RESUMO
Rechargeable batteries have transformed human lives and modern industry, ushering in new technological advancements such as mobile consumer electronics and electric vehicles. However, to fulfill escalating demands, it is crucial to address several critical issues including energy density, production cost, cycle life and durability, temperature sensitivity, and safety concerns is imperative. Recent research has shed light on the intricate relationship between these challenges and the chemical processes occurring at the electrode-electrolyte interface. Consequently, a novel approach has emerged, utilizing self-assembled molecular layers (SAMLs) of meticulously designed molecules as nanomaterials for interface engineering. This research provides a comprehensive overview of recent studies underscoring the significant roles played by SAML in rechargeable battery applications. It discusses the mechanisms and advantageous features arising from the incorporation of SAML. Moreover, it delineates the remaining challenges in SAML-based rechargeable battery research and technology, while also outlining future perspectives.
RESUMO
BACKGROUND: Although the victimization experiences of male college students in dating relationships are gaining increasing scholarly attention, there is still limited empirical evidence and theoretical understanding of the mechanism through which male victims of domestic violence experience subsequent dating violence. OBJECTIVE: This study aims to gain a deeper understanding of the specific mechanisms through which male victimization of domestic violence during childhood transmits to dating violence experience in adulthood. Whether the intergenerational transmission of violence may be explained by gendered pathways or by male participants' identification with the victim's position will be tested. PARTICIPANTS AND SETTING: Participants included 526 South Korean male college students in Seoul. METHODS: Child abuse, witnessing interparental violence, and beliefs justifying and accepting violence were divided based on the gender of the offender and victim to assess distinct effects. Structural equation modeling (SEM) was used to evaluate the relationships between dating violence victimization and child abuse/witnessing interparental violence and the mediation effect of beliefs justifying violence in the relationships between the variables. RESULTS: Both paternal and maternal abuse have significant direct relationships with male dating violence victimization. Witnessing mother-to-father violence had a significant and direct relationship with male victimization while witnessing father-to-mother violence did not. The mediation effect of justification of female-to-male violence was confirmed between witnessing mother-initiated violence and male victimization, whereas justification of male-to-female violence did not show a mediating effect between witnessing father-initiated violence and male victimization. CONCLUSION: Both role and gender associations were confirmed. The results imply that there are different ways through which children learn about violence. More specific targets should be addressed in education programs to break the vicious cycle of violence.
Assuntos
Vítimas de Crime , Violência Doméstica , Violência por Parceiro Íntimo , Criança , Humanos , Masculino , Feminino , Estudantes , MãesRESUMO
This study aimed to understand the heterogeneity of school violence experiences among South Korean youth, explicitly examining how each type of violence experienced transitions into different reporting behaviors. A latent profile analysis was conducted to classify different types of violence victimization and reporting behaviors, followed by a latent transition analysis, which contributed to an understanding of the relationships between profiles of violence and reporting. The influence of social support on reporting victimization was further examined. The results are as follows. First, school violence victimization experience was divided into five profiles: cyber violence-oriented (7.0%), ostracization-oriented (8.9%), verbal violence-oriented (41.8%), high-level of multiple-violence (2.8%), and medium-level of multiple-violence (39.5%). Second, reporting behavior was divided into four profiles: reporting to family and teachers (14.7%), reporting to family, teachers, and friends (11.0%), actively reporting (1.5%), and passively coping (72.8%). Third, students showed the highest probability of passively reporting, while the probability of actively reporting was low for all victimization profiles. Fourth, support from family and friends positively correlated with reporting violence, while support from teachers did not. The findings confirm that reporting violence may vary depending on the type of school violence victimization, implying that different types of violence need to be mitigated in distinct ways. Additionally, the study's result regarding the influence of social support suggests that school counselors and practitioners need to develop ways to facilitate violence reporting in schools.
