Opportunities for the CTEI:disentangling frequency and quality in evaluating teaching behaviours

Students' perceptions of teaching quality are vital for quality assurance purposes. An increasingly used, department-independent instrument is the (Cleveland) clinical teaching effectiveness instrument (CTEI). Although the CTEI was developed carefully and its validity and reliability confirmed, we noted an opportunity for improvement given an intermingling in its rating scales: the labels of the answering scales refer to both frequency and quality of teaching behaviours. Our aim was to investigate whether frequency and quality scores on the CTEI items differed. A sample of 112 residents anonymously completed the CTEI with separate 5-point rating scales for frequency and quality. Differences between frequency and quality scores were analyzed using paired t tests. Quality was, on average, rated higher than frequency, with significant differences for ten out of 15 items. The mean scores differed significantly in favour of quality. As the effect size was large, the difference in mean scores was substantial. Since quality was generally rated higher than frequency, the authors recommend distinguishing frequency from quality. This distinction helps to obtain unambiguous outcomes, which may be conducive to providing concrete and accurate feedback, improving faculty development and making fair decisions concerning promotion, tenure or salar

Serum 25-hydroxyvitamin D levels in hospitalized adults with community-acquired pneumonia

Introduction: Community‐acquired pneumonia (CAP) is the infectious disease with the highest number of deaths worldwide. Several studies have shown an association between vitamin D deficiency and increases susceptibility to respiratory tract infections. Objective: The aim of this study was to evaluate the serum 25‐hydroxyvitamin D (25OHD) levels in hospitalized adults in general room with CAP. Materials and methods: An observational study was carried out in 207 hospitalized adults of both sex with CAP (>18 years) from Rosario city, Argentina (32° 52′ 18″S) between July 2015 and June 2016. Results: In total, 167 patients were included in the data analysis [59% women (57.4 ± 19.6 years), body mass index 27.2 ± 7.8 kg/m2]. In brief, 63% showed unilobar infiltrate and 37% were multilobar. The CURB‐65 index was 66.5% low risk, 16.0% intermediate risk and 17.5% high risk. According to Charlson comorbidity index (CCI) 53.5% had not comorbidity (CCI = 0) and 46.5% showed CCI ≥ 1. The 25OHD level was: 11.92 ± 7.6 ng/mL (51.5%: 30 ng/mL). Higher 25OHD were found in male (female: 10.8 ± 6.7 ng/mL, male: 13.5 ± 8.5 ng/mL, P = .02) and 25OHD correlated with age (r = –.17; P = .02). 25‐Hydroxyvitamin D was also correlated with CURB65 index (r = –.13; P = .049), CCI (r = –.20, P = .007) and with the 10 years of life expectative (%) (r = .19; P = .008). In addition, higher 25OHD were found with lower CCI (CCI 0 = 13.0 ± 8.2 ng/mL, CCI ≥ 1= 10.5 ± 6.7 ng/mL; P = .0093). Conclusions: Hospitalized adults with CAP have lower 25OHD levels and would be associated with the severity of CAP.Fil: Brance, María Lorena. