bluuebunny/crossref_metadata_2025 huggingface dataset:
Chemical composition and phagocyte immunomodulatory activity of Ferula iliensis essential oils
Authors: Oüzek Gulmira , Schepetkin Igor A , Utegenova Gulzhakhan A , Kirpotina Liliya N , Andrei Spencer R , Oüzek Temel , Baser Kemal Huüsnuü Can , Abidkulova Karime T , Kushnarenko Svetlana V , Khlebnikov Andrei I , Damron Derek S , Quinn Mark T
Published: March 2017

Essential oil extracts from Ferula iliensis have been used traditionally in Kazakhstan for treatment of inflammation and other illnesses. Because little is known about the biologic activity of these essential oils that contributes to their therapeutic properties, we analyzed their chemical composition and evaluated their phagocyte immunomodulatory activity. The main components of the extracted essential oils were (E)-propenyl sec-butyl disulfide (15.7–39.4%) and (Z)-propenyl sec-butyl disulfide (23.4–45.0%). Ferula essential oils stimulated [Ca2+]i mobilization in human neutrophils and activated ROS production in human neutrophils and murine bone marrow phagocytes. Activation of human neutrophil [Ca2+]i flux by Ferula essential oils was dose-dependently inhibited by capsazepine, a TRPV1 channel antagonist, indicating that TRPV1 channels mediate this response. Furthermore, Ferula essential oils stimulated Ca2+ influx in TRPV1 channel–transfected HEK293 cells and desensitized the capsaicin-induced response in these cells. Additional molecular modeling with known TRPV1 channel agonists suggested that the active component is likely to be (Z)-propenyl sec-butyl disulfide. Our results provide a cellular and molecular basis to explain at least part of the beneficial therapeutic properties of FEOs.
Rationalized design of a mucosal vaccine protects against Mycobacterium tuberculosis challenge in mice
Authors: Ahmed Mushtaq , Jiao Hongmei , Domingo-Gonzalez Racquel , Das Shibali , Griffiths Kristin L , Rangel-Moreno Javier , Nagarajan Uma M , Khader Shabaana A
Published: March 2017

Pulmonary tuberculosis (TB) caused by Mycobacterium tuberculosis (Mtb) is a leading cause of global morbidity and mortality. The only licensed TB vaccine, Mycobacterium bovis bacillus Calmette-Guerin (BCG), has variable efficacy in protecting against pulmonary TB. Thus, the development of more effective TB vaccines is critical to control the TB epidemic. Specifically, vaccines delivered through the mucosal route are known to induce Th17 responses and provide superior protection against Mtb infection. However, already tested Th17-inducing mucosal adjuvants, such as heat-labile enterotoxins and cholera toxins, are not considered safe for use in humans. In the current study, we rationally screened adjuvants for their ability to induce Th17-polarizing cytokines in dendritic cells (DCs) and determined whether they could be used in a protective mucosal TB vaccine. Our new studies show that monophosphoryl lipid A (MPL), when used in combination with chitosan, potently induces Th17-polarizing cytokines in DCs and downstream Th17/Th1 mucosal responses and confers significant protection in mice challenged with a clinical Mtb strain. Additionally, we show that both TLRs and the inflammasome pathways are activated in DCs by MPL-chitosan to mediate induction of Th17-polarizing cytokines. Together, our studies put forward the potential of a new, protective mucosal TB vaccine candidate, which incorporates safe adjuvants already approved for use in humans.
Significant and Sustained Reduction in Chemotherapy Errors Through Improvement Science
Authors: Weiss Brian D. , Scott Melissa , Demmel Kathleen , Kotagal Uma R. , Perentesis John P. , Walsh Kathleen E.
Published: March 2017

Purpose:

A majority of children with cancer are now cured with highly complex chemotherapy regimens incorporating multiple drugs and demanding monitoring schedules. The risk for error is high, and errors can occur at any stage in the process, from order generation to pharmacy formulation to bedside drug administration. Our objective was to describe a program to eliminate errors in chemotherapy use among children.

Methods:

To increase reporting of chemotherapy errors, we supplemented the hospital reporting system with a new chemotherapy near-miss reporting system. After the model for improvement, we then implemented several interventions, including a daily chemotherapy huddle, improvements to the preparation and delivery of intravenous therapy, headphones for clinicians ordering chemotherapy, and standards for chemotherapy administration throughout the hospital.

Results:

Twenty-two months into the project, we saw a centerline shift in our U chart of chemotherapy errors that reached the patient from a baseline rate of 3.8 to 1.9 per 1,000 doses. This shift has been sustained for > 4 years. In Poisson regression analyses, we found an initial increase in error rates, followed by a significant decline in errors after 16 months of improvement work ( P < .001).

Conclusion:

After the model for improvement, our improvement efforts were associated with significant reductions in chemotherapy errors that reached the patient. Key drivers for our success included error vigilance through a huddle, standardization, and minimization of interruptions during ordering.
Reducing Overuse of Colony-Stimulating Factors in Patients With Lung Cancer Receiving Chemotherapy: Evidence From a Decision Support–Enabled Program
Authors: Adeboyeje Gboyega , Agiro Abiy , Malin Jennifer , Fisch Michael J. , DeVries Andrea
Published: March 2017

Purpose:

Colony-stimulating factors (CSFs) are frequently overused for the primary prevention of febrile neutropenia (FN) in patients receiving chemotherapy.

