Teaching Junior Medical Officers safe and effective prescribing.

Medication errors are an iatrogenic threat to patient safety, and recently graduated Junior Medical Officers (JMOs) are a common source of these errors. A ward-based, physician-led, small-group interactive teaching session was developed to improve JMOs competence in prescribing. The ability of JMOs to detect problems in mock medication charts before and after the teaching session was assessed, with the majority improving after the intervention, a result sustained on re-testing later in the year. The teaching sessions were well received by JMOs.

Intracranial time-resolved contrast-enhanced MR angiography at 3T.

BACKGROUND AND PURPOSE: A method is presented for high-temporal-resolution MR angiography (MRA) using a combination of undersampling strategies and a high-field (3T) scanner. Currently, the evaluation of cerebrovascular disorders involving arteriovenous shunting or retrograde flow is accomplished with conventional radiographic digital subtraction angiography, because of its high spatial and temporal resolutions. Multiphase MRA could potentially provide the same diagnostic information noninvasively, though this is technically challenging because of the inherent trade-off between signal intensity-to-noise ratio (S/N), spatial resolution, and temporal resolution in MR imaging. METHODS: Numerical simulations addressed the choice of imaging parameters at 3T to maximize S/N and the data acquisition rate while staying within specific absorption rate limits. The increase in S/N at 3T was verified in vivo. An imaging protocol was developed with S/N, spatial resolution, and temporal resolution suitable for intracranial angiography. Partial Fourier imaging, parallel imaging, and the time-resolved echo-shared acquisition technique (TREAT) were all used to achieve sufficient undersampling. RESULTS: In 40 volunteers and 10 patients exhibiting arteriovenous malformations or fistulas, intracranial time-resolved contrast-enhanced MRA with high acceleration at high field produced diagnostic-quality images suitable for assessment of pathologies involving arteriovenous shunting or retrograde flow. The technique provided spatial resolution of 1.1 x 1.1 x 2.5 mm and temporal resolution of 2.5 seconds/frame. The combination of several acceleration methods, each with modest acceleration, can provide a high overall acceleration without the artifacts of any one technique becoming too pronounced. CONCLUSION: By taking advantage of the increased S/N provided by 3T magnets over conventional 1.5T magnets and converting this additional S/N into higher temporal resolution through acceleration strategies, intracranial time-resolved MRA becomes feasible.

A prediction rule for the use of postdischarge medical services.

OBJECTIVE: To develop and validate a prediction rule screening instrument, easily incorporated into the routine hospital admission assessment, that could facilitate discharge planning by identifying patients at the time of admission who are most likely to need postdischarge medical services. DESIGN: Prospective cohort study with separate phases for prediction rule development and validation. SETTING: Urban teaching hospital. PATIENTS/PARTICIPANTS: General medical service patients, 381 in the derivation phase and 323 in the validation phase, who provided self-reported medical history, health status, and demographic data as a part of their admission nursing assessment, and were subsequently discharged alive. MEASUREMENTS AND MAIN RESULTS: Use of postdischarge medical services such as visiting nurse or physical therapy, medical equipment, or placement in a rehabilitation or long-term care facility was determined. A prediction rule based on a patient's age and Medical Outcomes Study 36-Item Short Form Health Survey (SF-36) physical function and social function scores stratified patients with regard to their risk of using postdischarge medical services. In the validation set, the rate of actual postdischarge medical service use was 15% (15 of 97), 36% (39 of 107), and 58% (57 of 98) among patients characterized by the prediction rule as being at "low", "intermediate," and "high" risk of using postdischarge medical services, respectively. CONCLUSIONS: This prediction rule stratified general medical patients with regard to their likelihood of needing discharge planning to arrange for postdischarge medical services. Further research is necessary to determine whether prospective identification of patients likely to need discharge planning will make the hospital discharge planning process more efficient.

Binding of 2-hydroxy-5-nitrobenzyl alcohol to rat alpha class glutathione S-transferases; evidence for binding at tryptophan 21.

2-Hydroxy-5-nitrobenzyl alcohol (HNB) was prepared from dimethyl(2-hydroxyl-5-nitrobenzyl)sulfonium bromide (HNBB). HNB binds to glutathione S-transferases (GSTs) 1-2 and 2-2 with moderate affinity at a site separate from 1-anilino-8-naphthalenesulfonate (ANS). Intrinsic fluorescence due to Trp-21 is strongly quenched by HNB binding but there is no effect on catalytic activity. There appear to be two HNB binding sites per dimer in each GST isoenzyme. We suggest that HNB binds directly at Trp-21 of each subunit and that previously reported quenching of intrinsic fluorescence in these proteins upon ligand binding may be due to indirect structural effects rather than direct binding at this residue.