Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Apr 2017
ReviewPoint-of-care monitoring for the management of trauma-induced bleeding.
Knowledge of trauma-induced coagulopathy has been grown in the past and point-of-care suitable devices for coagulation testing have been introduced. Methodology and clinical application of different systems for point-of-care coagulation monitoring are shown with a focus on thrombelastography as measured by TEG, rotational thromboelastometry as measured by ROTEM and impedance aggregometry as measured by the multiplate analyser and ROTEM platelet. ⋯ Point-of-care assessment of coagulation in trauma patients appears to be at least promising. However, because published data mostly are of retrospective or observational nature only, there is a need for prospective, randomized and controlled studies.
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Curr Opin Anaesthesiol · Apr 2017
ReviewContinuous electroencephalographic-monitoring in the ICU: an overview of current strengths and future challenges.
In ICUs, numerous physiological parameters are continuously monitored and displayed. Yet, functional monitoring of the organ of primary concern, the brain, is not routinely performed. Despite the benefits of ICU use of continuous electroencephalographic (EEG)-monitoring (cEEG) is increasingly recognized, several issues nevertheless seem to hamper its widespread clinical implementation. ⋯ In selected critically ill patient groups, ICU cEEG has clear benefits over (repeated) standard EEG or no functional brain monitoring at all and if available, cEEG should be used. However, several issues preventing optimal ICU cEEG usage persist and should be further explored.
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Decisions to forego life-sustaining treatments are complex, and disagreements between physicians and patients occur. This review discusses recent findings regarding what factors influence physicians and patients or their surrogates in these decisions and considers whether futility arguments regarding life-sustaining treatments should be abandoned. ⋯ Further research is needed about factors that affect both physicians and patients with regard to forgoing life-sustaining interventions. Physicians need more information regarding religious/spiritual preferences of patients and decision-makers. 'Futility' arguments in end-of-life decision-making are flawed and should probably be abandoned.
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Curr Opin Anaesthesiol · Apr 2017
ReviewQuality organization and risk in anaesthesia: the French perspective.
Ensuring the quality and safety of anaesthesia in the face of budgetary restrictions and changing demographics is challenging. In France, the environment is regulated by the legislation, and it is often necessary to find solutions that seize opportunities to break with the traditional organization. ⋯ The management of a patient undergoing surgery with anaesthesia is a seamless spectrum from the patient's home to the hospital and back to home. Decision-making must be multidisciplinary. Increased use of ambulatory care, breaks with traditional organizational structures, and efforts to reduce postoperative mortality represents opportunities to improve overall system performance. Demographic and economic constraints are potential threats to be identified.
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Curr Opin Anaesthesiol · Apr 2017
ReviewAssessment of competence: developing trends and ethical considerations.
This review explores new concepts in competency assessment in anesthesiology, the associated ethical challenges, and directions for new research. ⋯ The search for objective measures of competence is well underway. Current methods require substantial investment of resources, and further research into more efficient and financially feasible tools of assessment is needed. As these assessments become more common in use, the ethical challenges raised by defining competency in high-stakes clinical practice situations will need to be addressed.