The protein kinase, GSK-3, participates in diverse biological processes and is now recognized a promising drug discovery target in treating multiple pathological conditions. Over the last decade, a range of newly developed GSK-3 inhibitors of diverse chemotypes and inhibition modes has been developed. Even more conspicuous is the dramatic increase in the indications that were tested from mood and behavior disorders, autism and cognitive disabilities, to neurodegeneration, brain injury and pain. Indeed, clinical and pre-clinical studies were largely expanded uncovering new mechanisms and novel insights into the contribution of GSK-3 to neurodegeneration and central nerve system (CNS)-related disorders. In this review we summarize new developments in the field and describe the use of GSK-3 inhibitors in the variety of CNS disorders. This remarkable volume of information being generated undoubtedly reflects the great interest, as well as the intense hope, in developing potent and safe GSK-3 inhibitors in clinical practice.

/pdf/glycogen-synthase-kinase-3-inhibitors-preclinical-and-18xsiz41.pdf

Glycogen Synthase Kinase-3 Inhibitors: Preclinical and Clinical Focus on CNS-A Decade Onward

The most commonly used techniques for addressing each Emergency Department (ED) problem (overcrowding, prolonged waiting time, extended length of stay, excessive patient flow time, and high left-without-being-seen (LWBS) rates) were specified to provide healthcare managers and researchers with a useful framework for effectively solving these operational deficiencies. Finally, we identified the existing research tendencies and highlighted opportunities for future work. We implemented the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology to undertake a review including scholarly articles published between April 1993 and October 2019. The selected papers were categorized considering the leading ED problems and publication year. Two hundred and three (203) papers distributed in 120 journals were found to meet the inclusion criteria. Furthermore, computer simulation and lean manufacturing were concluded to be the most prominent approaches for addressing the leading operational problems in EDs. In future interventions, ED administrators and researchers are widely advised to combine Operations Research (OR) methods, quality-based techniques, and data-driven approaches for upgrading the performance of EDs. On a different tack, more interventions are required for tackling overcrowding and high left-without-being-seen rates.

Methodological Approaches to Support Process Improvement in Emergency Departments: A Systematic Review.

Despite major improvements in the United States trauma system over the past two decades, prehospital trauma triage is a significant challenge. Undertriage is associated with increased mortality, and overtriage results in significant resource overuse. The American College of Surgeons Committee on Trauma benchmarks for undertriage and overtriage are not being met. Many barriers to appropriate field triage exist, including lack of a formal definition for major trauma, absence of a simple and widely applicable triage mode, and emergency medical service adherence to triage protocols. Modern trauma triage systems should ideally be based on the need for intervention rather than injury severity. Future studies should focus on identifying the ideal definition for major trauma and creating triage models that can be easily deployed. This narrative review article presents challenges and potential solutions for prehospital trauma triage.

Field-Triage, Hospital-Triage and Triage-Assessment: A Literature Review of the Current Phases of Adult Trauma Triage.

Machine Learning and Improved Quality Metrics in Acute Intracranial Hemorrhage by Noncontrast Computed Tomography.

Comprehensive clinical decision support (CDS) care maps can improve the delivery of care and clinical outcomes. However, they are frequently plagued by usability problems and poor user acceptance.This study aims to characterize factors influencing successful design and use of comprehensive CDS care maps and identify themes associated with end-user acceptance of a thoracic trauma CDS care map earlier in the process than has traditionally been done. This was a planned adaptive redesign stage of a User Acceptance and System Adaptation Design development and implementation strategy for a CDS care map. This stage was based on a previously developed prototype CDS care map guided by the Unified Theory of Acceptance and Use of Technology.A total of 22 multidisciplinary end users (physicians, advanced practice providers, and nurses) were identified and recruited using snowball sampling. Qualitative interviews were conducted, audio-recorded, and transcribed verbatim. Generation of prespecified codes and the interview guide was informed by the Unified Theory of Acceptance and Use of Technology constructs and investigative team experience. Interviews were blinded and double-coded. Thematic analysis of interview scripts was conducted and yielded descriptive themes about factors influencing the construction and potential use of an acceptable CDS care map.A total of eight dominant themes were identified: alert fatigue (theme 1), automation (theme 2), redundancy (theme 3), minimalistic design (theme 4), evidence based (theme 5), prevent errors (theme 6), comprehensive across the spectrum of disease (theme 7), and malleability (theme 8). Themes 1 to 4 addressed factors directly affecting end users, and themes 5 to 8 addressed factors affecting patient outcomes. More experienced providers prioritized a system that is easy to use. Nurses prioritized a system that incorporated evidence into decision support. Clinicians across specialties, roles, and ages agreed that the amount of extra work generated should be minimal and that the system should help them administer optimal care efficiently.End user feedback reinforces attention toward factors that improve the acceptance and use of a CDS care map for patients with thoracic trauma. Common themes focused on system complexity, the ability of the system to fit different populations and settings, and optimal care provision. Identifying these factors early in the development and implementation process may facilitate user-centered design and improve adoption. 

/pdf/barriers-to-and-facilitators-for-acceptance-of-comprehensive-2wy2eh7i.pdf

Barriers to and Facilitators for Acceptance of Comprehensive Clinical Decision Support System–Driven Care Maps for Patients With Thoracic Trauma: Interview Study Among Health Care Providers and Nurses

Background Traumatic brain injury (TBI) is the leading cause of elderly trauma admissions. Previous research identified that each minute delay to TBI diagnosis was associated with a 2% mortality increase, delaying treatment to older patients (age ≥70 years) who do not meet trauma activation criteria. A TBI protocol and clinical decision support intervention (CDS-I) were developed to reduce time to imaging in older patients with head trauma not meeting trauma activation criteria. Study design An emergency department (ED) head CT protocol and CDS-I were developed and implemented to facilitate rapid imaging of older patients. Patients age ≥ 70 years, with TBI and receiving anticoagulation, met inclusion criteria. The primary outcomes measure was time from ED arrival to head CT imaging comparing before (PRE: January 1, 2016 to December 31, 2016) vs after (POST: August 1, 2018 to April 3, 2019) protocol implementation. Negative binomial regression models evaluated the association of intervention on time to imaging. LOWESS (locally weighted scatterplot smoothing) was used to evaluate the association of intervention on mortality over time. Results The study examined 451 patients (269 PRE and 182 POST). Positive head CTs were seen in 78 (17.3%), and 57 of 78 (73%) patients had a Glasgow Coma Scale > 13. POST-intervention decreased time to head CT from 56 to 27 minutes (interquartile range [IQR] PRE: 32 to 93 to POST:16 to 44, p Conclusions A significant proportion of older patients receiving anticoagulation, but not meeting trauma activation criteria, had positive CT findings. Implementation of a rapid triage protocol with CDS-I reduced time to imaging and may reduce mortality in the highest-risk populations.

Clinical Decision Support Intervention and Time to Imaging in Older Patients with Traumatic Brain Injury.

Implementation of a Prophylactic Anticoagulation Guideline for Patients with Traumatic Brain Injury.

Manic episode in patient with bipolar disorder and recent multiple sclerosis diagnosis: A case report.

Early Imaging Associated With Improved Survival in Older Patients With Mild Traumatic Brain Injuries.

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Clinical Decision Support Intervention and Time to Imaging in Older Patients with Traumatic Brain Injury.

Implementation of a Prophylactic Anticoagulation Guideline for Patients with Traumatic Brain Injury.

Manic episode in patient with bipolar disorder and recent multiple sclerosis diagnosis: A case report.

Early Imaging Associated With Improved Survival in Older Patients With Mild Traumatic Brain Injuries.