bluuebunny/crossref_metadata_2025 huggingface dataset:
A Systematic Review of the Impact of Potentially Inappropriate Medication on Health Care Utilization and Costs Among Older Adults
Authors: Hyttinen Virva , Jyrkkä Johanna , Valtonen Hannu
Published: July 2016

Background:

Potentially inappropriate medications (PIMs) are defined as those medicines having a greater potential risk than benefit for older adults. In this systematic literature review, we evaluate the current evidence on health care service use and health care costs associated with PIMs among older adults.

Methods:

A literature search was conducted in August 2015 without publication date restrictions using the databases PubMed and Scopus. Selected articles included in the review of articles were: (1) observational cohort or case-control, or intervention studies; (2) investigating PIM use among older adults aged 65 years or older with outcomes on health care utilization (eg, hospitalization) or health care costs; and (3) use of some published criteria for assessing PIMs.

Results:

Of 825 abstracts screened, in total 51 articles proceeded to full-text review. Of those full-text articles, 39 articles were included in this review. Most of the articles found that PIMs had a statistically significant effect on health care service use, especially on hospitalization, among older adults. The findings of impact on length of stay or readmissions were inconclusive. Five studies found statistically significant higher medical or total health care costs for PIM users compared those who did not use any PIMs.

Conclusions:

PIMs can, in addition to health and quality of life problems, also lead to greater health care service use and, thus, higher health care costs. However, the heterogeneity of the study settings makes the interpretation of the results difficult. Further studies, especially on economic issues with country-specific criteria, are needed.
Management of sudden sensorineural hearing loss
Authors: Metrailer Aaron M. , Babu Seilesh C.
Published: July 2016

Purpose of review

Sudden sensorineural hearing loss (SNHL) is an otologic emergency and should be managed quickly and effectively. This review focuses on the management of sudden SNHL, primarily idiopathic sudden SNHL as it is the most common cause.

Recent findings

Management options include observation, oral steroids, intratympanic steroids, or combined oral/intratympanic steroids. One-third to two-thirds of patients will achieve spontaneous recovery, most likely within the first 2 weeks. Despite the lack of randomized controlled trials on steroid therapy efficacy, all patients should be offered steroid treatment given low risk and possible significant benefits. All patients should undergo MRI with gadolinium to rule out retrocochlear disorder. Bilateral sudden hearing loss should alert the clinician to possible systemic disease.

Sudden hearing loss is an otologic emergency. Appropriate counseling of patients is necessary to allow physician and patient to make a joint, educated decision. It is paramount to rule out retrocochlear disorder and to follow patients closely for improvement or need for future auditory rehabilitation.
Primary treatment of idiopathic sudden sensorineural hearing loss with intratympanic dexamethasone
Authors: Hobson Candace E. , Alexander Thomas H. , Harris Jeffrey P.
Published: July 2016

Purpose of review

Systemic corticosteroids have been the mainstay of treatment of idiopathic sudden sensorineural hearing loss (ISSNHL) for over 30 years. Recently, intratympanic steroids have risen in popularity; however, there is no consensus regarding the details of their application. The purpose of this article is to review the current literature and share our opinion that intratympanic dexamethasone (alone or with systemic steroids) should be offered as primary treatment of ISSNHL.

Recent findings

Intratympanic steroids have been shown to result in higher inner ear concentrations than systemic steroids in animal and human studies. Primary treatment of ISSNHL with intratympanic steroids in combination with systemic steroids has been demonstrated to result in better hearing outcomes than systemic steroids alone. Recent evidence has revealed these hearing outcomes to be dependent on the dose of intratympanic steroid. Dexamethasone may be better absorbed than methylprednisolone, and potentially offer a greater benefit. Furthermore, intratympanic steroids provide an effective alternative for patients who cannot tolerate systemic steroids.

Intratympanic dexamethasone alone, or in combination with systemic steroids, provides effective treatment of ISSNHL and should be utilized as primary treatment. Further investigation is required to determine the optimal choice, concentration, and administration schedule of intratympanic steroids.
Hepatitis B immunity in the pediatric liver transplant population
Authors: Patel Shreena S. , Leung Daniel H.
Published: July 2016

Purpose of review

Hepatitis B virus (HBV) infection contributes significantly to vaccine-preventable disease related deaths, and insufficient HBV immunity may have unique implications for the pediatric liver transplant population. This article reviews the significance of HBV infection and the vaccination and screening measures needed to achieve adequate HBV immunity in these children.

Recent findings

HBV non-immunity among transplant candidates is higher than expected, even after appropriate completion of the vaccine series. Annual measurement of quantifiable HBV surface antibody in this vulnerable group should guide administration of booster and/or re-vaccination, improving immunoprotection from this potentially deadly hepatotropic virus. The liver plays a vital role in immune regulation; it induces immune tolerance and competence and both clears antigens from the circulation and generates liver-primed memory cells through antigen presentation via hepatic scavenger cells. Lymphocyte populations are depleted in patients with liver disease.