Methods:

A retrospective cohort study design was used to analyze commercial claims data in adults with lung cancer initiated on chemotherapy from April 1, 2013, to March 30, 2015. The tool was implemented at oncology practices in phases across 14 US states. Patients were assigned to intervention and nonintervention states according to whether they resided in service areas where the tool had been implemented. Patients were followed up to 6 months after initiating chemotherapy. Difference in pre- and postimplementation CSF use and FN incidence rates were compared with the use of difference-in-differences (DID) models that were adjusted for baseline FN risk factors.

Results:

The study population of 3,467 patients (intervention states: pre, 707; post, 1,150; nonintervention states: pre, 636; post, 974) showed no significant differences in FN risk factors at baseline. In adjusted results before and after implementation, CSF use decreased from 48.4% to 35.6% in the intervention states versus 43.2% to 44.4% in the nonintervention states (DID, −8.7%; 95% CI, −14.65% to −2.67%; P ≤ .001). The rates of FN were consistent for both groups in both periods, with no statistical difference in trend for the intervention (2.8% to 4.3%) versus the nonintervention (3.1% to 5.1%) states (DID, −0.13; 95% CI, −0.35 to 0.10; P = .927).

Conclusion:

These findings demonstrate that a decision support-enabled utilization management tool can improve risk-appropriate, guideline-adherent CSF use in patients with lung cancer.
Cost and Survival Analysis Before and After Implementation of Dana-Farber Clinical Pathways for Patients With Stage IV Non–Small-Cell Lung Cancer
Authors: Jackman David M. , Zhang Yichen , Dalby Carole , Nguyen Tom , Nagle Julia , Lydon Christine A. , Rabin Michael S. , McNiff Kristen K. , Fraile Belen , Jacobson Joseph O.
Published: March 2017

Purpose:

Increasing costs and medical complexity are significant challenges in modern oncology. We explored the use of clinical pathways to support clinical decision making and manage resources prospectively across our network.

Materials and Methods:

We created customized lung cancer pathways and partnered with a commercial vendor to provide a Web-based platform for real-time decision support and post-treatment data aggregation. Dana-Farber Cancer Institute (DFCI) Pathways for non–small cell lung cancer (NSCLC) were introduced in January 2014. We identified all DFCI patients who were diagnosed and treated for stage IV NSCLC in 2012 (before pathways) and 2014 (after pathways). Costs of care were determined for 1 year from the time of diagnosis.

Results:

Pre- and postpathway cohorts included 160 and 210 patients with stage IV NSCLC, respectively. The prepathway group had more women but was otherwise similarly matched for demographic and tumor characteristics. The total 12-month cost of care (adjusted for age, sex, race, distance to DFCI, clinical trial enrollment, and EGFR and ALK status) demonstrated a $15,013 savings after the implementation of pathways ($67,050 before pathways v $52,037 after pathways). Antineoplastics were the largest source of cost savings. Clinical outcomes were not compromised, with similar median overall survival times (10.7 months before v 11.2 months after pathways; P = .08).

Conclusion:

After introduction of a clinical pathway in metastatic NSCLC, cost of care decreased significantly, with no compromise in survival. In an era where comparative outcomes analysis and value assessment are increasingly important, the implementation of clinical pathways may provide a means to coalesce and disseminate institutional expertise and track and learn from care decisions.
Novel immunodeficient Pde6b rd1 mouse model of retinitis pigmentosa to investigate potential therapeutics and pathogenesis of retinal degeneration
Authors: Mishra Alaknanda , Das Barun , Nath Madhu , Iyer Srikanth , Kesarwani Ashwani , Bhattacharjee Jashdeep , Arindkar Shailendra , Sahay Preeti , Jain Kshama , Sahu Parul , Sinha Prakriti , Velpandian Thirumurthy , Nagarajan Perumal , Upadhyay Pramod
Published: March 2017

Retinitis pigmentosa (RP) is a common retinal degeneration disease caused by mutation in any gene of the photo transduction cascade and results in photoreceptor dystrophy. Over decades, several animal models have been used to address the need for elucidation of effective therapeutics and factors regulating retinal degeneration to prohibit or renew the damaged retina. However, controversies over immune privilege of retina during cell transplantation and role of immune modulation during RP still remain largely uninvestigated due to lack of proper animal models. Therefore, in our present study, we have developed an immune compromised mouse model NOD.SCID- rd1 for retinitis pigmentosa (RP) by crossing CBA/J and NOD SCID mice and selecting homozygous double mutant animals for further breeding. Characterization of the newly developed RP model indicates similar retinal degeneration pattern as CBA/J with decreased apoptosis rate and rhodopsin loss. It also exhibits loss of T cells, B cells and NK cells. NOD.SCID- rd1model is extremely useful for xenogenic cell based therapeutics as indicated by higher cell integration capacity post transplantation. The dissection of underlying role of immune system in the progression of RP and effect of immune deficiency on immune privilege of eye has also been further elucidated using comparative qPCR studies of this model with immune competent RP model.
A Drosophila model of dominant inclusion body myopathy 3 shows diminished myosin kinetics that reduce muscle power and yield myofibrillar defects
Authors: Suggs Jennifer A. , Melkani Girish C. , Glasheen Bernadette M. , Detor Mia M. , Melkani Anju , Marsan Nathan P. , Swank Douglas M. , Bernstein Sanford I.
Published: March 2017

