Comparison of Theory of Mind between Patients with Major Depressive Disorder and Stimulant-Induced Depressive Disorder

Objective: Theory of mind (ToM) denotes the ability to understand the mental state of others and perceive their unique beliefs and emotions. In this study, we compared ToM between individuals with major depressive disorder (MDD) and stimulant-induced depressive disorder (SIDD). Method : This cross-sectional, causal-comparative study included patients with MDD or SIDD admitted to Ostad Moharary Neuropsychiatric Hospital between January and June 2022. Each diagnosis was confirmed through a semi-structured interview conducted by a single attending psychiatrist according to the DSM-5 criteria. After consecutive sampling of 110 individuals, 51 patients completed the study in each group. Demographic characteristics were recorded, and the Persian version of the revised Reading the Mind in the Eyes Test (RMET) was used to evaluate ToM. Statistical analysis was performed using SPSS v.25, employing the t-test, chi-squared test, linear regression, and analysis of covariance (ANCOVA). Results: Our analysis included 102 subjects (65.7% male) with a mean age of 35.17 ± 7.54 years. The two groups were similar in age, gender, marital status, working status, occupation, economic class, and ethnicity (P > 0.05). The RMET scores were 12.94 ± 4.03 and 11.86 ± 3.15 in the MDD and SIDD groups, respectively (P = 0.135). Almost all patients had low RMET scores (< 22); only two individuals in the MDD group achieved normal scores (22-30). ANCOVA revealed no significant confounding effects between the independent variables. Furthermore, regression analysis revealed that the level of education had a significant linear relationship (β = 0.249) with the RMET score (P = 0.021). Conclusion: Hospitalized patients with MDD and SIDD have similar ToM deficits, as measured by the RMET.

Prediction of difficult laryngoscopy / difficult intubation cases using upper airway ultrasound measurements in emergency department: a prospective observational study

INTRODUCTION

Difficult laryngoscopy and intubation are serious problems among critically ill patients in emergency department (ED) so utility of a rapid, accurate and noninvasive method for predicting of these patients are necessary. Ultrasonography has been recently used in this regard and this study was conducted to investigate the correlation of some introduced upper airway ultrasound parameters with difficult laryngoscopy / difficult intubation in patients referred to the ED.

METHOD

In this prospective observational study all patients ≥ 18-year-old who had an indication for rapid sequence intubation (RSI) were included. Ultrasound parameters including Hyoid Bone Visibility (HBV), Distance from Skin to Hyoid Bone (DSHB), Distance from Skin to Vocal Cords (DSVC), Distance from Skin to Thyroid Isthmus (DSTI), and Distance between Arytenoids Cartilages (DBAC) were measured in all cases. The patients underwent RSI and thereafter the patients' baseline characteristics, Cormack-Lehane grade, number of attempted laryngoscopy were recorded in a pre-prepared check list and compared with measured ultrasound parameters. The "difficult laryngoscopy" was defined as Cormack-Lehane classification grades III/IV; and need for more than 3 intubation attempts was considered as "difficult intubation".

RESULTS

One hundred and twenty-three patients (52% male) were included of whom 10 patients (8.1%) were categorized as difficult laryngoscopy cases; and just 4 (3.3%) cases underwent more than 3 laryngoscopy attempts who considered as difficult intubation cases. The mean age of the patients in non-difficult and difficult intubation groups were 69.2 ± 15.16 and 68.77 ± 17.37 years, respectively (p > 0.05). There was no significant relationship between difficult laryngoscopy and HBV (p = 0.381) but has significant correlation with difficult intubation (p = 0.004). The DSHB had a significant correlation with difficult laryngoscopy (p = 0.002) but its correlation with difficult intubation was not significant (p = 0.629). The DSVC and DSTI had a significant relationship with both difficult laryngoscopy (p = 0.003 and p = 0.001), and difficult intubation (p = 0.025 and p = 0.001). The DBAC had not significant correlation neither with the difficult laryngoscopy (p = 0.142), nor with difficult intubation (p = 0.526).

CONCLUSION

The findings showed that ultrasound parameters including soft tissue DSHB, DSVC and DSTI could be proper predictors of difficult laryngoscopy. Also, HBV, DSVC and DSTI may be proper predictors for difficult intubation. But DBAC was not useful in this regard.

The Rapid Arterial oCclusion Evaluation (RACE) scale accuracy for diagnosis of acute ischemic stroke in emergency department - A multicenter study

OBJECTIVE

It seems that the available data on performance of the Rapid Arterial oCclusion Evaluation (RACE) as a prehospital stroke scale for differentiating all AIS cases, not only large vessel occlusion (LVO), from the stroke mimics is lacking. As a result, we intend to evaluate the accuracy of the RACE criteria in diagnosing of AIS in patients transferred to the emergency department (ED).

METHOD

The present study was a diagnostic accuracy cross-sectional study during 2021 in Iran. The study population consist of all suspected acute ischemic stroke (AIS) patients who transferred to the ED by emergency medical services (EMS). A 3-part checklist consisting of the basic and demographic information of the patients, items related to the RACE scale, and the final diagnosis of the patients based on interpretation of patients' brain MRI was used for data collection. All data were entered in Stata 14 software. We used the ROC analysis to evaluate the diagnostic power of the test.

RESULT

In this study, data from 805 patients with the mean age of 66.9 ± 13.9 years were studied of whom 57.5% were males. Of all the patients suspected of stroke who transferred to the ED, 562 (69.8%) had a definite final diagnosis of AIS. The sensitivity and specificity of the RACE scale for the recommended cut-off point (score ≥ 5) were 50.18% and 92.18%, respectively. According to the Youden J index, the best cut-off point for this tool for differentiating AIS cases was a score > 2, at which sensitivity and specificity were 74.73% and 87.65%, respectively.

CONCLUSION

It seems that, the RACE scale is an accurate diagnostic tool to detect and screen AIS patients in ED, Of course, not at the previously suggested cut-off point (score ≥ 5), but at the score > 2.

Development and modeling of a novel type of photoreactors with exterior ultraviolet (UV) reflector for water treatment applications

Ultraviolet (UV) water disinfection method has emerged as an alternative to chemical methods of disinfection. In typical UV photoreactors for water treatment, water flows in the space between the lamp's sleeve and outer shell. The contact of water and sleeve causes fouling, which reduces the effectiveness of UV. To clean the photoreactor, the quartz sleeve must be replaced; this may lead to quartz or lamp breakage and mercury leakage into water during cleaning. In this study, a novel type of multi-lamp UV photoreactors is proposed, in which the UV lamps are placed out of the water channel and their UV irradiation is redirected into the channel using an outer cylindrical reflector. This allows for the installment of a self-cleaning mechanism for the water channel. A well-validated three-dimensional CFD model is utilized to model the performance of this photoreactor for microbial inactivation. The impacts of several geometrical and optical parameters are investigated on the inactivation of microorganisms. The results revealed that the difference in log reduction values (LRV) between fully specular and fully diffuse reflector ranges from 10 to 47% as the lamp-to-channel distance increases. For the volumetric flow rate of 25 GPM, the LRV of a photoreactor with fully diffuse reflector can be 46% higher than a fully specular one. In addition, the performance of the proposed photoreactor is compared against a classic L-shaped annular photoreactor. The results show that the new design can provide equal or better microbial performance compared to the classic photoreactor, but it removes many of their common issues such as quartz fouling, lamp overheating at low flow rates, and sleeve breakage during lamp replacement.