Assuntos
Bullying , Vítimas de Crime , Adolescente , Humanos , Violência , Instituições Acadêmicas , Apoio SocialRESUMO
This study investigated the relationship between domestic violence and dating violence victimization, and the mediating influence of the justification of dating violence among female Korean university students. The present study uses a cross-sectional survey (N = 550) to examine three research questions. First, does exposure to domestic violence during childhood predict dating violence victimization later in life? Second, does justifying violence mediate the relationship between domestic violence experience and dating violence victimization? Third, does justifying violence show a difference depending on the sexes of the perpetrator in influencing victimization of violence? A series of structural equation modeling analyses were conducted. The results showed that witnessing interparental violence and experiencing child abuse directly influenced dating violence victimization. Second, the justification of violence mediated the relationship between witnessing interparental violence and dating violence victimization. Third, justifying male to female violence influenced dating violence victimization. The study's findings emphasize the importance of the gender-specific justification of violence among young female adults. This study makes essential empirical and theoretical contributions. A more in-depth understanding of the justification of violence between their prior and present experiences of violence in different contexts would support victims to recover and prevent poly-victimization experiences. Significant implications for school counselors as well as practitioners are discussed.
Assuntos
Vítimas de Crime , Violência Doméstica , Violência por Parceiro Íntimo , Adulto , Criança , Humanos , Masculino , Feminino , Estudos Transversais , Comportamento SexualRESUMO
OBJECTIVES: The in-hospital mortality rate among patients with antineutrophil cytoplasmic autoantibody-associated vasculitis (AAV) is high. Unfortunately, there is no reliable prognostic biomarker. This study aimed to investigate whether elevated D-dimer levels can predict hospitalisation outcomes among patients with AAV. METHODS: We performed a retrospective analysis at a tertiary medical centre in Seoul, South Korea, between 2005 and 2019. Patients with AAV requiring hospitalisation, whose D-dimer levels were available within one week of hospitalisation, were included; patients with known alternative reasons for elevated D-dimer were excluded. Death and intensive care unit requirements were defined as adverse outcomes. RESULTS: In total, 61 AAV patients with a total of 100 episodes of hospitalisation were included. Median D-dimer levels were significantly higher in patients with adverse outcomes than in those without adverse outcomes (1.84 vs. 0.42 mg/dL; p=0.006). Consistently, the incidence of the adverse outcomes was significantly higher in the high D-dimer group (≥0.699 mg/dL; n = 40) than in the low D-dimer group (<0.699 mg/dL; n = 60) (35% vs. 10%; p=0.002). Multivariate logistic regression analysis revealed that a high D-dimer level was a significant risk factor for adverse outcomes (hazard ratio, 4.852; 95% confidence interval, 1.320-17.833; p=0.017). Kaplan-Meier survival analysis revealed that the high D-dimer group was associated with more 30-day in-hospital adverse outcomes than the low D-dimer group (p=0.008). CONCLUSIONS: High D-dimer levels on admission are significantly associated with adverse outcomes among patients with AAV.
Assuntos
Vasculite Associada a Anticorpo Anticitoplasma de Neutrófilos , Vasculite Associada a Anticorpo Anticitoplasma de Neutrófilos/diagnóstico , Produtos de Degradação da Fibrina e do Fibrinogênio , Hospitalização , Humanos , República da Coreia/epidemiologia , Estudos Retrospectivos , SeulRESUMO
BACKGROUND/OBJECTIVE: Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) may involve the kidney, respiratory tract, skin, or central and peripheral nervous system. Reports of interstitial lung disease (ILD) in AAV (AAV-ILD) have been increasing. METHODS: We reviewed the medical records of all patients with AAV-ILD between January 1, 2007, and December 31, 2017, and compared their pulmonary involvement to patients with idiopathic pulmonary fibrosis (IPF). RESULTS: We identified 24 patients with AAV-ILD: 14 with microscopic polyangiitis, 8 with granulomatosis with polyangiitis, and 2 with eosinophilic granulomatosis with polyangiitis. Perinuclear or myeloperoxidase ANCA was present in 16 cases (66.7%), whereas cytoplasmic or proteinase 3 ANCA was positive in 8 (33.3%). Usual interstitial pneumonia (UIP) was seen in 11 (45.8%), probable UIP in 1 (4.2%), indeterminate UIP in 2 (8.3%), and an alternate diagnosis in 10 (41.7%), and was further characterized as chronic hypersensitivity pneumonitis-like pattern seen in 6 (25%), nonspecific interstitial pneumonia-like pattern in 3 (12.5%), and cryptogenic organizing pneumonia-like pattern in 1 (4.2%). Forced vital capacity and diffusing capacity declined over time in patients with AAV-ILD. When compared with the IPF cohort, patients with AAV-ILD had intermediate survival and speed of lung function decline (3-year survival in AAV-ILD group was 94% vs 69% in IPF). CONCLUSIONS: Antineutrophil cytoplasmic antibody-associated vasculitis ILD is a progressive and potentially fatal condition. Although most cases in the literature are associated with p-ANCA and positive myeloperoxidase, we found that a third of patients had c-ANCA or granulomatosis with polyangiitis. Our cohort adds experience in this rare manifestation of AAV.
