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Britta Regli-von Ungern-Sternberg AM FAHMS MD, PhD, DEAA, FANZA Chair of Paediatric anaesthesia, University of Western Australia; Consultant
Perioperative respiratory adverse events (PRAE) are a main cause of morbidity and mortality in paediatric anaesthesia. Clinicians need to be able to predict their patients' risk of PRAE to plan their care. Clinical risk prediction tools have been developed to assist with pre-operative risk stratification; however, validation outside the contexts of their development is limited. In this study, we test the ability of common risk prediction tools to identify patients at high risk of PRAE in general anaesthesia.
Obesity is linked to altered lung function and increased perioperative respiratory adverse events (PRAEs). We examined the effects of obesity, respiratory symptoms, and posture on PRAEs, lung mechanics, and ventilation distribution in children undergoing general anesthesia.
This article reflects on deeply ingrained societal biases with regard to gender. Patriarchal structures and gender socialization have created a perceived incongruity between traditional leadership qualities and traits associated with women. This perception, explained by the role congruity theory, contributes to prejudice against female leaders and can lead to toxic male behavior being misidentified as "strong" leadership. We further examine cognitive shortcuts, specifically implicit bias and the affect heuristic, which perpetuate unconscious favoritism towards male leaders.
When doctors working within healthcare systems under pressure perpetrate, witness, or fail to prevent acts that contradict their own moral or ethical values and expectations, it can lead to moral distress or moral injury. This can result from active behaviour and from purposeful inactive behaviour. It is a growing and critical concern, representing significant distress that extends far beyond traditional concepts such as burnout. This article discusses moral injury in clinical and academic medicine and actively gives suggestions to prevent and address moral injury.
The social determinants of health, as described by the World Health Organisation (WHO), are 'the non-medical factors' that influence health outcomes. They are the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life. According to the WHO, social determinants of health account for between 30-55% of health outcomes, and children can be particularly vulnerable to their impacts.
Pediatric perioperative care can be described as a journey, starting when surgery is first contemplated, all the way through to a patient’s full recovery. For the child and their family, this journey spans from the time at home pre-operatively through a hospital stay and finishes with at-home recovery.
Oral liquid prednisolone medications have poor acceptance among paediatric patients due to ineffective masking of the bitterness taste of prednisolone. This study aimed to develop a child-friendly prednisolone tablet using a patented chewable chocolate-based delivery system previously applied successfully to mask the bitterness tastes of midazolam and tramadol.
Tonsillectomy is one of the most common surgical procedures in childhood. While generally safe, it often is associated with a difficult early recovery phase with poor oral intake, dehydration, difficult or painful swallowing, postoperative bleeding, infection and/or otalgia.
Cognitive errors are known contributors to poor decision-making in healthcare. However, their incidence and extent of their contribution to negative outcomes during difficult airway management are unknown. We aimed to identify cognitive errors during paediatric difficult airway management using data from the Pediatric Difficult Intubation (PeDI) registry, to determine patient and clinician factors associated with these errors, and their contribution to complications.