Ayala Gover

The Impact of Rudeness on Medical Team Performance: A Randomized Trial.

BACKGROUND AND OBJECTIVES: Iatrogenesis often results from performance deficiencies among medical team members. Team-targeted rudeness may underlie such performance deficiencies, with individuals exposed to rude behavior being less helpful and cooperative. Our objective was to explore the impact of rudeness on the performance of medical teams. METHODS: Twenty-four NICU teams participated in a training simulation involving a preterm infant whose condition acutely deteriorated due to necrotizing enterocolitis. Participants were informed that a foreign expert on team reflexivity in medicine would observe them. Teams were randomly assigned to either exposure to rudeness (in which the expert’s comments included mildly rude statements completely unrelated to the teams’ performance) or control (neutral comments). The videotaped simulation sessions were evaluated by 3 independent judges (blinded to team exposure) who used structured questionnaires to assess team performance, information-sharing, and help-seeking. RESULTS: The composite diagnostic and procedural performance scores were lower for members of teams exposed to rudeness than to members of the control teams (2.6 vs 3.2 [P = .005] and 2.8 vs 3.3 [P = .008], respectively). Rudeness alone explained nearly 12% of the variance in diagnostic and procedural performance. A model specifying information-sharing and help-seeking as mediators linking rudeness to team performance explained an even greater portion of the variance in diagnostic and procedural performance (R2 = 52.3 and 42.7, respectively). CONCLUSIONS: Rudeness had adverse consequences on the diagnostic and procedural performance of the NICU team members. Information-sharing mediated the adverse effect of rudeness on diagnostic performance, and help-seeking mediated the effect of rudeness on procedural performance.

Sonographic definition of the fetal situs

The sonographic definition of the fetal situs is of diagnostic importance. However, the current methods that rely on the position of both heart and stomach are not always reliable. Presented are the right-hand rule for transabdominal scanning and the left-hand rule for transvaginal scanning which enable the definition of the fetal situs. The presented rules of thumb enable a definite diagnosis of the fetal situs in all cases and apply for all fetal positions and presentations.

Direct lower abdominal ureteral jet as sonographic sign of bladder exstrophy

Bladder exstrophy is a rare malformation characterized by an infra-umbilical abdominal wall defect, incomplete closure of the bladder with mucosa continuous with the abdominal wall, epispadias and alterations in the pelvic bones. Its incidence is low at 1 in 20 000–50 000 live births. It is diagnosed easily at birth but rarely in utero. Previous reports have identified four prenatal sonographic findings associated with bladder exstrophy: (1) the bladder is not visualized on ultrasound; (2) presence of a lower abdominal bulge representing the exstrophied bladder; (3) a small penis with anteriorly displaced scrotum; and (4) short umbilical cord insertion-to-genital tubercle length1–4. In this report, we suggest a novel auxiliary sign for the diagnosis of bladder exstrophy using power Doppler ultrasound. In the normal fetus, the ureters arise from the pelvis of each kidney and enter the bladder posteriorly on the left and right sides. A urine jet from the ureters into the bladder can often be seen by ultrasound. In cases of bladder exstrophy, the posterior urinary bladder wall is continuous with the abdominal wall and urine from the ureters passes directly into the amniotic sac. We hypothesized that, since the urine production and ureteral function in cases of bladder exstrophy are normal, visualization of urine jets directly into the amniotic cavity would be diagnostic. Using power Doppler ultrasound (Philips iU 22; 3–9-MHz transvaginal probe; CPA, 77%; MED, 1500 Hz; WF, 90 Hz; 3–6-MHz transabdominal probe; CPA, 77%; MED, 1500 Hz, WF, 90 Hz), we were indeed able to observe a urine jet coursing from the abdominal wall into the amniotic cavity, confirming the presence of bladder exstrophy. During a 5-year study period, we diagnosed bladder exstrophy in four fetuses (three at 15 weeks and one at 23 weeks). In these cases, the bladder was not visualized in the presence of normal kidneys, there was no lower abdominal bulge and cord insertion was slightly lower in the abdomen. In all four cases, the urine jet was seen flowing from the ureters directly into the amniotic cavity using color Doppler ultrasound (Figures 1a and 2, Videoclips S1–S3). In all cases the pregnancy was terminated on parental request and the autopsies confirmed the diagnosis of bladder exstrophy (Figure 1b).

