The effect of simulation-based training varies substantially between studies. Our meta-analysis showed a significant effect of simulation training compared to other learning strategies, but the quality of evidence was low indicating uncertainty. Other comparisons showed inconsistency in results. Based on our findings simulation training appears to be an effective strategy to improve nurses' skills, but further good-quality RCTs with adequate sample sizes are needed.

Introduction: Up to 30 % of patients undergoing bariatric surgery are dissatisfied with treatment outcomes in the long-term. The aim of this study was to examine overall satisfaction with treatment five years after bariatric surgery and its association with body mass index (BMI) and health-related quality of life (HRQOL). Methods: Patients were surveyed five years after bariatric surgery; 108 patients had Duodenal Switch (DS) and 153 patients had Laparoscopic Sleeve Gastrectomy (LSG). The main outcome was overall treatment satisfaction, assessed by a single question and analyzed by multiple logistic regression. Estimates for continuous independent variables represent the odds ratios (OR) for a 2-standard deviation difference. Results: Five years after surgery, 82.4 % of the patients were very satisfied or satisfied, whereas 17.6 % were unsure or dissatisfied. The following variables assessed at five years were associated with being dissatisfied/unsure: a higher BMI (OR = 6.1, 95% CI = 2.7-14.0, p < 0.001), reduced obesity-specific HRQOL (OR = 3.0, 95% CI = 1.1-7.8, p = 0.03), and reduced mental HRQOL (OR = 0.3, 95% CI = 0.1-0.8, p = 0.02). We also found that a higher proportion of patients who underwent LSG, compared to DS, reported being dissatisfied/unsure (OR = 3.3, 95% CI = 1.3-8.8, p = 0.01). Conclusion: Reduced mental HRQOL and obesity-related HRQOL, as well as higher BMI, were associated with less satisfaction with overall treatment outcomes five years after bariatric surgery. Differences in overall treatment satisfaction by type of operation warrant further investigation.

Patient-reported outcome monitoring with clinical feedback systems (PRO/CFS) has been employed in many disease states to measure and improve health-related quality of life (HRQOL). Exploring the role of PRO/CFS in treatment for obesity may prove valuable. Systematic reviews were summarized to determine the effectiveness of PRO/CFS on HRQOL in any disease area. Primary studies evaluating the effect of PRO/CFS on HRQOL in treatment for obesity were also considered for inclusion. Systematic searches were performed in The Cochrane Library, PROSPERO, Epistemonikos, HTA, DARE, CINAHL, Medline, Embase, PsycINFO, BMJ Clinical Evidence, PDQ-Evidence and PubPsych. Two reviewers independently screened references until final inclusion and critically appraised included reviews using PRISMA checklist. Five systematic reviews and no primary studies met inclusion criteria. Although results were inconsistent, effectiveness of PRO/CFS on HRQOL was demonstrated in some diseases/treatments (e.g. psychiatric treatment; symptom burden in cancer treatment). No trials using PRO/CFS in treatment for obesity were identified. In some trials, PRO/CFS was not fully integrated into consultations, thereby PRO/CFS was not extensively studied. General effectiveness of PRO/CFS on HRQOL is inconclusive due to heterogeneous and statistically insignificant findings, and lack of stringency in conceptualization and execution of PRO/CFS. There are no data relevant to treatment for obesity. Future studies should use rigorous methodology to examine the effectiveness of PRO/CFS in treatment for obesity.

