Evaluation of the effect of information integration in displays for ICU nurses on situation awareness and task completion time: A prospective randomized controlled study

ObjectiveThe study measured whether nurses’ situation awareness would increase and task completion time decrease when they used an integrated information display compared to traditional displays for medication management, patient awareness and team communication.SettingThe Burn Trauma Intensive Care Unit (BTICU) at the University Hospital, University of Utah Health Science Center, Salt Lake City, Utah, USA.Participants12 experienced BTICU nurses.MeasuresSituation awareness (accuracy of the participants’ answer) and task completion time (response time from seeing the question to submitting the answer) were measured using paper prototypes of both displays.Study designCounter-balanced (on display order), repeated-measures design.Main resultsNurses had a higher situation awareness when using the integrated display, with an overall accuracy of 85.3% compared to 61.8% with the traditional displays (odds ratio 3.61, P < .001, 95% CI = 2.34…5.57). Task completion times were nearly half with integrated displays compared to traditional displays (median 26.0 and 42.1 s, hazard ratio 2.31, P < .001, CI = 1.83…2.93).ConclusionsAn integrated ICU information display increased nurses’ situation awareness and decreased task completion time. Information integration has the potential to decrease errors, increase nurses’ productivity and may allow nurses to react faster to a patient's clinical needs. Bidirectional device communication is needed for these displays to achieve full potential in improving patient safety.     

Gastrointestinal quality of life in patients with symptomatic or asymptomatic cholelithiasis before and after laparoscopic cholecystectomy

Background: There is an ongoing need, from both the medical and the economic perspective, for a more accurate definition of the influence of symptomatic or asymptomatic gallstone disease on gastrointestinal symptomatology, as well as on the health of the individual in general. Methods: Using the Gastrointestinal Quality of Life Index (GIQLI), 37 symptomatic and 30 asymptomatic gallstone patients were evaluated at admission to the hospital and again 4 months after undergoing an uneventful laparoscopic cholecystectomy (LC). Results: Postoperatively, significant increases in the total GIQLI score were noted in both the symptomatic group (113.42 ± 21.9 vs 80.32 ± 19.1 preoperatively; p < 0.05) and the asymptomatic group (96.37 ± 14.26 vs 113.30 ± 15.22; p < 0.05). For the subgroups of items, the core symptoms and the physical, psychological, and disease-specific items improved significantly in both groups in the postoperative period (p < 0.05 for all comparisons), but only the symptomatic group achieved a significant improvement in the subgroup of social items (p < 0.05). Negative correlations were found in both the symptomatic and asymptomatic groups between the preoperative GIQLI scores and the improvement seen after LC (r = -0.70 and r = -0.49, respectively). Conclusion: Gallstone disease has a profoundly negative impact on quality of life, especially in symptomatic patients with a history of biliary colic attacks and/or the complications of the disease. Although the condition is not equally distressing for the asymptomatic group of patients without such a history, uncomplicated LC improves the quality of life significantly in both groups. Gallstone patients with lower GIQLI scores are more likely to benefit from LC.     

Systematic review and meta-analysis of chordal replacement versus leaflet resection for posterior mitral leaflet prolapse

Objectives

To compare outcomes of chordal replacement versus leaflet resection techniques for repair of isolated posterior mitral leaflet prolapse.

Evaluation of the correlation of automated and manual results of complete blood count in oncologic patients

The aim of this study is to evaluate the performance of Sysmex XS-800i analyzer and compare its correlation with standard manual method in oncologic patients. The complete blood count (CBC) with differential leukocyte count is one of the most frequently requested hematologic tests. In oncologic patients, it is more important because primary diagnosis and treatment follow-up are depending on CBC results. Automated hematology analyzers are designed to perform CBC with acceptable precision and accuracy, but manual slide examination still is needed to complement the analyzer results. One thousand CBC samples of oncologic patients analyzed by Sysmex XS-800i analyzer and the corresponding slides were examined independently by a skilled hematology technician and a pathologist. Their results analyzed for finding the degree of correlation between them. Our instrument showed excellent performance with a correlation coefficient of >0.91 for platelet and leukocyte differential count (except for basophil with r = 0.592). Sensitivity and specificity of identifying abnormal cells was 82.7 and 92 %, respectively. The Sysmex XS-800i hematology analyzer results are as reliable as the standard manual method; however, manual microscopic blood examination should be used to complete the uncompleted results, to validate analyzer flags, and for counting the cells with a flag.     

