Patient safety education for undergraduate medical students: a systematic review

<p>Abstract</p> <p>Background</p> <p>To reduce harm caused by health care is a global priority. Medical students should be able to recognize unsafe conditions, systematically report errors and near misses, investigate and improve such systems with a thorough understanding of human fallibility, and disclose errors to patients. Incorporating the knowledge of how to do this into the medical student curriculum is an urgent necessity. This paper aims to systematically review the literature about patient safety education for undergraduate medical students in terms of its content, teaching strategies, faculty availability and resources provided so as to identify evidence on how to promote patient safety in the curriculum for medical schools. This paper includes a perspective from the faculty of a medical school, a major hospital and an Evidence Based Medicine Centre in Sichuan Province, China.</p> <p>Methods</p> <p>We searched MEDLINE, ERIC, Academic Source Premier(ASP), EMBASE and three Chinese Databases (Chinese Biomedical Literature Database, CBM; China National Knowledge Infrastructure, CNKI; Wangfang Data) from 1980 to Dec. 2009. The pre-specified form of inclusion and exclusion criteria were developed for literature screening. The quality of included studies was assessed using Darcy Reed and Gemma Flores-Mateo criteria. Two reviewers selected the studies, undertook quality assessment, and data extraction independently. Differing opinions were resolved by consensus or with help from the third person.</p> <p>Results</p> <p>This was a descriptive study of a total of seven studies that met the selection criteria. There were no relevant Chinese studies to be included. Only one study included patient safety education in the medical curriculum and the remaining studies integrated patient safety into clinical rotations or medical clerkships. Seven studies were of a pre and post study design, of which there was only one controlled study. There was considerable variation in relation to contents, teaching strategies, faculty knowledge and background in patient safety, other resources and outcome evaluation in these reports. The outcomes from including patient safety in the curriculum as measured by medical students' knowledge, skills, and attitudes varied between the studies.</p> <p>Conclusions</p> <p>There are only a few relevant published studies on the inclusion of patient safety education into the undergraduate curriculum in medical schools either as a selective course, a lecture program, or by being integrated into the existing curriculum even in developed countries with advanced health and education systems. The integration of patient safety education into the existing curriculum in medical schools internationally, provides significant challenges.</p

Comparison Of The Genesis Solar Wind Regime Algorithm Results With Solar Wind Composition Observed By ACE

Launched on 8 August 2001, the NASA Genesis mission is now collecting samples of the solar wind in various materials, and will return those samples to Earth in 2004 for analysis. A primary science goal of Genesis is the determination of the isotopic and elemental composition of the solar atmosphere from the solar wind material returned. In particular, Genesis will provide measurements of those species that are not provided by solar and in situ observations. We know from in situ measurements that the solar wind exhibits compositional variations across different types of solar wind flows. Therefore, Genesis exposes different collectors to solar wind originating from three flow types: coronal hole, coronal mass ejection (CME), and interstream flows. Flow types are identified using in situ measurements of solar wind protons, alphas, and electrons from electrostatic analyzers carried by Genesis. The flow regime selection algorithm and subsequent collector deployment on Genesis act autonomously. We present an assessment of composition variations of O, He, and Mg ions observed by ACE/SWICS concurrent with Genesis observations, and compare these to the Genesis algorithm decisions. Not only does this serve as a test of the algorithm, the compilation of composition vs. regime will be important for comparison to the abundances determined from sample analysis at the end of the mission. © 2003 American Institute of PhysicsPeer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/87657/2/632_1.pd

Visual adaptation enhances action sound discrimination

Prolonged exposure, or adaptation, to a stimulus in one modality can bias, but also enhance, perception of a subsequent stimulus presented within the same modality. However, recent research has also found that adaptation in one modality can bias perception in another modality. Here we show a novel crossmodal adaptation effect, where adaptation to a visual stimulus enhances subsequent auditory perception. We found that when compared to no adaptation, prior adaptation to visual, auditory or audiovisual hand actions enhanced discrimination between two subsequently presented hand action sounds. Discrimination was most enhanced when the visual action ‘matched’ the auditory action. In addition, prior adaptation to a visual, auditory or audiovisual action caused subsequent ambiguous action sounds to be perceived as less like the adaptor. In contrast, these crossmodal action aftereffects were not generated by adaptation to the names of actions. Enhanced crossmodal discrimination and crossmodal perceptual aftereffects may result from separate mechanisms operating in audiovisual action sensitive neurons within perceptual systems. Adaptation induced crossmodal enhancements cannot be explained by post-perceptual responses or decisions. More generally, these results together indicate that adaptation is a ubiquitous mechanism for optimizing perceptual processing of multisensory stimuli

