Best Practice & Research Clinical Anaesthesiology RSS feed: Current Issue. In practical paperback format, each 200 page topic-based issue of Best Practice & Research Clinical Anaesthesiology will provide a comprehensive review of current clinical practice and thinking within the specialty anaesthesiology. All chapters are commissioned and written by an international team of practicing clinicians with the Guest Editors for each issue drawn from a pool of renowned experts and opinion leaders. Reference is made to: the latest original research Cochrane Reviews audits and confidential enquiries national and international conferences national and international guidelines personal communications All chapters take the form of practical, evidence-based reviews that seek to address key clinical issues of diagnosis, treatment and patient management. Each issue follows a problem-orientated approach that focuses on the key questions to be addressed, clearly defining what is known and not known. Management will be described in practical terms so that it can be applied to the individual patient. Boxed and bulleted Learning Objectives and Practice Points are features within each chapter and will highlight the core and essential knowledge that will help the physician to provide the best care to their patients. The series' objective is to provide a continuous update for the busy clinician and researcher. 2011 topics, Volume 25, Issues 1-4 Vol. 25:1 March - Obesity in anaesthesia and intensive care B. Bein & J. Scholz Vol. 25:2 June - Safety in anaesthesia S. Staender et. al. Vol. 25:3 September - Perioperative morbidity and mortality in the elderly D. Story Vol. 25:4 December - New approaches in clinical research G E. Nemergut 2012 topics, Volume 26, Issues 1-4 Vol. 26:1 March - Challenges in Anesthesia Education K. Sullivan & A.W. Gelb Vol. 26:2 June - Mechanical Circulatory Support K. Subramaniam Vol. 26:3 September - Delirium in the hospital setting P. Pelosi & C. Gregoretti Vol. 26:4 December - Perioperative intravascular volume replacement and blood transfusion in adults M. Gama & P. Pelosi http://www.clinicalanaesthesiology.com/?rss=yesElsevier Inc.en © 2011 Published by Elsevier Inc. All rights reserved. Best Practice & Research Clinical Anaesthesiology1521-6896254December 2011 © 2011 Published by Elsevier Inc. All rights reserved. healthpermissions@elsevier.comhttp://www.clinicalanaesthesiology.com/article/PIIS1521689611000899/abstract?rss=yesEditorial Board10.1016/S1521-6896(11)00089-9Best Practice & Research Clinical Anaesthesiology 25, 4 (2011)2011-12-01Best Practice & Research Clinical Anaesthesiology2011-12-01254S1521-6896(11)X0005-8iiiiiihttp://www.clinicalanaesthesiology.com/article/PIIS1521689611000838/abstract?rss=yes“Study the past if you would define the future”Confucius (551 BC– 479 BC) The prospective, randomized trial serves as the “gold standard” for the generation of medical evidence that guides patient care. The modern clinical trial has become so fundamental to the practice of medicine it is impossible to imagine the adoption of a new drug, therapy, or technique without supportive data. We could go on to argue that, more than any other advance, the clinical trial and modern clinical research is the single greatest medical advance of the past 100 years.The future of clinical researchEdward C. Nemergut10.1016/j.bpa.2011.10.001Best Practice & Research Clinical Anaesthesiology 25, 4 (2011)2011-12-01Best Practice & Research Clinical Anaesthesiology2011-12-01254S1521-6896(11)X0005-8viiviiihttp://www.clinicalanaesthesiology.com/article/PIIS1521689611000607/abstract?rss=yesMedical simulation has grown explosively over the last decade. Simulation is becoming commonplace in clinical education but can also be used as an investigative clinical tool in its own right. There are thus two arms of simulation in clinical research. The first is investigation of the clinical impact of simulation as an educational tool and the second as an instrument to assess the function of clinical practitioners and systems.This article reviews the terminology, current practice and current research in simulation. The use of simulation in assessment of the clinical performance of devices, people and systems will then be discussed and some current work in these areas presented. Finally, medical simulation will be discussed within the paradigm of translational research. Early examples of this ‘tool-bench to bedside’ model will be presented as possible prototypes for future work directed towards patient safety.High fidelity simulation as a research toolKeith E. Littlewood10.1016/j.bpa.2011.08.001Best Practice & Research Clinical Anaesthesiology 25, 4 (2011)2011-12-01Best Practice & Research Clinical Anaesthesiology2011-12-01254S1521-6896(11)X0005-8473487http://www.clinicalanaesthesiology.com/article/PIIS1521689611000814/abstract?rss=yesWhile the delivery of anaesthesia care is largely a safe process and adverse events are infrequent, they can have devastating consequences for patients and providers when they occur. Given concerns about the role of anaesthesia care in shaping long-term outcomes traditionally considered outside the scope of anaesthesiology, new avenues for perioperative research are being explored at a rapid rate by anaesthesia researchers. We propose that new research methodologies