L’utilisation des médias sociaux en éducation médicale : cas de Twitter

Contexte. Depuis les années 2000, les médias sociaux connaissent une expansion rapide et sont en voie de changer le monde actuel. Leur usage notamment par les jeunes transforme les habitudes de vie, les comportements et les attentes sociales des individus, y compris dans le milieu éducatif. La pédagogie universitaire contemporaine reflète bien ce changement. Depuis quelque temps, on constate une augmentation de leur utilisation dans les activités d’enseignement. Toutefois, cette pratique comporte des enjeux pédagogiques et éthiques considérables. Objectifs. Cet article vise àanalyser les modes d’utilisation des médias sociaux tels que Twitter, Facebook et YouTube en éducation médicale. En centrant le regard sur Twitter, il explore les façons dont ces médias peuvent être intégrés dans l’enseignement et ainsi met en évidence leurs potentiels apports pédagogiques. Méthodologie. Pour parvenir à ces objectifs, nous avons fait une observation ethnographique en ligne et une recherche documentaire sur les études portant sur l’utilisation des médias sociaux les plus populaires dans les activités universitaires. Nous avons ciblé les études et les pratiques qui mettent en évidence l’efficacité et les potentiels apports de ces médias, désormais considérés comme outils pédagogiques à l’éducation médicale. Conclusion. Même si l’évidence empirique demeure encore insuffisante, la revue de littérature effectuée montre que l’utilisation des médias sociaux a des effets positifs évidents et potentiels en éducation médicale. Twitter offre de formidables possibilités de contribuer à l’enseignement universitaire dans ce domaine. Néanmoins, il faut des études plus systématiques pour les découvrir et déterminer leur applicabilité. 

Cyberapprentissage en pédagogie médicale : l’internet va-t-il un jour remplacer les professeurs?

Le cyberapprentissage facilite l’accès en ligne à des ressources pédagogiques, partout et en tout temps. Il peut être utilisé à divers niveaux, comme dans le cadre de l’enseignement de nouveaux concepts, de la simulation, de l’évaluation et du travail collaboratif. Les outils de cyberapprentissage sont aussi excellents pour susciter la participation des apprenants et favoriser l’apprentissage actif. Dans cet article, les auteurs discuteront des différents outils du cyberapprentissage et des cinq étapes de la conception pédagogique en cyberapprentissage, à savoir la définition, la conception, la création, la distribution et la démonstration, puis ils articuleront les meilleures méthodes d’évaluation de l’efficacité de ces outils.

An Innovative Master in Anatomy: Combining Anatomy With Educational Scholarship

The purpose of this article is to describe the design of a unique, bilingual (English and French) Master of Applied Sciences (M.Sc.) in Anatomical Sciences Education (ASE) program at a Canadian postsecondary institution. Anatomy is a core foundational discipline that is essential to many undergraduate, graduate, and professional programs in the health sciences. However, the number of new individuals with the necessary knowledge base and the pedagogical training to teach cadaveric anatomy are in short supply and cannot satisfy the number of openings for trained educators in the field. The M.Sc. in ASE was created to meet the increasingly critical need for instructors trained in human anatomy. The program is designed to prepare students for a career teaching human anatomy to students in the health sciences, emphasizing hands-on cadaveric dissection. Moreover, this program aims to develop educational scholarship skills in trainees by leveraging faculty expertise in medical education research, particularly in the field of anatomy education research. This focus on scholarships will make graduates more competitive for future faculty positions. During their first year of the program, learners will develop clinically relevant anatomy knowledge, teaching skills, and anatomy education scholarship. In the second year, students will benefit from an immediate, hands-on application of this acquired knowledge. In the same year, students will serve as anatomy teachers in the faculty's Medical Program and conduct their education scholarship projects, culminating in a formal research paper. Although similar programs have been developed in recent years, this article provides the first description of the creation of a graduate program in anatomy education. It includes needs assessment, program development, challenges faced, and lessons learned during the approval process. The article serves as a valuable resource for other institutions aspiring to develop similar initiatives.

Indirect effect of extra-industry network and innovativeness on performance through proactiveness

Purpose

The current study aims to advance the research on the extra-industry network, innovativeness and performance of small and medium enterprises (SMEs) by examining the mediation role of proactiveness. The study also aims to examine the mediating role innovativeness between extra-industry network and performance.

Design/methodology/approach

This study used the proportionate stratified random sampling method to select the study sample and the questionnaire survey approach to 580 SMEs. A total of 150 completed questionnaires were returned. Partial least squares structural equation modeling was administered to analyze data via Smart PLS 3.0 software.

Findings

The results reflect that proactiveness is mediated by the relationship between the extra-industry network and the performance of Iranian SMEs. In addition, the results illustrated that proactiveness is mediated by the relationship between innovativeness and the performance. The findings also address the limitation of previous studies on Iranian SMEs through the independent examination of the mediating role of innovativeness between firm extra-industry network and performance.

Originality/value

This article is one of few attempts that have addressed the significance of proactiveness as the key mechanism to transform the advantages of extra-industry network and innovativeness relationships to enhance performance.

Tricuspid Annular Plane Systolic Excursion (TAPSE) Measurement by Emergency Medicine Residents in Patients Suspected of Pulmonary Emboli

OBJECTIVES

We aimed to evaluate the ability of emergency medicine (EM) residents to measure tricuspid annular plane systolic excursion (TAPSE) by M-Mode ultrasound.

METHODS

Four EM residents with prior focused cardiac ultrasound (FOCUS) experience participated in 10 hours of hands-on training and then performed TAPSE measurements in adult patients at high risk of having pulmonary emboli (PE) between December 2020 and April 2021. Patients underwent bedside echocardiography by cardiology residents, and a CT pulmonary angiogram (CTPA) was performed to confirm the diagnosis. The agreement between EM and cardiology residents was assessed by intraclass correlation coefficient (ICC).

RESULTS

Sixty-six patients were included (mean age = 58.7 ± 16.7 years), of which 28 patients (42.8%) had positive CTPA. The mean TAPSE, measured by EM residents was 16.36 ± 1.59 mm in the PE positive group and 21.68 ± 2.87 mm in the PE negative group (P-value = <.0001). The mean ± SD TAPSE, measured by cardiology residents, was 17.7 ± 1.98 mm in the PE group and 22.5 ± 3.6 mm in the PE negative group (P-value = <.0001). There was significant agreement between EM and cardiology residents in terms of measuring TAPSE (ICC = 0.91, 95% confidence interval [CI] = 0.80-0.95). The receiver operating characteristic (ROC) curves of TAPSE for diagnosing PE revealed that TAPSE, measured by EM residents, had a high level of accuracy (area under the ROC curve [AUC] = 0.93, 95% CI, 0.878-0.99).

CONCLUSIONS

EM residents can perform M-Mode TAPSE measurement in suspected PE cases after 10 hours of hands-on training. TAPSE measurement should be added to routine FOCUS protocols, especially when there is suspicion of PE.