Evidence of water ice near the lunar poles

Lunar Prospector epithermal neutron data were studied to evaluate the probable chemical state of enhanced hydrogen, [H], reported previously to be near both lunar poles [1,2]. Improved versions of thermal and epithermal neutron data were developed for this purpose. Most important is the improved spatial resolution obtained by using shortened integration times. A new data set was created, Epi* = [Epithermal - 0.057 x Thermal], to reduce effects of composition variations other than those due to hydrogen. The Epi* counting rates are generally low near both lunar poles and high over terrane near recent impact events such as Tycho and Jackson. However, other lunar features are also associated with high Epi* rates, which represent a wide range of terrane types that seem to have little in common. If we postulate that one property all bright Epi* features do have in common is low [H], then measured Epi* counting rates appear to be quantitatively self consistent. If we assume that [H]=O above the top 98th percentile of Epi* counting rates at 2{sup o} x 2{sup o} spatial resolution, then [H]{sub ave} = 55 ppm for latitudes equatorward of [75{sup o}]. This value is close to the average found in returned lunar soil samples, [H]{sub ave} {approx} 50 ppm [3]. Using the foregoing physical interpretation of Epi* counting rates, we find that the Epi* counts within most of the large craters poleward of {+-}70{sup o} are higher, and therefore [H] is lower, than that in neighboring inter-crater plains, as shown in Figure 1. Fourteen of these craters that have areas larger than the LP epithermal spatial resolution (55 km diameter at 30 km altitude), were singled out for study. [H] is generally found to increase with decreasing distance from the poles (hence decreasing temperature). However, quantitative estimates of the diffusivity of hydrogen at low temperature show that diffusion can not be an important factor in explaining the difference between the relatively low [H] observed within the large sunlit polar craters and the relatively high [H] in neighboring inter-crater plains. A closer look at the 'inter-crater' plains near the poles, shows that they are covered by many small craters that harbor permanent shade [4]. The temperatures within many of these craters are low enough [5] that they can disable sublimation as a viable loss process of [H{sub 2}O]. It is therefore tempting to postulate that the enhanced hydrogen within most regions of permanent shade is in the form of water molecules. This postulate is certainly viable within the bottoms of several large, permanently shaded craters near the south pole. Predicted temperatures within them [5] fall well below the 100 K temperature that is needed to stabilize water ice for aeons. The picture is different near the north pole. Here, there are relatively few permanently-shaded craters that are large enough to harbor temperatures that are sufficiently low to stabilize water ice indefinitely against sublimation [5]. Instead, the 'inter-crater' polar plains are a jumble of many permanently-shaded craters that have diameters less than 10 km [4]. Although simulations of temperatures within this class of craters show they are only marginally cold enough to indefinitely stabilize water ice [5], this terrane appears to have the highest [H]. Nevertheless, predicted temperatures are close enough to that needed to permanently stabilize [H{sub 2}O] to suggest that sublimation is indeed the process that discriminates between polar terrane that contains enhanced [H] and those that do not (see, e.g., the temperature estimates for doubly-shaded craters [6]). If correct, then an important fraction of the hydrogen near the north pole must be in the form of H{sub 2}O, which then resides within these small craters. Estimates using our improved data set of [H] within craters near the south pole remain unchanged from those derived from our previous analysis [2], [H] = 1700{+-}900 ppm. This translates to [H{sub 2}O]=1.5{+-}0.8%. If all of the enhanced hydrogen in the north is in the form of H{sub 2}O and is confined to the jumble of small permanently-shaded craters identified by radar [4], then we can estimate their water-ice fraction, [H{sub 2}O], using Figure 1a in [2]. We chose two regions near the north pole for this purpose. They each have areas just larger than the surface foot-print of the LP epithermal neutron spectrometer. The first was an inter-crater region nestled between Rozhdestvenskiy and Plaskett, and the second covered the southeast comer of Peary. Using Figure 3 of [4], the first area contains 232 km{sup 2} of measured permanent shade, and the second contains 129 km{sup 2}. Adopting the prescription used in Table 1 of [4] for estimating actual from sampled shaded areas, multiplication of sampled areas by 1.5 yields permanently shaded areas that amount to 350 km{sup 2} in region 1, and 200 km{sup 2} in the southeast comer of Peary

