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Background Serious games may be useful tools for asthma education. The objectives of this systematic review were to identify the available articles on serious games designed to educate patients and the general public about asthma and to assess their impact on patient's knowledge, behavior, and clinical outcomes related to asthma. Methods PubMed, EMBASE, Cochrane Library, PsychInfo, and Web of Science were systematically searched from January 1980 to December 2015 for studies investigating serious games in asthma education. Two investigators independently assessed studies against inclusion criteria and rated those included on indicators of quality. Investigators extracted data on serious games' content and learning objectives, and on outcomes following Kirkpatrick classification. Results A total of 12 articles were found to be relevant, describing a total of 10 serious games. All serious games were directed toward children, with eight games for children with asthma and two for school-based intervention. The average Medical Education Research Study Quality Instrument score was 13.9 of 18, which is high. Most of the serious games were associated with high rates of satisfaction and improvement in children's knowledge. Seven studies evaluated the impact of serious games on clinical outcomes and found no significant difference relative to control groups. Conclusions Although serious games designed for asthma education have evolved with advances in technology, results of their evaluation remained similar across studies, with clear improvements in knowledge but little or no change in behaviors and clinical outcomes. [ABSTRACT FROM AUTHOR]

Background: The first reports on the pandemic influenza 2009 A/H1N1v from the USA, Mexico, and Australia indicated that this disease was associated with a high mortality in pregnant women. The aim of this study was to describe and compare the characteristics of severe critically ill and non-severe pregnant women with 2009 A/H1N1v-related illness in France. Methodology/Principal Findings: A national registry was created to screen pregnant women with laboratory-confirmed 2009 A/H1N1v influenza. Three hundred and fifteen patients from 46 French hospitals were included: 40 patients were admitted to intensive care units (severe outcomes), 111 were hospitalized in obstetric or medical wards (moderate outcomes), and 164 were outpatients (mild outcomes). The 2009 A/H1N1v influenza illness occurred during all pregnancy trimesters, but most women (54%), notably the severe patients (70%), were in the third trimester. Among the severe patients, twenty (50%) underwent mechanical ventilation, and eleven (28%) were treated with extracorporeal membrane oxygenation. Three women died from A/H1N1v influenza. We found a strong association between the development of a severe outcome and both coexisting illnesses (adjusted odds ratio [OR], 5.1; 95% confidence interval [CI], 2.2-11.8) and a delay in oseltamivir treatment after the onset of symptoms (>3 or 5 days) (adjusted OR, 4.8; 95% CI, 1.9-12.1 and 61.2, 95% CI; 14.4-261.3, respectively). Among the 140 deliveries after 22 weeks of gestation known to date, 19 neonates (14%) were admitted to a neonatal intensive care unit, mainly for preterm delivery, and two neonates died. None of these neonates developed 2009 A/H1N1v infection. Conclusions: This series confirms the high incidence of complications in pregnant women infected with pandemic A/H1N1v observed in other countries but depicts a lower overall maternal and neonatal mortality and morbidity than indicated in the USA or Australia. Moreover, our data demonstrate the benefit of early oseltamivir treatment in this specific population. [ABSTRACT FROM AUTHOR]

Conventional cancer treatments mediate their effects via the direct elimination of tumor cells. Nonetheless, recent evidence indicates that radiotherapy and some chemotherapeutic agents can also induce specific immune responses that contribute to therapeutic outcomes. Two major tumor-intrinsic changes that determine the immune response against tumors have been identified: the translocation of calreticulin to the plasma membrane and the release of high-mobility group box 1 protein. Together, these changes improve engulfment and processing of apoptotic bodies by dendritic cells, which are involved in the cross-priming of antitumor T lymphocytes in vivo. We review these two molecular mechanisms that dictate the radio/chemotherapy-elicited antitumor immune response and discuss how this knowledge can be clinically exploited to predict and also ameliorate the success of chemo/radiotherapy. [ABSTRACT FROM AUTHOR]

We examined the effect of lidocaine on phosphorylation of the tyrosine kinase focal adhesion kinase (PP125FAK) in rat hippocampal slices by immunoblotting with both antiphosphotyrosine and specific anti-PP125FAK antibodies in the presence of tetrodotoxin (1 μM). Lidocaine induced a concentration-related increase in tyrosine phosphorylation of the 125-kDa band corresponding to PP125FAK phosphorylation (EC50 value=0.39±0.09 μM, maximal effect=169±28% of control, P<0.001). This effect was sensitive to neither the N-methyl-d-aspartate (NMDA) receptor antagonist dizocilpine (MK 801, 10 μM) nor the inhibitor of the ryanodine receptor dantrolene (30 μM). In contrast, it was completely blocked by the protein kinase C (PKC) inhibitors chelerythrin, bisindolylmaleimide I (GF 109203X) and bisindolylmaleimide IX (RO-318220, 10 μM). We conclude that lidocaine increases phosphorylation of the tyrosine kinase PP125FAK in the rat hippocampus by a tetrotoxin (TTX)-insensitive mechanism which involves activation of PKC. [Copyright &y& Elsevier]

