How safe is Healthcare? Perceptions within the Healthcare Community and the general public.

Objectives: Complexity of health care is progressively increasing and with that the number of medical errors and adverse events are increasing to an alarming level. The purpose of this study is to assess the perception of healthcare safety within the healthcare community and the general public and examine the association between the perception regarding healthcare safety and the prior exposure to medical errors. Methods: The study is a cross-sectional online survey. The online survey included basic demographics and a series of questions related to the knowledge and perception about healthcare safety and personal healthcare experience. Results: 504 respondent completed the survey. 78.6% were healthcare workers. 84% reported one or more exposure to medical errors or adverse events. Most respondents (81.5%) estimated the rate of medical errors to be 1:100 or less. only 29.3% of the respondents thought that medical errors are occurring more frequently than 10 years ago. 89.6% of the respondents thought that healthcare is a safe industry. Looking at Factors Predicting the Perception that Healthcare is Safe, there was no clear correlation with the exposure to medical errors except for surgical complications exposure (p-value=0.01, OR 21.4) Conclusions: There is a strong indication in our data that healthcare workers and public perception is far from the reality of the dangers of the healthcare system There is a need to educate the public regarding the medical error rate and the healthcare safety to help make patients and their families become partners in their care and to help healthcare workers better understand the limitations of healthcare processes that may affect patient safety and outcomes

How safe is Healthcare? Perceptions within the Healthcare Community and the general public

Objectives: Complexity of health care is progressively increasing and with that the number of medical errors and adverse events are increasing to an alarming level. The purpose of this study is to assess the perception of healthcare safety within the healthcare community and the general public and examine the association between the perception regarding healthcare safety and the prior exposure to medical errors. Methods: The study is a cross-sectional online survey. The online survey included basic demographics and a series of questions related to the knowledge and perception about healthcare safety and personal healthcare experience. Results: 504 respondent completed the survey. 78.6% were healthcare workers. 84% reported one or more exposure to medical errors or adverse events. Most respondents (81.5%) estimated the rate of medical errors to be 1:100 or less. only 29.3% of the respondents thought that medical errors are occurring more frequently than 10 years ago. 89.6% of the respondents thought that healthcare is a safe industry. Looking at Factors Predicting the Perception that Healthcare is Safe, there was no clear correlation with the exposure to medical errors except for surgical complications exposure (p-value=0.01, OR 21.4) Conclusions: There is a strong indication in our data that healthcare workers and public perception is far from the reality of the dangers of the healthcare system There is a need to educate the public regarding the medical error rate and the healthcare safety to help make patients and their families become partners in their care and to help healthcare workers better understand the limitations of healthcare processes that may affect patient safety and outcomes

Glucocorticoids, master modulators of the thymic catecholaminergic system?

There is evidence that the major mediators of stress, i.e., catecholamines and glucocorticoids, play an important role in modulating thymopoiesis and consequently immune responses. Furthermore, there are data suggesting that glucocorticoids influence catecholamine action. Therefore, to assess the putative relevance of glucocorticoid-catecholamine interplay in the modulation of thymopoiesis we analyzed thymocyte differentiation/maturation in non-adrenalectomized and andrenalectomized rats subjected to treatment with propranolol (0.4 mg.100 g body weight(-1).day(-1)) for 4 days. The effects of beta-adrenoceptor blockade on thymopoiesis in non-adrenalectomized rats differed not only quantitatively but also qualitatively from those in adrenalectomized rats. In adrenalectomized rats, besides a more efficient thymopoiesis [judged by a more pronounced increase in the relative proportion of the most mature single-positive TCR alpha beta(high) thymocytes as revealed by two-way ANOVA; for CD4(+)CD8(-)F (1,20) = 10.92, P lt 0.01; for CD4(-)CD8(+)F (1,20) = 7.47, P lt 0.05], a skewed thymocyte maturation towards the CD4(-)CD8(+) phenotype, and consequently a diminished CD4(+)CD8(-)/CD4(-)CD8(+) mature TCR alpha beta(high) thymocyte ratio (3.41 +/- 0.21 in non-adrenalectomized rats vs 2.90 +/- 0.31 in adrenalectomized rats, P lt 0.05) were found. Therefore, we assumed that catecholaminergic modulation of thymopoiesis exhibits a substantial degree of glucocorticoid-dependent plasticity. Given that glucocorticoids, apart from catecholamine synthesis, influence adrenoceptor expression, we also hypothesized that the lack of adrenal glucocorticoids affected not only beta-adrenoceptor- but also alpha-adrenoceptor-mediated modulation of thymopoiesis