fMR-adaptation indicates selectivity to audiovisual content congruency in distributed clusters in human superior temporal cortex

<p>Abstract</p> <p>Background</p> <p>Efficient multisensory integration is of vital importance for adequate interaction with the environment. In addition to basic binding cues like temporal and spatial coherence, meaningful multisensory information is also bound together by content-based associations. Many functional Magnetic Resonance Imaging (fMRI) studies propose the (posterior) superior temporal cortex (STC) as the key structure for integrating meaningful multisensory information. However, a still unanswered question is how superior temporal cortex encodes content-based associations, especially in light of inconsistent results from studies comparing brain activation to semantically matching (congruent) versus nonmatching (incongruent) multisensory inputs. Here, we used fMR-adaptation (fMR-A) in order to circumvent potential problems with standard fMRI approaches, including spatial averaging and amplitude saturation confounds. We presented repetitions of audiovisual stimuli (letter-speech sound pairs) and manipulated the associative relation between the auditory and visual inputs (congruent/incongruent pairs). We predicted that if multisensory neuronal populations exist in STC and encode audiovisual content relatedness, adaptation should be affected by the manipulated audiovisual relation.</p> <p>Results</p> <p>The results revealed an occipital-temporal network that adapted independently of the audiovisual relation. Interestingly, several smaller clusters distributed over superior temporal cortex within that network, adapted stronger to congruent than to incongruent audiovisual repetitions, indicating sensitivity to content congruency.</p> <p>Conclusions</p> <p>These results suggest that the revealed clusters contain multisensory neuronal populations that encode content relatedness by selectively responding to congruent audiovisual inputs, since unisensory neuronal populations are assumed to be insensitive to the audiovisual relation. These findings extend our previously revealed mechanism for the integration of letters and speech sounds and demonstrate that fMR-A is sensitive to multisensory congruency effects that may not be revealed in BOLD amplitude per se.</p

Prognostic model to predict postoperative acute kidney injury in patients undergoing major gastrointestinal surgery based on a national prospective observational cohort study.

Background: Acute illness, existing co-morbidities and surgical stress response can all contribute to postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery. The aim of this study was prospectively to develop a pragmatic prognostic model to stratify patients according to risk of developing AKI after major gastrointestinal surgery. Methods: This prospective multicentre cohort study included consecutive adults undergoing elective or emergency gastrointestinal resection, liver resection or stoma reversal in 2-week blocks over a continuous 3-month period. The primary outcome was the rate of AKI within 7 days of surgery. Bootstrap stability was used to select clinically plausible risk factors into the model. Internal model validation was carried out by bootstrap validation. Results: A total of 4544 patients were included across 173 centres in the UK and Ireland. The overall rate of AKI was 14·2 per cent (646 of 4544) and the 30-day mortality rate was 1·8 per cent (84 of 4544). Stage 1 AKI was significantly associated with 30-day mortality (unadjusted odds ratio 7·61, 95 per cent c.i. 4·49 to 12·90; P < 0·001), with increasing odds of death with each AKI stage. Six variables were selected for inclusion in the prognostic model: age, sex, ASA grade, preoperative estimated glomerular filtration rate, planned open surgery and preoperative use of either an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker. Internal validation demonstrated good model discrimination (c-statistic 0·65). Discussion: Following major gastrointestinal surgery, AKI occurred in one in seven patients. This preoperative prognostic model identified patients at high risk of postoperative AKI. Validation in an independent data set is required to ensure generalizability