Background. Postpartum hemorrhage (PPH) is the leading cause of maternal death in the world. Non-technical skills (e.g. communication) are now recognized as a contributing factor to medical safety. In the field of simulation, screen-based simulations are currently very popular with computer/technological development. This study evaluates a screen-based simulation device, PerinatSims, developed to improve technical and non-technical skills in PPH situation. This experiment hypothesized that exposure and repetition of training with PerinatSims would improve the self-assessment of non-technical skills, and therefore increase the ability to manage PPH. Methods. The primary endpoint was a self-assessment of non-technical skills during simulation session of PPH on a digital simulator. Twenty French midwives performed three of nine 25 minutes sessions of PPH screen-based simulation. Four self-assessment questionnaires were administered at the end of each simulation session: a leadership/team working questionnaire (BAT), a negative feelings/emotional questionnaire (DASS-21), a Flow questionnaire and a mental load questionnaire (NASA-TLX). Results between sessions were compared using a repeated measures ANOVA followed by a Bonferroni post hoc test. Results. The study showed a positive evolution during the three screen-based simulation sessions : an increase of leadership and team working self-assessment, an increase of Flow sense, and a decrease of negative emotions (anxiety and depression in the DASS-21 score). Significant decrease of stress was found only between the second and the third sessions, and significant differences in the NASA-TLX were observed only in two dimensions, Performance and Frustration. Conclusion. A repeated exposure to PPH situations with a screen-based simulation tool improved the midwives' self-assessment, especially for leadership, team working, emotion management and Flow sense. Furthermore, midwives had a very positive feedback on the device. They highlighted the desire to use PerinatSims more often to be trained to PPH management, for technical as well as non-technical skills. [ABSTRACT FROM AUTHOR]

Introduction: Health care simulation, as a complement to traditional learning, has spread widely and seems to benefit both students and patients. The teaching methods involved in health care simulation require substantial human, logistical, and financial investments that might preclude their spread in developing countries. The aim of this study was to analyze the health care simulation experiences in developing countries. Methods: A comprehensive literature search was performed from January 2000 to December 2016. Articles reporting studies on educational health care simulation in developing countries were included. Results: In total, 1161 publications were retrieved, of which 156 were considered eligible based on title and abstract screening. Thirty articles satisfied our predefined selection criteria. Most of the studies were case series; 76.7% (23/30) were prospective and comparative, and five were randomized trials. The development of dedicated task trainers and telesimulation were the primary techniques assessed. The retrieved studies showed encouraging trends in terms of trainee satisfaction with improvement after training, but the improvements were mainly tested on the training tool itself. Two of the tools have been proven to be construct valid with clinical impact. Conclusion: Health care simulation in developing countries seems feasible with encouraging results. Higher-quality studies are required to assess the educational value and promote the development of health care simulation programs. [ABSTRACT FROM AUTHOR]

Simulation-based trainings represent an interesting approach to teach medical students the management of pediatric asthma exacerbations (PAEs). In this study, we compared two pedagogical approaches, training students once on three different scenarios of PAEs versus training students three times on the same scenario of PAE. Eighty-five third-year medical students, novice learners for the management of PAEs, were randomized and trained. Students were assessed twice, 1 week and 4 months after the training, on a scenario of PAE new to both groups and on scenarios used during the training. The main outcome was the performance score on the new scenario of PAE at 1 week, assessed on a checklist custom-designed for the study. All students progressed rapidly and acquired excellent skills. One week after the training, there was no difference between the two groups on all the scenarios tested, including the new scenario of PAE (median performance score (IQR) of 8.3 (7.4-10.0) in the variation group versus 8.0 (6.0-10.0) in the repetition group (p = 0.16)). Four months later, the performance of the two groups remained similar.Conclusion: Varying practice with different scenarios was equivalent to repetitive practice on the same scenario for novice learners, with both methods leading to transfer and long-term retention of the skills acquired during the training. What is known: • Simulation-based trainings represent an interesting approach to teach medical students the management of pediatric asthma exacerbations. • It is unclear whether students would benefit more from repetitive practice on the same scenario of asthma exacerbation or from practice on different scenarios in terms of transfer of skills. What is new: • An individual 30-min training on the management of pediatric asthma exacerbations using simulation allows transfer and long-term retention of the skills acquired. • Varying practice with different scenarios is equivalent to repetitive practice on the same scenario in terms of transfer of skills. [ABSTRACT FROM AUTHOR]

The success of anticancer chemotherapy relies at least in part on the induction of an immune response against tumor cells. Thus, tumors growing on mice that lack the pattern recognition receptor TLR4 or the purinergic receptor P2RX7 fail to respond to chemotherapy with anthracyclins or oxaliplatin in conditions in which the same neoplasms growing on immunocompetent mice would do so. Similarly, the therapeutic efficacy (measured as progression-free survival) of adjuvant chemotherapy with anthracyclins is reduced in breast cancer patients bearing loss-of-function alleles of TLR4 or P2RX7. TLR4 loss-of-function alleles also have a negative impact on the therapeutic outcome of oxaliplatin in colorectal cancer patients. Here, we report that loss-of-function TLR4 and P2RX7 alleles do not affect overall survival in non-small cell lung cancer (NSCLC) patients, irrespective of the administration and type of chemotherapy. The intrinsic characteristics of NSCLC (which near-to-always is chemoresistant and associated with poor prognosis) and/or the type of therapy that is employed to treat this malignancy (which near-to-always is based on cisplatin) may explain why two genes that affect the immune response to dying cells fail to influence the clinical progression of NSCLC patients. [ABSTRACT FROM AUTHOR]

The concept of immunogenic chemotherapy that has recently emerged relies upon the capacity of a cytotoxic compound to trigger a cell-death modality. This modality elicits cross-priming by dendritic cells of tumor antigen-specific T cells that will contribute to the tumoricidal activity of the compound and protect the host against relapse. In contrast, most anticancer drugs elicit nonimmunogenic apoptosis that is not accompanied with an immunizing property. This review will discuss some molecular and metabolic changes required at the level of the tumor that must engage key pathways at the level of the host for the induction of Tc1 polarized-protective T cell responses during chemotherapy. We will summarize the immune adjuvants that can boost the immunogenicity of cell death to augment the efficacy of chemotherapy. [ABSTRACT FROM AUTHOR]