Do medical students studying in the United Kingdom have an adequate factual knowledge of basic life support?

BACKGROUND: Healthcare professionals have a duty to maintain basic life support(BLS) skills. This study aims to evaluate medical students' factual knowledge of BLS and the training they receive.METHODS: A cross-sectional, closed-response questionnaire was distributed to the fi rst-and fourth-year students studying at institutions in the United Kingdom. The paper questionnaire sought to quantify respondent's previous BLS training, factual knowledge of the BLS algorithm using five multiple choice questions(MCQs), and valuate their desire for further BLS training. Students received 1 point for each correctly identifi ed answer to the 5 MCQ's.RESULTS: A total of 3,732 complete responses were received from 21 medical schools. Eighty percent(n=2,999) of students completed a BLS course as part of their undergraduate medical studies. There was a signifi cant difference(P<0.001) in the percentage of the fourth-year students selecting the correct answer in all the MCQ's compared to the fi rst-year students except in identifyingthe correct depth of compressions required during CPR(P=0.095). Overall 10.3%(95% CI 9.9% to 10.7%) of respondents correctly identified the answer to 5 MCQ's on BLS: 9% of the first-year students(n=194) and 12% of the fourth-year students(n=190). On an institutional level the proportion of students answering all MCQ's correctly ranged from 2% to 54% at different universities. Eighty-one percent of students(n=3,031) wished for more BLS training in their curriculum.CONCLUSION: Factual knowledge of BLS is poor among medical students in the UK. There is a disparity in standards of knowledge across institutions and respondents indicating that they would like more training.

A qualitative study of nurse practitioner promotion of interprofessional care across institutional settings:Perspectives from different healthcare professionals

Objective:Interprofessional care,an aim of institutional healthcare settings globally,promotes safe,cost-effective,quality care.How professionals act to enable interprofessional care has not been described.The nurse practitioner role,with its expertise in both medicine and nursing,is known to enhance collaboration and promote interprofessional care delivery.The objective of this study was to identify,from the healthcare professionals'perspective,nurse practitioner strategies used to enhance interprofessional care.Method:A hermeneutic phenomenology design was employed.Healthcare professionals from acute care hospitals and associated long-term care residences(n=6)in one Canadian province were invited to participate.Individual interviews were held with healthcare professionals(n=52)who regularly work with a nurse practitioner.The participants were asked to share experiences that held significance or value in promoting interprofessional care.Results:Four valued role attributes were identified;consistent role presence,time to focus on the patient,effective communication,and respectful centrality.Identified strategies extending from the attributes included knowledge sharing,respectful negotiation,identifying patient issues,being open and transparent,listening to opinions,bridging professions,and working as the hub of the group.Multiple types of interprofessional relationships were perceived,with the hierarchical type as the most common.Conclusions:Nurse practitioners in acute care hospital and long-term care settings have valued attributes that can promote interprofessional care.Effective strategies to promote interprofessional care emerge from these role attributes.However,the interprofessional relationship type perceived could enhance or impede the contribution of the strategies to interprofessional care promotion.

Reduced normogastric electrical activity associated with emesis:A telemetric study in ferrets

AIM:To characterize the gastric myoelectric activity(GMA) and intra-abdominal pressure changes induced by emetic stimuli(apomorphine and cisplatin) in the ferret.METHODS:GMA and intra-abdominal pressure were recorded in conscious,unrestrained ferrets surgically implanted with radiotelemetry transmitters.Animals were challenged with apomorphine(0.25 mg/kg sc) and cisplatin(10 mg/kg ip),and the emetic response was quantif ied via direct observation and intra-abdominal pressure recording for 1 and 4 h,respectively.The GMA was analyzed by spectral analysis;the parameters used to characterize the GMA were the dominant frequency(DF) and the repartition of spectral power in the bradygastric,normogastric and tachygastric frequency ranges.RESULTS:Retches were identified on the intraabdominal pressure trace as peaks 0.30±1.01 s in duration and 59.57±2.74 mmHg in amplitude,vomit peaks were longer(0.82±0.06 s,P<0.01) and reached a higher pressure(87.73±8.12 mmHg,P<0.001).The number of retches and vomits quantified via direct observation [apomorphine:65.5 ± 11.8 retches + vomits(R+V),cisplatin:202.6±64.1 R+V] and intra-abdominal pressure(apomorphine:68.3±13.7 R+V,n=8;cisplatin:219.0±69.2 R+V,n=8) were correlated(r=0.97,P<0.0001) and the timing of emesis was consistent between the 2 methods.Apomorphine induced a decrease in normogastria from 45.48%±4.35% to 36.70±4.34%(n=8,P<0.05) but the DF of the slow waves was not changed [8.95±0.25 counts/min(cpm) vs 8.68±0.35 cpm,n=8,P> 0.05].Cisplatin induced a decrease in normogastria from 55.83%±4.30% to 29.22%±5.16% and an increase in bradygastria from 14.28%±2.32% to 31.19%±8.33%(n=8,P<0.001) but the DF(9.14±0.13 cpm) remained unchanged(P>0.05).The GMA changes induced by cisplatin preceded the emetic response as normogastria was reduced for 1 h before the onset of emesis(57.61%±5.66% to 39.91%±5.74%,n=6,P<0.05).Peri-emesis analysis revealed that the GMA was signif icantly disturbed during and immediately after,but not immediately before,the emetic episodes.CONCLUSION:The induction of emesis is reliably associated with a disrupted GMA,but changes may also occur prior to and following the emetic response.

