Controller size matters: User proficiency is affected by endoscopic controller size.

BACKGROUND: Endoscope controllers are traditionally a one-size-fits-all design. However, this design may not fit the modern workforce in endoscopy-related fields. Our study aims to determine if endoscopic controller size, independent of user dexterity, affects user proficiency. METHODS: 54 endoscopically naive participants completed a baseline dexterity test, followed by large-controller endoscopic and small-controller bronchoscopic simulation exercises. Participants were stratified by surgical glove size (≥7.5 and < 7.5) and gender. RESULTS: Endoscopy time was longer in participants with <7.5 size gloves (p = 0.01) and in females (p < 0.001). However, participants with glove size <7.5 had better dexterity measures (p = 0.04). There was no difference in bronchoscopy time based on glove size (p = 0.61). CONCLUSIONS: Participants with larger hands were more proficient with the larger controller despite being less dexterous than their counterparts. This advantage was less pronounced with the smaller controller. Our findings suggest that endoscopic controllers should be modified in design to accommodate all providers.

Procedural-based Specialties Benefit from a Formal Informed Consent and Disclosures Educational Program.

OBJECTIVE: At our tertiary academic center, residents undergo formalized training in obtaining informed consent and disclosing a complication. The informed consent portion has previously been shown to benefit a group of surgical and emergency medicine residents. We aimed to determine if the benefits from training persist across a larger number of procedural-based specialties and to ascertain the benefit of training in disclosing complications. DESIGN: This retrospective cohort study examined first-year residents from seven procedural-based specialties who participated in a formal informed consent and disclosures training program, consisting of a didactic lecture and two-part simulation. Two years after the start of the program, the disclosure scenario was added. Participants were given pre- and post-surveys assessing comfort and confidence in the informed consent and disclosure scenarios. Survey results were compared using the signed-rank test and Kruskal-Wallis test as appropriate. SETTING: This study occurred at Temple University Hospital, a tertiary academic institution in Philadelphia, PA. PARTICIPANTS: First-year residents from 2014 to 2020 in seven procedural-based specialties, including general surgery, orthopedic surgery, otolaryngology, obstetrics and gynecology, emergency medicine, radiology, and anesthesia, participated in this study. One hundred and ninety-three residents completed the program and surveys. RESULTS: Residents reported improved confidence in filling out an informed consent form (p = 0.036) and more comfortable in obtaining informed consent (p = 0.041), as well as more confidence (p = 0.018) and comfort (p = 0.001) in disclosing a complication. Surgical residents demonstrated greater confidence in obtaining informed consent (p = 0.009) and disclosing a complication (p = 0.0002) after training than non-surgical residents. CONCLUSIONS: Across multiple procedural-based specialties, formal training in informed consent and disclosure of complications increases resident ability to perform these tasks. A formal training program is valuable for residents who are expected to perform these tasks across various specialties.

Airway basal stem cells generate distinct subpopulations of PNECs.

Pulmonary neuroendocrine cells (PNECs) have crucial roles in airway physiology and immunity by producing bioactive amines and neuropeptides (NPs). A variety of human diseases exhibit PNEC hyperplasia. Given accumulated evidence that PNECs represent a heterogenous population of cells, we investigate how PNECs differ, whether the heterogeneity is similarly present in mouse and human cells, and whether specific disease involves discrete PNECs. Herein, we identify three distinct types of PNECs in human and mouse airways based on single and double positivity for TUBB3 and the established NP markers. We show that the three PNEC types exhibit significant differences in NP expression, homeostatic turnover, and response to injury and disease. We provide evidence that these differences parallel their distinct cell of origin from basal stem cells (BSCs) or other airway epithelial progenitors.

Blood Transfusion Vital Sign Frequency: What Does the Evidence Say?.

Blood transfusion vital sign protocols do not have sufficient evi- dence to mandate surveillance frequency. The purpose of this study was to examine the relationship of vital sign changes to reaction times in an effort to determine best practice for monitoring patients receiving blood products.