Development and implementation of local pediatric anesthesia performance metrics at a Canadian children's hospital: a technical report.

PURPOSE: In this project, we sought to develop and implement pediatric anesthesia metrics into electronic health records (EHR) in a hospital setting to improve quality and safety of patient care. While there has been an upsurge in metric-driven health care, specific metrics catering to pediatric anesthesia remain lacking despite widespread use of EHR. The rapid proliferation and implementation of EHR presents opportunities to develop and implement metrics appropriate to local patient care, in this case pediatric anesthesia, with the strategic goal of enhancing quality and safety of patient care, while also delivering transparency in reporting of such metrics. CLINICAL FEATURES: Using a quasi-nominal consensus group design, we collected requirements from attending anesthesiologists using Agile methodology. Forty-five metrics addressing quality of care (e.g., induction experience, anesthesia delivery, unanticipated events, and postanesthetic care unit stay) and provider performance (e.g., bundle-compliance, collaboration, skills assurance) were developed. Implementation involved integration into the EHR followed by transition from PDF-based feedback to interactive Power BI (Microsoft Corporation, Redmond, WA, USA) dashboards. CONCLUSION: We introduced and implemented customized pediatric anesthesia metrics within an academic pediatric hospital; however, this framework is easily adaptable across multiple clinical specialties and institutions. In harnessing data-collecting and reporting properties of EHR, the metrics we describe provide insights that facilitate real-time monitoring and foster a culture of continuous learning in line with strategic goals of high-reliability organizations.

RéSUMé: OBJECTIF: Dans le cadre de ce projet, nous avons cherché à développer et à mettre en œuvre des mesures d'anesthésie pédiatrique dans les dossiers de santé électroniques (DSE) en milieu hospitalier afin d'améliorer la qualité et la sécurité des soins aux patient·es. Bien qu'il y ait eu une recrudescence des soins de santé guidés par les procédures d'évaluation, les mesures spécifiques à l'anesthésie pédiatrique restent insuffisantes malgré l'utilisation généralisée du DSE. La prolifération et la mise en œuvre rapides des DSE offrent des possibilités d'élaborer et de mettre en œuvre des paramètres appropriés aux soins locaux aux patient·es, dans ce cas-ci en anesthésie pédiatrique, dans le but stratégique d'améliorer la qualité et la sécurité des soins tout en assurant la transparence des communications concernant ces paramètres. CARACTéRISTIQUES CLINIQUES: À l'aide d'un modèle de groupe consensuel quasi nominal, nous avons recueilli les exigences des anesthésiologistes traitant·es à l'aide de la méthodologie Agile. Quarante-cinq paramètres portant sur la qualité des soins (p. ex., l'expérience d'induction, l'administration de l'anesthésie, les événements imprévus et le séjour en salle de réveil) et la productivité des prestataires (p. ex., l'observance des forfaits, la collaboration, l'assurance des compétences) ont été élaborés. La mise en œuvre a impliqué l'intégration dans le DSE, suivie de la transition des commentaires en format PDF vers les tableaux de bord interactifs Power BI (Microsoft Corporation, Redmond, WA, États-Unis). CONCLUSION: Nous avons introduit et mis en œuvre des mesures personnalisées de l'anesthésie pédiatrique au sein d'un hôpital pédiatrique universitaire. Cependant, ce cadre est facilement adaptable à de multiples spécialités cliniques et institutions. Parce qu'elles exploitent les propriétés de collecte de données et de communications du DSE, les mesures que nous décrivons fournissent des informations qui facilitent la surveillance en temps réel et favorisent une culture d'apprentissage continu conforme aux objectifs stratégiques des organisations à haute fiabilité.

Use of Peer-Led Web-Based Platforms for Peer-Assisted Learning Among Canadian Anesthesia Residents and Fellows: Cross-Sectional Study.

BACKGROUND: Peer-assisted learning (PAL) using peer-led web-based platforms (PWPs), including social media, can be a highly effective method of supporting medical trainees. PWPs, such as mobile apps for sharing anesthesia resources and social media groups or discussion forums pertaining to anesthesia training, may play a role in facilitating anesthesia trainee-led web-based education. However, there have been many challenges facing anesthesia trainees when it comes to incorporating PWPs, especially social media and mobile apps for PAL. OBJECTIVE: The primary objective of this survey was to assess the proportion of trainees that use social media and mobile apps. The secondary objective was to identify the trainees' perceptions on the use of social media and mobile apps for educational purposes, including PAL. METHODS: This cross-sectional study was conducted through a survey administered via email at a single large academic center. The survey tool collected data between 2016 and 2017 on the following: demographic data (year of study, field of specialty), use of technology and web-based resources for medicine, use of social media platforms for anesthesia or training, benefits and barriers to future uses of social media for training, and ideas for trainee-led websites. Descriptive statistics were reported. RESULTS: In total, 80 anesthesia trainees (51 residents and 29 fellows) responded to the survey (response rate of 33% of out 240 trainees contacted). All trainees reported having a mobile device that most (n=61, 76%) reported using multiple times a day to access medical resources. The highest perceived benefits of PWPs according to residents were that the most valuable information was available on-demand (n=27, 53%), they saved time (n=27, 53%), and they improved their overall learning experience within anesthesia (n=24, 47%). In comparison, fellows thought that PWPs were beneficial because they provided multiple perspectives of a single topic (n=13, 45%) and served as an additional platform to discuss ideas with peers (n=13, 45%). The most popular platforms used by both residents and fellows were Facebook (residents: n=44, 86%; fellows: n=26, 90%) followed by LinkedIn (residents: n=21, 42%; fellows: n=9, 29%). Even though most anesthesia trainees used social media for personal reasons, only 26% (n=21) reported having used resident- or fellow-driven PWP resources. Examples of PWPs that trainees used included anesthesia groups and a resident Dropbox resource folder. CONCLUSIONS: There was generally an acceptance for using PWPs for PAL as they provided various benefits for trainees at all levels of learning. PWPs have the potential to garner an increased sense of community and sharing within learning experiences throughout all levels of training. The information gained from this survey will help inform the basis for developing an anesthesia trainee-led e-learning platform.