Clients' Satisfaction with Services Provided by Ambulances and Motor Ambulances of Tehran Emergency Medical Services: A Cross-sectional Study

Background: To improve the quality of services provided by emergency medical services (EMS), a correct understanding of the current situation and analysis of possible problems is required. The purpose of this study was to investigate the level of clients' satisfaction regarding the missions performed by ambulances and motor ambulances (motorlances) of the Tehran EMS center, and also identify the factors affecting their satisfaction. Methods: This cross-sectional study was conducted for 1 month in Tehran, Iran. All clients in the age range of 18 to 87 years who were approached by Tehran EMS motorlances or ambulances were eligible. Those with wrong registered phone numbers, uninformed callers (passers, coworkers), and those who were not willing to participate in the study were excluded. A valid and reliable researcher-made questionnaire was used to assess the clients' satisfaction. Missions were surveyed routinely, 1 to 2 days following their performance. The questionnaires were filled out by the investigators via a telephone call to the patients or the patients' siblings. The collected data were statistically analyzed using IBM SPSS Statistics 24.0. An independent t test and 1-way analysis of variance were used to compare the mean satisfaction score between the groups. Other tests, such as the Pearson correlation coefficient, were also used to examine the relationship between quantitative variables. P<0.05 were considered statistically significant. Results: In total, the data of 1100 missions were analyzed. The age range of the patients was between 1 and 100 years and their mean age was 52.1 ± 19.2 years, and the mean age of interviewees was 44.4 ± 13.4 years (18-87 years); of all the interviewees, 610 (55.5%) were women. The overall satisfaction of people with the Tehran EMS was rated as "very satisfied" in 78.5% of the cases; However, 11.2% of the participants had moderate and low satisfaction. We found that overall satisfaction was related to dependence on the health group (p≤0.001), educational status (p=0.006), economic status (p=0.002), sent vehicle (p=0.040), and diagnosis (p<0.001). Conclusion: Almost 80% of the participants were highly satisfied with the services provided by Tehran EMS motorlances/ambulances, according to this study. Those with a higher educational level, higher socioeconomic class, accurate diagnosis, proper sent car, and health dependency showed a higher level of happiness than the others.

Prediction of peritoneal soiling in acute appendicitis with simple clinical and laboratory data. Prospective, multicenter, cohort study of 2,645 adult patients nationwide

BACKGROUND AND AIMS

In order to facilitate the preoperative prediction of complicated appendicitis, we propose a complementary approach by selecting an endpoint defined by the intraoperative finding of peritoneal soiling (PS).

METHODS

Over a 6-month period, 38 centers (5% of all public hospitals) attending emergency general surgery patients on a 24-hour, 7-days a week basis, enrolled consecutive adult patients requiring appendectomy. Patients were stratified according to the absence or the finding of PS during the surgical procedure.

RESULTS

A total of 2645 patients were included; median age (IQR) was 35 (22-51) years, 44.3% were female. The laparoscopic approach was used in 70.8% of appendectomies. In a third of patients (31.7%), there was PS with pus around the appendix, or bowel contents, free pus, or blood in the peritoneal cavity. To develop the prediction model, 1764 patients were randomly selected for the derivation cohort and the remaining 881 patients were assigned to the validation cohort. On multivariable logistic regression analysis of all patients, two clinical variables (age, and pulse) and three laboratory variables (serum urea, serum sodium, and white blood cell count) were individually associated (P < .05) with a greater probability of having PS (Hosmer-Lemeshow chi, 1.63; P = .99; C-statistic, 0.7). Based on the multivariable regression model, both static and dynamic nomograms were developed for the prediction of PS in patients with acute appendicitis.

CONCLUSIONS

The entry of simple clinical and laboratory variables in the dynamic nomogram may be useful in guiding the initial management of patients with acute appendicitis in resource-limited settings.

Evaluation of Service-Oriented Nursing Supervisor Strategy Based on Data Envelopment Analysis (DEA)

Background: This study introduced a service-oriented nursing supervisor strategy to increase the performance efficiency of different hospital wards. The efficiency of this strategy in 12 wards under the supervision of 12 supervisors was evaluated using Data Envelopment Analysis (DEA). Materials and Methods: The efficiency of the service-oriented nursing supervisor strategy was evaluated using DEA. This study aims to evaluate the relative efficiency of hospital wards before and after implementing the service-oriented nursing supervisor strategy at Milad hospital. Data were evaluated using two basic models of data envelopment analysis technique, i.e., CCR and BCC output-oriented methods. Then, the relative performance efficiencies of 12 wards in 2 periods, including the first half of 2020 (before service-oriented nursing supervisor strategy) and the second half of 2020 (after service-oriented nursing supervisor strategy) were analyzed. Finally, efficient wards were ranked using the Anderson-Peterson method based on the results. Results: According to the CCR output-oriented method, after implementing service-oriented nursing supervisor strategy, Urology, Gastroenterology, and Neurosurgery wards, as well as ENT, had the highest and lowest efficiency rates, respectively. Based on the BCC output-oriented method, Urology, Renal Transplant, Neurosurgery, and Gynecology wards had the highest efficiency in performance, while ENT had the lowest efficiency. Conclusion: In conclusion, the findings of this study offer a service-oriented nursing supervisor strategy that improves the efficiency of different wards of the hospital.

Fundraising in Education: Road Map to Involving Medical Educators in Fundraising

Traditional funding models must change as governments decrease funding and often freeze tuition at a domestic level. As a result, universities face an increasing need to diversify their business models, including revenue streams. Therefore, interest in raising significant funds from other sources is stronger than ever, leading to the need for a fundraising approach that is more sophisticated. Medical educators and health professionals are some of the most trusted members of society, and with this paper, the authors aim to raise awareness of the critical role they play in helping universities with their global impact and fundraising efforts.

Perceptions of Educational Needs in an Era of Shifting Mental Health Care to Primary Care: Exploratory Pilot Study

BACKGROUND

There is an unmet need for mental health care in Canada. Primary care providers such as general practitioners and family physicians are the essential part of mental health care services; however, mental health is often underestimated and underprioritized by family physicians. It is currently not known what is required to increase care providers' willingness, comfort, and skills to adequately provide care to patients who present with mental health issues.

OBJECTIVE

The aim of this study was to understand the need of caregivers (family members overseeing care of an individual with a mental health diagnosis) and family physicians regarding the care and medical management of individuals with mental health conditions.

METHODS

A needs assessment was designed to understand the educational needs of caregivers and family physicians regarding the provision of mental health care, specifically to seek advice on the format and delivery mode for an educational curriculum to be accessed by both stakeholder groups. Exploratory qualitative interviews were conducted, and data were collected and analyzed iteratively until thematic saturation was achieved.

RESULTS

Caregivers of individuals with mental health conditions (n=24) and family physicians (n=10) were interviewed. Both the caregivers and the family physicians expressed dissatisfaction with the status quo regarding the provision of mental health care at the family physician's office. They stated that there was a need for more educational materials as well as additional support. The caregivers expressed a general lack of confidence in family physicians to manage their son's or daughter's mental health condition, while family physicians sought more networking opportunities to improve and facilitate the provision of mental health care.

CONCLUSIONS

Robust qualitative studies are necessary to identify the educational and medical management needs of caregivers and family physicians. Understanding each other's perspectives is an essential first step to collaboratively designing, implementing, and subsequently evaluating community-based mental health care. Fortunately, there are initiatives underway to address these need areas (eg, websites such as the eMentalHealth, as well as the mentorship and collaborative care network), and information from this study can help inform the gaps in those existing initiatives.

The Outcome Predictors of the Patients with Traumatic Brain Injury; A Cross-Sectional Study

Objective

To probe the factors associated with the outcomes of traumatic brain injury (TBI) patients admitted to emergency department (ED).