Prenatal Sonographic Abnormal Appearances of the Fetal Hyaloid Artery: From Normal Variants to Pathology: Prenatal Abnormal Sonographic Appearance of the Fetal Hyaloid Artery

This is a case series on the abnormal sonographic appearance and outcome of the fetal hyaloid artery (HA) detected during between 1987 and 2015 at one medical center. Fifteen cases were detected during fetal anatomy scans, usually performed at 14 to 16 weeks’ gestation. Three other cases were diagnosed following referral for a second opinion. In nine fetuses, the HA regressed normally throughout pregnancy. Of them, eight neonates had normal outcomes and one had cataract at the same eye. All nine other cases ended with adverse outcomes. Failure of the HA to regress in the third trimester appears to be an indicator of congenital blindness.

Direct lower abdominal ureteral jet: an auxiliary sonographic sign for diagnosing bladder extrophy.

Bladder exstrophy is a rare malformation characterized by an infra-umbilical abdominal wall defect, incomplete closure of the bladder with mucosa continuous with the abdominal wall, epispadias and alterations in the pelvic bones. Its incidence is low at 1 in 20 000–50 000 live births. It is diagnosed easily at birth but rarely in utero. Previous reports have identified four prenatal sonographic findings associated with bladder exstrophy: (1) the bladder is not visualized on ultrasound; (2) presence of a lower abdominal bulge representing the exstrophied bladder; (3) a small penis with anteriorly displaced scrotum; and (4) short umbilical cord insertion-to-genital tubercle length1–4. In this report, we suggest a novel auxiliary sign for the diagnosis of bladder exstrophy using power Doppler ultrasound. In the normal fetus, the ureters arise from the pelvis of each kidney and enter the bladder posteriorly on the left and right sides. A urine jet from the ureters into the bladder can often be seen by ultrasound. In cases of bladder exstrophy, the posterior urinary bladder wall is continuous with the abdominal wall and urine from the ureters passes directly into the amniotic sac. We hypothesized that, since the urine production and ureteral function in cases of bladder exstrophy are normal, visualization of urine jets directly into the amniotic cavity would be diagnostic. Using power Doppler ultrasound (Philips iU 22; 3–9-MHz transvaginal probe; CPA, 77%; MED, 1500 Hz; WF, 90 Hz; 3–6-MHz transabdominal probe; CPA, 77%; MED, 1500 Hz, WF, 90 Hz), we were indeed able to observe a urine jet coursing from the abdominal wall into the amniotic cavity, confirming the presence of bladder exstrophy. During a 5-year study period, we diagnosed bladder exstrophy in four fetuses (three at 15 weeks and one at 23 weeks). In these cases, the bladder was not visualized in the presence of normal kidneys, there was no lower abdominal bulge and cord insertion was slightly lower in the abdomen. In all four cases, the urine jet was seen flowing from the ureters directly into the amniotic cavity using color Doppler ultrasound (Figures 1a and 2, Videoclips S1–S3). In all cases the pregnancy was terminated on parental request and the autopsies confirmed the diagnosis of bladder exstrophy (Figure 1b).

Outcome of a right aortic arch diagnosed in utero.

Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel Department of Obstetrics and Gynecology, RAMBAM Health Care Campus, Haifa, Israel The Ruth and Bruce Rappaport Faculty of Medicine, Technion – Israel Institute of Technology, Haifa, Israel Pathology Institute, RAMBAM Health Care Campus, Haifa, Israel Department of Pediatrics, Carmel Medical Center, Haifa, Israel *Correspondence to: Zeev Blumenfeld. E-mail: bzeev@techunix.technion.ac.il; z_blumenfeld@rambam.health.gov.il

Damaging or Just Inappropriate: The Impact of Rudeness on Medical Team Performance

Background and Objective: Iatrogenesis often results from performance deficiencies among medical team members. Team-targeted rudeness may underlie such performance deficiencies with individuals exp...

P319: The natural history of omphalocele detected in early pregnancy

Presence of duodenal membrane is very rare diagnosed during prenatal. We report a case in routine ultrasound that showed a stomach large image associated with hydramnios and hydronephrosis, but vesical distensibility and growth intrauterine normals. Three days after birth, the neonate presented violent vomits and was operated, detecting a fine duodenal membrane. Actually the baby take his life without complications.