Explore the vast range of titles available.

Hutchinson et al present five things to know about foreign body aspiration in children. In Canada, choking or suffocation accounts for about 40% of unintentional deaths among children younger than 1 year. Foreign body aspiration can result in either partial or complete airway obstruction. Findings of physical examination are variable and chest radiographs are normal in 30%-50% of patients with foreign body aspiration confirmed by endoscopy. Aspiration of batteries, peanuts and sharp objects warrants urgent consultation for surgical management. Rigid bronchoscopy is the gold standard for diagnosis and intervention.

We examine the effect of foreign institutional investors on firm innovation. Using firm-level data across 26 non-U.S. economies between 2000 and 2010, we show that foreign institutional ownership has a positive, causal effect on firm innovation. We further explore three possible underlying mechanisms through which foreign institutions affect firm innovation: Foreign institutions act as active monitors, provide insurance for firm managers against innovation failures, and promote knowledge spillovers from high-innovation economies. Our article sheds new light on the real effects of foreign institutions on firm innovation.

We examine the impact of the 2007-2008 financial crisis on nonfinancial firms' financing and investment activities and the role of corporate governance in alleviating the adverse consequences of the external capital supply shock. Employing a difference-in-differences research design, we find that better governance mitigates the disruption caused by the bank credit supply shock to firms' financing and investment activities. A variety of robustness tests suggest that our findings are unlikely to be driven by an endogeneity problem. We obtain similar results when we extend the sample period to include the delayed spillover from the banking sector to other capital market sectors.

Background The widespread implementation of longitudinal assessment (LA) to document trainees’ progression to independent practice rests more on speculative rather than evidence-based benefits. We aimed to document stakeholders’ knowledge of- and attitudes towards LA, and identify how the supports and barriers can help or hinder the uptake and sustainable use of LA. Methods We interviewed representatives from four stakeholder groups involved in LA. The interview protocols were based on the Theoretical Domains Framework (TDF), which contains a total of 14 behaviour change determinants. Two team members coded the interviews deductively to the TDF, with a third resolving differences in coding. The qualitative data analysis was completed with iterative consultations and discussions with team members until consensus was achieved. Saliency analysis was used to identify dominant domains. Results Forty-one individuals participated in the study. Three dominant domains were identified. Participants perceive that LA has more positive than negative consequences and requires substantial ressources. All the elements and characteristics of LA are present in our data, with differences between stakeholders. Conclusion Going forward, we could develop and implement tailored and theory driven interventions to promote a shared understanding of LA, and maintain potential positive outcomes while reducing negative ones. Furthermore, ressources to support LA implementation need to be addressed to facilitate its uptake.

Background A longitudinal curriculum was developed in conjunction with anesthesiologists, otolaryngologists, emergency physicians and experts in medical simulation and education. Methods Residents participated in four different simulation-based training modules using animal models, cadavers, task trainers, and crisis scenarios using high fidelity manikins. Scenarios were based on various clinical settings (i.e. emergency room, operating room) and were followed by video-assisted structured debriefings. Participants completed both a self-assessment questionnaire and an exit survey using five-point Likert scales. Results 31 otolaryngology residents participated in the curriculum. Residents reported simulation training significantly improved technical skills such as tracheostomy, cricothyroidotomy and pediatric intubation ( p < 0.05 for all). Non-technical skills, including communication, delegation and management were significantly improved on post-test surveys in simulated crisis scenarios ( p < 0.05 for all). 90 (28/31) of participants found simulations to be very realistic. Junior residents placed increased value on didactic teaching and procedural skills, while senior residents on crisis scenarios. Survey results indicated that > 90% (28/31) of participants found the modules of the curriculum to be useful and would recommend them to others. Conclusion A longitudinal simulation-based medical curriculum can be an effective method to teach airway management and teamwork skills to otolaryngology residents.

Pancreatic cancer is one of the most aggressive malignancies and is characterized by a low 5-year survival rate, a broad genetic diversity and a high resistance to conventional therapies. As a result, novel therapeutic agents to improve the current situation are needed urgently. Curcumin, a polyphenolic colorant derived from Curcuma longa root, showed pleiotropic influences on cellular pathways in vitro and amongst others anti-cancer properties including sensitization of tumor cells to chemo- and radiation-therapy. In this study, we evaluated the impact of Curcumin on the radiosensitivity of the established human pancreatic cancer cell lines Panc-1 and MiaPaCa-2 in vitro . In contrast to MiaPaCa-2 cells, we found a significant radiosensitization by Curcumin in the more radioresistant Panc-1 cells, possibly caused by cell cycle arrest in the most radiation-sensitive G2/M-phase at the time of irradiation. Furthermore, a significant enhancement of radiation-induced apoptosis, DNA-double-strand breaks and G2/M-arrest after curcumin treatment was observed in both cell lines. These in vitro findings suggest that especially patients with more radioresistant tumors could benefit from a radiation-concomitant, phytotherapeutic therapy with Curcumin.

