Pair Scanning: Integrating the Student Sonographer Without Impacting Patient Care.

OBJECTIVES: Ultrasound departments in Canada frequently reduce patient bookings to support student training, which impacts not only patient care but also revenue generation. Therefore, physicians and employers are reluctant to host student sonographers, and educational programs struggle to find sufficient clinical placements for their students. Two research questions were investigated: (1) Can a pair scanning technique effectively integrate the student sonographer into the workplace without impacting patient volumes? (2) Does the pair scanning technique prepare the student sonographer for entry-level practice faster than traditional practice? METHODS: This research project was divided into 2 phases. The first phase used action research to develop the pair scanning protocol at a single site with a single preceptor and student. The second phase used a mixed methods approach to test the transferability of the pair scanning protocol across multiple sites, preceptors, and students. RESULTS: In phase 1, the student sonographer performed a greater number of total examinations than the rest of her cohort (who were at different placement sites), and the higher performance of independent examinations by the student sonographer under the pair scanning technique was statistically significant [H(4) = 36.297; P < .01]. In phase 2, the pair scanning group and the control group performed equally, with no statistically significant differences. CONCLUSIONS: The pair scanning protocol is effective at integrating the student sonographer into the work flow without impacting patient care. It prepares the student sonographer for entry-level practice equally with traditional practice and may be most effective with the weak to average student.

Family Presence at First Cardiopulmonary Resuscitation and Subsequent Limitations on Care in the Medical Intensive Care Unit.

BACKGROUND: The association of family-witnessed cardiopulmonary resuscitation (CPR) and subsequent advance directives in the medical intensive care unit is unknown. OBJECTIVE: To compare clinical outcomes, including subsequent limitations on care, of family-witnessed vs family-unwitnessed CPR in the inpatient setting. METHODS: Analysis of demographics and outcomes pertaining to family presence in a retrospective cohort of consecutive patients receiving first CPR in the medical intensive care unit of a tertiary academic medical center. RESULTS: In 5 years, 323 patients underwent attempted CPR, of which 49 attempts (15.2%) were witnessed by family. In patients with return of spontaneous circulation, 40.9% of those whose first CPR was witnessed by family later had a do not attempt resuscitation order, which did not differ from patients whose first CPR was unwitnessed by family (31.8%). Family-witnessed CPR in the unit was associated with significantly lower rates of return of spontaneous circulation (44.9%) than was family-unwitnessed CPR (62.0%; P = .02). Of all patients with a first CPR, 42 (13.0%) survived to hospital discharge. Only 1 patient with return of spontaneous circulation after first family-witnessed CPR survived to hospital discharge. In-hospital mortality for all patients requiring subsequent CPR was 97.1%. CONCLUSIONS: For unclear reasons, family-witnessed CPR in the medical intensive care unit is associated with a similar rate of subsequent CPR efforts and lower rates of return of spontaneous circulation and survival to hospital discharge.

Neuroprotective effects of anthocyanin- and proanthocyanidin-rich extracts in cellular models of Parkinson׳s disease.

Neuropathological evidence indicates that dopaminergic cell death in Parkinson׳s disease (PD) involves impairment of mitochondrial complex I, oxidative stress, microglial activation, and the formation of Lewy bodies. Epidemiological findings suggest that the consumption of berries rich in anthocyanins and proanthocyanidins may reduce PD risk. In this study, we investigated whether extracts rich in anthocyanins, proanthocyanidins, or other polyphenols suppress the neurotoxic effects of rotenone in a primary cell culture model of PD. Dopaminergic cell death elicited by rotenone was suppressed by extracts prepared from blueberries, grape seed, hibiscus, blackcurrant, and Chinese mulberry. Extracts rich in anthocyanins and proanthocyanidins exhibited greater neuroprotective activity than extracts rich in other polyphenols, and a number of individual anthocyanins interfered with rotenone neurotoxicity. The blueberry and grape seed extracts rescued rotenone-induced defects in mitochondrial respiration in a dopaminergic cell line, and a purple basal extract attenuated nitrite release from microglial cells stimulated by lipopolysaccharide. These findings suggest that anthocyanin- and proanthocyanidin-rich botanical extracts may alleviate neurodegeneration in PD via enhancement of mitochondrial function.

Targeting the intrinsically disordered structural ensemble of α-synuclein by small molecules as a potential therapeutic strategy for Parkinson's disease.

The misfolding of intrinsically disordered proteins such as α-synuclein, tau and the Aß peptide has been associated with many highly debilitating neurodegenerative syndromes including Parkinson's and Alzheimer's diseases. Therapeutic targeting of the monomeric state of such intrinsically disordered proteins by small molecules has, however, been a major challenge because of their heterogeneous conformational properties. We show here that a combination of computational and experimental techniques has led to the identification of a drug-like phenyl-sulfonamide compound (ELN484228), that targets α-synuclein, a key protein in Parkinson's disease. We found that this compound has substantial biological activity in cellular models of α-synuclein-mediated dysfunction, including rescue of α-synuclein-induced disruption of vesicle trafficking and dopaminergic neuronal loss and neurite retraction most likely by reducing the amount of α-synuclein targeted to sites of vesicle mobilization such as the synapse in neurons or the site of bead engulfment in microglial cells. These results indicate that targeting α-synuclein by small molecules represents a promising approach to the development of therapeutic treatments of Parkinson's disease and related conditions.

Development of required postgraduate palliative care training for internal medicine residents and medical oncology fellows.

BACKGROUND: The need for better care for terminally ill patients led us to create an educational program to provide internal medicine residents and medical oncology fellows basic competency in palliative and end-of-life care. METHODS: An interdisciplinary team identified educational strategies, course objectives, content, and evaluation instruments. RESULTS AND CONCLUSIONS: Our strategy is to use a required Web-based course to establish a knowledge base upon which specific training during clinical rotations build skills. Field testing of the Web course showed it was an effective tool for delivering clinically applicable content. Skill building experiences are now being integrated into selected clinical rotations.