Roux-en-Y gastric bypass or sleeve gastrectomy for obstructive sleep apnea:A systematic review and meta-analysis

Objective:Bariatric surgery has been shown to be an effective method of treatment for obstructive sleep apnea(OSA)with long-term benefits,however,the mechanisms of action and the optimum operative procedure remains unclear.The aim of this systemic review was to compare the efficacy of laparoscopic sleeve gastrectomy(LSG)and Roux-en-Y gastric bypass(RYGB)in resolving OSA.Methods:A comprehensive search of MEDLINE,Pubmed,Embase,and OVID was performed.Studies that reported OSA resolution in obese patients with BMI>30 kg/m2 were included in the study.RCTs,comparative prospective and matched cohort studies comparing RYGB with LSG were considered for this study.Results:Five studies(309 participants)were included:4 cohort studies and 1 RCT;all with low risk of bias.At 12 months follow-up,there was a trend towards improved resolution of OSA with LSG(OR 0.47,95%CI[0.20 to 1.06];p=0.07)when compared to RYGB.In contrast,there was a trend to poorer weight loss in the LSG group(SMD 3.83,95%CI[-1.82 to 9.48];p=0.18).Similarly,at 36 months follow-up,there was a trend towards better resolution of OSA with LSG(OR 0.52,95%CI[0.16 to 1.71];p=0.28)and a significantly poorer weight loss in LSG when compared to RYGB(SMD 8.25,95%CI[2.91 to 13.58];p=0.002).Conclusion:Despite poorer weight loss following LSG,there is a trend towards increased resolution of sleep apnea post-LSG.These findings suggest the possibility of weight loss independent factors causing OSA resolution,which should be further investigated.Registration:PROSPERO:CRD42018090367.

Subjective scar assessment scales in orthopaedic surgery and determinants of patient satisfaction: A systematic review of the literature

Purpose:Scar assessment tools can be utilized during the post-operative period to monitor scar progress.The primary aim of this systematic review was to evaluate current subjective scar assessment scales utilized in orthopaedic surgery.The secondary aim was to identify determinants of patients'satisfaction with their scars and evaluate current measurement scales.Methods:The preferred reporting items for systematic reviews and meta-analyses checklist was followed.Electronic databases,curently registered studies,conference proceedings and the reference lists of included studies were searched.There were no constraints based on language or publication status.A narrative synthesis provided a description and evaluation of scales utilized in orthopaedic surgery.Determinants of patient satisfaction were identified along with the scales used to measure satisfaction.Results:A total of 6059 records were screened in the initial search.Twenty-six articles satisfied the inclusion criteria,assessing 7130 patients.In the literature,six validated subjective scar scales were identified,including the Vancouver scar scale,patient and observer scar assessment scale,Manchester scar scale,Stony Brook scar evaluation scale,visual analogue scale,and Hollander wound evaluation scale.Studies utilizing these scales to evaluate scars following orthopaedic procedures did so successfully.These were total hip arthroplasty,total knee arthroplasty,and limb reconstruction.The scales demonstrated satisfactory validity.Functional outcomes such as restoration of movement ranked among patients'highest concerns.Scar cosmesis was found to be amongst patients'lowest priorities.Conclusions:Subjective scar assessment scales identified in the literature were not designed specifically for orthopaedic surgery.However,these were able to appropriately assess scars in the studies identified in this review.Current evidence suggests the effect of scar cosmesis on patient satisfaction with orthopaedic procedures is limited.