Inclusion body myopathy type 3 (IBM-3) patients display congenital joint contractures with early-onset muscle weakness that becomes more severe in adults. The disease arises from an autosomal dominant point mutation causing an E706K substitution in myosin heavy chain type IIa. We previously expressed the corresponding myosin mutation (E701K) in homozygous Drosophila indirect flight muscles and recapitulated the myofibrillar degeneration and inclusion bodies observed in the human disease. We also found that purified E701K myosin has dramatically reduced actin-sliding velocity and ATPase levels. Since IBM-3 is a dominant condition, we now examine the disease state in heterozygote Drosophila in order to gain a mechanistic understanding of E701K pathogenicity. Myosin ATPase activities in heterozygotes suggest that approximately equimolar levels of myosin accumulate from each allele. In vitro actin sliding velocity rates for myosin isolated from the heterozygotes were lower than the control, but higher than for the pure mutant isoform. Although sarcomeric ultrastructure was nearly wild-type in young adults, mechanical analysis of skinned indirect flight muscle fibers revealed an 85% decrease in maximum oscillatory power generation and an ∼6-fold reduction in the frequency at which maximum power was produced. Rate constant analyses suggest a decrease in the rate of myosin attachment to actin, with myosin spending decreased time in the strongly bound state. These mechanical alterations result in a one third decrease in wing beat frequency and marginal flight ability. With aging, muscle ultrastructure and function progressively declined. Aged myofibrils showed Z-line streaming, consistent with the human heterozygote phenotype. Based upon the mechanical studies, we hypothesize that the mutation decreases the probability of the power stroke occurring and/or alters the degree of movement of the myosin lever arm, resulting in decreased in vitro motility, reduced muscle power output and focal myofibrillar disorganization similar to that seen in human IBM-3 patients.
Validating accelerometry estimates of energy expenditure across behaviours using heart rate data in a free-living seabird
Authors: Hicks Olivia , Burthe Sarah , Daunt Francis , Butler Adam , Bishop Charles , Green Jonathan A.
Published: March 2017

Two main techniques have dominated the field of ecological energetics, the heart-rate and doubly labelled water methods. Although well established, they are not without their weaknesses, namely expense, intrusiveness and lack of temporal resolution. A new technique has been developed using accelerometers; it uses the Overall Dynamic Body Acceleration (ODBA) of an animal as a calibrated proxy for energy expenditure. This method provides high resolution data without the need for surgery. Significant relationships exist between rate of oxygen consumption (V̇o2) and ODBA in controlled conditions across a number of taxa; however, it is not known whether ODBA represents a robust proxy for energy expenditure consistently in all natural behaviours and there have been specific questions over its validity during diving, in diving endotherms. Here we simultaneously deployed accelerometers and heart rate loggers in a wild population of European shags (Phalacrocorax aristotelis). Existing calibration relationships were then used to make behaviour-specific estimates of energy expenditure for each of these two techniques. Compared against heart rate derived estimates the ODBA method predicts energy expenditure well during flight and diving behaviour, but overestimates the cost of resting behaviour. We then combine these two datasets to generate a new calibration relationship between ODBA and V̇o2 that accounts for this by being informed by heart rate derived estimates. Across behaviours we find a good relationship between ODBA and V̇o2. Within individual behaviours we find useable relationships between ODBA and V̇o2 for flight and resting, and a poor relationship during diving. The error associated with these new calibration relationships mostly originates from the previous heart rate calibration rather than the error associated with the ODBA method. The equations provide tools for understanding how energy constrains ecology across the complex behaviour of free-living diving birds.
A new cis-acting motif is required for the axonal SMN-dependent Anxa2 mRNA localization
Authors: Rihan Khalil , Antoine Etienne , Maurin Thomas , Bardoni Barbara , Bordonné Rémy , Soret Johann , Rage Florence
Published: March 2017

Spinal muscular atrophy (SMA) is caused by mutations and/or deletions of the survival motor neuron gene (SMN1). Besides its function in the biogenesis of spliceosomal snRNPs, SMN might possess a motor neuron specific role and could function in the transport of axonal mRNAs and in the modulation of local protein translation. Accordingly, SMN colocalizes with axonal mRNAs of differentiated NSC-34 motor neuron-like cells. We recently showed that SMN depletion gives rise to a decrease in the axonal transport of the mRNAs encoding Annexin A2 (Anxa2). In this work, we have characterized the structural features of the Anxa2 mRNA required for its axonal targeting by SMN. We found that a G-rich motif located near the 3′UTR is essential for axonal localization of the Anxa2 transcript. We also show that mutations in the motif sequence abolish targeting of Anxa2 reporter mRNAs in axon-like structures of differentiated NSC-34 cells. Finally, localization of both wild-type and mutated Anxa2 reporters is restricted to the cell body in SMN-depleted cells. Altogether, our studies show that this G-motif represents a novel and essential determinant for axonal localization of the Anxa2 mRNA mediated by the SMN complex.
Single-cell transcriptomics reveals specific RNA editing signatures in the human brain
Authors: Picardi Ernesto , Horner David S. , Pesole Graziano
Published: March 2017

While RNA editing by A-to-I deamination is a requisite for neuronal function in humans, it is under-investigated in single cells. Here we fill this gap by analyzing RNA editing profiles of single cells from the brain cortex of living human subjects. We show that RNA editing levels per cell are bimodally distributed and distinguish between major brain cell types, thus providing new insights into neuronal dynamics.
Nasal Septal Deviation and Concha Bullosa – Do They Have an Impact on Maxillary Sinus Volumes and Prevalence of Maxillary Sinusitis?
Authors: Kucybała Iwona , Janik Konrad Adam , Ciuk Szymon , Storman Dawid , Urbanik Andrzej
Published: March 2017

Background: The aim of the study was to assess if the presence of nasal septal deviation and concha bullosa is connected with the development of sinuses and the incidence of inflammation within them.