Immunity provided during early childhood against HBV infection is important to both pediatric liver transplant candidates and aging recipients. Appropriate vaccination and achievement of adequate immunity pre-transplant and post-transplant is critical. The field of pediatric transplantation is ripe for functional cellular and humoral immunity studies that examine factors which predict poor immune response to childhood vaccines, particularly HBV.
Fatal Pulmonary Embolism Due to Inherited Thrombophilia Factors in a Child With Wolfram Syndrome
Authors: Küçüktaşçi Kazim , Semiz Serap , Balci Yasemin Işik , Özsari Tamer , Gürses Dolunay , Önem Gökhan , Saçar Mustafa , Düzcan Füsun , Yüksel Doğangün , Semiz Ender
Published: July 2016

Wolfram syndrome-1 is a rare and severe autosomal recessive neurodegenerative disease characterized by diabetes mellitus (DM), optic atrophy, diabetes insipidus, and deafness. Poorly controlled type 1 DM increases the risk for thrombosis. However, coexistence of DM and hereditary thrombosis factors is rarely observed. Here we present the case of a 13.5-year-old, nonfollowed girl newly diagnosed with poorly controlled Wolfram syndrome on the basis of the results of clinical and laboratory examinations. On the eighth day after diabetic ketoacidosis treatment, pulmonary embolism developed in the subject. Thrombus identified in the right atrium using echocardiography was treated by emergency thrombectomy. Homozygous mutation in the methylenetetrahydrofolate reductase gene C677T, heterozygous factor-V Leiden mutation, and active protein C resistance were identified in the patient. The patient was lost because of a recurring episode of pulmonary embolism on the 86th day of hospitalization. We present this case to highlight the need for investigating hereditary thrombosis risk factors in diabetic patients in whom thromboembolism develops.
Etiology of Genital Ulcer Disease in Male Patients Attending a Sexually Transmitted Diseases Clinic: First Assessment in Cuba
Authors: Noda Angel A. , Blanco Orestes , Correa Consuelo , Pérez Lissette , Kourí Vivian , Rodríguez Islay
Published: July 2016

Background

Sexually transmitted diseases (STDs) and in particular genital ulcer disease (GUD) have a major impact on morbidity and mortality in developing countries. The World Health Organization recommends the use of syndromic guidelines for the treatment of sexually transmitted infections (STIs) in resource-constrained countries. Surveillance of autochthonous etiologies provides epidemiological information contributing to the prevention and treatment of STIs. We investigated the etiology and factors associated with GUD among male patients attending a STD clinic in Havana, Cuba.

Methods

Swabs from genital ulcers of 113 male patients, collected from May 2012 to June 2015, were analyzed using PCR for herpes simplex virus types 1 and 2, Treponema pallidum, Haemophilus ducreyi, and Chlamydia trachomatis. We also investigated the clinical and epidemiological characteristics associated with the presence of these pathogens in GUD.

Results

At least one of the pathogens was detected in 70% of patients. The occurrence of the pathogens was herpes simplex virus type 2 (HSV-2) (51.3%), T. pallidum (29.2%), and C. trachomatis (1.8%). Co-infections occurred as follows: T. pallidum-HSV-2 (10.6%), C. trachomatis-HSV-2 (0.9%) and C. trachomatis-T. pallidum (0.9%). Herpes simplex virus type 1 and H. ducreyi were not detected. Ages 15 to 40 years, HIV-positive serostatus, and no condom use were significant risk factors for the presence of HSV-2 in genital ulcers.

Conclusions

Our preliminary results highlight the predominance of HSV-2 and T. pallidum as the leading GUD etiologies in the study population and identified risk factors associated with HSV-2. This information should help to inform guidelines for better management of GUD in Havana, Cuba.
Use of a Prospective Sex Diary to Study Anal Lubricant and Enema Use Among High Risk Men Who Have Sex With Men—Implications for Human Immunodeficiency Virus Prevention
Authors: Rolle Charlotte-Paige Melanie , Bolton Marcus D. , Kelley Colleen F.
Published: July 2016

Longitudinal data on episodes of receptive anal intercourse (RAI), lubricant, and enema use in 41 sexually active men who have sex with men were collected using a prospective sex diary. Data on 550 episodes of RAI showed that lubricants were used in 489 (88.9%) of 550 episodes and enemas were used in 165 (30%) of 550 RAI episodes.
Effect of Short Recovery Periods on Ocular Comfort During Daily Lens Wear
Authors: Stahl Ulrike , Keir Nancy J. , Landers Alan , Jones Lyndon W.
Published: July 2016

Purpose

To assess the impact of lens-free intervals of varying lengths on end-of-day comfort with soft contact lenses.

Methods

Twenty-five symptomatic lens wearers participated in this randomized, cross-over study involving nine individual 12-hour days: one spectacle (no lens) and eight lens wear days. On each lens wear day, lenses were worn bilaterally in 2-hour intervals, separated by lens-free (recovery) periods of 0, 30, 60, or 80 minutes (repeated throughout the day). For each 2-hour lens wear interval, new lenses were worn. Ocular comfort was rated on a 0 to 100 visual analogue scale (0 = extremely uncomfortable); tear film and ocular parameters were assessed at the beginning and end of each study day. This study involved two different types of silicone hydrogel lenses, and the order of lens type and length of recovery period was randomized. Participants were unaware of the true study purpose and that a new lens pair was used for each lens wear interval.

