Comparison of visual vs. automated detection of lipemic, icteric and hemolyzed specimens: can we rely on a human eye?

Background: Results from hemolyzed, icteric, and lipemic samples may be inaccurate and can lead to medical errors. These preanalytical interferences may be detected using visual or automated assessment. Visual inspection is time consuming, highly subjective and not standardized. Our aim was to assess the comparability of automated spectrophotometric detection and visual inspection of lipemic, icteric and hemolyzed samples. Methods: This study was performed on 1727 routine biochemistry serum samples. Automated detection was performed using the Olympus AU2700 analyzer. We assessed: 1) comparability of visual and automated detection of lipemic, icteric and hemolyzed samples, 2) precision of automated detection, and 3) inter-observer variability for visual inspection. Results: Weighted κ coefficients for comparability of visual and automated detection were: 0.555, 0.529 and 0.638, for lipemic, icteric and hemolyzed samples, respectively. The precision for automated detection was high for all interferences, with the exception of samples being only slightly lipemic. The best overall agreement between observers was present in assessing lipemia (mean weighted κ=0.698), whereas the lowest degree of agreement was observed in assessing icterus (mean weighted κ=0.476). Conclusions: Visual inspection of lipemic, icteric and hemolyzed samples is highly unreliable and should be replaced by automated systems that report serum indices. Clin Chem Lab Med 2009;47:1361–5.Peer Reviewe

La formation procédurale par simulation au pré-externat pour réduire l’anxiété et renforcer la confiance des étudiants par rapport à leurs habiletés techniques

Introduction: Pre-clerkship procedural skills training is not yet a standard across Canadian medical school curricula, resulting in limited exposure to procedures upon entering clerkship. While simulated skills training has been documented in the literature to improve performance in technical ability, anxiety and confidence have yet to be investigated despite their documented impact on performance and learning. This study therefore aims to evaluate the effect of pre-clerkship procedural skills training on medical student anxiety and confidence. Methods: A procedural skills training program was designed based on an evidence-based near-peer, flipped classroom model of education. Ninety-two second-year medical students volunteered for the study. Fifty-six were randomized to the training group, and 36 were randomized to the control group. Students in the training group attended seven procedural skills tutorials over seven months. The control group represented the average medical school student without standardized procedural training. Student anxiety and confidence were assessed at the beginning and end of the program using the State Trait Anxiety Inventory and Confidence Questionnaires. Results: Students who participated in the procedural skills program demonstrated greater reductions in their state anxiety and greater improvements in confidence compared to the control group. Conclusion: Longitudinal procedural skills training in the simulation setting has demonstrated improvements in anxiety and confidence among pre-clerkship medical students. These added benefits to training have the potential to ease medical students’ transition into clerkship, while also contributing to a safer and more effective clinical experience. Therefore, future integration of standardized pre-clerkship procedural skills training within medical school curricula should be considered.Introduction : Les cursus de pré-externat des facultés de médecine canadiennes ne prévoient pas systématiquement de formation sur les habiletés techniques avant, si bien qu’à leur arrivée à l’externat, les étudiants ont une exposition limitée aux gestes techniques. Tandis que l’amélioration des aptitudes techniques par la simulation est bien documentée, il n’y a aucune étude sur l’effet de ces simulations sur l’anxiété et la confiance malgré leur impact avéré sur la performance et l’apprentissage. Cette étude vise donc à évaluer l’effet d’une formation sur les habiletés techniques au pré-externat sur l’anxiété et la confiance des étudiants en médecine. Méthodes : Une formation sur les habiletés techniques a été conçue sur la base d’un modèle d’enseignement fondé sur les données probantes, par les quasi-pairs suivant une approche de classe inversée. Quatre-vingt-douze étudiants en deuxième année de médecine ont participé à l’étude sur une base volontaire. Cinquante-six d’entre eux ont été répartis au hasard dans le groupe qui devait recevoir la formation, et 36 dans le groupe contrôle. Les étudiants du groupe qui a reçu la formation ont assisté à sept tutoriels étalés sur une période de sept mois. Le groupe témoin représentait l’étudiant en médecine moyen sans formation normalisée axée sur les habiletés techniques. L’anxiété et la confiance des étudiants ont été évaluées au début et à la fin du programme à l’aide du questionnaire State Trait Anxiety Inventory (questionnaire sur l’anxiété chronique et réactionnelle) et d’un questionnaire sur la confiance. Résultats : Chez les étudiants qui ont participé au programme de formation sur les habiletés techniques, la baisse de l’anxiété et l’amélioration de la confiance en soi ont été plus importantes que chez les étudiants du groupe contrôle. Conclusion : La formation longitudinale axée sur les habiletés techniques en contexte de simulation a eu des effets positifs en ce qui concerne l’anxiété et la confiance chez les étudiants en médecine au pré-externat. La formation offre l’avantage supplémentaire de faciliter la transition des étudiants en médecine vers l’externat, tout en contribuant à rendre l’expérience clinique plus sûre et plus efficace. Il serait donc intéressant pour les facultés de médecine d’intégrer dans le cursus une formation normalisée axée sur les habiletés techniques au pré-externat

