Dream one, do one, teach one: a mental practice script for bougie assisted cricothyrotomy.

Mental practice is an effective method for skill acquisition in medicine. We describe the integration of interview-derived sensory cues with a list of procedural steps into a cohesive script to facilitate mental practice for a High Acuity, Low-Occurrence procedure, the bougie-assisted cricothyrotomy. Data collection occurred through interviews with emergency physicians. Interview transcripts were analyzed on a coding framework based on a previously published list of procedural steps. These cues were integrated with procedural steps to create a narrative script. Eight interview transcripts were analyzed. A total of 328 cues were identified. On average, each participant identified 13.7 cues per procedure. This represents the first attempt to combine cues identified by practitioners along with procedural steps with the aim of supporting rich mental representations of a procedure. We expect that this script will be useful to physicians seeking to improve their skills in this rare procedure.

RéSUMé: La pratique mentale est une méthode efficace d'acquisition de compétences en médecine. Nous décrivons l'intégration d'indices sensoriels dérivés de l'entrevue avec une liste d'étapes procédurales dans un scénario cohésif pour faciliter la pratique mentale pour une procédure de haute acuité, de faible occurrence, la cricothyrotomie assistée par bougie. La collecte de données s'est faite au moyen d'entrevues avec des médecins urgentistes. Les transcriptions des entrevues ont été analysées selon un cadre de codage fondé sur une liste d'étapes procédurales déjà publiée. Ces indices ont été intégrés aux étapes procédurales pour créer un scénario narratif. Huit transcriptions d'entrevues ont été analysées. Au total, 328 indices ont été identifiés. En moyenne, chaque participant a identifié 13,7 indices par procédure. Il s'agit de la première tentative de combiner des indices identifiés par les praticiens avec des étapes procédurales dans le but de soutenir des représentations mentales riches d'une procédure. Nous nous attendons à ce que ce texte soit utile aux médecins qui cherchent à améliorer leurs compétences dans cette procédure rare.

Outcomes of Patients Transported in the Prone Position to a Regional Extracorporeal Membrane Oxygenation Center: A Retrospective Cohort Study.

Prone positioning is associated with improved mortality in patients with moderate/severe acute respiratory distress syndrome (ARDS) and has been increasingly used throughout the COVID-19 pandemic. In patients with refractory hypoxemia, transfer to an extracorporeal membrane oxygenation (ECMO) center may improve outcome but may be challenging due to severely compromised gas exchange. Transport of these patients in prone position may be advantageous; however, there is a paucity of data on their outcomes. OBJECTIVES: The primary objective of this retrospective cohort study was to describe the early outcomes of ARDS patients transported in prone position for evaluation at a regional ECMO center. A secondary objective was to examine the safety of their transport in the prone position. DESIGN: Retrospective cohort study. SETTING: This study used patient charts from Ornge and Toronto General Hospital in Ontario, Canada, between February 1, 2020, and November 31, 2021. PARTICIPANTS: Patient with ARDS transported in the prone position for ECMO evaluation to Toronto General Hospital. MAIN OUTCOMES AND MEASURES: Descriptive analysis of patients transported in the prone position and their outcomes. RESULTS: One hundred fifteen patients were included. Seventy-two received ECMO (63%) and 51 died (44%) with ARDS and sepsis as the most common listed causes of death. Patients were transported primarily for COVID-related indications (93%). Few patients required additional analgesia (8%), vasopressors (4%), or experienced clinically relevant desaturation during transport (2%). CONCLUSIONS AND RELEVANCE: This cohort of patients with severe ARDS transported in prone position had outcomes ranging from similar to better compared with existing literature. Prone transport was performed safely with few complications or escalation in treatments. Prone transport to an ECMO center should be regarded as safe and potentially beneficial for patients with ARDS and refractory hypoxemia.

Introducing the Safety Threats and Adverse events in Trauma (STAT) taxonomy: standardized classification system for evaluating safety during trauma resuscitation.

PURPOSE: Adverse events (AEs) during trauma resuscitation are common and heterogeneity in reporting limits comparisons between hospitals and systems. A recent modified Delphi study established a taxonomy of AEs that occur during trauma resuscitation. This tool was further refined to yield the Safety Threats and Adverse events in Trauma (STAT) taxonomy. The objective of this study was to evaluate the inter-rater reliability of the STAT taxonomy using in-situ simulation resuscitations. METHODS: Two reviewers utilized the STAT taxonomy to score 12 in-situ simulated trauma resuscitations. AEs were reported for each simulation and timestamped in the case of multiple occurrences of a single AE. Inter-rater reliability was assessed using Gwet's AC1. RESULTS: The agreement on all AEs between reviewers was 90.1% (973/1080). The Gwet's AC1 across AE categories were: EMS handover (median 0.72, IQR [0.54, 0.82]), airway and breathing (median 0.91, IQR [0.60, 1.0]), circulation (median 0.91, IQR [0.72, 1.0]), assessment of injuries (median 0.80, IQR [0.24, 0.91]), management of injuries (median 1.00, IQR [1.00, 1.00]), procedure related (median 1.00, IQR [81, 1.00]), patient monitoring and IV access (median 1.00, IQR [1.00, 1.00]), disposition (median 1.00, IQR [1.00, 1.00]), team communication and dynamics (median 0.80, IQR [0.62, 1.00]). CONCLUSIONS: The STAT taxonomy yielded 90.1% agreement and demonstrated excellent inter-rater reliability between reviewers in the in-situ simulation scenario. The STAT taxonomy may serve as a standardized evaluation tool of latent safety threats and adverse events in the trauma bay. Future work should focus on applying this tool to live trauma patients.

Phytohormone Profile of Medicago in Response to Mycorrhizal Fungi, Aphids, and Gibberellic Acid.

Although gibberellic acid (GA) is widely used in agriculture, it is unclear whether exogenous GA makes aphid-infested, mycorrhizal plants more susceptible to herbivory. This study investigates the role of GA in modulating defenses in barrel medic plants (Medicago truncatula) that are infested with pea aphids (Acyrthosiphon pisum) and colonized by the beneficial symbiont Rhizophagus intraradices. Mock- and R. intraradices-inoculated potted plants were grown in a topsoil: sand mix for 42 days and were treated with GA or solvent. Subsequently, plants were exposed to herbivory or no aphid herbivory for 36 h and 7 days. Afterwards, plant growth parameters, aphid fitness, and foliar phytohormone concentrations were measured. The results revealed that GA regulates plant defenses during arbuscular mycorrhizal (AM) fungus-plant-aphid interactions as aphids that fed for 7 days on mycorrhizal, GA-untreated plants weighed more than those that fed on mycorrhizal, GA-treated plants. No major differences were detected in phytohormone levels at 36 h. Overall, mycorrhizal plants showed more shoot biomass compared to non-mycorrhizal controls. The arbuscule density and fungal biomass of R. intraradices were not altered by exogenous GA and aphid herbivory based on molecular markers. This study indicates that exogenous GA may help reduce aphid fitness when feeding on mycorrhizal plants.