British journal of anaesthesia
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Randomized Controlled Trial Observational Study
Training novice anaesthesiology trainees to speak up for patient safety.
A neat little study...
Gurus and team showed improvement in assertiveness and 'speaking up' behaviour among junior anaesthesia trainees, during a simulation workshop after exposure to a didactic session on speaking up behaviour – when compared to a control simulation group who did not receive the didactic session. (n=22)
The take-home message
There is likely benefit to explicitly discussing the issue of, and most importantly techniques for, speaking up when anaesthesia trainees witness management errors or oversights.
The one short-coming
The effects were only observed in a simulation environment, and while probably applicable to the more-consequential real world, as with much simulation research we are often dependent on surrogate markers of performance improvement.
Nonetheless, "we don't rise to the level of our expectations, we fall to the level of our training",1 right?
summary
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This quote is usually attributed to the Greek poet Archilochus, over 2,500 years ago... though today popularised by the US Navy SEALs! (and perhaps a few medical simulation specialists 😉) ↩
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Clinical Trial
Subjective cognitive complaints in patients undergoing major non-cardiac surgery: a prospective single centre cohort trial.
Few perioperative studies have assessed subjective cognitive complaint (SCC) in combination with neuropsychological testing. New nomenclature guidelines require both SCC and objective decline on cognitive testing. The objective of our study was to compare SCC and neuropsychological testing in an elderly surgical cohort. ⋯ NCT02650687.
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Gestational changes in coagulation factor concentrations include elevations in fibrinogen, Factor VIII, and von Willebrand factor (vWF). We hypothesised that blood samples from term pregnant (TP) subjects are less prone to coagulation disturbances from haemodilution compared with those from non-pregnant (NP) females. ⋯ Our in vitro model showed relative resistance of TP blood to dilutional coagulation changes with respect to platelet adhesion, fibrin polymerisation, and thrombin generation. Careful therapeutic monitoring for different pro-haemostatic agents in pregnant women is warranted.
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Opioids are potent painkillers but come with serious adverse effects ranging from addiction to potentially lethal respiratory depression. A variety of drugs with separate mechanisms of action are available to prevent or reverse opioid-induced respiratory depression (OIRD). ⋯ Model-based drug development is needed to design an 'ideal' reversal agent-that is, one that is not influenced by opioid receptor kinetics, does not interfere with opioid analgesia, has a rapid onset of action with long-lasting effects, and is devoid of adverse effects.