Anaesthetics

A rapid response system may be an appropriate model for meeting the urgent need for more suitable care for patients at the end of life

Kenneth M Hillman MD, FRCA, FCICM · Gordon D Rubenfeld MD · Jeffrey Braithwaite PhD, FAIM, FCHSM

Emergency treatment of hyperammonaemia should be undertaken early to prevent devastating neurological injury

James R Anstey MB BS, FRACP, FCICM · Timothy P Haydon FRACP, FCICM, FANZCA · Rashmi B Ghanpur MB BS · Gerard de Jong MD, PhD, FRACP

A change in the law is needed to allow procurement after circulatory death to maximise organ procurement

James Tibballs MD, MHlth · Neera Bhatia LLB(Hons), LLM, PhD

Clinical care may be handicapped by older testing technology

Simon M Holliday BMed, FAChAM, FRACGP · Huy A Tran FRACP, FRCPA, MD

Diabetic ketoacidosis in patients with type 2 diabetes can indicate primary pancreatic disease

George Zhong MB BS(Hons), BSc(Hons) · Rosalba Cross FCICM, MB BS, BSc(Hons)

A multimodal perioperative care pathway leads to shorter hospital stays

Nicholas Christelis FFPMRCA, FANZCA, FFPMANZCA · Sophie Wallace BHSc(Nurs), GradCertInfectCont, MPH · Claire E Sage BAppSci(Nurs), MNurs · Uate Babitu MB BS, FANZCA · Susan Liew MB BS(Hons), FRACS(Orth) · James Dugal MB BS, FRACS · Ibolya Nyulasi MSc, GradDipMgt · Nora Mutalima BSc, MB ChB, DPhil · Ton Tran MB BS, FRACS, FAOA · Paul S Myles MD, FRARCSI, FANZCA

A drastic reduction in CLABSIs in an ICU

Damoon Entesari-Tatafi MB BS · Neil Orford MB BS, FCICM, PGDipEcho · Michael J Bailey PhD, MSc, BSc · Martina N I Chonghaile FCICM, FCARSCI, MB BCh · Jill Lamb-Jenkins RN, Grad Dip Ed, MN · Eugene Athan MB BS, FRACP, MPH

Recruiting more potential organ donors would not result in a large increase in organ donor numbers

Jonathan J Gatward MB ChB, FRCA, FCICM · Michael J O’Leary MD, FRCA, FCICM · Myra Sgorbini MN(Hon) · Paul R Phipps PhD, FRACP, FCICM

It is difficult to find agreement on the best ways to measure patient safety in hospitals

Kenneth M Hillman MD, FRCA, FCICM · Richard Lilford PhD, FRCP, FFPH · Jeffrey Braithwaite BA, PhD, FCHSM

Making our hospitals and communities safer

Christine Gee

Training for non-anaesthetists who care for sedated patients

Joanna R Sutherland · Ellen Rawstron · Christopher Ball

So far, so good — a strategy for improving outcomes, which could itself be improved

Kenneth M Hillman MD, FRCA, FCICM · Jack Chen MB BS, PhD, MBA · Daryl Jones MD, FRACP, FCICM,

Patients and families are not the only ones who need support after adverse iatrogenic events

Cameron I Knott MB BS(Hons), FRACP, FCICM

The National Pain Strategy is driving improvements in pain management, but greater impetus is needed

Michael J Cousins MD, DSc, FFPMANZCA · Lesley Brydon BPharm

Underfunding of pain research limits evidence for effective therapies

Michael J Cousins · Lesley Brydon

In reply: Patients need help confronting reality after treatment “failures”

Michael A Ashby

Objectives: To understand the changes in the population incidence of inhospital cardiopulmonary arrest (IHCA) and mortality associated with the introduction of rapid response systems (RRSs). Design, setting and participants: Population-based study of 9 221 138 hospital admissions in 82 public acute hospitals in New South Wales, using data linked to a death registry, from 1 Jan 2002 to 31 Dec 2009. Main outcome measures: Changes in IHCA, IHCA-related mortality, hospital mortality and proportion of IHCA patients surviving to hospital discharge. Results: RRS uptake increased from 32% in 2002 to 74% in 2009. This increase was associated with a 52% decrease in IHCA rate, a 55% decrease in IHCA-related mortality rate, a 23% decrease in hospital mortality rate and a 15% increase in survival to discharge after an IHCA (all P < 0.01). The adjusted absolute reductions in IHCA-related mortality and hospital mortality were 1.49 (95% CI, 1.30–1.68) and 4.05 (95% CI, 3.17–4.76) patients per 1000 admissions, respectively. The decrease in IHCA incidence rate accounted for 95% of the reduction in IHCA-related mortality. In contrast, the increase in IHCA survival accounted for only 5% of the reduction in IHCA-related mortality. Conclusions: During nearly a decade, as RRSs were progressively introduced, there was a coincidental reduction in IHCA, IHCA-related deaths and hospital mortality and an increased survival to hospital discharge after an IHCA. Reduced IHCA incidence, rather than improved postcardiac arrest survival, was the main contributor to the reduction in IHCA mortality.

Jack Chen MB BS, PhD, MBA(Exec) · Lixin Ou MBA, MPH, PhD · Kenneth M Hillman MD, FRCA, FCICM · Arthas Flabouris MD, FCICM, FANZCA · Rinaldo Bellomo MD, FCICM, FRACP · Stephanie J Hollis BSc, MMedSc, PhD · Hassan Assareh PhD, MEng, MSc(Manag)

Pain medicine needs to be clear about what can and cannot be achieved

Michael A Ashby MD, FRACP, FFPMANZCA

Morphine’s use in Australia has shaped public perception and current challenges

Matthew Grant MB BS, DipPallMed, MBioethics · Jennifer Philip PhD, FAChPM, MB BS · Anna Ugalde BA(Hons), PhD

Outlier patients may be at risk if their therapeutic and monitoring needs are only met on their home ward

John D Santamaria MD BS, FRACP, FCICM · Antony E Tobin MB BS, FRACP, FCICM · Matthew H Anstey MB BS, FCICM, FACEM · Roger J Smith BN, MPH · David A Reid

(a friend, his son) “They said I should beam protonsinto his brain fuzzy with morphine and painin the room where he hung on shadows of life, side by sidewith death waiting for me that I might see his smilea last time. Where have you gone beamsof particles or light or waves that my son could not ride youback to this world. They said I should ...

Meir Weksler PhD

A new tutorial support program delivered face-to-face and by distance is helping specialist international medical graduates in anaesthesia prepare for their College examinations.

Niall S Higgins GDipeH, PhD · Kersi Taraporewalla MB BS, MClinEd, FANZCA · Sisira Edirippulige GCertHigherEd, MSc, PhD · Robert S Ware PhD · Michael Steyn MB ChB, MSc, FANZCA · Marcus O Watson BSc(Hons), MSc, PhD