The Education of Medical Students in Human Factors – A National Survey

Background: The importance of human factors (HF) has been highlighted recently by the General Medical Council’s decision to include it in their processes for evaluating fitness to practice. Medical school is vital for embedding concepts into medical practice, but little is known about the rigor and extent to which HF is taught across United Kingdom (UK) medical schools. Methods: Cross-sectional study assessing HF among medical students in the UK. An 8-question survey was designed and disseminated nationally using the Qualtrics platform. Respondents were asked for their existing knowledge and perception of HF, education throughout medical school and relevant demographic factors. Results: The survey was completed by 304 medical students from 12 UK medical schools. In total, 45.7% of respondents had never heard of HF as a concept. Furthermore, 96.9% of respondents deemed the concept of HF as very important to medicine and future clinical practice. Moreover, simulated scenarios, one-to-one and small group teaching emerged as the most effective teaching methods, whilst many students agreed this teaching should occur in the early stages of medical education. Lastly, communication and teamwork were perceived to be the most important aspects of HF. Conclusion: These findings reveal a lack of awareness regarding HF among UK medical students. New strategies are needed to ensure the doctors of tomorrow are equipped with the necessary tools to implement and deliver safer, more effective patient care

Late trimming delays sugar accumulation in grapes

Background and Aims Climate change can alter the synchronous accumulation of sugar and other main berry compounds during ripening. The aim of this study was to determine whether post-veraison trimming could delay sugar accumulation and influence the production of anthocyanins and seed tannins in Sangiovese grapes. Methods and Results Shoots were trimmed in 2009, 2010 and 2011 when the berry total soluble solids (TSS) reached 15–17°Brix, leaving eight nodes on each main shoot. The accumulation of TSS, anthocyanins and seed tannins was measured during ripening, and yield parameters were recorded at harvest. Grapes from trimmed vines contained a lower TSS in 2009 and 2010, but there was no impact on the concentration of anthocyanins and seed tannins. In 2011, leaf area limitation was insufficient to reduce TSS accumulation, because yield constraints were observed and the leaf area/yield ratio was within the optimal range. Conclusions The lower rate of TSS accumulation in berries had no impact on the concentration of anthocyanins and seed tannins, suggesting that this approach could produce grapes with a lower TSS at harvest or delay harvest. In low-vigour vines suffering from water deficit, the post-veraison trimming repeated over the years could reduce yield, which may be responsible for the lack of TSS reduction compared with that of control vines. Significance of the Study Our study provides insight into the relationship between TSS accumulation and the production of anthocyanins and seed tannins in the berry in response to post-veraison leaf area reduction

Angiogenesis and Multiple Sclerosis Pathogenesis: A Glance at New Pharmaceutical Approaches

Multiple sclerosis is a chronic disease of the central nervous system characterized by demyelination and destruction of axons. The most common form of the disease is the relapsing-remitting multiple sclerosis in which episodic attacks with typical neurological symptoms are followed by episodes of partial or complete recovery. One of the underestimated factors that contribute to the pathogenesis of multiple sclerosis is excessive angiogenesis. Here, we review the role of angiogenesis in the onset and in the development of the disease, the molecular mechanisms underlying angiogenesis, the current therapeutic approaches, and the potential therapeutic strategies with a look at natural compounds as multi-target drugs with both neuroprotective and anti-angiogenic properties

Climate change and vine training systems: the influence different spatial distribution of shoots may have on sugar accumulation in Sangiovese grapevines.