Material/Methods: We retrospectively analysed 214 patients who underwent paranasal sinus computed tomography. There were 125 females and 89 males, the mean age being 47.67±16.74 years (range 18–97). Exclusion criteria included: age under 18 years, prior sinonasal surgery and S-shaped septum.

Results: Mean volume of the right maxillary sinus was 17.794 cm3, while for the left one it was 17.713 cm3. Nasal septal deviation was found in 79.9% of computed tomography examinations and concha bullosa was observed in 42.1% of the patients’ examinations. There was an association between the presence of unilateral or dominant concha bullosa and contralateral direction of septal deviation [right-sided (p=0.039), left-sided (p=0.003)]. There was higher incidence of bilateral maxillary sinusitis in patients with septal deviation (p=0.007). Bilateral concha bullosa did not influence the incidence of bilateral maxillary sinusitis (p=0.495). Neither septal deviation (right sided: p=0.962; left-sided: p=0.731), nor unilateral/dominant concha bullosa (right: p=0.512; left: p=0,430) affected the asymmetry in volumes of maxillary sinuses. Bilateral concha bullosa was connected with larger volume of maxillary sinuses (right sinus: p=0.005; left sinus: p=0.048).

Conclusions: Nasal septal deviation, contrary to concha bullosa, has influence on the development of maxillary sinusitis. There is a connection between the presence of concha bullosa and direction of septal deviation. Only bilateral concha bullosa affects maxillary sinus volumes.
Standardized Attending Rounds to Improve the Patient Experience: A Pragmatic Cluster Randomized Controlled Trial
Authors: Monash Bradley , Najafi Nader , Mourad Michelle , Rajkomar Alvin , Ranji Sumant R. , Fang Margaret C. , Glass Marcia , Milev Dimiter , Ding Yile , Shen Andy , Sharpe Bradley A. , Harrison James D.
Published: March 2017

BACKGROUND

At academic medical centers, attending rounds (AR) serve to coordinate patient care and educate trainees, yet variably involve patients.

OBJECTIVE

To determine the impact of standardized bedside AR on patient satisfaction with rounds.

DESIGN

Cluster randomized controlled trial.

SETTING

500‐bed urban, quaternary care hospital.

PATIENTS

1200 patients admitted to the medicine service.

INTERVENTION

Teams in the intervention arm received training to adhere to 5 AR practices: 1) pre‐rounds huddle; 2) bedside rounds; 3) nurse integration; 4) real‐time order entry; 5) whiteboard updates. Control arm teams continued usual rounding practices.

MEASUREMENTS

Trained observers audited rounds to assess adherence to recommended AR practices and surveyed patients following AR. The primary outcome was patient satisfaction with AR. Secondary outcomes were perceived and actual AR duration, and attending and trainee satisfaction.

RESULTS

We observed 241 (70.1%) and 264 (76.7%) AR in the intervention and control arms, respectively, which included 1855 and 1903 patient rounding encounters. Using a 5‐point Likert scale, patients in the intervention arm reported increased satisfaction with AR (4.49 vs 4.25; P = 0.01) and felt more cared for by their medicine team (4.54 vs 4.36; P = 0.03). Although the intervention shortened the duration of AR by 8 minutes on average (143 vs 151 minutes; P = 0.052), trainees perceived intervention AR as lasting longer and reported lower satisfaction with intervention AR.

CONCLUSIONS

Medicine teams can adopt a standardized, patient‐centered, time‐saving rounding model that leads to increased patient satisfaction with AR and the perception that patients are more cared for by their medicine team.
The Impact of Bedside Interdisciplinary Rounds on Length of Stay and Complications
Authors: Dunn Andrew S. , Reyna Maria , Radbill Brian , Parides Michael , Colgan Claudia , Osio Tobi , Benson Ari , Brown Nicole , Cambe Joy , Zwerling Margo , Egorova Natalia , Kaplan Harold
Published: March 2017

BACKGROUND

Communication among team members within hospitals is typically fragmented. Bedside interdisciplinary rounds (IDR) have the potential to improve communication and outcomes through enhanced structure and patient engagement.

OBJECTIVE

To decrease length of stay (LOS) and complications through the transformation of daily IDR to a bedside model.

DESIGN

Controlled trial.

SETTING

2 geographic areas of a medical unit using a clinical microsystem structure.

PATIENTS

2005 hospitalizations over a 12‐month period.

INTERVENTIONS

A bedside model (mobile interdisciplinary care rounds [MICRO]) was developed. MICRO featured a defined structure, scripting, patient engagement, and a patient safety checklist.

MEASUREMENTS

The primary outcomes were clinical deterioration (composite of death, transfer to a higher level of care, or development of a hospital‐acquired complication) and length of stay (LOS). Patient safety culture and perceptions of bedside interdisciplinary rounding were assessed pre‐ and postimplementation.

RESULTS

There was no difference in LOS (6.6 vs 7.0 days, P = 0.17, for the MICRO and control groups, respectively) or clinical deterioration (7.7% vs 9.3%, P = 0.46). LOS was reduced for patients transferred to the study unit (10.4 vs 14.0 days, P = 0.02, for the MICRO and control groups, respectively). Nurses and hospitalists gave significantly higher scores for patient safety climate and the efficiency of rounds after implementation of the MICRO model.

LIMITATIONS

The trial was performed at a single hospital.

