British journal of anaesthesia
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Clinical practice guidelines are increasingly important to guide clinical care. However, they can vary widely in quality, and many recommendations are based on low-level evidence. The COVID-19 pandemic highlighted the need for new flexible formats for rigorously developed guidelines. Future guideline development should be standardised, graded, registered, and updated to ensure that they are 'living' works in progress.
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The COVID-19 pandemic generated a surge of critically ill patients greater than the capacity of the UK National Health Service (NHS). There have been multiple well-documented impacts associated with the national COVID-19 pandemic surge on ICU staff, including an increased prevalence of mental health disorders on a scale potentially sufficient to impair high-quality care delivery. We investigated the prevalence of five mental health outcomes; explored demographic and professional predictors of poor mental health outcomes; and describe the prevalence of functional impairment; and explore demographic and professional predictors of functional impairment in ICU staff over the 2020/2021 winter COVID-19 surge in England. ⋯ The winter of 2020/2021 was associated with an increase in poor mental health outcomes and functional impairment amongst ICU staff during a period of peak caseload. These effects are likely to impact on patient care outcomes and the longer-term resilience of the healthcare workforce.
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How conscious experience becomes disconnected from the environment, or disappears, across arousal states is unknown. We sought to identify the neural correlates of sensory disconnection and unconsciousness using a novel serial awakening paradigm. ⋯ NCT03284307.
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Editorial Comment
Consciousness and the outside world: is there anyone listening?
Sedated patients have graded levels of consciousness and perceptual connection with the outside world. Disconnection is associated with widespread changes in the electroencephalogram, whereas full unconsciousness is linked with decreased activity specifically in the deep midline regions of the brain. These findings can be interpreted within the predictive coding model of consciousness as differences in model generation vs discrepancy detection. Anaesthetists should be cognisant that apparently unresponsive patients might still have some ongoing partially disconnected consciousness activity.
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In postgraduate specialist training, workplace assessments are expected to provide the information required for decisions on trainee progression. Research suggests that meeting this expectation can be difficult in practice, which has led to the development of informal processes, or 'shadow systems' of assessment. Rather than rejecting these informal approaches to workplace assessment, we propose borrowing from sociology the concept of 'desire paths' to legitimise and strengthen these well-trodden approaches. We asked what information about trainees is currently used or desired by those charged with making decisions on trainee progression, and how is it obtained? ⋯ From these themes, we propose a set of design principles for future workplace assessment. Understanding the reasons desire paths exist can inform future assessment redesign, and may address the current disjunct between the formal workplace assessment system and what happens in practice.