Using Patient Experience Surveys to Identify Potential Diagnostic Safety Breakdowns: A Mixed Methods Study.

Objectives: One in 20 outpatients in the United States experiences a diagnostic error each year, but there are no validated methods for collecting feedback from patients on diagnostic safety. We examined patient experience surveys to determine whether patients' free text comments indicated diagnostic breakdowns. Our objective was to evaluate associations between patient-perceived diagnostic breakdowns reported in free text comments and patients' responses to structured survey questions.

"What Else Could It Be?" A Scoping Review of Questions for Patients to Ask Throughout the Diagnostic Process.

Background: Diagnostic errors are a global patient safety challenge. Over 75% of diagnostic errors in ambulatory care result from breakdowns in patient-clinician communication. Encouraging patients to speak up and ask questions has been recommended as one strategy to mitigate these failures.

Fructose-1,6-bisphosphate and fructose-2,6-bisphosphate do not influence brain carbohydrate or high-energy phosphate metabolism in a rat model of forebrain ischemia.

Phosphorylated fructose compounds have been reported to lessen neuronal injury in in vitro models of hypoxia and in vivo models of ischemia. Although a variety of mechanisms have been proposed to account for this finding, it is unknown if intracellular uptake and incorporation of these compounds into the glycolytic pathway contribute to the benefit. We evaluated phosphorylated fructose administration in an adult rat model of transient, near-complete cerebral ischemia to determine its impact on brain metabolism before, during, and after ischemia.

In vitro studies of human hearts.

Background: Isolated mammalian hearts have been used in numerous studies that have led to many important discoveries in cardiac physiology, pharmacology, and surgery. Multiple methods of perfusion have been described including retrograde and/or antegrade flows and crystalloid or blood perfusates. Furthermore, multiple species have been utilized for such studies including the following: rat, rabbit, guinea pig, canine, and swine.

A study of shingles and the development of postherpetic neuralgia in East London.

The incidence of post-herpetic neuralgia following shingles and the factors that are known to predict it were examined in a prospective observational community study of patients with acute shingles presenting to their family doctors. The detection of viral DNA in the blood at presentation as a prognostic indicator for pain was also evaluated. Patients were followed for one year and the persistence of pain following rash assessed.

Opioid preconditioning: myocardial function and energy metabolism.

Background: Opioid receptor agonists are involved in ischemic preconditioning and natural hibernation. The aim of this study was to determine whether pretreatment with D-Ala2-Leu5-enkephalin or morphine confers cardioprotection in large mammalian hearts. We assessed myocardial functional recovery and global energy metabolism after ischemic cold storage.

Isolated four-chamber working swine heart model.

Background: Isolated heart models separate cardiac characteristics from systemic characteristics with subsequent findings used in cardiac research, including responses to pharmacologic, mechanical, and electrical components. The model objective was to develop the ability to represent in situ physiologic cardiac function ex vivo.

Methods: Swine hearts were chosen over rat or guinea pig models due to their notably greater anatomical and physiologic similarities to humans.

The effect of chronic dexamethasone-induced hyperglycemia and its acute treatment with insulin on brain glucose and glycogen concentrations in rats.

Background: In the rat model of forebrain ischemia, long-term dexamethasone treatment is reported to cause hyperglycemia and worsen postischemic functional and histologic injury. This effect was assumed to result from glucose enhancement of intraischemic lactic acidosis within the brain. Short-term insulin therapy restored normoglycemia but did not return histologic injury completely to baseline values.

Low-frequency magnetic noise in micron-scale magnetic tunnel junctions.

We have observed low-frequency noise due to quasiequilibrium thermal magnetization fluctuations in micron-scale magnetic tunnel junctions (MTJs). This strongly field-dependent magnetic noise occurs within the magnetic hysteresis loops, either as 1/f or Lorentzian (random telegraph) noise. We attribute it to the thermally excited hopping of magnetic domain walls between pinning sites.

Thermally assisted magnetization reversal in submicron-sized magnetic thin films.

