British journal of anaesthesia
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Shared decision making is rarely used in anaesthesia consultations. Because either spinal or general anaesthesia can be appropriate for many patients undergoing surgery to repair a hip fracture, this is an appropriate context to implement and test shared decision making and associated resources for anaesthesia decisions. Conversation aids can facilitate shared decision making between clinicians, patients, and caregivers about treatment choices. ⋯ Reasonable shared decision-making strategies such as conversation aids were seen by most participants as helpful to support shared decision making about anaesthesia options for hip fracture surgery. Engaging end users at the local level can address key implementation barriers.
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Ketamine, in doses suitable to induce anaesthesia in humans, gives rise to a unique state of unresponsiveness accompanied by vivid experiences and sensations, making it possible to disentangle the correlated but distinct concepts of conscious awareness and behavioural responsiveness. This distinction is often overlooked in the study of consciousness. ⋯ The CHD framework, which only requires resting-state fMRI data and can be applied retrospectively, has the ability to track alterations in conscious awareness in the absence of behavioural responsiveness on a group level. This is possible because of ketamine's unique property of decoupling these two facets, and is important for consciousness and anaesthesia research.
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Perioperative neurocognitive disorders (PNDs) are common complications after surgery and anaesthesia, particularly in older adults, leading to increased morbidity, mortality, and healthcare costs. Therefore, major medical societies have developed recommendations for the prevention and treatment of PNDs. Our study evaluated the reliability of large language models, specifically ChatGPT-4 and Gemini, in generating recommendations for PND management and comparing them with published guidelines. ⋯ Large language models can generate perioperative neurocognitive disorder recommendations that align closely with published guidelines. However, further validation and integration of clinician feedback are required before clinical application.