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BackgroundConsultations before and after bariatric surgery should include structured assessments of patients’ health-related quality of life (HRQOL) and mental health. One way to conduct this assessment is to implement patient-reported outcome monitoring with a clinical feedback system (PRO/CFS).AimWe will explore patients’ and healthcare professionals’ experiences when a PRO/CFS is an integrated part of bariatric surgery care.Methods and analysesThis is a design paper in which a PRO/CFS will be implemented in two bariatric outpatient clinics. All patients who have an appointment with a healthcare professional prior to, and 3 and 12 months after surgery, will be asked to complete six digital questionnaires measuring HRQOL, mental health, bowel symptoms and eating self-efficacy prior to each consultation. A digital summary report generated from the patient’s responses will form the basis for the clinical consultation. A team of patient representatives, healthcare professionals and researchers will be involved in all phases of designing the PRO/CFS to ensure its relevance for clinical consultations. The patients’ experiences will be explored with a generic 12-item questionnaire, developed for use in outpatient clinics, prior to and 12 months after bariatric surgery. We will conduct focus-group interviews with patients and healthcare professionals to explore their experiences when PRO/CFS is integrated into the consultations.Ethics and disseminationWritten informed consent will be obtained for all participants in the study. The project is approved by the Norwegian Centre for Research Data, Department of Data Protection Services (ref. no. 282738). The project has also undergone Data Protection Impact Assessments, both at Førde Hospital Trust and at St. Olav Hospital (registration no. 2016/3912). Data from the qualitative and quantitative studies will be kept in de-identified form in a secured research database, and the findings will be published in international peer-reviewed journals and presented at scientific conferences.

SAMANDRAG Vår erfaring med digitalisering av høgare utdanning er at det handlar om å hjelpe studentane å laere, gi dei betre oppfølging og legge til rette for denne laeringa på ein best mogeleg måte. På vår campus har vi erfaring med visuelle presentasjonar, simuleringar, omvendt undervising, ulike former for einvegsstrømming og strømming som tovegskommunikasjon med videobru med og utan laerar. I denne artikkelen presenterer vi synspunkt både frå laerarane og studentane si side om desse ulike teknologiske løysingane.

Background: Caesarean section under general anaesthesia is the surgical intervention with the highest incidence of accidental awareness. This state can result in traumatic complications such as anxiety, nightmares, sleep problems and posttraumatic stress disorder.Objective: The aim of this systematic review was to synthesise measurements of sleep depth throughout the whole course of anaesthesia from randomised controlled trials where we compared induction of anaesthesia with propofol and thiopental in elective caesarean section. Method:The study is a systematic review with meta-analysis. Systematic searches were carried out in the following databases: the Cochrane Database of Systematic Reviews CDSR , Embase OVID , Cinahl EBSCO , PubMed, Google Scholar and Epistemonikos. The objective was to obtain bispectral index BIS values at the following measurement points: induction, intubation, skin incision, uterine incision, delivery, uterine suture and skin suture.Result: a total of four randomised controlled trials were included in this systematic review. The meta-analysis shows significantly lower BIS values in favour of the propofol group (mean difference 9.27; 95 per cent confidence interval 11.32; 7.2 . For patients who had induction of anaesthesia with propofol, the mean BIS value was below 60 and the participants had a low risk of awareness compared with the thiopental group across all studies. The sub-groups of 'induction' , 'intubation' , 'skin incision' , 'uterine incision' , 'delivery' and 'uterine suture' show significant results in favour of lower BIS in induction with propofol compared with thiopental. The calculation of heterogeneity in the meta-analysis shows a high degree of statistical heterogeneity between the studies, with a p-value of < 0.00001 and I² at 78 per cent. Conclusion:This study shows that patients who had induction of anaesthesia with propofol in elective caesareans have a lower risk of experiencing accidental awareness during general anaesthesia. Furthermore, it illustrates the necessity of nurse anaesthetists measuring sleep depth and being conscious of risk factors in the pregnant woman which may involve increased risk of awareness.

Obstetric anaesthesia is a high-risk area for accidental awareness during general anaesthesia (AAGA) • Risk factors include: emergency surgery; inexperienced anaesthetists; the "intravenous-inhalational interval"; difficult or failed intubation • Strategies to reduce the incidence of awareness include: appropriate dose of anaesthetic induction agent; use of nitrous oxide for maintenance of anaesthesia; and use of depth of anaesthesia (DOA) monitors • Patients who experience AAGA are at risk of long-term sequelae including post-traumatic stress disorder (PTSD) and should be offered appropriate counselling