We have measured the rate of thermally assisted magnetization reversal of submicron-sized magnetic thin films. For fields H just less than the zero-temperature switching field H(C), the probability of reversal, P(exp)(s)(t), increases for short times t, achieves a maximum value, and then decreases exponentially. Micromagnetic simulations exhibit the same behavior and show that the reversal proceeds through the annihilation of two domain walls that move from opposite sides of the sample.

4-chloro-m-cresol triggers malignant hyperthermia in susceptible swine at doses greatly exceeding those found in drug preparations.

Background: Chlorocresols are used as preservatives in numerous commercial drugs that have been shown to induce myoplasmic Ca2+ release; the most potent isoform is 4-chloro-m-cresol. The aims of this study were to (1) examine the in vivo effects of 4-chloro-m-cresol on swine susceptible to malignant hyperthermia and (2) contrast in vivo versus in vitro dose-response curves.

Methods: Susceptible swine (weight: 38.

The effect of reduced myocardial cyclic AMP content on the response to milrinone in the isolated guinea pig heart.

Background: Cardiac beta receptor down-regulation is associated with a reduction of tissue cyclic adenosine monophosphate (AMP) content. Milrinone exerts its effects by inhibiting the metabolism of existing cyclic AMP. The purpose of this study was to evaluate the effect of reduced myocardial cyclic AMP content on the pharmacologic action of milrinone.

Metabolism of glucose, glycogen, and high-energy phosphates during transient forebrain ischemia in diabetic rats: effect of insulin treatment.

Background: Hyperglycemia associated with diabetes mellitus will exacerbate neurologic injury after global brain ischemia. Studies in a rat model of forebrain ischemia (bilateral carotid occlusion plus hypotension for 10 min) discovered that acute restoration of normoglycemia in diabetics, using an insulin infusion, resulted in a neurologic outcome that was similar to normoglycemic rats without diabetes. The current study evaluated cerebral glucose, glycogen, lactate, and high-energy phosphate concentrations to identify metabolic correlates that might account for an alteration in postischemic outcome.

In vitro contracture testing for determination of susceptibility to malignant hyperthermia: a methodologic update.

The in vitro contracture test determines the sensitivity of freshly obtained skeletal muscle specimens to caffeine or halothane applied to a bathing solution. Muscles from persons susceptible to malignant hyperthermia have lower contracture thresholds for these agents than do normal muscle. Thus, known concentrations of these agents must be accurately administered.

Multichannel hybrid system for neuromagnetic measurements.

This paper describes progress toward the development of a 28-multichannel system for neuromagnetic measurements. A novel 'hybrid' design consisting of 16 first-order axial gradiometers and 12 first-order planar gradiometers was chosen, which optimises the use of the available cylindrical volume of the dewar tail. This configuration maintains the symmetry of the detected pattern with respect to rotation of a biomagnetic source located under the centre of the array and features a localisation power considerably better than an array of all first-order planar gradiometers.

Effects of sufentanil on cerebral circulation and metabolism in dogs.

The cerebral and peripheral vascular effects of sufentanil (10-200 micrograms/kg) were examined in dogs. The cerebral blood flow (CBF) was measured continuously by an electromagnetic flow probe on the outflow of the posterior sagittal sinus. Sufentanil at all doses significantly increased CBF that lasted for approximately 20 min.

Benign smooth muscle tumors of the gastrointestinal tract. A 24-year experience.

Between 1963 and 1987, 131 patients with benign gastrointestinal stromal tumors, primarily leiomyomas, were treated at the Massachusetts General Hospital. Eighty per cent of tumors were located in stomach or small intestine. Two thirds of the tumors were discovered in symptomatic patients before operation by a variety of diagnostic studies.

Cerebral effects of fentanyl in dogs.

We have studied the cerebral haemodynamic and metabolic effects of fentanyl 50 micrograms kg-1 and 100 micrograms kg-1 in dogs undergoing ventilation with oxygen and nitrogen at normocapnia. Cerebral blood flow was measured continuously by direct measurement of the outflow of the posterior sagittal sinus. Arterial and sagittal sinus blood-gas tensions were measured intermittently for calculation of cerebral metabolism.