Фінансове забезпечення інноваційного розвитку фармбізнесу: глобальні виклики

Глобальні загрози життєдіяльності населення безперешкодно охоплюють держави як с потужною економікою так і ті, що розвиваються. В умовах коли Уряд не в змозі сприяти створенню власного потужного та ефективного фармацевтичного бізнесу. Слід сприяти забезпеченню національного ринку імпортними інноваційними препаратами та втілювати західну модель економіки здоров’я, як передумови інноваційного гармонійного розвитку фармбізнесу

Vitamin D status in mothers with pre-eclampsia and their infants: a case-control study from Serbia, a country without a vitamin D fortification policy

Objective: The objective of the present study was to determine if vitamin D intake and status are associated with pre-eclampsia in a country without a vitamin D fortification policy. Design: A case-control study of pregnancies with (case) and without (control) pre-eclampsia was conducted from January to April when UVB is minimal. Maternal and cord blood obtained at delivery were measured for plasma 25-hydroxycholecalciferol (25-OH-D-3), 3-epimer of 25-OH-D-3 (3-epi-25-OH-D-3) and 24,25-dihydroxycholecalciferol (24,25-(OH)(2)D-3) by LC-MS/MS and maternal 1,25-dihydroxyvitamin D (1,25-(OH) 2D). Differences between groups were tested with ANOVA and Bonferroni post hoc tests (P lt 0.05). Setting: Clinical Center of Serbia. Subjects: Pregnant women with and without pre-eclampsia (n 60) and their infants. Results: Exogenous vitamin D intake (0.95-16.25 mu g/d (38-650 IU/d)) was not significantly different between groups. Women with pre-eclampsia delivered infants at an earlier gestational age and had significantly lower mean total plasma 25-hydroxyvitamin D (25-OH-D; case: 11.2 (SD 5.1); control: 16.1 (SD 5.7) ng/ml; P=0.0006), 25-OH-D-3 (case: 10.0 (SD 4.9); control: 14.2 (SD 5.8) ng/ml; P=0.002), 3-epi-25-OH-D-3 (case: 0.5 (SD 0.2); control: 0.7 (SD 0.2) ng/ml; P=0.0007) and 1,25-(OH)(2)D (case: 56.5 (SD 26.6); control: 81.0 (SD 25.7) pg/ml; P=0.018), while 24,25-(OH)(2)D-3 was not different between groups. Infants did not differ in total plasma 25-OH-D, 25-OH-D-3, 3-epi-25-OH-D-3 and 24,25-(OH)(2)D-3, but the mean proportion of 3-epi-25-OH-D-3 was higher in the infant case group (case: 7.9 (SD 1.1); control: 7.0 (SD 1.4) % of total 25-OH-D-3; P=0.005). Conclusions: A high prevalence of vitamin D deficiency, as defined by plasma 25-OH-D lt 12 ng/ml, was observed in 47 % of all mothers and 77 % of all infants. These data underscore the need for prenatal vitamin D supplementation and a food fortification policy in Serbia

