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Gandhi J, Barker K, Cross S, Goddard A, Vaghela M, Cooper A. Volatile capture technology in sustainable anaesthetic practice: a narrative review. Anaesthesia 2024; 79:261-269. [PMID: 38205589 DOI: 10.1111/anae.16207] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2023] [Indexed: 01/12/2024]
Abstract
Anaesthetic practice contributes to climate change. Volatile capture technology, typically based on adsorption to a carbon- or silica-based substrate, has the potential to mitigate some of the harmful effects of using halogenated hydrocarbons. Anaesthetists have a professional responsibility to use anaesthetic agents which offer the greatest safety and clinical benefit with the lowest financial cost and environmental impacts. Inhalational anaesthetics should be used at an appropriate concentration with a minimal fresh gas flow via a circle system to minimise unnecessary waste. Once practice efficiencies have been maximised, only then should technical solutions such as volatile capture be employed. In this narrative review, we focus on the available literature relating to volatile capture technology, obtained via a targeted literature search and through contacting manufacturers and researchers. We found six studies focusing on the Blue-Zone Technologies Deltasorb®, SageTech Medical SID and Baxter/ZeoSys CONTRAfluran™ volatile capture systems. Though laboratory analyses of available systems suggest that > 95% in vitro mass transfer is possible for all three systems, the in vivo results for capture efficiency vary from 25% to 73%. Currently, there is no financial incentive for healthcare organisations to capture waste anaesthetic gases, and so the value of volatile capture technology requires quantification. System-level organisations, such as Greener NHS, are best positioned to commission such evaluations and make policy decisions to guide investment. Further research using volatile capture technology in real-world settings is necessary and we highlight some priority research questions to improve our understanding of the utility of this group of technologies.
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Mirza RM, MacKean G, Shaffer SR, Sewitch MJ, Heisler C, McLeod J, Habashi P, MacDonald KV, Barker K, Nguyen GC, Marshall DA. Patient Experiences in the Management of Inflammatory Bowel Disease: A Qualitative Study. J Can Assoc Gastroenterol 2022; 5:261-270. [PMID: 36467596 PMCID: PMC9713627 DOI: 10.1093/jcag/gwac014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/08/2023] Open
Abstract
BACKGROUND Inflammatory bowel disease (IBD) can lead to substantial impairments of quality-of-life. Clinical guidelines and quality indicators aid physicians in practice but may not reflect the perspectives and experiences of patients with IBD. To address this, the objectives of this study were to understand patient experiences with IBD care and to explore priorities. METHODS Based on a convenience sample of 36 participants, five focus groups were completed at four sites across Canada. Data were analyzed using a deductive thematic analysis approach to assess emergent themes and variability in participants' experiences. RESULTS Our results are organized by themes of structure, process and outcomes to illustrate common issues with respect to how care is organized in the healthcare system, how patients receive and experience care and how patients perceive the outcomes of their care. Our results frame a health systems quality approach that signal needed improvements in access to care, the need for innovation with respect to virtual medicine, the potential expansion of multidisciplinary team-based care and the importance of addressing the psychosocial dimensions for patients with IBD and their caregivers in order to better deliver patient-centred care. CONCLUSIONS The issues identified have the potential to impact priority areas in the system, IBD care delivery, and how outcomes can be improved by focusing on 'lived experience' and patient-centred care. The differing values and perspectives of all those involved in caring for patients with IBD underscore the importance of good communication with patients, caregivers and family members, as well as staying responsive to evolving needs.
