Preoperative chest radiographs in hip fracture patients: is there any additional value?

PURPOSE: Preoperative screening in hip fracture patients is vital to minimize perioperative complications. Preoperative chest radiographs (POCR) are performed in many hip fracture patients. Earlier research showed that few POCR abnormalities influence perioperative policy. However, no studies in nonelective patient with a specific surgical conditions have been performed. With many hip fractures per year worldwide, a significant cost reduction could be made by performing selective POCR without compromising the quality of care. This study assessed the need for POCR in hip fracture patients. METHOD: Retrospective analysis of low-energy trauma patients was performed aged 18 years and older in the VU University Medical Center for a hip fracture in a 5-year period. All preoperative diagnostics were analyzed. All adjourned operations were evaluated. RESULTS: A total of 642 patients were included, 70% female, matching current epidemiologic figures. The POCR showed abnormalities in 22.6%. In 0.6% the POCR lead to an adjournment of the operation (2.8% of abnormal POCR's). These patients suffered from pneumonia. The POCR in these cases acted as a confirmation of the clinical diagnosis. CONCLUSION: Many factors involving the treatment of hip fracture patients are of importance in minimizing the risk of complications and mortality during and after admission. In 0.6% of all performed POCR's an abnormality leads to the adjournment of the operation. In all four cases the POCR matched the clinical findings. Because the additional value of the POCR in hip fracture patients was limited, we think that its selective use in clinical abnormalities is safe and will reduce unnecessary costs.

State-of-the-art usage of simulation in anesthesia: skills and teamwork.

PURPOSE OF REVIEW: This review describes the level of evidence for the use of medical simulation in anesthesia. It also discusses the topic of realism in simulation and its use for assessment. RECENT FINDINGS: Medical simulation in anesthesia covers a variety of techniques used for training and assessment. The current level of evidence for the use of medical simulation strongly supports a shift from learning on patients to learning on simulators. Skill and multidisciplinary team training are effective modalities and improve (team) performance and patient outcome.Well defined learning objectives, not a high level of realism should be the main focus of a simulation activity. Simulation centers should focus on faculty development as emphasis on simulation facilities and simulator fidelity alone does not guarantee effective training.Formative and summative assessment can help identify the omissions in knowledge, skills, and the ability to work in a team for both residents and anesthesiologists. Not only does it help to obtain competence, it also helps to maintain it. SUMMARY: Simulation for skill and team training should be a mandatory component for anesthesia residency programs and continuous medical education. The 'see one, do one, teach one' approach is obsolete and should be abandoned.