An Integrated Mobile Acute Care Service Enhances Value.

Reducing the cost of care while enhancing its quality and experience are essential components to success in value-based care. Because emergency department (ED) and hospital settings represent high-cost environments, the authors sought to reduce their unnecessary use by deploying a novel care delivery service that offers mobile, on-demand care for high-acuity conditions in patient homes. This study is a retrospective quality improvement evaluation of the initial year of the mobile acute care model in a health system with a substantial penetration of value-based care.

A half-century of meningococcal vaccines.

The first safe and effective vaccine for the prevention of invasive meningococcal disease was created fifty years ago. The vaccine employed a novel platform, polysaccharide capsular antigen, based on the discovery that anticapsular antibody conferred protective immunity in humans. As with most new paradigms in vaccinology, it derived from important basic research from other scientific disciplines over the preceding years.

A Predictive Model Facilitates Early Recognition of Spinal Epidural Abscess in Adults.

Introduction: Spinal epidural abscess (SEA), a highly morbid and potentially lethal deep tissue infection of the central nervous system has more than tripled in incidence over the past decade. Early recognition at the point of initial clinical presentation may prevent irreversible neurologic injury or other serious, adverse outcomes. To facilitate early recognition of SEA, we developed a predictive scoring model.

Decreasing Emergency Department Walkout Rate and Boarding Hours by Improving Inpatient Length of Stay.

Introduction: Patient progress, the movement of patients through a hospital system from admission to discharge, is a foundational component of operational effectiveness in healthcare institutions. Optimal patient progress is a key to delivering safe, high-quality and high-value clinical care. The Baystate Patient Progress Initiative (BPPI), a cross-disciplinary, multifaceted quality and process improvement project, was launched on March 1, 2014, with the primary goal of optimizing patient progress for adult patients.

Spinal Epidural Abscess in Adults: A 10-Year Clinical Experience at a Tertiary Care Academic Medical Center.

 Delayed recognition of spinal epidural abscess (SEA) contributes to poor outcomes from this highly morbid and potentially lethal infection. We performed a case-control study in a regional, high-volume, tertiary care, academic medical center over the years 2005-2015 to assess the potential changing epidemiology, clinical and laboratory manifestations, and course of this disorder and to identify factors that might lead to early identification of SEA.  Diagnostic billing codes consistent with SEA were used to identify inpatient admissions for abstraction.

Promoting high value inpatient care via a coaching model of structured, interdisciplinary team rounds.

The professional development of early career hospital physicians may be improved by embedding an experienced physician in a coaching role during structured, interdisciplinary team rounds. This article gives a descriptive report of such a model and discusses how it may promote delivery of high-value care to adult inpatients.

Microdroplet sandwich real-time rt-PCR for detection of pandemic and seasonal influenza subtypes.

As demonstrated by the recent 2012/2013 flu epidemic, the continual emergence of new viral strains highlights the need for accurate medical diagnostics in multiple community settings. If rapid, robust, and sensitive diagnostics for influenza subtyping were available, it would help identify epidemics, facilitate appropriate antiviral usage, decrease inappropriate antibiotic usage, and eliminate the extra cost of unnecessary laboratory testing and treatment. Here, we describe a droplet sandwich platform that can detect influenza subtypes using real-time reverse-transcription polymerase chain reaction (rtRT-PCR).

Sepsis and scientific revolutions.

Hypothesis: The therapeutic approach to sepsis is following an evolutionary process of scientific discovery as articulated in the landmark work by Kuhn, The Structure of Scientific Revolutions, first published 50 years ago.

Background: Incremental advances, beginning with the introduction of antimicrobials and most recently highlighted by revised, evidence-based guidelines for the management of sepsis, have been accompanied by episodic paradigm shifts. Although some of these have shown success, there are numerous, noteworthy failures, largely involving immune- and coagulation-based therapeutic strategies.

Subtyping clinical specimens of influenza A virus by use of a simple method to amplify RNA targets.

