SUMMARY Review date: 1969 to 2003, 34 years. Background and context: Simulations are now in widespread use in medical education and medical personnel evaluation. Outcomes research on the use and effectiveness of simulation technology in medical education is scattered, inconsistent and varies widely in methodological rigor and substantive focus. Objectives: Review and synthesize existing evidence in educational science that addresses the question, ‘What are the features and uses of high-fidelity medical simulations that lead to most effective learning?’. Search strategy: The search covered five literature databases (ERIC, MEDLINE, PsycINFO, Web of Science and Timelit) and employed 91 single search terms and concepts and their Boolean combinations. Hand searching, Internet searches and attention to the ‘grey literature’ were also used. The aim was to perform the most thorough literature search possible of peer-reviewed publications and reports in the unpublished literature that have been judged for academic quality. Inclusion and exclusion criteria: Four screening criteria were used to reduce the initial pool of 670 journal articles to a focused set of 109 studies: (a) elimination of review articles in favor of empirical studies; (b) use of a simulator as an educational assessment or intervention with learner outcomes measured quantitatively; (c) comparative research, either experimental or quasi-experimental; and (d) research that involves simulation as an educational intervention. Data extraction: Data were extracted systematically from the 109 eligible journal articles by independent coders. Each coder used a standardized data extraction protocol. Data synthesis: Qualitative data synthesis and tabular presentation of research methods and outcomes were used. Heterogeneity of research designs, educational interventions, outcome measures and timeframe precluded data synthesis using meta-analysis. Headline results: Coding accuracy for features of the journal articles is high. The extant quality of the published research is generally weak. The weight of the best available evidence suggests that high-fidelity medical simulations facilitate learning under the right conditions. These include the following:

/pdf/features-and-uses-of-high-fidelity-medical-simulations-that-51wb8k5opy.pdf

Features and uses of high-fidelity medical simulations that lead to effective learning: a BEME systematic review

too fine for undergraduate readers who are new to agrarian debates. On the whole, however, the book is accessible and deserves to be widely read. The condition of rural populations in much of the global South is indeed dire-most of the 1 billion people living on less than a dollar a day live in the countryside. This book offers many important insights into why this is the case, and how the current regime of global capitalism works against a repetition of the agrarian transition that brought wealth and security to the global North.

The Bottom Billion: Why the Poorest Countries Are Failing and What Can Be Done About It

Numerous cardiac output (CO) monitors have been produced that provide continuous rather than intermittent readings. Bland and Altman has become the standard method for validating their performance against older standards. However, the Bland and Altman method only assesses precision and does not assess how well a device detects serial changes in CO (trending ability). Currently, there is no consensus on how trending ability, or trend analysis, should be performed. Therefore, we performed a literature review to identify articles published between 1997 and 2009 that compared methods of continuous CO measurement. Identified articles were grouped according to measurement technique and statistical methodology. Articles that analyzed trending ability were reviewed with the aim of finding an acceptable statistical method. Two hundred two articles were identified. The most popular methods were pulse contour (69 articles), Doppler (54), bioimpedance (38), and transpulmonary or continuous thermodilution (27). Forty-one articles addressed trending, and of these only 23 provided an in-depth analysis. Several common statistical themes were identified: time plots, regression analysis, Bland and Altman using change in CO (ΔCO), and the 4-quadrant plot, which used direction of change of ΔCO to determine the concordance. This plot was further refined by exclusion of data when values were small. Receiver operating characteristic curves were used to define the exclusion zone. In animal studies, a reliable reference standard such as an aortic flowprobe was frequently used, and regression or time plots could be used to show trending. Clinical studies were more problematic because data collection points were fewer (8-10 per subject). The consensus was to use the 4-quadrant plot with exclusion zones and apply concordance analysis. A concordance rate of >92% when using a 15% zone indicated good trending. A new method of presenting trend data (ΔCO) on a polar plot is proposed. Agreement was shown by the angle with the horizontal axis and ΔCO by the distance from the center. Trending can be assessed by the vertical limits of the data, similar to the Bland and Altman method.

A critical review of the ability of continuous cardiac output monitors to measure trends in cardiac output.

The African continent is distinguished by a much higher fertility rate than other regions. Fertility in Africa has remained almost constant at slightly over six children per woman on average while important declines have occurred elsewhere over the past 25 years. High fertility in Africa is often attributed to poor diffusion of family planning early marriage and low female educational attainment but other cultural and economic factors are involved. The significant decline of infant mortality over the past several decades has produced growth rates never before observed. Africas very young populations may be at the origin of uncontrollable political disorder as young persons with bleak prospects fall easy prey to ethnic religious and political extremism. Demographic growth has become an additional barrier to development. High fertility is tolerated or encouraged as constituting a cultural trait but the resulting population growth is not a cultural trait. Demographic pressure has increased environmental problems in many regions. It is estimated that over ten million rural residents of the Sahel have been affected by soil degradation. The per capita availability of arable land fell from one-half to one-third hectare between 1965 and 1987. Shortages of firewood and water have become more common. The relationship between demographic growth environmental crisis and poverty in the countryside depends on other factors such as production techniques modes of access to land and water and the degree of security of land tenure. Population pressure was not the initial factor that disturbed the balance of the traditional societies but it exacerbated the effects of other forces such as the introduction of cash crops and monetarization of the economy. Rural exodus and accelerated urban migration have been prompted in large part by the higher incomes and greater availability of services of all types in the cities. Achieving control of fertility in Africa will require stabilization of rural populations territorial management and reduction of disparities between rural and urban areas.

