Background Checklists have been shown to improve performance of complex, error-prone processes. To develop a checklist with potential to reduce the likelihood of diagnostic error for patients presenting to the Emergency Room (ER) with undiagnosed conditions. Methods Participants included 15 staff ER physicians working in two large academic centers. A rapid cycle design and evaluation process was used to develop a general checklist for high-risk situations vulnerable to diagnostic error. Physicians used the general checklists and a set of symptom-specific checklists for a period of 2 months. We conducted a mixed methods evaluation that included interviews regarding user perceptions and quantitative assessment of resource utilization before and after checklist use. Results A general checklist was developed iteratively by obtaining feedback from users and subject matter experts, and was trialed along with a set of specific checklists in the ER. Both the general and the symptom-specific checklists were judged to be helpful, with a slight preference for using symptom-specific lists. Checklist use commonly prompted consideration of additional diagnostic possibilities, changed the working diagnosis in approximately 10% of cases, and anecdotally was thought to be helpful in avoiding diagnostic errors. Checklist use was prompted by a variety of different factors, not just diagnostic uncertainty. None of the physicians used the checklists in collaboration with the patient, despite being encouraged to do so. Checklist use did not prompt large changes in test ordering or consultation. Conclusions In the ER setting, checklists for diagnosis are helpful in considering additional diagnostic possibilities, thus having potential to prevent diagnostic errors. Inconsistent usage and using the checklists privately, instead of with the patient, are factors that may detract from obtaining maximum benefit. Further research is needed to optimize checklists for use in the ER, determine how to increase usage, to evaluate the impact of checklist utilization on error rates and patient outcomes, to determine how checklist usage affects test ordering and consultation, and to compare checklists generally with other approaches to reduce diagnostic error.

Objectives were to evaluate the administration of an anti-gonadotropin releasing factor (GnRF) analog on suppression of estrus, consistency of feed intake, and growth performance in market gilts and to investigate the impact the physiological changes would have on carcass characteristics and fresh meat quality. Gonadotropin releasing factor stimulates the anterior pituitary to release luteinizing hormone that acts on the ovary to induce follicle development and indirectly initiates ovulation. Improvest (Zoetis, Kalamazoo, MI) contains an incomplete version of naturally occurring GnRF and causes the production of anti-GnRF antibodies that bind to the GnRF receptor and thus render GnRF inactive. This in turn suppresses estrus in female pigs. Gilts were initially separated into 10 blocks based on age and then within each block allotted to a pen (n = 114; 5 pigs/pen) based on BW. Gilts received the first dose at 12 wk of age and the second dose at 16 wk of age, were exposed to a boar daily from 20 to 26 wk of age, and were slaughtered at 26 wk of age (10 wk after second dose). Meat quality was analyzed on the 2 gilts closest to pen average ending live weight in 5 of the 10 blocks. Pen served as the experimental unit for all data analysis. During the 15-wk finishing period, ADG was 0.03 kg greater (P < 0.01) and G:F was 0.009 greater (P = 0.02) in gilts administered GnRF suppression (treated) compared with untreated gilts (control). The majority of improvements in growth performance were observed from 16 to 20 wk of age (4 wk after second dose), as ADG was 0.07 kg greater (P < 0.001) and G:F was 0.021 greater (P < 0.01) in treated gilts compared with control gilts. Ovarian weights were reduced (P < 0.0001) by 64.15% and gilts exhibiting puberty were reduced by 87.80% (P < 0.001) in treated gilts compared with control gilts. Back fat depth was 3.78 mm greater (P < 0.0001) and estimated lean was 1.31 percentage units less (P < 0.0001) in treated gilts compared with control gilts. With the exception of subjective color, there were no differences (P ≥ 0.12) in meat quality parameters between treated and control gilts. Subjective color was darker (P = 0.03) in treated gilts compared with control gilts. These data suggest market gilts treated with an anti-GnRF analog had suppressed estrus and episodical changes in ADFI, while they had improved feed efficiency, increased ADG, and increased back fat depth when compared with gilts without an anti-GnRF analog treatment.

The factor VIII coagulant activity (FVIII:C), factor VIII related antigen (FVIII:RAG), and factor VIII ristocetin cofactor activity (FVIII:RCF) was determined in the cord blood samples of 30 healthy term newborns. Sodium citrate anticoagulant, cold, and a proteolytic inhibitor were used in sample processing. All three factor VIII activities were elevated in infants compared to adults; additionally, FVIII:RAG was significantly higher in vaginally compared with caesarean section delivered infants. Crossed immunoelectrophoresis of the term infant plasma showed a consistently normal factor VIII mobility. An additional group of 22 sick premature and term infants had determinations of factor VIII antigen and crossed immunoelectrophoresis. The FVIII:RAG of sick infants was approximately twice that of the well term infants. Infants with severe lung disease, asphyxia, thrombosis and sepsis had normal electrophoretic mobility despite marked elevations in FVIII:RAG. Abnormal, symmetrical, more anodal migrations were seen only in a group of severely ill newborns with dissiminated intravascular coagulation (DIC) or signs of activated fibrinolysis. These results suggest that the elevated FVIII activities seen in well infants and most sick newborns are the result of increased release of a normal form of the FVIII molecule. Those elevations seen in sick newborns with DIC result from increased release and the production of an altered, faster moving FVIII molecule.

Objectives: To evaluate the improvement in lung donation and immediate lung function after the implementation of a 360° rotational positioning protocol within an organ procurement organization in the Midwest. Design: Retrospective observational study. Setting: The Midwest Transplant Network from 2005 to 2017. Rotational positioning of donors began in 2008. Subjects: Potential deceased lung donors. Interventions: A 360° rotational protocol. Presence of immediate lung function in recipients, change in Pao 2:Fio 2 ratio during donor management, initial and final Pao 2:Fio 2 ratio, and proportion of lungs donated were measured. Outcomes were compared between rotated and nonrotated donors. Measurements and Main Results: A total of 693 donors were analyzed. The proportion of lung donations increased by 10%. The difference between initial Pao 2:Fio 2 ratio and final Pao 2:Fio 2 ratio was significantly different between rotated and nonrotated donors (36 ± 116 vs 104 ± 148; p < 0.001). Lungs transplanted from rotated donors had better immediate function than those from nonrotated donors (99.5% vs 68%; p < 0.001). Conclusions: There was a statistically significant increase in lung donations after implementing rotational positioning of deceased donors. Rotational positioning significantly increased the average difference in Pao 2:Fio 2 ratios. There was also superior lung function in the rotated group. The authors recommend that organ procurement organizations consider adopting a rotational positioning protocol for donors to increase the lungs available for transplantation.