Making the move: from traditional neonatal education to simulation-based training

Resuscitating neonates is a critical skill set for obstetric and neonatal care providers. The principles, knowledge, and skills of neonatal resuscitation as developed by the Neonatal Resuscitation Program are taught in a variety of ways to enhance learning including didactic, CD-ROM, hands-on-task training, and mock codes. Despite this variety of educational methods, studies have called into question the ability of the care provider to adequately perform neonatal resuscitation. Simulation-based training is gaining more recognition in healthcare as a method of training that incorporates adult learning theory, real-time clinical situations, and video debriefing of the scenario to allow a healthcare team an opportunity to practice skills and evaluate their performance. The Neonatal Resuscitation Program is including simulation-based training as an educational methodology to promote skill acquisition and performance enhancement in its providers.     

Postconditioning: from the bench to bedside

Infarct size is determined not only by the severity of ischemia but also by pathological processes initiated at reperfusion. Accumulating experimental evidence indicates that lethal reperfusion injury might account for up to half of the final size of the myocardial infarct. Ischemic postconditioning (brief repeated periods of ischemia-reperfusion applied at the onset of coronary reflow) has been recently described as a powerful cardioprotection mechanism that prevents lethal reperfusion injury. This is the first method proven to reduce the final infarct size by about 50% in several in vivo models and to be confirmed in recent preliminary human studies. The molecular pathways are incompletely mapped but they probably converge to a mitochondrial key target: the mitochondrial permeability transition pore (PTP) which opening during early reperfusion is an event that promotes myocardial cell death. In different animal models and experimental settings, pharmacological PTP inhibition at the onset of reperfusion reproduces all the cardioprotective effects of ischemic postconditioning. In a recent proof-of-concept trial, the administration (just before percutaneous coronary intervention) of cyclosporine A, a potent PTP inhibitor, was associated with smaller infarct size. This review will focus on the physiological preclinical data on both ischemic and pharmacological postconditioning that are relevant to their translation to clinical therapeutics.     

New anticoagulants: from bench to bedside

Heparins and vitamin K antagonists have been the cornerstones of anticoagulation therapy for several decades. Although they are very effective at inhibiting the coagulation process, they have several practical limitations. This was a challenge for the development of therapies that will overcome these drawbacks while matching the efficacy of the two classes of anticoagulants. Advances were achieved in the development of safer, convenient, more specific treatments, which should provide predictable anticoagulant responses and substantially improve the prevention and management of thromboembolic disorders. In the search for new agents matching the ideal anticoagulant profile, different steps in the coagulation cascade have been targeted, including direct thrombin inhibition, and inhibition of factor Xa, factor IXa, the factor Vlla-tissue factor complex and the factor Va-factor Vllla complex. The most advanced clinical development has been achieved with direct factor Xa- and factor IIa-inhibitors which may replace conventional anticoagulants for long-term prevention and treatment of venous and arterial thromboembolic complications.     

Ventricular interaction: from bench to bedside

Decreased right ventricle (RV) output results in decreased left ventricle end-diastolic volume (LVEDV) and output by series interaction. Direct ventricular interaction may also have a major effect on LV function. Thus, decreased LVEDV caused by reduced RV output may be further reduced by a leftward septal shift and pericardial constraint. This has been shown to be true in acute and chronic pulmonary hypertension and is now also apparent in severe congestive heart failure. The use of intracavitary LV end-diastolic pressure (LVEDP) to assess LVEDV is inappropriate if pressure surrounding the LV is increased: the surrounding pressure should be subtracted from LVEDP to calculate the effective distending (transmural) pressure which governs preload. If the surrounding pressure increases more than LVEDP, transmural LVEDP and LVEDV will decrease despite the increased LVEDP. Thus, the use of filling pressure to reflect changes in LVEDV has led to erroneous conclusions regarding changes in myocardial compliance and contractility. It is now clear that volume loading may reduce LVEDV and stroke work in pulmonary embolism, chronic lung disease and severe congestive heart failure despite increased LVEDP. The decreased stroke work is a result of reduced LV preload, not decreased contractility as would be suggested if filling pressure is used to reflect preload.     

Understanding intra-abdominal hypertension: from the bench to the bedside

Intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) are highly morbid conditions that are common and underrecognized in the intensive care unit. Intra-abdominal hypertension affects the critically ill patient population and is not solely limited to the trauma and surgical subgroups. The recognition of IAH and ACS as distinct clinical states has become more apparent. Extensive bench and clinical research has shed significant light into the definition, incidence, etiology, physiology, clinical manifestations, and treatment strategies. Although further research into this morbid condition is needed, improvement in recognition is a critical first step. This review aims to scrutinize the basic science and clinical literature available on this condition in a surgically focused, organ-system-based approach.     