Methods

This is a cross-sectional study that data gathering was performed via census methods, retrospectively. During one year, all head injury's patients who admitted to the ED of a tertiary center in Tehran, Iran were included. Age, gender, mechanism of injury, Glasgow coma scale (GCS) and injury severity score (ISS) on admission, presence of extra-cranial injuries, findings of brain computed tomography (CT), duration of hospitalization, and in hospital outcomes were recorded. Outcome's assessment for survivors was performed within a 6 months-period after discharge based on Glasgow outcome scale (GOS). The variables and outcomes' association were assessed.

Results

Totally, 506 patients were evaluated with the mean age of 36.77±21.1 years that 411 (81.2%) were men. Follow up at 6-months post injury was feasible in 487 (96.2%) patients; 59 (11.7%) out of 506 eligible patients died. Logistic regression analysis showed the association between assessed variables and patients' outcome as follows: age>65 years (OR: 12.21; p<0.001), GCS on admission <8 (OR: 62.99; p<0.001), presence of traumatic Intracerebral hemorrhage (ICH) in brain CT scan (OR: 20.11; p=0.010), duration of hospitalization ≥ 5 days (OR: 0.28; p=0.001).

Conclusion

The findings of the current study distinguished some variables that were associated with the poor outcome of the patients with TBI. Therefore, TBI patients with any of these risk factors may need close continues monitoring, early ICU admission, and some other special extra care in ED.

The indirect effect of high-performance work practices on employees’ performance through trust in management

Purpose

The construction industry activities play a key role in achieving socio-economic development and sustaining economic growth in many countries. Increased awareness about the role of human resource management in employee performance has led construction firms to evaluate and focus on high-performance work practices (HPWPs) components, which intend to cultivate employee and organizational performance. This study aims to explain HPWPs affect employee performances through the mediating influence of trust in management in Aqaba, Jordan.

Design/methodology/approach

A questionnaire survey was administered to collect data among the contractors Grade1 across Aqaba, Jordan. This research was designed as a quantitative study and data were collected at one point of time. In total, 311 questionnaires were returned and only 279 completed questionnaires to test the relationship between HPWPs and employee performances according to the ability, motivation and opportunity conceptualized framework. The partial least squares technique was adopted to test the proposed relationships.

Findings

The results present that extensive training, rewards based on performance and job security have a significant relationship with trust in management. Trust in management exerts partial mediation effects between HPWPs (extensive training, rewards based on performance and job security) and employee performance (creativity and innovation).

Originality/value

The findings of the study provide useful and original information to improve the overall performance of construction firms.

Implementation of Clean Hospital Strategy and Prioritizing Covid-19 Prevention Factors Using Best-Worst Method

Many nations have suffered the catastrophe of COVID-19, and one of the first countries affected by the pandemic was Iran; all industries and individuals have been adversely affected by the pandemic. Health care systems and patients' conditions, in particular, were disrupted due to canceling elective surgery. To put it more sharply, a delay in performing elective surgery may potentially impact patients' survival and the quality of their lives. To cope with the new situation, in the first stage, the Clean Hospital strategy was proposed in order to minimize the effects of this pandemic on elective surgical services. The mentioned strategy is a try to provide a solution and resume elective surgeries in the pandemic period. In the second stage, panel discussion, Delphi method, and the best-worst method (BWM) were employed to prioritize the factors that inhibit Coronavirus transmission. The proposed strategy and the results of this study could be used by policymakers and health departments to resume elective surgeries and control the infection to maintain a hospital or a section of it clear. The overall result of the study showed that the most important Covid-19 prevention factors in Clean Hospitals were personal protection (w = 0.212), screening checklist (w = 0.182), and check body temperature (w = 0.126), respectively (C1 > C2 > C3). According to the financial, time, and human resource limitations, first, resources were allocated to higher priority criteria, and in order of priority, all items (C1, C2, …., C9) were used in the Clean hospital strategy.

Association of folate and vitamin B12 deficiency with vasovagal syncope: a case-control study

Background

Studies demonstrated an association between vitamin B12 deficiency and vasovagal syncope (VVS) in pediatric patients. Moreover, some evidence suggested a pathophysiological role of plasma catecholamines elevation in VVS, which can arise from folate or vitamin B12 deficiency in terms of biochemical pathways.

Purpose

We aimed to evaluate the association of folate and vitamin B12 deficiency with VVS in adults.

Methods

In this case-control study, adult patients (18–70 years of age) with the diagnosis of VVS based on history and physical examination (2018 ESC guidelines) who underwent a head-up tilt test (HUTT) were included as the case group. The control group comprised age- and sex-matched individuals who participated in a population-based cohort study. The most important exclusion criteria were taking vitamin B12 or folate supplements, carbamazepine and phenobarbital, and a history of bariatric surgeries. Plasma levels of vitamin B12, folate, homocysteine, and thyroid-stimulating hormone (TSH), a possible confounder, were measured by Abbott Diagnostics chemiluminescence kits. We compared categorical variables and continuous variables by Chi-square and t-test, respectively. Logistic regression models were employed for adjusting for possible confounders, including age, sex, and TSH.

Results

From February 2020 to February 2021, we screened 157 patients with VVS, of whom 44 patients were included. After matching for age and sex, 44 healthy individuals without a history of syncope were examined as the control group. The mean age was 37.9 years in both groups, with 23 women (52.3%) in each group. Baseline characteristics were comparable across the study groups. There were no significant differences between serum levels of vitamin B12, folate, homocysteine, and TSH, as well as the prevalence of deficiency of folate and vitamin B12 between case and control groups (Table 1), even after adjusting for confounding variables. Serum levels of vitamin B12 were remarkably lower in patients with a lifetime syncopal episodes of ≥3 compared to patients with &lt;3 lifetime attacks (Table 2, P=0.042). This correlation remained statistically significant after adjusting for possible confounders, including age, sex, and TSH by the logistic regression model (P=0.032).

Conclusions

In this study, we found that there is no significant difference between the prevalence of folate and vitamin B12 deficiency and serum levels of these vitamins in adult patients with VVS and healthy individuals; however, serum vitamin B12 was significantly lower in patients with recurrent VVS compared to patients with a lower burden of syncopal episodes. Future studies with larger sample sizes are recommended in the recurrent VVS subgroup. Therapeutic implications of these findings should be investigated in randomized-controlled trials.

Funding Acknowledgement

Type of funding sources: Foundation. Main funding source(s): Iran National Science Foundation Table 1Table 2

Initial experience of TAS-102 chemotherapy in Australian patients with Chemo-refractory metastatic colorectal cancer

For patients with refractory metastatic colorectal cancer (mCRC) treatment with Trifluridine/Tipiracil, also known as TAS-102, improves overall survival. This study aims to investigate the efficacy and safety of TAS-102 in a real-world population from Victoria, Australia. A retrospective analysis of prospectively collected data from the Treatment of Recurrent and Advanced Colorectal Cancer (TRACC) registry was undertaken. The characteristics and outcomes of patients receiving TAS-102 were assessed and compared to those enrolled in the registration study (RECOURSE). Across 13 sites, 107 patients were treated with TAS-102. The median age was 60 years (range: 31-83), compared to 63 for RECOURSE. Comparing registry TAS-102-treated and RECOURSE patients, 75% vs 100% were ECOG performance status 0-1, 74% vs 79% had initiated treatment more than 18 months from diagnosis of metastatic disease and 36% vs 49% were RAS wild-type. Median time on treatment was 10.4 weeks (range: 1.7-32). Median progression-free survival (PFS) was 3.3 months compared to 2 months in RECOURSE, while median overall survival was the same at 7.1 months. Two patients (2.3%) had febrile neutropenia and there were no treatment-related deaths, where TAS-102 dose at treatment initiation was at clinician discretion.TRACC registry patients treated with TAS-102 were younger than those from the RECOURSE trial, with similar overall survival observed. Less strict application of RECIST criteria and less frequent imaging may have contributed to an apparently longer PFS.