Programmable Bloch polaritons in graphene.

Efficient control of photons is enabled by hybridizing light with matter. The resulting light-matter quasi-particles can be readily programmed by manipulating either their photonic or matter constituents. Here, we hybridized infrared photons with graphene Dirac electrons to form surface plasmon polaritons (SPPs) and uncovered a previously unexplored means to control SPPs in structures with periodically modulated carrier density. In these periodic structures, common SPPs with continuous dispersion are transformed into Bloch polaritons with attendant discrete bands separated by bandgaps. We explored directional Bloch polaritons and steered their propagation by dialing the proper gate voltage. Fourier analysis of the near-field images corroborates that this on-demand nano-optics functionality is rooted in the polaritonic band structure. Our programmable polaritonic platform paves the way for the much-sought benefits of on-the-chip photonic circuits.

Income, occupation and education: Are they related to smoking behaviors in China?

BACKGROUND: The association between socioeconomic status (SES) and smoking behaviors may differ across countries. This study aimed to estimate the association between socioeconomic status (income, occupation and education) and multiple measures of smoking behaviors among the Chinese elderly population. METHODS: Using data from the China Health and Retirement Longitudinal Study in 2013, we examined the relationship between socioeconomic status and smoking behaviors through multivariate regression analysis. Sample selection models were applied to correct for sample selection bias. Smoking behaviors were measured by four indicators: smoking status, cigarette consumption, health risks related to smoking, and smoking dependence. Analyses were stratified by gender and urban-rural residence. RESULTS: Among Chinese people aged 45 years or older, smokers accounted for 40% of the population in 2013, smoking 19 cigarettes per day. It was also found that 79% of smokers were at an increased health risk. Overall, although the influence of income on smoking behaviors was small and even insignificant, occupation and education levels were significantly associated with smoking behaviors. Managers or professionals were more likely to smoke, however there was no significant relationship with smoking dependence. Individuals with higher educational attainment were less likely to be associated with smoking behaviors. In addition, gender and urban-rural differences existed in the relationship between SES and smoking behaviors. CONCLUSIONS: Smoking disparities among diverse levels of socioeconomic status existed but varied greatly by SES indicators and population characteristics. Tobacco control policies in China should be increasingly focused on populations with low socioeconomic status in order to break the link between socioeconomic disadvantage and smoking behaviors. Further actions should mitigate inequalities in education, improve the social culture of cigarette use, and tailor interventions based on characteristics of the population.

Smokeless tobacco reduction: preliminary study of tobacco-free snuff versus no snuff.

This preliminary study examined the effects of tobacco-free snuff (intervention, n = 52) compared with no snuff (control, n = 54) for reducing tobacco use among smokeless tobacco (ST) users not interested in quitting. Both groups received behavioral instructions, and intervention subjects received tobacco-free snuff for 8 weeks. Participants were required to reduce their intake by 50% during the first 4 weeks and by 75% during the subsequent 4 weeks. Follow-up occurred at 12 weeks. Significant reductions were observed from baseline to week 8 (end of treatment) for both treatment groups in the amount of ST use (tins/week and dips/day, p<.001); mean urinary cotinine (p<.001); and mean urinary total NNAL, a carcinogen biomarker (p<.001). At week 8 the intervention resulted in a lower mean total NNAL (p = .048). Compared with the control condition, the intervention resulted in a higher percentage of subjects achieving at least a 50% reduction in cotinine (p = .046) and total NNAL (p = .002) at the end of treatment, more quit attempts (p = .030), and a longer mean duration of abstinence (p = .013) through follow-up. An ST reduction intervention incorporating tobacco-free snuff could potentially reduce risk for ST-related disease beyond that achieved with no snuff by increasing the number of patients who achieve significant reductions in carcinogen exposure and, more important, by facilitating tobacco abstinence by increasing quit attempts and abstinence duration.