Background: The preadmission clinic (PAC) is crucial in perioperative care, offering evaluations, education, and patient optimization before surgical procedures. During the COVID-19 pandemic, the PAC adapted by implementing telephone visits due to a lack of infrastructure for video consultations. While the pandemic significantly increased the use of virtual care, including video appointments as an alternative to in-person consultations, our PAC had not used video consultations for preoperative assessments. Objective: This study aimed to develop, implement, and integrate preoperative video consultations into the PAC workflow. Methods: A prospective quality improvement project was undertaken using the Plan-Do-Study-Act (PDSA) methodology. The project focused on developing, implementing, and integrating virtual video consultations at London Health Sciences Centre and St. Joseph Health Care (London, Ontario, Canada) in the PAC. Data were systematically collected to monitor the number of patients undergoing video consultations, address patient flow concerns, and increase the percentage of video consultations. Communication between the PAC, surgeon offices, and patients was analyzed for continuous improvement. Technological challenges were addressed, and procedures were streamlined to facilitate video calls on appointment days. Results: The PAC team, which includes professionals from medicine, anesthesia, nursing, pharmacy, occupational therapy, and physiotherapy, offers preoperative evaluation and education to surgical patients, conducting approximately 8000 consultations annually across 3 hospital locations. Following the initial PDSA cycles, the interventions consistently improved the video consultation utilization rate to 17%, indicating positive progress. With the onset of PDSA cycle 3, there was a notable surge to a 29% utilization rate in the early phase. This upward trend continued, culminating in a 38% utilization rate of virtual video consultations in the later stages of the cycle. This heightened level was consistently maintained throughout 2023, highlighting the sustained success of our interventions. Conclusions: The quality improvement process significantly enhanced the institution’s preoperative video consultation workflow. By understanding the complexities within the PAC, strategic interventions were made to integrate video consultations without compromising efficiency, morale, or safety. This project highlights the potential for transformative improvements in health care delivery through the thoughtful integration of virtual care technologies.

Background: Protection of healthcare providers (HCP) has been a serious challenge in the management of patients during the coronavirus 2019 (COVID-19) pandemic. Additional physical barriers have been created to enhance personal protective equipment (PPE). In this study, user acceptability of two novel barriers was evaluated and the performance of airway management using PPE alone versus PPE plus the additional barrier were compared. Methods: An open-label, double-armed simulation pilot study was conducted. Each participant performed bag-mask ventilation and endotracheal intubation using a GlideScope in two scenarios: 1) PPE donned, followed by 2) PPE donned plus the addition of either the isolation chamber (IC) or aerosol box (AB). Endotracheal intubation using videolaryngoscopy was timed. Participants completed pre- and post-simulation questionnaires.Results: Twenty-nine participants from the Department of Anesthesia were included in the study. Pre- and post-simulation questionnaire responses supported the acceptance of additional barriers. There was no significant difference in intubating times across all groups (PPE vs. IC 95% CI, 26.3–35.1; PPE vs. AB 95% CI, 25.9–35.5; IC vs. AB 95% CI, 23.6–39.1). Comparison of post-simulation questionnaire responses between IC and AB showed no significant difference. Participants did not find the additional barriers negatively affected communication, visualization, or maneuverability. Conclusions: Overall, the IC and AB were comparable, and there was no negative impact on performance under testing conditions. Our study suggests the positive acceptance of additional patient protection barriers by anesthesia providers during airway management.

Background: Surgical recovery after hospital discharge often presents challenges for patients and caregivers. Postoperative complications and poorly managed pain at home can lead to unexpected visits to the emergency department (ED) and readmission to the hospital. Digital home monitoring (DHM) may improve postoperative care compared to standard methods. Objective: We conducted a feasibility study for a randomized controlled trial (RCT) to assess DHM's effectiveness following thoracic surgical procedures compared to standard care. Methods: We conducted a 2-arm parallel-group pilot RCT at a single tertiary care center. Adult patients undergoing thoracic surgical procedures were randomized 1:1 into 2 groups: the DHM group and the standard of care (control group). We adhered to the intention-to-treat analysis principle. The primary outcome was predetermined RCT feasibility criteria. The trial would be feasible if more than 75% of trial recruitment, protocol adherence, and data collection were achieved. Secondary outcomes included 30-day ED visit rates, 30-day readmission rates, postoperative complications, length of stay, postdischarge 30-day opioid consumption, 30-day quality of recovery, patient-program satisfaction, caregiver satisfaction, health care provider satisfaction, and cost per case. Results: All RCT feasibility criteria were met. The trial recruitment rate was 87.9% (95% CI 79.4%-93.8%). Protocol adherence and outcome data collection rates were 96.3% (95% CI 89.4%-99.2%) and 98.7% (95% CI 92.9%-99.9%), respectively. In total, 80 patients were randomized, with 40 (50%) in the DHM group and 40 (50%) in the control group. Baseline patient and clinical characteristics were comparable between the 2 groups. The DHM group had fewer unplanned ED visits (2.7% vs 20.5%; P=.02), fewer unplanned admission rates (0% vs 7.6%; P=.24), lower rates of postoperative complications (20% vs 47.5%, P=.01) shorter hospital stays (4.0 vs 6.9 days; P=.05), but more opioid consumption (111.6, SD 110.9) vs 74.3, SD 71.9 mg morphine equivalents; P=.08) compared to the control group. DHM also resulted in shorter ED visit times (130, SD 0 vs 1048, SD 1093 minutes; P=.48) and lower cost per case (CAD $12,145 [US $ 8436.34], SD CAD $8779 [US $ 6098.20] vs CAD $17,247 [US $11,980.37], SD CAD $15,313 [US $10,636.95]; P=.07). The quality of recovery scores was clinically significantly better than the controls (185.4, SD 2.6 vs 178.3, SD 3.3; P<.001). All 37 patients who completed the intervention answered the program satisfaction survey questionnaires (100%; 95% CI 90.5%-100%). Only 36 out of 80 caregivers responded to the caregiver satisfaction questionnaires at the end of the fourth week post hospital discharge (47.7%; 95% CI 35.7%-59.1%). Health care providers reported a 100% satisfaction rate. Conclusions: This pilot RCT demonstrates the feasibility of conducting a full-scale trial to assess DHM's efficacy in improving postoperative care following thoracic surgery. DHM shows promise for enhancing continuity of care and warrants further investigation. Trial Registration: ClinicalTrials.gov NCT04340960; https://clinicaltrials.gov/study/NCT04340960

