Anesthesiologists have made several major medical advances over the past 150 years, including the development of anesthesia itself. Recent advances in regional anesthesia techniques using ultrasound have improved outcomes. While perioperative care has improved, morbidity and mortality after surgery remain high. The speaker highlights key areas for future research at the University of Ottawa, including perioperative medicine, pain management, and medical education. Continued research is needed to improve outcomes and advance the field of anesthesiology.
HISTORY OF 3-STEP LADDER WHO
1980 – WHO establishes Cancer Control Programme
Cancer prevention
Early diagnosis with curative treatment
Pain relief and palliative care
1986 – ” Cancer Pain Relief “ published by WHO
Step Ladder WHO
Updated on 1996
Worldwide acceptance protocol
Today, worldwide consensus favouring its used for management of all pain associated with serious illness
HISTORY OF 3-STEP LADDER WHO
1980 – WHO establishes Cancer Control Programme
Cancer prevention
Early diagnosis with curative treatment
Pain relief and palliative care
1986 – ” Cancer Pain Relief “ published by WHO
Step Ladder WHO
Updated on 1996
Worldwide acceptance protocol
Today, worldwide consensus favouring its used for management of all pain associated with serious illness
Regional Anesthesia in the Prevention of Persistent Postsurgical PainEdward R. Mariano, MD
Persistent postsurgical pain (PPSP), or chronic pain that develops after surgery, occurs more frequently than one may expect: up to 50% after relatively common operations. For anesthesiologists, surgeons, and pain physicians, there is an urgent need to discover methods to prevent the development of PPSP which is considered one of the more dreaded adverse outcomes following elective surgery.
EBM is the practice of integrating individual clinical expertise with the best available clinical evidence from systematic research to maximize the quality and quantity of life for individual patients.
Update on regional anesthesia for breast surgery - Michael Herrick - SSAI2017scanFOAM
A talk by Michael Herrick at the 2017 meeting of the Scandinavian Society of Anaestesiology and Intensive Care Medicine.
All available content from SSAI2017: https://scanfoam.org/ssai2017/
Delivered in collaboration between scanFOAM, SSAI & SFAI.
Theera-Ampornpunt N. Information and technology: emergency medical informatics. Presented at: The International Conference in Emergency Medicine: Challenges in Emergency Medicine: It’s Time for Change!; 2012 Feb 1; Bangkok, Thailand. Invited speaker.
Regional Anesthesia in the Prevention of Persistent Postsurgical PainEdward R. Mariano, MD
Persistent postsurgical pain (PPSP), or chronic pain that develops after surgery, occurs more frequently than one may expect: up to 50% after relatively common operations. For anesthesiologists, surgeons, and pain physicians, there is an urgent need to discover methods to prevent the development of PPSP which is considered one of the more dreaded adverse outcomes following elective surgery.
EBM is the practice of integrating individual clinical expertise with the best available clinical evidence from systematic research to maximize the quality and quantity of life for individual patients.
Update on regional anesthesia for breast surgery - Michael Herrick - SSAI2017scanFOAM
A talk by Michael Herrick at the 2017 meeting of the Scandinavian Society of Anaestesiology and Intensive Care Medicine.
All available content from SSAI2017: https://scanfoam.org/ssai2017/
Delivered in collaboration between scanFOAM, SSAI & SFAI.
Theera-Ampornpunt N. Information and technology: emergency medical informatics. Presented at: The International Conference in Emergency Medicine: Challenges in Emergency Medicine: It’s Time for Change!; 2012 Feb 1; Bangkok, Thailand. Invited speaker.
Picture Archival and Communication System [PACS] has evolved continuously over the last two decades. You can read the overview of PACS in this PPT Slides
A successful career in emergency medicine can be accomplished by following some basic principles in life. These principles are known to all…they are learned from parents, mentors and colleagues, but they are often at first not appreciated or recognized. Amal discusses many of these principles as he discusses an all-time classic movie, The Princess Bride. This movie, beloved by millions around the world, demonstrates and teaches many of those basic principles that, the speaker argues, can lead to a successful career in emergency medicine.
What Exactly Is The "Internet of Things"?Postscapes
Over the last several years, stories of the technologies making up an Internet of Things have started to slip into public consciousness. As this is occurring, we believe the whole story of Smart Systems and the Internet of Things is not being told. Many of the dispatches coming in from the “front lines” of technology innovation are but fragments of a much larger narrative.
Postscapes collaborated with Harbor Research on an infographic to tell a more complete story about the Internet of Things.
From our perspective, this story is not just about people communicating with people or machines communicating with machines. Smart, connected systems are a technological and economic phenomenon of unprecedented scale, encompassing potentially billions if not trillions of nodes -- an Internet of infinite interactions and values...
