A prospective study on the efficacy of patient simulation in heart and lung auscultation

Background: The use of simulation technology for skill training and assessment in medical education has progressively increased over the last decade. Nevertheless, the teaching efficacy of most technologies remains to be fully determined. The aim of this prospective study was to evaluate if a short individual training on a patient simulator could improve heart and lung auscultation skills in undergraduate students. Methods: A group of fifth-year medical school students, who had trained on a patient simulator in their third year (EXP, n = 55), was compared to a group of fifth-year medical school students who had not previously trained on it (CNT, n = 49). Students were recruited on a voluntary basis. Students were evaluated in terms of their ability to correctly identify three heart (II sound wide split, mitral regurgitation, aortic stenosis) and five lung sounds (coarse crackles, fine crackles, pleural rubs, rhonchi, wheezes), which were reproduced in a random order on the Kyoto-Kagaku patient simulator. Results: Exposure to patient simulator significantly improved heart auscultation skills, as mitral regurgitation was correctly recognized by 89.7% of EXP students as compared to 71.4% of CNT students (p = 0.02). In addition, a significantly greater percentage of EXP students correctly graphed all the heart diagnoses as compared to CNT students. There were no differences between the groups in lung auscultation. Conclusions: This study demonstrates that training medical students with a patient simulator, individually for one hour, significantly ameliorated their heart auscultation skills. Our data suggests that patient simulation might be useful for learning auscultation skills, especially when it is combined with graphic sound display

A new integrated approach to cardiac mechanics: reference values for normal left ventricle

The association between left ventricular (LV) myocardial deformation and hemodynamic forces is still mostly unexplored. The normative values and the effects of demographic and technical factors on hemodynamic forces are not known. The authors studied the association between LV myocardial deformation and hemodynamic forces in a large cohort of healthy volunteers. One-hundred seventy-six consecutive subjects (age range, 16\u201382; 51% women), with no cardiovascular risk factors or any relevant diseases, were enrolled. All subjects underwent an echo-Doppler examination. Both 2D global myocardial and endocardial longitudinal strain (GLS), circumferential strain (GCS), and the hemodynamic forces were measured with new software that enabled to calculate all these values and parameters from the three apical views. Higher LV mass index and larger LV volumes were found in males compared to females (85 \ub1 17 vs 74 \ub1 15\ua0g/m2 and 127 \ub1 28 vs 85 \ub1 18\ua0ml, p < 0.0001 respectively) while no differences of the mean values of endocardial and myocardial GLS and of myocardial GCS were found (p = ns) and higher endocardial GCS in women ( 12\ua030.6 \ub1 4.2 vs 12\ua031.8 \ub1 3.7; p = 0.05). LV longitudinal force, LV systolic longitudinal force and LV impulse were higher in men (16.2 \ub1 5.3 vs 13.2 \ub1 3.6; 25.1 \ub1 7.9 vs 19.4 \ub1 5.6 and 20.4 \ub1 7 vs 16.6 \ub1 5.2, p < 0.0001, respectively). A weak but statistically significant decline with age (p < 0.0001) was also found for these force parameters. This new integrated approach could differentiate normality from pathology by providing average deformation values and hemodynamic forces parameters, differentiated by age and gender

Fast Rotation of the N=Z Nucleus 36Ar

A highly-deformed rotational band has been identified in the N=Z nucleus 36Ar. At high spin the band is observed to its presumed termination at I=16+, while at low spin it has been firmly linked to previously known states in 36Ar. Spins, parities, and absolute excitation energies have thus been determined throughout the band. Lifetime measurements establish a large low-spin quadrupole deformation (beta_2=0.46+-0.03) and indicate a decreasing collectivity as the band termination is approached. With effectively complete spectroscopic information and a valence space large enough for significant collectivity to develop, yet small enough to be meaningfully approached from the shell model perspective, this rotational band in 36Ar provides many exciting opportunities to test and compare complementary models of collective motion in nuclei

Novel 3,4-dihydropyrazino[1,2-b]indazol-1(2H)-one derivatives targeting serotonin 2A and adrenergic alpha1 receptors as ocular antihypertensive agents