Intracranial Displacement Measurements Within Targeted Anatomical Regions of a Postmortem Human Surrogate Brain Subjected to Impact

The dynamic response of the human brain subjected to impulsive loading conditions is of fundamental importance to the understanding of traumatic brain injuries. Due to the complexity of such measurements, the existing experimental datasets available to researchers are sparse. However, these measurements are used extensively in the validation of complex finite element models used in the design of protective equipment and the development of injury mitigation strategies. The primary objective of this study was to develop a comprehensive methodology to measure displacement in specific anatomical regions of the brain. A state-of-the-art high-speed cineradiography system was used to capture brain motion in post-mortem human surrogate specimens at a rate of 7500 fps. This paper describes the methodology used to capture these data and presents measurements from these tests. Two-dimensional displacement fields are presented and analyzed based on anatomical regions of the brain. These data demonstrated a multi-modal displacement response in several regions of the brain. The full response of the brain consisted of an elastic superposition of a series of bulk rotations of the brain about its centre of gravity. The displacement field could be linked directly to specific anatomical regions. The methods presented mark an improvement in temporal and spatial resolution of data collection, which has implications for our developing understanding of brain trauma.

Five-Year Outcomes After Hybrid Coronary Revascularization: A Single Center Experience

OBJECTIVE

Hybrid coronary revascularization (HCR) combines both surgical and percutaneous coronary revascularization procedures. It offers a minimally invasive strategy for multivessel coronary artery disease and combines the advantages of both. However, quantitative long-term patency and clinical outcomes remain understudied. The objective of this study was to assess clinical outcomes and graft and stent patency at 5-year follow-up.

METHODS

From January 2004 to January 2015, 120 patients were enrolled in this study. They underwent robotically assisted minimally invasive coronary artery bypass grafting of left internal thoracic artery (LITA) to the left descending artery (LAD) and percutaneous coronary intervention of non-LAD vessels. Primary outcome was graft (LITA-LAD) patency determined at 5 years of follow-up, assessed by computed tomography angiography and rest and stress myocardial perfusion scintigraphy (MPS-MIBI). Secondary outcomes were stent patency and major adverse major cardiac and cerebrovascular events (MACCE). Also, freedom from recurrence of angina was assessed.

RESULTS

At follow-up, 18 of 120 patients (15%) had died (in 5 patients the cause of death was cardiovascular). Among survivors, follow-up was achieved in 83 of 102 (81%). In 76 of 83 patients (92%) there was a patent LITA-LAD graft and in 75 of 83 (90%) a patent stent was demonstrated. MACCE occurred in 36 of 120 patients (30%). Freedom from recurrence of angina occurred in 92 of 120 patients (77%).

CONCLUSIONS

HCR is a safe and a promising procedure. It provides a minimally invasive approach and results in complete revascularization with good 5-year patency and clinical outcomes.

Predicting the 30-day Adverse Outcomes of Non-Critical New-Onset COVID-19 Patients in Emergency Departments based on their Lung CT Scan Findings; A Pilot Study for Derivation an Emergency Scoring Tool

Introduction: Coronavirus Disease (COVID‐19) has become the most important global health issue, and chest computed tomography (CT) scan can help determine the severity of the infection. Objectives: This study aimed to provide an emergency scoring tool for predicting 30-day adverse outcomes in non-critical new-onset COVID-19 patients.  Methods: This derivation study was conducted on new-onset COVID-19 patients presenting to the emergency department of an urban teaching hospital in Tehran, Iran, between 20 February and 20 March 2020. The total lobe severity score (TSS), age, history of comorbidities, and 30-day adverse outcomes (death, ICU admission or intubation) were taken into account to produce three prediction models. Results: Overall, 137 patients were included in the study. Their mean age was 59.9±16.8 years and 62% were male. The ground glass nodule, patch B/punctate ground-glass opacity, fibrous stripes, and air bronchogram sign with perihilar distribution, bilateral and ≥ 2 affected lobes were the most common findings. The mean TSS (model 1) was significantly higher in patients with an adverse outcome (9.4±3.2) compared to the discharged patients (7.2±3.3) (p<0.001, AUC: 0.703, sensitivity: 64.4% and specificity: 74.1%). The optimal cut-off point of model 2 (TSS and age) had the following parameters: AUC: 0.721, sensitivity: 71.2% and specificity: 67.2%. The optimal cut-off point of model 3 (TSS, age, comorbidities) had: AUC: 0.755, sensitivity: 79.7% and specificity: 65.5%. The discrimination achieved with model 3 based on Bonferroni’s test was significantly better than that achieved with TSS (p<0.001). Conclusion: TSS combined with age and history of at least one comorbidity had a better predictive value for adverse outcomes with a cut-off point above 8.

Steroid use for recovery of advanced atrioventricular block immediately after valvular surgery (survival): a randomized clinical trial

Funding Acknowledgements

Type of funding sources: None.

Background

Limited inconsistent evidence support use of steroids in recovery of atrioventricular block (AVB) after trans-catheter aortic valve implantation. However, there is no study to examine the efficacy of steroids in recovery of high-grade AVB following valvular surgery.

Purpose

 To assess the effect of high-dose dexamethasone on recovery of advanced AVB following valvular heart surgery.

Methods

In this randomized controlled trial, patients with advanced postoperative AVB (either Mobitz type II or third degree) were randomly assigned to receive either dexamethasone (0.4 mg /kg, maximum 30 mg /day in three divided doses) intravenously for three days or conservative care only. Primary endpoint was recovery rate in day five since randomization. Secondary endpoints were recovery rate in day 7 and day 10, cumulative AVB time, PPM implantation rate, length of stay in critical care units, and post-operative major adverse events (MAE) during one month. We defined MAE as composite of all-cause mortality, all-type infections, major bleeding, prolonged sternal dehiscence, new stroke, postoperative MI, complicated uncontrolled hyperglycemia and readmission for decompensated heart failure.

Results

We enrolled 139 subjects (48.9% male) with mean age of 59.9 years who were randomly allocated to intervention group (n= 69) and control group (n= 70). Dexamethasone led to higher recovery rates at day 5 (82.6% vs. 62.9%, P= 0.009) and day 7 (88.4% vs. 61.4%, P&lt; 0.0001) respectively. Random 24-hours ECG Holter monitoring of patients at day 5 revealed the same results and confirmed the superiority of dexamethasone for recovery of AVB (80.5% vs 61.2%, respectively, P = 0.024). Although this benefit ceased at day 10 (83.05 vs 78.6 %, P = 0.547), Generalized Estimating Equation analysis for recovery over 10 days favored intervention (odds ratio: 2.56, 95% CI: 1.27- 5.15, P = 0.008). Median cumulative AVB time was shorter in dexamethasone group compared to control group (41 hours vs 64 hours, P = 0.044). PPM implantation rates were similar between the dexamethasone and control groups (15.9% vs 17.1 %, respectively, P = 0.849). Median length of stay in ICU (10 days vs 12 days, P= 0.03) and MAE (17.4 % vs 25.7%, P = 0.133) tended to be lower with dexamethasone.