Results

End-of-day comfort on lens wear days was significantly worse than on the spectacle day (p < 0.002). There was no significant effect of the recovery periods on end-of-day comfort (p > 0.05). Although lens wear affected noninvasive tear film break-up time and conjunctival staining, there were no effects of recovery period length on noninvasive tear film break-up time (p > 0.05), tear meniscus height (p > 0.05), corneal staining (p > 0.05), conjunctival staining (p > 0.05), bulbar conjunctival redness (p > 0.05), or limbal redness (p > 0.05). There was no consistent effect of recovery period length on lid margin staining.

Conclusions

Lens-free recovery periods during a 12-hour lens wear day did not positively impact end-of-day comfort in this study. Cumulative lens wear times ranged from 8 to 12 hours, and the results suggest that once the length of lens wear exceeds the usual comfortable wear time, there is no benefit of short recovery periods.
Diurnal Variation in Comfort in Contact Lens and Non-contact Lens Wearers
Authors: Dumbleton Kathryn A. , Guillon Michel , Theodoratos Panagiotis , Patel Trisha
Published: July 2016

Purpose

The purpose of this investigation was to evaluate the diurnal variation in symptoms associated with ocular discomfort in contact lens (CL) wearers and non-CL wearers.

Methods

The study population comprised 604 individuals attending pre-screening visits at the OTG-i research clinic; 60% were current soft CL wearers (hydrogel and silicone hydrogel) and 40% were non-CL wearers. Symptomatology status was determined by the OSDI questionnaire (58% asymptomatic, 42% symptomatic). Participants were asked to grade their comfort, vision, and other symptoms during the day and in the evening (before lens removal for CL wearers) on 0 to 100 visual analogue scales.

Results

Diurnal decrease in comfort was significantly greater for CL wearers (−16.0 vs. −6.3, p < 0.001) and symptomatic participants (p = 0.015). Diurnal decrease in subjective vision was also significantly greater for CL wearers (−10.4 vs. −6.9, p = 0.005) and symptomatic participants (p = 0.001), and the interaction between these factors was also significant (p = 0.019). Dryness, grittiness, and irritation increased significantly more for CL wearers (p < 0.001, p = 0.012, and p = 0.004, respectively) and grittiness, irritation, and stinging for symptomatic participants (p = 0.016, p < 0.001, and p < 0.001, respectively). For the CL wearers, there was a significant interaction between dryness and age (p = 0.026) with the diurnal increase in dryness being greater in those under 40 (+15.6 vs. +10.0).

Conclusions

The diurnal decrease in comfort and subjective vision, and the diurnal increase in dryness, grittiness, and irritation, were significantly more marked for CL wearers than non-CL wearers. Diurnal changes in comfort, grittiness, stinging, irritation, and vision were influenced by the subject’s overall symptomatology as assessed by the OSDI questionnaire. For dryness symptoms, the diurnal decrease was most marked in young CL wearers. For the symptoms of stinging and vision, the diurnal changes were most pronounced in the symptomatic groups.
Remote Ischemic Preconditioning in the PICU: A Simple Concept With a Complex Past
Authors: Fuhrman Dana Y. , Kellum John A.
Published: July 2016

Objective:

In this study, we will review the most recently proposed mechanisms for remote ischemic preconditioning and summarize the past 10 years of clinical studies, as well as potential reasons for why, despite over 20 years of research on remote ischemic preconditioning, it is not routinely used in the pediatric critical care patient. In addition, future directions for remote ischemic preconditioning research will be discussed.

Data Sources:

We searched the PubMed database for relevant literature.

Study Selection and Data Extraction:

In PubMed, the search terms “ischemic preconditioning” and “remote preconditioning” were used. Randomized controlled trials published from 2006 until the present time that used a blood pressure cuff to induce remote ischemic preconditioning were included. We also reviewed the reference lists of the articles found in the PubMed search and included those thought to contribute to the objectives. All studies pertaining to remote ischemic preconditioning that included pediatric patients were reviewed.

Data Synthesis and Conclusions:

Differences in study outcomes in the effect of remote ischemic preconditioning on organ protection have been reported and may have played a large role in limiting the translation of findings into routine clinical practice. Ongoing efforts to protocolize the remote ischemic preconditioning technique in large multicenter trials with clearly delineated patient risk groups, including the use of biomarkers for enrichment, may help to ultimately determine if this procedure can be safely and effectively used for critically ill children.
Factors Associated With Mortality in Neonates Requiring Extracorporeal Membrane Oxygenation for Cardiac Indications: Analysis of the Extracorporeal Life Support Organization Registry Data*
Authors: Ford Mackenzie A. , Gauvreau Kimberlee , McMullan D. Michael , Almodovar Melvin C. , Cooper David S. , Rycus Peter T. , Thiagarajan Ravi
Published: July 2016

Objectives:

Survival among neonates supported with extracorporeal membrane oxygenation for cardiac indications is 39%. Previous single-center studies have identified factors associated with mortality, but a comprehensive multivariate analysis is not available for this population. Understanding factors associated with mortality may help design treatment strategies, determine optimal timing for cannulation, and inform patient selection. This study identifies factors associated with mortality in neonates supported with extracorporeal membrane oxygenation for cardiac indications.

Design:

Retrospective cohort study.

Setting:

Two hundred and thirty U.S. and international centers reporting extracorporeal membrane oxygenation data to the Extracorporeal Life Support Organization.

Subjects:

Four thousand and four seventy one neonates with congenital and acquired cardiac disease supported with extracorporeal membrane oxygenation for cardiac indications during 2001–2011.