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Watkinson J, Barker K, Rao N. WS09.03 A review of patients’ thoughts, feelings and priorities as evidenced in their responses to the paediatric cystic fibrosis annual review questionnaires. J Cyst Fibros 2022. [DOI: 10.1016/s1569-1993(22)00203-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Shamputa IC, Nguyen DTK, Burdo T, Dao G, Gharbiya L, Burns M, MacKenzie H, Barker K, Webster D. Canadian immigrants´ awareness and perceptions of TB infection and TB. Int J Tuberc Lung Dis 2022; 26:454-456. [PMID: 35505486 DOI: 10.5588/ijtld.21.0629] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Heelas L, Nicholas J, Wiltshire S, Barker K. Evaluation of patient reported outcomes following pain management programmes delivered via video conferencing during the Covid-19 pandemic. Physiotherapy 2022. [PMCID: PMC8848155 DOI: 10.1016/j.physio.2021.12.249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Heelas L, Wiltshire S, Nicholas J, Barker K. Development of adapted, Covid secure pain management programmes: Preliminary outcomes. Physiotherapy 2022. [DOI: 10.1016/j.physio.2021.12.145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Wood S, Newman M, Batting M, Barker K. Is the squat test a valid and reliable test for the diagnosis of femoral acetabular impingement? A systematic review. Physiotherapy 2022. [DOI: 10.1016/j.physio.2021.12.106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Room J, Dawes H, Boulton M, Barker K. What effect does interaction with a physiotherapist have on self-rated confidence, capacity, and motivation to exercise? Physiotherapy 2022. [DOI: 10.1016/j.physio.2021.12.236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Batting M, Barker K. Minimal clinically important difference of the four square step test in people with hip or knee joint replacements. Physiotherapy 2022. [DOI: 10.1016/j.physio.2021.12.166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Barker K, Room J, Knight R, Dutton S, Toye F, Leal J, Kenealy N, Schussel M, Collins G, Beard D, Price A, Underwood M, Drummond A, Lamb S. Community-based rehabilitation after knee arthroplasty: A randomised controlled trial with economic evaluations (CORKA trial): ISRCTN: 13517704. Physiotherapy 2021. [DOI: 10.1016/j.physio.2021.10.223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Rao N, Watkinson J, Russell L, Barker K, Warburton L. P012 Clinical profile of 4 children with variant R117H in our cystic fibrosis clinic. J Cyst Fibros 2020. [DOI: 10.1016/s1569-1993(20)30349-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Hannink E, Shannon T, Dawes H, Barker K. The validity of the kinect sensor for the measurement of sagittal spine curvature against the gold standard lateral spinal radiograph. Physiotherapy 2020. [DOI: 10.1016/j.physio.2020.03.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Hannink E, Shannon T, Dawes H, Barker K. Measurement of sagittal spine curvature: comparing the Kinect depth camera to the flexicurve and digital inclinometers in a clinical population. Physiotherapy 2020. [DOI: 10.1016/j.physio.2020.03.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Gilson C, Sharp T, Jenkins C, Barker K. The effectiveness of hip strengthening exercises in the management of patellofemoral pain syndrome (PFPS) in females: a systematic review. Physiotherapy 2020. [DOI: 10.1016/j.physio.2020.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Heelas L, Wiltshire S, Wall A, Barker K. Does patients’ perception of Improvement following a pain management programme, match reported minimally clinically important differences? Physiotherapy 2020. [DOI: 10.1016/j.physio.2020.03.140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Room J, Dawes H, Boulton M, Barker K. Can a brief behavioural assessment improve exercise adherence in older people with musculoskeletal conditions? A feasibility randomised controlled trial. Physiotherapy 2020. [DOI: 10.1016/j.physio.2020.03.127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Garriga C, Murphy J, Leal J, Price A, Prieto-Alhambra D, Carr A, Arden NK, Rangan A, Cooper C, Peat G, Fitzpatrick R, Barker K, Judge A. Impact of a national enhanced recovery after surgery programme on patient outcomes of primary total knee replacement: an interrupted time series analysis from "The National Joint Registry of England, Wales, Northern Ireland and the Isle of Man". Osteoarthritis Cartilage 2019; 27:1280-1293. [PMID: 31078777 DOI: 10.1016/j.joca.2019.05.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 04/02/2019] [Accepted: 05/01/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE We aimed to test whether a national Enhanced Recovery After Surgery (ERAS) Programme in total knee replacement (TKR) had an impact on patient outcomes. DESIGN Natural-experiment (April 2008-December 2016). Interrupted time-series regression assessed impact on trends before-during-after ERAS implementation. SETTING Primary operations from the UK National Joint Registry (NJR) were linked with Hospital Episode Statistics (HES) data which contains inpatient episodes undertaken in National Health Service (NHS) trusts in England, and Patient Reported Outcome Measures (PROMs). PARTICIPANTS Patients undergoing primary planned TKR aged ≥18 years. INTERVENTION ERAS implementation (April 2009-March 2011). OUTCOMES Regression coefficients of monthly means of Length of stay (LOS), bed day costs, change in Oxford knee scores (OKS) 6-months after surgery, complications (at 6 months), and rates of revision surgeries (at 5 years). RESULTS 486,579 primary TKRs were identified. Overall LOS and bed-day costs decreased from 5.8 days to 3.7 and from £7607 to £5276, from April 2008 to December 2016. Oxford knee score (OKS) change improved from 15.1 points in April 2008 to 17.1 points in December 2016. Complications decreased from 4.1 % in April 2008 to 1.7 % in March 2016. 5-year revision rates remained stable at 4.8 per 1000 implants years in April 2008 and December 2011. After ERAS, declining trends in LOS and bed costs slowed down; OKS improved, complications remained stable, and revisions slightly increased. CONCLUSIONS Different secular trends in outcomes for patients having TKR have been observed over the last decade. Although patient outcomes are better than a decade ago ERAS did not improve them at national level.
