British journal of anaesthesia
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Procedural sedation is practised by a heterogeneous group of practitioners working in a wide array of settings. However, there are currently no accepted standards for the competencies a sedation practitioner should have, the content of sedation training programmes, and guidelines for credentialing. The multidisciplinary International Committee for the Advancement of Procedural Sedation sought to develop a consensus statement on the following: which competencies should medical or dental practitioners have for procedural sedation and how are they obtained, assessed, maintained, and privileged. ⋯ Following an iterative Delphi review method, final consensus was reached. Using multispeciality consensus, we defined procedural sedation competence by identifying a set of core competencies in the domains of knowledge, skills, and attitudes across physical safety, effectiveness, psychological safety, and deliberate practice. In addition, we present a standardised framework for competency-based training and credentialing of procedural sedation practitioners.
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Review Meta Analysis
Effectiveness of dexmedetomidine on patient-centred outcomes in surgical patients: a systematic review and Bayesian meta-analysis.
Dexmedetomidine is increasingly used for surgical patients requiring general anaesthesia. However, its effectiveness on patient-centred outcomes remains uncertain. Our main objective was to evaluate the patient-centred effectiveness of intraoperative dexmedetomidine for adult patients requiring surgery under general anaesthesia. ⋯ PROSPERO (CRD42023439896).
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Editorial Review
Attaining expertise in regional anaesthesia training using a multifactorial approach incorporating deliberate practice.
The most effective way of delivering regional anaesthesia training and the best means of demonstrating competency have not been established. Clinical competency, based on the Dreyfus and Dreyfus lexicon, appears unachievable using current training approaches. Lessons should be taken from the worlds of music, chess, and sports. Modern skills training programmes should be built on an explicit and detailed understanding with measurement of a variety of factors such as perception, attention, psychomotor and visuospatial function, and kinesthetics, coupled with quantitative, accurate, and reliable measurement of performance.
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Editorial Review
Virtual reality-based analgesia: towards a novel framework for the biopsychosocial management of chronic pain.
Virtual reality (VR) holds unmeasured potential as a multicomponent tool for managing chronic pain by adapting conventional in-person biopsychosocial pain management strategies into one virtual space. We review recent evidence showcasing the successful integration of cognitive behavioural therapy, mindfulness-based stress reduction, embodiment techniques, and physical therapy into VR environments, demonstrating positive outcomes in patients with chronic pain. We propose that future clinical and basic research build on this by integrating pain neuroscience techniques to help better understand pathophysiological pain mechanisms and treatment response. This could help facilitate early assessment and personalised treatment of chronic pain using a VR-based biopsychosocial approach.