Anaesthesia and intensive care
-
Anaesth Intensive Care · Aug 2006
Review Historical ArticleProblem-based learning: description, advantages, disadvantages, scenarios and facilitation.
Problem-based learning arose out of educational initiatives in the 1960s and is often one of the most contentious issues within medical education. McMaster University in Canada was the first to implement problem-based learning on a large scale within medicine and this was soon followed by universities in Europe and Australia. In modern times, few western medical schools do not include at least some aspect of problem-based learning within their instructional itinerary, and many build their entire curriculum and instructional procedures around problem-based learning. This article provides an overview of problem-based learning within medical education, pertinent background, describes the characteristics of problem-based learning, its advantages and disadvantages, problem-based learning scenarios and facilitation.
-
Anaesth Intensive Care · Aug 2006
Postoperative changes in prothrombin time following hepatic resection: implications for perioperative analgesia.
Disorders of coagulation may occur after uncomplicated hepatic resection in patients who have normal preoperative coagulation profiles and liver function tests. We present a retrospective study performed in a tertiary care university teaching hospital examining changes in liver function tests and coagulation profiles in patients undergoing hepatic resection. Data were obtained for 124 patients. ⋯ There was no relationship between prothrombin time and patient age. Disorders of coagulation occur after hepatic resection even in patients who have normal preoperative coagulation and liver function tests. This has implications for anaesthetic practice, particularly when considering the use of an indwelling epidural catheter in patients undergoing hepatic resection.
-
Anaesth Intensive Care · Aug 2006
Randomized Controlled Trial Multicenter StudyHighly conservative phlebotomy in adult intensive care--a prospective randomized controlled trial.
Anaemia in critically ill patients is common and phlebotomy associated blood loss may contribute towards this anaemia. The aims of this study were twofold. Firstly, a survey was conducted to provide a summary of current phlebotomy practices within Australian intensive care units. ⋯ Using our highly conservative protocol, median phlebotomy-associated blood loss was reduced by over 80% (40 ml vs 8 ml P<0.001). Mean haemoglobin fell from 13.7 g/dl to 11.7 g/dl in controls (P=0.002) and from 12.7 g/dl to 11.5 g/dl (P=0.074) in our study group. We conclude that highly conservative phlebotomy is feasible in a critical care unit and is associated with a reduction in blood loss.
-
Anaesth Intensive Care · Aug 2006
Clinical TrialAntenatal self-hypnosis for labour and childbirth: a pilot study.
In our institution we have used antenatal training in self-hypnosis for over three years as a tool to provide relaxation, anxiolysis and analgesia for women in labour. To assess the effects of hypnotherapy, we prospectively collected data related to the use of hypnosis in preparation for childbirth, and compared the birth outcomes of women experiencing antenatal hypnosis with parity and gestational age matched controls. ⋯ Our clinical findings are consistent with recent meta-analyses showing beneficial outcomes associated with the use of hypnosis in childbirth. Adequately powered, randomized trials are required to further elucidate the effects of hypnosis preparation for childbirth.