such as perioperative effectiveness research could shed useful insight into processes leading to improved clinical care if applied appropriately and optimally. In this article, we outline the basic concepts of perioperative outcomes and effectiveness research. We highlight many sources of data, both clinical and non-clinical, and evaluate their utility in perioperative research. We then discuss how to design a successful effectiveness study, focussing particularly on which questions in anaesthesiology would be most amenable to exploration with this method, thereby providing a guide for future research endeavours.Perioperative effectiveness research using large databasesRobert E. Freundlich, Sachin Kheterpal10.1016/j.bpa.2011.08.008Best Practice & Research Clinical Anaesthesiology 25, 4 (2011)2011-12-01Best Practice & Research Clinical Anaesthesiology2011-12-01254S1521-6896(11)X0005-8489498http://www.clinicalanaesthesiology.com/article/PIIS1521689611000656/abstract?rss=yesIn silico modelling, in which computer models are developed to model a pharmacologic or physiologic process, is a logical extension of controlled in vitro experimentation. It is the natural result of the explosive increase in computing power available to the research scientist at continually decreasing cost.In silico modelling combines the advantages of both in vivo and in vitro experimentation, without subjecting itself to the ethical considerations and lack of control associated with in vivo experiments. Unlike in vitro experiments, which exist in isolation, in silico models allow the researcher to include a virtually unlimited array of parameters, which render the results more applicable to the organism as a whole.In silico modelling is best known for its extensive use in pharmacokinetic experimentation, the best-known example of which is the development of the three-compartment model. In addition, complex in silico models have been applied to pathophysiological problems to provide information which cannot be obtained practically or ethically by traditional clinical research methods. These experiments have led to the development of significant insights in subject matters ranging from pure physiology to congenital heart surgery, obstetric anaesthesia airway management, mechanical ventilation and cardiopulmonary bypass/ventricular support devices.The utility of these models is based on both the validity of the model framework as well as the corresponding assumptions. In vivo experimentation has validated some, but not all of the in silico strategies employed. We present a review illustrating by example how in silico modelling has been applied to a number of cardio-respiratory problems in states of health and disease, the purpose of which is to give the reader a sense of the complexity and assumptions which underlie this diverse and underappreciated research strategy, as well as an introduction to a research strategy that will likely continue to grow in importance.In silico modelling of physiologic systemsRichard B. Colquitt, Douglas A. Colquhoun, Robert H. Thiele10.1016/j.bpa.2011.08.006Best Practice & Research Clinical Anaesthesiology 25, 4 (2011)2011-12-01Best Practice & Research Clinical Anaesthesiology2011-12-01254S1521-6896(11)X0005-8499510http://www.clinicalanaesthesiology.com/article/PIIS1521689611000668/abstract?rss=yesFor more than 30 years in the United States, we have been lamenting the fate of the clinician-scientist in anaesthesiology. In the past 5 years, attention to the issues has escalated and a number of new training pathways have emerged. This chapter summarizes programs which have innovative curricula, analyzes current research needs and discusses the limited studies in regards to best practices for research training in graduate medical education. It also proposes further development of residency research curricula through the application of basic educational concepts and explores funding issues and resources that remain relevant to all faculty and departments training the residents. We hope the ideas proposed here will promote the academic caliber of our profession; however, much more data and outcomes research needs to be done to determine our best practices for the future.Improving outcomes in anaesthesiology education on researchPamela C. Nagle10.1016/j.bpa.2011.08.007Best Practice & Research Clinical Anaesthesiology 25, 4 (2011)2011-12-01Best Practice & Research Clinical Anaesthesiology2011-12-01254S1521-6896(11)X0005-8511522http://www.clinicalanaesthesiology.com/article/PIIS1521689611000644/abstract?rss=yesMeta-analysis uses numerical tools to pool data and to estimate a summary effect size for the comparison of two interventions from a set of randomised controlled trials identified in a systematic review. An effect size is a single number that expresses the difference in outcome from the interventions. The most commonly used effect sizes for dichotomous outcomes, for example, mortality, are the odds ratio and the relative risk. The results of a meta-analysis are usually presented in a complex figure, known as a forest plot, which shows both the individual studies and the summary statistics. Sensitivity analyses are performed to clarify the effect of the experimental design bias on the effect size. Clinical and statistical heterogeneity of the included studies are