Simulation training results in performance retention for the management of airway fires: A prospective observational study.

Given the severity of the consequences of operating room fires, it is recommended that every anaesthesiologist master fire safety protocols and periodically participate in operating room fire drills. The aim of the present study was to evaluate skill retention one year after an airway fire training programme. Anaesthesiology residents were evaluated using an airway fire simulation-based scenario one year after an educational programme that included a one-h long problem-based learning session, a simulation-based airway fire drill with debriefing, and a formal group discussion. The same simulation scenario was used for both the initial training and the one-year assessment. Thirty-eight anaesthesiology residents participated as pairs in the initial training programme. Of these, 36 participated in the evaluation a year later. Performance after one year was better than performance during the initial simulation. Time to removal of tracheal tube was 7.0 (4.0-12.8) s (median (interquartile range)) at the one-year assessment compared with 22.0 (18.5-52.5) s at the time of initial training (P < 0.001). Performance improvement was also demonstrated by a higher incidence of performance of crucial action items (cessation of airway gases, removal of sponges and pouring of saline), as well as shorter duration of time necessary to perform these tasks. After controlling the fire, the time to re-establish ventilation by bag-mask ventilation or intubation was shorter at one year: 18.0 (11.0-29.0 ) s, compared with initial training 54.0 s (36.2-69.8) s (P = 0.001). We conclude that skills are effectively retained for a year after an airway fire management training session.

Comparative Genomics of Sibling Fungal Pathogenic Taxa Identifies Adaptive Evolution without Divergence in Pathogenicity Genes or Genomic Structure.

It has been estimated that the sister plant pathogenic fungal species Heterobasidion irregulare and Heterobasidion annosum may have been allopatrically isolated for 34-41 Myr. They are now sympatric due to the introduction of the first species from North America into Italy, where they freely hybridize. We used a comparative genomic approach to 1) confirm that the two species are distinct at the genomic level; 2) determine which gene groups have diverged the most and the least between species; 3) show that their overall genomic structures are similar, as predicted by the viability of hybrids, and identify genomic regions that instead are incongruent; and 4) test the previously formulated hypothesis that genes involved in pathogenicity may be less divergent between the two species than genes involved in saprobic decay and sporulation. Results based on the sequencing of three genomes per species identified a high level of interspecific similarity, but clearly confirmed the status of the two as distinct taxa. Genes involved in pathogenicity were more conserved between species than genes involved in saprobic growth and sporulation, corroborating at the genomic level that invasiveness may be determined by the two latter traits, as documented by field and inoculation studies. Additionally, the majority of genes under positive selection and the majority of genes bearing interspecific structural variations were involved either in transcriptional or in mitochondrial functions. This study provides genomic-level evidence that invasiveness of pathogenic microbes can be attained without the high levels of pathogenicity presumed to exist for pathogens challenging naïve hosts.

Interoperable electronic prescribing in the United States: a progress report.

Although the vast majority of U.S. physicians still handwrite prescriptions, adoption of electronic prescribing is slowly growing. Major barriers to adoption remain, including the inability to electronically submit prescriptions for controlled substances and confusion about standards for data exchange. Federal and state governments and private insurers are using payment and policy incentives to boost e-prescribing because they still believe in its promise for improving the quality and efficiency of health care. However, additional efforts and further investments are needed to reap the benefits of e-prescribing on a national scale.

E-prescribing and the medicare modernization act of 2003.

Provisions of the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003 are intended to foster electronic prescribing by requiring standards for interoperability and by permitting third parties to offset implementation costs. Although physicians have been slow to embrace e-prescribing, adoption may increase in 2006, when a new tide of pharmacy messages will arrive from patients entering multi-tier drug coverage under Medicare. However, the e-prescribing systems selected may lack the advanced features needed to improve patient safety and chronic disease control. To optimize the return on Medicare drug spending, the government should consider additional incentives to spur the uptake of more advanced systems.