Interventions:

None.

Measurements and Results:

The primary outcome measure was mortality prior to hospital discharge. Overall hospital mortality was 59%. Demographic and preextracorporeal membrane oxygenation factors associated with mortality were evaluated in a multivariable model. Factors associated with death prior to hospital discharge included lower body weight, earlier era, single ventricle physiology, lower preextracorporeal membrane oxygenation arterial pH, and longer time from intubation to extracorporeal membrane oxygenation cannulation. Lower pH was associated with increased mortality regardless of cardiac diagnosis and surgical complexity. The majority of survivors separated from extracorporeal membrane oxygenation less than 8 days after extracorporeal membrane oxygenation deployment.

Conclusions:

Mortality for neonates supported with extracorporeal membrane oxygenation for cardiac indications is high. Severity of preextracorporeal membrane oxygenation acidosis was independently associated with increased risk of mortality. Earlier initiation of extracorporeal membrane oxygenation may reduce the degree and duration of acidosis and may improve survival. Further studies are needed to determine optimal timing of cannulation in this population.
Effects of a Multicomponent Life-Style Intervention on Weight, Glycemic Control, Depressive Symptoms, and Renal Function in Low-Income, Minority Patients With Type 2 Diabetes: Results of the Community Approach to Lifestyle Modification for Diabetes Randomized Controlled Trial
Authors: Moncrieft Ashley E. , Llabre Maria M. , McCalla Judith Rey , Gutt Miriam , Mendez Armando J. , Gellman Marc D. , Goldberg Ronald B. , Schneiderman Neil
Published: July 2016

Objective

Few interventions have combined life-style and psychosocial approaches in the context of Type 2 diabetes management. The purpose of this study was to determine the effect of a multicomponent behavioral intervention on weight, glycemic control, renal function, and depressive symptoms in a sample of overweight/obese adults with Type 2 diabetes and marked depressive symptoms.

Methods

A sample of 111 adults with Type 2 diabetes were randomly assigned to a 1-year intervention (n = 57) or usual care (n = 54) in a parallel groups design. Primary outcomes included weight, glycosylated hemoglobin, and Beck Depression Inventory II score. Estimated glomerular filtration rate served as a secondary outcome. All measures were assessed at baseline and 6 and 12 months after randomization by assessors blind to randomization. Latent growth modeling was used to examine intervention effects on each outcome.

Results

The intervention resulted in decreased weight (mean [M] = 0.322 kg, standard error [SE] = 0.124 kg, p = .010) and glycosylated hemoglobin (M = 0.066%, SE = 0.028%, p = .017), and Beck Depression Inventory II scores (M = 1.009, SE = 0.226, p < .001), and improved estimated glomerular filtration rate (M = 0.742 ml·min−1·1.73 m−2, SE = 0.318 ml·min−1·1.73 m−2, p = .020) each month during the first 6 months relative to usual care.

Conclusions

Multicomponent behavioral interventions targeting weight loss and depressive symptoms as well as diet and physical activity are efficacious in the management of Type 2 diabetes.

Trial Registration: This study is registered at Clinicaltrials.gov ID: NCT01739205.
The Specificity of Health-Related Autobiographical Memories in Patients With Somatic Symptom Disorder
Authors: Walentynowicz Marta , Raes Filip , Van Diest Ilse , Van den Bergh Omer
Published: July 2016

Objective

Patients with somatic symptom disorder (SSD) have persistent distressing somatic symptoms that are associated with excessive thoughts, feelings, and behaviors. Reduced autobiographical memory specificity (rAMS) is related to a range of emotional disorders and is considered a vulnerability factor for an unfavorable course of pathology. The present study investigated whether the specificity of health-related autobiographical memories is reduced in patients with SSD with medically unexplained dyspnea complaints, compared with healthy controls.

Methods

Female patients with SSD (n = 30) and matched healthy controls (n = 24) completed a health-related Autobiographical Memory Test, the Beck Depression Inventory, the Ruminative Response Scale, and rumination scales concerning bodily reactions. Depressive symptoms and rumination were assessed because both variables previously showed associations with rAMS.

Results

Patients with SSD recalled fewer specific (F(1,52) = 13.63, p = .001) and more categoric (F(1,52) = 7.62, p = .008) autobiographical memories to health-related cue words than healthy controls. Patients also reported higher levels of depressive symptoms and rumination (all t > 3.00, p < .01). Importantly, the differences in memory specificity were independent of depressive symptoms and trait rumination.

Conclusions

The present study extends findings on rAMS to a previously unstudied sample of patients with SSD. Importantly, the presence of rAMS could not be explained by increased levels of depressive symptoms and rumination. We submit that rAMS in this group reflects how health-related episodes and associated symptoms are encoded in memory.
Race and Resting-State Heart Rate Variability in Brazilian Civil Servants and the Mediating Effects of Discrimination: An ELSA-Brasil Cohort Study
Authors: Kemp Andrew H. , Koenig Julian , Thayer Julian F. , Bittencourt Marcio S. , Pereira Alexandre C. , Santos Itamar S. , Dantas Eduardo M. , Mill José G. , Chor Dora , Ribeiro Antonio L.P. , Benseñor Isabela M. , Lotufo Paulo A.
Published: July 2016

Objectives

African Americans are characterized by higher heart rate variability (HRV), a finding ostensibly associated with beneficial health outcomes. However, these findings are at odds with other evidence that blacks have worse cardiovascular outcomes. Here, we examine associations in a large cohort from the ELSA-Brasil study and determined whether these effects are mediated by discrimination.

