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BACKGROUND: Intensive care outreach nurses are required to work as part of an ad hoc team to review and manage patients who are deteriorating outside of critical care environments. Nontechnical skills, such as those encompassed by crisis resource management principles, are essential when working in these situations. Used commercially for entertainment, escape rooms have recently been utilised by clinical educators to teach both technical and nontechnical skills. OBJECTIVE: This exploratory study evaluates how advanced clinicians, intensive care outreach nurses, experience an escape room scenario designed to consolidate crisis resource management (CRM) principles. METHODS: Three escape room sessions were conducted in a 1038-bed metropolitan tertiary referral hospital. A purposive sample of 12 intensive care outreach nurses were invited to participate. The participant's experience of the escape room scenario was determined by their responses to a post-escape room survey and focus group discussion. Transcripts of the audio recordings from focus group discussions were analysed using an inductive coding approach. RESULTS: Two primary categories emerged from analysis of the focus group discussions: (i) the clinicians' experiences of the escape room and (ii) CRM principles. The first category included descriptions of emotions, including confusion, frustration, and a dislike for puzzles. The second category included both the participants understanding of the CRM principles, and how the principles influence the work within the escape room. CONCLUSIONS: Escape rooms have shown promise as novel educational environments, which challenge participants. Despite initial negative descriptions of the escape room, focus group discussions demonstrated that the participants were able to recognise the impact of CRM principles and acknowledge how these affect their clinical work in an ad hoc team.
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Proyectos Piloto , HumanosRESUMEN
Bacteriophages Phonegingi and Dropshot were isolated from soil in North Carolina using the host Microbacterium foliorum. Both phages have siphovirus morphologies. Based on gene content similarity to one another and to other actinobacteriophages, both phages are assigned to phage cluster GA.
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BACKGROUND: Focal areas of T2 hyperintensity are seen on magnetic resonance imaging (MRI) in patients with neurofibromatosis type 1 (NF1). These lesions are commonly known as "unidentified bright objects" of the brain. We have seen similar lesions in the spinal cord of the same patient population. Our aim was to determine the prevalence and characterize the imaging features of these T2 hyperintense spinal cord lesions in children with NF1. METHODS: A search of our hospital's medical imaging database yielded all children with NF1 and MRI of the brain and/or spine between February 2014 and April 2017. Medical imaging was reviewed for T2 hyperintense signal changes and medical records were reviewed of those children with T2 hyperintense spinal cord lesions. RESULTS: During the study period 155 children underwent a brain MRI and 72 had a spine MRI. One hundred twenty-three (79%) showed multiple cerebral T2 hyperintense lesions and six (8%) had non-contrast enhancing spinal cord T2 hyperintensities with five children having had a follow-up scan. The one child without follow-up imaging was not further pursued. Interval scanning showed stable appearance of the spinal cord lesions in four children and signal reduction in one child. All five children with T2 hyperintense changes in the spinal cord had an MRI brain and all (100%) also exhibited cerebral T2 hyperintensities. CONCLUSIONS: Focal areas of signal hyperintensity in the spinal cord are the corollary of the better described cerebral T2 hyperintensities in individuals with NF1.
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Encéfalo/diagnóstico por imagen , Imagen por Resonancia Magnética , Neurofibromatosis 1/diagnóstico por imagen , Médula Espinal/diagnóstico por imagen , Adolescente , Neoplasias Encefálicas/diagnóstico por imagen , Neoplasias Encefálicas/epidemiología , Niño , Preescolar , Estudios de Seguimiento , Humanos , Neurofibromatosis 1/epidemiología , Prevalencia , Neoplasias de la Médula Espinal/diagnóstico por imagen , Neoplasias de la Médula Espinal/epidemiologíaRESUMEN
PURPOSE: The aim of this study was to document the range and frequency of ethical dilemmas associated with genetic testing encountered by genetic health professionals and to determine the strategies used to manage them. METHODS: An online survey was used to document how often the 11 key ethical dilemmas have been encountered; whether any additional dilemmas have been encountered; and how these dilemmas have been managed. Members of the Australasian Association of Clinical Geneticists, Australasian Society of Genetic Counsellors, and genetic social workers practicing in Australia and New Zealand were invited to participate. RESULTS: A total of 102 responses were received (31% response rate). Respondents had encountered all of the 11 ethical dilemmas included in the survey, and 18 respondents had encountered 14 additional dilemmas. Respondents encountered an average of 2.2 dilemmas per year of practice. Peer and clinical supervision were the most common strategies used to manage dilemmas, and seeking advice from clinical ethics committees was rare. Occasionally, respondents facilitated practices they deemed unethical as a consequence of client deception. CONCLUSION: Ethical dilemmas of genetic testing are encountered regularly in clinical genetics practice. Evidence provided by our study can assist in targeting training, support, and guidance to help genetic health professionals navigate such dilemmas in the future.