CONCLUSIONS

Bedside IDR did not reduce overall LOS or clinical deterioration. Future studies should examine whether comprehensive transformation of medical units, including co‐leadership, geographic cohorting of teams, and bedside interdisciplinary rounding, improves clinical outcomes compared to units without these features.
Condition Help: A Patient‐ and Family‐Initiated Rapid Response System
Authors: Eden Elizabeth L. , Rack Laurie L. , Chen Ling‐Wan , Bump Gregory M.
Published: March 2017

BACKGROUND

Rapid response teams (RRTs) help in delivering safe, timely care. Typically they are activated by clinicians using specific parameters. Allowing patients and families to activate RRTs is a novel intervention. The University of Pittsburgh Medical Center developed and implemented a patient‐ and family‐initiated rapid response system called Condition Help (CH).

METHODS

When the CH system is activated, a patient care liaison or an on‐duty administrator meets bedside with the unit charge nurse to address the patient's concerns. In this study, we collected demographic data, call reasons, call designations (safety or nonsafety), and outcome information for all CH calls made during the period January 2012 through June 2015.

RESULTS

Two hundred forty patients/family members made 367 CH calls during the study period. Most calls were made by patients (76.8%) rather than family members (21.8%). Of the 240 patients, 43 (18%) made multiple calls; their calls accounted for 46.3% of all calls (170/367). Inadequate pain control was the reason for the call in most cases (48.2%), followed by dissatisfaction with staff (12.5%). The majority of calls involved nonsafety issues (83.4%) rather than safety issues (11.4%). In 41.4% of cases, a change in care was made.

CONCLUSION

Patient‐ and family‐initiated RRTs are designed to engage patients and families in providing safer care. In the CH system, safety issues are identified, but the majority of calls involve nonsafety issues.
Family Report Compared to Clinician‐Documented Diagnoses for Psychiatric Conditions Among Hospitalized Children
Authors: Doupnik Stephanie K. , Feudtner Chris , Marcus Steven C.
Published: March 2017

BACKGROUND

Psychiatric comorbidity is common in pediatric medical and surgical hospitalizations and is associated with worse hospital outcomes. Integrating medical or surgical and psychiatric hospital care depends on accurate estimates of which hospitalized children have psychiatric comorbidity.

OBJECTIVE

We conducted a study to determine agreement of family report (FR) and clinician documentation (CD) identification of psychiatric diagnoses in hospitalized children.

DESIGN AND SETTING

This was a cross‐sectional study at a tertiary‐care children's hospital.

PATIENTS

The patients were children and adolescents (age, 4‐21 years) who were hospitalized for medical or surgical indications.

MEASUREMENTS

Psychiatric diagnoses were identified from structured interviews (FR) and from inpatient notes and International Classification of Diseases codes in medical records (CD). We compared estimates of point prevalence of any comorbid psychiatric diagnosis using each method, and estimated FR–CD agreement in identifying psychiatric comorbidity in hospitalized children.

RESULTS

Of 119 study patients, 26 (22%; 95% confidence interval [CI], 14%‐29%) had a psychiatric comorbidity identified by FR, 30 (25%; 95% CI, 17%‐34%) had it identified by CD, and 37 (23%‐40%) had it identified by FR or CD. Agreement between FR and CD was low overall (κ = .46; 95% CI, .27‐.66), highest for attention‐deficit/hyperactivity disorder (κ = .78; 95% CI, .59‐.97), and lowest for anxiety disorders (κ = .11; 95% CI, –.16 to .56).

CONCLUSIONS

Current methods may underestimate the prevalence of psychiatric conditions in hospitalized children. Information from multiple sources may be needed to develop accurate estimates of the scope of the population in need of services so that mental health resources can be appropriately allocated.
“We're Almost Guests in Their Clinical Care”: Inpatient Provider Attitudes Toward Chronic Disease Management
Authors: Blecker Saul , Meisel Talia , Dickson Victoria Vaughan , Shelley Donna , Horwitz Leora I.
Published: March 2017

BACKGROUND

Many hospitalized patients have at least 1 chronic disease that is not optimally controlled. The purpose of this study was to explore inpatient provider attitudes about chronic disease management and, in particular, barriers and facilitators of chronic disease management in the hospital.

METHODS

We conducted a qualitative study of semi‐structured interviews of 31 inpatient providers from an academic medical center. We interviewed attending physicians, resident physicians, physician assistants, and nurse practitioners from various specialties about attitudes, experiences with, and barriers and facilitators towards chronic disease management in the hospital. Qualitative data were analyzed using constant comparative analysis.

RESULTS

Providers perceived that hospitalizations offer an opportunity to improve chronic disease management, as patients are evaluated by a new care team and observed in a controlled environment. Providers perceived clinical benefits to in‐hospital chronic care, including improvements in readmission and length of stay, but expressed concerns for risks related to adverse events and distraction from the acute problem. Barriers included provider lack of comfort with managing chronic diseases, poor communication between inpatient and outpatient providers, and hospital‐system focus on patient discharge. A strong relationship with the outpatient provider and involvement of specialists were facilitators of inpatient chronic disease management.

CONCLUSIONS

Providers perceived benefits to in‐hospital chronic disease management for both processes of care and clinical outcomes. Efforts to increase inpatient chronic disease management will need to overcome barriers in multiple domains.
The Unmet Need for Postacute Rehabilitation Among Medicare Observation Patients: A Single‐Center Study
Authors: Goldstein Jennifer N. , Schwartz J. Sanford , McGraw Patricia , Banks Tobias L. , Hicks LeRoi S.
Published: March 2017

BACKGROUND

Medicare beneficiaries admitted under observation status must pay for postacute inpatient rehabilitation (PAIR) services, out of pocket, at potentially prohibitive costs.

OBJECTIVE

To determine if there is an unmet need for PAIR among Medicare observation patients and if this care is associated with longer hospital stay and increased rehospitalization.

