Interprofessional communication: There's no "I" in team!

Background: The Joint Commission reports communication errors as a leading cause of sentinel events in the U.S. Breakdown in communication across various health fields has been attributed to a lack of teamwork amongst healthcare professionals. Undergraduate health science students rarely have opportunities to work with other disciplines; this lack of opportunity is related to a lack of teamwork. To foster interprofessional teamwork, in 2017, an interprofessional case study event was conducted with undergraduate nursing, nutrition, childlife, social work, and OT/PT students at Tennessee Technological University.Purpose: The purpose of this quantitative, one group (n=130) pre/post test research study was to determine the effects of undergraduate interprofessional educational opportunities on students’ perceptions of interprofessional teamwork.Methods: The case study event consisted of nursing, nutrition, childlife, social work, and OT/PT students at Tennessee Technological University. We gathered data using the SPICE-R2 Instrument to gather quantitative data regarding students’ perceptions of interprofessional team-based practice. The self-report survey was administered before and after the interprofessional case study event to compare pre-event and post-event scores. Our results support statistically significant improvement in students’ perceptions of teamwork.Conclusion: These results indicate the interprofessional case study event helped students realize that interdisciplinary teamwork improved their collaboration and view of teamwork. This increase in communication may decrease the amount of future sentinel events, creating a safer healthcare environment for patients. Due to the statistically significant improvement in students’ perceptions of teamwork, we recommend these events be included in health science students’ educations semesterly

Using a population-based approach to prevent hepatocellular cancer in New South Wales, Australia: effects on health services utilisation

<p>Abstract</p> <p>Background</p> <p>Australians born in countries where hepatitis B infection is endemic are 6-12 times more likely to develop hepatocellular cancer (HCC) than Australian-born individuals. However, a program of screening, surveillance and treatment of chronic hepatitis B (CHB) in high risk populations could significantly reduce disease progression and death related to end-stage liver disease and HCC. Consequently we are implementing the <it>B Positive </it>pilot project, aiming to optimise the management of CHB in at-risk populations in south-west Sydney. Program participants receive routine care, enhanced disease surveillance or specialist referral, according to their stage of CHB infection, level of viral load and extent of liver injury. In this paper we examine the program's potential impact on health services utilisation in the study area.</p> <p>Methods</p> <p>Estimated numbers of CHB infections were derived from Australian Bureau of Statistics data and applying estimates of HBV prevalence rates from migrants' countries of birth. These figures were entered into a Markov model of disease progression, constructing a hypothetical cohort of Asian-born adults with CHB infection. We calculated the number of participants in different CHB disease states and estimated the numbers of GP and specialist consultations and liver ultrasound examinations the cohort would require annually over the life of the program.</p> <p>Results</p> <p>Assuming a 25% participation rate among the 5,800 local residents estimated to have chronic hepatitis B infection, approximately 750 people would require routine follow up, 260 enhanced disease surveillance and 210 specialist care during the first year after recruitment is completed. This translates into 5 additional appointments per year for each local GP, 25 for each specialist and 420 additional liver ultrasound examinations.</p> <p>Conclusions</p> <p>While the program will not greatly affect the volume of local GP consultations, it will lead to a significant increase in demand for specialist services. New models of CHB care may be required to aid program implementation and up scaling the program will need to factor in additional demands on health care utilisation in areas of high hepatitis B sero-prevalence.</p

Surveillance of Sentinel Node-Positive Melanoma Patients with Reasons for Exclusion from MSLT-II:Multi-Institutional Propensity Score Matched Analysis

BACKGROUND: In sentinel lymph node (SLN)-positive melanoma, two randomized trials demonstrated equivalent melanoma-specific survival with nodal surveillance vs completion lymph node dissection (CLND). Patients with microsatellites, extranodal extension (ENE) in the SLN, or >3 positive SLNs constitute a high-risk group largely excluded from the randomized trials, for whom appropriate management remains unknown. STUDY DESIGN: SLN-positive patients with any of the three high-risk features were identified from an international cohort. CLND patients were matched 1:1 with surveillance patients using propensity scores. Risk of any-site recurrence, SLN-basin-only recurrence, and melanoma-specific mortality were compared. RESULTS: Among 1,154 SLN-positive patients, 166 had ENE, microsatellites, and/or >3 positive SLN. At 18.5 months median follow-up, 49% had recurrence (vs 26% in patients without high-risk features, p 3 positive SLN constitute a high-risk group with a 2-fold greater recurrence risk. For those managed with nodal surveillance, SLN-basin recurrences were more frequent, but all-site recurrence and melanoma-specific mortality were comparable to patients treated with CLND. Most recurrences were outside the SLN-basin, supporting use of nodal surveillance for SLN-positive patients with microsatellites, ENE, and/ or >3 positive SLN

