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Yousef KM, Alananzeh I, Beegom S, Chavez J, Hatahet S, Khalil H, Krom Z, Svetlov O. Assessing Outcome Measurements and Impact of Simulation in Neurocritical Care Training: A Systematic Review. J Neurosci Nurs 2024; 56:130-135. [PMID: 38876470 DOI: 10.1097/jnn.0000000000000767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2024]
Abstract
ABSTRACT AIM: The use of simulation training in neurocritical care is increasing. Yet, the pooled impact on patient and trainee outcomes remains unclear. This systematic review aims to determine the outcome measurements used after simulation training in neurocritical care and to synthesize the current evidence about the impact of simulation training on these outcomes. METHODS: A 3-step search was conducted in CINAHL, Cochrane, MEDLINE, PsychINFO, and Scopus. The inclusion criteria were composed of studies exploring simulation training in neurocritical care, published in English between 2000 and 2023. Two reviewers independently conducted screening, critical appraisal, and data extraction, using standardized Joanna Briggs Institute tools. Meta-analysis was precluded because of clinical, methodological, and statistical heterogeneity. RESULTS: Nine relevant studies were found: 1 quality improvement project and 8 quasi-experimental studies. The overall quality of the relevant studies was moderate to high (61.1%-77.8%). Three types of outcome measurements for simulation in neurocritical care were identified: knowledge and clinical performance; confidence and comfort; and teamwork, communication, and leadership skills. Simulation training was associated with a significant improvement in knowledge and clinical performance, and confidence and comfort, but not in communication and leadership skills. CONCLUSION: Significant improvement in trainees' outcomes was observed. The current literature includes significant heterogeneity in the methods of evaluating simulation outcomes, although no patient outcomes were observed. Investigating the effect of simulation in neurocritical care training on patient outcomes in future studies is warranted.
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Gheihman G, Harrold GK, Howard D, Albin CSW, Kaplan TB. Using Neurology Trainees as Standardized Patients in a Neurological Emergency Simulation Curriculum for Medical Students. MEDICAL SCIENCE EDUCATOR 2024; 34:589-599. [PMID: 38887414 PMCID: PMC11180045 DOI: 10.1007/s40670-024-02016-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/21/2024] [Indexed: 06/20/2024]
Abstract
Purpose Simulation manikins have limited ability to mimic neurological exam findings, which has historically constrained their use in neurology education. We developed a cased-based simulation curriculum in which neurology trainees acted as standardized patients (SPs) and portrayed the neurologic exam for medical students. Materials/Methods We ran monthly simulations of two cases (acute stroke and seizure) with resident/fellow SPs. Pre-/post-session surveys assessed students' self-rated confidence in neurological clinical skills (gathering a history, performing an exam, presenting a case) and knowledge domains. Questions about students' attitudes about neurology were adapted from a validated assessment tool. Paired t-tests were performed for quantitative items. Qualitative thematic analysis identified key themes. Results Sixty-one students participated. Post-session, students reported significantly higher self-confidence in all neurological clinical skills and knowledge domains (p < 0.002). Greater than ninety-five percent agreed the session met the learning objectives; 95% recommended it to others. Resident/fellow SPs were cited as the most effective educational component. Students appreciated evaluating acute emergencies and reported an increased interest in neurology careers. Conclusions A case-based simulation curriculum with neurology trainees portraying the SP increased students' self-reported knowledge, skills, and confidence in managing neurological emergencies. Our intervention may improve medical student neurology education and increase interest in the field. Future research should evaluate clinical skills objectively. Supplementary Information The online version contains supplementary material available at 10.1007/s40670-024-02016-w.