DESIGN/SETTING

Observational study using electronic medical record and administrative data from a regional health system.

PATIENTS

1323 community‐dwelling Medicare patients admitted under observation status.

MEASUREMENTS

Summary statistics were calculated for demographic and administrative variables. Physical therapy (PT) and case management recommendations for a representative sample of 386 medical records were reviewed regarding need for PAIR services. Linear regression was used to measure the association between PT recommendation and hospital length of stay, adjusting for ICD‐9 (International Classification of Diseases, Ninth Revision) diagnosis, age, sex, and provider. Chi‐square test was used to determine the association between PT recommendation and 30‐day hospital revisit.

RESULTS

Of the 1323 study patients, 11 (0.83%) were discharged to PAIR facilities. However, 17 (4.4%) of the 386 patients whose charts were reviewed received a recommendation for this care. Adjusted mean hospital stay was longer (P < 0.001) for patients recommended for rehabilitation (75.9 h) than for patients with no PT needs (46.8 h). In addition, the 30‐day hospital revisit rate was higher (P = 0.037) for the patients who had been recommended for rehabilitation (52.9%, 9/17) than for those who had not (25.4%, 30/118).

CONCLUSIONS

Medicare observation patients' potential need for PAIR services is 5‐ to 6‐fold higher than their use of these services. Observation patients recommended for this care may have worse outcomes.
Perceived Safety and Value of Inpatient “Very Important Person” Services
Authors: Allen‐Dicker Joshua , Auerbach Andrew , Herzig Shoshana J.
Published: March 2017

Providing care to “very important person” (VIP) patients can pose unique moral and value‐based challenges for providers. No studies have examined VIP services in the inpatient setting. Through a multi‐institutional survey of hospitalists, we assessed physician viewpoints and behavior surrounding the care of VIP patients. A significant proportion of respondents reported feeling pressured by patients, family members, and hospital representatives to provide unnecessary care to VIP patients. Based on self‐reported perceptions, as well as case‐based questions, we also found that the VIP status of a patient may impact physician clinical decision‐making related to unnecessary medical care. Additional studies to quantify the use of VIP services and its effect on cost, resource availability, and patient‐specific outcomes are needed.
A Time and Motion Study of Pharmacists and Pharmacy Technicians Obtaining Admission Medication Histories
Authors: Nguyen Caroline B. , Shane Rita , Bell Douglas S. , Cook‐Wiens Galen , Pevnick Joshua M.
Published: March 2017

Pharmacists' admission medication histories (AMHs) are known to reduce adverse drug events (ADEs). Pharmacist‐supervised pharmacy technicians (PSPTs) have also been used in this role. Nonetheless, few studies estimate the costs of utilizing PSPTs to obtain AMHs. We used time and motion methodology to study the time and cost required for pharmacists and PSPTs to obtain AMHs for patients at high risk for ADEs. Pharmacists and PSPTs required 58.5 (95% confidence interval [CI], 46.9‐70.1) and 79.4 (95% CI, 59.1‐99.8) minutes per patient, respectively (P = 0.14). PSPT‐obtained AMHs also required 26.0 (95% CI, 14.9‐37.1) minutes of pharmacist supervision per patient. Based on 2015 US Bureau of Labor Statistics wage data, we estimated the cost of having pharmacists and PSPTs obtain AMHs to be $55.91 (95% CI, 44.9‐67.0) and $45.00 (95% CI, 29.7‐60.4), respectively, which included pharmacist supervisory cost, per patient (P = 0.32). Thus, we found no statistically significant difference in time or cost between the two provider types.
Hospital Medicine Resident Training Tracks: Developing the Hospital Medicine Pipeline
Authors: Sweigart Joseph R. , Tad‐y Darlene , Kneeland Patrick , Williams Mark V. , Glasheen Jeffrey J.
Published: March 2017

BACKGROUND

Hospital medicine (HM) is rapidly evolving into new clinical and nonclinical roles. Traditional internal medicine (IM) residency training likely does not optimally prepare residents for success in HM. Hospital medicine residency training tracks may offer a preferred method for specialized HM education.

METHODS

Internet searches and professional networks were used to identify HM training tracks. Information was gathered from program websites and discussions with track directors.

RESULTS

The 11 HM tracks at academic medical centers across the United States focus mostly on senior residents. Track structure and curricular content are determined largely by the structure and curricula of the IM residency programs in which they exist. Almost all tracks feature experiential quality improvement projects. Content on healthcare economics and value is common, and numerous track leaders report this content is expanding from HM tracks into entire residency programs. Tracks also provide opportunities for scholarship and professional development, such as workshops on abstract creation and job procurement skills. Almost all tracks include HM preceptorships as well as rotations within various disciplines of HM.

CONCLUSIONS

HM residency training tracks focus largely on quality improvement, health care economics, and professional development. The structures and curricula of these tracks are tightly linked to opportunities within IM residency programs. As HM continues to evolve, these tracks likely will expand to bridge clinical and extra‐clinical gaps between traditional IM training and contemporary HM practice.
Health Information Exchange in US Hospitals: The Current Landscape and a Path to Improved Information Sharing
Authors: Holmgren A Jay , Adler‐Milstein Julia
Published: March 2017

Electronic health information exchange (HIE) was a foundational goal of the 2009 Health Information Technology for Economic and Clinical Health (HITECH) Act, but 7 years later we are far from a nationally interoperable health system. Connected electronic health records have the potential to enable fast access to a wealth of clinical data and can deliver a solution to the highly fragmented US healthcare system. In this review, we present a history and background of HIE, including its potential to deliver significant cost savings to the healthcare system. We examine the key components of HIE, including exchanges, the mechanism, and options available to providers. Health information exchange faces significant challenges, ranging from technical issues to lack of a clear goal, but continued policy initiatives and new technologies represent a promising path to providing clinicians with routine, electronic patient data.
Inhibitory effects of vancomycin and fosfomycin on methicillin-resistant Staphylococcus aureus from antibiotic-impregnated articulating cement spacers
Authors: Yuenyongviwat V. , Ingviya N. , Pathaburee P. , Tangtrakulwanich B.
Published: March 2017

Objectives

Vancomycin and fosfomycin are antibiotics commonly used to treat methicillin-resistant Staphylococcus aureus (MRSA) infection. This study compares the in vitro inhibitory effects against MRSA of articulating cement spacers impregnated with either vancomycin or fosfomycin.