Assuntos
Vasculite Associada a Anticorpo Anticitoplasma de Neutrófilos , Síndrome de Churg-Strauss , Granulomatose com Poliangiite , Fibrose Pulmonar Idiopática , Doenças Pulmonares Intersticiais , Vasculite Associada a Anticorpo Anticitoplasma de Neutrófilos/complicações , Vasculite Associada a Anticorpo Anticitoplasma de Neutrófilos/diagnóstico , Vasculite Associada a Anticorpo Anticitoplasma de Neutrófilos/terapia , Anticorpos Anticitoplasma de Neutrófilos , Humanos , Fibrose Pulmonar Idiopática/diagnóstico , Fibrose Pulmonar Idiopática/terapia , Pulmão , Doenças Pulmonares Intersticiais/diagnóstico , Doenças Pulmonares Intersticiais/etiologia , Doenças Pulmonares Intersticiais/terapia , Estudos RetrospectivosRESUMO
CASE PRESENTATION: A 64-year-old man presented for consideration for lung transplant. He had a history of previous tobacco use, OSA on CPAP therapy, and gastroesophageal reflux disease. He worked as a design engineer. The patient had a 4-year history of dyspnea on exertion, followed with periodic CT scan of the chest. Nine months prior to his evaluation for lung transplant, the patient developed worsening of dyspnea, dry cough, poor appetite, and weight loss. At times, the cough was violent and associated with chest pressure. He was prescribed systemic corticosteroids and antibiotics without improvement. Four months later, the patient noted sudden onset of severe chest pain and worsening dyspnea. A CT scan of the chest demonstrated extensive pneumomediastinum in addition to changes consistent with pulmonary fibrosis. An esophagogram showed thickening of the distal esophagus, but no signs of perforation. He was prescribed supplemental oxygen and advised to stop the use of CPAP. The patient sought a second opinion. A CT scan of the chest showed improvement of the pneumomediastinum and extensive fibrotic lung disease. Pulmonary function tests (PFTs) were consistent with a restrictive pattern, decreased diffusing capacity (Dlco), and a preserved residual volume over total lung capacity ratio. The patient was prescribed systemic corticosteroids with no improvement of his symptoms. Repeat PFTs showed further decline of Dlco, and he was referred for lung transplant evaluation.