Methods

Three groups were compared on the basis of self-declared race: “black” (n = 2,020), “brown” (n = 3,502), and “white” (n = 6,467). Perceived discrimination was measured using a modified version of the Everyday Discrimination Scale. Resting-state HRV was extracted from 10-minute resting-state electrocardiograms. Racial differences in HRV were determined by regression analyses weighted by propensity scores, which controlled for potentially confounding variables including age, sex, education, and other health-related information. Nonlinear mediation analysis quantified the average total effect, comprising direct (race–HRV) and indirect (race–discrimination–HRV) pathways.

Results

Black participants displayed higher HRV relative to brown (Cohen's d = 0.20) and white participants (Cohen's d = 0.31). Brown relative to white participants also displayed a small but significantly higher HRV (Cohen's d = 0.14). Discrimination indirectly contributed to the effects of race on HRV.

Conclusions

This large cohort from the Brazilian population shows that HRV is greatest in black, followed by brown, relative to white participants. The presence of higher HRV in these groups may reflect a sustained compensatory psychophysiological response to the adverse effects of discrimination. Additional research is needed to determine the health consequences of these differences in HRV across racial and ethnic groups.
Layout Improvement Study to Reduce Staff Walking Distance in a Large Health Care Facility: How to Not Walk an Extra 4740 Miles
Authors: Ley-Chavez Adriana , Hmar-Lagroun Tatiana , Douglas-Ntagha Pamela , Cumbo Charlotte L.
Published: July 2016

Inefficient facility layouts have been found to be a challenge in health care, with excessive walking adding to the demands of staff and creating delays, which can impact the quality of care. Minimizing unnecessary transportation during care delivery improves efficiency, reduces delays, and frees up resources for use on value-added activities. This article presents a methodology and application of facility design to improve responsiveness and efficiency at a large hospital. The approach described provides the opportunity to improve existing layouts in facilities in which the floor plan is already defined, but there is some flexibility to relocate key areas. The existing physical constraints and work flows are studied and taken into consideration, and the volume of traffic flow throughout the facility guides the decision of where to relocate areas for maximum efficiency. Details on the steps followed and general recommendations to perform the necessary process and data analyses are provided. We achieved a 34.8% reduction in distance walked (4740 miles saved per year) and a 30% reduction in floors traveled in elevators (344 931 floors, which translate to 842 hours spent using elevators) by relocating 4 areas in which frequently used resources are housed.
Impact of the Hospital to Home Initiative on Readmissions in the VA Health Care System
Authors: Heidenreich Paul A. , Sahay Anju , Oliva Nancy , Gholami Parisa , Lin Shoutzu , Mittman Brian S. , Rumsfeld John S.
Published: July 2016

Background:

Hospital to Home (H2H) is a national quality improvement initiative sponsored by the Institute for Healthcare Improvement and the American College of Cardiology, with the goal of reducing readmission for patients hospitalized with heart disease. We sought to determine the impact of H2H within the Veterans Affairs (VA) health care system.

Methods:

Using a controlled interrupted time series, we determined the association of VA hospital enrollment in H2H with the primary outcome of 30-day all-cause readmission following a heart failure hospitalization. VA heart failure providers were surveyed to determine quality improvement projects initiated in response to H2H. Secondary outcomes included initiation of recommended H2H projects, follow-up within 7 days, and total hospital days at 30 days and 1 year.

Results:

Sixty-five of 104 VA hospitals (66%) enrolled in the national H2H initiative. Hospital characteristic associated with H2H enrollment included provision of tertiary care, academic affiliation, and greater use of home monitoring. There was no significant difference in mean 30-day readmission rates (20.0% ± 5.0% for H2H vs 19.3% ± 5.9% for non-H2H hospitals; P = .48) The mean fraction of patients with a cardiology visit within 7 days was slightly higher for H2H hospitals (3.0% ± 2.4% for H2H vs 2.0% ± 1.9% for non-H2H hospitals; P = .05). Patients discharged from H2H hospitals had fewer mean hospitals days during the following year (7.6% ± 2.6% for H2H vs 9.2% ± 3.0 for non-H2H; P = .01) early after launch of H2H, but the effect did not persist.

Conclusions:

VA hospitals enrolling in H2H had slightly more early follow-up in cardiology clinic but no difference in 30-day readmission rates compared with hospitals not enrolling in H2H.
Physiological and functional failure in chronic obstructive pulmonary disease, congestive heart failure and cancer: a debilitating intersection of sarcopenia, cachexia and breathlessness
Authors: Dudgeon Deborah , Baracos Vickie E.
Published: July 2016

Purpose of review

Loss of skeletal muscle mass and cachexia are important manifestations of chronic obstructive pulmonary disease and have been associated with breathlessness, functional limitation and poor prognosis. A number of other life-limiting illnesses, including cancer and chronic heart failure as well as acute conditions seen in ICU such as sepsis, are characteristically associated with cachexia and sarcopenia. These conditions may have respiratory muscle atrophy of sufficient magnitude to contribute to the development of breathlessness and associated functional limitation. The purpose of this review is to summarize findings related to a direct role for severe respiratory muscle wasting in the etiology of breathlessness in advanced, life limiting illness.

