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  1. Article ; Online: Anesthesiologists Are Integral to Value-Based Surgical Care Reform.

    Flexman, Alana M / Ke, Janny Xue Chen

    JAMA surgery

    2023  Volume 158, Issue 5, Page(s) 556–557

    MeSH term(s) Humans ; Anesthesiologists ; Health Care Reform
    Language English
    Publishing date 2023-01-03
    Publishing country United States
    Document type Letter ; Comment
    ZDB-ID 2701841-6
    ISSN 2168-6262 ; 2168-6254
    ISSN (online) 2168-6262
    ISSN 2168-6254
    DOI 10.1001/jamasurg.2022.7240
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  2. Article ; Online: Measuring enhanced recovery in obstetrics: a narrative review.

    Ciechanowicz, Sarah / Ke, Janny Xue Chen / Sharawi, Nadir / Sultan, Pervez

    AJOG global reports

    2022  Volume 3, Issue 1, Page(s) 100152

    Abstract: Enhanced recovery after cesarean delivery is a protocolized approach to perioperative care, with the aim to optimize maternal recovery after surgery. It is associated with improved maternal and neonatal outcomes, including decreased length of hospital ... ...

    Abstract Enhanced recovery after cesarean delivery is a protocolized approach to perioperative care, with the aim to optimize maternal recovery after surgery. It is associated with improved maternal and neonatal outcomes, including decreased length of hospital stay, opioid consumption, pain scores, complications, increased maternal satisfaction, and increased breastfeeding success. However, the pace and enthusiasm of adoption of enhanced recovery after cesarean delivery internationally has not yet been matched with high-quality evidence demonstrating its benefit, and current studies provide low- to very low-quality evidence in support of enhanced recovery after cesarean delivery. This article provides a summary of current measures of enhanced recovery after cesarean delivery success, and optimal measures of inpatient and outpatient postpartum recovery. We summarize outcomes from 22 published enhanced recovery after cesarean delivery implementation studies and 2 meta-analyses. A variety of disparate metrics have been used to measure enhanced recovery after cesarean delivery success, including process measures (length of hospital stay, bundle compliance, preoperative fasting time, time to first mobilization, time to urinary catheter removal), maternal outcomes (patient-reported outcome measures, complications, opioid consumption, satisfaction), neonatal outcomes (breastfeeding success, Apgar scores, maternal-neonatal bonding), cost savings, and complication rates (maternal readmission rate, urinary recatheterization rate, neonatal readmission rate). A core outcome set for use in enhanced recovery after cesarean delivery studies has been developed through Delphi consensus, involving stakeholders including obstetricians, anesthesiologists, patients, and a midwife. Fifteen measures covering key aspects of enhanced recovery after cesarean delivery adoption are recommended for use in future enhanced recovery after cesarean delivery implementation studies. The use of these outcome measures could improve the quality of evidence surrounding enhanced recovery after cesarean delivery. Using evidence-based evaluation guidelines developed by the COSMIN (COnsensus-based Standards for the selection of health Measurement INstruments) group, the Obstetric Quality of Recovery score (ObsQoR) was identified as the best patient-reported outcome measure for inpatient postpartum recovery. Advances in our understanding of postpartum recovery as a multidimensional and dynamic construct have opened new avenues for the identification of optimum patient-reported outcome measures in this context. The use of standardized measures such as these will facilitate pooling of data in future studies and improve overall levels of evidence surrounding enhanced recovery after cesarean delivery. Larger studies with optimal study designs, using recommended outcomes including patient-reported outcome measures, will reduce variation and improve data quality to help guide future recommendations.
    Language English
    Publishing date 2022-12-24
    Publishing country United States
    Document type Journal Article
    ISSN 2666-5778
    ISSN (online) 2666-5778
    DOI 10.1016/j.xagr.2022.100152
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  3. Article ; Online: Perioperative mobile application for mothers undergoing Cesarean delivery: a prospective cohort study on patient engagement.

