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https://www.readbyqxmd.com/read/29346222/-to-err-is-human-but-disclosure-must-be-taught-a-simulation-based-assessment-study
#1
Ashley C Crimmins, Ambrose H Wong, James W Bonz, Alina Tsyrulnik, Karen Jubanyik, James D Dziura, Kelly L Dodge, Leigh V Evans
INTRODUCTION: Although error disclosure is critical in promoting safety and patient-centered care, physicians are inconsistently trained in its practice, and few objective methods to assess competence exist. We used an immersive simulation scenario to determine whether providers with varying levels of clinical experience adhere to the disclosure safe practice guidelines when exposed to a serious adverse event simulation scenario. METHODS: This was a prospective cohort study with medical students, junior emergency medicine (EM) residents (PGY 1-2), senior EM residents (PGY 3-4), and attending EM physicians participating in a simulated case in which a scripted medication overdose resulted in an adverse event...
January 17, 2018: Simulation in Healthcare: Journal of the Society for Simulation in Healthcare
https://www.readbyqxmd.com/read/29346142/neonatal-abstinence-syndrome-an-update
#2
Lauren A Sanlorenzo, Ann R Stark, Stephen W Patrick
PURPOSE OF REVIEW: The current review provides an update focused on the evolving epidemiology of neonatal abstinence syndrome (NAS), factors influencing disease expression, advances in clinical assessment of withdrawal, novel approaches to NAS treatment, and the emerging role of quality improvement in assessment and management of NAS. RECENT FINDINGS: The rise in the incidence of NAS disproportionately occurred in rural and suburban areas. Polysubstance exposure and genetic polymorphisms have been shown to modify NAS expression and severity...
January 17, 2018: Current Opinion in Pediatrics
https://www.readbyqxmd.com/read/29345964/immune-response-to-dengue-and-zika
#3
Annie Elong Ngono, Sujan Shresta
Flaviviruses such as dengue (DENV), yellow fever (YFV), West Nile (WNV), and Zika (ZIKV) are human pathogens of global significance. In particular, DENV causes the most prevalent mosquito-borne viral diseases in humans, and ZIKV emerged from obscurity into the spotlight in 2016 as the etiologic agent of congenital Zika syndrome. Owing to the recent emergence of ZIKV as a global pandemic threat, the roles of the immune system during ZIKV infections are as yet unclear. In contrast, decades of DENV research implicate a dual role for the immune system in protection against and pathogenesis of DENV infection...
January 18, 2018: Annual Review of Immunology
https://www.readbyqxmd.com/read/29345350/activation-of-the-sympathetic-nervous-system-modulates-neutrophil-function
#4
Alyce J Nicholls, Shu Wen Wen, Pam Hall, Michael J Hickey, Connie H Y Wong
Emerging evidence has revealed that noradrenaline (NA), the main neurotransmitter of the sympathetic nervous system (SNS), regulates a variety of immune functions via binding to adrenergic receptors present on immune cells. In this study, we examined the role of NA in the regulation of neutrophil functions. Neutrophils were isolated from the bone marrow of naïve mice and treated with NA at various concentrations to assess the effect on various neutrophil functions. Additionally, we performed cremaster intravital microscopy to examine neutrophil-endothelial cell interactions following NA superfusion in vivo...
December 21, 2017: Journal of Leukocyte Biology
https://www.readbyqxmd.com/read/29345207/thresholds-and-interpretations-how-clinical-competency-committees-identify-pediatric-residents-with-performance-concerns
#5
Daniel J Schumacher, Catherine Michelson, Sue Poynter, Michelle M Barnes, Su-Ting T Li, Natalie Burman, Daniel J Sklansky, Lynn Thoreson, Sharon Calaman, Beth King, Alan Schwartz, Sean Elliott, Tanvi Sharma, Javier Gonzalez Del Rey, Kathleen Bartlett, Shannon E Scott-Vernaglia, Kathleen Gibbs, Jon F McGreevy, Lynn C Garfunkel, Caren Gellin, John G Frohna
BACKGROUND: Clinical competency committee (CCC) identification of residents with performance concerns is critical for early intervention. METHODS: Program directors and 94 CCC members at 14 pediatric residency programs responded to a written survey prompt asking them to describe how they identify residents with performance concerns. Data was analyzed using thematic analysis. RESULTS: Six themes emerged from analysis and were grouped into two domains...
