Examining the nature of interprofessional interventions designed to promote patient safety : a narrative review

Purpose: This narrative review aimed to scope the patient safety literature to identify interprofessional intervention approaches, sources of evidence and reported outcomes. Data sources: Two major databases (MEDLINE and CINAHL) were searched from 2005 to 2015. Study selection: A total of 1552 abstracts were initially identified. After screening these abstracts, 129 full papers were obtained. Further screening resulted in a total of 89 papers included in this review. Data extraction: The following information was extracted from each included paper: details on the patient safety intervention, study methods employed and outcomes reported. Results of data synthesis: It was found that the bulk of the included studies was undertaken in a North American acute care context. Most often, studies involved qualified professionals from nursing and medicine collaborating in hospitals and medical centres. Nearly half the studies reported in this review employed educational interventions, such as TeamSTEPPS, aimed at enhancing practitioners' competence of delivering safe patient care. Nearly a third of studies involved practice-based interventions (e.g. checklists) aimed at improving the delivery of safe care. Most of the studies used a quasi-experimental design and typically gathered survey data. The majority reported outcomes related to changes in professionals' attitudes, knowledge and skills. There were, however, fewer studies reporting changes in practitioners' safety behaviours, organizational practices or patient benefit. Conclusion: The use of different interprofessional interventions are key activities involved in promoting safe patient care practices. However, further work is needed to strengthen these interventions and their evaluations

Oculomotor Behavior Predict Professional Cricket Batting and Bowling Performance

Importance: A new, shorter version of cricket was introduced recently (Twenty20; T20). Since its inception, T20 cricket has rapidly become a popular and exciting format of cricket. However, there is little understanding of factors such as visual-motor control that influence expert performance. Objective: The purpose of this project is to determine if a series of oculomotor measures can predict batting and bowling performance in professional cricket players. Design: This study used a cross-sectional design. Each participant took part in a suite of eye-tracking tests to measure oculomotor behavior compared to their performance data. Participants: This study used a sample of 59 male T20 league professional cricket players (30 Bowlers and 29 Batsman). Results: One-way univariate analyses of variance examined the differences in oculomotor behavior between batsman and bowlers. A series of multiple regression analyses was conducted to evaluate how well the visual variables predict bowling and batting performance variables. Results demonstrate that several oculomotor eye tracking measures were good predictors of run performance and strike rate, including sports total score, sports on-field score, and sports functional score. Likewise, several of the same metrics predicted Runs and Wicket performance for bowlers. Overall, results provided further validation to a growing body of literature supporting the use of eye-tracking technology in performance evaluation

Transmission and Transport of Energy in the Western U.S. and Canada: A Law and Policy Road Map

This collection of short essays arose from the inaugural meeting of the Idaho Symposium on Energy in the West, which was held in November, 2014. The topic for this first Symposium was Transmission and Transport of Energy in the Western U.S. and Canada: A Law and Policy Road Map. The essays in this collection provide a notable introduction to the major energy issues facing the West today. Topics include: building a resilient legal architecture for western energy production; natural gas flaring; transmission planning for wind energy; utilities and rooftop solar; special considerations for western states and the Clean Power Plan; the Clean Power Plan\u27s implications for the western grid; siting renewable energy on public lands; and implications of utility reform in New York and Hawaii for the Northwest

Suppression of MMP-9 by doxycycline in brain arteriovenous malformations

BACKGROUND: The primary aim of this study is to demonstrate the feasibility of utilizing doxycycline to suppress matrix metalloproteinase-9 (MMP-9) in brain arteriovenous malformations (AVMs). METHODS: Ex-vivo treatment of AVM tissues: Intact AVM tissues were treated with doxycycline for 48 hours. Active and total MMP-9 in the medium were measured. Pilot trial: AVM patients received either doxycycline (100 mg) or placebo twice a day for one week prior to AVM resection. Active and total MMP-9 in BVM tissues were measured. RESULTS: Ex-vivo treatment of AVM tissues: Doxycycline at 10 and 100 μg/ml significantly decreased MMP-9 levels in AVM tissues ex-vivo (total: control vs 10 vs 100 μg/ml = 100 ± 6 vs 60 ± 16 vs 61 ± 9%; active: 100 ± 8 vs 48 ± 16 vs 59 ± 10%). Pilot trial: 10 patients received doxycycline, and 4 patients received placebo. There was a trend for both MMP-9 levels to be lower in the doxycycline group than in the placebo group (total: 2.18 ± 1.94 vs 3.26 ± 3.58, P = .50; active: 0.48 ± 0.48 vs 0.95 ± 1.01 ng/100 μg protein, P = .25). CONCLUSIONS: A clinically relevant concentration of doxycycline decreased MMP-9 in ex-vivo AVM tissues. Furthermore, there was a trend that oral doxycycline for as short as one week resulted in a decrease in MMP-9 in AVM tissues. Further studies are warranted to justify a clinical trial to test effects of doxycycline on MMP-9 expression in AVM tissues

Differences in NT-proBNP Response and Prognosis in Men and Women With Heart Failure With Reduced Ejection Fraction.

