Bedside rounds versus board rounds in an emergency department.

BACKGROUND: Our objective was to gain insight into whether bedside rounding at shift turnover in the emergency department improved education quality, as compared with board rounds. Board rounds are commonly used in the emergency department, where the teams review the patient and transfer care near a computer screen or written board, rather than at the patient's bedside. The impact on teaching or patient care has not been extensively compared between the two approaches. METHODS: We conducted a prospective study in an academic emergency department to compare bedside rounds versus board rounds. A convenience sample of 408-hour clinical shifts were randomised to either bedside or board rounds. Data collected included frequency of discussion of differential diagnosis, questions asked per patient, total time for which alternative therapies were discussed, total time for which alternative tests were discussed, total time for which exam findings were discussed and demonstrated, and resident impression of education quality. RESULTS: The randomisation of 20 shifts in each cohort provided a total of 274 patient cases. Our primary outcome was an increased frequency of discussion of the differential diagnosis, which occurred more often in the bedside group (72 versus 53%). We also detected that with bedside rounding more questions per patient were asked, and alternative therapies and tests, exam findings and results were discussed more often. CONCLUSIONS: Bedside rounding in the emergency department, as compared with board rounding, appears to increase the frequency of learner education measures. Emergency medicine residents reported the quality of education was better with bedside rounding. Bedside rounds took on average 4 minutes longer, without achieving statistical significance.

Adenosine signaling promotes regeneration of pancreatic ß cells in vivo.

Diabetes can be controlled with insulin injections, but a curative approach that restores the number of insulin-producing ß cells is still needed. Using a zebrafish model of diabetes, we screened ~7,000 small molecules to identify enhancers of ß cell regeneration. The compounds we identified converge on the adenosine signaling pathway and include exogenous agonists and compounds that inhibit degradation of endogenously produced adenosine. The most potent enhancer of ß cell regeneration was the adenosine agonist 5'-N-ethylcarboxamidoadenosine (NECA), which, acting through the adenosine receptor A2aa, increased ß cell proliferation and accelerated restoration of normoglycemia in zebrafish. Despite markedly stimulating ß cell proliferation during regeneration, NECA had only a modest effect during development. The proliferative and glucose-lowering effect of NECA was confirmed in diabetic mice, suggesting an evolutionarily conserved role for adenosine in ß cell regeneration. With this whole-organism screen, we identified components of the adenosine pathway that could be therapeutically targeted for the treatment of diabetes.

Case reports: Death of active duty soldiers following ingestion of dietary supplements containing 1,3-dimethylamylamine (DMAA).

Dietary supplements and their associated adverse events are not uncommon in the U.S. military, and selected dietary supplements have been associated with a number of nontraumatic deaths in service members. Specific ingredients and dietary supplement products in the civilian community are often associated with multiple adverse events and some have subsequently been removed from the marketplace; the most notable in the last decade is ephedra. We present case reports for two soldiers who were taking commercially available dietary supplements containing multiple ingredients to include the sympathomimetic, 1,3-dimethylamylamine (DMAA); both collapsed during physical exertion from cardiac arrest and ultimately died. A presentation of their clinical courses and a discussion of the history and pharmacology of dietary supplement ingredients, including DMAA, are provided. Our cases highlight concerns that DMAA in combination with other ingredients may be associated with significant consequences, reminiscent of previous adverse events from other sympathomimetic drugs previously removed from the market.