Assuntos
Enfisema Mediastínico/fisiopatologia , Insuficiência Respiratória/fisiopatologia , Humanos , Transplante de Pulmão , Masculino , Enfisema Mediastínico/cirurgia , Pessoa de Meia-Idade , Testes de Função Respiratória , Insuficiência Respiratória/cirurgiaAssuntos
Encefalopatias Metabólicas/terapia , Hemofiltração , Hiperamonemia/terapia , Transplante de Pulmão/efeitos adversos , Complicações Pós-Operatórias/terapia , Amônia/sangue , Encefalopatias Metabólicas/sangue , Encefalopatias Metabólicas/diagnóstico , Encefalopatias Metabólicas/etiologia , Feminino , Humanos , Hiperamonemia/sangue , Hiperamonemia/diagnóstico , Hiperamonemia/etiologia , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Doença Pulmonar Obstrutiva Crônica/cirurgia , Fibrose Pulmonar/cirurgia , Resultado do TratamentoRESUMO
PURPOSE OF REVIEW: To discuss the controversy over the effect of dietary fiber (DF) on (1) outcomes in critical illness, (2) microbiome and metabolic homeostasis, and (3) current evidence and guidelines regarding supplementation in critically ill patients. RECENT FINDINGS: In healthy individuals, consumption of DF is widely known as a long-term protecting factor against colon cancer, cardiovascular disease, and other metabolic disorders like obesity, type 2 diabetes, and fatty liver disease; in hospitalized patients, DF may have a beneficial effect in the incidence of diarrhea, infections, and length of stay. But, what does that mean for critically ill patients? What is the recommended DF intake and what are current guidelines? There are many confounding factors that limit the evidence of beneficial effects from fiber supplementation in critically ill patients, including the side effects critical care therapies can have on gut microbiota, but after extrapolating data from healthy and hospitalized non-critical patients and considering that its administration appears to be safe, it may be wise to administer fiber-containing enteral feedings in ICU patients. Analysis of those confounders requires future research.
Assuntos
Estado Terminal/terapia , Fibras na Dieta/uso terapêutico , Microbioma Gastrointestinal/fisiologia , Diabetes Mellitus Tipo 2 , Diarreia/dietoterapia , Nutrição Enteral , Fígado Gorduroso , Humanos , Incidência , Unidades de Terapia Intensiva , Tempo de Internação , Doenças Metabólicas , Obesidade , Prebióticos , Probióticos/uso terapêutico , SimbolismoRESUMO
BACKGROUND: Lung cancer is one of the most lethal malignancies, with a 5-year survival rate < 20% in patients with stage IV lung cancer. Impaired host immunity is associated with lung cancer pathogenesis, and interferon gamma (IFN-γ) plays an important role in antitumor immune surveillance. We evaluated the clinical significance of ex vivo production of IFN-γ in patients with lung adenocarcinoma. PATIENTS AND METHODS: We reviewed the medical records of 109 treatment-naive patients with lung adenocarcinoma who had undergone IFN-γ releasing assay. Differences in the IFN-γ level in nil and mitogen tubes were defined as ex vivo IFN-γ production. Correlation analysis was performed to evaluate the correlation between ex vivo IFN-γ production, cancer staging, and Eastern Cooperative Oncology Group performance status. The optimal cutoff values of low and high ex vivo IFN-γ production were estimated using receiver operator characteristic curve analysis. Cox proportional hazard analyses were used to evaluate the prognostic factors of 1-year overall patient survival. RESULTS: Ex vivo IFN-γ production correlated with N stage, M stage, cancer staging, and Eastern Cooperative Oncology Group performance status. Low ex vivo IFN-γ production (ex vivo IFN-γ production ≤ 7.79 IU/mL) was independently associated with 1-year overall survival (odds ratio = 3.289; 95% confidence interval, 1.573-6.872; P = .002). Additionally, low ex vivo IFN-γ production was an independent predictor of 1-year overall survival in patients with stage IV cancer (odds ratio = 3.156; 95% confidence interval, 1.473-6.760; P = .003). CONCLUSION: Ex vivo IFN-γ production before treatment might be a useful biomarker for predicting prognosis in patients with lung adenocarcinoma.
Assuntos
Adenocarcinoma de Pulmão/diagnóstico , Interferon gama/metabolismo , Células Matadoras Naturais/imunologia , Neoplasias Pulmonares/diagnóstico , Linfócitos T/imunologia , Adenocarcinoma de Pulmão/imunologia , Adenocarcinoma de Pulmão/mortalidade , Idoso , Biomarcadores , Células Cultivadas , Feminino , Humanos , Neoplasias Pulmonares/imunologia , Neoplasias Pulmonares/mortalidade , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Prognóstico , Análise de SobrevidaRESUMO
BACKGROUND: With growing interest in parenting stress among mothers of children with disabilities, the current study examined the multidimensional aspects of parenting stress and their impact on life satisfaction among Korean mothers of children with disabilities. Based on the suggestions of prior findings concerning the potential role of intrapersonal resources on moderating parenting stress, the study focused on intrinsic religious orientation as one of the intrapersonal resources. METHOD: Participants completed measures of three types of parenting stress (parental distress, parent-child dysfunctional interaction and difficult child), life satisfaction and religious orientation. RESULTS: Two subscales of parenting stress (i.e., parental distress and difficult child) had negative associations with life satisfaction. Intrinsic religious orientation weakened the relationship between parental distress and life satisfaction, especially among individuals who held moderate and high levels of intrinsic religious orientation. CONCLUSION: These findings indicate the existence of differential associations between parenting stress type and life satisfaction in Korean mothers of children with disabilities. The current findings also identified the interrelationships between the religious resources and maternal parenting stress of children with disabilities. Intrapersonal religious resources have the potential to counterbalance the negative impact of maternal distress.
