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11.
Julia H. Vermylen Gordon J. Wood Elaine R. Cohen Jeffrey H. Barsuk William C. McGaghie Diane B. Wayne 《Journal of pain and symptom management》2019,57(3):682-687
Introduction
Physician communication impacts patient outcomes. However, communication skills, especially around difficult conversations, remain suboptimal, and there is no clear way to determine the validity of entrustment decisions. The aims of this study were to 1) describe the development of a simulation-based mastery learning (SBML) curriculum for breaking bad news (BBN) conversation skills and 2) set a defensible minimum passing standard (MPS) to ensure uniform skill acquisition among learners.Innovation
An SBML BBN curriculum was developed for fourth-year medical students. An assessment tool was created to evaluate the acquisition of skills involved in a BBN conversation. Pilot testing was completed to confirm improvement in skill acquisition and set the MPS.Outcomes
A BBN assessment tool containing a 15-item checklist and six scaled items was developed. Students' checklist performance improved significantly at post-test compared to baseline (mean 65.33%, SD = 12.09% vs mean 88.67%, SD = 9.45%, P < 0.001). Students were also significantly more likely to have at least a score of 4 (on a five-point scale) for the six scaled questions at post-test. The MPS was set at 80%, requiring a score of 12 items on the checklist and at least 4 of 5 for each scaled item. Using the MPS, 30% of students would require additional training after post-testing.Comments
We developed a SBML curriculum with a comprehensive assessment of BBN skills and a defensible competency standard. Future efforts will expand the mastery model to larger cohorts and assess the impact of rigorous education on patient care outcomes. 相似文献12.
Christopher N. Cooley Tyler J. Beranek Matthew A. Warpinski Robert Alexander Amanda O. Esquivel 《The American journal of emergency medicine》2019,37(2):199-203
Introduction
In the United States there has been a large increase in participation in lacrosse for both males and females. The purpose of this study was to analyze the number of head injuries, injury rates (calculated using the reported number of participants) and types of head injuries that are seen in emergency departments in the United States.Methods
We compared injuries between male and female lacrosse participants. This was a retrospective study using a publicly available database produced by the US Consumer Product Safety Commission and information about lacrosse participation from US Lacrosse.Results
A linear regression was performed and showed a positive correlation between number of head injuries to males and time from 2002 to 2010 (R2?=?0.823; p?=?0.001). While the number of injuries to the head in female lacrosse participants was not significant. There was a negative correlation between the number of head injuries to males from 2010 to 2016 (R2?=?0.800; p?=?0.007), but again, there was no significance for female injury count (R2?=?0.417; p?=?0.117). Other significant differences between head injuries in males and females included the mechanism of injury and the type of injury recorded.Conclusion
The most recent data from 2010 to 2016, suggest that both males and females have had a decrease in injury rate. However the total number of female head injuries is not significantly decreasing and as the sport continues to grow there will likely be more total head injuries and visits to the emergency department. 相似文献13.
Sophia A. Traven Russell A. Reeves Molly G. Sekar Harris S. Slone Zeke J. Walton 《The Journal of arthroplasty》2019,34(1):140-144
Background
While the 11-factor modified frailty index (mFI) has been shown to predict adverse outcomes in patients undergoing total joint arthroplasty, the 5-factor index has not been evaluated in this patient population. The goal of this study was to evaluate the utility of the mFI-5 as a predictor of morbidity and mortality in patients undergoing primary total hip and knee arthroplasty.Methods
A retrospective analysis of the American College of Surgeons National Surgical Quality Improvement Program's database for patients undergoing total hip arthroplasty and total knee arthroplasty between the years 2005 and 2016 was conducted. The 5-factor score, which includes the presence of comorbid diabetes, hypertension, congestive heart failure, chronic obstructive pulmonary disease, and functional status, was calculated for each patient. Multivariate logistic regression models were used to assess the relationship between the mFI-5 and postoperative complications while controlling for demographic variables.Results
One hundred forty thousand one hundred fifty-eight patients undergoing total hip arthroplasty and 226,398 patients undergoing total knee arthroplasty were identified. After adjusting for demographic variables and comorbid conditions, logistic regression analyses revealed that the mFI-5 was a strong predictor for total complications, Clavien-Dindo grade IV complications (cardiac arrest, myocardial infarction, septic shock, pulmonary embolism, postoperative dialysis, reintubation, and prolonged ventilator requirement), surgical site infections, readmission, and 30-day mortality (P < .001).Conclusions
The mFI-5 is an independent predictor of postoperative complications including life-threatening medical complications, surgical site infections, hospital readmission, and 30-day mortality after primary hip and knee arthroplasty. This clinical tool can be used to identify high-risk surgical patients and guide preoperative counseling to optimize outcomes.Level of Evidence