This work presents the clinical application of a robust and unique approach for RNA amplification, called a simple method for amplifying RNA targets (SMART), for the detection and identification of subtypes of H1N1 pandemic, H1N1 seasonal, and H3N2 seasonal influenza virus. While all the existing amplification techniques rely on the diffusion of two molecules to complex RNA structures, the SMART achieves fast and efficient amplification via single-molecule diffusion. The SMART utilizes amplifiable single-stranded DNA (ssDNA) probes, which serve as reporter molecules for capturing specific viral RNA (vRNA) sequences and are subsequently separated on a microfluidic chip under zero-flow conditions.

The "forgotten zone": acquired disorders of the trachea in adults.

The upper airway is generally defined as the air passage segment that extends between the naso- or oropharynx and the carina. The longest segment of the upper airway-the trachea-begins at the inferior portion of the larynx and extends to the branch point of the main carina. The trachea has the potential to be a "forgotten zone" in differential diagnoses, as pathological processes involving this portion may not receive prominent clinical consideration in disorders presenting with respiratory symptoms and signs.

A simple method for amplifying RNA targets (SMART).

We present a novel and simple method for amplifying RNA targets (named by its acronym, SMART), and for detection, using engineered amplification probes that overcome existing limitations of current RNA-based technologies. This system amplifies and detects optimal engineered ssDNA probes that hybridize to target RNA. The amplifiable probe-target RNA complex is captured on magnetic beads using a sequence-specific capture probe and is separated from unbound probe using a novel microfluidic technique.

The discovery of viruses: advancing science and medicine by challenging dogma.

The discovery of viruses in the final years of the nineteenth century represented the culmination of two decades of work on tobacco mosaic disease by three botanical scientists. Eventually their discovery led to a paradigm shift in scientific thought, but it took more than 20 years to appreciate its implications because it was inconsistent with the prevailing dogma of the time-Koch's postulates. Although these 'rules' were actually conceived of as guidelines upon which to establish microbial causality and their implementation resulted in many new discoveries, they also had the unintended effect of limiting the interpretation of novel findings.

Critical episodes in the understanding and control of epidemic meningococcal meningitis.

Epidemic meningococcal meningitis continues to be an important worldwide cause of morbidity and mortality, especially in developing countries. Throughout its relatively brief history, especially over the past century, a number of 'critical episodes' have occurred that have enhanced our understanding of the disease and allowed for its potential control. This article reviews three such 'episodes': the first effective treatment for the disease; the development of the first effective meningococcal vaccine; and the description of its epidemiology in sub-Saharan Africa, where the majority of epidemic meningococcal disease continues to occur.

Ligation with nucleic acid sequence-based amplification.

This work presents a novel method for detecting nucleic acid targets using a ligation step along with an isothermal, exponential amplification step. We use an engineered ssDNA with two variable regions on the ends, allowing us to design the probe for optimal reaction kinetics and primer binding. This two-part probe is ligated by T4 DNA Ligase only when both parts bind adjacently to the target.

Novel approaches to the treatment of systemic anthrax.

Anthrax continues to generate concern as an agent of bioterrorism and as a natural cause of sporadic disease outbreaks. Despite the use of appropriate antimicrobial agents and advanced supportive care, the mortality associated with the systemic disease remains high. This is primarily due to the pathogenic exotoxins produced by Bacillus anthracis as well as other virulence factors of the organism.

Early in vitro transcription termination in human H5 influenza viral RNA synthesis.

Rapid diagnostic identification of the human H5 influenza virus is a strategic cornerstone for outbreak prevention. We recently reported a method for direct detection of viral RNA from a highly pathogenic human H5 influenza strain (A/Hanoi/30408/2005(H5N1)), which necessarily was transcribed in vitro from non-viral sources. This article provides an in-depth analysis of the reaction conditions for in vitro transcription (IVT) of full-length influenza H5 RNA, which is needed for diagnostic RNA production, for the T7 and SP6 phage promoter systems.