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Clinical Decision-Making and Debiasing Strategies
Debnath Chatterjee, MD, FAAP, and Gina Whitney, MD
Croskerry P, Singhal G, Mamede S. Cognitive debiasing 1: origins of bias and theory of debiasing. BMJ Qual Saf. 2013 Oct;22 Suppl 2(Suppl 2):ii58-ii64. doi: 10.1136/bmjqs-2012-001712. Epub 2013 Jul 23. PMID: 23882089
Croskerry P, Singhal G, Mamede S. Cognitive debiasing 2: impediments to and strategies for change. BMJ Qual Saf. 2013 Oct;22 Suppl 2(Suppl 2):ii65-ii72. doi: 10.1136/bmjqs-2012-001713. Epub 2013 Aug 30. PMID: 23996094
How our brains are wired allows bias to affect our judgement and decision making. These articles review the 2 most common biases that affect our decision making and debiasing strategies.
A febrile, A typical, A noxia and now A ponvie (Aprepitant)
Myron Yaster MD and Lynne G. Maxwell MD
Thomas Wiesmann, Peter Kranke, Leopold Eberhart. Postoperative nausea and vomiting – a narrative review of pathophysiology, pharmacotherapy and clinical management strategies. Expert Opin Pharmacother. 2015 May;16(7):1069-77. PMID: 25866213
Jin Z, Daksla N, Gan TJ. Neurokinin-1 Antagonists for Postoperative Nausea and Vomiting. Drugs. 2021 Jul;81(10):1171-1179. PMID: 34106456
Gan TJ, Diemunsch P, Habib AS, Kovac A, Kranke P, Meyer TA, Watcha M, Chung F, Angus S, Apfel CC, Bergese SD, Candiotti KA, Chan MT, Davis PJ, Hooper VD, Lagoo-Deenadayalan S, Myles P, Nezat G, Philip BK, Tramèr MR; Society for Ambulatory Anesthesia. Consensus guidelines for the management of postoperative nausea and vomiting. Anesth Analg. 2014 Jan;118(1):85-113 PMID: 24356162
A new IV anti-emetic for PONV (APONVIE or an IV aprepitant) was recently approved by the US FDA. Although it does not currently have a pediatric indication or dosing guidelines it’s a drug worth keeping on your radar.
Perioperative transfusion therapy
Myron Yaster MD and Genie Heitmiller MD
Trentino KM, Leahy MF, Erber WN, Mace H, Symons K, Budgeon CA, Murray K. Hospital-Acquired Infection, Length of Stay, and Readmission in Elective Surgery Patients Transfused 1 Unit of Red Blood Cells: A Retrospective Cohort Study. Anesth Analg. 2022 Sep 1;135(3):586-591 PMID: 35977367
Adult patients transfused 1 unit of red blood cells during their hospital admission had greater odds of hospital-acquired infection, increased length of stay, and all-cause emergency readmission within 28 days. This association (NOT CAUSATION!) has not been studied in pediatrics.