Analysis of Task Attributes Associated with Crisis Checklist Compliance in Pediatric Trauma Resuscitation

Although checklists can improve overall team performance during medical crises, non-compliant checklist use poses risks to patient safety. We examined how task attributes affected checklist compliance by studying the use of a digital checklist during trauma resuscitation. We first determined task attributes and checklist compliance behaviors for 3,131 resuscitation tasks. Using statistical analyses and qualitative video review, we then identified barriers to accurately tracking task status, finding that certain task attributes were associated with non-compliant checklist behaviors. For example, tasks with multiple steps were more likely to be incorrectly recorded as completed when the task was not performed to completion. We discuss challenges in capturing and tracking the status of tasks with attributes that contribute to non-compliant checklist use. We also contribute a framework for understanding how tasks with certain attributes can be designed on checklists to improve compliance.

Horizontal violence in the operating room

The concept of horizontal violence is something you may or may not have heard of or know about. However, you will probably have experienced it during your career; and reading about it may make you feel uncomfortable. Indeed, some of you, like myself, may have unknowingly perpetuated it.

AMPA-selective glutamate receptor subunits and their relation to glutamate- and GABA-like immunoreactive terminals in the nucleus submedius of the rat

Glutamate plays an important role in supraspinal nociceptive systems. Thus, glutamate is present in the nucleus submedius of the medial thalamus, a major relay for nociceptive information. In this study, immunoreactivity for the four subunits (GluR1-4) of alpha-amino-3-hydroxy-5-methyl-4-isoxasoleproprionate (AMPA) receptors was examined by a preembedding immunohistochemical method in order to evaluate the presence of this glutamate receptor subtype in the nucleus submedius. Combining the preembedding method with a postembedding immunogold technique, we found that AMPA receptor-like immunoreactivity was present postsynaptically to glutamatergic terminals but not to terminals containing gamma-aminobutyric acid (GABA). These findings suggest a role for AMPA receptors in excitatory synaptic transmission in the nucleus submedius of the rat thalamus.

Milk selenium of rural African women: influence of maternal nutrition, parity, and length of lactation

The selenium content of milk samples from rural Gambian women (n = 55) was evaluated as a function of parity, stage of lactation, and maternal nutrition. Samples were collected during periods of relative food abundance (dry season) and food scarcity (rainy season). Milk selenium was lower (p less than 0.01) in the rainy than in the dry season (208 vs 256 nmol/L, respectively). Milk selenium was similar in samples from women in early (1-6 mo postpartum) and late (13-19 mo postpartum) lactation. During late lactation, parity, which ranged from 1 to 11, was negatively correlated with milk selenium regardless of plane of maternal nutrition (p less than 0.02). Measures of protein, glutathione peroxidase, and total peroxidase were not affected by stage of lactation or parity. Glutathione peroxidase activity accounted for 38% of the peroxidase activity in milk. Results show that although length of lactation alone had little impact, milk selenium secretion was influenced by both maternal nutritional adequacy and parity of rural Gambian women.