    Ke, Janny Xue Chen / George, Ronald B / Wozney, Lori / Munro, Allana

    Canadian journal of anaesthesia = Journal canadien d'anesthesie

    2021  Volume 68, Issue 4, Page(s) 505–513

    Abstract: Purpose: Giving birth is the most common reason for hospital admission, with Cesarean delivery being the most frequently performed inpatient surgery. Through a needs assessment and iterative design process involving patients and obstetric ... ...

    Title translation Application mobile périopératoire destinée aux mères avec un accouchement par césarienne : une étude de cohorte prospective sur l’intérêt des patientes.
    Abstract Purpose: Giving birth is the most common reason for hospital admission, with Cesarean delivery being the most frequently performed inpatient surgery. Through a needs assessment and iterative design process involving patients and obstetric anesthesiologists, we previously developed a mobile application, C-Care, for patients undergoing Cesarean delivery. The focus of C-Care is perioperative education and self-monitoring of potential anesthetic complications. This study aimed to obtain feedback on patient engagement with C-Care.
    Method: We conducted a prospective cohort study of patients ≥ 18 yr (n = 36) undergoing elective Cesarean delivery. Anonymous usage data were recorded for 30 days. On postoperative days 1-5, participants received daily self-monitoring questionnaires within C-Care. Fourteen days after surgery, participants received an online survey regarding satisfaction and use of C-Care.
    Results: Thirty-five out of 36 participants visited the application after orientation, with a median [interquartile range (IQR)] age of 32 [31-36] yr. Each participant visited the application a median of 15 [9-31] times over 30 days and completed a median of 3 [2-4] out of five self-monitoring questionnaires. Each participant viewed a median of 4 [2-7] out of eight education topics, with the most viewed patient education topics being "Controlling Pain" and "The First Few Days". Visits to the application were highest in the first week postpartum. Of the 18 respondents who completed the day 14 survey, 83% (n = 15) participants would recommend C-Care to other women, and the median participant satisfaction score was 7.5 out of 10 (range, 2-10).
    Conclusion: Most participants used this mobile application for patient education and self-monitoring after elective Cesarean delivery. Insights into patient engagement with C-Care after Cesarean delivery could help design more effective perioperative mobile telehealth programs.
    Trial registration: www.ClinicalTrials.gov (NCT03746678); registered 5 November 2018.
    MeSH term(s) Cesarean Section ; Female ; Humans ; Mobile Applications ; Mothers ; Patient Participation ; Pregnancy ; Prospective Studies
    Language English
    Publishing date 2021-01-09
    Publishing country United States
    Document type Journal Article
    ZDB-ID 91002-8
    ISSN 1496-8975 ; 0832-610X
    ISSN (online) 1496-8975
    ISSN 0832-610X
    DOI 10.1007/s12630-020-01907-x
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    Zs.A 109: Show issues Location:
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  4. Article ; Online: Near-complete glottic obstruction from a loose glottic cancer mass.

    Ke, Janny Xue Chen / Wafa, Karim / Piccott, Devin / Galgay, Susan

    Canadian journal of anaesthesia = Journal canadien d'anesthesie

    2021  Volume 68, Issue 9, Page(s) 1437–1439

    MeSH term(s) Glottis/diagnostic imaging ; Humans ; Laryngeal Neoplasms/complications ; Laryngeal Neoplasms/diagnostic imaging ; Laryngeal Neoplasms/surgery ; Laryngoscopy ; Retrospective Studies
    Language English
    Publishing date 2021-05-04
    Publishing country United States
    Document type Journal Article
    ZDB-ID 91002-8
    ISSN 1496-8975 ; 0832-610X
    ISSN (online) 1496-8975
    ISSN 0832-610X
    DOI 10.1007/s12630-021-02009-y
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    Zs.A 109: Show issues Location:
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  5. Article ; Online: Accelerating innovation in medicine: a wake-up call amidst the COVID-19 pandemic.

