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Background: Early detection and response to patient deterioration influence patient prognosis. Nursing education is therefore essential. The objective of this randomized controlled trial was to compare the respective educational value of simulation by gaming (SG) and a traditional teaching (TT) method to improve clinical reasoning (CR) skills necessary to detect patient deterioration.Methods: In a prospective multicenter study, and after consent, 2nd year nursing students were randomized into two groups:-Simulation by gaming "SG": the student played individually with a serious game consisting of 2 cases followed by a common debriefing with an instructor; -Traditional Teaching "TT": the student worked on the same cases in text paper format followed by a traditional teaching course with a PowerPoint presentation by an instructor.CR skill was measured by script concordance tests (80 SCTs, score 0-100) immediately after the session (primary outcome) and on month later. Other outcomes included students' satisfaction, motivation and professional impact.Results: One hundred forty-six students were randomized. Immediately after training, the SCTs scores were 59 ± 9 in SG group (n = 73) and 58 ± 8 in TT group (n = 73) (p = 0.43). One month later, the SCTs scores were 59 ± 10 in SG group (n = 65) and 58 ± 8 in TT group (n = 54) (p = 0.77). Global satisfaction and motivation were highly valued in both groups although significantly greater in the SG group (p < 0.05). The students declared that the training course would have a positive professional impact, with no difference between groups. Conclusions:In this study assessing nursing student CR to detect patient deterioration, no significant educational difference (SCT), neither immediate nor 1 month later, was observed between training by SG and the TT course. However, satisfaction and motivation were found to be greater with the use of SG. Trial registration: ClinicalTrials.gov; NCT03428269. Registered 30 january 2018.

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Background: Head-to-head comparisons of combinations of more than one non-opioid analgesic (NOA) with morphine alone, for postoperative analgesia, are lacking. The objective of this multicentre, randomised, double-blind controlled trial was to compare the morphine-sparing effects of different combinations of three NOAsdparacetamol (P), nefopam (N), and ketoprofen (K)dfor postoperative analgesia.

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After traumatic brain injury (TBI), lesions are anatomically heterogeneous, but the spatial heterogeneity of the post-traumatic brain's vulnerability to hypoxia-hypotension (HH) has been poorly studied. Our objective was to compare the effect of HH after TBI on brain energy metabolism into two regions: the frontal lobe and the thalamus. Twenty-eight Sprague-Dawley rats were randomized into four groups: sham, TBI (brain trauma alone, impact acceleration, 450-g weight drop from 1.8 m), HH (blood depletion to mean arterial pressure 40 mm Hg, FiO(2) 10%, 15 min), and TBI-HH (TBI followed by HH, 45-min delay). Cerebral perfusion pressure (CPP) was continuously measured. Brain microdialysis and brain tissue oxygen partial pressure (PtiO(2)) probes were both inserted stereotaxically into the right thalamus and frontal lobe. Except during the HH period, CPP was always above 60 mm Hg. During the hour following the HH period, significant increases in cerebral lactate-pyruvate ratio, glycerol, and glutamate were observed, and were always higher in the frontal lobe than in the thalamus (p<0.001). In the TBI-HH group and in the frontal lobe, increases in glutamate and glycerol were significantly higher than in the HH group (p<0.001). During the 30 min following the HH phase (reperfusion), an increase in PtiO(2) was observed. In the TBI-HH group, this increase was significantly lower in the frontal lobe than in the thalamus. These findings demonstrate that in the early post-traumatic period, the metabolic cerebral response to HH is higher in the frontal lobe than in the thalamus, and is worsened by TBI, suggesting a higher vulnerability for the frontal lobes.