Assessing anaesthesiology and intensive care specialty physicians: An Italian language multisource feedback system

Background Physician professionalism, including anaesthesiologists and intensive care doctors, should be continuously assessed during training and subsequent clinical practice. Multi-source feedback (MSF) is an assessment system in which healthcare professionals are assessed on several constructs (e.g., communication, professionalism, etc.) by multiple people (medical colleagues, coworkers, patients, self) in their sphere of influence. MSF has gained widespread acceptance for both formative and summative assessment of professionalism for reflecting on how to improve clinical practice. Methods Instrument development and psychometric analysis (feasibility, reliability, construct validity via exploratory factor analysis) for MSF questionnaires in a postgraduate specialty training in Anaesthesiology and intensive care in Italy. Sixty-four residents at the Università del Piemonte Orientale (Italy) Anesthesiology Residency Program. Main outcomes assessed were: development and psychometric testing of 4 questionnaires: self, medical colleague, coworker and patient assessment. Results Overall 605 medical colleague questionnaires (mean of 9.3 ±1.9) and 543 coworker surveys (mean 8.4 ±1.4) were collected providing high mean ratings for all items (> 4.0 /5.0). The self-assessment item mean score ranged from 3.1 to 4.3. Patient questionnaires (n = 308) were returned from 31 residents (40%; mean 9.9 ± 6.2). Three items had high percentages of “unable to assess” (> 15%) in coworker questionnaires. Factor analyses resulted in a two-factor solution: clinical management with leadership and accountability accounting for at least 75% of the total variance for the medical colleague and coworker’s survey with high internal consistency reliability (Cronbach’s α > 0.9). Patient’s questionnaires had a low return rate, a limited exploratory analysis was performed. Conclusions We provide a feasible and reliable Italian language MSF instrument with evidence of construct validity for the self, coworkers and medical colleague. Patient feedback was difficult to collect in our setting.

Correlation of the Plasma Concentration of Eltrombopag With Efficacy in the Treatment of Refractory Aplastic Anemia: A Single-Centre Study in China

Background and purpose: Eltrombopag (ELT) can be effective in the treatment of relapse/refractory aplastic anemia (AA) patients. Responses and adverse drug reactions (ADRs) differed greatly among individuals treated at the same dosage of ELT.Methods: Patients diagnosed with nonsevere aplastic anemia (NSAA) between January 2018 and January 2019 in Peking Union Medical Colleague Hospital who were refractory to immunosuppressive therapy were treated with ELT and followed up for at least 6 months. Plasma concentrations of ELT were detected by high-performance liquid chromatography-mass spectrometry after at least two months of ELT treatment and treatment at the same dosage for at least 2 weeks. The dose-concentration, concentration-response and concentration-ADR relationships were evaluated.Results: Among the 72 patients treated with ELT during the study period, 44 patients with complete data were enrolled. Six (13.6%) were males, and 38 were females (86.4%), with a median age of 54 years [interquartile range (IQR): 38.5–63]. At the time the ELT plasma concentration was detected, the median dosage of ELT was 75 (IQR 50–100) mg/d, the median time of total ELT exposure was 3 (IQR 2.0–6.0) months, and 37 (70.5%) patients had responded to ELT. The median concentration of ELT was 10.4 μg/ml (IQR 3.7–24.4 μg/ml). The concentration of ELT was positively correlated with the daily dose of ELT (r = 0.68, p < 0.001). Multivariate logistic regression analysis showed that the risk of inefficacy of ELT at a concentration between 11.2 and 15.2 μg/ml was 0.028-fold (95% CI: 0.001–0.864; p = 0.041) of that at a concentration between 3.2 and 7.2 μg/ml. The cutoff value for the concentration of ELT showing efficacy was 12.50 μg/ml according to the receiver operation characteristic curve. A higher risk of ADR was related to a longer total exposure to ELT (p = 0.012). Although the correlation was not significant, the odds ratio increased with the ELT concentration, suggesting that it was possible that an elevated risk of ADR was correlated with the ELT blood concentration.Conclusion: ELT is effective for the treatment of NSAA and has acceptable side effects. The plasma concentration of ELT was correlated with the dose and the effects of ELT.

