Search

Abstract Introduction Even physicians who routinely work in complex, dynamic practices may be unprepared to optimally manage challenging critical events. High-fidelity simulation can realistically mimic critical clinically relevant events, however the reliability and validity of simulation-based assessment scores for practicing physicians has not been established. Methods Standardised complex simulation scenarios were developed and administered to board-certified, practicing anesthesiologists who volunteered to participate in an assessment study during formative maintenance of certification activities. A subset of the study population agreed to participate as the primary responder in a second scenario for this study. The physicians were assessed independently by trained raters on both teamwork/behavioural and technical performance measures. Analysis using Generalisability and Decision studies were completed for the two scenarios with two raters. Results The behavioural score was not more reliable than the technical score. With two raters > 20 scenarios would be required to achieve a reliability estimate of 0.7. Increasing the number of raters for a given scenario would have little effect on reliability. Conclusions The performance of practicing physicians on simulated critical events may be highly context-specific. Realistic simulation-based assessment for practicing physicians is resource-intensive and may be best-suited for individualized formative feedback. More importantly, aggregate data from a population of participants may have an even higher impact if used to identify skill or knowledge gaps to be addressed by training programs and inform continuing education improvements across the profession.

Introduction: Non-focal postoperative mental status changes can be challenging.Methods: Single patient case report and medical literature review.Results: We describe a 67-year-old male who was admitted for radical cystectomy andileal conduit urinary diversion. General anesthesia was uneventful and the patient remainedhemodynamically stable throughout the procedure. At the end of the procedure, thepatient's trachea was extubated. Initially, he was arousable, able to move all extremities,and answer questions appropriately. Over the next 2 hours, his mental status waxed andwaned and respirations became irregular. An emergent head computed tomogram withoutcontrast revealed a hyperdense basilar artery consistent with acute thrombosis. Vascularradiology intervention occurred approximately 9 hours after the onset of symptoms, butthere was no improvement in the patient's neurological status and he subsequently died.Conclusion: Although nonfocal postoperative mental status changes are common andoften secondary to benign etiologies, they may herald more significant pathology, includingstroke. Patients with postoperative mental status changes should be evaluated carefully toidentify life-threatening and treatable etiologies. Recent advances in the acute care of stroke,such as thrombolysis and angioplasty, can improve outcome if instituted promptly. [ABSTRACT FROM AUTHOR]

Objective: We describe BIS values for a patient undergoing breast surgery under self-hypnosis in order to access the value of global surface EEG measures occurring during this process. Methods: Following verbal consent, a BISTM monitor (Aspect Medical, Newton MA) was placed and values measured while the patient performed self-hypnosis for a simple mastectomy and sentinel node biopsy. Results: Thirty-nine minutes after incision the BIS value decreased transiently to 72 followed by several other transient decreases, the lowest of which was 59. Values remained at approximately 90 throughout most of the operative period. The BIS value returned to baseline after completion of the operation. Conclusions: Our findings support the hypothesis that hypnosis is a dynamic cerebral process incorporating many changes within brain activation centers and one distinct from dissociative patterns seen under anesthesia. Current algorithms employed by the BISTM monitor add little to the management of patients utilizing hypnosis for analgesia. [ABSTRACT FROM AUTHOR]