Global surgery and the World Health Organization: indispensable partners to achieve triple billion goals The legend of the Figure currently reads: “A formula for advancing surgical system strengthening and World Health Assembly resolution 68.15 through the World Health Organization’s thirteenth General Programme of Work (GPW-13). This graphic depicts the three strategic shifts outlined in GPW-13 and ties them to specific avenues for surgical system strengthening to achieve overarching goals. GPW-13 = Thirteenth General Programme of Work; NSOAPs = National Surgical, Obstetric, and Anesthesia Plans; PHC = primary healthcare; SDG 3 = Sustainable Development Goal 3; UHC = universal health coverage; WHA 68.18 = World Health Assembly resolution 68.15. “ The corrected Figure legend should read: A formula for advancing surgical system strengthening and World Health Assembly resolution 68.15 through the World Health Organization’s thirteenth General Programme of Work (GPW-13). This graphic depicts the three strategic shifts outlined in GPW-13 and ties them to specific avenues for surgical system strengthening to achieve overarching goals. GPW-13 = Thirteenth General Programme of Work; NSOAPs = National Surgical, Obstetric, and Anesthesia Plans; PHC = primary healthcare; SDG 3 = Sustainable Development Goal 3; UHC = universal health coverage; WHA 68.15 = World Health Assembly resolution 68.15.

Correction to: Intraoperative cerebral oximetry-based management for optimizing perioperative outcomes: a meta-analysis of randomized controlled trials In the article entitled “Intraoperative cerebral oximetry-based management for optimizing perioperative outcomes: a meta-analysis of randomized controlled trials” Can J Anesth 2018; 65: 529-42, we wish to clarify the following items.

Can electrical nerve stimulation guidance assist in cervical erector spinae plane block catheter placement for total shoulder arthroplasty?

Critical Care Medicine: Principle of Diagnosis and Management in the Adult

A potential risk from under-recognized perioperative anticoagulation from dalteparin used for extracorporeal circuit anticoagulation during hemodialysis

Transesophageal echocardiographic imaging of an aortic intramural hematoma: characterizing the crescent

A cadaver pilot study to evaluate the impact of the needle bevel orientation on the ease of paravertebral catheter insertion

Implementation of population-level screening for frailty among patients admitted to adult intensive care in Alberta, Canada Abstract Purpose A substantial proportion of patients admitted to intensive care units (ICUs) are frail; however, the epidemiology of frailty has not been explored at a population-level. Following implementation of a validated frailty measure into a provincial ICU clinical information system, we describe the population-based prevalence and outcomes of frailty in patients admitted to ICUs. Methods Retrospective cohort study of adult admissions to 17 ICUs. Data were captured using eCritical Alberta. A Clinical Frailty Scale (CFS) score assigned at ICU admission was used to define the exposure (CFS score ≥ 5). Primary outcome was hospital mortality. Secondary outcomes were ICU and hospital stay, and receipt of organ support. Results Fifteen thousand two hundred and thirty-eight patients (81%) were assigned a CFS score at ICU admission. Of these, 28% (95% confidence interval [CI], 27 to 28) were frail. Prevalence of frailty was 9-43% across ICUs. Frail patients were older [mean (standard deviation) 63 (15) vs 56 (17) yr; P < 0.001], more likely to be male (54% vs 46% female; P < 0.001), and had higher APACHE II scores [22 (8) vs 17 (8); P < 0.001] compared with non-frail patients. Frail patients received less mechanical ventilation (62% vs 68%; P < 0.001) and vasoactive therapy (24% vs 57%; P < 0.001), but more non-invasive ventilation (22% vs 9%; P < 0.001). Frail patients had higher hospital mortality (23% vs 9%; adjusted odds ratio, 1.80; 95% CI, 1.64 to 2.05, along with longer ICU stay (median [interquartile range] 4 [2-8] vs 3 [2-6] days; P < 0.001), and longer hospital stay (16 [8-36] vs 10 [5-20] days; P < 0.001) compared with non-frail patients. Conclusion A validated measure of frailty can be implemented at the population level in ICU. Frailty is common in ICU patients and has implications for health service use and clinical outcomes.

Pulse-ox paradox: potential versus pitfalls of pulse oximetry monitoring in surgical patients with obstructive sleep apnea

Faculty perspectives on the transition to competency-based medical education in anesthesia Abstract Purpose Canadian residency programs are transitioning from time-based to competency-based medical education (CBME). The anesthesia department at Dalhousie University enrolled its first CBME cohort in 2016, one year prior to national anesthesia rollout. Early implementation allowed a unique opportunity to examine faculty anesthesiologists’ experiences with the transition. Methods Using Rogers’ Diffusion of Innovations (DOI) theory, we conducted a qualitative interview study. In-depth interviews were held with faculty members (n = 12) at varying stages of innovation adoption (e.g., innovators/early adopters, early/late majority, and laggards) at two time points: onset of CBME and one year later. Interview data were analyzed based on the DOI promoting factors: relative advantage, compatibility, complexity, trialability, and observability. Results Relative advantage: Early adopters believed CBME had benefits over the traditional curriculum, while laggards viewed the change as an unproven paradigm shift. CBME was compatible with the values of early adopters, who appreciated resident accountability for learning. Trialability, the degree to which an intervention can be trialed and modified, arose with the early/late majority group, who described an organic process of adaptation over the year. All groups mentioned the need for observable results. Innovators and early adopters were confident CBME would improve learner experiences. Early/late majority noted expedited skill acquisition and improved quality of feedback. Laggards believed observable results would take many years to emerge, if ever. The early/late majority group showed the most progress toward adoption over the study time period, moving from skeptical optimism to active investment. Conclusion Targeted interventions for faculty uptake should emphasize the trialability and observable results achieved over time. These efforts may have the greatest impact in the early/late majority group.