with other risk factors for poor outcomes, including multimorbidity, sarcopenia and disability. Despite the prevalence of these conditions, current perioperative pathways are not always tailored to high-risk, older surgical patients, resulting in unacceptable variation in access to and quality of care across the UK.
Comprehensive geriatric assessment (CGA) can be used to assess and optimise frailty, multimorbidity and other age-related syndromes, reducing postoperative morbidity and mortality with proven cost-effectiveness. Implementing CGA-based perioperative services is therefore key in delivering high-quality and cost-effective care of older people undergoing surgery.
Jenny Westaway, Chair, PatientsVoices@RCoA discusses Martha's Rule and how brave families campaigning for change can make all the difference.
It’s a sad truth that necessary change sometimes only comes in the aftermath of something going terribly wrong.
When I see a family that has suffered a tragedy calling for change – and it often seems to be a family campaign that makes the difference – I find myself in awe of their courage. Stephen Lawrence’s family working for a more equitable society, Molly Russell’s family calling for greater online safety and support for young people, Natasha Ednan-Laperouse’s family campaigning for better food labelling to protect allergies. I also wish that they’d never had to find themselves in that position.
Drs Whittingham and Lee tell us why they nominated their College tutor, Dr Minich for a College Honour Award and why they were pleased he received a President's Commendation.
These colleagues are easily recognised and often appreciated but, with the merry-go-round of training and rotational placements, attaining formal acknowledgement of their work can be overlooked.
We recently took steps to nominate our College tutor and were delighted when he received a President’s Commendation from our College.
Several years ago, Dr Minich took over the school-wide final FRCA teaching programme. With his dedication and blindingly structured approach, it quickly became clear that we were fortunate to have an excellent educator in our midst. To say we all benefited from the provision of exam-practice resources and Dr Minich’s efforts coordinating hours of SOE practice feels like an understatement; it simply does not portray the level of help and support Dr Minich provided to the trainee body preparing for the exams.
Differential attainment is a gap in attainment between two groups of people with differing characteristics in one or more areas. This article looks at how and why attainment can be affected in examinations.
Duncan McMillan, our Head of Content, welcomes you to the second article in our new feature, in which we share and showcase education and training content.