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Affiliation(s)
- Galina Gheihman
- Department of Neurology, Brigham & Women’s Hospital, Boston, MA USA
- Department of Neurology, Massachusetts General Hospital, Boston, MA USA
- Harvard Medical School, Boston, MA USA
| | - G. Kyle Harrold
- Department of Neurology, Brigham & Women’s Hospital, Boston, MA USA
- Department of Neurology, Massachusetts General Hospital, Boston, MA USA
- Harvard Medical School, Boston, MA USA
| | - Danielle Howard
- Department of Neurology, Tufts Medical Center, Boston, MA USA
| | | | - Tamara B. Kaplan
- Department of Neurology, Brigham & Women’s Hospital, Boston, MA USA
- Harvard Medical School, Boston, MA USA
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Aljuwaiser S, Abdel-Fattah AR, Brown C, Kane L, Cooper J, Mostafa A. Evaluating the effects of simulation training on stroke thrombolysis: a systematic review and meta-analysis. Adv Simul (Lond) 2024; 9:11. [PMID: 38424568 PMCID: PMC10905914 DOI: 10.1186/s41077-024-00283-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 02/17/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Ischaemic strokes are medical emergencies, and reperfusion treatment, most commonly intravenous thrombolysis, is time-critical. Thrombolysis administration relies on well-organised pathways of care with highly skilled and efficient clinicians. Simulation training is a widespread teaching modality, but results from studies on the impact of this intervention have yet to be synthesised. This systematic review and meta-analysis aimed to synthesise the evidence and provide a recommendation regarding the effects of simulation training for healthcare professionals on door-to-needle time in the emergency thrombolysis of patients with ischaemic stroke. METHODS Seven electronic databases were systematically searched (last updated 12th July 2023) for eligible full-text articles and conference abstracts. Results were screened for relevance by two independent reviewers. The primary outcome was door-to-needle time for recombinant tissue plasminogen activator administration in emergency patients with ischaemic stroke. The secondary outcomes were learner-centred, improvements in knowledge and communication, self-perceived usefulness of training, and feeling 'safe' in thrombolysis-related decision-making. Data were extracted, risk of study bias assessed, and analysis was performed using RevMan™ software (Web version 5.6.0, The Cochrane Collaboration). The quality of the evidence was assessed using the Medical Education Research Study Quality Instrument. RESULTS Eleven studies were included in the meta-analysis and nineteen in the qualitative synthesis (n = 20,189 total patients). There were statistically significant effects of simulation training in reducing door-to-needle time; mean difference of 15 min [95% confidence intervals (CI) 8 to 21 min]; in improving healthcare professionals' acute stroke care knowledge; risk ratio (RR) 0.42 (95% CI 0.30 to 0.60); and in feeling 'safe' in thrombolysis-related decision-making; RR 0.46 (95% CI 0.36 to 0.59). Furthermore, simulation training improved healthcare professionals' communication and was self-perceived as useful training. CONCLUSION This meta-analysis showed that simulation training improves door-to-needle times for the delivery of thrombolysis in ischaemic stroke. However, results should be interpreted with caution due to the heterogeneity of the included studies.
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Affiliation(s)
- Sameera Aljuwaiser
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, AB25 2ZD, UK
| | | | - Craig Brown
- Emergency Medicine, NHS Grampian, Aberdeen, Scotland
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, AB25 2ZD, UK
| | - Leia Kane
- Emergency Medicine, NHS Grampian, Aberdeen, Scotland
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, AB25 2ZD, UK
| | - Jamie Cooper
- Emergency Medicine, NHS Grampian, Aberdeen, Scotland
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, AB25 2ZD, UK
| | - Alyaa Mostafa
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, AB25 2ZD, UK.
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Nakatani R, Patel K, Chowdhury T. Simulation in Anesthesia for Perioperative Neuroscience: Present and Future. J Neurosurg Anesthesiol 2024; 36:4-10. [PMID: 37903630 DOI: 10.1097/ana.0000000000000939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 09/27/2023] [Indexed: 11/01/2023]
Abstract
The brain's sensitivity to fluctuations in physiological parameters demands precise control of anesthesia during neurosurgery, which, combined with the complex nature of neurosurgical procedures and potential for adverse outcomes, makes neuroanesthesia challenging. Neuroanesthesiologists, as perioperative physicians, work closely with neurosurgeons, neurologists, neurointensivists, and neuroradiologists to provide care for patients with complex neurological diseases, often dealing with life-threatening conditions such as traumatic brain injuries, brain tumors, cerebral aneurysms, and spinal cord injuries. The use of simulation to practice emergency scenarios may have potential for enhancing competency and skill acquisition amongst neuroanesthesiologists. Simulation models, including high-fidelity manikins, virtual reality, and computer-based simulations, can replicate physiological responses, anatomical structures, and complications associated with neurosurgical procedures. The use of high-fidelity simulation can act as a valuable complement to real-life clinical exposure and training in neuroanesthesia.
