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Rodgers D.L.,Penn State Hershey Medical Center
Simulation and Gaming | Year: 2015

Background: Brain-based learning (BBL), also referred to as educational neuroscience, examines learning as a biological process. Teaching to support BBL requires blending of understanding of neuroscience with the practice of education. With BBL, the learning environment is designed to enhance the brain’s natural ability to learn. Aim: This manuscript describes the fundamentals of brain-based learning, translates the basic tenets of BBL to the simulation learning environment, and presents practical application strategies for simulation-based learning. Method: Focusing on the work of Renate and Geoffrey Caine, this article examines their approach to BBL, including the three core elements of brain-based learning experience: orchestrated immersion in complex environments, relaxed alertness, and active processing. The three elements of the Caine and Caine model are well-embedded in the larger BBL literature and have particular utility with simulation-based education. Results: The three core elements of BBL have direct application to simulation as a teaching and learning practice. This paper presents several specific strategies designed to enhance both the simulation event experience and the debriefing. Conclusion: The simulation learning environment can be adapted to capitalize on the tenets of BBL. Several instructional strategies are available to enhance the biological process of learning while utilizing simulation-based learning practices. © 2015, © 2015 SAGE Publications.

Wicklund M.P.,Penn State Hershey Medical Center
CONTINUUM Lifelong Learning in Neurology | Year: 2013

PURPOSE OF REVIEW: With transition to the genetic era, the number of muscular dystrophies has grown significantly, but so too has our understanding of their pathogenic underpinnings. Clinical features associated with each muscular dystrophy still guide us to the diagnosis. However, improved diagnostic abilities refine and expand phenotypic and genotypic correlates. This article discusses the epidemiology, clinical features, and diagnosis of these disorders. RECENT FINDINGS: Some important recent advancements include (1) a much greater understanding of the pathogenetic pathways underlying facioscapulohumeral muscular dystrophy and myotonic dystrophy type 1; (2) the publication of diagnostic and treatment guidelines for Duchenne muscular dystrophy; and (3) further clarification of the many genetic muscle disorders presenting a limb-girdle pattern of weakness. SUMMARY: Muscular dystrophies are genetic, progressive, degenerative disorders with the primary symptom of muscle weakness. Duchenne, Becker, facioscapulohumeral, and myotonic muscular dystrophies are most prevalent and tend to have distinctive features helpful in diagnosis. The limb-girdle, Emery-Dreifuss, and oculopharyngeal muscular dystrophies are less common but often may also be diagnosed on the basis of phenotype. Researchers hope to help patients with future discoveries effective in slowing or halting disease progression, reversing or preventing underlying mechanisms, and repairing previously damaged muscle. Copyright © American Academy of Neurology.

Litt H.I.,University of Pennsylvania | Gatsonis C.,Brown University | Snyder B.,Brown University | Singh H.,Penn State Hershey Medical Center | And 4 more authors.
New England Journal of Medicine | Year: 2012

