Conflict Resolution for the Classroom

Conflict significantly disrupts achievement within classrooms. It effects individuals but also influences group members and potentially a wider community. Minimizing conflict optimizes opportunity and this is the goal of sharing these insights

Recertification and Reentry to Practice for Nurse Anesthetists: Determining Core Competencies and Evaluating Performance via High-Fidelity Simulation Technology

Introduction The National Board of Certification and Recertification for Nurse Anesthetistsaddressed a barrier to return to practice of uncertified practitioners by replacing required direct patient care experiences with high-fidelity simulation. Objectives The aims of this study were to: (a) validate a set of clinical activities for their relevance to reentry and determine if they could be replicated using simulation, (b) evaluate the content validity of an existing simulation scenario containing the proposed clinical activities and determine its substitutability for a clinical practicum, and (c) evaluate the validity of two methods to assess simulation performance. Methods A modified Delphi method incorporating an autonomous, anonymous, three-round online survey process using three unique expert certified registered nurse anesthetists groups was used to address each study aim. Results Twenty-seven clinical activities gained consensus as necessary to be assessed in the simulation. All 14 survey questions used to determine simulation content validity exceeded the minimum content validity index (CVI) value of 0.78, with a mean CVI of 0.99. The global rating scale CVI and the competency checklist CVI were 0.83 and 1.0, respectively. Conclusion The findings add to the existing literature supporting the utility of simulation for high-stakes provider assessment and certification

Tocilizumab administration in COVID-19 patients: Water on the fire or gasoline?

Tocilizumab is widely being used to treat COVID-19. Although reducing systemic inflammation, it also increases the risk for secondary infections as a result of the immunosuppression produced. We report the case of a 69-year-old patient admitted to the ICU with severe respiratory distress caused by COVID-19 pneumonia who developed pulmonary aspergillosis. On the basis of these findings, we suggest early testing for pulmonary aspergillosis in COVID-19 patients treated with tocilizumab

SUGAMMADEX versus neostigmine after ROCURONIUM continuous infusion in patients undergoing liver transplantation

Background: Rapid neuromuscular block reversal at the end of major abdominal surgery is recommended to avoid any postoperative residual block. To date, no study has evaluated sugammadex performance after rocuronium administration in patients undergoing liver transplantation. This is a randomized controlled trial with the primary objective of assessing the neuromuscular transmission recovery time obtained with sugammadex versus neostigmine after rocuronium induced neuromuscular blockade in patients undergoing orthotopic liver transplantation. Methods: The TOF-Watch SX\uae, calibrated and linked to a portable computer equipped with TOF-Watch SX Monitor Software\uae, was used to monitor and record intraoperative neuromuscular block maintained with a continuous infusion of rocuronium. Anaesthetic management was standardized as per our institution's internal protocol. At the end of surgery, neuromuscular moderate block reversal was obtained by administration of 2 mg/kg of sugammadex or 50 mcg/kg of neostigmine (plus 10 mcg/kg of atropine). Results: Data from 41 patients undergoing liver transplantation were analysed. In this population, recovery from neuromuscular block was faster following sugammadex administration than neostigmine administration, with mean times\ub1SD of 9.4 \ub1 4.6 min and 34.6 \ub1 24.9 min, respectively (p < 0.0001). Conclusion: Sugammadex is able to reverse neuromuscular block maintained by rocuronium continuous infusion in patients undergoing liver transplantation. The mean reversal time obtained with sugammadex was significantly faster than that for neostigmine. It is important to note that the sugammadex recovery time in this population was found to be considerably longer than in other surgical settings, and should be considered in clinical practice. Trial registration: ClinicalTrials.gov NCT02697929 (registered 3rd March 2016)

Learning from the italian experience during covid-19 pandemic waves: Be prepared and mind some crucial aspects

COVID-19 pandemic has rapidly spread worldwide causing a serious challenge to the global medical community. Italy was struck hard during the first wave earlier this year and several weaknesses as well as general unpreparedness of the national healthcare system were acknowledged. Learning essential lessons from the past, we realized how implementing contingency response measures, human resources and social dynamics could have changed the outcome if promptly adopted. This review translates the previous experience into strategic actions that has to be considered when developing appropriate national and regional operational plans to respond to a pandemic

Marine fog inputs appear to increase methylmercury bioaccumulation in a coastal terrestrial food web

Coastal marine atmospheric fog has recently been implicated as a potential source of ocean-derived monomethylmercury (MMHg) to coastal terrestrial ecosystems through the process of sea-to-land advection of foggy air masses followed by wet deposition. This study examined whether pumas (Puma concolor) in coastal central California, USA, and their associated food web, have elevated concentrations of MMHg, which could be indicative of their habitat being in a region that is regularly inundated with marine fog. We found that adult puma fur and fur-normalized whiskers in our marine fog-influenced study region had a mean (±SE) total Hg (THg) (a convenient surrogate for MMHg) concentration of 1544 ± 151 ng g−1 (N = 94), which was three times higher (P < 0.01) than mean THg in comparable samples from inland areas of California (492 ± 119 ng g−1, N = 18). Pumas in California eat primarily black-tailed and/or mule deer (Odocoileus hemionus), and THg in deer fur from the two regions was also significantly different (coastal 28.1 ± 2.9, N = 55, vs. inland 15.5 ± 1.5 ng g−1, N = 40). We suggest that atmospheric deposition of MMHg through fog may be contributing to this pattern, as we also observed significantly higher MMHg concentrations in lace lichen (Ramalina menziesii), a deer food and a bioindicator of atmospheric deposition, at sites with the highest fog frequencies. At these ocean-facing sites, deer samples had significantly higher THg concentrations compared to those from more inland bay-facing sites. Our results suggest that fog-borne MMHg, while likely a small fraction of Hg in all atmospheric deposition, may contribute, disproportionately, to the bioaccumulation of Hg to levels that approach toxicological thresholds in at least one apex predator. As global mercury levels increase, coastal food webs may be at risk to the toxicological effects of increased methylmercury burdens.publishedVersio