Background Randomized controlled trials are the gold standard in medical and surgical research to assess the efficacy of therapeutic interventions. The reporting of these trials should be of high quality to allow readers’ appropriate interpretation and application. Methods The objectives of our study were to assess the extent to which the recent Otolaryngology – Head and Neck Surgery (ORL-HNS) randomized control trials in the top nine journals and in the top Canadian journal comply with the Consolidated Standards of Reporting Trials (CONSORT) statement, and to identify the CONSORT items most in need of improvement. Based on the impact factor and circulation number of 2014, the top nine Otolaryngology journals and the top Canadian Otolaryngology journal were selected and were searched to identify RCTs published in English and between 2010 and 2014. Two authors independently reviewed and extracted data using a standardized data extraction form constructed with the help of a medical librarian. Our outcome was to assess the adherence of articles reporting to the CONSORT items. Descriptive statistics were used. Results One hundred and eighty-two Otolaryngologic RCTs were identified in the top nine international journals and in the top Canadian journal. The inter-rater reliability between two raters was 0.32. The extent of adherence to CONSORT Statement ranged from 25 to 93.5% with a mean of 59.0% and a median of 59.4%. Only 6.5% of RCTs described the individual responsible for enrolling and assigning subjects and method of randomization; 32.4% reported the estimated effect size and precision; 40.6% reported a sample size calculation and 32.4% mentioned external validity or implications of the findings. Conclusion Findings revealed that the reporting of RCTs in the top nine ORL-HNS journals and in the top Canadian ORL-HNS journal is suboptimal. The quality of reporting can be improved by addressing the three CONSORT items found most deficient in this study namely, sample size calculations, estimated effect size and precision, and external validity.

Background To evaluate the clinical management of choanal atresia (CA) in tertiary centers across Canada. Methods Multi-centre case series involving six tertiary care pediatric hospitals across Canada. Retrospective chart review of patients born between 1980 and 2010 diagnosed with choanal atresia to a participating center. Results The health charts of 215 patients (59.6% female) with choanal atresia (CA) were reviewed. Mean age of initial surgical repair was 0.8 months for bilateral CA, and 48.6 months for unilateral CA. Approaches of surgical repair consisted of endoscopic transnasal (31.7%), non-endoscopic transnasal (42.6%), and transpalatal (25.2%). Stents were used on 70.7% of patients. Forty-nine percent of patients were brought back to the OR for a planned second look; stent removal being the most common reason (86.4%). Surgical success rate of initial surgeries was 54.1%. Surgical technique was not associated with rate of restenosis [χ 2 (2) = 1.6, p  = .46]. Conclusions The present study is the first national multi-institutional study exploring the surgical outcomes of CA over a 30-year period. The surgical repair of CA presents a challenge to otolaryngologists, as the rate of surgical failure is high. The optimal surgical approach, age at surgical repair, use of stents, surgical adjuncts, and need for planned second look warrant further investigation. Graphical abstract

Purpose Complex clinical situations, involving multiple medical specialists, create potential for tension or lack of clarity over leadership roles and may result in miscommunication, errors and poor patient outcomes. Even though copresence has been shown to overcome some differences among team members, the coordination literature provides little guidance on the relationship between coordination and leadership in highly specialized health settings. The purpose of this paper is to determine how different specialties involved in critical medical situations perceive the role of a leader and its contribution to effective crisis management, to better define leadership and improve interdisciplinary leadership and education. Design/methodology/approach A qualitative study was conducted featuring purposively sampled, semi-structured interviews with 27 physicians, from three different specialties involved in crisis resource management in pediatric centers across Canada: Pediatric Emergency Medicine, Otolaryngology and Anesthesia. A total of three researchers independently organized participant responses into categories. The categories were further refined into conceptual themes through iterative negotiation among the researchers. Findings Relatively “structured” (predictable) cases were amenable to concrete distributed leadership – the performance by micro-teams of specialized tasks with relative independence from each other. In contrast, relatively “unstructured” (unpredictable) cases required higher-level coordinative leadership – the overall management of the context and allocations of priorities by a designated individual. Originality/value Crisis medicine relies on designated leadership over highly differentiated personnel and unpredictable events. This challenges the notion of organic coordination and upholds the validity of a concept of leadership for crisis medicine that is not reducible to simple coordination. The intersection of predictability of cases with types of leadership can be incorporated into medical simulation training to develop non-technical skills crisis management and adaptive leaderships skills.