Post-urethroplasty complications in hypospadias repair: a systematic review and meta-analysis comparing, polydioxanone and polyglactin sutures

Background Polyglactin(PG)and polydioxanone(PDS)sutures are extensively used based on the surgeon's preference.The development of post-reconstruction urethrocutaneous fistula(UCF)is variably attributed to the choice of suture material for urethroplasty.This meta-an alysiscompares complications of hypospadia srepair using PGand PDS sutures.Methods The systematic review and meta-analysis were performed as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.The authors conducted thorough searches in databases including MEDLINE,EMBASE,CENTRAL,Scopus,Google Scholar,and clinical trial registries.Outcome measures included UCF,meatal stenosis,wound infection,urethral stricture,glans dehiscence,and overall complications.Quantitative analysis was used with fixed or random-effect models to find the pooled risk ratio and I2 heterogeneity.Results The criteria for inclusion were met by five comparative studies with the inclusion of 1244 children altogether.Pooled analysis failed to show a statistically significant difference in the incidence of meatal stenosis,urethral stricture,wound infection,and total complications using PG and PDS sutures.However,it showed a reduction in the incidence of UCF with PDS suture hypospadias repairs(risk ratio=0.66,95%Cl 0.48 to 0.92).Conclusions PDS sutures are associated with decreased incidence of UCF than PG after hypospadias repair.The incidence of meatal stenosis,urethral stricture,wound infection,and total complications was not affected by the type of suture material used for repair.Clinical implications This meta-analysis suggests decreased incidence of UCF when PDS sutures are used for hypospadias repair which may impact the choice of suturematerialforrepair.

结核病短程化疗实验研究中的复发时间

我们对英国医学研究委员会于1970年至1983年间在非洲和东亚地区开展的15项结核病治疗的试验研究结果进行了回顾。在574例复发病例中,447例(78%)的复发发生在停止治疗后6个月内,525例(91%)发生在停止治疗后12个月内。我们建议:研究者应考虑,在对纳入的最后1例病人完成6个月的治疗后随访时即停止,而对早期纳入病人的治疗后随访也在那时停止。与对所有病人均随访24个月相比,整个试验研究的时间缩短了18个月,而在非劣效试验研究设计中的病例数并未增加。

水果和蔬菜消耗与卒中:队列研究荟萃分析

Background: Increased consumption of fruit and vegetables has been show n to b e associated with a reduced risk of stroke in most epidemiological studies, alth ough the extent of the association is uncertain. We quantitatively assessed the relation between fruit and vegetable intake and incidence of stroke in a meta- analysis of cohort studies. Methods: We searched MEDLINE, EMBASE, the Cochrane L ibrary, and bibliographies of retrieved articles. Studies were included if they reported relative risks and corresponding 95% CIs of stroke with respect to fr equency of fruit and vegetable intake. Findings: Eight studies, consisting of ni ne independent cohorts, met the inclusion criteria. These groups included 257 55 1 individuals(4917 stroke events) with an average follow- up of 13 years. Compa red with individuals who had less than three servings of fruit and vegetables pe r day, the pooled relative risk of stroke was 0.89(95% CI 0.83- 0.97) for tho se with three to five servings per day, and 0.74(0.69- 0.79) for those with mor e than five servings per day. Subgroup analyses showed that fruit and vegetables had a significant protective effect on both ischaemic and haemorrhagic stroke. Interpretation: Increased fruit and vegetable intake in the range commonly consu med is associated with a reduced risk of stroke. Our results provide strong supp ort for the recommendations to consume more than five servings of fruit and vege tables per day, which is likely to cause a major reduction in strokes.

Migrasomes released by HSV-2-infected cells serve as a conveyance for virus spread

Dear Editor,Migrasomes are newly discovered cellular organelles with diameters of 0.5–3μm which have been found to be produced by normal and cancer cells,and distributed in various organs of animals(Ma et al.,2015)and in human sera(Zhao et al.,2019).Migrasomes are present inside the cavities of pulmonary alveoli,blood vessels and lymph capillaries(Zhang et al.,2020),and can be captured by surrounding cells with their cargoes internalized.