Conclusion

Our findings suggest that dexamethasone may serve as a safe and effective medication to improve recovery of advanced AVB after valvular surgery. Further studies are needed to confirm these findings, particularly regarding subsequent PPM implantation rate.

Atomoxetine in patients with recurrent vasovagal syncope for preventing vasovagal attacks and improvement of depression and anxiety: a randomized double-blind placebo-controlled clinical trial

Background

Studies showed that sibutramine or reboxetine reduced head-up tilt (HUT)-induced syncope and pre-syncope by 78%. Furthermore, in an open-label series of highly symptomatic patients with vasovagal syncope (VVS), sibutramine reduced frequency of vasovagal spells. In a recent proof of principle study, atomoxetine reduced number of HUT-induced syncopal episodes by about 50% compared to placebo.

Purpose

In this study, we aimed to evaluate the effectiveness of atomoxetine on preventing recurrence of syncopal and pre-syncopal episodes in patients with recurrent VVS after three months of follow-up. Moreover, we determined whether it can improve patients' anxiety and depression.

Methods

In this double-blind placebo-controlled randomized clinical trial, we screened 843 patients with VVS. Patients with 10 &lt; age &lt; 70 years who had ≥3 syncopal episodes in the past three months were included. Eventually, 46 patients were randomized to receive atomoxetine (20 mg daily for two weeks followed by 40 mg daily for two weeks, N=23) or placebo (for four weeks, N=23). The primary endpoint was the number of syncopal and pre-syncopal episodes at one and three months and was analyzed by the repeated measures analysis of variance. Secondary endpoints were decrements of depression and anxiety measured by the Hospital Anxiety and Depression Scale after three months and were analyzed by the Mann-Whitney U test.

Results

The primary endpoint was lower after three months in the atomoxetine arm (2.3±1.3 vs 4.3±1.7), with a significant between-subjects effect by atomoxetine versus placebo (P&lt;0.001). This observation was primarily due to the reduction of pre-syncopal episodes rather than syncopal episodes (P&lt;0.001 vs P=0.944, respectively, Table). In contrast with placebo, atomoxetine significantly improved anxiety (P=0.048 vs P=0.352) and depression (P=0.001 vs P=0.206) after three months; nonetheless, anxiety and depression scores of the patients were not different across the groups after three months (P&gt;0.05, Figure).

Conclusions

In patients with VVS, atomoxetine significantly reduced the recurrence of a composite of syncopal and pre-syncopal episodes, and remarkably improved anxiety and depression at three months.

Anxiety and Depression of the Patients

Funding Acknowledgement

Type of funding source: Public Institution(s). Main funding source(s): Tehran University of Medical Sciences

Managing STEMI & other time sensitive cardiac emergencies by using smart phones-a study utilizing social media as tool to integrate local health network in remote areas of India-save Heart initiative

Introduction

Kashmir is a resource limited, region of India having its own distinctive regional challenges, operational limitations and poor accessibility of remote areas to health care. Utilizing smart phones as a medium for providing access to the optimum cardiac care in the remotest of the areas of our region served as a platform for SAVE HEART INITIATIVE (SHI) launched in the form of Social Media Whatsapp Group connecting peripheral hospitals (spokes) in the Kashmir region to experts (Hub).

Material and methods

SHI, a novel initiative was started voluntarily by a team of cardiologists and physicians. All the government hospitals along with their Emergency (ER) teams were roped in, integrated with expert physicians and cardiologists via whats app based technology creating a virtual cardiac ER facility and a CYBER HUB where teams of experts lended optimum support to all the peripheral hospitals of the region which acted as CYBER SPOKES of the initiative. Simultaneously all the peripheral hospitals upgraded to a functional Emergency room with all the emergency drugs available including the clot busters as streptokinase and vital anti arrhythmic drugs free of cost. Emergency room proformas, algorithms, protocols were created and standardized to aid in management. CME's regarding cardiac emergencies and response workshops were organized at regional institutes regularly for capacity building locally. The decision to use whatsapp as technology in medical care was taken due to its unique features of being readily available, handy technology, and as it could transfer all data in form of text, images, audios, visuals to and from the cyber spokes and cyber hubs respectively.

Results

Within 500 days of the initiative about 130 hospitals and 1200 doctors were taken on board. A total of 38000 ECGs were analyzed till date wherein the average response time in this social media group to any case was 1–2 minutes mostly and the diagnostic delays decreased to minimum. This initiative managed 950 STEMI's with thrombolysis, 2723 NSTEMI, 5320 arrhythmias, 345 heart blocks, 16 pulmonary thrombo-embolisms, 53 PCI decisions.

Conclusion

Our experiment demonstrated the feasibility of the approach adopted for better cardiac care that reached the poorest living in far flung area without any extra burden to the state exchequer. SHI reduced morbidity, mortality; CCU occupancy rate in tertiary care brought down undue referrals and established a vibrant patient tracking system in the region depicting its success. Using Smartphone based technology in time sensitive cardiac events seems to be the most vibrant, novel and viable option being available, portable, efficient, and cost-effective, with least technical glitches. It seems to be the way forward in providing optimum and timely treatment in all acute cardiac emergencies in resource deficient regions as Kashmir.

Funding Acknowledgement

Type of funding source: None

Comparing Diazepam Plus Fentanyl With Midazolam Plus Fentanyl in the Moderate Procedural Sedation of Anterior Shoulder Dislocations: A Randomized Clinical Trial

BACKGROUND

The reduction of shoulder dislocation requires adequate procedural sedation and analgesia. The mixture of midazolam and fentanyl is reported in the literature, but long-acting benzodiazepines in conjunction with fentanyl are lacking.

STUDY OBJECTIVE

Our aim was to compar e IV diazepam with IV midazolam in moderate procedural sedation (based on the classification of the American Society of Anesthesiologists) for the reduction of shoulder dislocation.

METHODS

This was a randomized controlled clinical trial conducted from April 2019 to December 2019 in the emergency department of a university-affiliated hospital in Tehran, Iran. Participants were adult patients (aged 18-65 years) with anterior shoulder dislocation. Group A (n = 42) received diazepam 0.1 mg/kg plus fentanyl 1 μg/kg IV and group B received midazolam 0.1 mg/kg plus fentanyl 1 μg g/kg IV. Main outcomes measured were onset of muscle relaxation, time taken to reduction, total procedure time, number of the reduction attempts, patient recovery time, the occurrence of the adverse effects, amount of the pain reported by the patients using visual analog scale, and patients and physicians overall satisfaction with the procedure using a Likert scale question.

RESULTS

Eighty-one patients were included. The mean ± standard deviation time of the onset of the muscle relaxation and time taken to reduction was shorter in the diazepam plus fentanyl group (p = 0.016 and p = 0.001, respectively). Adverse effects and pain relief were not statistically different between the two groups. Patient recovery time and total procedure time was shorter in the midazolam plus fentanyl group (p = 0.008 and p = 0.02, respectively). The overall satisfaction of patients and physicians was higher in the diazepam plus fentanyl group.

CONCLUSIONS

As compared with midazolam plus fentanyl, diazepam plus fentanyl was superior in terms of the onset of the muscle relaxation, patient and physician satisfaction, and time taken to reduction.