January 2018: Medical Teacher
https://www.readbyqxmd.com/read/29344967/predictive-neuromechanical-simulations-indicate-why-walking-performance-declines-with-aging
#6
Seungmoon Song, Hartmut Geyer
Healthy elderly people walk slower and energetically less efficiently than young adults. This decline in walking performance lowers the quality of life for a growing aging population, and understanding its physiological origin is critical for devising interventions that can delay or revert it. However, the origin of the decline in walking performance remains unknown, as aging produces a range of physiological changes whose individual effects on gait are difficult to separate in experiments with human subjects...
January 17, 2018: Journal of Physiology
https://www.readbyqxmd.com/read/29344536/a-cry-for-help-and-protest-self-immolation-in-young-kurdish-iraqi-women-a-qualitative-study
#7
Pakestan Mohammad Amin, Jila Mirlashari, Alireza Nikbakht Nasrabadi
Background: Suicide is a major psychiatric emergency that has always been a topic of great interest to researchers. Self-immolation is a heinous suicide method that is common in Eastern societies. The present study was conducted to explore probable issues which might lead to self-immolation in young Kurdish Iraqi women. Methods: The present qualitative study was conducted in Soran, Erbil Governorate in Iraq, and the surrounding villages of Soran District (March 2015 to May 2016)...
January 2018: International Journal of Community Based Nursing and Midwifery
https://www.readbyqxmd.com/read/29344358/the-global-problem-of-childhood-diarrhoeal-diseases-emerging-strategies-in-prevention-and-management
#8
REVIEW
Margaret Mokomane, Ishmael Kasvosve, Emilia de Melo, Jeffrey M Pernica, David M Goldfarb
Acute diarrhoeal diseases remain a leading cause of global morbidity and mortality particularly among young children in resource-limited countries. Recent large studies utilizing case-control design, prospective sampling and more sensitive and broad diagnostic techniques have shed light on particular pathogens of importance and highlighted the previously under recognized impact of these infections on post-acute illness mortality and growth. Vaccination, particularly against rotavirus, has emerged as a key effective means of preventing significant morbidity and mortality from childhood diarrhoeal disease...
January 2018: Therapeutic Advances in Infectious Disease
https://www.readbyqxmd.com/read/29344113/downregulated-mirna-1269a-variant-rs73239138-decreases-the-susceptibility-to-gastric-cancer-via-targeting-znf70
#9
Wenshuai Li, Huilu Zhang, Pei Min, Jie Zhu, Diannan Xu, Weiru Jiang, Yanyun Ma, Jigang Qiu, Weihong Xu, Jian Chen, Mingqing Zhang, Min Li, Dongqin Yang, Jianping Shi, Jun Zhang, Jie Liu
Although emerging evidence has indicated that single nucleotide polymorphisms (SNPs) in microRNAs (miRNAs) are associated with susceptibility to gastric cancer, a limited number of studies have revealed the underlying molecular mechanisms. In the present study, the results suggested that miR-1269a rs73239138 has a role in decreasing the risk of gastric cancer. The level of miR-1269a variant expression was significantly downregulated compared with the wild-type miR-1269a in the gastric cells (Fig. 1). Furthermore, overexpression of miR-1269a inhibited apoptosis of gastric cancer cells...
December 2017: Oncology Letters
https://www.readbyqxmd.com/read/29343828/widespread-persistent-changes-to-temperature-extremes-occurred-earlier-than-predicted
#10
Chao Li, Yuanyuan Fang, Ken Caldeira, Xuebin Zhang, Noah S Diffenbaugh, Anna M Michalak
A critical question for climate mitigation and adaptation is to understand when and where the signal of changes to climate extremes have persistently emerged or will emerge from the background noise of climate variability. Here we show observational evidence that such persistent changes to temperature extremes have already occurred over large parts of the Earth. We further show that climate models forced with natural and anthropogenic historical forcings underestimate these changes. In particular, persistent changes have emerged in observations earlier and over a larger spatial extent than predicted by models...