An end to poverty

The ischemia-reperfusion injury,which is called I/R,is an important problem in the surgical practices.It plays an important role in the developing of pathology,such as the small intestine transplantation,the serious infection,the wound,the shock,the cardiorespiratory functional defeat.The consequence of intestinal I/R,not only causes partial histologic lesion of intestinal mucosa,more over may cause intestinal bacteria colony shifting,changes the intestines absorption function,as well as damages to the distance organ,even leads to the multi-systems organ function defect syndrome.This article explained its mechanism and prevention measure for the past few years and hoped to provide the basis for the future clinical work.

Ischemia-Reperfusion Injury of the Intestine and Protective Strategies Against Injury

Rationale: The robust advances in pain management for companion animals underlie the decision of the American Animal Hospital Association (AAHA) and American Association of Feline Practitioners (AAFP) to expand on the information provided in the 2007 AAHA/AAFP Pain Management Guidelines. The 2015 Guidelines summarize and offer a discriminating review of much of this new knowledge. Relevance: Pain management is central to veterinary practice, alleviating pain, improving patient outcomes, and enhancing both quality of life and the veterinarian‐client‐patient relationship. These Guidelines support veterinarians in incorporating pain management into practice, improving patient care. Approaches: The management of pain requires a continuum of care that includes anticipation, early intervention, and evaluation of response on an individual patient basis. A team-oriented approach, including the owner, is essential for maximizing the recognition, prevention and treatment of pain in animals. Evidence base: The Guidelines include both pharmacologic and non-pharmacologic modalities to manage pain; they are evidence-based insofar as possible and otherwise represent a consensus of expert opinion. Behavioral changes are currently the principal indicator of pain and its course of improvement or progression, and the basis for recently validated pain scores. Post-surgical pain is eminently predictable but a strong body of evidence exists supporting strategies to mitigate adaptive as well as maladaptive forms. Chronic pain is dominated by degenerative joint disease (DJD), which is one of the most significant and under-diagnosed diseases of cats and dogs. DJD is ubiquitous, found in pets of all ages, and inevitably progresses over time; evidence-based strategies for management are established in dogs, and emerging in cats.

/pdf/2015-aaha-aafp-pain-management-guidelines-for-dogs-and-cats-52ov3lm2de.pdf

2015 AAHA/AAFP Pain Management Guidelines for Dogs and Cats*

Karol Mathews DVM DVSc DACVECC (Canada) Peter W Kronen Dr Vet Med, DVM DECVAA (Switzerland) Duncan Lascelles BSc BVSc PhD DSAS DECVS DACVS MRCVS (USA) Andrea Nolan MVB DVA PhD DECVAA DECVPT MRCVS (UK) Sheilah Robertson BVMS (Hons) PhD DACVAA DECVAA DECAWBM (WSEL) DACAW MRCVS (USA) Paulo VM Steagall MV MS PhD DACVAA (Brazil/Canada) Bonnie Wright DVM DACVAA (USA) Kazuto Yamashita DVM MS PhD DJCVS (Japan)

https://onlinelibrary.wiley.com/doi/epdf/10.1111/jsap.12200

Guidelines for recognition, assessment and treatment of pain: WSAVA Global Pain Council members and co-authors of this document:.

Nonsteroidal anti-inflammatory drugs in cats: a review

The pharmacokinetics and thermal antinociceptive effects of buprenorphine after intravenous (i.v.) or oral transmucosal (OTM) administration were studied in six adult cats. Plasma buprenorphine concentrations were measured using radioimmunoassay in a crossover study after a dose of 20 microg/kg given by the i.v. or OTM route. Oral pH was measured. Blood for drug analyses was collected before, and at 1, 2, 4, 6, 10, 15, 30, and 60 min and at 2, 4, 6, 8, 12, and 24 h after treatment. Thermal thresholds were measured before treatment, then following treatment every 30 min to 6 h, every 1 hour to 12 h and at 24 hours postadministration. Plasma buprenorphine concentration effect relationships were analyzed using a log-linear effect model. Oral pH was 9 in each cat. Peak plasma buprenorphine concentration was lower and occurred later in the OTM group but median bioavailability was 116.3%. Thermal thresholds increased significantly between 30 and 360 min in both groups. Peak effect was at 90 min and there was no difference at any time between the two groups. There was distinct hysteresis between plasma drug concentration and effect in both groups. Overall, OTM administration of buprenorphine is as effective as i.v. treatment and offers a simple, noninvasive method of administration which produces thermal antinociception for up to 6 h in cats.

PK-PD modeling of buprenorphine in cats: intravenous and oral transmucosal administration

This sales letter may not influence you to be smarter, but the book that we offer will evoke you to be smarter. Yeah, at least you'll know more than others who don't. This is what called as the quality life improvisation. Why should this veterinary anesthesia and analgesia? It's because this is your favourite theme to read. If you like this theme about, why don't you read the book to enrich your discussion?

Sheilah A. Robertson

Papers

2015 AAHA/AAFP Pain Management Guidelines for Dogs and Cats*

Guidelines for recognition, assessment and treatment of pain: WSAVA Global Pain Council members and co-authors of this document:.

Nonsteroidal anti-inflammatory drugs in cats: a review

PK-PD modeling of buprenorphine in cats: intravenous and oral transmucosal administration

Veterinary anesthesia and analgesia