Introduction to Antiracism in Anaesthesia

Pulse oximetry and encoded inequity

Link to online feedback form: ⁠https://forms.gle/XsxAD6jtNbeBauvz6⁠ [https://forms.gle/XsxAD6jtNbeBauvz6]  References: 1. https://anaesthetists.org/Portals/0/PDFs/Guidelines%20PDFs/Recommendations%20for%20standards%20of%20monitoring%20during%20anaesthesia%20and%20recovery%202021.pdf?ver=2021-05-26-141701-007 [https://anaesthetists.org/Portals/0/PDFs/Guidelines%20PDFs/Recommendations%20for%20standards%20of%20monitoring%20during%20anaesthesia%20and%20recovery%202021.pdf?ver=2021-05-26-141701-007 ] 2. https://www.who.int/docs/default-source/patient-safety/9789241598590-eng-checklist.pdf [https://www.who.int/docs/default-source/patient-safety/9789241598590-eng-checklist.pdf] 3. Sjoding MW et al. Racial Bias in Pulse Oximetry Measurement. N Engl J Med. 2020 Dec 17;383(25):2477-2478. 4. https://www.gov.uk/guidance/the-use-and-regulation-of-pulse-oximeters-information-for-healthcare-professionals [https://www.gov.uk/guidance/the-use-and-regulation-of-pulse-oximeters-information-for-healthcare-professionals ] 5. https://ics.ac.uk/resource/pulse-oximetry-and-ethnicity.html [https://ics.ac.uk/resource/pulse-oximetry-and-ethnicity.html ] 6. https://www.gov.uk/government/publications/equity-in-medical-devices-independent-review-final-report [https://www.gov.uk/government/publications/equity-in-medical-devices-independent-review-final-report] 7. Al-Halawani R et al. A review of the effect of skin pigmentation on pulse oximeter accuracy. Physiol Meas. 2023 Jun 1;44(5):05TR01. 8. Jubran A and Tobin MJ. Reliability of pulse oximetry in titrating supplemental oxygen therapy in ventilator-dependent patients. Chest. 1990;97:1420–5. 9. Tobin MJ and Jubran A. Pulse oximetry, racial bias and statistical bias. Ann Intensive Care. 2022 Jan 4;12(1):2. 10. Martin D et al. Effect of skin tone on the accuracy of the estimation of arterial oxygen saturation by pulse oximetry: a systematic review. Br J Anaesth. 2024 May;132(5):945-956. 11. Ries AL et al. Accuracy of two ear oximeters at rest and during exercise in pulmonary patients. Am Rev Respir Dis 1985; 132: 685–9. 12. https://www.bostonreview.net/articles/amy-moran-thomas-pulse-oximeter/ [https://www.bostonreview.net/articles/amy-moran-thomas-pulse-oximeter/ ] 13. Bickler PE et al. Effects of skin pigmentation on pulse oximeter accuracy at low saturation. Anesthesiology. 2005 Apr;102(4):715-9. 14. Feiner JR et al. Dark skin decreases the accuracy of pulse oximeters at low oxygen saturation: the effects of oximeter probe type and gender. Anesth Analg. 2007 Dec;105(6 Suppl):S18-S23. 15. https://www.gov.uk/government/publications/government-response-to-the-report-of-the-equity-in-medical-devices-independent-review/government-response-to-the-report-of-the-equity-in-medical-devices-independent-review#the-governments-response-to-the-report [ 15. https://www.gov.uk/government/publications/government-response-to-the-report-of-the-equity-in-medical-devices-independent-review/government-response-to-the-report-of-the-equity-in-medical-devices-independent-review#the-governments-response-to-the-report] 16. Baskett F. Books: Invisible Women: Exposing Data Bias in a World Designed For Men: Mind the Gap. Br J Gen Pract. 2020 Apr 30;70(694):250. 17. https://www.bma.org.uk/news-and-opinion/in-harm-s-way#:~:text=One%20by%20union%20Prospect%2C%20last,postings%20to%20the%20online%20portal [https://www.bma.org.uk/news-and-opinion/in-harm-s-way#:~:text=One%20by%20union%20Prospect%2C%20last,postings%20to%20the%20online%20portal] 18. Vyas DA et al. Hidden in Plain Sight - Reconsidering the Use of Race Correction in Clinical Algorithms. N Engl J Med. 2020 Aug 27;383(9):874-882. 19. MBRRACE-UK Report 2024 Key Messages: https://www.npeu.ox.ac.uk/assets/downloads/mbrrace-uk/reports/maternal-report-2024/MBRRACE-UK_Maternal_Report_2024%20_Lay_Summary_V1.0.pdf [MBRRACE-UK Report 2024 Key Messages: https://www.npeu.ox.ac.uk/assets/downloads/mbrrace-uk/reports/maternal-report-2024/MBRRACE-UK_Maternal_Report_2024%20_Lay_Summary_V1.0.pdf ] 20. Bamber JH et al. A national cohort study to investigate the association between ethnicity and the provision of care in obstetric anaesthesia in England between 2011 and 2021. Anaesthesia. 2023 Jul;78(7):820-829. 21. Kearns RJ, Kyzayeva A, Halliday LOE, Lawlor DA, Shaw M, Nelson SM. Epidural analgesia during labour and severe maternal morbidity: population based study. BMJ. 2024 May 22;385:e077190.