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Russell L, Rao N, Barker K, Watkinson J, Warburton L. P084 A review of unscheduled patient contact with a paediatric cystic fibrosis team. J Cyst Fibros 2019. [DOI: 10.1016/s1569-1993(19)30378-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Barker K, Batting M, Nederend J. Measuring everyday mobility in patients before and after knee replacement: the validity and reliability of the Four Square Step test. Physiotherapy 2019. [DOI: 10.1016/j.physio.2018.11.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Barker K, Hannink E, Pemberton S, Jenkins C. Knee arthroplasty patients predicted versus actual recovery: What are their expectations about time of recovery for functional activities following surgery? Physiotherapy 2019. [DOI: 10.1016/j.physio.2018.11.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Hannink E, Shannon T, Parker I, Barker K, Dawes H. The intra-rater and inter-rater reliability of a method measuring the sagittal curvature of the spine using surface topography. Physiotherapy 2019. [DOI: 10.1016/j.physio.2018.11.127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Hamilton D, Beard D, Barker K, MacFarlane G, Murray G, Simpson H. Targeting physiotherapy to patients at risk of poor outcomes following total knee arthroplasty: the TRIO randomised controlled trial. Physiotherapy 2019. [DOI: 10.1016/j.physio.2018.11.162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Jenkins C, Jackson W, Bottomley N, Price A, Murray D, Barker K. Delaying knee flexion after unicompartmental knee replacement leads to improved outcomes: changes to a physiotherapy pathway. Physiotherapy 2019. [DOI: 10.1016/j.physio.2018.11.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Martin J, Barker K. The Hierarchical Assessment of Balance and Mobility (HABAM): an underutilised tool to track physical function and estimate length of stay. Physiotherapy 2019. [DOI: 10.1016/j.physio.2018.11.160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Sano H, Barker K, Odom T, Lewis K, Giordano P, Walsh V, Chambers JP. A survey of dog and cat anaesthesia in a sample of veterinary practices in New Zealand. N Z Vet J 2017; 66:85-92. [PMID: 29207250 DOI: 10.1080/00480169.2017.1413959] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
AIMS To survey current anaesthesia practices for dogs and cats in small and mixed animal practices in New Zealand in order to improve anaesthesia education. METHODS A questionnaire was sent to 440 small and mixed animal practices, including questions regarding the type of practice, preanaesthetic examination, anaesthetic drugs and management, anaesthetic machines, monitoring and topics of interest for continuing professional development. RESULTS Responses were obtained from 113/440 (26%) practices, with 78 (69%) respondents from small and 35 (31%) from mixed animal practices. A preanaesthetic physical examination was carried out by >95% of respondents and premedication was usually given to dogs (112/113; 99%) and cats (95/113; 85%). Acepromazine was the preferred sedative for dogs and cats, with morphine or buprenorphine. Propofol and alfaxalone were the preferred induction agents, and isoflurane was preferred for maintenance in both dogs and cats. A venous catheter was usually placed for anaesthesia in dogs (59/113; 52%), but less so in cats (39/113; 35%). Perioperative fluid was administered at 10 mL/kg/hour by 62/110 (56%) respondents. Intubation was usually used for anaesthesia in dogs (111/112; 99%), and cats (87/112; 78%). Almost 40% of respondents usually administered supplementary oxygen if patients were not intubated. Local analgesia was used by 69/111 (88%) respondents sometimes or always if applicable. Morphine or buprenorphine, and meloxicam were common choices for post-operative analgesia after neuter surgery in dogs and cats. A semiclosed (non-rebreathing) system was used in animals weighing <10 kg, and a Mapleson E or F non-rebreathing circuit was used by 66/109 (61%) practices. Only 15/111 (14%) practices had a ventilator in their practice. A dedicated anaesthetist was usually used by 104/113 (92%) practices, and apnoea alarms, pulse oximeters, thermometers and oesophageal stethoscopes were the main monitoring devices available in practices. Loco-regional block, pain management, and anaesthetic drugs were the main topics of interest for continuing education. CONCLUSIONS AND CLINICAL RELEVANCE Responses by the veterinarians taking part in this survey indicated that they had a reasonably good standard of anaesthetic practice. A physical examination was carried out preanaesthesia, and premedication including analgesia was routinely administered to most patients. A dedicated anaesthetist usually monitored patients and most respondents reported they had access to basic anaesthetic monitoring equipment. Areas where changes could lead to improved anaesthetic practice were increased use of I/V catheterisation, endotracheal intubation, and supplementary oxygen, and reduced I/V fluid rates.
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