Effect of human amniotic membrane on anastomosis leakage in dog model

One of the major concerns in rectal cancer surgery and complicated anastomosis is anastomosis breakdown and leakage. For decades, radiation (as neoadjuvant or adjuv ant therapy) was known as a risk factor for anastomosis leakage. Diverting loop ileostomy has been usually employed to divert the fecal flow and protect complicated anastomosis. However, there is a high rate of complications related to diverting loop ileostomy and its closure. This experimental study was carried out to investigate the effect of human amniotic membrane on colonic anastomosis in dogs that underwent preoperative radiation therapy. In this prospective controlled animal trial study, a total of ten male cross-breed dogs aged 6–8 months and weighing 10–15 kg were randomly assigned in to two groups of five dogs. Group 1 with five dogs received 10 Gy of external radiation preoperatively, while the second didn’t receive radiation. After anesthesia and exploration, about 8 cm above the dentate line, the bowel was cut and end-to-end anastomosis was done in two layers hand sewn technique. HAM measuring 2.5 cm × 2.5 cm was wrapped around the anastomosis and sutured with vicryl 3-0. In each group, one of the dogs died. The non-parametric Mann—Whitney test was used to compare the two groups. Two-tailed P value <0.05 was considered statistically significant. Cross sections of the healed anastomosis were scored according to modified scoring system. Histological evaluation of both groups demonstrated ulceration of the mucosa with infiltration of the acute and chronic inflammatory cells as well as granulation tissue formation. The healing starts by fibroblast proliferation and collagen deposition. A thin fibrotic tissue was formed between the serosa and patch graft. (P > 0.05, i.e., healing in both irradiated and non-irradiated groups was the same). Unfavorable effects of radiotherapy and loop ileostomy may be resolved with application of human amniotic membrane, which influences anastomosis healing and eliminates the need for ileostomy insertion.     

Proteasome inhibition induces α-synuclein SUMOylation and aggregate formation

Parkinson's disease (PD) and Dementia with Lewy Bodies (DLB) are characterized pathologically by intraneuronal inclusions called Lewy bodies (LBs) and Lewy neurites. A major component of these inclusions is the protein α-synuclein, which is natively unfolded but forms oligomers and insoluble fibrillar aggregates under pathological conditions. Although α-synuclein is known to undergo several posttranslational modifications, the contribution of SUMOylation to α-synuclein aggregation and the pathogenesis of α-synucleinopathies have not been elucidated. Here, we provide evidence that aggregates and inclusions formed as a result of impaired proteasome activity contain SUMOylated α-synuclein. Additionally, SUMO1 is present in the halo of LBs colocalizing with α-synuclein in the brains of PD and DLB patients. Interestingly, SUMOylation does not affect the ubiquitination of α-synuclein. These findings suggest that proteasomal dysfunction results in the accumulation of SUMOylated α-synuclein and subsequently its aggregation, pointing to the contribution of this posttranslational modification to the pathogenesis of inclusion formation in α-synucleinopathies.     

Association between DNA repair gene polymorphisms and risk of glioma: A systematic review and meta-analysis

Background

Association studies of germline DNA repair single nucleotide polymorphisms (SNPs) and glioma risk have yielded inconclusive results. We therefore performed a systematic review and meta-analysis of studies investigating this association.

Methods

We identified 27 eligible studies investigating 105 SNPs in 42 DNA repair genes. Of these, 10 SNPs in 7 genes were analyzed in at least 4 studies and were therefore included in our meta-analysis. The meta-analysis was performed for homozygote comparison, heterozygote comparison, and dominant and recessive models by applying a fixed- or random-effects model. The funnel and forest plots were created using RevMan software.

Results

We found that SNPs rs3212986 (odds ratio [OR] = 1.35 (1.08–1.68), P = .008), rs13181 (OR = 1.18 (1.06–1.31), P = .002), and rs25487 (OR = 1.12 (1.03–1.22), P = .007) in DNA repair genes ERCC1, ERCC2 (XPD), and XRCC1 may increase the risk of glioma, while polymorphisms rs1136410 (OR = 0.78 (0.68–0.89), P = .0004) and rs12917 (OR = 0.84 (0.73–0.96), P = .01) in PARP1(ADPRT) and MGMT are associated with decreased susceptibility to glioma. No evidence of significant associations between ERCC2 rs1799793, OGG1 rs1052133, XRCC1 rs25489, XRCC1 rs1799782, or XRCC3 rs861539 and risk of glioma was observed.

Conclusion

This study provides evidence that DNA repair genes ERCC1, ERCC2, and XRCC1 might be low-penetrance glioma-risk genes, while MGMT and PARP1 polymorphisms may confer protection against glioma.     

MicroRNAs in Parkinson's disease

Besides the classic mutations in coding regions of genes, the critical role of gene expression regulators in disease states is increasingly recognized. The network of small non-coding microRNAs is crucial for the normal development and survival of distinct neuronal populations that are vulnerable in various neurodegenerative disorders. In midbrain dopaminergic neurons, which degenerate in Parkinson's disease (PD) causing motor signs and symptoms, disruption of this network results in their progressive loss associated with impaired motor activity in Drosophila and mouse models. Studies of families with dominantly inherited PD linked to multiplication of the α-synuclein gene locus indicate that the amount of this key pathogenic protein in neurons is an important determinant of its tendency to aggregate pathologically and increase neuronal susceptibility. Recent reports demonstrate that the α-synuclein mRNA is under negative control by at least two microRNAs, miR-7 and miR-153. In addition to studying the regulation of candidate genes by specific microRNA species, different profiling approaches are uncovering variations in the abundance of certain microRNAs that may prove to be relevant to the disease. For example, miR-133b is deficient in the PD midbrain as well as in mouse models, and miR-34b/34c are decreased in several affected brain regions in PD and incidental Lewy body disease. Polymorphisms in the 3'-untranslated region of microRNA target mRNAs, including in the gene encoding α-synuclein found in Genome Wide Association studies, are another potential reason for variations in the rate of protein production and thus disease risk. And finally, the impact of a disease associated gene product, and in particular LRRK2, on the microRNA network compounds the complexity of the interplay between the microRNA system and pathogenic proteins. The wealth of knowledge accumulating from these studies in a few short years holds considerable promise to harness its potential and translate it into therapeutic strategies for PD.