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Rosario; Argentina. Universidad Nacional de Rosario. Facultad de Ciencias Médicas. Laboratorio de Biología Ósea; ArgentinaFil: Miljevic, Julio Norberto. Provincia de Santa Fe. Municipalidad de Rosario; Argentina. Universidad Nacional de Rosario. Facultad de Ciencias Médicas; ArgentinaFil: Tizziani, Raquel. Universidad Nacional de Rosario. Facultad de Ciencias Médicas; Argentina. Provincia de Santa Fe. Municipalidad de Rosario; ArgentinaFil: Taberna, María E.. Provincia de Santa Fe. Municipalidad de Rosario; Argentina. Universidad Nacional de Rosario. Facultad de Ciencias Médicas; ArgentinaFil: Grossi, Georgina P.. Universidad Nacional de Rosario. Facultad de Ciencias Médicas; Argentina. Provincia de Santa Fe. Municipalidad de Rosario; ArgentinaFil: Toni, Pablo. Universidad Nacional de Rosario. Facultad de Ciencias Médicas; Argentina. Provincia de Santa Fe. Municipalidad de Rosario; ArgentinaFil: Valentini, Elina. Universidad Nacional de Rosario. Facultad de Ciencias Médicas; Argentina. Sanatorio de la Mujer; ArgentinaFil: Trepat, Andrea. Universidad Nacional de Rosario. Facultad de Ciencias Médicas; Argentina. Sanatorio de la Mujer; ArgentinaFil: Zaccardi, Julia. Universidad Nacional de Rosario. Facultad de Ciencias Médicas; Argentina. Hospital Español de Rosario; ArgentinaFil: Moro, Juan. Universidad Nacional de Rosario. Facultad de Ciencias Médicas; Argentina. Hospital Español de Rosario; ArgentinaFil: Finuci Curi, Baltasar. Provincia de Santa Fe. Ministerio de Salud. Hospital Provincial de Rosario; Argentina. Universidad Nacional de Rosario. Facultad de Ciencias Médicas; ArgentinaFil: Tamagnone, Norberto. Provincia de Santa Fe. Ministerio de Salud. Hospital Provincial de Rosario; Argentina. Universidad Nacional de Rosario. Facultad de Ciencias Médicas; ArgentinaFil: Ramirez, Mariano. Sanatorio Plaza de Rosario; Argentina. Universidad Nacional de Rosario. Facultad de Ciencias Médicas; ArgentinaFil: Severini, Javier. Universidad Nacional de Rosario. Facultad de Ciencias Médicas; Argentina. Provincia de Santa Fe. Municipalidad de Rosario; ArgentinaFil: Chiarotti, Pablo Ignacio. Provincia de Santa Fe. Municipalidad de Rosario; Argentina. Universidad Nacional de Rosario. Facultad de Ciencias Médicas; ArgentinaFil: Consiglio, Francisco. Universidad Nacional de Rosario. Facultad de Ciencias Médicas; Argentina. Sanatorio Laprida de Rosario; ArgentinaFil: Piñeski, Raúl. Universidad Nacional de Rosario. Facultad de Ciencias Médicas; Argentina. Sanatorio Laprida de Rosario; ArgentinaFil: Ghelfi, Albertina. Universidad Nacional de Rosario. Facultad de Ciencias Médicas; Argentina. Provincia de Santa Fe. Ministerio de Salud. Hospital Escuela "Eva Perón"; ArgentinaFil: Kilstein, Jorge Guillermo. Provincia de Santa Fe. Ministerio de Salud. Hospital Escuela "Eva Perón"; Argentina. Universidad Nacional de Rosario. Facultad de Ciencias Médicas; ArgentinaFil: Street, Eduardo. Hospital Rosendo García de Rosario; Argentina. Universidad Nacional de Rosario. Facultad de Ciencias Médicas; ArgentinaFil: Moretti, Dino. Universidad Nacional de Rosario. Facultad de Ciencias Médicas; Argentina. Sanatorio Delta de Rosario; ArgentinaFil: Oliveto, Viviana. Sanatorio Nuestra Señora del Rosario; Argentina. Universidad Nacional de Rosario. Facultad de Ciencias Médicas; ArgentinaFil: Mariño, Marcelo. Universidad Nacional de Rosario. Facultad de Ciencias Médicas; Argentina. Sanatorio Británico de Rosario; ArgentinaFil: Manera, Jorge. Sanatorio Británico de Rosario; Argentina. Universidad Nacional de Rosario. Facultad de Ciencias Médicas; ArgentinaFil: Brun, Lucas Ricardo Martín. Universidad Nacional de Rosario. Facultad de Ciencias Médicas; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Rosario; Argentin

Blinded randomised controlled trial of low-dose Adjuvant Steroids in Adults admitted to hospital with Pandemic influenza (ASAP): a trial 'in hibernation', ready for rapid activation