Implementing a Competency-Based Approach to Anatomy Teaching: Beginning With the End in Mind

BACKGROUND

The shift in the medical education system from a time-based to a competency-based model has encouraged its adoption and application in competency-based education in anatomy classrooms, such as team-based learning models and flipped classroom models. This pilot study aimed to build on previous work of the linkages between anatomy-based learning (a flipped classroom model inspired by a modified team-based learning) and student learning and engagement, and further to assess the linkage between anatomy-based learning and academic performance.

METHODS

A sequential mixed-methods design was employed to first gather and analyse quantitative data, including confidential student first semester scores in anatomy: gender, stream, anatomy-based learning, and final anatomy overall mark. The quantitative phase was followed by a qualitative phase in which a series of 8 anatomy laboratories were observed (4 anatomy-based learning and 4 traditional). Thematic analysis was performed on the observation data.

RESULTS

Aggregate anatomy-based learning and traditional stream tests, and final unit scores were compared. The anatomy-based learning and final unit scores showed little difference between students in the anatomy-based learning and students in the traditional stream. Students using anatomy-based learning had an aggregate score of 1.15 and final aggregate mark of 72, whereas students in the traditional section had an aggregate score of 1.19 and final mark of 79. Qualitative phase was undertaken to try to assess the linkages between anatomy-based learning and student learning. Observations showed that students in the anatomy-based learning section spent more time on task as compared with their peers in the traditional stream. The anatomy-based learning students also seemed to practice more self-directed learning and employed more multimodal learning strategies than the traditional section stream.

DISCUSSION/CONCLUSIONS

Although the quantitative results of this study showed no significant difference in mean scores between anatomy-based learning and traditional designs, it was possible to observe the potential of flipped classroom model in engaging students in individual preparation, in team-based learning, and in consensus-based learning approaches.

Preclerkship Point-of-Care Ultrasound: Image Acquisition and Clinical Transferability

INTRODUCTION

The integration of point-of-care ultrasound (POCUS) in preclerkship medical education is currently popular and based on the notion that POCUS may improve diagnostic and procedural skills in medical students. However, empirical evidence demonstrating that POCUS can enhance clinical skills in preclerkship students has been lacking. We sought to evaluate anatomical sonographic knowledge and ultrasound generation capabilities associated with the implementation of a 3-h echocardiography training camp led by 2 emergency physicians and using a flipped classroom design.

METHODS

Preclerkship students from the University of Ottawa (n = 32) were recruited to participate. A flipped classroom model was adopted, providing students with a 3-chaptered peer-designed, expert validated ultrasound manual before the workshop, to maximize scanning times (2 h of reading). A pretest Likert-type design was used to assess student perception of the ultrasound tool. Similarly, a pretest/post-test model was used to assess sonographic anatomical identification. In addition, a subsequent Objective Structured Clinical Examination (OSCE) test was done 3 weeks after the hands-on session, to evaluate image generation (4 cardiac views: parasternal long, parasternal short, subxiphoid, and apical 4 chambers), understanding of knobology and structural labeling.

RESULTS

For the sonographic anatomy, there was a statistically significant increase (P < .001) between pretest (average = 12.12) and post-test (average = 18.85). The OSCE, which also ascertained knowledge retention, found that 81% of students were able to generate all 4 cardiac views perfectly, 6% were able to obtain 3 views, 10% obtained 2 views and 3% successfully generated a single view. The most challenging scan to generate was the apical 4-chamber view.

CONCLUSION

The positive outcomes stemming from this study reinforces the notion that formal curricular integration of POCUS at the preclerkship level has tangible benefits for medical students.

Post-traumatic stress disorder or emergence phenomena? A case of psychomotor agitation after procedural sedation and analgesia

Background Psychomotor agitation can be problematic in an overcrowded emergency department (ED) during uncontrolled procedural sedation. Although emergence phenomena have been studied, various presentations may exist. Case presentation During procedural sedation, a 58-year-old man was sedated with a dissociative dose of ketamine in conjunction with propofol. His shoulder dislocation was reduced successfully but eventually, an exaggerated agitation occurred resembling a post-traumatic stress disorder (PTSD) flashback of past war scenes He was controlled by physical and chemical restraint with an intramuscular injection of 0.1 mg/kg midazolam. After resolution of sedation in rather stable psychiatric conditions, he left the ED with his relatives insisting for discharge against medical advice. Conclusions A PTSD flashback may occur from ketamine sedation in patients with a past history of military experience and can be a manifestation of psychologic adverse effects of ketamine.

Evaluation of eMentalHealth.ca, a Canadian Mental Health Website Portal: Mixed Methods Assessment

BACKGROUND

Many Canadians have mental health needs, and it can be challenging not knowing where to go for mental health information, services, and support. The website eMentalHealth.ca was created to facilitate and assist Canadians to (1) learn about mental health, (2) screen for common mental health issues, and (3) find mental health services and support.

OBJECTIVE

The aim of this study was to use multiple methods to learn about visitors of eMentalHealth.ca, their perceptions, and their satisfaction with the website.

METHODS

Website analytics (Google Analytics) provided information about the number of unique visits to the website and how the site was used. Web-based self-administered surveys were used to gather additional information on users' characteristics and to assess their perception of the website and satisfaction with the website.

RESULTS

Web analytic results showed that from January 1 to December 31, 2017, there were 651,107 users, with 1.97 million page views. Users were more often female than male, and the majority of users were aged 35 years and older. Most users were located in Canada (612,806/651,107, 94.12%), and the most common city of origin of users was Toronto (101,473/651,107, 15.58%), followed by Ottawa (76,692/651,107, 11.78%), and Montreal (26,621/651,107, 4.09%). Web-based surveys were completed by a total of 370 respondents from June to December 2017. Overall, the majority of users were satisfied with the website (93.0%, 320 out of 344 responses). Positive feedback was related to the content of the website as a helpful resource, and negative feedback was related to technical difficulties as well as the design of the main page. This analysis will be used to help the team with ongoing improvements to the website, for example, improving technical issues and homepage usability.

CONCLUSIONS

Most visitors reported satisfaction with their use of eMentalHealth.ca to learn about mental health as well as where to find help. Mental health websites such as eMentalHealth.ca are a low-cost way to increase public awareness about mental health.

A Devastating Complication of Central Venous Catheter Insertion

Retained guidewire is a major complication of central line placement. We present a patient with infective endocarditis caused by a retained guidewire. A young man admitted to our emergency department complained of debilitating weakness, productive cough, and fever for seven days. Chest radiography showed some lesions in both lungs as well as a retained guidewire. Past history revealed a thermal burn injury one month before, during which an internal jugular central venous line was inserted. Echocardiography showed multiple large vegetations in right atrium and right ventricle. Thus, infective endocarditis and multiple embolic lung lesions were treated with empirical antibiotics. Guidewire was removed by vascular surgery service. Unfortunately, the patient died before undergoing open-heart surgical intervention. It is believed that central vein catheterization requires special attention to perform through the Seldinger technique skillfully and under supervision to avoid preventable complications.

