Anaesthesia
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Viscoelastic haemostatic assays provide rapid testing at the bed-side that identify all phases of haemostasis, from initial fibrin formation to clot lysis. In obstetric patients, altered haemostasis is common as pregnancy is associated with coagulation changes that may contribute to bleeding events such as postpartum haemorrhage, as well as thrombosis events. ⋯ The use of viscoelastic haemostatic assay-guided algorithms may be beneficial to diagnose coagulopathy, predict postpartum haemorrhage, reduce transfusion requirements and monitor fibrinolysis in women with obstetric haemorrhage. Further studies are required to assess whether viscoelastic haemostatic assay-guided treatment improves clinical outcomes, and to confirm the utility of prepartum viscoelastic haemostatic assay measurements for identifying patients at risk of postpartum haemorrhage.
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Randomized Controlled Trial
Deception in simulation-based education: a randomised controlled trial of the effect of deliberate deception on the performance of anaesthesia trainees.
The use of deliberate deception in simulation allows for a level of realism that is not normally feasible. However, the use of deception is controversial, and carries the risk of psychological harm to learners. There are currently no quantitative data on the effect of deception on learner performance, making it difficult to judge its usefulness. ⋯ Trainees exposed to deliberate deception, who thought that the consultant anaesthetist was a subject, had a less-effective best challenge, likely mimicking real-life behaviour. Deliberate deception appears to modify behaviour, particularly relating to communication involving hierarchical relationships. This technique may improve authenticity, especially with a steep power gradient, and so has demonstrable value which must be balanced against the ethical considerations.