BACKGROUND: Admission rates among patients presenting to emergency departments with possible acute coronary syndromes are high, although for most of these patients, the symptoms are ultimately found not to have a cardiac cause. Coronary computed tomographic angiography (CCTA) has a very high negative predictive value for the detection of coronary disease, but its usefulness in determining whether discharge of patients from the emergency department is safe is not well established. METHODS:We randomly assigned low-to-intermediate-risk patients presenting with possible acute coronary syndromes, in a 2:1 ratio, to undergo CCTA or to receive traditional care. Patients were enrolled at five centers in the United States. Patients older than 30 years of age with a Thrombolysis in Myocardial Infarction risk score of 0 to 2 and signs or symptoms warranting admission or testing were eligible. The primary outcome was safety, assessed in the subgroup of patients with a negative CCTA examination, with safety defined as the absence of myocardial infarction and cardiac death during the first 30 days after presentation. RESULTS: We enrolled 1370 subjects: 908 in the CCTA group and 462 in the group receiving traditional care. The baseline characteristics were similar in the two groups. Of 640 patients with a negative CCTA examination, none died or had a myocardial infarction within 30 days (0%; 95% confidence interval [CI], 0 to 0.57). As compared with patients receiving traditional care, patients in the CCTA group had a higher rate of discharge from the emergency department (49.6% vs. 22.7%; difference, 26.8 percentage points; 95% CI, 21.4 to 32.2), a shorter length of stay (median, 18.0 hours vs. 24.8 hours; P<0.001), and a higher rate of detection of coronary disease (9.0% vs. 3.5%; difference, 5.6 percentage points; 95% CI, 0 to 11.2). There was one serious adverse event in each group. CONCLUSIONS:A CCTA-based strategy for low-to-intermediate-risk patients presenting with a possible acute coronary syndrome appears to allow the safe, expedited discharge from the emergency department of many patients who would otherwise be admitted. (Funded by the Commonwealth of Pennsylvania Department of Health and the American College of Radiology Imaging Network Foundation; ClinicalTrials.gov number, NCT00933400.) Copyright © 2012 Massachusetts Medical Society.

Rao S.V.,The Duke Clinical Research Institute | Cohen M.G.,University of Miami | Kandzari D.E.,Scripps Research Institute | Bertrand O.F.,Quebec Heart Lung Institute | Gilchrist I.C.,Penn State Hershey Medical Center
Journal of the American College of Cardiology | Year: 2010

Periprocedural bleeding complications after percutaneous coronary intervention (PCI) are associated with increased short- and long-term morbidity and mortality. Although clinical trials have primarily assessed pharmacological strategies for reducing bleeding risk, there is a mounting body of evidence suggesting that adoption of a transradial rather than a transfemoral approach to PCI may permit greater reductions in bleeding risk than have been achieved with pharmacological strategies alone. However, despite a long history of use, a lack of widespread uptake by physicians coupled with the technological limitations of available devices has in the past confined transradial PCI to the status of a niche procedure, and many operators lack experience in this technique. In this review, we examine the history of the transradial approach to PCI and discuss some of the circumstances that have hitherto limited its appeal. We then review the current state of the peer-reviewed literature supporting its use and summarize the unresolved issues affecting broader application of this technique, including lack of operator familiarity and an insufficient evidence base for guiding practice. Finally, we describe potential directions for future investigation in the transradial realm. © 2010 American College of Cardiology Foundation.

Lunn M.,Penn Medicine | Fausnight T.,Penn State Hershey Medical Center
Pediatrics | Year: 2011

Immunoglobulin E (IgE)-mediated food allergies affect 6% to 8% of children in the United States with symptoms ranging from localized hives to life-threatening anaphylaxis. Intravenous fat emulsions (IFEs) are a vital component of total parental nutrition, because they provide essential fatty acids. IFE is a sterile fat emulsion that contains egg-yolk phospholipids. Although egg allergy is listed as a contraindication, adverse reactions are uncommon. We report here the case of a hypersensitivity to IFE in a 2-year-old patient with previously undocumented egg allergy. Our patient was placed on total parental nutrition and a 20% IFE postoperatively and developed diffuse pruritus 14 days after initiation of therapy. She showed transient improvement with intravenous antihistamine, but her symptoms did not resolve until the IFE was stopped. On the basis of clinical history, including aversion to egg, we performed skin-prick testing, the results of which were positive for egg white allergy. Serum testing confirmed allergy to both egg yolk and egg white. To our knowledge, this is the first reported case of a pediatric patient with a history suggestive of egg allergy, positive skin-prick and serum testing to egg, and reaction to IFE infusion. Although ingestion of egg lecithin in cooked food is generally tolerated by egg-allergic people, administration of intravenous egg-containing lipid emulsions may cause significant adverse reactions. Copyright © 2011 by the American Academy of Pediatrics.

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