Patient-centered structured interdisciplinary bedside rounds provide a venue for increased rounding efficiency, provider satisfaction, and consistent teaching, without impacting patient/family perception.

ObjectiveThe aim of this study was to investigate the feasibility of using augmented reality (AR) glasses in central line simulation by novice operators and compare its efficacy to standard central line simulation/teaching.DesignThis was a prospective randomized controlled study enrolling 32 novice operators. Subjects were randomized on a 1:1 basis to either simulation using the augmented virtual reality glasses or simulation using conventional instruction.SettingThe study was conducted in tertiary-care urban teaching hospital.SubjectsA total of 32 adult novice central line operators with no visual or auditory impairments were enrolled. Medical doctors, respiratory therapists, and sleep technicians were recruited from the medical field.Measurements and main resultsThe mean time for AR placement in the AR group was 71±43 s, and the time to internal jugular (IJ) cannulation was 316±112 s. There was no significant difference in median (minimum, maximum) time (seconds) to IJ cannulation for those who were in the AR group and those who were not (339 [130, 550] vs 287 [35, 475], p=0.09), respectively. There was also no significant difference between the two groups in median total procedure time (524 [329, 792] vs 469 [198, 781], p=0.29), respectively. There was a significant difference in the adherence level between the two groups favoring the AR group (p=0.003).ConclusionAR simulation of central venous catheters in manikins is feasible and efficacious in novice operators as an educational tool. Future studies are recommended in this area as it is a promising area of medical education.

The presence of eosinophilic inflammation is a characteristic feature of chronic and acute inflammation in asthma. An estimated 5%–10% of the 300 million people worldwide who suffer from asthma have a severe form. Patients with eosinophilic airway inflammation represent approximately 40%–60% of this severe asthmatic population. This form of asthma is often uncontrolled, marked by refractoriness to standard therapy, and shows persistent airway eosinophilia despite glucocorticoid therapy. This paper reviews personalized novel therapies, more specifically benralizumab, a humanized anti-IL-5Rα antibody, while also being the first to provide an algorithm for potential candidates who may benefit from anti-IL-5Rα therapy.

Bronchial thermoplasty (BT) delivers targeted radiofrequency energy to bronchial airway walls and results in the partial ablation of the airway smooth muscle that is responsible for bronchoconstriction. It is approved for the treatment of severe persistent asthma. Multiple, large clinical trials including a recent "real-world" study demonstrate significant improvements in asthma-related quality of life, reduction in asthma exacerbations, emergency department visits, and hospitalizations after BT that is sustained out to 5 years. In this article, we review the state of the art of BT treatment in severe persistent asthma and share a decade of BT research and clinical experience. We share our personal experience and introduce the three "I"s (identification, implementation, and intense follow-up) that we believe promote successful patient outcomes and help build a successful BT program.

Introduction: Patient satisfaction has become an essential metric in addition to the type of care they receive. Phone calls, emails, and text to patients after their healthcare visit are the typical way of obtaining the data reflecting patient satisfaction. The purpose of this retrospective quality improvement study is to compare the traditional post-outpatient clinic survey method with an onsite concise two-question survey using a tablet method immediately after the patient visit using Net Promoter Score (NPS) questions. Methods: Data were collected retrospectively from February to August 2018 from an outpatient subspecialty clinic in southern California using an existing database from two different sources: the traditional method (TM) and the tablet-based tool (TBT), using NPS. The TM data were obtained from a third-party company using two questions via phone, email, and text collected 2-4 weeks after the patient's visit. The TBT has only two questions that were given to patients upon their visit check-out. These two questions assessed both provider and clinic's performance using the NPS method. Results: In total, there were 1708 patients seen from February to August 2018. In the TM, the total outgoing messages during this period were 580 (34.0%) with 156 responses (27%). In the TBT, 648 out of 1708 (37.9%) surveys were collected with a 100% response rate. The NPS score showed that 99.2% of the providers were promoters. The NPS score for the clinic was 96% which reflects a promoter score. Conclusion: Our results indicate that when using the TBT immediately after their visit to the clinic, a higher response rate was noted. In addition, both methods had similar outcomes in terms of patient satisfaction NPS scores. Future prospective studies with a larger sample size are warranted to evaluate the effectiveness of the TBT tool in assessing patient satisfaction.