Methods

Vancomycin-impregnated articulating cement spacers and fosfomycin-impregnated articulating cement spacers were immersed in sterile phosphate-buffered saline (PBS) solutions and then incubated. Samples were collected for bioactivity evaluation. The aliquots were tested for MRSA inhibition with the disc diffusion method, and the inhibition zone diameters were measured. The inhibition zone differences were evaluated using the Wilcoxon Rank Sum Test.

Results

The vancomycin group had significantly larger inhibition zones than the fosfomycin group from day three through to completion of the fourth week of incubation (p < 0.001). The vancomycin group exhibited a MRSA inhibition zone up to four weeks but the fosfomycin group showed an inhibition zone for only three days and after that did not show the the potential to inhibit MRSA.

Conclusion

This in vitro study found that the inhibitory effect of vancomycin-impregnated articulating cement spacers against MRSA outperformed fosfomycin-impregnated articulating cement spacers. Further comparing our results to other published reports suggests there might be a limitation of the disc diffusion bioassay to show a large inhibitory zone in a high concentration of a highly soluble antibiotic. Cite this article: V. Yuenyongviwat, N. Ingviya, P. Pathaburee, B. Tangtrakulwanich. Inhibitory effects of vancomycin and fosfomycin on methicillin-resistant Staphylococcus aureus from antibiotic-impregnated articulating cement spacers. Bone Joint Res 2017;6:132–136. DOI: 10.1302/2046-3758.63.2000639.
The effect of systemic administration of G-CSF on a full-thickness cartilage defect in a rabbit model MSC proliferation as presumed mechanism
Authors: Sasaki T. , Akagi R. , Akatsu Y. , Fukawa T. , Hoshi H. , Yamamoto Y. , Enomoto T. , Sato Y. , Nakagawa R. , Takahashi K. , Yamaguchi S. , Sasho T.
Published: March 2017

Objectives

The aim of this study was to investigate the effect of granulocyte-colony stimulating factor (G-CSF) on mesenchymal stem cell (MSC) proliferation in vitro and to determine whether pre-microfracture systemic administration of G-CSF (a bone marrow stimulant) could improve the quality of repaired tissue of a full-thickness cartilage defect in a rabbit model.

Methods

MSCs from rabbits were cultured in a control medium and medium with G-CSF (low-dose: 4 μg, high-dose: 40 μg). At one, three, and five days after culturing, cells were counted. Differential potential of cultured cells were examined by stimulating them with a osteogenic, adipogenic and chondrogenic medium. A total of 30 rabbits were divided into three groups. The low-dose group (n = 10) received 10 μg/kg of G-CSF daily, the high-dose group (n = 10) received 50 μg/kg daily by subcutaneous injection for three days prior to creating cartilage defects. The control group (n = 10) was administered saline for three days. At 48 hours after the first injection, a 5.2 mm diameter cylindrical osteochondral defect was created in the femoral trochlea. At four and 12 weeks post-operatively, repaired tissue was evaluated macroscopically and microscopically.

Results

The cell count in the low-dose G-CSF medium was significantly higher than that in the control medium. The differentiation potential of MSCs was preserved after culturing them with G-CSF. Macroscopically, defects were filled and surfaces were smoother in the G-CSF groups than in the control group at four weeks. At 12 weeks, the quality of repaired cartilage improved further, and defects were almost completely filled in all groups. Microscopically, at four weeks, defects were partially filled with hyaline-like cartilage in the G-CSF groups. At 12 weeks, defects were repaired with hyaline-like cartilage in all groups.

Conclusions

G-CSF promoted proliferation of MSCs in vitro. The systemic administration of G-CSF promoted the repair of damaged cartilage possibly through increasing the number of MSCs in a rabbit model. Cite this article: T. Sasaki, R. Akagi, Y. Akatsu, T. Fukawa, H. Hoshi, Y. Yamamoto, T. Enomoto, Y. Sato, R. Nakagawa, K. Takahashi, S. Yamaguchi, T. Sasho. The effect of systemic administration of G-CSF on a full-thickness cartilage defect in a rabbit model MSC proliferation as presumed mechanism: G-CSF for cartilage repair. Bone Joint Res 2017;6:123–131. DOI: 10.1302/2046-3758.63.BJR-2016-0083.
Augmented reality in bone tumour resection
Authors: Cho H. S. , Park Y. K. , Gupta S. , Yoon C. , Han I. , Kim H-S. , Choi H. , Hong J.
Published: March 2017

Objectives

We evaluated the accuracy of augmented reality (AR)-based navigation assistance through simulation of bone tumours in a pig femur model.

