Edward Jasper

The Effect of Magnesium on Oxidative Neuronal Injury In Vitro

Abstract: The effect of magnesium on the oxidative neuronal injury induced by hemoglobin was assessed in murine cortical cell cultures. Exposure to 5 µM hemoglobin in physiologic (1 mM) magnesium for 26 h resulted in the death of about one‐half the neurons and a sixfold increase in malondialdehyde production; glia were not injured. Increasing medium magnesium to 3 mM reduced neuronal death by about one‐half and malondialdehyde production by about two‐thirds; neuronal death and lipid peroxidation were approximately doubled in 0.3 mM magnesium. Comparable results were observed in spinal cord cultures. The NMDA antagonist MK‐801 weakly attenuated hemoglobin neurotoxicity in low‐magnesium medium, but tended to potentiate injury in physiologic magnesium. Incubation in low‐magnesium medium alone for 24 h reduced cellular glutathione by ∼50% in mixed neuronal and glial cultures but by only 10% in pure glial cultures. The iron‐dependent oxidation of phosphatidylethanolamine liposomes was attenuated in a concentration‐dependent fashion by 2.5–10 mM magnesium; a similar effect was provided by 0.01–0.1 mM cobalt. However, oxidation was weakly enhanced by 0.5–1 mM magnesium. These results suggest that the vulnerability of neurons to iron‐dependent oxidative injury is an inverse function of the extracellular magnesium concentration. At high concentrations, magnesium inhibits lipid peroxidation directly, perhaps by competing with iron for phospholipid binding sites. At low concentrations, enhancement of cell death may be due to the combined effect of increased NMDA receptor activity, glutathione depletion, and direct potentiation of lipid peroxidation.

Preparedness of Hospitals to Respond to a Radiological Terrorism Event as Assessed by a Full-Scale Exercise

Hospitals and healthcare workers face the challenge of being prepared to manage victims of acts of terrorism that involve chemical, biological, and radiological agents that they do not commonly encounter. One example that is often cited as a potential terrorism scenario is the use of a conventional explosive that is mixed with radioactive material. On November 10, 2004, we conducted a regional multihospital full-scale exercise involving 11 hospitals and 358 victim-observers to evaluate hospital preparedness for such an event. Our results demonstrate that hospitals are not adequately prepared to manage mass casualties with associated radiological contamination.

Disaster Preparedness What Training Do Our Interns Receive During Medical School

Disaster preparedness training is a critical component of medical student education. Despite recent natural and man-made disasters, there is no national consensus on a disaster preparedness curriculum. The authors designed a survey to assess prior disaster preparedness training among incoming interns at an academic teaching hospital. In 2010, the authors surveyed incoming interns (n = 130) regarding the number of hours of training in disaster preparedness received during medical school, including formal didactic sessions and simulation, and their level of self-perceived proficiency in disaster management. Survey respondents represented 42 medical schools located in 20 states. Results demonstrated that 47% of interns received formal training in disaster preparedness in medical school; 64% of these training programs included some type of simulation. There is a need to improve the level of disaster preparedness training in medical school. A national curriculum should be developed with aspects that promote knowledge retention.

Venomous snakebites in an urban area: what are the possibilities?

OBJECTIVE To estimate the number of different species of venomous snakes privately kept in a large urban area. METHODS An anonymous survey of potential snake owners in the Philadelphia urban and suburban area. The survey was mailed to members of the Philadelphia Herpetological Society. In addition, the survey was published in 2 herpetological newsletters and online in the Herpetology Network. RESULTS One hundred sixty responses were obtained during a 6-month period. Ownership of 74 different varieties of venomous snakes was reported. Antivenin was not locally available for 13 of these species. CONCLUSION A wide variety of venomous captive snakes can be found in the private sector. The potential for having to treat an envenomation requires the emergency physician to maintain an education of snakebite management options, including the various antivenin options available in their geographical location.

