Azithromycin Reduces Markers of Vascular Damage in Pediatric Patients With Sickle Cell Disease.

Background: Immunomodulatory effects of macrolides in chronic inflammation are well known. In this study, we tested our hypothesis that azithromycin (AZT) can decrease inflammation in pediatric patients with sickle cell disease (SCD). Methods: The use of AZT as an anti-inflammatory agent was evaluated in double-blind, placebo-controlled, cross-over study for 8 weeks of treatment with 8 weeks of washout. Blood samples were collected before (PRE) and after (POST) each 8-week treatment period. Repeated measures analysis of variance (ANOVA) with post hoc multiple comparison procedures and Chi-square test were used for statistical analysis of the data. Complete blood count, distribution of the lymphocyte subsets, and plasma levels of markers of vascular damage were analyzed. Results: A significant decrease in the number of leucocytes and granulocytes was observed in AZT group following treatment. An opposite dynamic was observed in placebo group; numbers of granulocytes significantly increased at POST interval. All markers of vascular damage were reduced in AZT group at POST interval with overall significance (P = 0.026). The most prominent significant changes were observed in levels of myeloid-related protein 8/14 (MRP8/14), lipocalin A (NGAL), matrix metalloproteinases (MMP) 9, and insulin-like growth factor-binding protein (IGFBP) 4. Plasma level of C-reactive protein (CRP) was significantly decreased in AZT group as well. Conclusions: Data suggested that AZT may be beneficial in management of microvascular injury in SCD.

Conceptions of Learning and Teaching for Faculty Who Teach Basic Science.

INTRODUCTION: Conceptions of learning and teaching refer to what faculty think about teaching effectiveness. Approaches to teaching refer to the methods they use to teach. Both conceptions and approaches range from student-centered/learning-focused (active learner engagement) to teaching-centered/content-focused (passive learner engagement). This study explored how faculty teaching experience influenced faculty conceptions and their approaches to teaching. The authors hypothesized that more experienced educators appreciate and apply active learning approaches. METHODS: The authors used a cross-sectional survey to collect anonymous data from the Basic Science faculty at Virginia Tech Carilion School of Medicine (VTCSOM). The survey included the Conceptions of Learning and Teaching scale (COLT; Jacobs et al. 2012) and demographic information. They assessed instrument reliability with Cronbach's alpha and examined relationships between variables with correlation and chi-square and group differences with ANOVA. RESULTS: Thirty-eight percent (50/130) of faculty responded to the survey. COLT scores for student-centered (4.06 ± 0.41) were significantly higher (p < 0.001) than teacher-centered (3.12 ± 0.6). Teacher-centered scores were lower (p < 0.05) for younger (30-39, 2.65 ± 0.48) than older faculty (50-59, 3.57 ± 0.71) and were negatively correlated with using multiple teaching methods (p = 0.022). However, 83% (39/50) reported using both traditional lectures and active approaches. DISCUSSION: Faculty conceptions about teaching showed appreciation for active learning, but a tendency to use traditional teaching methods interspersed with student-centered ones. Teaching experience was not related to faculty conceptions but was related to their teaching approaches. The amount of time dedicated to teaching was related to the appreciation of active learning, and young teachers were more student-oriented. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s40670-021-01264-4.

Brief Mindfulness Practice Course for Healthcare Providers.

OBJECTIVE: The aim of this study was to examine the short-term and sustained effect on well-being, burnout, and mindful awareness of an abbreviated mindfulness practice course designed for nurses and other healthcare professionals. BACKGROUND: Most mindfulness programs are impractical for frontline healthcare providers because of the intensive, off-site initial training and prolonged practice commitment. A psychiatric nurse educator developed a brief training program tailored for healthcare providers. METHODS: Two institutional review board-approved studies examined the abbreviated mindfulness practice course for healthcare providers: the first, a single-group pretest-posttest design with 25 nursing employees in an academic medical center, and the second, a randomized controlled trial with 83 healthcare professionals. RESULTS: Significant improvement in mindful awareness and at least 1 indicator of burnout were demonstrated. Improvements in quality of life were noted with nurses. CONCLUSIONS: Findings support the short-term and sustained impact of this brief mindfulness curriculum on mindful awareness, quality of life, and aspects of burnout for healthcare professionals.

Mindfulness in the OR: A Pilot Study Investigating the Efficacy of an Abbreviated Mindfulness Intervention on Improving Performance in the Operating Room.

