British journal of anaesthesia
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Review
Systematic review and narrative synthesis of competency-based medical education in anaesthesia.
Competency-based medical education (CBME) addresses the accountability of postgraduate training programmes to graduate specialists capable of independent practice. ⋯ Evidence on outcomes of CBME was limited to acquisition of specific competencies during training. The large number of unanswered questions and the dearth of studies across the core components of CBME suggest that we need a collaborative approach to create the evidence required to implement CBME wisely and cost effectively, to have positive impacts on patients, trainees, and healthcare systems.
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Randomized Controlled Trial
Remifentanil and perioperative glycaemic response in cardiac surgery: an open-label randomised trial.
This study investigated whether remifentanil infusion decreased intraoperative hyperglycaemia and insulin resistance compared with intermittent fentanyl administration in patients undergoing elective cardiac surgery. ⋯ NCT02349152.
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Early administration of the antifibrinolytic drug tranexamic acid reduces death from bleeding in trauma and postpartum haemorrhage. We examined how the effectiveness and safety of antifibrinolytic drugs varies by the baseline risk of death as a result of bleeding. ⋯ Tranexamic acid appears to be safe and effective regardless of baseline risk of death. Because many deaths are in patients at low and intermediate risk, tranexamic acid use should not be restricted to the most severely injured or bleeding patients.
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Elevated red cell distribution width (RDW) has been associated with worse outcomes in several medical patient populations. The aim of this study was to investigate the association of increased preoperative RDW and short- and long-term mortality after noncardiac surgery. ⋯ Increased preoperative RDW is associated with increased long-term mortality after noncardiac surgery. RDW could be a composite biomarker of pre-existing chronic inflammation and poor nutritional status. Future studies should clarify if this is a modifiable risk factor for improved surgical outcomes.