explored by the additional tools of fixed effect versus random effects models and subgroup analyses.Research methods for meta-analysesNathan Leon Pace10.1016/j.bpa.2011.08.005Best Practice & Research Clinical Anaesthesiology 25, 4 (2011)2011-12-01Best Practice & Research Clinical Anaesthesiology2011-12-01254S1521-6896(11)X0005-8523533http://www.clinicalanaesthesiology.com/article/PIIS1521689611000632/abstract?rss=yesThe goal of comparative effectiveness research (CER) is to improve effectiveness, efficacy and efficiency in health care. While CER seems to present a major opportunity to introduce accountability into health care by identifying and promoting best practices in medicine, many issues surrounding CER remain poorly understood by clinicians and researchers, including what study designs are most appropriate for such research and what analytic tools are most helpful. The goal of this review is therefore to provide background and definitions of what constitutes CER and to discuss the various study designs and their strengths and weaknesses in achieving the stated goals of CER, while relating them to examples relevant to perioperative research. We provide a brief outline of the types of analytic methods particularly useful for CER and connect the reader to references for their practice. Finally, we assess the role of CER in perioperative research and provide some thoughts on future paths.Perioperative comparative effectiveness researchStavros G. Memtsoudis, Melanie C. Besculides10.1016/j.bpa.2011.08.004Best Practice & Research Clinical Anaesthesiology 25, 4 (2011)2011-12-01Best Practice & Research Clinical Anaesthesiology2011-12-01254S1521-6896(11)X0005-8535547http://www.clinicalanaesthesiology.com/article/PIIS1521689611000826/abstract?rss=yesSince the completion of the Human Genome Project 10 years ago, the world has witnessed an incredible progress in human genetics and genomics. This progress was largely driven by the availability of better, faster and cheaper sequencing technology. While it took more than 10 years and more than 1 billion dollars to complete the Human Genome Project, an individual in the year 2011 can have his whole genome sequenced within a week for less than $30 000. With cheaper and faster sequencing came a wealth of novel discoveries which makes it timely to review how these newly found insights into the human genome are relevant for perioperative medicine. This article summarises the basics of genetic inheritance, the human genome and modern sequencing methods, as well as genetic variation and how this knowledge may be applied to patient care and research in the perioperative setting.Perioperative genomicsPeter Nagele10.1016/j.bpa.2011.09.001Best Practice & Research Clinical Anaesthesiology 25, 4 (2011)2011-12-01Best Practice & Research Clinical Anaesthesiology2011-12-01254S1521-6896(11)X0005-8549555http://www.clinicalanaesthesiology.com/article/PIIS1521689611000619/abstract?rss=yesFar too many patients suffer preventable harm from medical errors that add to needless suffering and cost of care. Underdeveloped residency training programmes in patient safety are a major contributor to preventable harm. Consequently, the Institute of Medicine has called for health professionals to reform their educational programmes to advance health-care safety and quality. Additionally, the Accreditation Council for Graduate Medical Education (ACGME) now requires education in ‘systems-based practice’ and ‘practice-based learning and improvement’ as core competencies of residency training programmes. The specific aim of this article is to describe the implementation of a novel programme designed to enhance residency education, meet ACGME core competencies and improve quality and safety education in one residency programme at an academic medical institution.A novel approach to implementation of quality and safety programmes in anaesthesiologyDeborah A. Schwengel, Bradford D. Winters, Lauren C. Berkow, Lynette Mark, Eugenie S. Heitmiller, Sean M. Berenholtz10.1016/j.bpa.2011.08.002Best Practice & Research Clinical Anaesthesiology 25, 4 (2011)2011-12-01Best Practice & Research Clinical Anaesthesiology2011-12-01254S1521-6896(11)X0005-8557567http://www.clinicalanaesthesiology.com/article/PIIS1521689611000620/abstract?rss=yesThe history of ethics in clinical research parallels the history of abuse of human beings. The Nuremberg Code, Declaration of Helsinki, and the Belmont Report laid the foundations for modern research ethics. In the United States, the OHRP and the FDA provide guidelines for the ethical conduct of research. Investigators should be familiar with regulations concerning informed consent, doing research in vulnerable populations, and protection of privacy.Best practice & research in anaesthesiology issue on new approaches in clinical research ethics in clinical researchKaren J. Schwenzer10.1016/j.bpa.2011.08.003Best Practice & Research Clinical Anaesthesiology 25, 4 (2011)2011-12-01Best Practice & Research Clinical Anaesthesiology2011-12-01254S1521-6896(11)X0005-8569582http://www.clinicalanaesthesiology.com/article/PIIS1521689611000930/abstract?rss=yesKeyword index10.1016/S1521-6896(11)00093-0Best Practice & Research Clinical Anaesthesiology 25, 4 (2011)2011-12-01Best Practice & Research Clinical Anaesthesiology2011-12-01254S1521-6896(11)X0005-8I1I1