Our results demonstrate that NORA is a growing component of anesthesiology practice. The proportion of cases performed outside of the OR increased during the study period. In addition, we identified an upward trend in the age of patients receiving NORA care. NORA cases were different from OR cases in a number of aspects. Data collected by NACOR in the coming years will further characterize the trends identified in this study.

ObjectivesTo evaluate the effects of more intensive smoking cessation interventions compared to less intensive interventions on smoking cessation in people with type 1 or type 2 diabetes.DesignA systematic review and meta-analysis of randomised trials of smoking cessation interventions was conducted. Electronic searches were carried out on the following databases: MEDLINE, EMBASE, CINAHL and PsycINFO to September 2013. Searches were supplemented by review of trial registries and references from identified trials. Citations and full-text articles were screened by two reviewers. A random-effect Mantel-Haenszel model was used to pool data.SettingPrimary, secondary and tertiary care.ParticipantsAdults with type 1 or type 2 diabetes.InterventionsSmoking cessation interventions or medication (more intensive interventions) compared to usual care, counselling or optional medication (less intensive interventions).Outcome measuresBiochemically verified smoking cessation was the primary outcome. Secondary outcomes were adverse events and effects on glycaemic control. We also carried out a pooled analysis of self-reported smoking cessation outcomes.ResultsWe screened 1783 citations and reviewed seven articles reporting eight trials in 872 participants. All trials were of 6 months duration. Three trials included pharmacotherapy for smoking cessation. The risk ratio of biochemically verified smoking cessation was 1.32 (95% CI 0.23 to 7.43) for the more intensive interventions compared to less intensive interventions with significant heterogeneity (I2=76%). Only one trial reported measures of glycaemic control.ConclusionsThere is an absence of evidence of efficacy for more intensive smoking cessation interventions in people with diabetes. The more intensive strategies tested in trials to date include interventions used in the general population, adding in diabetes-specific education about increased risk. Future research should focus on multicomponent smoking cessation interventions carried out over a period of at least 1 year, and also assess impact on glycaemic control.

Thrombocytopenia is a common perioperative clinical problem. While global haemostasis is influenced by many patientand procedure-related factors, the contribution of thrombocytopenia to bleeding risk is difficult to predict, as platelet count does not linearly correlate with likelihood of bleeding. Thus, the widely used definition of thrombocytopenia and grading of its severity have limited clinical utility. We present a summary and analysis of the current recommendations for invasive procedures in thrombocytopenic patients, although the platelet count at which any given procedure may safely proceed is unknown. The benefits and risks of preoperative platelet transfusions should be assessed on a patientby-patient basis, and alternatives to platelet transfusion should be considered. In non-emergent surgeries or in postoperative thrombocytopenic patients, haematology consultation should be considered to guide diagnostics and management. We present a pragmatic approach to the evaluation of perioperative thrombocytopenia. Editor's key pointsMost 'threshold' recommendations for preprocedural platelet transfusions are based on low quality evidence or opinion. Existing data suggest no linear relationship between platelet count and risk of spontaneous bleeding. Given the risks associated with platelet transfusion, alternatives should be considered: desmopressin and antifibrinolytic agents in the acute setting and thrombopoietin receptor agonists for select groups in the elective setting. Thrombopoietin receptor agonists effectively increase platelet count in thrombocytopenic patients, but are currently off-label except in patients with thrombocytopenia as a result of chronic liver disease.