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1.
BMC Med Educ ; 24(1): 819, 2024 Jul 30.
Artigo em Inglês | MEDLINE | ID: mdl-39080688

RESUMO

BACKGROUND: Effective teamwork is crucial to providing safe and high-quality patient care, especially in acute care. Crew Resource Management (CRM) principles are often used for training teamwork in these situations, with escape rooms forming a promising new tool. However, little is known about escape room design characteristics and their effect on learning outcomes. We investigated the current status of design characteristics and their effect on learning outcomes for escape room-based CRM/teamwork training for acute care professionals. We also aimed to identify gaps in literature to guide further research. METHODS: Multiple databases were searched for studies describing the design and effect of escape rooms aimed training CRM/teamwork in acute care professionals and in situations that share characteristics. A standardized process was used for screening and selection. An evidence table that included study characteristics, design characteristics and effect of the escape room on learning outcomes was used to extract data. Learning outcomes were graded according to IPE expanded typology of Kirkpatrick's levels of learning outcome and Medical Education Research Study Quality Instrument (MERSQI) scores were calculated to assess methodology. RESULTS: Fourteen studies were included. Common design characteristics were a team size of 4-6 participants, a 40-minute time limit, linear puzzle organization and use of briefing and structured debriefing. Information on alignment was only available in five studies and reporting on several other educational and escape room design characteristics was low. Twelve studies evaluated the effect of the escape room on teamwork: nine evaluated reaction (Kirkpatrick level 1; n = 9), two evaluated learning (Kirkpatrick level 2) and one evaluated both. Overall effect on teamwork was overtly positive, with little difference between studies. Together with a mean MERSQI score of 7.0, this precluded connecting specific design characteristics to the effect on learning outcomes. CONCLUSIONS: There is insufficient evidence if and how design characteristics affect learning outcomes in escape rooms aimed at training CRM/teamwork in acute care professionals. Alignment of teamwork with learning goals is insufficiently reported. More complete reporting of escape rooms aimed at training CRM/teamwork in acute care professionals is needed, with a research focus on maximizing learning potential through design.


Assuntos
Equipe de Assistência ao Paciente , Humanos , Gestão de Recursos da Equipe de Assistência à Saúde , Cuidados Críticos/organização & administração
2.
Blood ; 135(24): 2171-2181, 2020 06 11.
Artigo em Inglês | MEDLINE | ID: mdl-32128589

RESUMO

Megakaryoblastic leukemia 1 (MKL1) promotes the regulation of essential cell processes, including actin cytoskeletal dynamics, by coactivating serum response factor. Recently, the first human with MKL1 deficiency, leading to a novel primary immunodeficiency, was identified. We report a second family with 2 siblings with a homozygous frameshift mutation in MKL1. The index case died as an infant from progressive and severe pneumonia caused by Pseudomonas aeruginosa and poor wound healing. The younger sibling was preemptively transplanted shortly after birth. The immunodeficiency was marked by a pronounced actin polymerization defect and a strongly reduced motility and chemotactic response by MKL1-deficient neutrophils. In addition to the lack of MKL1, subsequent proteomic and transcriptomic analyses of patient neutrophils revealed actin and several actin-related proteins to be downregulated, confirming a role for MKL1 as a transcriptional coregulator. Degranulation was enhanced upon suboptimal neutrophil activation, whereas production of reactive oxygen species was normal. Neutrophil adhesion was intact but without proper spreading. The latter could explain the observed failure in firm adherence and transendothelial migration under flow conditions. No apparent defect in phagocytosis or bacterial killing was found. Also, monocyte-derived macrophages showed intact phagocytosis, and lymphocyte counts and proliferative capacity were normal. Nonhematopoietic primary fibroblasts demonstrated defective differentiation into myofibroblasts but normal migration and F-actin content, most likely as a result of compensatory mechanisms of MKL2, which is not expressed in neutrophils. Our findings extend current insight into the severe immune dysfunction in MKL1 deficiency, with cytoskeletal dysfunction and defective extravasation of neutrophils as the most prominent features.


Assuntos
Citoesqueleto de Actina/metabolismo , Mutação da Fase de Leitura , Neutrófilos/fisiologia , Doenças da Imunodeficiência Primária/genética , Doenças da Imunodeficiência Primária/metabolismo , Transativadores/deficiência , Transativadores/genética , Citoesqueleto de Actina/química , Movimento Celular/genética , Movimento Celular/fisiologia , Consanguinidade , Feminino , Fibroblastos/metabolismo , Perfilação da Expressão Gênica , Transplante de Células-Tronco Hematopoéticas , Humanos , Lactente , Masculino , Linhagem , Polimerização , Doenças da Imunodeficiência Primária/terapia , Proteômica , Fatores de Transcrição/metabolismo
4.
Acta Paediatr ; 100(10): e181-3, 2011 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-21382081

RESUMO

UNLABELLED: We report on a 5-year-old girl with a severe kerion celsi, caused by Trichophyton mentagrophytes, probably acquired from a pet guinea pig. The lesions had started as small irritating squamous lesions that had been accurately diagnosed as skin infection, but had only been treated with local antifungal agents. The lesions progressed and developed into a kerion celsi that had to be treated with long-term systemic griseofulvin. Nevertheless, reinfection occurred and treatment had to be restarted. The girl is left with areas of alopecia, as a result of which she is required to wear a wig. CONCLUSION: Tinea capitis is a common skin infection that should be considered in any type of scalp lesion. It requires systemic treatment, and inappropriate and delayed treatment can result in the development of kerion celsi, with sometimes devastating consequences.