The Development of a Validated Checklist for Radial Arterial Line Placement Preliminary Results

Radial arterial line placement is an invasive procedure that may result in complications. Validated checklists are central to teaching and assessing procedural skills and may result in improved health care quality. The results of the first step of the validation of a radial arterial line placement checklist are described. A comprehensive literature review of articles published on radial arterial line placement did not yield a checklist validated by the Delphi method. A modified Delphi technique, involving a panel of 9 interdisciplinary, interinstitutional experts, was used to develop a radial arterial line placement checklist. The internal consistency coefficient using Cronbach α was .99. Developing a 22-item checklist for teaching and assessing radial arterial line placement is the first step in the validation process. For this checklist to become further validated, it should be implemented and studied in the simulation and clinical environments.

Are medical students being taught invasive skills using simulation

Introduction Basic invasive procedural skills are traditionally taught during clerkships. Using simulation to teach invasive skills provides students the opportunity to practice in a structured environment without risking patient safety. We surveyed incoming interns at Thomas Jefferson University Hospital to assess the prevalence of simulation training for invasive and semi-invasive procedural skills during medical school. Methods From 2008 to 2010, we surveyed 357 incoming interns at Thomas Jefferson University Hospital. The questionnaire asked incoming interns if they received formal instruction or procedural training with or without a simulation component for 34 procedures during medical school. Interns indicated their number of attempts and successes for each procedure in clinical care. Results All 357 incoming interns completed the survey. Experience in 28 procedures is reported in this article. For all but three basic procedures, more than 75% of interns received formal didactic instruction. Only 3 advanced procedures were formally taught to most interns. The prevalence of simulation training for the basic and advanced procedures was 46% and 23%, respectively. For the basic procedures, the average number of attempts and successes was 6.5 (range, 0–13.9) and 6.2 (range, 0–13.4), respectively. For the advanced procedures, the average number of attempts and successes was 1.5 (range, 0–4.8) and 1.3 (range, 0–4.7), respectively. Conclusions Although most medical students receive formal instruction in basic procedures, fewer receive formal instruction in advanced procedures. The use of simulation to complement this training occurs less often. Simulation training should be increased in undergraduate medical education and integrated into graduate medical education.

Implementing a Disaster Preparedness Curriculum for Medical Students

Objectives Training in disaster medicine and preparedness is minimal or absent in the curricula of many medical schools in the United States. Despite a 2003 joint recommendation by the Association of American Medical Colleges and the Centers for Disease Control and Prevention, few medical schools require disaster training for medical students. The challenges of including disaster training in an already rigorous medical school curriculum are significant. We evaluated medical students’ experiences with mandatory disaster training during a 2-year period in a medical university setting. Methods Disaster training has been mandatory at Thomas Jefferson University since 2002 and requires all first-year medical students to attend lectures, undergo practical skills simulation training, and participate in the hospital’s interdisciplinary disaster exercise. Medical students were encouraged to complete a survey after each component of the required training. Twenty-three survey questions focused on assessing students’ experiences and opinions of the training, including evaluation of the disaster exercise. Students provided ratings on a 5-point Likert scale (5 = strongly agree, 1 = strongly disagree). Results A total of 503 medical students participated in the disaster preparedness curriculum during the course of 2 years. Survey response rates were high for each portion of the training: lectures (91%), skills sessions (84%), and disaster exercise (100%). Students believed that disaster preparedness should remain part of the medical school curriculum (rating 4.58/5). The disaster lectures were considered valuable (rating 4.26/5) and practical skills sessions should continue to be part of the first-year curriculum (4.97/5). Students also believed that participation in the disaster exercise allowed them to better understand the difficulties faced in a real disaster situation (4.2/5). Conclusions Our mandatory disaster preparedness training course was successfully integrated into the first-year curriculum >10 years ago and has been well received by students without compromising the existing university curriculum. Integrating interdisciplinary teams and course components important to other education stakeholders may help other schools overcome obstacles to implementing disaster medicine training. Future education research should focus on developing interdisciplinary education to help disseminate disaster medicine topics across all 4 years of medical school.