The prolonged elevation of the intraocular pressure (IOP) is one of the main risk factor associated with Glaucoma. As a consequence, the current available pharmacological strategies for the treatment of this pathology (e. g. Prostaglandin F2alpha analogues, adrenergic beta blockers and carbonic anhydrase inhibitors) are essentially aimed to reduce IOP level. Unfortunately all these medical treatments are associated with relevant side effects or have significant percentage of non-responders, with the result that more than 50% of the patients failed to control the glaucoma progression. With the aim to develop novel lead compounds, without the important drawbacks of the existing drugs, we envisaged that the dual interaction with serotonin 2A (5-HT2A) and adrenergic alpha1 (α1) receptor could be a potential approach for ocular antihypertensive. This hypothesis is substantiate by the well-established effect of the two receptor systems on aqueous humour dynamic. In this work we briefly describe the discovery of the novel class of selective 5-HT2A receptor ligands (I) with balanced affinity for adrenergic α1 receptors. The general synthetic pathway used for the preparation of this class of compounds and the binding assay results of some representative products are showed. Moreover, we demonstrate the in vivo IOP reduction efficacy of one 3,4-dihydropyrazino[1,2-b]indazol-1(2H)-one derivative, by means of an ocular hypertensive rabbit model (carbomer model)

Lung ultrasound and short-term prognosis in heart failure patients

Background Heart failure (HF) is the leading cause of hospitalization for patients older than 65 years, with a 30-day readmission rate of 20-25%. Although several markers have been evaluated to stratify timing of follow-up after an acute decompensation is mostly based on clinical judgment. Lung ultrasound (LUS) has been demonstrated to be a valid tool for the assessment and monitoring of pulmonary congestion. Aim of our study was to evaluate if LUS performed in HF patients at discharge could predict 100-day hospital readmission or death. Methods One-hundred fifty patients were enrolled. The anterolateral chest was scanned to evaluate the presence of B-lines. A sonographic score was calculated attributing 1 to each positive ( 65 3 B-lines) sector. Clinical, biochemical and echocardiographic data were recorded. A Cox proportional hazard regression analysis was performed to evaluate the association between variables and 100-day events. Results Follow-up was obtained in 149 patients. Thirty-four events were recorded. Sonographic score was significantly associated with events (HR 1.19; CI 1.05 to 1.34; p = 0.005). On average, the increase of 1 point in the sonographic score was associated with an increase of approximately 24% in the risk of event within 100 days. At multivariate analysis NTproBNP remained the only independent prognostic factor. Conclusions We confirmed that B-lines at discharge are a prognostic marker for hospital readmission and death at 100 days in HF patients. Nevertheless, further randomized clinical studies are needed to definitely support the routine use of LUS in the clinical management of HF patients, in combination or not with NT-proBNP

Code of ethics and workers' communication policies: The role of corporate governance

A good monitoring that reduces agency conflicts can help in developing structured policies in code of ethics to help the social information processing for employees. The objective of this research is to investigate whether the corporate governance characteristics, such as duality, board of directors' size and independence as measures of monitor capacity are related to workers' communication policies disclosed in code of ethics. Based on a content analysis of code of ethics to define the latter polices and on regression analyses on 808 firm-year observations, our results show that board of directors' independence is positively related to code of ethics policies related to communication with employees. Independence of the board is expression of supervising, supporting transparency and aiming to safeguard the best interests of all stakeholders, including employees

&apos;&apos;Neutron Shell&apos;&apos;: a high efficiency array of neutron detectors for g-ray spectroscopic studies with Gammasphere

Abstract A shell of neutron detectors was designed, constructed, and employed in g-ray spectroscopy with Gammasphere. It consists of up to 35 tapered regular hexagons that replace the same number of forward Ge-detector modules in Gammasphere. The shell was designed for high detection efficiency and very good neutron-g discrimination. The simultaneous use of time-of-flight, and two methods of pulse shape discrimination between neutrons and g rays is described. Techniques for spectroscopy with efficient detection of two neutrons are discussed.