III. 相似文献14.
Paul Macadam Kim D. Simperingham John B. Cronin 《Journal of Science and Medicine in Sport》2019,22(3):348-352
Objectives
Arm swing is a distinctive characteristic of sprint-running with the arms working in a contralateral manner with the legs to propel the body in a horizontal direction. The purpose of this study was to determine the acute changes in kinematics and kinetics when wearable resistance (WR) of 1 kg (equivalent to ～1% body mass) was attached to each forearm during over ground short distance (20 m) maximal sprint-running.Design
Cross-sectional study.Methods
Twenty-two male amateur rugby athletes (19.4 ± 0.5 years; 97.0 ± 4.8 kg; 180.4 ± 7.2 cm) volunteered to participate in the study. Radar and Optojump were used to examine kinematic and kinetics between WR and unloaded sprint-running conditions.Results
No significant (p < 0.05) differences were found at 2 m or 5 m between conditions, however, the WR condition resulted in a significant increase in 10 m, 20 m and 10–20 m split time (all, ～2%, small effect size) compared to the unloaded condition. Significant decreases were also found in theoretical maximum velocity (V0) (?1.4%, small effect size) and relative peak horizontal power production (Pmax) (?5.5%, small effect size). Step length (2.1%, small effect size) and contact time (6.5%, medium effect size) were significantly increased, while step frequency (?4.1%, small effect size) and flight time (?5.3%, medium effect size) were significantly decreased.Conclusions
WR forearm loading provides a movement specific overload of the arms which significantly alters step kinematics and sprint times ≥10 m. 相似文献15.
Spyridon G. Deftereos Dimitrios A. Vrachatis Christos Angelidis Agathi-Rosa Vrettou Eleni K. Sarri Sotiria G. Giotaki Efthymia Varytimiadi Charalampos Kossyvakis Eleana Kotsia Gerasimos S. Deftereos Konstantinos Doudoumis Georgios Giannopoulos 《Clinical therapeutics》2019,41(1):21-29
Purpose
The goal of this review was to summarize, analyze, and compare trials studying the efficacy of colchicine in the prevention of atrial fibrillation (AF) post-operatively (POAF) and post–catheter ablation. Ongoing studies and current guidelines are also presented and reviewed.Methods
Published studies on the field were identified through a literature search of the PubMed and clinicaltrials.gov databases.Findings
Four original studies regarding POAF, two original studies regarding post–catheter ablation AF, and six meta-analyses were identified. In addition, the 3 most recent guidelines/expert consensus documents were scrutinized.Implications
AF occurs frequently after cardiac surgery (POAF) and catheter pulmonary vein isolation (postablation AF) and is associated with increased cardiovascular morbidity. A number of trials over the last few years have investigated the role of colchicine in the prevention of POAF and postablation AF targeting the local and systemic inflammatory process that leads to initiation and maintenance of AF. Available data imply that colchicine may have a preventive role in POAF and/or postablation AF. However, certain limitations of these studies underline the need for further investigation. 相似文献16.
Christine A. White Ayub Akbari Celine Allen Andrew G. Day Patrick A. Norman David Holland Michael A. Adams Greg A. Knoll 《Kidney international》2021,99(4):957-966
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17.
18.
