Tackling the problem of blood culture contamination in the intensive care unit using an educational intervention

Blood culture contamination (BCC) has been associated with unnecessary antibiotic use, additional laboratory tests and increased length of hospital stay thus incurring significant extra hospital costs. We set out to assess the impact of a staff educational intervention programme on decreasing intensive care unit (ICU) BCC rates to <3% (American Society for Microbiology standard). BCC rates during the pre-intervention period (January 2006-May 2011) were compared with the intervention period (June 2011-December 2012) using run chart and regression analysis. Monthly ICU BCC rates during the intervention period were reduced to a mean of 3·7%, compared to 9·5% during the baseline period (P < 0·001) with an estimated potential annual cost savings of about £250 100. The approach used was simple in design, flexible in delivery and efficient in outcomes, and may encourage its translation into clinical practice in different healthcare settings.

"Should I prioritize medical problem solving or attentive listening?": the dilemmas and challenges that medical students experience when learning to conduct consultations

Objective: Communication skills can be trained alongside clinical reasoning, history taking or clinical examination skills. This is advocated as a solution to the low transfer of communication skills. Still, students have to integrate the knowledge/skills acquired during different curriculum parts in patient consultations at some point. How do medical students experience these integrated consultations within a simulated environment and in real practice when dealing with responsibility?

Methods: Six focus groups were conducted with (pre-)/clerkship students.

Results: Students were motivated to practice integrated consultations with simulated patients and felt like 'real physicians'. However, their focus on medical problem solving drew attention away from improving their communication skills. Responsibility for real patients triggered students' identity development. This identity formation guided the development of an own consultation style, a process that was hampered by conflicting demands of role models.

Conclusion: Practicing complete consultations results in the dilemma of prioritizing medical problem solving above attention for patient communication. Integrated consultation training advances this dilemma to the pre-clerkship period. During clerkships this dilemma is heightened because real patients trigger empathy and responsibility, which invites students to define their role as doctor.

Practice Implications: When training integrated consultations, educators should pay attention to students' learning priorities and support the development of students' professional identity.

‘The Problem of the Future in Nineteenth-Century Spain’

This article examines the problems and paradoxes in the representation of the future in three nineteenth-century Spanish works: El futuro Madrid (1868) by Fernández de los Ríos, ‘Madrid en el siglo xxi’ (1847) by Neira de Mosquera, and Ni en la vida ni en la muerte by Juan Bautista Amorós (Silverio Lanza). While these texts demonstrate Spain’s participation in the general movement towards using the future as a setting for literary works, they do not corroborate the theory that the nineteenth century was a time of optimism and belief in the doctrine of Progress. Concepts derived from discussions of the future in the history of ideas, such as historia magistra vitae, are shown to be relevant to discussion of these futuristic fictions, in sometimes unexpected ways.

Query Suggestions for Textual Problem Solution Repositories

Textual problem-solution repositories are available today in
various forms, most commonly as problem-solution pairs from community
question answering systems. Modern search engines that operate on
the web can suggest possible completions in real-time for users as they
type in queries. We study the problem of generating intelligent query
suggestions for users of customized search systems that enable querying
over problem-solution repositories. Due to the small scale and specialized
nature of such systems, we often do not have the luxury of depending on
query logs for finding query suggestions. We propose a retrieval model
for generating query suggestions for search on a set of problem solution
pairs. We harness the problem solution partition inherent in such
repositories to improve upon traditional query suggestion mechanisms
designed for systems that search over general textual corpora. We evaluate
our technique over real problem-solution datasets and illustrate that
our technique provides large and statistically significant

The effect of preferential paw usage on dogs' (Canis familiaris) performance in a manipulative problem-solving task

In a number of species, individuals showing lateralized hand/paw usage (i.e. the preferential use of either the right or left paw) compared to ambilateral individuals have been shown to be more proactive in novel situations. In the current study we used an established test to assess preferential paw usage in dogs (the Kong test) and then compared the performance of ambilateral and lateralized dogs as well as left- vs. right-pawed dogs in a novel manipulative problem solving task. Results showed an equal proportion of ambilateral and lateralized dogs but contrary to predictions non-lateralized dogs were faster at accessing the apparatus in test trials. No differences emerged between right- and left-pawed dogs. Results are discussed in relation to previous studies on lateralization. © 2013 Elsevier B.V.