Economics of Sickle Cell Disease and Evidence to Support Comprehensive Care.

Sickle cell disease (SCD) is a serious blood disorder leading to complex care needs. Comprehensive, multidisciplinary programs are ideally suited to deliver patient-centered care and address other relevant social determinants of health. Patients with SCD face many inequities in health care, further reinforcing the need for comprehensive care models to address these relevant issues.

Neuropsychological, neuropsychiatric, and quality-of-life assessments in Alzheimer's disease patients treated with plasma exchange with albumin replacement from the randomized AMBAR study.

Introduction: We report the effects of plasma exchange (PE) with albumin replacement on neuropsychological, neuropsychiatric, and quality-of-life (QoL) outcomes in mild-to-moderate Alzheimer's disease (AD) patients in a phase 2b/3 trial (Alzheimer's Management by Albumin Replacement [AMBAR] study).

Methods: Three hundred forty-seven patients were randomized into placebo (sham-PE) and three PE-treatment arms with low/high doses of albumin, with/without intravenous immunoglobulin (IVIG). Specific test measurements were performed at baseline; month 2 (weekly conventional PE); months 6, 9, and 12 (monthly low-volume PE [LVPE]); and month 14.

A Simple Physical Therapy Algorithm Is Successful in Decreasing Skilled Nursing Facility Length of Stay and Increasing Cost Savings After Hip Fracture With No Increase in Adverse Events.

Introduction: Shorter length of stays (LOS) at a Skilled Nursing Facility (SNF) after hip fracture surgery would be expected to lead to costs savings for the healthcare system. Evidence also suggests that shorter SNF stays also leads to improved 30-day outcomes, thus compounding this value proposition. Our Integrated Fragility Hip Fracture Program created a simple algorithm at discharge to provide each post-operative hip fracture patient with an expected SNF LOS.

A randomized, controlled clinical trial of plasma exchange with albumin replacement for Alzheimer's disease: Primary results of the AMBAR Study.

Introduction: This phase 2b/3 trial examined the effects of plasma exchange (PE) in patients with mild-to-moderate Alzheimer's disease (AD).

Methods: Three hundred forty-seven patients (496 screened) were randomized (1:1:1:1) into three PE treatment arms with different doses of albumin and intravenous immunoglobulin replacement (6-week period of weekly conventional PE followed by a 12-month period of monthly low-volume PE), and placebo (sham).

Results: PE-treated patients performed significantly better than placebo for the co-primary endpoints: change from baseline of Alzheimer's Disease Cooperative Study-Activities of Daily Living (ADCS-ADL; P = .

Utilization, financial outcomes and stakeholder perspectives of a re-organized adult sickle cell program.

In 2011 Yale New Haven Hospital, in response to high utilization of acute care services and widespread patient and health care personnel dissatisfaction, set out to improve its care of adults living with sickle cell disease. Re-organization components included recruitment of additional personnel; re-locating inpatients to a single nursing unit; reducing the number of involved providers; personalized care plans for pain management; setting limits upon access to parenteral opioids; and an emphasis upon clinic visits focused upon home management of pain as well as specialty and primary care. Outcomes included dramatic reductions in inpatient days (79%), emergency department visits (63%), and hospitalizations (53%); an increase in outpatient visits (31%); and a decrease in costs (49%).

Marijuana Use in Adults Living with Sickle Cell Disease.

Legal access to marijuana, most frequently as "medical marijuana," is becoming more common in the United States, but most states do not specify sickle cell disease as a qualifying condition. We were aware that some of our patients living with sickle cell disease used illicit marijuana, and we sought more information about this. We practice at an urban, academic medical center and provide primary, secondary, and tertiary care for ∼130 adults living with sickle cell disease.

Use of human immunoglobulins as an anti-infective treatment: the experience so far and their possible re-emerging role.

Pooled human immunoglobulins (IGs) are prepared from plasma obtained from healthy donors as a concentrated antibody-containing solution. In addition, high-titer IGs (hyperimmune) against a specific pathogen can be obtained from vaccinated or convalescing donors. Currently, IGs can be used for the treatment of a variety of infections for which no specific therapy exists or that remain difficult to treat.

Production in stirred-tank bioreactor of recombinant bovine chymosin B by a high-level expression transformant clone of Pichia pastoris.

