EDICAL ERRORS AND PAtient safety continue to be an important concern for patients and physicians, especially since the Institute of Medicine reported in 1999 that between 48 000 and 98 000 Americans die each year due to preventable adverse events. 1 As many as 50% of hospitalized patients may be affected by medical errors, 2,3 and the human and monetary costs of these events are great. 4,5 Numerous reports have implicated fatigue and sleepiness as contributors to medical errors. 1,[6][7][8][9] In separate studies, resident distress has also been shown to be an important factor in selfreported major medical errors 10 and medication errors. 11 This research on fatigue and distress has informed the 2008 Institute of Medicine report on resident duty hours calling for prevention or mitigation of fatigue and promotion of resident well-being. Specific recommendations have primarily focused on reducing fatigue by limiting shift lengths, reducing the frequency of overnight work, and protecting time off duty. 12 The costs to implement these recommendations would be great and their effectiveness is unknown, 13 but there is little doubt that the proposed changes would transform the modern training environment.As such changes are considered, it is important to note that the indepen-dent contributions of fatigue and distress to medical errors are unknown because to our knowledge, fatigue and distress have not been assessed together in prior published research. Since fatigue and distress are related but distinct entities, 12 assessment of their joint effects on patient safety outcomes is a critical part of efforts to improve patient care. To address this

The aborted trial of semagacestat has led some to invoke unanticipated effects of γ‐secretase inhibition on formation of amyloid β. However, the many substrates for γ‐secretases and the varied biological effects of each of the resultant cleavage products make ascribing causality much more complex than that. Ann Neurol 2011

Purpose This study evaluates the two-year overall survival (OS), adverse event rate, local control rate and impact on pulmonary function tests (PFTs) in medically inoperable patients with stage IA NSCLC undergoing CT-guided RFA in a prospective multi-center trial. Methods 54 patients M:F=25:29, median age/range= 76/60–89 were enrolled from 16 US centers 51 patients were eligible (biopsy proven stage IA NSCLC and deemed medically inoperable by board certified thoracic surgeon) for evaluation. PFTs were obtained within 60 days of RFA, 3 and 24 months after RFA. Adverse events were recorded and categorized. Patients were followed by CT and FDG PET. Local control rate and recurrence patterns were analyzed. RESULTS The OS rate was 86.3% at one year and 69.8% at two years. Local tumor recurrence free rate was 68.9% at one year and 59.8% at two years and was worse for tumors >2 cm. In the 19 patients with local recurrence, 11 had retreatment with RFA, nine had radiation and three had chemotherapy. There were 21 grade 3, two grade 4 and one grade 5 AEs in 12 patients within the first 90 days after RFA. None of the grade 4 and 5 AEs were attributed to the RFA. There was no significant change in the FEV1 or DLCO after RFA. Tumor size less than 2.0 cm and performance status of 0–1 were associated with a statistically significant improved survival of 83% and 78% respectively, at two years. CONCLUSIONS RFA is a single minimally invasive procedure, that is well tolerated in medically inoperable patients, does not adversely affect PFTs and gives two year OS that is comparable to that reported following SBRT in similar patients.

The authors found a significantly higher prevalence of daytime somnolence in 201 patients with PD compared with 214 age- and sex-matched healthy control subjects (Epworth Sleepiness Scale score 5.6 vs 4.6). The prevalence of "sleep attacks" (SA) was about seven times higher in patients with PD than in control subjects (13.9% vs 1.9%; p < 0.0005). Multivariate analysis demonstrated that a higher dose of levodopa and longer duration of disease significantly predicted for SA in patients with PD. Epworth Sleepiness Scale scores of > or =10 had 71.4% sensitivity and 88.4% specificity for SA.