ObjectiveTo establish the role of high-fidelity simulation training to test the efficacy and safety of the electronic health record (EHR)–user interface within the intensive care unit (ICU) environment.DesignProspective pilot study.SettingMedical ICU in an academic medical centre.ParticipantsPostgraduate medical trainees.InterventionsA 5-day-simulated ICU patient was developed in the EHR including labs, hourly vitals, medication administration, ventilator settings, nursing and notes. Fourteen medical issues requiring recognition and subsequent changes in management were included. Issues were chosen based on their frequency of occurrence within the ICU and their ability to test different aspects of the EHR–user interface. ICU residents, blinded to the presence of medical errors within the case, were provided a sign-out and given 10 min to review the case in the EHR. They then presented the case with their management suggestions to an attending physician. Participants were graded on the number of issues identified. All participants were provided with immediate feedback upon completion of the simulation.Primary and secondary outcomesTo determine the frequency of error recognition in an EHR simulation. To determine factors associated with improved performance in the simulation.Results38 participants including 9 interns, 10 residents and 19 fellows were tested. The average error recognition rate was 41% (range 6–73%), which increased slightly with the level of training (35%, 41% and 50% for interns, residents, and fellows, respectively). Over-sedation was the least-recognised error (16%); poor glycemic control was most often recognised (68%). Only 32% of the participants recognised inappropriate antibiotic dosing. Performance correlated with the total number of screens used (p=0.03).ConclusionsDespite development of comprehensive EHRs, there remain significant gaps in identifying dangerous medical management issues. This gap remains despite high levels of medical training, suggesting that EHR-specific training may be beneficial. Simulation provides a novel tool in order to both identify these gaps as well as foster EHR-specific training.

The successful establishment of a postcrisis SV-40 T antigen transformed epithelial cell line, 1HAEo-, which retains tight junctions and vectorial ion transport, is described. Immunocytochemical analysis of 1HAEo- cells shows a defined pattern of cytokeratin staining and a characteristic pericellular localization of the adhesion molecule cellCAM 120/80, indicating the presence of junctional complexes. The presence of both tight junctions and desmosomes has been confirmed by electron microscopy. Cell monolayers have good transepithelial resistance measured in Ussing chambers. Cells increase chloride ion transport in response to addition of agents that raise either intracellular cAMP or calcium, measured either by 36Cl- efflux or whole-cell patch clamp. An increase in short-circuit current, in response to these agents, can be measured in Ussing chambers. The presence of a depolarization-induced outwardly rectifying 45 pS chloride channel has been demonstrated in single cell detached membrane patches. In addition, the cells have been found to express mucin mRNA. These cells therefore demonstrate that it is possible to select transformed cell clones with particular morphologic characteristics, i.e. the presence of tight junctions and cell polarity, which also retain useful epithelial cell-specific functions, including vectorial ion transport. They also provide a major resource for the study of the structure and function of human epithelia.

Our findings support current theories that blood transfusions may have modulatory effects on the immune system of the recipients. Our specific study in spine patients may contribute to the expanding literature on allogeneic blood transfusions and the risk of nosocomial infections and encourage surgeons to favor a more restrictive policy with regard to transfusions.

Background The impact of asthma diagnosis and asthma endotype on outcomes from COVID-19 infection remains unclear. Objective To describe the association between asthma diagnosis and endotype and clinical outcomes among patients diagnosed with COVID-19 infection. Methods Retrospective multicenter cohort study of outpatients and inpatients presenting to six hospitals in the Mount Sinai Health System New York metropolitan region between March 7 th to June 7 th , 2020, with COVID-19 infection, with and without a history of asthma. The primary outcome assessed was in-hospital mortality. Secondary outcomes included hospitalization, intensive care unit (ICU) admission, mechanical ventilation, and hospital length of stay. Outcomes were compared in patients with or without asthma using a multivariate Cox regression model. Outcomes stratified by blood eosinophilia count were also assessed. Results Of 10,523 patients diagnosed with COVID-19 infection, 4902 patients were hospitalized, and 468 had a diagnosis of asthma (4.4%). When adjusted for COVID-19 disease severity, comorbidities, and concurrent therapies, patients with asthma had a lower mortality [adjusted odds ratio (OR) 0.64 (0.53-0.77), p<0.001] and a lower rate of hospitalization and ICU admission [OR 0.43 (0.28-0.64) p<0.001 and OR 0.51 (0.41-0.64), p<0.001 respectively]. Those with blood eosinophils ≥200 cells/μL, both with and without asthma, had lower mortality. Conclusion Patients with asthma may be at a reduced risk of poor outcomes from COVID-19 infection. Eosinophilia, both in those with and without asthma, may be associated with reduced mortality risk.