January 17, 2018: Scientific Reports
https://www.readbyqxmd.com/read/29343541/immune-monitoring-of-infectious-complications-in-transplant-patients-an-important-step-towards-improved-clinical-management
#11
Rajiv Khanna
Immune reconstitution following organ transplantation is absolutely critical in preventing infectious complications. However, understanding the kinetics of immune reconstitution and its potential impact on the clinical management of transplant patients remains a significant challenge. Over the last decade, various platform technologies have emerged which have provided important insights into the immune reconstitution kinetics in transplant patients. However, many of these technologies are too complicated and cumbersome to implement in a clinical setting...
January 17, 2018: Journal of Clinical Microbiology
https://www.readbyqxmd.com/read/29341941/cauda-equina-syndrome-due-to-lumbar-disc-herniation-a-review-of-literature
#12
Stylianos Kapetanakis, Constantinos Chaniotakis, Constantinos Kazakos, Jannis V Papathanasiou
Cauda equina syndrome (CES) is a rare neurologic condition that is caused by compression of the cauda equina. Cauda equina consists of spinal nerves L2-L5, S1-S5 and the coccygeal nerve. The compression of these nerve roots can be caused mainly by lumbar disc herniation (45% of all causes). The diagnosis consists of two critical points: a) detailed history and physical examination and b) MRI or CT. The gold standard of the treatment of this syndrome is the surgical approach in combination with the timing of onset of symptoms...
December 20, 2017: Folia Medica
https://www.readbyqxmd.com/read/29341880/targetable-long-non-coding-rnas-in-cancer-treatments
#13
Liang Chen, Emmanuel Enoch Dzakah, Ge Shan
Aberrant expression of many long non-coding RNAs has been observed in various types of cancer, implicating their crucial roles in tumorigenesis and cancer progression. Emerging knowledge with regard to the critical physiological and pathological roles of long non-coding RNAs in cancers makes them potential targets in cancer treatments. In this review, we present a summary of the relatively well studied long non-coding RNAs that are involved in oncogenesis and outline their functions and functional mechanisms...
January 13, 2018: Cancer Letters
https://www.readbyqxmd.com/read/29341698/general-linearized-theory-of-quantum-fluctuations-around-arbitrary-limit-cycles
#14
Carlos Navarrete-Benlloch, Talitha Weiss, Stefan Walter, Germán J de Valcárcel
The theory of Gaussian quantum fluctuations around classical steady states in nonlinear quantum-optical systems (also known as standard linearization) is a cornerstone for the analysis of such systems. Its simplicity, together with its accuracy far from critical points or situations where the nonlinearity reaches the strong coupling regime, has turned it into a widespread technique, being the first method of choice in most works on the subject. However, such a technique finds strong practical and conceptual complications when one tries to apply it to situations in which the classical long-time solution is time dependent, a most prominent example being spontaneous limit-cycle formation...
September 29, 2017: Physical Review Letters
https://www.readbyqxmd.com/read/29341498/review-article-sepsis-in-the-emergency-department-part-2-investigations-and-monitoring
#15
REVIEW
Amith Shetty, Stephen Pj Macdonald, Gerben Keijzers, Julian M Williams, Benjamin Tang, Bas de Groot, Kelly Thompson, John F Fraser, Simon Finfer, Rinaldo Bellomo, Jonathan Iredell
Sepsis is characterised by organ dysfunction resulting from infection, with no reliable single objective test and current diagnosis based on clinical features and results of investigations. In the ED, investigations may be conducted to diagnose infection as the cause of the presenting illness, identify the source, distinguish sepsis from uncomplicated infection (i.e. without organ dysfunction) and/ or risk stratification. Appropriate sample collection for microbiological testing remains key for subsequent confirmation of diagnosis and rationalisation of antimicrobials...