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Affiliation(s)
| | - Krisha Patel
- Toronto Western Hospital, University of Toronto, Toronto
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Albin C, Berkowitz AL. Engaging teaching strategies in neurology: the flipped classroom and simulation training. Pract Neurol 2022; 22:pn-2022-003371. [PMID: 35863883 DOI: 10.1136/pn-2022-003371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2022] [Indexed: 11/04/2022]
Abstract
Just as neurology continues to expand its diagnostic and therapeutic modalities, so too does neurology education continue to expand in its pedagogical modalities. In this article, we describe two educational techniques-the flipped classroom and simulation-that we have incorporated in our teaching of neurology to students and doctors in training, with some practical tips for their successful implementation.
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Affiliation(s)
| | - Aaron L Berkowitz
- Neurology, Kaiser Permanente Bernard J Tyson School of Medicine, Pasadena, California, USA
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Chen PM, Trando A, LaBuzetta JN. Simulation-Based Training Improves Fellows' Competence in Brain Death Discussion and Declaration. Neurologist 2021; 27:6-10. [PMID: 34842565 DOI: 10.1097/nrl.0000000000000354] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Despite well-defined American Academy of Neurology guidelines for death by whole brain criteria (brain death), there is marked variability in national practice, which some have attributed to lack of formal education. Further, communication with surrogates and families about brain death is integral to brain death declaration. As such, we developed a targeted brain death curriculum combining didactics and simulation-based education to improve examination and subsequent communication skills with families. METHODS Multidisciplinary critical care fellows participated in (1) didactic and case-based curriculum, (2) brain death simulated examination (SimMan3G mannequin), and (3) a standardized family scenario with delivery of a brain death diagnosis to a surrogate "family member". Fellows completed a precurriculum and postcurriculum multiple choice knowledge test and survey (Likert 1 to 10 scale) evaluating measures regarding diagnosis and communication of brain death. t Test and 2-tailed Wilcoxon signed rank test were used for statistical analysis (P<0.05). RESULTS Thirteen critical care fellows participated in the curriculum. Most fellows [80% (N=12)] had only participated in 0 to 5 brain death declarations before this intervention. There was significant improvement across all measures: self-rated knowledge (P=0.004), perceived knowledge relative to peers (P=0.002), confidence (P=0.001), and comfort (P=0.001) with performing a brain death exam, and comfort with family discussion (P=0.01). Objective test scores improved from 56 to 73% after simulation (P=0.004). All fellows found the curriculum beneficial. CONCLUSION Trainees may lack sufficient exposure to brain death education. Didactics with simulation-based education can improve objective knowledge and subjective measures of comfort with brain death declaration and surrogate communication.
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Affiliation(s)
- Patrick M Chen
- Department of Neurosciences, Division of Neurocritical Care, University of California, San Diego, CA
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Aaron Trando
- Department of Neurosciences, Division of Neurocritical Care, University of California, San Diego, CA
| | - Jamie Nicole LaBuzetta
- Department of Neurosciences, Division of Neurocritical Care, University of California, San Diego, CA
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Mass-Ramírez S, Vergara-Burgos H, Sierra-Ochoa C, Lozada-Martinez ID, Moscote-Salazar LR, Janjua T, Rahman MM, Rahman S, Picón-Jaimes YA. Utility of medical simulation in neurovascular critical care education. JOURNAL OF NEUROCRITICAL CARE 2021. [DOI: 10.18700/jnc.210010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Anderson TN, Kaba A, Gros E, Schmiederer IS, Shi R, Aalami LR, Lin DT, Lau JN. A Novel Blended Curriculum for Communication of Informed Consent With Surgical Interns. J Grad Med Educ 2021; 13:411-416. [PMID: 34178267 PMCID: PMC8207932 DOI: 10.4300/jgme-d-20-01057.1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 12/14/2020] [Accepted: 03/17/2021] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Interns often conduct procedural informed consent discussions (ICDs), identified as a core entrustable professional activity. Deficiencies in the training process for ICDs span across specialties. OBJECTIVE We provide evidence for a curriculum and assessment designed to standardize the training process and ensure ICD competency in surgical interns. METHODS In March 2019, PowerPoint educational materials were emailed to one academic institution's new surgical interns, who in June participated in an onsite 1-hour role-play "hot seat" group activity (GA) with an untrained simulated patient, and in October completed a single trained simulated patient (real-time raters) verification of proficiency (VOP) assessment. Curriculum evaluation was measured through intern pre-/post-confidence (5-point scale), and the VOP's Cronbach's alpha and test-retest were examined. Data were analyzed with descriptive statistics, paired t tests, and 2-way random effects models. RESULTS Of 44 new interns, 40 (91%) participated in the remote teaching and live GA and were assessed by the VOP. Pre-/post-GA confidence increased a mean difference of 1.3 (SD = 0.63, P < .001). The VOP's Cronbach's alpha was 0.88 and test-retest was 0.84 (95% CI 0.67-0.93, P < .001), with a 95% pass rate. The 2 first-time fail students required remediation. Time commitment included 1 hour maximum for individual training and implementation and 30 minutes for assessment. The use of volunteers and donated space mitigated additional costs. CONCLUSIONS Remote asynchronous and group skills teaching for new general surgical interns improved their confidence in conducting procedural ICDs. A patient-simulation verification process appeared feasible with preliminary evidence of retest and internal consistency.