Rescue Mission Following the Hi-Jacking of the Lufthansa 737, “Landshut”

At 15:15 hrs on 17 October 1977, the Lufthansa Medical Service in Frankfurt was notified about the hijacking of a 737 Boeing aircraft. At 15:30 hrs the Crisis Management Staff (CMS) asked me if I would accompany a stand-by crew on the rescue mission. The intention of the CMS was to come to an agreement with the hijackers to exchange the crew of the hijacked plane for a stand-by crew accompanied by an airline physician. I agreed. Medicines and medical equipment for the treatment of injured and sick passengers were packed by medical assistants. At 16:30 hrs highly confidential information was received from CMS—GSG 9 that the Border Patrol Special Commando led by Commander Wegner would accompany the rescue mission which would henceforth be termed “Special Mission”. The hijacked plane was to be followed and seized. It was likely that in the course of this operation an unpredictable number of burns, gunshot wounds and other serious injuries could occur. In a very short time, medical assistants packed further huge crates full of first-aid packs, Macrodex infusions, analgesics, and so forth. I asked Dr. Straub, a medical colleague, and Mr. Reiser, a nursing assistant, both employees of the Lufthansa Medical Service, to accompany me as volunteers, and they agreed. At 16:45 hrs the CMS approved the medical team and the medical equipment.

Thucydides' Description of the Great Plague at Athens

The nature of the Plague described by Thucydides in Book 2, chapter 49, has long been discussed both by medical and by classical scholars. Of numerous suggested identifications none has found general approval; and it is doubtful whether any opinion is more prevalent today than that the problem is insoluble. The classical scholar is handicapped by his ignorance of medical science; his medical colleague has often been led astray by translations deficient in exactitude if not disfigured by error. The difficulties are great enough: but there is one indispensable preliminary task which can be undertaken with some prospect of success. If Thucydides' description is to be compared with modern records, it is necessary first to determine what the Greek words mean; and that can only be done by determining how far the Greek is expressed in the technical terms of contemporary medical science. It is obvious that Thucydides required a special vocabulary for this part of his work; and in fact over forty words in chapters 49 and 50 are unexampled elsewhere in his History, and a dozen more are used in meanings unexampled elsewhere. It is certain that a number of medical treatises were in circulation in Thucydides' lifetime, and that a more or less standard vocabulary had been or was being established. Now if it can be shown that the great majority of the terms employed by Thucydides in ch. 49 recur, apparently with the same meanings, as standard terms in the contemporary doctors, our second task—the comparison of Thucydides' description with modern records—will become a more rational undertaking than it was before, no longer the doubtful speculation which many of the modern doctors suppose it to be, thinking as they do that they have to deal with a layman's generalities expressed in literary language.

The Evil of Irresponsible Criticism

Perusing certain remarks made recently by a Mr. Berdoe in a lay paper, anent a therapeutic enquiry by Dr. Berkley at the City Asylum, Baltimore, and weighing these after a consideration of criticisms to be found in the British Medical Journal of September 18th and September 25th last, the thoughtful ratepayer—especially of the Metropolis, where Mr. Berdoe's superfluous energies find a vent—may well pray to be saved from his friends. Everywhere, and especially, probably, in the Metropolis, any painstaking investigation having for its object the determination of means whereby mental disorders may be arrested before they pass into the interminable night of chronic dementia, would be cordially approved of by those who contribute to the maintenance of county asylums, which look to become vast hostelries for the incurable in mind. Dr. Berkley records in the Bulletin of the Johns Hopkins Hospital for July, 1897, the results of the administration of thyroid extract in cases that “had either passed, or were about to pass, the limit of time in which recovery could be confidently expected.” We need not here describe Dr. Berkley's work, of which our readers can judge in the original. We content ourselves with the observation that it is the record of the trial of a medicinal agent, carried out scientifically, and for the benefit of the patient. To Mr. Berdoe, however, it appears that Dr. Berkley's work was “a study of poisoning, as a poison might be tested on an animal.” Viewing the matter in this lurid light, Mr. Berdoe felt forcibly that the interests of the public were in jeopardy, and, thus agitated in mind, was constrained to seek out a sympathetic confidant, whom he found in the Daily Chronicle. The “up-to-date” and democratic organ upon which Mr. Berdoe's choice fell was far too astute to miss the opportunity of heading a letter “Experiments on Lunatics;” and consequently we find his feelings concentrated under that harrowing title in an issue of the above newspaper. Those members of the profession who may have seen his letter, though it may be denied them to gauge the intensity of Mr. Berdoe's feelings, will not fail correctly to estimate his action in this matter. They cannot but regret that he should have condescended, not merely to have addressed his strictures upon a medical colleague to a lay organ, but further—to quote from our medical contemporary above-mentioned—to have made statements which “are not accurate,” and to have given “a very unfair version of the facts.”