A Henry Ford Hospital study found that simulation training improved the critical decision-making skills of medical residents performing actual resuscitations in the Emergency Department.
Researchers say the residents performed better in four key skill areas after receiving the simulation training: leadership, problem solving, situational awareness and communication. Their overall performance also sharpened.
While many studies have shown the benefits of simulation training for honing the skill level of medical professionals, Henry Ford

In a new study, a program known as Spatially Invariant Vector Quantisation (SIVQ) was able to separate malignancy from background tissue in digital slides of micropapillary urothelial carcinoma, a type of bladder cancer whose features can vary widely from case to case and that presents diagnostic challenges even for experts.
‘Being able to pick out cancer from background tissue is a key test for this type of software tool,’ says U-M informatics fellow Jason Hipp, M.D., Ph.D., who shares lead authorship of the paper with resident Steven Christopher Smith, M.D., Ph.D. ‘This is the type of validation that has to happen before digital pathology tools can be widely used in a clinical setting.’
To test the software

The use of a dedicated pediatric imaging department (with dedicated pediatric computed tomography (CT) technologists) for pediatric CT scans significantly reduces the radiation dose delivered to the patient, according to a study.
When performed and monitored properly, the benefits of CT scans outweigh the potential long-term risk of radiation. To minimise the potential adverse effects of radiation exposure to pediatric patients, it is necessary to reduce the dose of radiation delivered to these patients while preserving the diagnostic quality of the images produced.
‘There are many strategies for reducing radiation dose. The use of protocols with adjusted exposure parameters for pediatric patients on the basis of child size, organ system scanned and the size of the region scanned is most notable. However, compliance with these protocols can be challenging for technologists, particularly when scanning a combination of adult and pediatric patients,’ said Heather L. Borders, MD, lead author of the study.
A retrospective review of abdominal and pelvic CT console dose and exposure parameter data on 495 patients from a combined pediatric and adult radiology department and subsequently 244 patients from a dedicated pediatric radiology department was performed. Patients were divided into 1 of 8 weight categories for analysis.
A statistically significant decrease in the estimated effective dose for abdominal and pelvic CT studies was observed in all but one of the weight categories at the pediatric radiology department compared with the pediatric and adult radiology department.
‘Imaging pediatric patients in a dedicated pediatric imaging department with dedicated pediatric CT technologists may result in greater compliance with pediatric protocols and significantly reduced patient dose,’ said Borders.
‘Conversely, greater scrutiny of compliance with pediatric dose-adjusted CT protocols may be necessary for departments that scan both children and adults,’ she said. EurekAlert

Magnetic resonance imaging (MRI) provides an indication of a breast tumour

There is no difference in early measures of pulmonary function, immunologic status or coagulation status after fresh versus standard issue single-unit red blood cell (RBC) transfusion, according to a new study from the Mayo Clinic.

‘Longer duration of RBC storage is thought to increase the risk of transfusion-related pulmonary complications,’ said Daryl J. Kor, assistant professor of anaesthesiology at the Mayo Clinic College of Medicine. ‘In our study of 100 intubated, mechanically ventilated patients, we did not see evidence for an increased risk associated with RBC storage duration, at least not in the early post-transfusion period.’

In the double-blind trial, 50 patients were randomised to receive fresh (median storage duration = 4.0 days) RBC and 50 were randomised to receive standard issue RBC (median storage duration = 26.5 days). The primary outcome measure was change in pulmonary gas exchange, as measured by the partial pressure of arterial oxygen to fraction of inspired oxygen concentration ratio (ΔPaO2/FiO2). Post-transfusion measurements were performed upon completion of the transfusion and within two hours of the transfusion (median 1.9 hours in the fresh RBC group and 1.8 hours in the standard issue RBC group).

No significant differences between groups were seen in the primary outcome measure of change in PaO2/FiO2 ratio (2.5 +/- 49.3 vs. -9.0 +/- 69.8; fresh RBC vs. standard issue RBC; p = 0.22). Similarly, no significant differences were seen for any of the other outcome measures of pulmonary function (fraction of dead space ventilation, dynamic and static pulmonary compliance), immunologic status (tumor necrosis factor-alpha, interleukin-8, C-reactive protein) or coagulation status (fibrinogen, anti-thrombin consumption).

‘Our data do not support a significant effect of RBC storage duration on respiratory, immunologic or coagulation parameters in the immediate post-transfusion period,’ said Dr. Kor. ‘Previous observational studies linking RBC storage duration and respiratory complications may have suffered from bias and unmeasured confounding, which were more effectively addressed in our double-blind, randomised trial study design.’

The study did have some limitations, including the short duration of follow-up, the study’s limited sample size and the single centre, tertiary-care setting, which may limit the generalisability of the results.

‘Given the lack of an association between RBC storage duration and evidence of transfusion-related pulmonary complications in our study, randomization to fresh versus longer storage duration RBC in clinical trials would clearly seem ethical,’ said Dr. Kor. ‘Further study will need to clarify the impact of RBC storage duration on other patient-centered outcomes.’