    Ke, Janny Xue Chen / Waslen, Alexander / Park, Chance / Hung, Orlando

    Canadian journal of anaesthesia = Journal canadien d'anesthesie

    2021  Volume 68, Issue 12, Page(s) 1744–1746

    MeSH term(s) COVID-19 ; Humans ; Pandemics ; SARS-CoV-2
    Language English
    Publishing date 2021-08-17
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 91002-8
    ISSN 1496-8975 ; 0832-610X
    ISSN (online) 1496-8975
    ISSN 0832-610X
    DOI 10.1007/s12630-021-02087-y
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    Zs.A 109: Show issues Location:
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  6. Article ; Online: Association of anaesthesia technique with 30-day primary graft patency after open lower limb revascularization: retrospective cohort study.

    Ke, Janny Xue Chen / Flexman, Alana M / Schwarz, Stephan K W / MacDonald, Shaun / Prabhakar, Christopher

    BJS open

    2022  Volume 6, Issue 3

    Abstract: Background: The relationship between anaesthetic technique and graft patency after open lower limb revascularization is unclear. The aim of this study was to evaluate the association between 30-day graft patency after elective infrainguinal bypass and ... ...

    Abstract Background: The relationship between anaesthetic technique and graft patency after open lower limb revascularization is unclear. The aim of this study was to evaluate the association between 30-day graft patency after elective infrainguinal bypass and anaesthetic technique (regional anaesthesia (RA, i.e. neuraxial and/or peripheral nerve blockade) compared with general anaesthesia (GA)).
    Methods: Patients who underwent elective infrainguinal bypass in the 2014-2019 National Surgical Quality Improvement Program Vascular Procedure Targeted Lower Extremity Open data set were included. Excluded patients were those under 18 years old, those who did not receive RA or GA, and/or had an international normalized ratio of 1.5 of greater, a partial thromboplastin time more than 35 s, or a platelet count less than 80 × 109/L. The primary outcome was primary graft patency without reintervention. The relationship between anaesthetic technique and patency was analysed with multivariable logistic regression.
    Results: Included were 8893 patients with a mean(s.d.) age of 68(11) years and 31.5 per cent female. Within the cohort, 7.7 per cent (n = 688) patients received RA only, 90.4 per cent (n = 8039) GA only, and 1.9 per cent (n = 166) both GA and RA. In the RA-only group, 91.7 per cent (631 of 688) received neuraxial anaesthesia. The primary patency rate was 93.2 per cent (573 of 615) for RA only, and 91.5 per cent (6390 of 6983) for GA only (standardized mean difference, 0.063). RA was not associated with a higher rate of patency compared with GA (adjusted OR, 1.16; 95 per cent c.i., 0.83 to 1.63; P = 0.378).
    Conclusion: There was no association between anaesthetic technique and 30-day graft patency after elective infrainguinal bypass surgery. Further prospective studies would be useful to study the impact of anaesthesia technique on important patient-centred outcomes such as long-term patency and non-home discharge.
    MeSH term(s) Adolescent ; Aged ; Anesthesia ; Female ; Humans ; Lower Extremity/surgery ; Prospective Studies ; Retrospective Studies ; Vascular Surgical Procedures
    Language English
    Publishing date 2022-06-03
    Publishing country England
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ISSN 2474-9842
    ISSN (online) 2474-9842
    DOI 10.1093/bjsopen/zrac061
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  7. Article ; Online: Outcomes of Coronary Artery Bypass Grafting in Patients With Poor Myocardial Viability: A Systematic Review and Meta-Analysis of the Last Decade.

    Sharma, Varun J / Arghami, Arman / Pasupula, Deepak Kumar / Haddad, Abdullah / Ke, Janny Xue Chen

    Heart, lung & circulation

    2022  Volume 31, Issue 7, Page(s) 916–923

    Abstract: Objectives: Our objective is to assess whether the presence of myocardial viability is a predictor of mortality among patients undergoing coronary artery bypasss grafting (CABG) through a systematic review meta-analysis.: Methods: Comprehensive ... ...