Voltage-dependent calcium entry in confluent bovine capillary endothelial cells

AbstractConfluent bovine capillary endothelial cells display, when examined for voltage-dependent calcium entries using cell-attached channel recordings, two types of Ca2+ channels (4 and 23.5 pS in 110 mM Ba2+) both sensitive to the dihydropyridine Ca agonist BAY K 8644. In contrast to isolated cells, confluent cells display no T-type, low threshold activity, and Ca currents were typically only elicited at very depolarized potentials. In these cells, voltage-dependent calcium entries will only be made operative by substances able to shift their activation towards the resting potential

Sustained stimulation shifts the mechanism of endocytosis from dynamin-1-dependent rapid endocytosis to clathrin- and dynamin-2-mediated slow endocytosis in chromaffin cells

Transient stimulation of secretion in calf chromaffin cells is invariably followed by rapid endocytosis (RE), a clathrin- and K(+)-independent process with a half time of several seconds. Here we show that when exocytosis is triggered in a more sustained manner, a much slower form of endocytosis (SE) replaces RE. SE is complete within 10 min and is abolished when anticlathrin antibodies are introduced into the cell or when intracellular K(+) is removed. RE, but not SE, is blocked by intracellular administration of antidynamin-1 antibodies; the inverse specificity was found for antidynamin-2 antibodies. Replacement of extracellular Ca(2+) by Ba(2+) or Sr(2+) completely blocked RE but had little effect on SE. Thus chromaffin cells exhibit two kinetically and mechanistically distinct forms of endocytosis that are coupled to different extents of exocytosis and are mediated by different isoforms of dynamin. We surmise that RE is associated with the transient fusion (“kiss-and-run”) mechanism of transmitter release and is the prevalent means of vesicle recapture and recycling under normal physiological conditions, whereas the clathrin-based SE mechanism comes into play only at higher levels of stimulation and may be associated with complete fusion of vesicles with the plasma membrane

Abstract 11318: Countering the Impact of Covid-19 on Fellow Transesophageal Echocardiogram Education in a Tertiary Academic Program

Introduction: TEE’s are an essential component of cardiology fellowship education. At our institution, COVID peaked twice in 2020. The first peak showed a drop in total fellow TEE’s. To counter this decline, the use of personal protective equipment (PPE) and COVID testing patients requiring TEE’s were implemented to maintain patient care and ensure the safety of health personnel. We analyzed the differences in fellow TEE’s during the second COVID wave compared to the first to determine if these interventions prevented a decline in fellow TEE’s. Methods: The monthly number of TEE’s performed by fellows on core TEE rotations was plotted for the year 2019, prior to the COVID pandemic. For the data set, a linear line was fit to account for the variation of studies read over the year. This linear variation was subtracted from the monthly totals to remove seasonal variation. The degree of variation was taken as the standard deviation (SD) for 2019. The 2020 data was processed using the predictions for 2019 and the upper and lower limits of variation were taken as three times the SD of the 2019 data. Results: Using the 2019 TEE data (Figure 1A), the linear seasonal variation line was created and used to account for variations in the 2020 TEE data (Figure 1B). After accounting for seasonal variation, a significant decline is noted, indicated by the red dot, in the number of fellow TEE’s during the month of April, the first peak (Figure 1C). Institutional guidelines for PPE and COVID testing were put in place in June 2020 and December 2020. After implementation, fellow TEE numbers improve back to baseline and remain consistent even through the December peak (Figure 1C). Conclusions: Our data demonstrates the value of PPE and COVID testing prior to TEE’s can help maintain fellow education during a pandemic while ensuring the safety of fellows, faculty, and technicians. COVID brings uncertainty to the healthcare field and these systems will allow for maintenance of both fellow education and patient care. </jats:p