Assuntos
Deficiências do Desenvolvimento/enfermagem , Crianças com Deficiência , Deficiência Intelectual/enfermagem , Mães/psicologia , Poder Familiar/psicologia , Satisfação Pessoal , Religião e Psicologia , Estresse Psicológico/psicologia , Adulto , Criança , Feminino , Humanos , Masculino , Poder Familiar/etnologia , República da Coreia/etnologia , Estresse Psicológico/etnologiaRESUMO
Ventricular premature complexes (VPCs) during stress testing in the general population are commonly seen in clinical practice, but their prognostic value is not well understood. A comprehensive literature search of MEDLINE, Embase, and the Cochrane Library from January 1970 to May 2015 was conducted. Observational cohort studies on general populations evaluating the association between exercise-induced VPCs and all-cause or cardiovascular mortality were included in the analysis. Nine studies comprising 62,488 participants comparing clinical outcomes of patients with and without exercise-induced VPCs were included. The overall combined relative risks (RRs) for all-cause mortality and cardiovascular mortality in patients with exercise-induced VPCs were 1.41 (95% CI 1.23 to 1.61) and 1.86 (95% CI 1.51 to 2.30), respectively. In subgroup analysis, both frequent VPCs (RR 1.35, 95% CI 1.14 to 1.60) and infrequent VPCs (RR 1.57, 95% CI 1.13 to 2.18) were associated with an adverse outcome. VPCs during recovery were associated with an increased risk of death (RR 1.55, 95% CI 1.22 to 1.96). VPCs during exercise did not achieve statistical significance (RR 1.14, 95% CI 0.96 to 1.34), but only a few studies were included in the analysis. In conclusion, our meta-analysis suggests that exercise-induced VPCs in the general population significantly increase the risk of total mortality and cardiovascular mortality. Our study calls for further studies to assess the prognostic significance of exercise-induced VPCs and the utility of efforts to reduce the VPC burden to improve the clinical outcome.
Assuntos
Morte Súbita Cardíaca/epidemiologia , Morte Súbita Cardíaca/etiologia , Teste de Esforço/efeitos adversos , Complexos Ventriculares Prematuros/etiologia , Complexos Ventriculares Prematuros/mortalidade , Medicina Baseada em Evidências , Humanos , Estudos Observacionais como Assunto , Prognóstico , Medição de Risco , Fatores de Risco , Estados Unidos/epidemiologia , Complexos Ventriculares Prematuros/complicaçõesRESUMO
In two-dimensional interfacial assemblies, there is an interplay between molecular ordering and interface geometry, which determines the final morphology and order of entire systems. Here we present the interfacial phenomenon of spontaneous facet formation in a water droplet driven by designed peptide assembly. The identified peptides can flatten the rounded top of a hemispherical droplet into a plane by forming a macroscopic two-dimensional crystal structure. Such ordering is driven by the folding geometry of the peptide, interactions of tyrosine and crosslinked stabilization by cysteine. We discover the key sequence motifs and folding structures and study their sequence-specific assembly. The well-ordered, densely packed, redox-active tyrosine units in the YYACAYY (H-Tyr-Tyr-Ala-Cys-Ala-Tyr-Tyr-OH) film can trigger or enhance chemical/electrochemical reactions, and can potentially serve as a platform to fabricate a molecularly tunable, self-repairable, flat peptide or hybrid film.
