INTRODUCTION While teaching patient safety and quality improvement (QI) skills to medical students is endorsed as being important, best practice for achieving learner outcomes in QI is particularly unclear. We systematically reviewed QI curricula for medical students to identify approaches to QI training that are associated with positive learner outcomes. METHODS We searched databases (Medline, EMBASE, and Scopus) and article bibliographies for studies published from 2009 to 2018. Studies evaluating QI teaching for medical students in any setting and reporting learner outcomes were included. Educational content, teaching format, achievement of learning outcomes, and methodological features were abstracted. Outcomes assessed were learners' satisfaction, attitudes, knowledge and skills, changes in behavior and clinical processes, and benefits to patients. RESULTS Twenty of 25 curricula targeted medical students exclusively. Most curricula were well accepted by students (11/13 studies), increased their confidencclinical setting leads to better learner outcomes with location being potentially a surrogate for clinical experience. INTRODUCTION Despite recent changes to medical education, surgical training remains largely based on the apprenticeship model. However, after completing training, there are few structured learning opportunities available for surgeons in practice to refine their skills or acquire new skills. Personalized observation with feedback is rarely a feature of traditional continuing medical education learning. Coaching has recently been proposed as a modality to meet these educational gaps; however, data are limited, and few coaching programs presently exist.  https://www.selleckchem.com/products/tolebrutinib-sar442168.html  The purpose of this study is to summarize the characteristics of coaching programs for surgeons in practice including participant satisfaction, program outcomes, and barriers to implementation, in the published literature. METHODS A mixed studies systematic review was conducted according to PRISMA guidelines to identify all original studies describing or investigating coaching for practicing surgeons up to 06/2019. Quantitative analysis was used to summarize nume often results in clinical practice changes, while cultural and logistical issues were identified as barriers to implementation. A better understanding of these factors is required to guide coaching program development and implementation. We performed a post hoc analysis of data from phase 3 and 4 studies to evaluate the efficacy of silodosin 8mg in patients with severe lower urinary tract symptoms (LUTS) related to benign prostatic obstruction (BPO). The presence of two or more of the following criteria was adopted to define severity total International Prostate Symptom Score (IPSS) 20-35, quality of life (QoL) score 5-6, maximum urinary flow less then 5ml/s or postvoid residual volume ≥100ml, and prostate volume ≥50ml. Mean improvements in total (8.1 vs 4.7), storage (3.1 vs 2.0), voiding (5.0 vs 2.7), and QoL (1.3 vs 0.7) IPSS scores were significantly greater for patients receiving silodosin compared to placebo (all p less then 0.0001). Mean improvements in total, storage, voiding, and QoL IPSS scores were similar for the severe and not severe LUTS cohorts. In conclusion, silodosin significantly improves symptoms and QoL in all LUTS/BPO patients, including those with severe symptoms. PATIENT SUMMARY Silodosin improves symptoms and quality of life for patients with severe lower urinary tract symptoms related to benign prostatic obstruction. V.BACKGROUND Heart failure (HF) is the fastest growing form of cardiovascular disease both nationally and globally, underlining a need to phenotype subclinical HF intermediaries to improve primary prevention. OBJECTIVES We aimed to identify novel metabolite associations with left ventricular (LV) remodeling, one upstream HF intermediary, among a community-based cohort of individuals. METHODS We examined 1052 Bogalusa Heart Study participants (34.98% African American, 57.41% female, aged 33.6-57.5 years). Measures of LV mass and relative wall thickness (RWT) were obtained using two-dimensional-guided echocardiographic measurements via validated eqs. LV mass was indexed to height2.7 to calculate left ventricular mass index (LVMI). Untargeted metabolomic analysis of fasting serum samples was conducted. In combined and ethnicity-stratified analyses, multivariable linear and multinomial logistic regression models tested the associations of metabolites with the continuous LVMI and RWT and categorical LV geometry phenotypes, respectively, after adjusting for demographic and traditional cardiovascular disease risk factors. RESULTS Pseudouridine (B = 1.38; p = 3.20 × 10-5) and N-formylmethionine (B = 1.65; 3.30 × 10-6) were significantly associated with LVMI in the overall sample as well significant in Caucasians, with consistent effect direction and nominal significance (p  less then  .05) in African Americans. Upon exclusion of individuals with self-report myocardial infarction or congestive HF, we similarly observed a 1.33 g/m2.7 and 1.52 g/m2.7 higher LVMI for each standard deviation increase in pseudouridine and N-formylmethionine, respectively. No significant associations were observed for metabolites with RWT or categorical LV remodeling outcomes. CONCLUSIONS The current analysis identified novel associations of pseudouridine and N-formylmethionine with LVMI, suggesting that mitochondrial-derived metabolites may serve as early biomarkers for LV remodeling and subclinical HF. Diabetes is an important risk factor for the development of cardiovascular disease including atherosclerosis and ischemic heart disease. Vascular complications including macro- and micro-vascular dysfunction are the leading causes of morbidity and mortality in diabetes. Disease mechanisms at present are unclear and no ideal therapies are available, which urgently calls for the identification of novel therapeutic targets/agents. An altered nucleotide- and nucleoside-mediated purinergic signaling has been implicated to cause diabetes-associated vascular dysfunction in major organs. Alteration of both purinergic P1 and P2 receptor sensitivity rather than the changes in receptor expression accounts for vascular dysfunction in diabetes. Activation of P2X7 receptors plays a crucial role in diabetes-induced retinal microvascular dysfunction. Recent findings have revealed that both ecto-nucleotidase CD39, a key enzyme hydrolyzing ATP, and CD73, an enzyme regulating adenosine turnover, are involved in the renal vascular injury in diabetes.