January 16, 2018: Emergency Medicine Australasia: EMA
https://www.readbyqxmd.com/read/29341200/human-agency-in-disaster-planning-a-systems-approach
#16
John Hamer Powell, Michael Hammond, Albert Chen, Navonil Mustafee
Current approaches to risk management place insufficient emphasis on the system knowledge available to the assessor, particularly in respect of the dynamic behavior of the system under threat, the role of human agents (HAs), and the knowledge available to those agents. In this article, we address the second of these issues. We are concerned with a class of systems containing HAs playing a variety of roles as significant system elements-as decisionmakers, cognitive agents, or implementers-that is, human activity systems...
January 16, 2018: Risk Analysis: An Official Publication of the Society for Risk Analysis
https://www.readbyqxmd.com/read/29340856/core-point-of-care-ultrasound-curriculum-what-does-every-anesthesiologist-need-to-know
#17
REVIEW
Massimiliano Meineri, Gregory L Bryson, Ramiro Arellano, Nikolaos Skubas
Point-of-care ultrasound (POCUS) is becoming an integral part of anesthesia practice throughout the world. Despite the growing interest in POCUS among trainees and faculty, POCUS training is variable among universities across Canada. This suggests a need for curriculum development and standardization. International guidelines for Emergency Medicine and Critical Care have common frameworks and may be used as a reference to model anesthesia-specific curricula. The Royal College of Anaesthetists of the United Kingdom currently offers the only nationally approved POCUS curriculum for anesthesia and critical care trainees...
January 16, 2018: Canadian Journal of Anaesthesia, Journal Canadien D'anesthésie
https://www.readbyqxmd.com/read/29340538/autonomic-nervous-system-monitoring-in-intensive-care-as-a-prognostic-tool-systematic-review
#18
Luis Bento, Rui Fonseca-Pinto, Pedro Póvoa
OBJECTIVE: To present a systematic review of the use of autonomic nervous system monitoring as a prognostic tool in intensive care units by assessing heart rate variability. METHODS: Literature review of studies published until July 2016 listed in PubMed/Medline and conducted in intensive care units, on autonomic nervous system monitoring, via analysis of heart rate variability as a prognostic tool (mortality study). The following English terms were entered in the search field: ("autonomic nervous system" OR "heart rate variability") AND ("intensive care" OR "critical care" OR "emergency care" OR "ICU") AND ("prognosis" OR "prognoses" OR "mortality")...
October 2017: Revista Brasileira de Terapia Intensiva
https://www.readbyqxmd.com/read/29340276/clinical-value-of-ultrasonography-in-diagnosis-of-pulmonary-embolism-in-critically-ill-patients
#19
Ran Zhu, Xiao-Chun Ma
Pulmonary embolism (PE) is a clinical emergency that will increase the mortality if complicated with unstable hemodynamics. Because of its nonspecific clinical symptoms, it's a great challenge to make a PE diagnosis. The golden standard to diagnose PE is computed tomography of pulmonary artery (CTPA), but a diagnosis of PE also composed of evaluation of PE risk factors, possibilities, and risk stratification. Ultrasonography may detect right ventricle strain related to hemodynamic change, intravascular thrombosis, thrombosis in right heart or pulmonary arteries, pulmonary infarction, and local pleural effusion...
December 2017: Journal of Translational Internal Medicine
https://www.readbyqxmd.com/read/29340102/the-impact-of-antibiotic-usage-on-the-efficacy-of-chemoimmunotherapy-is-contingent-on-the-source-of-tumor-reactive-t-cells
#20
Michal P Kuczma, Zhi-Chun Ding, Tao Li, Tsadik Habtetsion, Tingting Chen, Zhonglin Hao, Locke Bryan, Nagendra Singh, James N Kochenderfer, Gang Zhou
In recent years the combined use of chemotherapy and immunotherapy, collectively termed chemoimmunotherapy, has emerged as a promising treatment option for patients with cancer. Antibiotics are commonly used to reduce infection-related complications in patients undergoing chemotherapy. Intriguingly, accumulating evidence has implicated gut microbiota as a critical determinant of host antitumor immune responses, raising the question as to whether the use of broad-spectrum antibiotics would invariably diminish tumor response to chemoimmunotherapies...
December 19, 2017: Oncotarget
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