Nursing leadership from bedside to boardroom: commentary

In this commentary, the author reflects on the results of the Robert Wood Johnson Foundation-funded survey, Opinion Leaders' Views on Nursing Leadership From Bedside to Boardroom: A National Survey Conducted by Gallup, and the article in this issue by Khourey et al, "Nursing Leadership From Bedside to Boardroom: A Gallup National Survey of Opinion Leaders."     

心肌造影超声心动图:从基础走向临床

篇基础和临床研究 ,这些论文反映了我国ＭＣＥ研究的最新进展 ,体现了ＭＣＥ从基础走向临床的国际发展趋势。ＭＣＥ已走过了 2 0年的发展历程。 1980年 ,ＤｅＭａｒｉａ等人首先在实验动物中揭示了心肌超声显像的可能性。早期手振或声振制造的造影剂微泡较大(>10 μｍ)且不稳定 ,不能通过肺循环 ,故只能由左心或冠脉内注射。 80年代末期穿肺造影剂Ａｌｂｕｎｅｘ的问世 ,使经静脉左心造影成为可能。 90年代以来第二代超声造影剂和一系列显像新技术的产生 ,大大加快了ＭＣＥ走向临床实践的步伐。近年来 ,国际文献中经静脉ＭＣＥ的临床研究已…     

Embryonic stem cells: from bench to bedside

As early as their derivation, embryonic stem (ES) cells have attracted a great attention to clinicians. Derived from early embryos, these cells remain pluripotent in culture while they can be expanded in principle without limit. They give rise to most progenies and differentiate to all major somatic lineages of potential use in regenerative medicine. The great therapeutic promises put forward almost 10 years ago to cure or relieve degenerative diseases are still up to date. However, cell therapy is a complex process that significantly differs from drug-based medicine. Although a clinical trial has been announced by GERON for next year to cure spinal cord injury, many issues remain to be addressed at the bench before these cells can be used in clinics.     

New biochemical markers: from bench to bedside

BACKGROUND: Evaluation of patients presenting to hospital with chest pain or other signs or symptoms suggesting acute coronary syndrome (ACS) is problematic, time-consuming and sometimes expensive, even if new biochemical markers, such as troponins, have improved the ability to detect cardiac injury. However, patients with normal troponin values are not necessarily risk-free for major cardiac events. METHODS: Recent investigations indicate that the overall patient risk may be assessed earlier than before, thanks to new knowledge acquired concerning the pathobiology of atherosclerosis and molecular events involved in the progression of disease, thus allowing the development of new biochemical markers. Some selected markers are released during the different phases of development of cardiovascular disease and may be useful for the diagnosis of patients with cardiovascular disease. In particular, the identification of emerging markers that provide relevant information on the inflammatory process, and the development of biomarkers whose circulating concentrations suggest the status of plaque instability and rupture, seems to be of particular value in prognosis and risk stratification. The overall expectations for a cardiovascular biochemical marker are not only its biological plausibility but also the availability at a reasonable cost of rapid, high quality assays, and their correct interpretation by clinicians using optimal cut-offs. CONCLUSION: The crossing from bench to bedside for each new marker discovered, must be associated with concurrent advances in the characterization of analytical features and the development of routine assay, in the assessment of analytical performance and in interpretative reporting of test results as well as in the training of physicians to use the array of biomarkers available appropriately and to interpret them correctly. This approach calls for the coordinated support of clinicians, technology experts, statisticians and the industry so that new biochemical developments can be of optimal value.     

Preventing deaths from cryptococcal meningitis: from bench to bedside

Cryptococcal meningitis (CM), a fungal disease caused by Cryptococcus spp., is the most common form of meningitis and a leading cause of death among persons with HIV/AIDS in sub-Saharan Africa. Detection of cryptococcal antigen, which is present several weeks before overt signs of meningitis develop, provides an opportunity to detect infection early. Screening persons with HIV for cryptococcal infection when they access healthcare can identify asymptomatic infected patients allowing for prompt treatment and prevention of death. A newly developed point-of-care assay for cryptococcal antigen, as well as growing evidence supporting the utility and cost-effectiveness of screening, are further reasons to consider broad implementation of cryptococcal screening in countries with a high burden of cryptococcal disease.     

Cytokines in multiple sclerosis: from bench to bedside

Cytokines play an important role in the pathogenesis of inflammatory diseases including multiple sclerosis (MS). Experimental models have played a critical role in unraveling the roles of individual cytokines in this disease; however, these studies occasionally yield conflicting results, highlighting the complex role cytokines play in the disease process. Efforts to modulate cytokine function in MS have shown that effective treatments alter cytokine expression in the central nervous system (CNS) and in activated mononuclear cells, indicating that they are important therapeutic targets. In this review, we will summarize the current knowledge on the role of cytokine pathways in MS and what we learned from investigation of its animal model: experimental autoimmune encephalomyelitis (EAE).