Leveraging the electronic health record to identify delivery of goal-concordant care.

Background: Goal-concordant care (GCC) is recognized as the highest quality of care and most important outcome measure for serious illness research, yet there is no agreed-upon or validated method to measure it.

Objective: Assess feasibility of measuring GCC using clinical documentation in the electronic health record (EHR).

Design: Retrospective chart review study.

Classification of Documented Goals of Care Among Hospitalized Patients with High Mortality Risk: a Mixed-Methods Feasibility Study.

Background: The ability to classify patients' goals of care (GOC) from clinical documentation would facilitate serious illness communication quality improvement efforts and pragmatic measurement of goal-concordant care. Feasibility of this approach remains unknown.

Objective: To evaluate the feasibility of classifying patients' GOC from clinical documentation in the electronic health record (EHR), describe the frequency and patterns of changes in patients' goals over time, and identify barriers to reliable goal classification.

Reciprocal Signaling between Glioblastoma Stem Cells and Differentiated Tumor Cells Promotes Malignant Progression.

Glioblastoma is the most lethal primary brain tumor; however, the crosstalk between glioblastoma stem cells (GSCs) and their supportive niche is not well understood. Here, we interrogated reciprocal signaling between GSCs and their differentiated glioblastoma cell (DGC) progeny. We found that DGCs accelerated GSC tumor growth.

Transitioning from intravenous to subcutaneous insulin in the medical intensive care unit.

Background: There is a paucity of studies on transitions from IV insulin infusion (IVII) to subcutaneous (SC) insulin in the medical ICU (MICU).

Methods: We conducted a retrospective study of patients admitted to the Cleveland Clinic MICU from June 2013 to January 2014 who received IVII. We compared blood glucose (BG) control between 3 cohorts based on timing of basal insulin dose: (1) NB (no basal), (2) IB (incorrect basal), (3) CB (correct basal) at 5 time points post-IVII discontinuation (1, 4, 8, 12, and 24h).

Poverty and Child Behavioral Problems: The Mediating Role of Parenting and Parental Well-Being.

The detrimental impact of poverty on child behavioral problems is well-established, but the mechanisms that explain this relationship are less well-known. Using data from the Families in Germany Study on parents and their children at ages 9-10 (middle childhood), this study extends previous research by examining whether or not and to what extent different parenting styles and parents' subjective well-being explain the relationship between poverty and child behavior problems. The results show that certain parenting styles, such as psychological control, as well as mothers' life satisfaction partially mediate the correlation between poverty and child behavioral problems.

MYC-Regulated Mevalonate Metabolism Maintains Brain Tumor-Initiating Cells.

Metabolic dysregulation drives tumor initiation in a subset of glioblastomas harboring isocitrate dehydrogenase (IDH) mutations, but metabolic alterations in glioblastomas with wild-type IDH are poorly understood. MYC promotes metabolic reprogramming in cancer, but targeting MYC has proven notoriously challenging. Here, we link metabolic dysregulation in patient-derived brain tumor-initiating cells (BTIC) to a nexus between MYC and mevalonate signaling, which can be inhibited by statin or 6-fluoromevalonate treatment.

Gr-1(high) CD11b+ cells suppress B cell differentiation and lupus-like disease in lupus-prone male mice.

Objective: Systemic lupus erythematosus (SLE) develops much more readily in females than in males. Previous research has focused primarily on identifying mechanisms pertinent to the pathology in females. The aim of the current study was to delineate active protective mechanisms in males.