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Two sentiments governed the postwar world: fear and hope. These two feelings dominated the debates that gave birth to both the Charter of the United Nations and the Universal Declaration of Human Rights. The League of Nations had failed. Leaders had expressed the desire for a world grounded in human rights but could not agree on what that meant or whether individual rights trumped the sovereign rights of nations. The UN Charter reflected these concerns, recognizing human rights but leaving their scope undefined. No precedents existed to guide the work. A committee of eighteen nations, chaired by Eleanor Roosevelt, accepted the unprecedented assignment of defining basic rights for all people everywhere. After consulting with noted jurists, philosophers, and social justice organizations, the committee set out to draft a document that would recognize the horrors of war and engender a commitment to peace. They envisioned a world governed more by hope than by fear. It was hard work. The debate was punctuated by escalating Cold War politics. A legally binding document seemed out of reach. All efforts turned instead to securing a declaration of human rights, which ultimately paved the way for legally binding commitments and energized a budding human rights movement.
We assessed the impact of an embedded electronic medical record decision-support matrix (Cerner software system) for the reduction of hospital-onset Clostridioides difficile. A critical review of 3,124 patients highlighted excessive testing frequency in an academic medical center and demonstrated the impact of decision support following a testing fidelity algorithm.
Cardiac surgery-associated acute kidney injury is common. In order to improve our understanding of acute kidney injury, we formed the multi-centre Neonatal and Pediatric Heart and Renal Outcomes Network. Our main goals are to describe neonatal kidney injury epidemiology, evaluate variability in diagnosis and management, identify risk factors, investigate the impact of fluid overload, and explore associations with outcomes.
The Neonatal and Pediatric Heart and Renal Outcomes Network collaborative includes representatives from paediatric cardiac critical care, cardiology, nephrology, and cardiac surgery. The collaborative sites and infrastructure are part of the Pediatric Cardiac Critical Care Consortium. An acute kidney injury module was developed and merged into the existing infrastructure. A total of twenty-two participating centres provided data on 100–150 consecutive neonates who underwent cardiac surgery within the first 30 post-natal days. Additional acute kidney injury variables were abstracted by chart review and merged with the corresponding record in the quality improvement database. Exclusion criteria included >1 operation in the 7-day study period, pre-operative renal replacement therapy, pre-operative serum creatinine >1.5 mg/dl, and need for extracorporeal support in the operating room or within 24 hours after the index operation.
A total of 2240 neonatal patients were enrolled across 22 centres. The incidence of acute kidney injury was 54% (stage 1 = 31%, stage 2 = 13%, and stage 3 = 9%).
Neonatal and Pediatric Heart and Renal Outcomes Network represents the largest multi-centre study of neonatal kidney injury. This new network will enhance our understanding of kidney injury and its complications.
Emerging in the English language during the 1590s, the etymological origins of the word “disaster” are found in désastre from Middle French (1560s) and disastro from Italian, meaning “ill-starred,” with “dis-,” a pejorative and “astro” meaning “star” or “planet”—from the Latin astrum and from the Greek ástron. The notion was of “an unfavorable aspect of a star or planet,” a “malevolent astral influence,” or a “calamity blamed on an unfavorable position of a planet.”
The development of medical school courses on medical responses for disaster victims has been deemed largely inadequate. To address this gap, a 2-week elective course on Terror Medicine (a field related to Disaster and Emergency Medicine) has been designed for fourth year students at Rutgers New Jersey Medical School in Newark, New Jersey (USA). This elective is part of an overall curricular plan to broaden exposure to topics related to Terror Medicine throughout the undergraduate medical education.
A course on Terror Medicine necessarily includes key aspects of Disaster and Emergency Medicine, though the converse is not the case. Courses on Disaster Medicine may not address features distinctively associated with a terror attack. Thus, a terror-related focus not only assures attention to this important subject but to accidental or naturally occurring incidents as well.
The course, implemented in 2014, uses a variety of teaching modalities including lectures, videos, and tabletop and hands-on simulation exercises. The subject matter includes biological and chemical terrorism, disaster management, mechanisms of injury, and psychiatry. This report outlines the elective’s goals and objectives, describes the course syllabus, and presents outcomes based on student evaluations of the initial iterations of the elective offering.
All students rated the course as “excellent” or “very good.” Evaluations included enthusiastic comments about the content, methods of instruction, and especially the value of the simulation exercises. Students also reported finding the course novel and engaging.
An elective course on Terror Medicine, as described, is shown to be feasible and successful. The student participants found the content relevant to their education and the manner of instruction effective. This course may serve as a model for other medical schools contemplating the expansion or inclusion of Terror Medicine-related topics in their curriculum.
ColeLA, NatalB, FoxA, CooperA, KennedyCA, ConnellND, SugalskiG, KulkarniM, FeravoloM, LambaS. A Course on Terror Medicine: Content and Evaluations. Prehosp Disaster Med. 2016;31(1):98–101.