BACKGROUND: Surgery requires operating room physicians to succumb to unpredictable schedules, long hours, and involved operations, which have led many to acquire maladaptive habits to attain focus in the OR. Research on mindfulness in the medical community has shown positive results on stress, burnout, and quality of life. However, due to the seemingly subjective nature of the benefits of mindfulness as well as the lengthy time requirement by participants, researchers have had difficulty conducting experiments with adequate sample sizes and controls in operating room specialties. OBJECTIVE: We assessed the hypotheses that a brief mindfulness intervention on physicians, residents, and anesthesiologists can improve mindfulness, focus, and perceived stress in the operating room. Additionally, we hypothesized that the improvement in scores are independent of level of training and physician type. METHODS: As part of a 3 (Physician Type) X 3 (Case) X 2(Timing) factorial design, 33 surgeons, anesthesiologists, and surgical residents completed a pre- and postintervention Mindfulness Awareness and Attention Scales (MAAS) survey. Three categories of surgery cases, routine-elective, complex-elective, and add-on, were completed pre- and postintervention, along with measures addressing focus and perceived stress. The intervention included a 25-minute mindfulness training on the benefits of mindfulness and how to utilize a brief, 4-minute mindfulness skill employed prior to each postintervention surgery. RESULTS: The mindfulness intervention was associated with a significant increase in mindfulness (p = 0.006) and flow state (p = 0.009) and a significant decrease in perceived stress (p = 0.033), particularly during the complex routine cases (p = 0.024). CONCLUSIONS: We have developed a brief mindfulness intervention that is compatible with the busy workflow of operating room physicians and can increase the mindful state of participants as well as improve factors that are associated with burnout and distractions.

Bras for Breast Support After Sternotomy: Patient Satisfaction and Wear Compliance.

BACKGROUND: For women undergoing median sternotomy, especially those with a bra cup size C or larger, breast support can reduce pain, wound breakdown, and infection. This study addressed a gap in research, identifying the best bra after sternotomy in terms of patient satisfaction and wear compliance. OBJECTIVES: To evaluate larger-breasted women's satisfaction and compliance with wearing 3 commercially available front-closure bras-with a hook-loop closure (the hospital's standard of care), a zipper closure, or a hook-eye closure-after cardiac surgery. METHODS: This study used a posttest-only, 3-group randomized controlled design. A convenience sample of participants were sized and randomly assigned a product that was placed immediately postoperatively. Participants agreed to wear the bra at least 20 h/d until the provider cleared them for less wear. At inpatient day 5 or discharge, and at the follow-up outpatient visit, subjects completed investigator-developed surveys. Data were analyzed from 60 participants by using the χ2 test and Kruskal-Wallis analysis of variance; also, patterns were identified within written comments. RESULTS: Participants were most satisfied with the hook-eye front-closure product before (P = .05) and after (P = .02) discharge. Participants recommended the hook-eye and zipper products over the hook-loop bra (H = 8.39, P = .02). Wear compliance was strongest in the group wearing the hook-eye bra. CONCLUSIONS: The hook-eye closure product had the most satisfaction and greatest wear compliance, and it received the highest recommendation. A practice change was made to fit and place the hook-eye bra in the operating room immediately after surgery.

Pulseless Electrical Activity: Echocardiographic Explanation of a Perplexing Phenomenon.

Pulseless electrical activity (PEA) is considered an enigmatic phenomenon in resuscitation research and practice. Finding individuals with no consciousness or pulse but with continued electrocardiographic (EKG) complexes obviously raises the question of how they got there. The development of monitors that can display the underlying rhythm has allowed us to differentiate between VF, asystole, and PEA. Lack of clear understanding of the emergence of PEA has limited the research and development of interventions that might improve the low rates of survival typically associated with PEA. Over 30 years of studying and practicing resuscitation have allowed the authors to see a substantial rise in PEA with variable survival rates, based on the patients' illness spectrum and intensity of monitoring. This paper presents a small case series of individuals with brain death whose family members consented to the echocardiographic observation of the dying process after disconnection from life support. The observation from these cases confirms that PEA is a late phase in the clinical dying process. Echocardiographic images delineate the stages of pseudo-PEA with ineffective contractions, PEA, and then asystole. The process is contiuous with none of the sudden phase shifts seen in dysrhythmic events such as VF, VT or SVT. The implications of these findings are that PEA is a common manifestation of tissue hypoxia and metabolic substrate depletion. Our findings offer prospects for studies of the development of interventions to improve PEA survival.

Fatigue in medical residents leads to reactivation of herpes virus latency.

The main objective of this study was to detect fatigue-induced clinical symptoms of immune suppression in medical residents. Samples were collected from the subjects at rest, following the first night (low-stress), and the last night (high-stress) of night float. Computerized reaction tests, Epworth Sleepiness Scale, and Wellness Profile questionnaires were used to quantify fatigue level. DNA of human herpes viruses HSV-1, VZV, EBV, as well as cortisol and melatonin concentrations, were measured in saliva. Residents at the high-stress interval reported being sleepier compared to the rest interval. EBV DNA level increased significantly at both stress intervals, while VZV DNA level increased only at low-stress. DNA levels of HSV-1 decreased at low-stress but increased at high-stress. Combined assessment of the viral DNA showed significant effect of stress on herpes virus reactivation at both stress intervals. Cortisol concentrations at both stress intervals were significantly higher than those at rest.

Resuscitation in the hospital: circadian variation of cardiopulmonary arrest.