Validity of an FFQ assessing the vitamin D intake of young Serbian women living in a region without food fortification: the method of triads model

Objective: The objective of the present study was to examine the external validity of an FFQ designed to estimate dietary vitamin D intake compared with a plasma biomarker and three repeated 24 h dietary recalls in women of reproductive age in Serbia, where there is no exposure to food fortified with vitamin D. The method of triads was applied. Design: In a cross-sectional study, 422 women completed the Women and Reproductive Health FFQ (WRH-FFQ) during the winter months. From a representative subgroup (n 44), three 24 h dietary recalls and anthropometric parameters were collected as well as a fasting blood sample for vitamin D biomarker analyses. Correlation coefficients were calculated between each of the dietary methods. Validity coefficients, as a correlation between the measured and estimated 'true' exposure, were calculated using the method of triads. Bland-Altman plots were also constructed. Setting: Three major universities in Serbia. Subjects: Healthy young women (n 422) aged 18-35 years. Results: The WRH-FFQ estimate of vitamin D intake for all participants was 4.0 (SD 3.3) mu g/d and 3.1 (SD 2.3) mu g/d for the subgroup. Bland-Altman plots for these intakes showed high agreement. Validity coefficients for the FFQ, 24 h recall and biomarker were. rho(QI) = 0.847 (95 % CI 0.564, 0.928), rho(RI) = 0.810 (95 % CI 0.537, 0.997) and rho(BI) = 0.499 (95 % CI 0.190, 0.840), while the correlation coefficients were 0.686, 0.422 and 0.404. Conclusions: The FFQ applied in the present study is a valid tool for assessing dietary vitamin D intake in women living in Serbia, a region without mandatory vitamin D food fortification

Prospective Validation of the Emergency Heart Failure Mortality Risk Grade for Acute Heart Failure: The ACUTE Study

Background: Improved risk stratification of acute heart failure in the emergency department may inform physicians\u27 decisions regarding patient admission or early discharge disposition. We aimed to validate the previously-derived Emergency Heart failure Mortality Risk Grade for 7-day (EHMRG7) and 30-day (EHMRG30-ST) mortality. Methods: We conducted a multicenter, prospective validation study of patients with acute heart failure at 9 hospitals. We surveyed physicians for their estimates of 7-day mortality risk, obtained for each patient before knowledge of the model predictions, and compared these with EHMRG7 for discrimination and net reclassification improvement. We also prospectively examined discrimination of the EHMRG30-ST model, which incorporates all components of EHMRG7 as well as the presence of ST-depression on the 12-lead ECG. Results: We recruited 1983 patients seeking emergency department care for acute heart failure. Mortality rates at 7 days in the 5 risk groups (very low, low, intermediate, high, and very high risk) were 0%, 0%, 0.6%, 1.9%, and 3.9%, respectively. At 30 days, the corresponding mortality rates were 0%, 1.9%, 3.9%, 5.9%, and 14.3%. Compared with physician-estimated risk of 7-day mortality (PER7; c-statistic, 0.71; 95% CI, 0.64-0.78) there was improved discrimination with EHMRG7 (c-statistic, 0.81; 95% CI, 0.75-0.87; P=0.022 versus PER7) and with EHMRG7 combined with physicians\u27 estimates (c-statistic, 0.82; 95% CI, 0.76-0.88; P=0.003 versus PER7). Model discrimination increased nonsignificantly by 0.014 (95% CI, -0.009-0.037) when physicians\u27 estimates combined with EHMRG7 were compared with EHMRG7 alone (P=0.242). The c-statistic for EHMRG30-ST alone was 0.77 (95% CI, 0.73-0.81) and 30-day model discrimination increased nonsignificantly by addition of physician-estimated risk to 0.78 (95% CI, 0.73-0.82; P=0.187). Net reclassification improvement with EHMRG7 was 0.763 (95% CI, 0.465-1.062) when assessed continuously and 0.820 (0.560-1.080) using risk categories compared with PER7. Conclusions: A clinical model allowing simultaneous prediction of mortality at both 7 and 30 days identified acute heart failure patients with a low risk of events. Compared with physicians\u27 estimates, our multivariable model was better able to predict 7-day mortality and may guide clinical decisions. Clinical Trial Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT02634762

