Jono Brüün, Chief Executive Officer of the Royal College of Anaesthetists looks at the benefits of research and why it will always be at the centre of our activities, creating significant impact for patients and the public.
Read the latest letters submitted by members in October's Bulletin.
The NIHR-HTA funded Continuous rectus sheath Analgesia in eMErgency LaparOTomy (CAMELOT) is another trial led by the Perioperative Medicine Clinical Trials Network (POMCTN) that is currently open for recruitment.
The study aims to find out whether adding rectus sheath catheters (RSCs) to standard analgesia provides better pain relief, fewer side effects and complications, and greater satisfaction for patients undergoing emergency laparotomy. It will also determine whether RSCs are safe and cost-effective. All POMCTN trials are registered with the NIHR Associate Principal Investigator (API) scheme. In this article, one of our trainees shares her experience working on the CAMELOT study.
We hope that this work will not simply add another metric to NELA reports, but will also provide useful information to clinicians, patients and organisations involved in the planning and delivery of emergency surgical care.
The NELA risk-prediction tool was designed to be used to adjust for differences in case mix between Centres but has additionally become an increasingly important tool to support shared decision-making. Population-level risk (as estimated by the NELA risk calculator) can provide a starting point for collaborative discussions, which combine data on risk with patient-specific clinical information and personal wishes.
Authors:
The challenges of providing care for an aging surgical population require no further introduction. Perioperative clinical teams are often managing surgical patients with multiple complex co-morbidities, higher levels of frailty, and poorer physiological reserve.
In the eighth annual report of the National Emergency Laparotomy Audit (NELA), we found that more than half of the patients undergoing emergency laparotomy (EL) were 65 years old or more, and that around 20% were aged over 80 years.1 Despite improvements in perioperative care, one in ten patients die within 30 days of their surgery and mortality risk doubles in patients living with frailty.1,2 Are we doing more harm than good by subjecting these patients to surgery?
Despite national improvement initiatives, such as the National Emergency Laparotomy Audit (NELA), clinical outcomes for older people have remained significantly worse than for their younger counterparts. Frailty confers additional complexity, with risk of mortality and morbidity persisting up to 12 months following surgery, and one-third of this group requiring new or additional social-care support following surgery.1
Shared decision-making around emergency laparotomy is challenging for both patients and clinicians. When reflecting on decision-making, older patients have indicated that potential long-term quality of life implications, including loss of independence, are more of a priority than numerical mortality-risk assessment tools.2 Yet, patient-reported measures are not routinely collected within NELA, nor reflected widely in research studies. ‘Perioperative care of older people living with frailty’, published by the Centre for Perioperative Care and British Geriatrics Society, highlights research into patient experience as a key recommendation.3
FICM’s Professional Affairs and Safety Committee (FICMPAS) is one of the three large committees of the FICM board. The major focuses of work are, as our name suggests, professional affairs and safety. We have seen important developments in both areas.
In safety there is a new look Safety Bulletin, developed by Dr Peter Hersey. Short; one paragraph, case-reports of safety incidents are shared with commentary and hyperlinks to additional information. The safety incidents come from the National Reporting and Learning System (NRLS), though Dr Hersey is working to be able to draw from a wider source of incidents.
Like Alexander of Macedon, the new curriculum has swept all before it. For Egypt, read regional anaesthesia; for the sacked cities of Tyre and Persepolis, read the subspecialties.
Although Pain may seem distant, much like Alexander reached India, the new curriculum has reached it.
In 2010 Pain featured as a module requiring a sign off (with 17 syllabus points) and Intermediate Level (18), and was optional at Higher and Advanced.
This has been replaced by compulsory HALOs at Stages 1, 2 and 3, with new and more generalised curriculum points.
Dyslexia is not just a learning difficulty affecting reading and writing; it can be related to difficulty processing and remembering information such as phonological processing, rapid naming, working memory, processing speed, and the autonomic development of skills.1
Up to 10% of the population is estimated to have dyslexia. The newer term ‘neurodivergent’ is postulated to be the wider term, encompassing having cognitive functioning different from what is seen as ‘normal’,2 and it includes dyslexia.
