Author(s) Wilson A.; Lie J.
Source Anaesthesia; Jan 2020; vol. 75 ; p. 66
Following the recommendations of the Francis report, it has been NHS policy that all hospital patients have a named consultant responsible for their care to ensure patient safety. Many theatre lists are run by non-autonomous SAS grades (NASG) who, although they are the lead anaesthetist for their list, have a designed consultant supervisor [1].
At East Lancashire Hospitals NHS Trust (ELHT), there is a designated duty anaesthetist at both Royal Blackburn Teaching Hospital (RBTH) and Burnley General Teaching Hospital (BGTH).

Methods The audit was conducted as per the Cappuccini test guidance produced by the Royal College of Anaesthetists [2]. Twenty elective lists conducted by NASG over 2 weeks were identified at ELHT. The NASG was asked who is supervising you and how would you get hold of them if you needed them now? I then checked that I was able to contact the consultant myself and then asked the consultant the following four questions: which lists are you currently supervising, in which surgical specialty are they working currently, do you know of any issues that the NASG are concerned about and if they required your help would be able to attend?

​Results The NASG knew 19/20 of the names of the duty anaesthetists and all of them knew how to get in contact with the consultant if required, which was by a designated deck phone. I was able to get in contact with all the duty anaesthetists. The duty anaesthetist was aware of 15/20 lists and knew the specialities for 14/ 15 of the lists they were aware of. There were no issues reported and all duty anaesthetists said they were able to attend if required for the lists they were aware of (15/15); however, for two of the lists (same supervisor/session), the duty anaesthetist was carrying the registrar bleep due to sickness so would have been less available than usual. Discussion The results show that the NASG knew who the duty anaesthetist was and how to contact them. This is most likely due to the fact that there is a designated duty anaesthetist at both RBTH and BGTH, who is not attached to a specific theatre list, but has the responsibility of supervising all theatres including the NASG and giving assistance when required. The knowledge of the duty anaesthetist of the lists they were supervising was lower, RBTH and BGTH are large departments with 11 and 14 theatres, respectively, which likely factors into this score. All duty anaesthetists said they would be able to attend if required with the one example of slight difficulty due to carrying the registrar's bleep due to sickness.

Author(s) Bashir M.; Harky A.
Source The Journal of cardiovascular surgery; Jan 2020
Type A dissection is a clinical emergency and the extent of repairing the damaged tissue is variable and depends on several factors including the expanse of dissection, entry tear, surgeon's experience, and unit resource availability and performance. The conservative surgeon prefers to perform aortic root up-to hemi arch replacement while the patient recovers planning onward for the second stage approach, however, the aggressive school prefers to replace the entire aortic arch with the deployment of a frozen elephant trunk and control intimal tear and alter false lumen natural history. Data to date remains debatable in terms of short- and long-term outcomes with equivocal results between both approaches. Through our manuscript, we aim to highlight the indifferences, challenges, resultant optimum outcomes from the surgeon and patients' perspectives, plus we will mull over the evidence best practice in limited versus extended type A aortic dissection repair.

​Author(s) Chichareon P.; Modolo R.; Kerkmeijer L.; Kogame N.; Takahashi K. et al.
Source JAMA Cardiology; Jan 2020; vol. 5 (no. 1); p. 21-29
Importance: Women experience worse ischemic and bleeding outcomes after percutaneous coronary intervention (PCI). Objective(s): To assess the association of sex with patient outcomes at 2 years after contemporary PCI and with the efficacy and safety of 2 antiplatelet strategies. 

Author(s) Altmann E.S.; Crossingham I.; Wilson S.; Davies H.R.
Source Cochrane Database of Systematic Reviews; Oct 2019; vol. 2019 (no. 10)
Background Pleural infection, including parapneumonic effusions and thoracic empyema, may complicate lower respiratory tract infections. Standard treatment of these collections in adults involves antibiotic therapy, effective drainage of infected fluid and surgical intervention if conservative management fails. Intrapleural fibrinolytic agents such as streptokinase and alteplase have been hypothesised to improve fluid drainage in complicated parapneumonic effusions and empyema and therefore improve treatment outcomes and prevent the need for thoracic surgical intervention. Intrapleural fibrinolytic agents have been used in combination with DNase, but this is beyond the scope of this review. 

• Available in full text at The Cochrane database of systematic reviews from Cochrane Collaboration (Wiley)

Author(s) Chichareon P.; Modolo R.; Kerkmeijer L.; Kogame N.; Takahashi K. et al.
Source JAMA Cardiology; 2019
Importance: Women experience worse ischemic and bleeding outcomes after percutaneous coronary intervention (PCI). Objective(s): To assess the association of sex with patient outcomes at 2 years after contemporary PCI and with the efficacy and safety of 2 antiplatelet strategies.

Design, Setting, and Analysis: This study is a prespecified subgroup analysis of the investigator-initiated, prospective, randomized GLOBAL LEADERS study evaluating 2 strategies of antiplatelet therapy after PCI in an unselected population including 130 secondary/tertiary care hospitals in different countries. The main study enrolled 15991 unselected patients undergoing PCI between July 2013 and November 2015. Patients had an outpatient clinic visit at 30 days and 3, 6, 12, 18, and 24 months after the index procedure. Data were analyzed between January 1, 2019, and March 31, 2019. Intervention(s): Eligible patients were randomized to either the experimental or reference antiplatelet strategy. Experimental strategy consisted of 1 month of dual antiplatelet therapy (DAPT) followed by 23 months of ticagrelor monotherapy, while the reference strategy comprised of 12 months of DAPT followed by 12 months of aspirin monotherapy.

Main Outcomes and Measures: The primary efficacy end point was the composite of all-cause mortality and new Q-wave myocardial infarction at 2 years. The secondary safety end point was Bleeding Academic Research Consortium type 3 or 5 bleeding. Result(s): Of the 15968 patients included in this study, 3714 (23.3%) were women. The risk of the primary end point at 2 years was similar between women and men (adjusted hazard ratio [HR], 1.00; 95% CI, 0.83-1.20). Compared with men, women had higher risk of Bleeding Academic Research Consortium type 3 or 5 bleeding (adjusted HR, 1.32; 95% CI, 1.04-1.67) and hemorrhagic stroke at 2 years (adjusted HR, 4.76; 95% CI, 1.92-11.81). At 2 years, there was no between-sex difference in the efficacy and safety of the 2 antiplatelet strategies. At 1 year, compared with DAPT, ticagrelor monotherapy was associated with a lower risk of bleeding in men (HR, 0.72; 95% CI, 0.53-0.98) but not in women (HR, 1.23; 95% CI, 0.80-1.89; P for interaction =.045).

​Conclusions and Relevance: Compared with men, women experienced a higher risk of bleeding and hemorrhagic stroke after PCI. The effect of 2 antiplatelet strategies on death and Q-wave myocardial infarction following PCI did not differ between the sexes at 2 years. Trial Registration: ClinicalTrials.gov identifier: NCT01813435.Copyright © 2019 American Medical Association. All rights reserved.