The choice of training system may influence vineyard efficiency in terms of light interception and water consumption, particularly in the current context of climate change. On this basis, during the 2017 season, Sangiovese potted vines were grown outdoors using two different training systems: guyot vertical shoot positioned system (C) and V-shaped open canopy (A). From the end of June until September, vine transpiration was continuously monitored by the gravimetric approach and at different times in the season, the leaf area, light interception, photosynthetic activity and stem water potential were measured. Grape yield and fruit composition were recorded at harvest. C plants did not differ from A in terms of leaf area during the entire season. Light interception was higher in C vines during the early hours of the morning and lower in the central part of the day and the transpiration loss was higher, as was the net photosynthesis detected on some days in August. No differences were detected in terms of yield but a significant increase in soluble solids was found in C compared to A. The open canopy compared to a closed one, in a particularly hot year like 2017, resulted in negative consequences on the accumulation of soluble solids, probably as a result of the radiative stress suffered by the A vines in the middle hours of the day

LIFE Monza: comparison between ante and post-operam noise and air quality monitoring activities in a Noise Low Emission Zone

AbstractLIFE MONZA project (Methodologies fOr Noise low emission Zones introduction And management) aims at defining an easy-replicable method for the identification and management of theNoise Low Emission Zones(Noise LEZ), urban areas subject to traffic restrictions, usually introduced in order to ensure compliance with the air pollutants limit values, prescribed by the European Directive on ambient air quality 2008/50/EC, whose impacts and potential benefits regarding noise issues have been taken into account, tested and analysed in a pilot area of the city of Monza, located in North Italy. Noise LEZ has been established in Libertà district, introducing infrastructural interventions carried out by the municipality (top-down actions) and encouraging an active involvement of the citizens, in the definition of a more sustainable lifestyle (bottom-up actions). The analysis of potential effects on noise reduction due to the Noise LEZ can contribute to the implementation of the EU Directive 2002/49/EC, related to the assessment and management of environmental noise (Environmental Noise Directive – END), which introduces noise action plans, designed to manage noise issues and their effects, suggesting the adoption of urban and mobility planning. Noise and air quality monitoring activities have been carried out in pilot area inanteandpost-operamconditions. The monitoring methods, the measurement techniques, the analysis procedures, able to describe the effects due to Noise LEZ establishment, for both the main environmental issues are reported in this paper, as proposals to be applied in other different contexts. Results of monitoring activities highlight a reduction of noise, in term of sound pressure levels, betweenanteandpost-operam, during the day and particularly during the night period, and it is essentially due to the interventions realised. The effect of the Noise LEZ on air pollution seems to be negligible for combustion related pollutant and carbon fractions of PM, due both to the moderate spatial effects of the measures undertaken and confounding factors due to concomitant emission sources and meteorology

Monitoring COVID-19 transmission risks by quantitative real-time PCR tracing of droplets in hospital and living environments

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) environmental contamination occurs through droplets and biological fluids released in the surroundings from patients or asymptomatic carriers. Surfaces and objects contaminated by saliva or nose secretions represent a risk for indirect transmission of coronavirus disease 2019 (COVID-19). We assayed surfaces from hospital and living spaces to identify the presence of viral RNA and the spread of fomites in the environment. Anthropic contamination by droplets and biological fluids was monitored by detecting the microbiota signature using multiplex quantitative real-time PCR (qPCR) on selected species and massive sequencing on 16S amplicons. A total of 92 samples (flocked swabs) were collected from critical areas during the pandemic, including indoor (three hospitals and three public buildings) and outdoor surfaces exposed to anthropic contamination (handles and handrails, playgrounds). Traces of biological fluids were frequently detected in spaces open to the public and on objects that are touched with the hands (.80%). However, viral RNA was not detected in hospital wards or other indoor and outdoor surfaces either in the air system of a COVID hospital but only in the surroundings of an infected patient, in consistent association with droplet traces and fomites. Handled objects accumulated the highest level of multiple contaminations by saliva, nose secretions, and fecal traces, further supporting the priority role of handwashing in prevention. In conclusion, anthropic contamination by droplets and biological fluids is widespread in spaces open to the public and can be traced by qPCR. Monitoring fomites can support evaluation of indirect transmission risks for coronavirus or other flu-like viruses in the environment

Patients in long-term maintenance therapy for drug use in Italy: analysis of some parameters of social integration and serological status for infectious diseases in a cohort of 1091 patients

