We found that increased invigoration and reduced tranquillity during simulation training were associated with increased cognitive load, and that the likelihood of correctly identifying a trained murmur declined with increasing cognitive load. Further studies are needed to evaluate the impact on performance of strategies to alter emotion and cognitive load during simulation training.

The value of administering sequential courses of chemotherapy containing highdose cytarabine in both induction and consolidation therapy for acute myeloid leukemia (AML) has not been assessed in a prospective randomized trial. Two hundred ninety-two AML patients aged 15 to 60 years were enrolled in the Australasian Leukaemia and Lymphoma Group (ALLG) AML trial number 7 (M7) protocol to evaluate this question. All received induction therapy with the ICE protocol (idarubicin 9 mg/ m 2 ؋ 3; cytarabine 3 g/m 2 twice a day on days 1, 3, 5, 7; etoposide 75 mg/m 2 ؋ 7). Complete remission was achieved in 234 (80%) patients. Two hundred two patients in remission were then randomized to either a further identical cycle of ICE or 2 attenuated courses (cytarabine 100 mg/m 2 daily ؋ 5, idarubicin ؋ 2, etoposide ؋ 5 [IcE]). ICE consolidation therapy was more toxic than IcE, however, the treatment-related death rate was not significantly different. There was no difference between the 2 consolidation arms for relapse-free survival at 3 years (49% for ICE vs 46% for IcE; P ‫؍‬ .66), survival following randomization (61% vs 62%; P ‫؍‬ .91), or the cumulative incidence of relapse (43% vs 51%; P ‫؍‬ .31), and there was no difference within cytogenetic risk groups. Intensive induction chemotherapy incorporating high-dose cytarabine results in high complete remission rates, but further intensive consolidation treatment does not appear to confer additional benefit. (Blood. 2005;105:481-488)

The Australian Leukaemia Study Group (ALSG) investigated whether G-CSF would accelerate haemopoietic recovery after induction treatment for acute myeloid leukaemia (AML) intensified with high-dose cytarabine, and therefore improve response rates and survival. Patients were randomised to receive lenograstim (glycosylated recombinant human G-CSF) 5 g per kg body weight subcutaneously daily from day 8 after starting chemotherapy, or no cytokine, following chemotherapy with cytarabine 3 g/m 2 every 12 h on days 1, 3, 5, and 7, together with idarubicin 9 or 12 mg/m 2 on days 1, 2, and 3, plus etoposide 75 mg/m 2 on days 1 to 7 inclusive. Patients had untreated AML, and were aged 16 to 60 years. Overall, 54 evaluable patients were randomised to receive lenograstim and 58 to no cytokine. Patients in the lenograstim arm had a significantly shorter duration of neutropenia Ͻ0.5 × 10 9 /l compared to patients in the no cytokine arm (median 18 vs 22 days; P = 0.0005), and also shorter duration of total leucopenia Ͻ1.0 × 10 9 /l (17 vs 19 days; P = 0.0002), as well as a reduction in duration of treatment with therapeutic intravenous antibiotics (20 vs 24 days; P = 0.015) and a trend to reduced number of days with fever Ͼ38.0°C (9 vs 12 days; P = 0.18). There were no differences between the two groups in platelet recovery, red cell or platelet transfusions, or non-haematological toxicities. For patients achieving CR after their first induction course, a reduction in the time to the start of the next course of therapy was observed in the lenograstim arm, from a median of 40.5 days to a median of 36 days (P = 0.082). The overall complete response rates to chemotherapy were similar, 81% in the lenograstim arm vs 75% for the no cytokine arm (P = 0.5), and there was no significant difference in the survival durations. We conclude that the granulopoietic stimulating effect of G-CSF is observed after induction therapy for AML intensified by highdose cytarabine, resulting in an improvement in a number of clinically important parameters with no major adverse effects. Leukemia (2001Leukemia ( ) 15, 1331Leukemia ( -1338

The performance of StrepB Carrot Broth (SCB) versus group B Lim broth (LIM) for detection of group B streptococcus (GBS) colonization status in near-term pregnant women (35 to 37 weeks of gestation) was evaluated. Dually collected vaginal/rectal swabs from 279 women enrolled from a single large maternity clinic were analyzed. Fifty (18%) women were colonized by GBS according to both methods. SCB had excellent diagnostic performance compared to LIM, with sensitivity, specificity, positive predictive value, and negative predictive value of 92%, 100%, 100%, and 98.3%, respectively. Improved diagnostic efficiency due to direct reporting of GBS cases based on an orange color change in the SCB decreased overall labor and material costs.Group B streptococcus (GBS) is the most common cause of early-onset neonatal sepsis in developed countries (5). Earlyonset disease (0 to 6 days of life) is acquired intrapartum from mothers with vaginal/rectal colonization with GBS (9,10,12,13,15,17). Maternal GBS colonization rates range from approximately 10% to 40% in developed countries, with an estimated rate of 20% in near-term pregnant women in the Calgary Health Region (CHR) (4-6). Studies have shown that intrapartum administration of antibiotics reduces neonatal transmission of GBS, thereby preventing early-onset disease (8,12,14,15). Laboratory detection of GBS colonization status in near-term pregnant women is therefore important for the selective prescription of antibiotic prophylaxis at delivery.The Centers for Disease Control and Prevention (CDC) (3,8,14) and other medical organizations (1, 2, 16) have published consensus guidelines on the prevention of early-onset neonatal GBS disease. Two prevention strategies have been described, a risk-based approach (based on maternal factors with or without known GBS colonization) and a screeningbased approach (based on a combination of risk factors and GBS colonization). Because recent evidence showed a protective effect of prenatal GBS screening compared with the riskbased approach, new guidelines were set out by the CDC recommending universal prenatal culture-based screening for vaginal/rectal colonization of all pregnant women at 35 to 37 weeks of gestation (or sooner if membrane rupture occurs), with intrapartum chemoprophylaxis offered to the carriers (3,8). Laboratory confirmation of GBS colonization requires collection of a vaginal/rectal swab that is cultured using a group B selective broth such as Lim broth (LIM; Todd-Hewitt broth with colistin and nalidixic acid) and incubated for 24 h, with subculture onto blood agar and phenotypic identification of potential beta-hemolytic GBS colonies (3).Since our high-volume laboratory performs ϳ1,200 GBS screen cultures on vaginal/rectal swabs each month, it was of interest to further improve the diagnostic performance and efficiency of this method. Inclusion of direct plating of swabs onto selective agar media had been implemented in our laboratory since it decreased the test turnaround time (6). Since most GBS strains are hemolytic...

Background: Ultrasonography is increasingly used for teaching physical examination in medical schools. This study seeks the opinions of educators as to which physical examinations would be most enhanced by the addition of ultrasonography. We also asked when ultrasound-aided physical examination teaching could have deleterious effects if used outside its intended scope. Methods: All of the educators from the University of Calgary Master Teacher Program were invited to complete a 22-item paper-based survey. Survey items were generated independently by two investigators, with input from an expert panel (N = 5). Results: Of the 36 educators, 27 (75%) completed the survey. Examinations identified to be potentially most useful included: measuring the size of the abdominal aorta, identifying the presence/absence of ascites, identifying the presence/absence of pleural effusions, and measuring the size of the bladder. Examinations thought to be potentially most harmful included: identifying the presence/absence of intrauterine pregnancy, measuring the size of the abdominal aorta, and identifying the presence/absence of pericardial effusion. Conclusions: Examinations that are potentially the most useful may also be potentially the most harmful. When initiating an ultrasound curriculum for physical examinations, educators should weigh the risks and benefits of examinations chosen.