Anesthesiology clinics
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Anesthesiology clinics · Jun 2007
ReviewDoes simulation improve patient safety? Self-efficacy, competence, operational performance, and patient safety.
Simulation training is an essential educational strategy for health care systems to improve patient safety. The strength of simulation training is its suitability for multidisciplinary team training. There is good evidence that simulation training improves provider and team self-efficacy and competence on manikins. ⋯ Also, no evidence to date proves that simulation training actually improves patient outcome. Even so, confidence is growing in the validity of medical simulation as the training tool of the future. The use of medical simulation will continue to grow in the context of multidisciplinary team training for patient safety.
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Anesthesiology clinics · Jun 2007
ReviewStatewide simulation systems: the next step for anesthesiology?
Statewide simulation networks afford not only the possibility of meeting capacity needs for anesthesiologists, but also provide a venue for training trainers, setting standards, and bringing academic and nonacademic practices together. Furthermore, a statewide network that is appropriately designed opens the door to interdisciplinary activity. ⋯ The model provides an example of how simulation can be successfully applied across a large and diverse area. The article details the benefits of statewide simulation networks, discusses challenges to implementing such networks, and describes Oregon's statewide efforts.
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Anesthesiology clinics · Jun 2007
ReviewSimulation applications for human factors and systems evaluation.
Simulation applications have become increasingly common in health care. A convergence of factors has stimulated this growth, including the rapid advance of enabling technologies, demand for improved outcomes and objectively assessed competencies, and translation of lessons learned from other high-risk industries as a function of the patient safety and quality movements. The bulk of the experience gained and resources expended has been focused on education, training, and assessment of clinicians' knowledge, skills, and attitudes. Simulation methods lend themselves to supporting human factors and systems-level investigations, yet work in health care has, to a large degree, been limited to a few experienced centers, interdisciplinary research teams, and isolated novel studies.
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Anesthesiology clinics · Mar 2007
ReviewBattlefield anesthesia: advances in patient care and pain management.
Expeditionary maneuver warfare and the asymmetric battlefield have forced changes in the traditional methods with which we deliver anesthesia and surgery to the wounded. Although in many ways similar to how we have operated on the wounded for the past half century, new advances in diagnostic and therapeutic modalities and doctrinal shifts have changed the face of the battlefield hospital. In this article, the authors discuss these changes in regard to anesthetic care for surgical and pain management for wounded airmen, sailors, soldiers, and marines.
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Treatment of hemorrhagic shock continues to evolve. Surgically, the concept of "damage control" has become the standard, with shorter operations focused on the control of life-threatening injuries. For the anesthesiologist, practice has changed, with a better understanding of the pathophysiology of shock, new techniques such as deliberate hypotension and perfusion-focused therapy, improved management of transfusion, and the advent of systemic hemostatic drug therapy. In this article, the author reviews each of these topics, and presents an integrated recommendation for early and late management of the patient in hemorrhagic shock.