Background: There are no completed randomised trials of the use of corticosteroids in patients with severe influenza infection. Corticosteroid use in influenza is widespread, non-systematic and marked by controversy. A recent meta-analysis of observational studies of adjuvant corticosteroids in influenza found an association with increased mortality but there were important concerns regarding the risks of bias. Objectives: To (1) evaluate whether or not low-dose corticosteroids given as an adjunct to standard treatment is beneficial in patients who are hospitalised with severe pandemic influenza and (2) develop an 'off-the-shelf' clinical trial that is ready to be activated in a future pandemic. Design: Multicentre, pragmatic, blinded, randomised placebo-controlled trial. Setting: Thirty to 40 hospitals in the UK. Participants: Adults (>/= 16 years) admitted to hospital with an influenza-like illness during a pandemic. INTERVENTION: Five-day course of dexamethasone (Dexsol(R), Rosemont Pharmaceuticals Ltd) 6 mg daily, started within 24 hours of admission. Main outcome measure: Admission to Intensive Care Unit, or death, within 30 days of admission to hospital. Results: This trial has not yet been activated. It is currently set up with full ethics and regulatory approvals in place, ready for rapid activation at the onset of the next pandemic. Hurdles to setting up a pandemic trial include planning for pandemic-level pressures on UK NHS resources and co-enrolment of patients to multiple pandemic studies, ensuring adequate geographical distribution of participating sites, maintaining long-term low-level engagement with site investigators, addressing future trial-specific training needs of local investigators and resilience planning in trial management. Identified threats to trial delivery include changes to research capabilities or policies during the hibernation phase, lack of staff resources during a pandemic and the influence of media at the time of a pandemic. A mismatch in the approach to informed consent required by current regulations to that preferred by patients and the public was identified. Conclusions: This study demonstrates that advance set-up of a trial to be conducted during a pandemic, with full regulatory approvals in place, is possible. Regular review during the hibernation phase will be required. This study serves as a model for the development of other 'off-the-shelf' trials as part of preparedness planning for public health emergencies. Trial registration: Current Controlled Trials ISRCTN72331452. European Union Drug Regulating Authorities Clinical Trials number: 2013-001051-12. Funding: This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 19, No. 16. See the NIHR Journals Library website for further project information

Vitamin D deficiency in human and murine sepsis

Objectives: Vitamin D deficiency has been implicated as a pathogenic factor in sepsis and ICU mortality but causality of these associations has not been demonstrated. To determine whether sepsis and severe sepsis are associated with vitamin D deficiency and to determine whether vitamin D deficiency influences the severity of sepsis.  Design, Setting, and Patients: Sixty-one patients with sepsis and severe sepsis from two large U.K. hospitals and 20 healthy controls were recruited. Murine models of cecal ligation and puncture and intratracheal lipopolysaccharide were undertaken in normal and vitamin D deficient mice to address the issue of causality.  Measurements and Main Results: Patients with severe sepsis had significantly lower concentrations of 25-hydroxyvitamin D3 than patients with either mild sepsis or age-matched healthy controls (15.7 vs 49.5 vs 66.5 nmol/L; p = 0.0001). 25-hydroxyvitamin D3 concentrations were significantly lower in patients who had positive microbiologic culture than those who were culture negative (p = 0.0023) as well as those who died within 30 days of hospital admission (p = 0.025). Vitamin D deficiency in murine sepsis was associated with increased peritoneal (p = 0.037), systemic (p = 0.019), and bronchoalveolar lavage (p = 0.011) quantitative bacterial culture. This was associated with reduced local expression of the cathelicidin-related antimicrobial peptide as well as evidence of defective macrophage phagocytosis (p = 0.029). In the intratracheal lipopolysaccharide model, 1,500 IU of intraperitoneal cholecalciferol treatment 6 hours postinjury reduced alveolar inflammation, cellular damage, and hypoxia.  Conclusions: Vitamin D deficiency is common in severe sepsis. This appears to contribute to the development of the condition in clinically relevant murine models and approaches to correct vitamin D deficiency in patients with sepsis should be developed

Correction to:An antibody-free LC-MS/MS method for the quantification of intact insulin-like growth factors 1 and 2 in human plasma