Racial equity in organ donation and transplantation

Link to online feedback form: https://forms.gle/XsxAD6jtNbeBauvz6 [https://forms.gle/XsxAD6jtNbeBauvz6]  References 1. Inquiry Report - Where are our Nation's Donors? All Party Parliamentary Group: Ethnicity Transplantation and Transfusion. Dec 2023. Accessed from: https://raceequalityfoundation.org.uk/wp-content/uploads/2023/12/APPG-Report-Where-are-our-nations-donors_.pdf [https://raceequalityfoundation.org.uk/wp-content/uploads/2023/12/APPG-Report-Where-are-our-nations-donors_.pdf] 2. Vyas DA et al. Hidden in Plain Sight - Reconsidering the Use of Race Correction in Clinical Algorithms. N Engl J Med. 2020 Aug 27;383(9):874-882.  3. https://www.kidneyresearchuk.org/2021/08/25/ethnicity-adjustment-for-kidney-function-testing-removed-from-nice-chronic-kidney-disease-guideline/ [https://www.kidneyresearchuk.org/2021/08/25/ethnicity-adjustment-for-kidney-function-testing-removed-from-nice-chronic-kidney-disease-guideline/] 4. Annual Report on Ethnicity Differences in Organ Donation and Transplantation. Report for 2023/2024. NHS Blood and Transplant. Accessed from: https://www.odt.nhs.uk/statistics-and-reports/annual-report-on-ethnicity-differences/ [https://www.odt.nhs.uk/statistics-and-reports/annual-report-on-ethnicity-differences/] 5. Sims JM et al. Overcoming barriers to registering as an organ donor among minority ethnic groups. Race Equality Foundation. Nov 2012. Accessed from: https://raceequalityfoundation.org.uk/wp-content/uploads/2022/10/Overcoming-barriers-to-registering-as-an-organ-donor-among-minority-ethnic-groups_0-2.pdf [https://raceequalityfoundation.org.uk/wp-content/uploads/2022/10/Overcoming-barriers-to-registering-as-an-organ-donor-among-minority-ethnic-groups_0-2.pdf] 6. Randhawa G and Gardiner D. Tackling organ donation among minority ethnic communities in the UK-a whole systems approach. Br Med Bull. 2022 Jul 9;142(1):4-14 7. Sundaram R et al. 237.4: Diversity in Organ Donation in Scotland - Improving Awareness in Black and Ethnic Minority Groups. Transplantation 106(9S):p S116, September 2022