ABORDAGENS CIRÚRGICAS EM ÚLCERAS PÉPTICAS PERFURADAS: COMPARAÇÃO ENTRE TÉCNICAS LAPAROSCÓPICAS E ABERTAS

Peptic ulcer is a lesion that occurs in the mucosa of the stomach or duodenum, characterized by tissue erosion due to the action of gastric acid and digestive enzymes. Thus, the treatment of perforated peptic ulcers represents a significant challenge in surgical practice due to the need for rapid and effective intervention to prevent serious complications. In recent years, laparoscopic approaches have gained popularity compared to traditional open techniques. Objective: To compare laparoscopic and open surgical approaches in the treatment of perforated peptic ulcers, evaluating the efficacy, safety and clinical results of each technique. Methodology: The Cochrane, Scielo and Pubmed databases were used, searching for articles published between 2020 and 2023, in Portuguese or English. Final Considerations: Laparoscopic surgery offers significant benefits, including reduced postoperative pain, faster recovery, and lower infection rates. However, open surgery remains crucial in cases of patients with hemodynamic instability or complex perforations that make laparoscopic visualization difficult. The decision between the two approaches must be individualized, considering the patient's clinical conditions, the surgeon's experience and available resources, to ensure the best possible recovery and reduce the risk of complications.Úlcera péptica é uma lesão que ocorre na mucosa do estômago ou do duodeno, caracterizada pela erosão do tecido devido à ação do ácido gástrico e das enzimas digestivas. Assim, o tratamento de úlceras pépticas perfuradas representa um desafio significativo na prática cirúrgica devido à necessidade de intervenção rápida e eficaz para prevenir complicações graves. Nos últimos anos, as abordagens laparoscópicas têm ganhado popularidade em comparação com as técnicas abertas tradicionais.  Objetivo: Comparar as abordagens cirúrgicas laparoscópicas e abertas no tratamento de úlceras pépticas perfuradas, avaliando a eficácia, segurança e os resultados clínicos de cada técnica. Metodologia:  Foram utilizadas as bases de dados Cochrane, Scielo e Pubmed, buscando artigos publicados entre os anos de 2020 e 2023, nos idiomas Português ou Inglês. Considerações Finais: A cirurgia laparoscópica oferece benefícios significativos, incluindo menor dor pós-operatória, recuperação mais rápida e menores taxas de infecção. No entanto, a cirurgia aberta continua sendo crucial em casos de pacientes com instabilidade hemodinâmica ou com perfurações complexas que dificultam a visualização laparoscópica. A decisão entre as duas abordagens deve ser individualizada, considerando as condições clínicas do paciente, a experiência do cirurgião e os recursos disponíveis, para garantir a melhor recuperação possível e reduzir o risco de complicações

A pre-clerkship simulation-based procedural skills curriculum: decreasing anxiety and improving confidence of procedural skill performance