    Abstract Objectives: Our objective is to assess whether the presence of myocardial viability is a predictor of mortality among patients undergoing coronary artery bypasss grafting (CABG) through a systematic review meta-analysis.
    Methods: Comprehensive review of EMBASE and PubMed in accordance with PRISMA guidelines, including studies of patients undergoing CABG with assessment of myocardial viability and recorded long-term mortality, age and sex. Studies were restricted to the last decade, and data were stratified by imaging modality (magnetic resonance imaging [MRI] or nuclear medicine). Random-effects model for assessing pooled effect, heterogeneity assessment using Chi-square and I
    Results: Meta-analysis of contemporary data (January 2010 to October 2020) yielded 3,621 manuscripts of which 92 were relevant, and 6 appropriate for inclusion with 993 patients. Pooled analysis showed that patients with non-viable myocardium undergoing CABG are at 1.34 times the risk of mortality compared to those with viable myocardium (95% CI 1.01-1.79, p=0.05). Subgroup analysis of the MRI or nuclear medicine modalities was not statistically significant and there was no confounding by age or sex in meta-regression. There was significant heterogeneity in imaging modality and diagnostic criteria, but heterogeneity between study findings was low with an I
    Conclusions: There is a multitude of methods for assessing cardiac viability for coronary revascularisation surgery, making meta-analyses fraught with limitations. Our meta-analysis demonstrates that the finding of non-viable myocardium can not be used draw conclusions for risk assessment in coronary surgery.
    MeSH term(s) Coronary Artery Bypass/methods ; Coronary Artery Disease/diagnosis ; Coronary Artery Disease/etiology ; Coronary Artery Disease/surgery ; Humans ; Myocardium ; Risk Assessment
    Language English
    Publishing date 2022-03-24
    Publishing country Australia
    Document type Journal Article ; Meta-Analysis ; Review ; Systematic Review
    ZDB-ID 2020980-0
    ISSN 1444-2892 ; 1443-9506
    ISSN (online) 1444-2892
    ISSN 1443-9506
    DOI 10.1016/j.hlc.2021.12.016
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    Zs.A 4988: Show issues Location:
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  8. Article ; Online: Assessing resident member needs at the Canadian Anesthesiologists' Society: a national survey.

    Ke, Janny Xue Chen / Kothari, Rohan / McKeen, Dolores / Bainbridge, Daniel

    Canadian journal of anaesthesia = Journal canadien d'anesthesie

    2020  Volume 67, Issue 11, Page(s) 1645–1646

    MeSH term(s) Anesthesiologists ; Anesthesiology ; Canada ; Humans ; Societies, Medical ; Surveys and Questionnaires
    Keywords covid19
    Language English
    Publishing date 2020-08-14
    Publishing country United States
    Document type Letter
    ZDB-ID 91002-8
    ISSN 1496-8975 ; 0832-610X
    ISSN (online) 1496-8975
    ISSN 0832-610X
    DOI 10.1007/s12630-020-01794-2
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  9. Article ; Online: Coagulopathy Management of an Acute Type A Aortic Dissection in a Patient Taking Apixaban.

    Neira, Victor M / Baghaffar, Abdullah / Doggett, Nathan / Ke, Janny Xue Chen / Stewart, Keir

    Journal of cardiothoracic and vascular anesthesia

    2021  Volume 36, Issue 6, Page(s) 1720–1725

    Abstract: This paper reports the successful management of a patient with acute type A Penn B thoracic aortic dissection who was on apixaban therapy for atrial fibrillation. Emergency surgery was performed due to the patient's clinical deterioration, with ... ...

