Curēus
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Background Teaching during patient care is an important competency for faculty. Little is known about anesthesiology resident preferences for teaching by anesthesiology faculty in the operating room (OR). If the behaviors and characteristics of anesthesia teaching in the OR that are most valued by residents were identified, faculty could incorporate that best practice to teach residents during OR cases. ⋯ The most commonly mentioned codes were: autonomy - step back and let resident work through (mentioned by 13 residents), reasoning - explain why attending does things (12), context - teach something relevant to the case (8), commitment - take time to teach (8), literature - bring relevant papers (8), prior knowledge - assess the baseline level (7), flexibility - be open to trying different approaches (7), focus on just a few learning points (6), reflection - ask resident questions (6), provide real-time feedback (6), teach back - ask residents to explain what they were taught in their own words (5), belonging - facilitate communication with the OR team (5), psychological safety - be open and approachable (5), equanimity - stay calm and collected (5), select proper timing for instruction when the resident is not occupied with patient care (5), visualization - use graphs or diagrams (5), and specify learning goals ahead of time (5). Conclusion The best practice for OR teaching, as perceived by anesthesia residents, includes social characteristics, such as context, commitment, psychological safety, equanimity, and proper timing, as well as teaching methods, such as autonomy, reasoning, literature, prior knowledge, flexibility, reflection, real-time feedback, and teach back. Further studies can determine if training anesthesiology faculty to incorporate these elements increases the caliber of daily teaching in the OR.
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Introduction The emergency department (ED) is under pressure to meet length of stay (LOS) metrics for care in the ED. An aspect that we propose affects LOS is the order for urine sample collection and subsequent urinalysis (UA) as both are time consuming steps. This project's primary goals are to determine if ordering a UA increases LOS and how often UA contributes to clinical decision-making and/or disposition decisions in the ED. ⋯ In our ED, routine UAs are ordered more often by MLPs than physicians. A routine UA may not impact clinical decision-making up to 33% of the time, nor alter disposition decision one out of four times. Given that 9% have the test eventually cancelled, one should reconsider the utility in ordering routine UAs in ED patients, as they increase LOS and place an additional burden on the patient and the ED personnel.
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Guillain-Barre syndrome is a rare but fatal autoimmune disease. The exact cause of Guillain-Barre syndrome is still unknown. The most common known etiology of Guillain-Barre syndrome is infectious disease notably caused by Campylobacter jejuni. ⋯ There is little to no data available on the incidence of Guillain-Barre syndrome due to vaccinations in Pakistan. Most of the cases of Guillain-Barre syndrome due to vaccination are either undiagnosed or misdiagnosed. In this case report, we are presenting a case of vaccine-associated Guillain-Barre syndrome due to neural tissue anti-rabies vaccine in a young girl, who presented with lower limb weakness, inability to pass urine and abdominal pain.
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Transcatheter aortic valve replacement (TAVR) is a newer alternative to surgical aortic valve replacement (SAVR) for patients with severe aortic stenosis. Clinical trials have investigated TAVR's safety and effectiveness. Cerebral embolization is a common complication leading to stroke after TAVR and SAVR; different cerebral protection methods have been studied to prevent this. ⋯ The DEFLECT III, CLEAN-TAVI, and SENTINEL trials assessed the safety and efficacy of transcatheter cerebral embolic protection devices (CEPDs); their results ranged from 50% improvement (CLEAN-TAVI) to none (DEFLECT III, SENTINEL), therefore, showing non-inferiority of cerebral embolic protection devices for TAVR patients. The clinical trials studied in this paper showed a similar incidence of stroke in both groups, with the majority of TAVR patients developing cerebral lesions. With the addition of cerebral embolic protective devices, this incidence has decreased.
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Introduction Lumbar spinal stenosis (LSS) is a kinetic-dependent disease typically aggravating during spinal loading. To date, assessment of LSS is usually performed with magnetic resonance imaging (MRI). However, conventional supine MRI is associated with significant drawbacks as it does not truly reflect physiological loads, experienced by discoligamentous structures during erect posture. ⋯ Assessment of lumbar lordosis yielded in a significant increase when assessed at HY (+22.1%) or UP (+8.7%) compared to SP (P ≤ 0.05). Conclusions Our data suggest that neuroforaminal dimensions assessed by conventional supine MRI are potentially overestimated in patients with LSS. Especially, in patients having occult disease not visualized on conventional imaging modalities, upright MRI allows for a precise, clinically relevant, and at the same time non-invasive evaluation of neural elements in LSS when neural decompression is considered.