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Affiliation(s)
- Tiffany N. Anderson
- All authors are with Stanford University School of Medicine, Department of Surgery
- Tiffany N. Anderson, MD, MHPE, is a Surgical Education Fellow
| | - Aboubacar Kaba
- All authors are with Stanford University School of Medicine, Department of Surgery
- Aboubacar Kaba, BS, is a Medical Student
| | - Eniola Gros
- All authors are with Stanford University School of Medicine, Department of Surgery
- Eniola Gros, BA, is a Medical Student
| | - Ingrid S. Schmiederer
- All authors are with Stanford University School of Medicine, Department of Surgery
- Ingrid S. Schmiederer, MD, is a Surgical Education Fellow
| | - Robert Shi
- All authors are with Stanford University School of Medicine, Department of Surgery
- Robert Shi, MS, is a Research Assistant
| | - Lauren R. Aalami
- All authors are with Stanford University School of Medicine, Department of Surgery
- Lauren R. Aalami, BS, is a Research Assistant
| | - Dana T. Lin
- All authors are with Stanford University School of Medicine, Department of Surgery
- Dana T. Lin, MD, is Assistant Program Director
| | - James N. Lau
- All authors are with Stanford University School of Medicine, Department of Surgery
- James N. Lau, MD, MHPE, FACS, is Associate Professor, Surgical Education Program, and Director
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Singh H, Bharadvaja N. Treasuring the computational approach in medicinal plant research. PROGRESS IN BIOPHYSICS AND MOLECULAR BIOLOGY 2021; 164:19-32. [PMID: 34004233 DOI: 10.1016/j.pbiomolbio.2021.05.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 05/11/2021] [Indexed: 01/24/2023]
Abstract
Medicinal plants serve as a valuable source of secondary metabolites since time immemorial. Computational Research in 21st century is giving more attention to medicinal plants for new drug design as pharmacological screening of bioactive compound was time consuming and expensive. Computational methods such as Molecular Docking, Molecular Dynamic Simulation and Artificial intelligence are significant Insilico tools in medicinal plant research. Molecular docking approach exploits the mechanism of potential phytochemicals into the target active site to elucidate its interactions and biological therapeutic properties. MD simulation illuminates the dynamic behavior of biomolecules at atomic level with fine quality representation of biomolecules. Dramatical advancement in computer science is illustrating the biological mechanism via these tools in different diseases treatment. The advancement comprises speed, the system configuration, and other software upgradation to insights into the structural explanation and optimization of biomolecules. A probable shift from simulation to artificial intelligence has in fact accelerated the art of scientific study to a sky high. The most upgraded algorithm in artificial intelligence such as Artificial Neural Networks, Deep Neural Networks, Neuro-fuzzy Logic has provided a wide opportunity in easing the time required in classical experimental strategy. The notable progress in computer science technology has paved a pathway for understanding the pharmacological functions and creating a roadmap for drug design and development and other achievement in the field of medicinal plants research. This review focus on the development and overview in computational research moving from static molecular docking method to a range of dynamic simulation and an advanced artificial intelligence such as machine learning.