    Abstract This paper reports the successful management of a patient with acute type A Penn B thoracic aortic dissection who was on apixaban therapy for atrial fibrillation. Emergency surgery was performed due to the patient's clinical deterioration, with innominate artery compromise and severe aortic valve regurgitation. The anesthesia team used point-of-care rotational thromboelastometry-guided coagulation replacement therapy consisting of prothrombin concentrate, fibrinogen, and platelets. The surgical team used a complementary approach with topical hemostatic agents and a pericardial patch. No additional blood products were required. The patient recovered fully and was discharged home.
    MeSH term(s) Aneurysm, Dissecting/diagnostic imaging ; Aneurysm, Dissecting/surgery ; Blood Coagulation Disorders/therapy ; Humans ; Pyrazoles ; Pyridones/adverse effects ; Thrombelastography
    Chemical Substances Pyrazoles ; Pyridones ; apixaban (3Z9Y7UWC1J)
    Language English
    Publishing date 2021-03-24
    Publishing country United States
    Document type Case Reports ; Journal Article
    ZDB-ID 1067317-9
    ISSN 1532-8422 ; 1053-0770
    ISSN (online) 1532-8422
    ISSN 1053-0770
    DOI 10.1053/j.jvca.2021.03.028
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  10. Article ; Online: Patient-centred perioperative mobile application in Cesarean delivery: needs assessment and development.

    Ke, Janny Xue Chen / George, Ronald B / Wozney, Lori / Chorney, Jill L

    Canadian journal of anaesthesia = Journal canadien d'anesthesie

    2019  Volume 66, Issue 10, Page(s) 1194–1201

    Abstract: Purpose: Cesarean delivery (CD) is the most commonly performed inpatient surgery in Canada, with 103,425 performed in 2016-2017. Mobile technology can contribute to patient-centred perioperative care. Our aim was to involve patients and ... ...

    Title translation Évaluation des besoins et mise au point d’une application mobile périopératoire centrée sur la patiente accouchant par césarienne.
    Abstract Purpose: Cesarean delivery (CD) is the most commonly performed inpatient surgery in Canada, with 103,425 performed in 2016-2017. Mobile technology can contribute to patient-centred perioperative care. Our aim was to involve patients and anesthesiologists in designing a mobile application to enhance the perioperative care of CD patients.
    Method: We completed an exploratory qualitative study involving three iterative design cycles. Individual structured phone or in-person interviews with CD patients (n = 15) and anesthesiologists (n = 9) were conducted. Thematic analysis was used to 1) assess gaps and opportunities in the anesthesiology care after CD, 2) identify roles and limitations of mobile application technology in bridging perioperative care, and 3) to solicit feedback on a prototype mobile application for the anesthesiology postoperative care of elective CD patients.
    Results: Patients and anesthesiologists were in favour of adding mobile applications to the interdisciplinary perioperative management of patients undergoing CD, particularly for providing reliable information, identifying and following patients with complications, and research in perioperative outcomes. Medical-legal issues, privacy, workflow, and payment policy frameworks are barriers for mobile technology linking patients and anesthesiologists. Our final prototype was refined to focus on timely, concise education and self-monitoring.
    Conclusion: The participant-driven changes in direction of the prototype showed the importance of involving key stakeholders early. This study provides guidance on further iterative development and implementation of an interdisciplinary mobile platform for patient-centred perioperative care and outcomes research.
    MeSH term(s) Adult ; Anesthesiologists/organization & administration ; Anesthesiology/methods ; Canada ; Cesarean Section/methods ; Female ; Humans ; Interdisciplinary Communication ; Middle Aged ; Mobile Applications ; Needs Assessment ; Patient-Centered Care/methods ; Perioperative Care/methods ; Postoperative Care/methods ; Pregnancy
    Language English
    Publishing date 2019-05-13
    Publishing country United States
    Document type Journal Article
    ZDB-ID 91002-8
    ISSN 1496-8975 ; 0832-610X
    ISSN (online) 1496-8975
    ISSN 0832-610X
    DOI 10.1007/s12630-019-01392-x
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