Introduction: Pre-clerkship procedural skills training is not yet a standard across Canadian medical school curricula, resulting in limited exposure to procedures upon entering clerkship. While simulated skills training has been documented in the literature to improve performance in technical ability, anxiety and confidence have yet to be investigated despite their documented impact on performance and learning. This study therefore aims to evaluate the effect of pre-clerkship procedural skills training on medical student anxiety and confidence.Methods: A procedural skills training program was designed based on an evidence-based near-peer, flipped classroom model of education. Ninety-two second-year medical students volunteered for the study. Fifty-six were randomized to the training group, and 36 were randomized to the control group. Students in the training group attended seven procedural skills tutorials over seven months. The control group represented the average medical school student without standardized procedural training. Student anxiety and confidence were assessed at the beginning and end of the program using the State Trait Anxiety Inventory and Confidence Questionnaires.Results: Students who participated in the procedural skills program demonstrated greater reductions in their state anxiety and greater improvements in confidence compared to the control group.Conclusion: Longitudinal procedural skills training in the simulation setting has demonstrated improvements in anxiety and confidence among pre-clerkship medical students. These added benefits to training have the potential to ease medical students’ transition into clerkship, while also contributing to a safer and more effective clinical experience. Therefore, future integration of standardized pre-clerkship procedural skills training within medical school curricula should be considered.Introduction : Les cursus de pré-externat des facultés de médecine canadiennes ne prévoient pas systématiquement de formation sur les habiletés techniques avant, si bien qu’à leur arrivée à l’externat, les étudiants ont une exposition limitée aux gestes techniques. Tandis que l’amélioration des aptitudes techniques par la simulation est bien documentée, il n’y a aucune étude sur l’effet de ces simulations sur l’anxiété et la confiance malgré leur impact avéré sur la performance et l’apprentissage. Cette étude vise donc à évaluer l’effet d’une formation sur les habiletés techniques au pré-externat sur l’anxiété et la confiance des étudiants en médecine.Méthodes : Une formation sur les habiletés techniques a été conçue sur la base d’un modèle d’enseignement fondé sur les données probantes, par les quasi-pairs suivant une approche de classe inversée. Quatre-vingt-douze étudiants en deuxième année de médecine ont participé à l’étude sur une base volontaire. Cinquante-six d’entre eux ont été répartis au hasard dans le groupe qui devait recevoir la formation, et 36 dans le groupe contrôle. Les étudiants du groupe qui a reçu la formation ont assisté à sept tutoriels étalés sur une période de sept mois. Le groupe témoin représentait l’étudiant en médecine moyen sans formation normalisée axée sur les habiletés techniques. L’anxiété et la confiance des étudiants ont été évaluées au début et à la fin du programme à l’aide du questionnaire State Trait Anxiety Inventory (questionnaire sur l’anxiété chronique et réactionnelle) et d’un questionnaire sur la confiance.Résultats : Chez les étudiants qui ont participé au programme de formation sur les habiletés techniques, la baisse de l’anxiété et l’amélioration de la confiance en soi ont été plus importantes que chez les étudiants du groupe contrôle.Conclusion : La formation longitudinale axée sur les habiletés techniques en contexte de simulation a eu des effets positifs en ce qui concerne l’anxiété et la confiance chez les étudiants en médecine au pré-externat. La formation offre l’avantage supplémentaire de faciliter la transition des étudiants en médecine vers l’externat, tout en contribuant à rendre l’expérience clinique plus sûre et plus efficace. Il serait donc intéressant pour les facultés de médecine d’intégrer dans le cursus une formation normalisée axée sur les habiletés techniques au pré-externat

Heavy metals in the Adriatic-Ionian Seas

Harmonization of monitoring protocols and analytical methods is a crucial issue for transnational marine environmental status assessment, yet not the only one. Coherent data management and quality control become very relevant when environmental status is assessed at regional or subregional scale (e.g., for the Mediterranean or the Adriatic Sea), thus requiring data from different sources. Heavy metals are among the main targets of monitoring activities. Significant efforts have been dedicated to share best practices for monitoring and assessment of ecosystem status and to strengthen the network of national, regional and European large data infrastructures in order to facilitate the access to data among countries. Data comparability and interoperability depend not only on sampling and analytical protocols but also on how data and metadata are managed, quality controlled and made accessible. Interoperability is guaranteed by using common metadata and data formats, and standard vocabularies to assure homogeneous syntax and semantics. Data management of contaminants is complex and challenging due to the high number of information required on sampling and analytical procedures, high heterogeneity in matrix characteristics, but also to the large and increasing number of pollutants. Procedures for quality control on heterogeneous datasets provided by multiple sources are not yet uniform and consolidated. Additional knowledge and reliable long time-series of data are needed to evaluate typical ranges of contaminant concentration. The analysis of a coherent and harmonized regional dataset can provide the basis for a multi-step quality control procedure, which can be further improved as knowledge increases during data validation process