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Affiliation(s)
- Harshita Singh
- Plant Biotechnology Laboratory, Delhi Technological University, Delhi, 110042, India
| | - Navneeta Bharadvaja
- Plant Biotechnology Laboratory, Delhi Technological University, Delhi, 110042, India.
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Yao RQ, Jin X, Wang GW, Yu Y, Wu GS, Zhu YB, Li L, Li YX, Zhao PY, Zhu SY, Xia ZF, Ren C, Yao YM. A Machine Learning-Based Prediction of Hospital Mortality in Patients With Postoperative Sepsis. Front Med (Lausanne) 2020; 7:445. [PMID: 32903618 PMCID: PMC7438711 DOI: 10.3389/fmed.2020.00445] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 07/06/2020] [Indexed: 12/29/2022] Open
Abstract
Introduction: The incidence of postoperative sepsis is continually increased, while few studies have specifically focused on the risk factors and clinical outcomes associated with the development of sepsis after surgical procedures. The present study aimed to develop a mathematical model for predicting the in-hospital mortality among patients with postoperative sepsis. Materials and Methods: Surgical patients in Medical Information Mart for Intensive Care (MIMIC-III) database who simultaneously fulfilled Sepsis 3.0 and Agency for Healthcare Research and Quality (AHRQ) criteria at ICU admission were incorporated. We employed both extreme gradient boosting (XGBoost) and stepwise logistic regression model to predict the in-hospital mortality among patients with postoperative sepsis. Consequently, the model performance was assessed from the angles of discrimination and calibration. Results: We included 3,713 patients who fulfilled our inclusion criteria, in which 397 (10.7%) patients died during hospitalization, and 3,316 (89.3%) patients survived through discharge. Fluid-electrolyte disturbance, coagulopathy, renal replacement therapy (RRT), urine output, and cardiovascular surgery were important features related to the in-hospital mortality. The XGBoost model had a better performance in both discriminatory ability (c-statistics, 0.835 vs. 0.737 and 0.621, respectively; AUPRC, 0.418 vs. 0.280 and 0.237, respectively) and goodness of fit (visualized by calibration curve) compared to the stepwise logistic regression model and baseline model. Conclusion: XGBoost model has a better performance in predicting hospital mortality among patients with postoperative sepsis in comparison to the stepwise logistic regression model. Machine learning-based algorithm might have significant application in the development of early warning system for septic patients following major operations.
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Affiliation(s)
- Ren-qi Yao
- Trauma Research Center, Fourth Medical Center of the Chinese PLA General Hospital, Beijing, China
- Department of Burn Surgery, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Xin Jin
- School of Mathematics and Statistics, Beijing Institute of Technology, Beijing, China
| | - Guo-wei Wang
- School of Computer Science and Technology, Wuhan University of Technology, Wuhan, China
| | - Yue Yu
- Department of Cardiothoracic Surgery, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Guo-sheng Wu
- Department of Burn Surgery, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Yi-bing Zhu
- Medical Research and Biometrics Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lin Li
- School of Computer Science and Technology, Wuhan University of Technology, Wuhan, China
| | - Yu-xuan Li
- Department of General Surgery, First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Peng-yue Zhao
- Department of General Surgery, First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Sheng-yu Zhu
- Department of General Surgery, First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Zhao-fan Xia
- Department of Burn Surgery, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Chao Ren
- Trauma Research Center, Fourth Medical Center of the Chinese PLA General Hospital, Beijing, China
| | - Yong-ming Yao
- Trauma Research Center, Fourth Medical Center of the Chinese PLA General Hospital, Beijing, China
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Hemphill JC, James ML. Translational Neurocritical Care Research: Advancing Understanding and Developing Therapeutics. Neurotherapeutics 2020; 17:389-391. [PMID: 32424631 PMCID: PMC7283417 DOI: 10.1007/s13311-020-00867-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- J Claude Hemphill
- Departments of Neurology and Neurological Surgery, University of California, San Francisco, CA, USA.
- Department of Neurology, Zuckerberg San Francisco General Hospital, Building 1, Room 101, 1001 Potrero Avenue, San Francisco, CA, 94110, USA.
| | - Michael L James
- Departments of Anesthesiology and Neurology, Duke University, Durham, USA
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