Plasma protein C levels in immunocompromised septic patients are significantly lower than immunocompetent septic patients: a prospective cohort study

Introduction: Activated Protein C [APC] improves outcome in immunocompetent patients with severe sepsis particularly in those who are perceived to have high mortality risk. Before embarking on a trial of APC administration in immunocompromised septic patients, a preliminary study on plasma levels of protein C in this cohort is essential

The impact of organ donation on coronial processes and forensic investigation: a literature review

There are competing requirements between organ donation for transplantation and coronial/forensic investigation. Both require access to the body of the deceased. Optimally preserving physical evidence may reduce availability of organs for life saving transplants. Performing organ retrieval could impact on death determination and at worst could potentially interfere with criminal trial outcomes. Objective: To summarise published literature regarding the interaction between organ donation and coronial/forensic processes. Methods: A standard search strategy using the terms organ donation and coroner or medical examiner. Results: There is a paucity of published literature. The incidence of coronial restriction of donation varies between jurisdictions and between individual practitioners. A significant number of organs are lost to transplantation through coronial restrictions. A number of strategies have been proposed to reduce the rate of coronial restrictions but implementation is inconsistent despite support from forensic professional bodies. There was no published report of a significant impact on death determination or trial outcome caused by organ retrieval. Conclusions: Increased consistency in coronial/forensic decision making and implementation of recognised strategies would increase the availability of organs for transplantation

Peer-Assisted learning in simulation-based medical education: A mixed-methods exploratory study

INTRODUCTION: Peer-assisted learning (PAL) is well described in medical education but there has been little research on its application in simulation-based education (SBE). This exploratory study aimed to determine the perceptions of senior medical students at two universities to teaching and learning in SBE using PAL (PAL-SBE). METHODS: Ninety-seven medical students at two universities working in small groups with facilitator oversight wrote, ran and debriefed a simulation scenario for their peers. This was a mixed-methods study. Participants completed a written free-text and Likert survey instrument, and participated in a facilitated focus group immediately after the scenario. Thematic analysis was performed on the free-text and focus group transcripts. RESULTS: Student-led scenarios ran without major technical issues. Instructor presence was required throughout scenario delivery and debrief, making the exercise resource intensive. Participant responses were more positive regarding learning as peer teachers in simulation than they were regarding participation as a peer learner. Five themes were identified: learning in the simulated environment; teaching in the simulated environment; teaching peers and taking on an educator role; learning from peers; and time and effort expended. Perceived benefits included learning in depth through scenario writing, improved knowledge retention, understanding the patient’s perspective and learning to give feedback through debriefing. CONCLUSION: PAL in SBE is feasible and was perceived positively by students. Perceived benefits appear to be greater for the peer teachers than for peer learners

Does organ donation impact on forensic outcomes? A review of coronial outcomes and criminal trial proceedings

Despite increases in organ donation rates, there continue to be waiting lists for patients in urgent need of transplantation. Where a death occurs under a number of specific circumstances, donation can only proceed where a coroner consents to donation. In deaths that are reportable under the Coroners Act, concerns about compromising autopsy evidence can be barriers to gaining coronial consent for retrieval. Objectives: This study aimed to identify the impact of organ donation, where it did occur, on coronial processes and on trial proceedings where a criminal trial ensued. Where donation was restricted by the coroner or forensic pathologist we sought to determine whether it would have affected forensic determinations. Design: We retrospectively examined 177 records of reportable deaths referred for organ donation over a four year period in Queensland Australia. We also reviewed records of any criminal proceedings which were commenced in relation to these deaths. Results: There were 10 cases in which the forensic pathologist recommended restrictions to organ donation with the loss of a number of organs to transplantation. There was no case where organ donation altered the outcome of criminal proceedings or significantly impacted cause of death findings. Conclusions: Organ donation, where permitted, had limited impact on autopsy evidence and any subsequent court proceedings. Where organ donation was not permitted, autopsy evidence did not significantly alter coronial findings or judicial outcomes

Moulage in high-fidelity simulation-A chest wall burn escharotomy model for visual realism and as an educational tool

Introduction: There is a paucity of literature pertaining to the role and techniques of moulage for creating high-fidelity medical simulations. As part of an Intensive Care Crisis Event Management Course, simulation of an extensive torso burn was desired. The aim of the moulage was to enhance the realism of the scenario but additionally to enable a chest wall escharotomy to be performed

High-stakes assessment of the non-technical skills of critical care trainees using simulation: feasibility, acceptability and reliability

To evaluate the use of high-fidelity simulation for summative high-stakes assessment of intensive care trainees, focusing on non-technical skills (NTS), testing feasibility and acceptability of simulation assessment, and the reliability of two NTS rating scales.Prospective observational study of senior intensive care trainees in a simulated specialist examination.Participants undertook a simulated patient management scenario and were assessed using two rating scales: the Anaesthesia Non-technical Skills (ANTS) scale and the Ottawa Global Rating Scale (GRS). Assessors were trained, currently active, high-stakes examiners. Participants also completed a survey on simulation-based summative assessment.The inter-rater reliability of two rating scales for NTS assessment. We evaluated the feasibility of simulation-based assessment, and used survey results to assess acceptability to participants.Simulation assessment was feasible. Participants considered simulation-based high-stakes assessment to be acceptable and felt their scenario performance was reflective of real-world performance. Participants identified a need for debriefing following scenario-based assessment. Inter-rater reliability was fair for the ANTS and Ottawa GRS scores (intra-class correlation coefficient, 0.39 and 0.42, respectively). There was only fair agreement between raters for an NTS pass or fail (weighted kappa, 0.32) and for a technical skills pass or fail (weighted kappa, 0.36).Summative high-stakes assessment using a single simulated scenario was feasible and acceptable to senior intensive care trainees. The low inter-rater reliability for the ANTS and Ottawa GRS rating scales and for pass or fail discrimination may limit its incorporation into an existing examination format

An assessment of knowledge and education about sepsis among medical students: a multi-university survey

Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection; it affects 55 000 Australians and results in around 8700 deaths annually.1 Studies have shown that junior doctors have reduced awareness of the importance of sepsis as a time-critical illness.2 Whether this deficiency is a consequence of insufficient training on sepsis in medical schools is unknown. This study evaluated the knowledge of sepsis among medical students in two Australian universitie

Conflicts of interest in the context of end of life care for potential organ donors in Australia

End-of-life (EOL) care has become an integral part of intensive care medicine and includes the exploration of possibilities for deceased organ and tissue donation. Donation physicians are specialist doctors with expertise in EOL processes encompassing organ and tissue donation, who contribute significantly to improvements in organ and tissue donation services in many countries around the world. Donation physicians are usually also intensive care physicians, and thus they may be faced with the dual obligation of caring for dying patients and their families in the intensive care unit (ICU), whilst at the same time ensuring organ and tissue donation is considered according to best practice. This dual obligation poses specific ethical challenges that need to be carefully understood by clinicians, institutions and healthcare networks. These obligations are complementary and provide a unique skillset to care for dying patients and their families in the ICU.In this paper we review current controversies around EOL care in the ICU, including the use of palliative analgesia and sedation specifically with regards to withdrawal of cardio respiratory support, the usefulness of the so-called doctrine of double effect to guide ethical decision-making, and the management of potential or perceived conflicts of interest in the context of dual professional roles