Assuntos
Peptídeos/química , Tirosina/química , CatáliseRESUMO
BACKGROUND: Active tuberculosis (TB) risk increases during anti-tumor necrosis factor (TNF) therapy; therefore, latent TB infection (LTBI) screening is recommended in potential TNF inhibitor users. It is unclear whether anti-TNF therapy increases the risk of active TB infection even after standard LTBI treatment. OBJECTIVE: The objective of this study was to compare the risk of active TB development in LTBI-positive versus LBTI-negative TNF inhibitor users following the current national LTBI treatment guidelines for LTBI. METHODS: We retrospectively studied 949 TNF inhibitor users with immune-mediated inflammatory diseases from 2005 to 2012 at the Yonsei University Health System. We compared the incidence of active TB among LTBI-positive TNF inhibitor users treated according to national guidelines (n = 256) and LTBI-negative TNF inhibitor users (n = 521), using Poisson regression. RESULTS: The active TB incidence was 1107 per 100,000 patient-years in LTBI-positive TNF inhibitor users who received standard LTBI treatment and 490 per 100,000 patient-years in LTBI-negative TNF inhibitor users. Analysis showed that despite this numerical trend active TB risk was not statistically significantly elevated in LTBI-positive versus LTBI-negative TNF inhibitor users (incidence risk ratio, 2.15; P = 0.24; 95% confidence interval, 0.6-7.7). CONCLUSIONS: This study demonstrated no statistically significantly increased risk of active TB in LTBI-positive TNF inhibitor users who received standard LTBI treatment compared with LTBI-negative TNF inhibitor users.
Assuntos
Antirreumáticos/efeitos adversos , Antirreumáticos/uso terapêutico , Antituberculosos/uso terapêutico , Tuberculose Latente/tratamento farmacológico , Doenças Reumáticas/tratamento farmacológico , Tuberculose/epidemiologia , Fator de Necrose Tumoral alfa/antagonistas & inibidores , Adulto , Feminino , Humanos , Incidência , Tuberculose Latente/microbiologia , Masculino , Pessoa de Meia-Idade , Mycobacterium tuberculosis , Análise de Regressão , República da Coreia , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento , Tuberculose/microbiologiaRESUMO
AIM: To examine whether a hospitalist-directed interdisciplinary (ITD) team in an internal medicine residency program enhances the hospital and clinical outcomes for seniors with acute medical illness. METHODS: Seniors admitted to a USA teaching hospital medical floor-teaching services were allocated to the ITD (n = 379) and usual care teams (n = 383). Compared with the usual care team, the ITD team physicians carried out daily "geriatric" assessment and management, and led ITD team meetings. RESULTS: The mean probability of functional decline on hospital discharge in the ITD team (25%; 95% CI 19-30%) was significantly lower than that in the usual care team (36%; 95% CI 30-43%; OR 0.35; 95% CI 0.10-0.92; P < 0.001). The mean probability of delirium in the ITD team (26%; 95% CI 20-32%) was significantly lower than that in the usual care team (34%; 95% CI 28-41%; OR 0.48; 95% CI 0.16-0.97; P = 0.03). The mean probability of transition to an institution in the ITD team (18%; 95% CI 13-23%) was significantly lower than that in the usual care team (26%; 95% CI 19-32%; OR 0.41; 95% CI 0.14-0.95; P = 0.01). CONCLUSIONS: Hospitalist-directed ITD team care is associated with reductions of functional decline, delirium and transition to an institution for seniors with acute medical illness.
