Feasibility of a palmtop-based interactive education to promote patient safety.

Institute of Medicine defines "patient safety" as a set of measures taken by healthcare professionals to prevent adverse outcomes from medical errors. Kohn estimated that medical errors are likely to result in a death of 44,000 to 98,000 people in U.S. hospitals each year, making it almost the fifth leading cause of death. The costs of medical errors, made by healthcare professionals, amount to $29 billions annually. Recent studies showed that current system of medical training and continuous education has limited capability in promoting and sustaining awareness of patient safety and medical error issues. Use of Personal Digital Assistants (PDA) has been increasingly widespread among clinical students and residents. Despite significant improvement in PDA functionality, current literature does not provide systematic assessment of potential use of hand-held computing for interactive clinician education. To address these issues, we assessed the feasibility of a PDA-based interactive multimedia tool aimed to provide self-paced patient safety education for clinicians.

Interferon-gamma protects primary monocytes against infection with human immunodeficiency virus type 1.

Monocytes treated with 500 IU/ml human recombinant interferon-gamma (rIFN-gamma) 1 day before and continuously after human immunodeficiency virus (HIV) infection showed no evidence of virus replication 7 days after addition of the viral inoculum. There was no HIV-associated cytopathic effect, no reverse transcriptase (RT) activity or p24 detected in culture fluids, and no HIV RNA or DNA in cell lysates. Furthermore, no evidence of HIV infection was evident in replicate cultures in which all IFN-gamma was removed at 7 days and the cells were cultured for an additional 3 weeks without IFN-gamma. The 50% inhibitory dose for reduction of maximum RT activity in HIV-infected monocyte cultures was about 1 IU/ml IFN-gamma. No increase in HIV replication was evident in monocytes treated with IFN-gamma at any concentration (0 to 5000 IU/ml) or at any time (7 days before to 10 days after HIV infection). In side-by-side experiments with identical monocytes and HIV-1 stock, rIFN-gamma was 10 to 20 times more effective than rIFN-alpha 2b for induction of antiviral activity. With both interferons, significant antiviral activity was evident with monocytes treated 1 day before, at the time of, or up to 3 days after infection. At 7 to 10 days after infection (a time at which less than 20% of total cells were infected with HIV) addition of even high concentrations of IFN-alpha or IFN-gamma had no effect on virus replication. These data suggest that the principal action of IFN-alpha and IFN-gamma was directed against the fluid-phase virus. Cell-cell spread of infection within the HIV-infected monocyte culture and extent of virus replication in HIV-infected cells were not affected by interferon treatment.