The Language of Discovery: Designing Big Data InteractionsJoe Lamantia
The Language of Discovery: A Grammar for Designing Big Data Interactions
The oncoming tidal wave of Big Data, with its rapidly evolving ecosystem of multi-channel information saturated environments and services, brings profound challenges and opportunities for the design of effective user experiences.
Looking deeper than the celebratory rhetoric of information quantity, at its core, Big Data makes possible unprecedented awareness and insight into every sphere of life; from business and politics, to the environment, arts and society. In this coming Age of Insight, 'discovery' is not only the purview of specialized Data Scientists who create exotic visualizations of massive data sets, it is a fundamental category of human activity that is essential to everyday interactions between people, resources, and environments.
To provide architects and designers with an effective starting point for creating satisfying and relevant user experiences that rely on discovery interactions, this session presents a simple analytical and generative toolkit for understanding how people conduct the broad range of discovery activities necessary in the information-permeated world.
Specifically, this session will present:
• A simple, research-derived language for describing discovery needs and activities that spans domains, environments, media, and personas
• Observed and reusable patterns of discovery activities in individual and collaborative settings
• Examples of the architecture of successful discovery experiences at small and large scales
• A vocabulary and perspective for discovery as a critical individual and organizational capability
• Leading edge examples from the rapidly emerging space of applied discovery
• Design futures and concepts exploring the possible evolution paths of discovery interactions
To Determine Preference of Shoulder Pain Management by General Physicians in ...suppubs1pubs1
Rotator cuff muscles are functionally active and provide stability to the shoulder joint and also thereby allow the full Range of Motion (ROM) by moving the head of humerus in the glenoid cavity. Any tear or fragility of the rotator cuff muscles can cause the dislocation or instability and hence damaging other muscles specially the long head of biceps muscle. The diseases related to the supraspinatus tendon are frequently linked with the long head of the biceps tendon. Other cause of chronic shoulder pain is the adhesive capsulitis with large prevalence rates of more than 5.3% in the general target population [3].
No poison can kill a positive thinker and no medicine can cure a negative thinker. Pain is a complex perceptual experience. Pain is a major public health problem. Beat back pain without surgery and conquer pain without painkillers. Delays have dangerous ends. Knee braces invite injury. Chronic pain affects one in three people in the United States. There are more Americans suffering from chronic pain than with diabetes, heart disease, and cancer combined. Chronic pain is caused by degeneration, illnesses, injuries, surgeries, and treatment side effects. Pain is a major public health problem and is the most common reason why Americans use complementary and integrative health practices. Recent imaging evidence suggests a possible hypothalamic origin for a headache attack, but further research is needed. A migraine is associated with a modest increase in the risk of ischemic stroke.
Oesophageal surgery- Is there light at the end of the tunnel? Professor Neil ...SMACC Conference
The 105 years since the first successful thoracic oesophagectomy was performed saw initially slow progress in terms of operative mortality, morbidity and oncological outcomes. Even until the late 1990’s, operative mortality figures of 15-20% were commonplace and long term survival was poor, as low as 12%1. The last 20 years has seen a major change in these outcomes both within Australia and overseas. These improvements have been based on the bed rocks of improved surgical techniques, improved peri operative care, changes in the distribution of the pathophysiology of the disease, improved patient selection through better staging, Development of endoscopic techniques for early tumours, development of effective neo adjuvant regimes and the development of “high” volume centres have all contributed to the current figures of 4% preoperative mortality and overall 5 year survivals in the post surgical patient of 40%. Better understanding of the nutritional issues involved has led to an emphasis on better quality of life issues in both the curative and palliative settings. This talk outlines the forces that have brought about the changes including outlining the modern treatment algorithm and discussing the volume effects of surgery in the Australian context
1. Earlam R, Cunha-Melo JR. Oesophageal squamous cell carcinoma: I. A critical review of surgery. Br J Surg 1980;67: 381-90
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This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
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These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
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Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
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Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
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Does medicine need academic anesthesia
1. Colin J.L. McCartney MBChB PhD FRCA FCARCSI FRCPC
Professor and Chair, Department of Anesthesiology
University of Ottawa
2. Describe three key medical advances made by
anesthesiologists
Discuss advances in regional anesthesia and pain
medicine in the last ten years
Highlight key areas where uOttawa
anesthesiologists can advance medical practice
in the next ten years
3. Anesthetists have made major contributions to
medicine in the last 150 years
Many surgical advances related to advances in
anesthesia
230 million major surgical procedures worldwide
each year
Perioperative morbidity and mortality remains
unacceptably high
Chronic pain after surgery in 10-50% of individuals
Many known beneficial treatments remain
underutilized
Lots of work to be done!