Assuntos
Tinha do Couro Cabeludo/diagnóstico , Trichophyton/isolamento & purificação , Alopecia/etiologia , Pré-Escolar , Feminino , Humanos , Couro Cabeludo/microbiologia , Couro Cabeludo/patologia , Tinha do Couro Cabeludo/complicações
5.
Inflamm Bowel Dis ; 12(9): 831-6, 2006 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-16954801

RESUMO

6-Mercaptopurine (6-MP) maintains remission in pediatric Crohn's disease (CD). Azathioprine, a prodrug of 6-MP, is used for maintenance of remission of CD in Europe. We evaluated to what extent azathioprine is used in newly diagnosed pediatric CD patients and whether maintenance of remission differed between patients using azathioprine or not. Charts of children (diagnosed 1998-2003, follow-up > or = 18 mo) were reviewed. Active disease was defined as Pediatric Crohn's Disease Activity Index (PCDAI) greater than 10 or systemic corticosteroid use. Remission was defined as PCDAI 10 or less without use of corticosteroids. Eighty-eight children (55M/33F, age 12 +/- 3 yr) were included. Seventy-two (82%) patients received azathioprine during the follow-up period (38 +/- 17 mo). Patients diagnosed after 2000 received azathioprine significantly earlier during the course of disease compared with those diagnosed earlier (median, at 233 vs. 686 days; P < 0.05). At initial presentation, moderate-severe disease activity and prescription of corticosteroids were more prevalent in patients using azathioprine compared with nonazathioprine patients (75% vs. 52%; P < 0.05; and 89% vs. 58%; P < 0.005, respectively). Duration of corticosteroid use was longer in patients receiving azathioprine (232 vs. 168 days; P < 0.005). Median maintenance of first remission in patients who initially used corticosteroids, however, was longer in patients receiving azathioprine compared with nonazathioprine patients (PCDAI, 544 vs. 254 days, P = 0.08; corticosteroid free, 575 vs. 259 days, P < 0.05, respectively). We conclude that, since 2000, azathioprine is being introduced earlier in the treatment of newly diagnosed pediatric CD patients. The use of azathioprine is associated with prolonged maintenance of the first remission.


Assuntos
Azatioprina/administração & dosagem , Doença de Crohn/tratamento farmacológico , Adolescente , Criança , Esquema de Medicação , Feminino , Humanos , Masculino , Indução de Remissão , Estudos Retrospectivos
6.
Syst Rev ; 3: 97, 2014 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-25189273

RESUMO

A study-level meta-analysis has shown that proton magnetic resonance spectroscopy is a promising prognostic marker in neonatal hypoxic-ischemic encephalopathy. An individual patient data meta-analysis could yield a prognostic tool with improved accuracy enabling well-founded clinical decisions. Our request to share patient data remained unanswered by five out of 18 research groups. Another four declined collaboration for various reasons, including own reanalysis of the data, and lack of parental consent. With less than 40% of the individual patient data available, we refrained from pursuing the proposed study. As future patients may benefit from it, policies mandating data sharing should be introduced.


Assuntos
Hipóxia-Isquemia Encefálica/diagnóstico por imagem , Disseminação de Informação , Metanálise como Assunto , Tomada de Decisões , Humanos , Hipóxia-Isquemia Encefálica/terapia , Recém-Nascido , Disseminação de Informação/ética , Prontuários Médicos , Neuroimagem , Radiografia , Suspensão de Tratamento
8.
Syst Rev ; 2: 96, 2013 Oct 25.
Artigo em Inglês | MEDLINE | ID: mdl-24156407

RESUMO

BACKGROUND: The prognostic accuracy of 1H (proton) magnetic resonance spectroscopy (MRS) in neonatal hypoxic-ischemic encephalopathy has been assessed by a criticized study-based meta-analysis. An individual patient data meta-analysis may overcome some of the drawbacks encountered in the aggregate data meta-analysis. Moreover, the prognostic marker can be assessed quantitatively and the effect of covariates can be estimated. METHODS: Diagnostic accuracy studies relevant to the study topic were retrieved. The primary authors will be invited to share the raw de-identified study data. These individual patient data will be analyzed using logistic regression analysis. A prediction tool calculating the individualized risk of very adverse outcome will be devised. DISCUSSION: The proposed individual patient data meta-analysis provides several advantages. Inclusion and exclusion criteria can be applied more uniformly. Furthermore, adjustment is possible for confounding factors and subgroup analyses can be conducted. Our goal is to develop a prediction model for outcome in newborns with hypoxic-ischemic encephalopathy.


Assuntos
Hipóxia-Isquemia Encefálica/metabolismo , Espectroscopia de Ressonância Magnética , Metanálise como Assunto , Projetos de Pesquisa , Coleta de Dados/métodos , Humanos , Recém-Nascido , Prognóstico
9.
Ned Tijdschr Geneeskd ; 155(18): A1558, 2011.
Artigo em Holandês | MEDLINE | ID: mdl-21429251

RESUMO

We were consulted with pictures of a 10-year-old Ukrainian boy with red maculae over a large part of his body and hypertrophy and varicose veins of the right arm and leg due to Klippel-Trenaunay syndrome.


Assuntos
Síndrome de Klippel-Trenaunay-Weber/diagnóstico , Criança , Humanos , Hipertrofia/diagnóstico , Hipertrofia/etiologia , Síndrome de Klippel-Trenaunay-Weber/complicações , Síndrome de Klippel-Trenaunay-Weber/patologia , Masculino , Varizes/diagnóstico , Varizes/etiologia
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