Assuntos
Doença Aguda/terapia , Delírio/prevenção & controle , Médicos Hospitalares , Hospitalização/estatística & dados numéricos , Comunicação Interdisciplinar , Equipe de Assistência ao Paciente/organização & administração , Transição para Assistência do Adulto/tendências , Idoso , Idoso de 80 Anos ou mais , Hospitais de Ensino , Humanos , Estados UnidosRESUMO
To investigate the possibility of treating multidrug-resistant tumors with targeted chemo-photothermal treatment, we conducted in vitro and in vivo studies using a doxorubicin (DOX)-resistant DLD-1 cell line (DLD-1/DOX) and nude mice with human xenograft tumors, respectively. The chemo-photothermal treatment consisted of DOX-loaded-poly(lactic-co-glycolic acid)-Au half-shell nanoparticles with targeting moieties of anti-death receptor-4 monoclonal antibody conjugated to the Au surface. The cells or xenografted tumors treated with nanoparticles were exposed to near infrared light for 10 min, which caused an increase in temperature to 45 °C. Chemo-photothermal treatment resulted in a large reduction in the rate of tumor xenograft growth on DLD-1/DOX tumor-bearing mice with a much smaller dose of DOX than conventional DOX chemotherapy. These results demonstrate that targeted chemo-photothermal treatment can provide high therapeutic efficacy and low toxicity in the treatment of multidrug-resistant tumors.
Assuntos
Neoplasias do Colo/tratamento farmacológico , Portadores de Fármacos , Resistencia a Medicamentos Antineoplásicos , Ouro/química , Nanopartículas Metálicas , Animais , Humanos , Camundongos , Camundongos Nus , Ensaios Antitumorais Modelo de XenoenxertoRESUMO
BACKGROUND: The "July phenomenon" describes poor patient outcomes in teaching hospitals at the beginning of a new academic year when trainees begin. Whether this phenomenon truly exists is unclear. OBJECTIVE: The purpose of this study was to identify whether trainee and attending inexperience is associated with cardiac electrophysiologic procedural outcomes including total procedure time, fluoroscopy time, and complications. METHODS: We retrospectively reviewed the available electronic records of 488 consecutive patients undergoing initial dual-chamber pacemaker (PM) or cardiac resynchronization therapy (CRT) device implantation performed at University of California, San Francisco from February 2004 through November 2011. We calculated physician's year of experience using the procedure date and the physician's job start date. Patients were stratified into two subgroups based on their device type. Procedural outcomes including procedure length, fluoroscopy time, and complications were retrieved from electronic databases. RESULTS: After multivariate analysis, fellow experience was associated with decreased procedure time (19% less procedure time/year of experience, 95% confidence interval [CI] 13%-25%, P <.001 in the PM subgroup; and 15% less procedure time/year of experience, 95% CI 7%-23%, P <.001 in the CRT subgroup). Fellow experience was associated with decreased fluoroscopy time in the CRT subgroup (19% less fluoroscopy time/experience years, 95% CI 5%-34%, P = .009). Neither fellow nor attending experience was associated with complications. CONCLUSION: Each year of fellow experience is associated with a decrease in cardiac device implantation procedure time and a decrease in fluoroscopy time during CRT implantation. No associations between fellow experience and in-hospital complications were observed.
Assuntos
Cardiologia/educação , Competência Clínica/normas , Desfibriladores Implantáveis , Educação Médica Continuada/normas , Docentes/normas , Insuficiência Cardíaca/terapia , Duração da Cirurgia , Idoso , California/epidemiologia , Feminino , Fluoroscopia/efeitos adversos , Seguimentos , Hospitais de Ensino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Fatores de TempoRESUMO
AIM: To examine whether an internal medicine interdisciplinary floor team enhances the hospital and clinical outcomes for seniors with acute medical illness. METHODS: Seniors admitted to medical floor teaching services of a USA teaching hospital were recruited and allocated to the interdisciplinary (ITD; n = 236) and usual care teams (n = 248). Compared with the usual care team, the interdisciplinary team physicians carried out daily "geriatric" assessment and management, and led the interdisciplinary team meeting designed for improving interprofessional collaboration. RESULTS: After controlling for patient and physician characteristics, the mean hospital length of stay in the ITD team (6.1 days; 95% CI 5.2-7.7 days) was 0.7 days shorter than that in the usual care team (6.8 days; 95% CI 5.7-8.3 days; P = 0.008). There was no significant difference in delirium and 30-day hospital readmission between care groups. CONCLUSIONS: Notwithstanding partly positive associations, the results from the present study suggest that interdisciplinary team-based care is, at best, associated with enhancing the clinical and hospital outcomes for seniors with acute medical illness.