Medical Error: Using Storytelling and Reflection to Impact Resident Error Response Factors.

Introduction: Medical error is common and has a significant impact on physicians, learners, and patients' perception of the medical system; however, residents receive little formal training on this topic. This curriculum aims to foster sharing of personal medical error stories, review and practice error management and coping strategies, and impact error response factors.

Methods: Faculty identified factors related to effective physician error management and recovery in order to develop a targeted curriculum for family medicine residents.

Less-Invasive Surfactant Administration for Neonatal Respiratory Distress Syndrome: A Consensus Guideline.

Introduction: Less-invasive surfactant administration (LISA) is a method of surfactant delivery to preterm infants for treating respiratory distress syndrome (RDS), which can reduce the composite risk of death or bronchopulmonary dysplasia and the time on mechanical ventilation.

Methods: A systematic literature search of studies published up to April 2021 on minimally invasive catheter surfactant delivery in preterm infants with RDS was conducted. Based on these studies, with parental feedback sought via an online questionnaire, 9 UK-based specialists in neonatal respiratory disease developed their consensus for implementing LISA.

Stabilisation of the preterm infant in the delivery room using nasal high flow: A 5-year retrospective analysis.

Aim: This study reviews clinical outcomes after initiating a routine policy of preterm respiratory stabilisation using nasal high flow (HF) in the delivery room (DR).

Method: This was a retrospective observational cohort study in a single-centre neonatal intensive care unit and included all neonates born before 32 weeks of gestation between 1 April 2015 and 31 March 2020. Stabilisation measures and outcomes were recorded including oxygen requirements, admission temperature, surfactant administration, invasive ventilation within 72 h of birth, bronchopulmonary dysplasia (BPD) and death.

Use of Intraosseous Needles in Neonates: A Systematic Review.

Background: The use of intraosseous (IO) access during resuscitation is widely accepted and promoted in paediatric medicine but features less prominently in neonatal training. Whilst umbilical venous catheterization (UVC) is a reliable method of delivering emergency drugs and fluids, it is not always achievable in a timely manner. IO access warrants exploration as an alternative.

Survey of less Invasive Surfactant Administration in England, slow adoption and variable practice.

Aim: National survey to evaluate the uptake of Less Invasive Surfactant Administration (LISA) in neonatal units across England.

Methods: A web-based survey was sent out by email to all 150 neonatal units in England. It consisted of questions regarding indications for LISA, the practicalities of the procedure and reasons for not using this technique.

Nasal High-Flow Therapy as Primary Respiratory Support for Preterm Infants without the Need for Rescue with Nasal Continuous Positive Airway Pressure.

Aim: To evaluate the effectiveness of nasal high-flow therapy (nHFT) as primary respiratory support for preterm infants with respiratory distress syndrome (RDS) in two tertiary neonatal units.

Methods: A retrospective outcome analysis of initial respiratory support strategies was performed in two tertiary neonatal units in the UK: John Radcliffe Hospital (JRH), Oxford and St Peter's Hospital (SPH), Chertsey. Infants born between 28+0 and 36+6 weeks gestational age (GA) between May 2013 and June 2015 were included.

rhIGF-1/rhIGFBP-3 in Preterm Infants: A Phase 2 Randomized Controlled Trial.

Objective: To investigate recombinant human insulin-like growth factor 1 complexed with its binding protein (rhIGF-1/rhIGFBP-3) for the prevention of retinopathy of prematurity (ROP) and other complications of prematurity among extremely preterm infants.

Study Design: This phase 2 trial was conducted from September 2014 to March 2016. Infants born at a gestational age of 23 weeks to 27 weeks were randomly allocated to rhIGF-1/rhIGFBP-3 (250 µg/kg/ 24 hours, continuous intravenous infusion from <24 hours of birth to postmenstrual age 29 weeks) or standard neonatal care, with follow-up to a postmenstrual age of 40 weeks.

Randomised cross-over study of automated oxygen control for preterm infants receiving nasal high flow.

Objective: To evaluate a prototype automated controller (IntellO) of the inspired fraction of oxygen (FiO) in maintaining a target range of oxygen saturation (SpO) in preterm babies receiving nasal high flow (HF) via the Vapotherm Precision Flow.

Design: Prospective two-centre order-randomised cross-over study.

Setting: Neonatal intensive care units.

Decisionmaking in practice: The dynamics of muddling through.

An alternative to conventional models that treat decisions as open-loop independent choices is presented. The alterative model is based on observations of work situations such as healthcare, where decisionmaking is more typically a closed-loop, dynamic, problem-solving process. The article suggests five important distinctions between the processes assumed by conventional models and the reality of decisionmaking in practice.

Neonatal listeriosis in the UK 2004-2014.

Objective: To define the clinical features and outcomes of neonatal listeriosis, and identify the maternal risk factors to seek scope for improvement.

Methods: Neonatal listeriosis was identified prospectively from a United Kingdom neonatal infection surveillance network (neonIN) between 2004 and 2014. The participating neonatal units completed a study-specific proforma.