Differential attainment in anaesthesia

Link to online feedback form: https://forms.gle/XsxAD6jtNbeBauvz6 [https://forms.gle/XsxAD6jtNbeBauvz6] References: 1. https://rcoa.ac.uk/bulletin/spring-2024/tackling-differential-attainment-frca [https://rcoa.ac.uk/bulletin/spring-2024/tackling-differential-attainment-frca] 2. https://www.gmc-uk.org/-/media/documents/somep-workforce-report-2024-full-report_pdf-109169408.pdf [https://www.gmc-uk.org/-/media/documents/somep-workforce-report-2024-full-report_pdf-109169408.pdf] 3.  https://www.gmc-uk.org/-/media/documents/workforce-report-2023-full-report_pdf-103569478.pdf [https://www.gmc-uk.org/-/media/documents/workforce-report-2023-full-report_pdf-103569478.pdf] 4.  https://www.gmc-uk.org/-/media/documents/96887270_tackling-disadvantage-in-medical-education-020323.pdf [https://www.gmc-uk.org/-/media/documents/96887270_tackling-disadvantage-in-medical-education-020323.pdf] 5. https://www.rcoa.ac.uk/examinations/examination-pass-rates-cost-training-reviews-reports/examination-research-reports [https://www.rcoa.ac.uk/examinations/examination-pass-rates-cost-training-reviews-reports/examination-research-reports]: 6. https://www.kingsfund.org.uk/insight-and-analysis/long-reads/specialty-specialist-locally-employed-doctors-nhs [https://www.kingsfund.org.uk/insight-and-analysis/long-reads/specialty-specialist-locally-employed-doctors-nhs]

Care for patients with sickle cell disease

Link to online feedback form: https://forms.gle/QQS5JGsKut8ajE9S7 References: 1. https://www.ncepod.org.uk/2008sc.html [https://www.ncepod.org.uk/2008sc.html] 2. https://www.sicklecellsociety.org/no-ones-listening/ [https://www.sicklecellsociety.org/no-ones-listening/]  3. Guideline on the peri-operative management of patients with sickle cell disease: Guideline from the Association of Anaesthetists. Walker et al. Anaesthesia. 2021 Jun;76(6):805-817 4. https://thehopeprojectscotland.org.uk/ [https://thehopeprojectscotland.org.uk/] 5. The Transfusion Alternatives Preoperatively in Sickle Cell Disease (TAPS) study: a randomised, controlled, multicentre clinical trial. Howard et al. Lancet. 2013 Mar 16;381(9870):930-8 6. Guidance for sickle cell care: https://www.nn.nhs.scot/spah/ [https://www.nn.nhs.scot/spah/]

Introduction to Antiracism in Anaesthesia

Link to online feedback form: https://forms.gle/YxTjfZyfcLarQ8ez9 [https://forms.gle/YxTjfZyfcLarQ8ez9] References: 1. https://www.glasgow.gov.uk/article/6530/Glasgow-s-Slavery-Legacy [https://www.glasgow.gov.uk/article/6530/Glasgow-s-Slavery-Legacy] 2. Ethnic Inequalities in Healthcare: A Rapid Evidence Review. Kapadia et al. 2022. Accessed from https://www.nhsrho.org/wp-content/uploads/2023/05/RHO-Rapid-Review-Final-Report_.pdf [https://www.nhsrho.org/wp-content/uploads/2023/05/RHO-Rapid-Review-Final-Report_.pdf].  3. A national cohort study to investigate the association between ethnicity and the provision of care in obstetric anaesthesia in England between 2011 and 2021. Bamber et al. 2023. Anaesthesia. 78(7):820-829.  4. Risk factors for complications after emergency surgery for paediatric appendicitis: a national prospective observational cohort study. Sogbodjor et al. 2024. Anaesthesia. 79(5):524-534. 5. 'Shut Up and Go Back to Your Own Country'. A survey of the experiences of different ethnicities in Anaesthesia and Intensive Care Medicine in the United Kingdom. Watson and Davis. 2024. Anaesthesia News.