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In order to account for subgrid-scale spatial variability (heterogeneity) of land surface characteristics in regional-scale hydrological-atmospheric models, a land surface parameterization of areally-averaged sensible heat and évapotrans-piration fluxes which is based upon areally-averaged hydrological soil water flow and soil heat flow equations, was developed. This land surface parameterization is fully coupled in a two-way interaction with the atmospheric boundary layer and the regional atmospheric model's first layer. The Monin-Obukhov similarity theory which is utilized in modelling the atmospheric boundary layer, and the areallyaveraged hydrological conservation equations are strictly valid only over stationaryheterogeneous areas where the fluctuations of the hydrological and boundary layer state variable values, parameter values, and of boundary conditions have spatially invariant means, spatially invariant higher moments and spatially invariant probability distributions. Therefore, the coupled two-way interactive model was run first for the computation of land surface fluxes over stationary-heterogeneous land patches, each corresponding to a single soil texture-vegetation class. Then, utilizing a mosaic scheme, the land surface fluxes over a regional model grid cell were obtained by numerical probabilistic averaging. The application of the regional model with this land surface parameterization to California during April 1989 has produced promising results. Paramétrisation du territoire à l'échelle régionale basée sur les équations de conservation hydrologique Résumé Pour tenir compte de la variabilité des caractéristiques de surface d'un territoire à une échelle inférieure à celle du maillage du modèle régional couplant phénomènes hydrologiques et atmosphériques, nous avons développé une paramétrisation des moyennes surfaciques des flux de chaleur sensible et d'évapo-transpiration basée sur les équations des flux d'eau et de chaleur dans le sol. Cette paramétrisation de la surface du sol repose sur l'interaction avec la couche limite atmosphérique et la première couche du modèle atmosphérique régional. La théorie de Monin-Obukhov qui a été utilisée pour modéliser la couche limite atmosphérique et les équations de conservation hydrologiques moyennées spatialement ne sont strictement applicables que sur des aires hétérogènes stationnaires où les fluctuations des variables d'état hydrologiques et de celles de la couche limite, les paramètres et les conditions aux limites possèdent des moyennes, des moments et des distributions de probabilité spatialement invariants. Par conséquent, le modèle couplé a d'abord Open for discussion until 1 February 1999 Downloaded by [University of Utah] at 07:20 06 October 2014 612 M. L, Kavvas et al.été utilisé pour le calcul des flux sur des parcelles de terrain hétérogènes mais stationnaires correspondant à différentes classes de texture de la végétation. Les flux selon le maillage du modèle régional ont été obtenus en effectuant numériquement une moyenne probabiliste à part...

Background: The risk of failing or delaying endotracheal intubation in critically ill patients has commonly been associated with inadequate procedure preparation. Clinicians and trainees in simulation courses for tracheal intubation are encouraged to recall the steps of how to intubate in order to mitigate the risk of a failed intubation. The purpose of this study was to assess the effectiveness of using optical head mounted display augmented reality (AR) glasses as an assistance tool to perform intubation simulation procedure. Methods: A total of 32 subjects with a mean age of 30±7.8, AR (n 1 =15) vs non-augmented reality(non-AR) (n 2 =17). The majority were males (n=22, 68.7%). Subjects were randomly assigned into two groups: the AR group and the non-AR group. Both groups reviewed a video on how to intubate following the New England Journal of Medicine (NEJM) intubation guidelines. The AR group had to intubate using the AR glasses head mount display compared to the non-AR where they performed regular intubation. Results: The AR group took longer median (min, max) time (seconds) to ventilate than the non-AR group (280 (130,740) vs 205 (100,390); η 2 =1.0, p =0.005, respectively). Similarly, there was a higher percent adherence of NEJM intubation checklist (100% in the AR group vs 82.4% in the non-AR group; η 2 =1.8, p <0.001). Conclusion: The AR glasses showed promise in assisting different health care professionals on endotracheal intubation simulation. Participants in the AR group took a longer time to ventilate but scored 100% in the developed checklist that followed the NEJM protocol. This finding shows that the AR technology can be used in a simulation setting and requires further study before clinical use.