Background NT-proBNP (N-terminal pro-B-type natriuretic peptide) is a prognostic biomarker in heart failure (HF) with reduced ejection fraction. However, it is unclear whether there is a sex difference in NT-proBNP response and whether the therapeutic goal of NT-proBNP ≤1000 pg/mL has equivalent prognostic value in men and women with HF with reduced ejection fraction. Methods and Results In a secondary analysis of the GUIDE-IT (Guiding Evidence Based Therapy Using Biomarker Intensified Treatment) trial we analyzed trends in NT-proBNP and goal attainment by sex. Differences in clinical characteristics, HF treatment, and time to all-cause death or HF hospitalization were compared. Landmark analysis at 3 months determined the prognostic value of early NT-proBNP goal achievement in men and women. Of the 286 (32%) women and 608 (68%) men in the GUIDE-IT trial, women were more likely to have a nonischemic cause and shorter duration of HF. Guideline-directed medical therapy was less intense over time in women. The absolute NT-proBNP values were consistently lower in women; however, the change in NT-proBNP and clinical outcomes were similar. After adjustment, women achieving the NT-proBNP goal had an 82% reduction in death or HF hospitalization compared with a 59% reduction in men. Conclusions Men and women with HF with reduced ejection fraction had a similar NT-proBNP response despite less intensive HF treatment among women. However, compared with men, the early NT-proBNP goal of ≤1000 pg/mL had greater prognostic value in women. Future efforts should be aimed at intensifying guideline-directed medical therapy in women, which may result in greater NT-proBNP reductions and improved outcomes in women with HF with reduced ejection fraction. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT01685840

On the notion of home and the goals of palliative care

The notion of home is well known from our everyday experience, and plays a crucial role in all kinds of narratives about human life, but is hardly ever systematically dealt with in the philosophy of medicine and health care. This paper is based upon the intuitively positive connotation of the term “home.” By metaphorically describing the goal of palliative care as “the patient’s coming home,” it wants to contribute to a medical humanities approach of medicine. It is argued that this metaphor can enrich our understanding of the goals of palliative care and its proper objectives. Four interpretations of “home” and “coming home” are explored: (1) one’s own house or homelike environment, (2) one’s own body, (3) the psychosocial environment, and (4) the spiritual dimension, in particular, the origin of human existence. Thinking in terms of coming home implies a normative point of view. It represents central human values and refers not only to the medical-technical and care aspects of health care, but also to the moral context

Cerebral blood flow response to simulated hypovolemia in essential hypertension a magnetic resonance imaging study

Hypertension is associated with raised cerebral vascular resistance and cerebrovascular remodeling. It is currently unclear whether the cerebral circulation can maintain cerebral blood flow (CBF) during reductions in cardiac output (CO) in hypertensive patients thereby avoiding hypoperfusion of the brain. We hypothesized that hypertension would impair the ability to effectively regulate CBF during simulated hypovolemia. In the present study, 39 participants (13 normotensive, 13 controlled, and 13 uncontrolled hypertensives; mean age±SD, 55±10 years) underwent lower body negative pressure (LBNP) at -20, -40, and -50 mmHg to decrease central blood volume. Phase-contrast MR angiography was used to measure flow in the basilar and internal carotid arteries, as well as the ascending aorta. CBF and CO decreased during LBNP (P<0.0001). Heart rate increased during LBNP, reaching significance at -50 mmHg (P<0.0001). There was no change in mean arterial pressure during LBNP (P=0.3). All participants showed similar reductions in CBF (P=0.3, between groups) and CO (P=0.7, between groups) during LBNP. There was no difference in resting CBF between the groups (P=0.36). In summary, during reductions in CO induced by hypovolemic stress, mean arterial pressure is maintained but CBF declines indicating that CBF is dependent on CO in middle-aged normotensive and hypertensive volunteers. Hypertension is not associated with impairments in the CBF response to reduced CO