5. Science of anesthesia: John Snow, ether and
father of epidemiology
Neuromuscular blockade: Harold Griffith
Multidisciplinary pain clinics: John Bonica
6. • BMJ 2007: 11300 readers polled on most important
medical advance since 1840
7. • BMJ 2007: 11300 readers polled on most important
medical advance since 1840
• Anaesthesia ranked as 3rd most important
• John Snow (1813-1858): British physician and
anaesthetist. Father of epidemiology.
8. Developed scientific basis
of anesthesia
Anaesthetist to Queen
Victoria for last two
children
“First epidemiologist”
Cholera and the Broad
Street pump
Rickets
9.
10.
11.
12. Harold Griffith 1894-1985
MD, McGill University 1922
Chief of Anesthesia, Montreal Homeopathic Hospital
1923
Recruited by Frank McMechan,Wesley Bourne and Ralph
Waters and IARS to help advance anesthesia
Innovator of tracheal intubation (34FG urinary
catheters!)
First used Curare for muscle relaxation in anesthesia in
1942 with resident, Dr Enid Johnston
Mentor of Dr. J. EarlWynands
16. John J. Bonica 1917-1994
Understood the multidimensional
biopsychosocial nature of pain
Authored or edited 41 books
Published 274 scientific articles
18. John J. Bonica 1917-1994
Understood the multidimensional
biopsychosocial nature of pain
Developed the first multidisciplinary pain clinic at
University ofWashington in 1961
Organized first international pain symposium in
1973 and helped to develop IASP
20. Virginia Apgar Neonatal resuscitation
Peter Safar Resuscitation
JW Severinghaus Blood-gas analysis
John Lundy Transfusion Medicine
John Bonica Pain Management
21.
22. Use of PNBs: Improvements in ambulatory
anesthesia
Ultrasound: Improved efficacy and less
complications
Perioperative outcomes research: evidence of
changes in morbidity and mortality
39. Reduced postoperative pain, opioid
consumption, adverse effects
No difference in blood loss orTE events
No difference in mortality
40. 400 hospitals between 2006-10
Data from primary hip/knee arthroplasty
Subgrouped by anesthetic technique
30 day morbidity and mortality data
Anesthesiology 2013
41. 382,000 patients
25% neuraxial
Neuraxial associated with less mortality, length of
stay, in-patient morbidity
Anesthesiology 2013
42.
43.
44.
45. Faster discharge due to better pain control and
less side effects
Safer more effective techniques with ultrasound
Emerging evidence of morbidity and mortality
benefits of neuraxial techniques for major joint
arthroplasty
46. Faster discharge but significant pain at home
Ultrasound beneficial but training lags evidence
Emerging evidence of morbidity and mortality
benefits of neuraxial techniques for major joint
arthroplasty but only 25% patients receive
benefit
47. Medical education scholarship: more effective
training throughout medical careers
Perioperative medicine: bench to bedside
Pain Medicine: training and research
53. Potential uses of MSC therapy:
Ventilator induced lung injury
Pulmonary hypertension
Infectious acute lung injury
Sepsis
Trauma
Burn injury
Lalu M et al 2014
54. Prediction and prevention of perioperative
morbidity and mortality
Optimizing functional outcome
Prevention and reduction of chronic pain after
surgery
58. CPET can help predict outcome after major
colonic surgery
59. 198 patients having major colonic surgery
CPET variables are associated with postoperative
morbidity
Prehabilitation, consideration of alternative
approaches and modified perioperative
management may alter risk
60.
61.
62. Much research to be done in pain medicine
Mechanisms
Which treatment and when?
Translation of knowledge to practice
Transition from acute to chronic pain
Classification of chronic pain
Neuropathic pain
63. Chronic pain remains a major societal issue
Huge under provision of chronic pain services
Only 12-14 specialty fellowship training positions
available annually across Canada
Fragmentation of care and approaches to care
Lack of knowledge translation
Opioid addiction and opiophobia are barriers to
good pain management
64.
65. Pain Medicine now a recognized subspecialty
program at Royal College
Anesthesia is primary parent specialty
Specialty committee predominantly
anesthesiologists (analogous to UK and
Australia)
Dr. Catherine Smyth MD PhD has been a leader
in this initiative
66. Anesthesia and anesthesiologists have led key
advances in medicine in the last 150 years
Many questions remain that may have huge
impact on the way we teach and practice
medicine in the future
Anesthesiologists are keen to collaborate with
colleagues to answer these questions and
improve care for patients locally, nationally and
internationally
67. “A discipline not continually engaged in an active
and imaginative program of research is dead,
and will not advance, and will probably
deteriorate in general standards and efficiency.”
Kitz and Biebuyck 1970’s
DOES MEDICINE NEED ACADEMIC
ANESTHESIOLOGY?
68. Anesthesiologists have made major contributions to
advances in medicine
As Anesthesiologists we need to think how we can
contribute to medicine and not just anesthesia
At uOttawa we can make major academic
contributions to education, perioperative and pain
medicine