Anaesthesia
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Ultrasound-guided regional anaesthesia enhances pain control, patient outcomes and lowers healthcare costs. However, teaching this skill effectively presents challenges with current training methods. Simulation-based medical education offers advantages over traditional methods. However, the use of instructional design features in ultrasound-guided regional anaesthesia simulation training has not been defined. This systematic review aimed to identify and evaluate the prevalence of various instructional design features in ultrasound-guided regional anaesthesia simulation training and their correlation with learning outcomes using a modified Kirkpatrick model. ⋯ Ultrasound-guided regional anaesthesia simulation training incorporating specific instructional design features enhances educational outcome; this was particularly evident at lower Kirkpatrick levels. Optimal combinations of instructional design features for higher-level outcomes (Kirkpatrick levels 3 and 4) remain unclear. Future research should standardise outcome measurements and isolate individual instructional design features to better understand their impact on clinical practice and patient safety.
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Demand for total hip and knee arthroplasty procedures continues to rise. Ongoing changes in surgical care and patient populations require continued monitoring of outcome trends. Using nationwide data from the USA, we aimed to describe updated trends in patient and peri-operative care characteristics as well as complications among total hip and knee arthroplasty recipients. ⋯ Compared with previous trend analyses of patients having total hip or knee arthroplasty, the present study shows: an increasing rate of outpatient surgeries; increasing numbers of arthroplasty procedures in high comorbidity burden groups; and an increase incidence of certain serious postoperative complications.
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Evidence to support intra-operative lidocaine infusion regimens in patients with obesity is lacking, risking underdosing or toxicity. We aimed to measure the plasma concentrations of lidocaine and its active metabolites to develop a pharmacokinetic model and optimised dosing regimen in patients with obesity. ⋯ Our simulated dosing regimen achieved therapeutic concentrations more successfully in patients with obesity. Further studies should evaluate the clinical safety and efficacy of this dosing regimen.