BACKGROUND: Heroin addiction often severely disrupts normal social functioning. The aims of this multi-centre study of heroin users in long-term replacement treatment were: i) to provide information on aspects of social condition such as employment, educational background, living status, partner status and any history of drug addiction for partners, comparing these data with that of the general population; ii) to assess the prevalence of hepatitis, syphilis and HIV, because serological status could be a reflection of the social conditions of patients undergoing replacement treatment for drug addiction; iii) to analyse possible relationships between social conditions and serological status. METHODS: A cross-sectional study was carried out in sixteen National Health Service Drug Addiction Units in northern Italy. The data were collected from February 1, 2002 to August 31, 2002. Recruitment eligibility was: maintenance treatment with methadone or buprenorphine, treatment for the previous six months, and at least 18 years of age. In the centres involved in the study no specific criteria or regulations were established concerning the duration of replacement therapy. Participants underwent a face-to-face interview. RESULTS: The conditions of 1091 drug treatment patients were evaluated. The mean duration of drug use was 14.5 years. Duration was shorter in females, in subjects with a higher educational background, and in stable relationships. Most (68%) had completed middle school (11–14 years of age). Seventy-nine percent were employed and 16% were unemployed. Fifty percent lived with their parents, 34% with a partner and 14% alone. Males lived more frequently with their parents (55%), and females more frequently with a partner (60%). Sixty-seven percent of male patients with a stable relationship had a partner who had never used heroin. HCV prevalence was 72%, HBV antibodies were detected in 42% of patients, while 30% had been vaccinated; 12.5% of subjects were HIV positive and 1.5% were positive for TPHA. CONCLUSION: A significant percentage of heroin users in treatment for opiate addiction in the cohort study have characteristics which indicate reasonable integration within broader society. We posit that the combination of effective treatment and a setting of economic prosperity may enhance the social integration of patients with a history of heroin use

Evolving trends in the management of acute appendicitis during COVID-19 waves. The ACIE appy II study

Background: In 2020, ACIE Appy study showed that COVID-19 pandemic heavily affected the management of patients with acute appendicitis (AA) worldwide, with an increased rate of non-operative management (NOM) strategies and a trend toward open surgery due to concern of virus transmission by laparoscopy and controversial recommendations on this issue. The aim of this study was to survey again the same group of surgeons to assess if any difference in management attitudes of AA had occurred in the later stages of the outbreak. Methods: From August 15 to September 30, 2021, an online questionnaire was sent to all 709 participants of the ACIE Appy study. The questionnaire included questions on personal protective equipment (PPE), local policies and screening for SARS-CoV-2 infection, NOM, surgical approach and disease presentations in 2021. The results were compared with the results from the previous study. Results: A total of 476 answers were collected (response rate 67.1%). Screening policies were significatively improved with most patients screened regardless of symptoms (89.5% vs. 37.4%) with PCR and antigenic test as the preferred test (74.1% vs. 26.3%). More patients tested positive before surgery and commercial systems were the preferred ones to filter smoke plumes during laparoscopy. Laparoscopic appendicectomy was the first option in the treatment of AA, with a declined use of NOM. Conclusion: Management of AA has improved in the last waves of pandemic. Increased evidence regarding SARS-COV-2 infection along with a timely healthcare systems response has been translated into tailored attitudes and a better care for patients with AA worldwide

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Is simulation useful in preparing doctors-to-be for patient death: A narrative review

Clinical and communication skills involved in managing patient death are essential for medical practitioners, yet these skills are often neglected in undergraduate medical education. We aim to review current reported evidence of simulation-based education on medical students' preparedness and performance toward patient death. A narrative review of the literature on simulation-based education for medical students on patient death was conducted. Data on study design, simulation dimension, evaluation tool, and outcome were collected and summarized. Eleven prospective studies were included for narrative review. Simulation modalities included mannequins, standardized patients, and online virtual reality. Heterogeneity in the evaluation tool of simulation-based education was demonstrated. Ninety percent of studies concluded positive outcome of simulation on improving medical students' preparedness in patient death. No negative or adverse learner reaction was reported. Simulation-based education may safely improve medical students' competence in handling patient death. Current data and evaluation tools of education outcomes are sparse and heterogeneous. Future research is encouraged to explore this under-researched topic, amid increasing interest in the use of simulation in medical education