Stabilisation of premature infants in the delivery room with nasal high flow.

Objective: This was a pilot study to determine the feasibility of using nasal high flow (nHF) (also known as heated humidified high-flow nasal cannula) for stabilisation of babies born at <30 weeks gestation in the delivery room (DR) and transfer to the neonatal intensive care unit (NICU).

Design: Observational study.

Setting: Single-centre NICU.

Supporting 'Baby Friendly': a quality improvement initiative for the management of transitional neonatal hypoglycaemia.

We describe a quality improvement initiative conducted in a medium-sized district general hospital with a neonatal intensive care unit, which involved working with the multidisciplinary team to create a 'Baby Friendly' neonatal hypoglycaemia pathway with implementation of dextrose gel as a first-line treatment. As a result of the project, formula supplementation rates and admissions for transitional hypoglycaemia were reduced and breastfeeding rates at 3 months improved. This initiative demonstrates that evidence-based guidelines with multidisciplinary team input can improve standards of care.

Encouraging formative assessments of leadership for foundation doctors.

Background: Clinical leadership is considered essential for maintaining and improving patient care and safety in the UK, and is incorporated in the curriculum for all trainee doctors.

Context: Despite the growing focus on the importance of leadership, and the introduction of the Medical Leadership Competency Framework (MLCF) in the UK, leadership education for doctors in training is still in its infancy. Assessment is focused on clinical skills, and trainee doctors receive very little formal feedback on their leadership competencies.

Generalized variational principle for excited states using nodes of trial functions.

The familiar variational principle provides an upper bound to the ground-state energy of a given Hamiltonian. This allows one to optimize a trial wave function by minimizing the expectation value of the energy. This approach is also trivially generalized to excited states, so that given a trial wave function of a certain symmetry, one can compute an upper bound to the lowest-energy level of that symmetry.

Colorectal cancer: a summary of the evidence for screening and prevention.

Colorectal cancer causes significant morbidity and mortality in the United States. The incidence of colorectal cancer can be reduced with increasing efforts directed at mass screening of average-risk adults 50 years and older. Currently, fecal occult blood test and flexible sigmoidoscopy have the highest levels of evidence to support their use for colorectal cancer screening.

Management dilemma in a paediatric patient with chronic gastric volvulus: a case report.

Gastric volvulus in children is rare. While the acute form is a surgical emergency, the chronic form may be managed either surgically or conservatively. The present report describes a premature (26+1 weeks) Afro-Caribbean neonate girl who presented with severe multiple bradycardias and apnoeas; she subsequently underwent pH monitoring and a barium study which demonstrated gastro-oesophageal reflux disease (GORD) and gastric volvulus.

The influence of gestational stage on urinary iodine excretion in pregnancy.

Introduction: Median urinary iodine concentration (UIC) is the most commonly used indicator of population iodine nutrition. However, its validity as an indicator of dietary intake relies on a stable relationship between dietary iodine intake and urinary excretion. Physiological alterations in normal pregnancy, such as increased glomerular filtration rate, potentially invalidate UIC as an assessment tool in pregnancy.

A case for universal salt iodisation to correct iodine deficiency in pregnancy: another salutary lesson from Tasmania.

Objective: To assess the impact of iodine fortification of bread on the iodine status of pregnant women, and to determine if studies of iodine levels in school-age children were indicative of women's gestational iodine status.

Design: Urinary iodine surveys of pregnant Tasmanian women before and after bread was fortified with iodine in October 2001.

Participants And Setting: 285 women attending the Royal Hobart Hospital (RHH) antenatal clinic from 1 October 2000 to 30 September 2001 and 517 women attending the RHH antenatal clinic or primary health care centres in 2003-2006.

Imaging molecular and cellular events in transplantation.

Imaging methods such as nuclear medicine (including positron emission tomography), magnetic resonance imaging, ultrasound, and optical imaging can be used to provide information about the expression of genes, and the location of molecules and cells in intact animals or patients. In the setting of transplantation, this will allow monitoring of inflammatory responses, as well as the state of the graft. In this review, the advantages and disadvantages of different approaches to imaging will be discussed, as well as their potential application to transplantation.

Detection of vascular expression of E-selectin in vivo with MR imaging.

Purpose: To develop a contrast agent for targeting E-selectin expressed on activated vascular endothelium and to evaluate detection of the agent with magnetic resonance (MR) imaging in an in vivo mouse model of inflammation.

Materials And Methods: All animal experiments were approved according to animal welfare and local ethics committee regulations. An anti-murine E-selectin F(ab')2 monoclonal antibody, MES-1, was conjugated with ultrasmall superparamagnetic iron oxide (USPIO) nanoparticles.

Unexpected symmetry in the nodal structure of the He atom.

The nodes of even simple wave functions are largely unexplored. Motivated by their importance to quantum simulations of fermionic systems, we have found unexpected symmetries in the nodes of several atoms and molecules. Here, we report on helium.