PURPOSE: Over 25 reports have found outpatient frequency of sudden cardiac death peaks between 6 am and noon; few studies, with inconsistent results, have examined circadian variation of death in hospitalized patients. This study assesses circadian variation in cardiopulmonary arrest of in-hospital patients across patient, hospital, and event variables and its effect on survival to discharge. METHODS: A retrospective, single institution registry included all admissions to the Medical Center of Central Georgia in which resuscitation was attempted between January 1987 and December 2000. The registry included 4692 admissions; only the first attempt was reported. Analyses of 1-, 2-, 4-, and 8-hour intervals were performed; 1- and 4-hour intervals are presented. RESULTS: Significant circadian variation was found at 1 hour (P=.01), but not at 4-hour intervals. Significant circadian variation was found for initial rhythms that were perfusing (P=.03) and asystole (P=.01). A significantly higher percentage of unwitnessed events were found as asystole during the overnight hours (P=.002). Using simple logistic regression, time in 4-hour intervals and rhythm were each significantly related to patient survival until hospital discharge (P=.003 and P <.0001). In multivariate analysis, only rhythm remained significant. CONCLUSIONS: Circadian variation of cardiopulmonary arrest in this hospital has several temporal versions and is related to survival. Late night variation in witnessed events and rhythm suggests a delay between onset of clinical death and discovery, which contributes to poorer outcomes.

Ethical issues in registry research: in-hospital resuscitation as a case study.

RESEARCH BASED ON REGISTRY STUDIES involves significant ethical issues. Using detailed information about one registry concerning in-hospital resuscitation, we present issues concerning informed consent, access to identifiable medical information, and benefit for participants. In addition, multiple methodological difficulties have indirect implications for the ethical conduct of registry research, including consensus about variable definitions, validity and reliability for clinical decisions, sample sizes, and sources of data. Both direct and indirect ethical issues are examined from the viewpoint of accepted regulations and codes regarding ethical conduct of research; specific examples of more or less ethical solutions to the problems are presented from published research.

Success changes the problem: why ventricular fibrillation is declining, why pulseless electrical activity is emerging, and what to do about it.

BACKGROUND: Programs for research and practice in resuscitation have focused on identification and reversal of ventricular fibrillation (VF). While substantial progress has been achieved, evidence is accumulating that clinical death is less likely to be caused by fibrillation now than in the 1960s and 1970s. Pulseless electrical activity (PEA) has emerged as the most common rhythm found in arrests in the hospital and is rapidly rising in pre-hospital reports. PURPOSE: To identify the magnitude of changes occurring, search for potential explanations from population and clinical epidemiology and present the data available regarding etiology and treatment of PEA. DATA SOURCES: Synthesis of material from population epidemiology, clinical epidemiology, animal and human research on VF and PEA. CONCLUSIONS: VF is a manifestation of severe, undiagnosed coronary artery disease (CAD). Rates of death from CAD increased from rare in 1930 to become the most common cause of death in the US. CAD death rates peaked in the early 1960s and had declined over 50% by the late 1990s. Primary and secondary prevention, early diagnosis and aggressive, successful treatment have contributed to this decline. PEA is a brief phase in clinical death that occurs after losses in consciousness, ventilatory drive and circulation but before decay to asystole; survival rates are poor. PEA is a common stage in clinical death from any of a variety of tissue hypoxic/anoxic insults. Research on PEA is needed; 50 years of attention to CAD and VF have resulted in improved survival and changed the disease spectrum. Similar attention to animal and clinical research on PEA may have the potential to improve survival.

Medical students' attitudes in a PBL curriculum: trust, altruism, and cynicism.

PURPOSE: Studies have shown that medical students become more cynical and less altruistic as they advance in training. However, these studies were conducted in traditional medical schools, and many used unvalidated tools. This study examined students' attitudes in a problem-based learning (PBL) curriculum using reliable and valid measures. METHOD: Medical students and PGY-1 residents at Mercer University School of Medicine in Macon, Georgia, completed Wrightsman's Philosophies of Human Natures Scale (PHNS) in 1999 and 2000. Chronbach's alpha assessed internal reliability among subscales, and test-retest reliability coefficients confirmed acceptable reliability. For 114 students who completed both surveys, changes in PHNS scores were analyzed, with particular attention to the subscales of trustworthiness, altruism, and cynicism. RESULTS: Students assessed at the beginning of their second year increased the extent to which they believed people are trustworthy and increased their beliefs in how altruistic people are. They also showed a significant decrease in cynicism. There was not a significant change in trustworthiness, altruism, or cynicism among the participants beyond first year. In general, female students held less cynical views about others and believed people to be more trustworthy. CONCLUSIONS: Contrary to prior reports, this study found that more advanced trainees were not more cynical or less altruistic than their more junior counterparts. Indeed, a significant and positive change of attitudes among the participants during their first year of medical school refuted earlier reports. Thus, results of earlier studies and the effect of a PBL curriculum on attitudes of medical students need to be re-examined.