Keeping up with the literature: A current practice survey and qualitative needs assessment among emergency physicians.

Purpose: Physicians face the challenge of staying current with a rapidly growing body of evidence and applying it to their practice. How emergency physicians (EPs) do so is unknown. The authors sought to describe and assess needs around EP patterns of evidence-based medicine (EBM) and continuing medical education (CME) resource use. Methods: The authors conducted a multicenter, cross-sectional study in 2019 across 12 tertiary care, community, and suburban emergency department (ED) sites in the greater area of Edmonton. Information on EBM/CME resource use along with barriers and facilitators to staying current was gathered using a rigorously developed survey tool, distributed electronically and by mail. Responses were tabulated and subgroups analyzed using MANOVA and ANOVA tests. Thematic analysis of comments used a phenomenological lens. Results: A total of 118 EPs (40.1%) completed the survey. Listening to podcasts, attending EM conferences, and subscription-based resources were preferred for staying current. Resource use differed by years in practice but not by age, sex, training background, or site type. EBM had an important impact on respondents' practice (average rating 3.8 out of 5, with 5 indicating "practice changing"). Time was an important barrier. Most (62.7%) felt that they did not spend enough time, despite spending a median of 4 to 5 h monthly on EBM. Facilitators (including journal club summaries or lists of practice-relevant papers) had only moderate impacts. Thematic analysis found three themes (importance of EBM, implementation challenges, and dissemination of EBM) and 13 subthemes. Conclusion: EPs preferentially chose podcasts, conferences, and subscription-based resources to stay current with EBM; time was the biggest barrier. These findings help ED leads and educators tailor CME to physician learning preferences to maximize application of EBM to clinical practice. The next steps include developing/curating resources and disseminating the survey on a larger scale to identify opportunities for shared virtual resources.

Novel pH-sensitive catechol dyes synthesised by a three component one-pot reaction.

The synthesis and characterisation of new dyes based on indolizines bearing catechol groups in their structure is presented. The preparation was carried out through a simple three component one-pot reaction promoted by CuNPs/C, between pyridine-2-carbaldehyde, an aromatic alkyne and a tetrahydroisoquinoline (THIQ) functionalized with catechol groups. The products were isolated in 30%-34% yield, which was considered more than acceptable considering that the catechol hydroxyl groups were not protected prior to reaction. In view of the colour developed by the products and their response to the acidic and basic conditions of the medium, product 3aa was studied by UV-Vis and NMR spectroscopies at different pH values. We concluded that product 3aa suffered two deprotonations at pKa of 4.4 and 9.5, giving three species in a pH range between 2-12, with colours varying from light red to deep orange. The reversibility of the process observed for 3aa at different pH values, together with its changes in colour, make this new family of products attractive candidates to use them as pH indicators.

Severe pandemic 2009 H1N1 influenza disease due to pathogenic immune complexes.

Pandemic influenza viruses often cause severe disease in middle-aged adults without preexisting comorbidities. The mechanism of illness associated with severe disease in this age group is not well understood. Here we find preexisting serum antibodies that cross-react with, but do not protect against, 2009 H1N1 influenza virus in middle-aged adults. Nonprotective antibody is associated with immune complex-mediated disease after infection. We detected high titers of serum antibody of low avidity for H1-2009 antigen, and low-avidity pulmonary immune complexes against the same protein, in severely ill individuals. Moreover, C4d deposition--a marker of complement activation mediated by immune complexes--was present in lung sections of fatal cases. Archived lung sections from middle-aged adults with confirmed fatal influenza 1957 H2N2 infection revealed a similar mechanism of illness. These observations provide a previously unknown biological mechanism for the unusual age distribution of severe cases during influenza pandemics.