Methods

We developed an AR-based navigation system for bone tumour resection, which could be used on a tablet PC. To simulate a bone tumour in the pig femur, a cortical window was made in the diaphysis and bone cement was inserted. A total of 133 pig femurs were used and tumour resection was simulated with AR-assisted resection (164 resection in 82 femurs, half by an orthropaedic oncology expert and half by an orthopaedic resident) and resection with the conventional method (82 resection in 41 femurs). In the conventional group, resection was performed after measuring the distance from the edge of the condyle to the expected resection margin with a ruler as per routine clinical practice.

Results

The mean error of 164 resections in 82 femurs in the AR group was 1.71 mm (0 to 6). The mean error of 82 resections in 41 femurs in the conventional resection group was 2.64 mm (0 to 11) (p < 0.05, one-way analysis of variance). The probabilities of a surgeon obtaining a 10 mm surgical margin with a 3 mm tolerance were 90.2% in AR-assisted resections, and 70.7% in conventional resections.

Conclusion

We demonstrated that the accuracy of tumour resection was satisfactory with the help of the AR navigation system, with the tumour shown as a virtual template. In addition, this concept made the navigation system simple and available without additional cost or time. Cite this article: H. S. Cho, Y. K. Park, S. Gupta, C. Yoon, I. Han, H-S. Kim, H. Choi, J. Hong. Augmented reality in bone tumour resection: An experimental study. Bone Joint Res 2017;6:137–143.
Indicadores de sustentabilidade em duas áreas distintas, em Caldas/MG, através da metodologia MESMIS
Authors: Barbosa Milta Margaret , Reis Jéssica Daiane dos , Giunti Otavio Duarte , Silva Ariana Vieira
Published: March 2017

O desenvolvimento sustentável é condição essencial para reverter e minimizar os impactos decorrentes das mudanças oriundas da intervenção humana nos recursos ambientais. Esse trabalho teve por objetivos a criação, seleção e aplicação de indicadores de sustentabilidade, por meio de diagnóstico visual, composto por 26 parâmetros indicadores através da metodologia MESMIS. Foram escolhidas duas áreas para a aplicação, uma constituída por um fragmento de mata nativa e a outra constituída por área de pastagem, próxima a uma nascente, ambas na Fazenda Pedra Branca, município de Caldas, no sul de Minas Gerais, que está inserida dentro da Área de Proteção Ambiental (APA) Santuário Ecológico da Pedra Branca. Como resultados, o fragmento de mata apresentou elevado índice de sustentabilidade, sendo necessário um baixo manejo da área. Já a área de pastagem apresentou vários pontos críticos a serem melhorados. A maior parte dos pontos críticos está relacionada à pouca diversidade ecológica da área e sugere-se como alternativa para elevar a diversidade a integração entre a manejo da pastagem e a produção florestal, através da inserção de ilhas e aleias compostas por espécies arbóreo-arbustivas. Também é proposta a recomposição da vegetação ciliar da nascente próxima à pastagem, em área rural consolidada.
Estimativa de recarga do sistema aquífero guarani por meio da aplicação do método da variação da superfície livre na bacia do Rio Ibicuí-RS
Authors: Simon Flora Würth , Reginato Pedro Antonio Roehe , Kirchheim Roberto Eduardo , Troian Guilherme Casarotto
Published: March 2017

A estimativa da recarga subterrânea é determinante para a gestão sustentável das águas subterrâneas. A recarga pode ser estimada usando diferentes métodos que variam de acordo com as características da área estudada, as escalas temporais e espaciais adotadas e a disponibilidade de dados. O objetivo é estimar a recarga de unidades hidroestratigráficas pertencentes ao Sistema Aquífero Guarani (SAG), localizado na bacia do rio Ibicuí, com base na aplicação do método Variação dos Níveis d'Água (VNA). Os dados de nível d'água foram obtidos a partir de cinco poços de monitoramento pertencentes à rede RIMAS (Rede Integrada de Monitoramento de Águas Subterrâneas) da CPRM/Serviço Geológico do Brasil, instalados na bacia. O método foi aplicado para a média mensal dos níveis de água em cada poço de monitoramento, em períodos que variaram entre 24 e 39 meses. A recarga mensal foi estimada entre 417 mm e 730,7 mm, e as porcentagens de recarga em relação à precipitação variaram entre 11% e 18%, com média de 13,82%. Na região noroeste da bacia foram encontrados valores mais altos em contraposição à região sul. O método apresentou resultados compatíveis com outros estudos realizados na mesma região.
O que são poços? um panorama das terminologias utilizadas para captações de águas subterrâneas
Authors: Vasconcelos Mickaelon Belchior
Published: March 2017

Os avanços dos estudos de hidrologia subterrânea muitas vezes deixam de lado alguns conceitos essenciais e básicos referentes à área de conhecimento. As unidades de captações de águas subterrâneas, também conhecidas como poços, recebem diversas denominações nos mais diversos estudos e pesquisas em regiões distintas. Palavras como artesiano, freático, dentre outras, correlatas com os estudos com águas subterrâneas, são muitas vezes utilizadas de forma errônea na literatura existente. A falta de uma padronização de termos pode gerar dificuldades na interpretação dos dados em determinadas situações por causa da diferenciação das linguagens e, consequentemente, falta de compatibilidade entre banco de dados. Este trabalho objetiva traçar um panorama das terminologias utilizadas para denominar as unidades de captação de águas subterrâneas e, com isso, gerar uma discussão sobre a uniformização de uma nomenclatura única. A metodologia adotada na execução deste estudo foi realizada basicamente através da análise de trabalhos anteriores. Foi verificado que o assunto da “falta de uma padronização” já foi abordado por outros pesquisadores, porém a ausência de uma nomenclatura específica para as unidades de captação de águas subterrâneas continua existindo.