Yang Liu Yoshifumi Baba Takatsugu Ishimoto Hiroyasu Tsutsuki Tianli Zhang Daichi Nomoto Kazuo Okadome Kensuke Yamamura Kazuto Harada Kojiro Eto Yukiharu Hiyoshi Masaaki Iwatsuki Yohei Nagai Shiro Iwagami Yuji Miyamoto Naoya Yoshida Yoshihiro Komohara Masaki Ohmuraya Xiaoming Wang Jaffer A. Ajani Tomohiro Sawa Hideo Baba 《British journal of cancer》2021,124(5):963
Background Fusobacterium nucleatum (F. nucleatum) is a gut microbe implicated in gastrointestinal tumorigenesis. Predicting the chemotherapeutic response is critical to developing personalised therapeutic strategies for oesophageal cancer patients. The present study investigated the relationship between F. nucleatum and chemotherapeutic resistance in oesophageal squamous cell carcinoma (ESCC).Methods We examined the relationship between F. nucleatum and chemotherapy response in 120 ESCC resected specimens and 30 pre-treatment biopsy specimens. In vitro studies using ESCC cell lines and co-culture assays further uncovered the mechanism underlying chemotherapeutic resistance.Results ESCC patients with F. nucleatum infection displayed lesser chemotherapeutic response. The infiltration and subsistence of F. nucleatum in the ESCC cells were observed by transmission electron microscopy and laser scanning confocal microscopy. We also observed that F. nucleatum modulates the endogenous LC3 and ATG7 expression, as well as autophagosome formation to induce chemoresistance against 5-FU, CDDP, and Docetaxel. ATG7 knockdown resulted in reversal of F. nucleatum-induced chemoresistance. In addition, immunohistochemical studies confirmed the correlation between F. nucleatum infection and ATG7 expression in 284 ESCC specimens.Conclusions F. nucleatum confers chemoresistance to ESCC cells by modulating autophagy. These findings suggest that targeting F. nucleatum, during chemotherapy, could result in variable therapeutic outcomes for ESCC patients.Subject terms: Tumour biomarkers, Oesophageal cancer 相似文献
19.
Emiliano A. Rodríguez-Caulo Ana Guijarro-Contreras Arantza Guzón Juan Otero-Forero María José Mataró Gemma Sánchez-Espín Carlos Porras José M. Villaescusa José María Melero-Tejedor Manuel Jiménez-Navarro 《Seminars in thoracic and cardiovascular surgery》2021,33(2):328-334
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20.
Wei-Yuan Fang Kuerbanjiang Abuduxikuer Peng Shi Yi-Ling Qiu Jing Zhao Yu-Chuan Li Xue-Yuan Zhang Neng-Li Wang Xin-Bao Xie Yi Lu A S Knisely Jian-She Wang 《World Journal of Clinical Cases》2021,9(14):3273-3286
BACKGROUNDAcute liver failure (ALF) can be a primary presentation of Wilson disease (WD). Mortality rates are high in WD with ALF (WDALF). Predictions of mortality in WDALF vary by model and are sometimes contradictory, perhaps because few patients are studied or WD diagnoses are questionable. AIMTo determine the outcomes among well-documented WDALF patients and assess mortality model performance in this cohort.METHODSWe reviewed the medical records of our pediatric WDALF patients (n = 41 over 6-years-old, single-center retrospective study) and compared seven prognostic models (King’s College Hospital Criteria, model for end-stage liver disease/pediatric end-stage liver disease scoring systems, Liver Injury Unit [LIU] using prothrombin time [PT] or international normalized ratio [INR], admission LIU using PT or INR, and Devarbhavi model) with one another.RESULTSAmong the 41 Han Chinese patients with ALF, WD was established by demonstrating ATP7B variants in 36. In 5 others, Kayser-Fleischer rings and Coombs-negative hemolytic anemia permitted diagnosis. Three died during hospitalization and three underwent liver transplantation (LT) within 1 mo of presentation and survived (7.3% each); 35 (85.4%) survived without LT when given enteral D-penicillamine and zinc-salt therapy with or without urgent plasmapheresis. Parameters significantly correlated with mortality included encephalopathy, coagulopathy, and gamma-glutamyl transpeptidase activity, bilirubin, ammonia, and serum sodium levels. Area under the receiver operating curves varied among seven prognostic models from 0.981 to 0.748 with positive predictive values from 0.214 to 0.429.CONCLUSIONWDALF children can survive and recover without LT when given D-penicillamine and Zn with or without plasmapheresis, even after enlisting for LT. 相似文献