Recent findings

Localized wasting of respiratory muscles appears to be part of systemic wasting of skeletal muscles, driven by deconditioning, nutritional insufficiencies and inflammation, and because of disease-specific factors (tumor factors and exacerbations), anabolic insufficiency, autonomic dysfunction, drugs (such as corticosteroids and chemotherapy agents), mechanical ventilation and comorbidities. Marked morphological and biochemical abnormalities have been noted in diaphragm muscle biopsies.

Older patients with multiple comorbidities associated with muscle loss and cachexia are likely to be at elevated risk of respiratory muscle atrophy and functional loss, because of the presence of multiple, interacting etiologic factors.
Human Cytomegalovirus-Encoded Receptor US28 Is Expressed in Renal Allografts and Facilitates Viral Spreading In Vitro
Authors: Lollinga Wouter T. , de Wit Raymond H. , Rahbar Afsar , Vasse Gwenda F. , Davoudi Belghis , Diepstra Arjan , Riezebos-Brilman Annelies , Harmsen Martin C. , Hillebrands Jan-Luuk , Söderberg-Naucler Cecilia , van Son Willem J. , Smit Martine J. , Sanders Jan-Stephan , van den Born Jacob
Published: July 2016

Background

Renal transplantation is the preferred treatment for patients with end-stage renal disease. Human cytomegalovirus (HCMV) activation is associated with decreased renal graft function and survival. Human cytomegalovirus encodes several immune modulatory proteins, including the G protein-coupled receptor US28, which scavenges human chemokines and modulates intracellular signaling.

Methods

Our aim was to identify the expression and localization of US28 in renal allograft biopsies by immunohistochemistry and determine its role in viral spreading in vitro.

Results

Immunohistochemistry revealed US28 in 31 of 34 renal transplant biopsies from HCMV-seropositive donors. Expression was independent of HCMV viremia or IgG serostatus. US28 was predominantly expressed in the cytoplasm of vascular smooth muscle cells (VSMCs) and tubular epithelial cells, with a median positivity of 20% and 40%, respectively. Also, US28-positive cells were present within arterial neointima. In contrast to US28, HCMV-encoded immediate early antigen was detected in less than 5% of VSMCs, tubular epithelial cells, interstitial endothelium, interstitial inflammatory infiltrates, and glomerular cells.

Primary VSMCs were infected with green fluorescent protein–tagged wild type or US28-deficient HCMV. The viral spreading of US28-deficient HCMV, via culture medium or cell-to-cell transmission, was significantly impeded as shown by green fluorescent protein (ie, infected) cell quantification and quantitative real-time polymerase chain reaction. Additionally, the number and size of foci was smaller.

Conclusions

In summary, HCMV-encoded US28 was detected in renal allografts from HCMV-positive donors independent of viremia and serostatus. Also, US28 facilitates HCMV spreading in VSMCs in vitro. Because the vasculature is affected in chronic renal transplant dysfunction, US28 may provide a potential target for therapeutic intervention.
Eliminating Xenoantigen Expression on Swine RBC
Authors: Wang Zheng-Yu , Martens Gregory R. , Blankenship Ross L. , Sidner Richard A. , Li Ping , Estrada Jose L. , Tector Matthew , Tector A. Joseph
Published: July 2016

Background

The rapidly improving tools of genetic engineering may make it possible to overcome the humoral immune barrier that prevents xenotransplantation. We hypothesize that levels of human antibody binding to donor tissues from swine must approximate the antibody binding occurring in allotransplantation. It is uncertain if this is an attainable goal. Here we perform an initial analysis of this issue by comparing human antibody binding to red blood cells (RBC) isolated from knockout swine and to allogeneic or autologous human RBC.

Methods

Human sera were incubated with RBC isolated from various genetically engineered swine or from humans. The level of IgG and IgM binding to these cells were compared using either flow cytometry or a novel mass spectrometric assay.

Results

Mass spectroscopic quantitation of human antibody binding demonstrated that as few as 3 gene inactivations can reduce the levels human antibody binding to swine RBC that is as low as autologous human RBC. Flow cytometry showed that RBC from 2-gene knockout swine exhibited less human antibody binding than human blood group O allogeneic RBC in 22% of tested sera. Deletion of a third gene from pigs resulted in 30% of human samples having less IgG and IgM RBC xenoreactivity than alloreactivity.

Conclusions

Xenoantigenicity of swine RBC can be eliminated via gene disruption. These results suggest that the gene knockout approach may be able reduce antigenicity in other pig tissues to levels that enable the xenotransplantation humoral barrier to be overcome.
Prognosis of Invasive Aspergillosis in Kidney Transplant Recipients: A Case-Control Study
Authors: Desbois Anne-Claire , Poiree Sylvain , Snanoudj Renaud , Bougnoux Marie-Elisabeth , Sberro-Soussan Rebecca , Lanternier Fanny , Legendre Christophe , Lortholary Olivier , Scemla Anne
Published: July 2016

Background

Invasive aspergillosis (IA) is a major cause of invasive fungal infection in kidney transplant recipients (KTR), and it has a high mortality rate. However, its impact on patients and graft survival has not been well defined in the current era of voriconazole first-line therapy.