Background: Ensuring accurate and continuous monitoring of patients’ physiological parameters is paramount for evaluating their health status and guiding clinical decision-making. Technological advancements have the potential to significantly improve patient care and outcomes by offering a seamless continuum of healthcare experiences. Biobeat Technologies Ltd has pioneered a non−invasive wearable approach to acquiring advanced hemodynamic parameters, employing devices such as the BB−613WP wrist monitor and the BB−613P chest patch. Biobeat devices have been applicable across many clinical settings, as substantiated by a growing body of research. This systematic review endeavours to comprehensively consolidate the evidence regarding using Biobeat monitors across various clinical scenarios. Methods: From 2016 to 2024, a thorough literature search was conducted across multiple databases. The inclusion criteria for selected studies comprised adult patients aged 18 years or older in any healthcare setting, employing Biobeat monitoring devices (wrist monitors and/or chest patches), reporting at least one outcome or finding, and presenting fully published original research studies, including randomized controlled trials and prospective or retrospective cohort studies. The quality and risk of bias assessment for the studies was performed using the Newcastle−Ottawa scale and COSMIN scoring system. Results: Among 27 studies identified, 15 met the inclusion criteria, involving 4248 patients. These included 14 prospective observational studies and one retrospective cohort study; no randomized control trials were identified. Notably, eight studies were conducted in ambulatory settings, with 1 study focusing on patients undergoing labor and delivery. Additionally, three studies were carried out in general inpatient wards, 1 in a medical ICU and another in a cardiac surgery ICU (CSICU). Furthermore, 1 study presented results from 3 separate investigations— 2 in ambulatory settings and 1 in the CSICU. Across all studies, Biobeat devices were consistently utilized, with each study reporting positive outcomes associated with their use. Conclusion: This systematic review demonstrates that Biobeat's non-invasive wearable devices have been effectively utilized across various clinical settings, consistently contributing to positive patient outcomes. The versatility and reliability of these devices highlight their potential to enhance patient care and support clinical decision-making, warranting further research to explore their broader applications.

Objective: Sinonasal squamous cell carcinoma (SNSCC) is rare in the general population. No clear and consistent etiologic correlation between human papillomavirus (HPV) and SNSCC has yet been delineated in the literature. p16 is a tumor suppressor protein used as a surrogate marker for HPV. This study aims to evaluate the relationship between p16 overexpression in SNSCC and its role in prognosis and survival.Methods: A population‐based retrospective analysis was performed using prospectively collected data from the Northern Alberta Head and Neck Tumour Board, the Alberta Cancer Registry, and the Alberta Cancer Research Biobank. p16 overexpression was analyzed from pathologic samples of patients meeting study criteria, and participants were dichotomized by status. Subsequently, nonparametric analysis of demographics, initial staging, and initial treatment were performed, and a Kapan–Meier curve was developed to assess differences in survival.Results: Sixteen patients were included in the analysis. p16 overexpression was seen in 68.8% of patients. p16 positive and negative groups were comparable for age, gender, smoking status, stage, and treatment. A statistically significant 5‐year survival advantage was observed in patients with p16 positive SNSCC (P = 0.013).Conclusions: This is the first Canadian study to demonstrate a high prevalence of p16 positivity in SNSCC and its presence denoting a statistically significant survival advantage. Results demonstrate a previously unconfirmed role of oncogenic HPV in SNSCC.

Summary: We present a case of a woman who received a left single‐injection supraclavicular brachial plexus block for analgesia to facilitate upper extremity orthopaedic surgery. Before tracheal extubation she desaturated, was noted to have a low tidal volume and reduced left‐sided air entry on auscultation of the chest. A chest x‐ray taken 1 h following tracheal extubation revealed elevation of the left hemidiaphragm and a rightward shift of the trachea and mediastinal structures, with no evidence of pneumothorax. Findings were in‐keeping with phrenic nerve palsy complicating the brachial plexus block performed. The patient was asymptomatic and discharged home the next day following repeat chest x‐rays. We believe this is the first report of tracheal deviation contralateral to the side of an elevated hemidiaphragm secondary to phrenic nerve palsy from a brachial plexus block.