Finishing the euchromatic sequence of the human genome

The sequence of the human genome encodes the genetic instructions for human physiology, as well as rich information about human evolution. In 2001, the International Human Genome Sequencing Consortium reported a draft sequence of the euchromatic portion of the human genome. Since then, the international collaboration has worked to convert this draft into a genome sequence with high accuracy and nearly complete coverage. Here, we report the result of this finishing process. The current genome sequence (Build 35) contains 2.85 billion nucleotides interrupted by only 341 gaps. It covers ∼99% of the euchromatic genome and is accurate to an error rate of ∼1 event per 100,000 bases. Many of the remaining euchromatic gaps are associated with segmental duplications and will require focused work with new methods. The near-complete sequence, the first for a vertebrate, greatly improves the precision of biological analyses of the human genome including studies of gene number, birth and death. Notably, the human enome seems to encode only 20,000-25,000 protein-coding genes. The genome sequence reported here should serve as a firm foundation for biomedical research in the decades ahead

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Object Lessons: The Victorians and the Material Text

This volume offers a series of ‘object lessons’ on Victorian publications from broadsides to Bibles, asking what the material forms of these texts teach us about their significance in Victorian culture. Some of our contributors direct their attention to the neglected material forms of the Victorian period—the blank journal, the almanac, the broadside temperance ballad, the thumb Bible, the Illustrated London News’s special issue printed at the Great Exhibition of 1851, and magazines for blind readers. Others consider the under-studied original material forms of now-canonical texts, including the serial and first edition of Sketches by Boz (1836), the first ‘whole book’ written by Dickens as he emerged from his early journalistic career; the first edition of Alice’s Adventures in Wonderland (1865), whose page layout constructs an active child reader; and the neglected serial edition of Henry James’s The Turn of the Screw (1898), written as a marketable commodity by a writer who scorned—but could not afford to ignore—the commodity market. Spanning a temporal range from the 1820s to 1912, all contributions focus attention on the physical ‘book-object’ as nineteenth- and twentieth-century readers encountered it—in all its insistent physicality. Ce volume offre une série de « leçons de choses » sur les publications victoriennes allant des imprimés placardés jusqu’aux Bibles miniatures, interrogeant ce que les formes matérielles de ces textes nous apprennent quant à leur importance dans la culture victorienne. Certains des auteurs portent leurs regards sur des formes matérielles négligées de la période victorienne – le journal, l’almanach, la ballade placardée à visée anti-alcoolique, la Bible miniature, l’édition spéciale de l’Illustrated London News imprimée lors de l’Exposition Universelle de 1851, ainsi que les magazines pour aveugles. D’autres étudient les formes matérielles originales sous-étudiées de textes aujourd’hui canoniques, comme la première édition en séries de Esquisses de Boz (1836), le premier « livre entier » écrit par Dickens lorsqu’il quittait sa carrière journalistique des débuts; la première édition d’Alice au pays des merveilles (1865), dont la mise en page encourage l’enfant lecteur à faire une lecture active; ainsi que l’édition sérielle négligée du Tour d’écrou de Henry James (1898), écrit en tant que produit commercialisable par un écrivain qui méprisait mais ne pouvait toutefois se passer du marché. Couvrant un éventail temporel des années 1820 à 1912, toutes les contributions se concentrent sur l’aspect physique de l’objet-livre tel que les lecteurs des dix-neuvième et vingtième siècles l’ont découvert, dans toute son inévitable matérialité. Nous adressons tous nos remerciements à Laurence Petit qui a effectué la traduction française des résumés et notes biographiques