Methods

We retrospectively collected all cases of KTR-associated IA occurring at Necker Enfants Malades Hospital, Paris, from 2003 to 2013. These cases were compared with a group of controls (1:3) who were matched by age, year of kidney transplantation, and sex. The characteristics of IA were also studied.

Results

Sixteen patients developed IA after KTR. Most IA cases were limited to the lungs (81.3%), with mild respiratory symptoms in only 53% of the patients. The patients were administered voriconazole (n = 15, 94%) and/or posaconazole (n = 2, 13%). The 12-week and 1-year postinfection survival rates were 94% and 81%, respectively. Compared with the controls (n = 46), patients and death-censored graft survivals rates were significantly lower after IA (P = 0.017 and 0.001, respectively). In the patients with IA, the occurrences of cardiovascular diseases before transplantation (P < 0.0001), delayed graft function (P < 0.0001), and infectious complications (0.0018) were significantly more frequent.

Conclusions

Even with voriconazole therapy, the prognosis of patients with IA after kidney transplantation is still poor. When the patients survive to IA, they have a high risk of graft loss.
Rituximab in Combination With Bortezomib, Plasmapheresis, and High-Dose IVIG to Treat Antibody-Mediated Renal Allograft Rejection
Authors: Waiser Johannes , Duerr Michael , Schönemann Constanze , Rudolph Birgit , Wu Kaiyin , Halleck Fabian , Budde Klemens , Lachmann Nils
Published: July 2016

Background

Current treatment strategies for antibody-mediated renal allograft rejection (AMR) are not sufficiently effective. In most centers, “standard of care” treatment includes plasmapheresis (PPH) and IVIG preparations. Since several years, modern therapeutics targeting B cells and plasma cells have become available. We investigated, whether combined administration of rituximab and bortezomib in addition to PPH and high-dose IVIG is useful.

Methods

Between November 2011 and January 2013, we treated 10 consecutive patients with biopsy-proven AMR with rituximab (500 mg), bortezomib (4× 1.3 mg/m2), PPH (6×), and high-dose IVIG (1.5 g/kg) (group A). This group was compared with a group of 11 consecutive patients treated with an identical regimen without rituximab between July 2010 and November 2011 (group B).

Results

Median follow-up was 41(33-46) months in group A and 55(47-63) months in group B. At 40 months after treatment, graft survival was 60% in group A and 64% in group B, respectively (P = 0.87). Before and after treatment, serum creatinine, estimated glomerular filtration rate, and proteinuria were not different between groups. A significant reduction in donor-specific HLA antibody mean fluorescence intensity was observed in group A (25.2%, P = 0.046) and B (38.3%, P = 0.01) at 3 months posttreatment. In group A, more patients suffered from side effects compared with group B (infections: 70% vs 18%, P = 0.02).

Conclusions

The addition of rituximab to bortezomib, PPH, and high-dose IVIG did not further improve graft survival. Instead, we observed an increase of side effects. Therefore, combined administration of bortezomib and rituximab in addition to PPH and IVIG should be regarded with caution.
Electroconvulsive Therapy in a Patient With Chronic Catatonia
Authors: Pigato Giorgio , Roiter Beatrice , Cecchin Diego , Morbelli Silvia , Tenconi Elena , Minelli Alessandra , Bortolomasi Marco
Published: July 2016

Catatonia is a psychomotor syndrome that can be associated with both psychiatric diseases (mainly mood disorders, but also psychotic disorders) and medical conditions. Lorazepam (6-21 mg/day, occasionally up to 30 md/day) is the first choice treatment and electroconvulsive therapy (ECT) is the second line, regardless of the underlying clinical condition. There are some evidences also for effectiveness of other medications. Patients treated acutely usually show rapid and full therapeutic response but even longstanding catatonia can improve. However, some authors suggested that chronic catatonia in the context of schizophrenia is phenomenologically different and less responsive to lorazepam and ECT, especially if associated with echophenomena. We present here the case of a patient with longstanding catatonic schizophrenia treated with antipsychotics who significantly improved after ECT. Improvement regarded mainly catatonia, but also negative symptoms, cognition and psychosocial functioning. A slight amelioration in prefrontal metabolism (Brain18[F]FDG PET) one month following the ECT course was also noted.
Carbon emission risks and management accounting: Australian evidence
Authors: Kumarasiri Jayanthi , Jubb Christine
Published: July 2016

Purpose

The purpose of this paper is to apply regulatory mix theory as a framework for investigating the use of management accounting techniques by Australian large listed companies in constraining their carbon emissions.

Design/methodology/approach

Semi-structured interviews are conducted with senior managers involved with managing their companies’ carbon emission risks. Analysis of the interview data is undertaken with a view to provision of insight to the impact of the regulatory framework imposed to deal with carbon emissions.

Findings

The findings reveal that regulation impacting companies’ economic interests rather than requiring mere disclosure compliance is much more likely to be behind focusing top management and board attention and use of management accounting techniques to set targets, measure performance and incentivise emission mitigation. However, there remains much scope for increased use of accounting professionals and accounting techniques in working towards a carbon-constrained economy.

Research limitations/implications

The usual limitations associated with interpretation of interview data are applicable.

Practical implications

Under-use of management accounting techniques is likely to be associated with less than optimal constraint of carbon emissions.