Insulin-like growth factors 1 and 2 (IGF-1 and IGF-2) are important biomarkers in research and diagnosis of growth disorders. Quantitative analysis is performed using various ligand-binding assays or enzymatic digestion LC-MS/MS methods, whose widespread adoption is hampered by time-consuming sample preparation procedures. We present a simple and fast antibody-free LC-MS/MS method for the quantification of intact IGF-1 and IGF-2 in human plasma. The method requires 50 mu L of plasma and uses fully N-15-labelled IGF-1 as internal standard. It features trifluoroethanol (TFE)-based IGF/IGF-binding protein complex dissociation and a two-step selective protein precipitation workflow, using 5% acetic acid in 80/20 acetone/acetonitrile (precipitation 1) and ice-cold ethanol (precipitation 2). Detection of intact IGF-1 and IGF-2 is performed by means of a Waters XEVO TQ-S triple quadrupole mass spectrometer in positive electrospray ionisation (ESI+) mode. Lower limits of quantification were 5.9 ng/mL for IGF-1 and 8.4 ng/mL for IGF-2. Intra-assay imprecision was below 4.5% and inter-assay imprecision was below 5.8% for both analytes. An excellent correlation was found between nominal and measured concentrations of the WHO reference standard for IGF-1. Comparison with the IDS-iSYS IGF-1 immunoassay showed good correlation (R-2 > 0.97), although a significant bias was observed with the immunoassay giving substantially higher concentrations. The LC-MS/MS method described here allows for reliable and simultaneous quantification of IGF-1 and IGF-2 in plasma, without the need for enzymatic digestion. The method can be readily implemented in clinical mass spectrometry laboratories and has the potential to be adapted for the analysis of different similarly sized peptide hormones

An antibody-free LC-MS/MS method for the quantification of intact insulin-like growth factors 1 and 2 in human plasma

Insulin-like growth factors 1 and 2 (IGF-1 and IGF-2) are important biomarkers in research and diagnosis of growth disorders. Quantitative analysis is performed using various ligand-binding assays or enzymatic digestion LC-MS/MS methods, whose widespread adoption is hampered by time-consuming sample preparation procedures. We present a simple and fast antibody-free LC-MS/MS method for the quantification of intact IGF-1 and IGF-2 in human plasma. The method requires 50 mu L of plasma and uses fully N-15-labelled IGF-1 as internal standard. It features trifluoroethanol (TFE)-based IGF/IGF-binding protein complex dissociation and a two-step selective protein precipitation workflow, using 5% acetic acid in 80/20 acetone/acetonitrile (precipitation 1) and ice-cold ethanol (precipitation 2). Detection of intact IGF-1 and IGF-2 is performed by means of a Waters XEVO TQ-S triple quadrupole mass spectrometer in positive electrospray ionisation (ESI+) mode. Lower limits of quantification were 5.9 ng/mL for IGF-1 and 8.4 ng/mL for IGF-2. Intra-assay imprecision was below 4.5% and inter-assay imprecision was below 5.8% for both analytes. An excellent correlation was found between nominal and measured concentrations of the WHO reference standard for IGF-1. Comparison with the IDS-iSYS IGF-1 immunoassay showed good correlation (R-2 > 0.97), although a significant bias was observed with the immunoassay giving substantially higher concentrations. The LC-MS/MS method described here allows for reliable and simultaneous quantification of IGF-1 and IGF-2 in plasma, without the need for enzymatic digestion. The method can be readily implemented in clinical mass spectrometry laboratories and has the potential to be adapted for the analysis of different similarly sized peptide hormones

Vitamin D deficiency contributes directly to the acute respiratory distress syndrome (ARDS)

Rationale: Vitamin D deficiency has been implicated as a pathogenic factor in sepsis and intensive therapy unit mortality but has not been assessed as a risk factor for acute respiratory distress syndrome (ARDS). Causality of these associations has never been demonstrated. Objectives: To determine if ARDS is associated with vitamin D deficiency in a clinical setting and to determine if vitamin D deficiency in experimental models of ARDS influences its severity. Methods: Human, murine and in vitro primary alveolar epithelial cell work were included in this study. Findings: Vitamin D deficiency (plasma 25(OH)D levels 600 genes. In a clinical setting, pharmacological repletion of vitamin D prior to oesophagectomy reduced the observed changes of in vivo measurements of alveolar capillary damage seen in deficient patients. Conclusions: Vitamin D deficiency is common in people who develop ARDS. This deficiency of vitamin D appears to contribute to the development of the condition, and approaches to correct vitamin D deficiency in patients at risk of ARDS should be developed