Development of a 3D Printed Neuroanatomy Teaching Model

Gross anatomy has been seen as one of the basic bodies of knowledge that must be mastered as part of medical training. Likewise, neuroanatomy has been seen as foundational to clinical neurosciences. However, Neuroanatomy is different from gross anatomy and this is due to the complexity of the central nervous system, moreover, some of its structures cannot be dissected or demonstrated in anatomy cadaveric lab. The use of anatomical models in medical curricula has been reported as an effective way in teaching and learning anatomy. They have been used to replace cadaveric material when the latter is difficult to acquire, or when the anatomical structures cannot be dissected like the brain ventricles for instance, moreover they have the privilege of visualizing the structures in a 3 dimensional modality. The goal of this study was to create a 3 D printed neuroanatomy model in order to complement the University of Ottawa anatomy models’ library, and help medical students visualize the pathway of different nervous tracts on a 3 D simulation model.To assist with this, 2D images of slices of the cerebrum, brainstem, cervical, thoracic, and lumbar spinal cord were downloaded online to be imported to Adobe Photoshop CC 2015. The images were manually converted to black and white, and separated into different layers to export each components separately into Tinker CAD (online software). The different components were then assembled on Tinker CAD to create 3D printer compatible files. The files were printed using white ABS on a Replicator 2X MakerBot printer at the library of University of Ottawa.    

Increasing Access to Medical Training With Three-Dimensional Printing: Creation of an Endotracheal Intubation Model

BACKGROUND

Endotracheal intubation (ETI) is a crucial life-saving procedure, where more than 2 failed attempts can lead to further complications or even death. Like all technical skills, ETI requires sufficient practice to perform adequately. Currently, the models used to practice ETI are expensive and, therefore, difficult to access, particularly in the developing world and in settings that lack a dedicated simulation center.

OBJECTIVE

This study aimed to improve access to ETI training by creating a comparable yet cost-effective simulation model producible by 3-dimensional (3D) printers.

METHODS

Open-source mesh files of relevant anatomy from BodyParts3D were modified through the 3D modeling programs Meshlab (ISTI-CNR) and Blender (Blender Foundation). Several prototypes with varying filaments were tried to optimize the ETI simulation.

RESULTS

We have created the novel 3D-printed pediatric ETI model for learners at all levels to practice this airway management skill at negligible costs compared with current simulation models. It is an open-source design available for all medical trainees.

CONCLUSIONS

Revolutions in cost and ease of use have allowed home and even desktop 3D printers to become widespread. Therefore, open-source access to the ETI model will improve accessibility to medical training in the hopes of optimizing patient care.

Who tweets in academia? An overview of Twitter use in higher education

Higher education institutions are increasingly using social media as a platform of communication with students, faculty, other institutions and the public. Based on the movement of most universities actively engaging in having a presence on social media, we were interested in analyzing which faculty or school, in the same university, has the most active followship online and generates the most social media impact.

Hemodynamic Responses to Tracheal Intubation in Elderly Patients: Intravenous or Spray of Lidocaine versus Fentanyl

Introduction

Laryngoscopy and tracheal intubation are known to increase sympathetic activity that may be detrimental to patients with preexisting ischaemic or hypertensive heart disease.

Aim

The aim of this study was to compare of intravenous and oropharyngeal spray of lidocaine and high dose of fentanyl on systolic and diastolic blood pressures and heart rate of patients over 65 years during tracheal intubation.

Material and Methods

In this clinical trial, 160 patients over 65 yrs who were randomly divided into five groups of 32 patients. For group one lidocaine spray 10%, group two intravenous lidocaine 1.5 mg/kg, group three lidocaine spray along with intravenous lidocaine 0.75 mg/kg, and for group four fentanyl 5μg/kg were administered and group five patients were controls which were given 1 mg of midazolam along with 2 μg/kg fentanyl. Systolic and diastolic blood pressures and heart rate were measured before and after anesthesia and intubation. ANOVA, Scheffe's and Repeated measure tests were used for data comparison and P<0.05 was considered significant.

Results

No significant difference was detected in terms of gender among the understudy groups. The mean (SD) age of patients in all groups were 69 ±3.5 yrs. (65-80 yrs.) and there is no significant difference was detected between the mean age and other basic variables of under study groups (P<0.328). Study results showed that the kind of surgery hasn't different between groups. The table showed that no difference between male and female. No significant difference was observed between groups with different sizes of tracheal tube in terms of systolic and diastolic blood pressures and heart rate. No significant difference was detected in terms of systolic and diastolic blood pressures and heart rate among groups prior to the induction of anesthesia.

Conclusion

All methods were effective for efficient blood pressure control during laryngoscopy and tracheal intubation.

How to apply the optimal estimation method to your lidar measurements for improved retrievals of temperature and composition

The optimal estimation method (OEM) has a long history of use in passive remote sensing, but has only recently been applied to active instruments like lidar. The OEM’s advantage over traditional techniques includes obtaining a full systematic and random uncertainty budget plus the ability to work with the raw measurements without first applying instrument corrections. In our meeting presentation we will show you how to use the OEM for temperature and composition retrievals for Rayleigh-scatter, Ramanscatter and DIAL lidars.

The Effects of Hydroxyethyl Starch 6% and Crystalloid on Volume Preloading Changes following Spinal Anesthesia

BACKGROUND

Hypotension is one of the most common complications after spinal anesthesia for cesarean delivery. Normally, preloading with fluids, especially crystalloids, is used to prevention of hypotension.

METHODS

In the present randomized clinical trial study, 120 parturients presenting for elective cesarean section with the American Society of Anesthesiologists Class I and II received either 15 cc normal saline or 7 cc/kg hydroxyethyl starch 6% (Voluven) fluid. Information regarding to systolic, diastolic, mean arterial pressure, and heart rate, incidence of hypotension, adverse effects, the total dose of atropine, and ephedrine were recorded in before and 3, 6, 9, 15, and 20 min after spinal anesthesia. Furthermore, Apgar score of newborn at the 1^st and 5^th min after birth was recorded.

RESULTS

There was no significant difference in mean arterial pressure at different stages such as: Exactly after spinal and 3, 6, 15, and 20 min after spinal anesthesia between two groups (P > 0.05). Total dose of ephedrine and atropine were similar between groups (P > 0.05), respectively. There was no significant difference in Apgar score at the 1^st and 5^th min after birth between two groups. There were not any adverse effects of drugs in two groups.

CONCLUSIONS

The results of this study show that hydroxyethyl starch 6% compared to normal saline are similar to prevent hypotension during spinal anesthesia for cesarean delivery.

3D Printing for 21st Century Medical Learners: Opportunities for Innovative Research and Collaboration

AbstractWith the commercialization of accessible 3D printers, using 3D printing for creation of personalized medical interventions has become a rapidly expanding area of research. In keeping with these developments, the Faculty of Medicine at the University of Ottawa has purchased 3D printers (Makerbot Replicator 2X and Ultimaker 2 Extended +) and launched a collaboration with Makerspace and the Health Sciences Library to investigate local opportunities to incorporate 3D printing into education, simulations and research. This article aims to summarize some of the recent developments in 3D printing and introduce readers to how one could use 3D printing for personalized medicine. RésuméAvec la venue de la commercialisation d’imprimantes 3D accessibles, l’emploi de l’impression 3D pour la création d’interventions médicales personnalisées est un domaine de recherche en développement rapide. Afin de rester à jour avec ces développements, la Faculté de Médecine de l’Université d’Ottawa s’est procuré des imprimantes 3D (Makerbot Replicator 2X et Ultimaker 2 Extended +) et a entamé une collaboration avec Makerspace et la Bibliothèque des Sciences de la Santé, pour examiner des opportunités locales visant à incorporer l’impression 3D à l’éducation, aux simulations et à la recherche. Cet article vise à résumer certains des développe- ments récents en impression 3D et à présenter aux lecteurs la manière dont celle-ci peut être utilisée pour la médecine personnalisée.