Best practice & research. Clinical anaesthesiology
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Best Pract Res Clin Anaesthesiol · Jun 2015
ReviewNeurocognitive outcomes after extracorporeal membrane oxygenation.
Extracorporeal membrane oxygenation (ECMO) has been a therapy of last resort for the treatment of severe cardiorespiratory failure since the 1970s [1]. In recent years, ECMO has seen a resurgence in its use in adults. ⋯ This review aims to summarize recent findings as they pertain to pathophysiology, monitoring techniques, prevention, therapy, and emerging experimental concepts in the context of ECMO for adult patients. Given that neurocognitive outcomes after cardiac surgery have been recently reviewed [3,4], we will limit the discussion of findings from the cardiac surgery/CPB literature to those especially relevant for ECMO.
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Best Pract Res Clin Anaesthesiol · Jun 2015
Myocardial injury and protection related to cardiopulmonary bypass.
During cardiac surgery with cardiopulmonary bypass, the heart is isolated from the circulation. This inevitably induces myocardial ischemia. ⋯ Over the years, several strategies have been developed that aim to attenuate and/or modulate the extent of this ischemia-reperfusion injury related to the episode of cardiopulmonary bypass. This article reviews the pathophysiology of myocardial injury related to cardiopulmonary bypass and summarizes potential therapeutic strategies that may modulate the extent of this myocardial injury.
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With the increased use of simulation to teach the knowledge and skills demanded of clinical practice, toward the achievement of optimal patient care outcomes, it becomes increasingly important that clinician educators have fundamental knowledge about educational science and its applications to teaching and learning. As the foremost goal of teaching is to facilitate learning, it is essential that the simulation experience be oriented to the learning process. In order for this to occur, is it necessary for the clinician educator to understand the fundamentals of educational science and theories of education such that they can apply them to teaching and learning in an environment focused on medical simulation. Underscoring the rationale for the fundamentals of educational science to be applied to the simulation environment, and to work in tandem with simulation, is the importance that accurate and appropriate information is retained and applied toward establishing competence in essential practice-based skills and procedures.
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Best Pract Res Clin Anaesthesiol · Mar 2015
ReviewThe matter of 'fidelity': Keep it simple or complex?
Simulation often relies on a case-based learning approach and is used as a teaching tool for a variety of audiences. The knowledge transmission goes beyond the mere exchange of soft skills and practical abilities, including practical knowledge and decision-making behaviour as well. As it seems, simulation requirements largely depend on the skills, abilities or competences to be conveyed. ⋯ For simulation-based learning, learning outcomes depend not only on knowledge, practical skills and motivational variables, but also on the onset of negative emotions, perception of own ability and personality profile. 'Simulation' training alone does not appear to guarantee learning success. Rather, it seems necessary to establish a simulation setting suitable for the education level, needs and personality characteristics of the students. Thus, it is fair to conclude that there is no evidence correlating the realism of a simulation scenario with the learning success of students.
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About 10 years ago, the first human patient simulators were introduced to intensive care units (ICUs). Since then, there has been a rapid development of both technical and non-technical aspects in medical education. ⋯ Furthermore, a practical example describes how a simulation curriculum can be designed, which challenges might need to be faced and which steps need to be taken to make the most out of the training. Human patient simulation is an effective tool in the education of health-care professionals and will surely become an important part in the training of ICU physicians as well.