心率震荡对心脑血管疾病危险性的预测价值

心率震荡（HRT）是指正常个体自发性室性早搏（室早）后窦性心率先是短暂的加速，随后短暂的心率逐渐减速的现象。这种现象也可发生于程控性室早或室上性早搏之后，反映了自主神经在早搏后反射性快速调节及窦房结的双向变时功能。1999年Schmidt等首先提出了HRT的概念，并用于预测心肌梗死（MI）后患者死亡的危险性。此后HRT的研究又延伸到慢性心力衰竭（CHF）患者。

脑部磁共振白质高信号的临床重要性：系统性综述和荟萃分析（摘要）

目的 回顾与卒中、认知功能衰退、痴呆和死亡风险相关的脑白质高信号的证据。 设计 系统性回顾和荟苇分析。 数据来源 从1966年至2009年11月23日PubMed数据库。

将比值比转化为合理范围内的相对危险度以便于更好地探讨研究结果

医学研究中，比值比（OR）通常在Logistic回归和病例对照研究中用来估计效应的大小，但人们对它的理解不够透彻，因此成为研究中不可避免的难点。本文为读者提供了将OR转化成相对危险度（RR）的方法。

为缓和医疗正名改变观念比改变名字更重要

世界卫生组织(WHO)首次提出“缓和医疗(palliative care)”这个概念已经30年了,我们依然没有真正认同这个理念。开展缓和医疗以来,终末期患者的照护情况得到了显著的改善,关于“死亡”的探讨也渐渐不再是禁忌话题。很多国家政府和国际组织开始提倡推广缓和医疗。柳叶刀健康委员会(Lancet Commission)更激进地提出,对于全球数百万终末期患者,对缓和医疗的自主选择是基本人权。

DC-SIGN promotes Japanese encephalitis virus transmission from dendritic cells to T cells via virological synapses

Skin-resident dendritic cells(DCs) likely encounter incoming viruses in the first place, and their migration to lymph nodes following virus capture may promote viral replication. However, the molecular mechanisms underlying these processes remain unclear. In the present study, we found that compared to cell-free viruses, DC-bound viruses showed enhanced capture of JEV by T cells.Additionally, JEV infection was increased by co-culturing DCs and T cells. Blocking the C-type lectin receptor DC-specific intercellular adhesion molecule-3-grabbing non-integrin(DC-SIGN) with neutralizing antibodies or antagonists blocked JEV transmission to T cells. Live-cell imaging revealed that DCs captured and transferred JEV viral particles to T cells via virological synapses formed at DC-T cell junctions. These findings indicate that DC-SIGN plays an important role in JEV transmission from DCs to T cells and provide insight into how JEV exploits the migratory and antigen-presenting capabilities of DCs to gain access to lymph nodes for dissemination and persistence in the host.

隐源性卒中的心电监测策略：2015年卒中诊断和监测专题组的报告

卒中是一个重要的全球性公共卫生问题。2010年全世界总共发生3300万例卒中，其中1690万为首发卒中。卒中是仅次于心脏病的第二大全球人口死亡原因，占全部死亡的10％以上。卒中是一类异质性疾病，其病因可以是血管破裂（出血性）或血管闭塞（缺血性）。缺血性卒中约占全部卒中的85％，可根据发病机制进行分类。

体质指数是衡量肥胖的最好指标吗？大多数情况下对大多数人来说，它都是衡量肥胖的最好指标

肥胖的定义为：脂肪异常沉积导致健康受到损害，最常用的评估指标是身体质量指数（BMI），简称体质指数。但有些人质疑BMI是否是最好的诊断方法。

A signature for biological heterogeneity in susceptibility to HIV infection?

Data on female sex workers and sero-discordant couples indicate a pattern of waning of the risk of HIV infection with longer duration of exposure to infected partners.Understanding risk of HIV acquisition and transmission is critical to understanding HIV epidemiology and informing prevention interventions.Informed by empirical data,we aimed to develop a statistical model to explain these observations.In our proposed model,the time to infection for each individual is exponentially distributed,but the marginal(population averaged)distribution of time to infection follows a Weibull distribution with shape parameter of about 0.5,and with the L
evy distribution being the mixing distribution.Simulations based on this model demonstrated how HIV epidemics are destined to emerge rapidly,because of the rapid sero-conversion upon exposure,but also simultaneously destined to saturate and decline rapidly after emergence,just as observed for the HIV epidemics in sub-Saharan Africa.These results imply considerable individual variability in infection risk,probably because of biological heterogeneity in the susceptibility to HIV infection.Factoring this variability in mathematical models,through the methodology provided here,could be critical for valid estimations of impact of HIV interventions and assessments of cost-effectiveness.