Social implications

Carbon emissions are accepted as being involved in harmful climate change. To the extent effective techniques are under-utilised in constraining emissions, harmful consequences for society are likely to be heightened unnecessarily.

Originality/value

The topic and data collected are original and provide valuable insights into the dynamics of management accounting technique use in managing carbon emissions.
SEC publishes guidance on mutual fund distribution and sub-accounting fees
Authors: Adelfio Marco , Delligatti Paul J. , Monfort Jason F.
Published: July 2016

Purpose

To explain the guidance published on January 6, 2016 by the SEC’s Division of Investment Management containing its views and recommendations relating to mutual fund distribution and sub-accounting fees.

Design/methodology/approach

Explains the SEC’s Office of Compliance Inspections and Examinations focus on “distribution in guise” payments, its 2013 “sweep exam,” an enforcement action against a fund’s adviser and affiliated distributor related to payments for distribution-related activities outside of a 12b-1 plan, lists SEC staff recommendations with respect to mutual fund distribution and sub-accounting fees, summarizes the SEC’s guidance on board oversight of sub-accounting fees, provides indicia that a payment may be for distribution-related activities, and points to the need for mutual funds to have policies and procedures designed to prevent violations of Section 12(b) and Rule 12b-1.

Findings

The guidance is an outgrowth of the staff’s observations from a three-year “distribution in guise” sweep exam of mutual fund complexes, investment advisers, broker-dealers and transfer agents conducted by the SEC’s Office of Compliance Inspections and Examinations and other offices and divisions of the SEC to identify whether firms were using fund assets to directly or indirectly finance any activities primarily intended to result in the sale of fund shares outside of an approved Rule 12b-1 distribution plan.

Originality/value

Practical guidance from experienced financial services lawyers.
The European market abuse regulation: MAR ado about everything
Authors: Green Jake , Torrens Emily
Published: July 2016

Purpose

To provide a practical look at the European Union Market Abuse Regulation (Regulation EU No. 596/2014) (“MAR”) and some of its uncertainties, particularly the issue of its wide reaching jurisdictional scope.

Design/methodology/approach

The article takes a three pillar approach covering the following: a brief discursive overview of MAR, consideration of some of its uncertainties and key areas of controversy, and a detailed consideration of the jurisdictional scope of MAR.

Findings

Many questions and considerations about MAR remain, particularly those regarding how the investment recommendations requirements will be met in practice, most notably in respect of sales notes. Further, additional extensive record keeping obligations and prescriptive market soundings procedures are now expected of firms in order to show the legitimacy of their activities. In addition, the geographical scope of MAR is wide and all encompassing. Whilst its market manipulation, improper disclosure and insider dealing provisions must undoubtedly be adhered to worldwide, it remains to be seen how far the conduct requirements included in MAR will be implemented by non EU firms.

Originality/value

Consolidation and detailed consideration of the most common questions being asked in the market by market participants and issuers on The Market Abuse Regulation in the run up to its implementation. Practical guidance from experienced financial regulatory lawyers.
SEC’s division of investment management offers new guidance on “distribution in guise” payments
Authors: Delibert Arthur , Schneider Lori , Clement Megan , Shannon Shane
Published: July 2016

Purpose

To explain the January 6, 2016 written guidance (the “New Guidance”) issued by the Securities and Exchange Commission’s Division of Investment Management on payments made by mutual funds to intermediaries for distribution and non-distribution-related services.

Design/methodology/approach

Explains the SEC’s earlier guidance in the 1998 “Supermarket Letter,” the provisions of Rule 12b-1, the practice termed “distribution in guise,” the emphasis in the “New Guidance” on the role of a fund board’s business judgment, how Rule 12b-1 compliance fits into Rule 38a-1 compliance programs, specific fund activities and arrangements with intermediaries that are of concern to the SEC staff, and the focus of the New Guidance on an adviser’s fiduciary duty to mitigate or eliminate conflicts of interest.

Findings

The New Guidance articulates clear expectations that fund boards will have a process to evaluate the nature of intermediary payments and that fund advisers will provide boards with information in the advisers’ possession that the boards need to carry out that evaluation. Another intent of the New Guidance is apparently to give the SEC a clearer basis to bring enforcement actions concerning the use of fund assets to pay intermediaries for distribution-related activities.

Originality/value

Practical guidance from experienced investment management lawyers.
The SEC turns up the heat on private equity expense allocations
Authors: Lieberman Samuel , Araneo John T.
Published: July 2016

Purpose

To discuss the US Securities and Exchange Commission’s (“SEC’s”) increasing focus on disclosure and conflict-of-interest problems arising from how private equity fund (“PE Fund”) managers allocate expenses between management and fund investors.

Design/methodology/approach

This article summarizes the background of this focus on expense allocations and, drawing from the recent SEC enforcement actions focused on this issue, and identifies the types of both expenses and disclosures that have caught SEC attention.

Findings

After spending the first two or three years post Dodd-Frank raising awareness of these issues, the SEC has begun to impose large fines over expense-allocation conflicts and disclosure issues.

Practical implications

It is imperative for PE Fund managers to retain counsel to review their fund offering documents, expense allocation practices, and compliance programs to ensure consistency with the SEC’s recent decisions on these issues.

Originality/value

Practical guidance from experienced financial services lawyers.