An intense screening of Pichia pastoris clones transformed with the gene of bovine chymosin under methanol-inducible AOX1 promoter was performed, obtaining a transformant clone with a higher milk-clotting activity value in comparison with our previous studies. The scaling of recombinant-chymosin production was carried out by a fed-batch strategy in a stirred-tank bioreactor using biodiesel-byproduct crude glycerol as the carbon source and pure methanol for the induction of chymosin expression, achieving a biomass concentration of 158 g DCW/L and a maximum coagulant activity of 192 IMCU/ml after 120 h of methanol induction. Recombinant bovine chymosin was purified from bioreactor-fermentation culture by a procedure including anion-exchange chromatography which allowed obtaining heterologous chymosin with high level of purity and activity; suggesting that this downstream step could be scaled up in a successful manner for chymosin purification.

Multidisciplinary Proactive Psychiatric Consultation Service: Impact on Length of Stay for Medical Inpatients.

Background: Mental illness correlates with an increased length of stay (LOS) for patients hospitalized for medical conditions. While psychiatric consultations help manage mental illness among those hospitalized for medical conditions, consultations initiated by nonpsychiatric mental disease may lack maximum effectiveness.

Methods: In a before-and-after design, in 2 contiguous years LOS for internist-initiated, conventional consultation (CC) as usual treatment was compared to LOS of a proactive, mental health professional-initiated, multidisciplinary intervention delivered by the behavioral intervention team (BIT) on the same units.

Herpetofaunal community change in multiple habitats after fifteen years in a southwest Florida preserve, USA.

Herpetofaunal declines have been documented globally, and southern Florida, USA, is an especially vulnerable region because of high impacts from hydrological perturbations and nonindigenous species. To assess the extent of recent change in herpetofauna community composition, we established a baseline inventory during 1995-97 at a managed preserve in a habitat rich area of southwest Florida, and repeated our sampling methods fifteen years later (2010-11). Nine drift fence arrays were placed in four habitat types: mesic flatwood, mesic hammock, depression marsh, and wet prairie.

Association of inpatient and outpatient glucose management with inpatient mortality among patients with and without diabetes at a major academic medical center.

Background: Hospitalized patients with diabetes have experienced a disproportionate reduction in mortality over the past decade.

Objective: To examine whether this differential decrease affected all patients with diabetes, and to identify explanatory factors.

Design: Serial, cross-sectional observational study.

Using the glucometrics website to benchmark ICU glucose control before and after the NICE-SUGAR study.

Prior to 2009, intensive glycemic control was the standard in main intensive care units (ICUs). Glucose targets have been recalibrated after publication of the NICE-SUGAR study in that year, followed by updated guidelines that endorsed more moderated control. We sought to determine if the prevalence of hyperglycemia in US ICUs had increased after the NICE-SUGAR study's results were reported.

Proactive psychiatric consultation services reduce length of stay for admissions to an inpatient medical team.

Background: Some studies suggest intensive psychiatric consultation services facilitate medical care and reduce length of stay (LOS) in general hospitals.

Objective: To compare LOS between a consultation-as-usual model and a proactive consultation model involving review of all admissions, rapid consultation, and close follow-up.

Methods: LOS was compared in an ABA design between a 33-day intervention period and 10 similar control periods, 5 before and 5 after the intervention, on an internal medical unit.

Evaluating inpatient glycemic management: the Quality Hyperglycemia Score.

Background: Inpatient hyperglycemia has become a major focus at many hospitals. However, although several professional organizations have pushed for improved inpatient glucose management, glycemic control at many institutions remains suboptimal. There is a general consensus that improved quality of care is needed, but objective assessment of care quality remains a challenge.

The year's new drugs and biologics--2007.

This annual article presents new drugs and biologics that were launched or approved for the first time during the previous year. In 2007, 30 new medicines--this figure includes both drugs and biologics for therapeutic use as well as new diagnostic agents--reached their first markets. Drug repositioning continues to have a significant impact, with line extensions (new indications, new formulations and new combinations of previously marketed products) accounting for 45% of the new medicines launched in 2007.

Spotlight on autoimmune lymphoproliferative syndrome.

This month's Spotlight on...

Chronicles in drug discovery.

Chronicles in Drug Discovery features special interest reports on advances in drug discovery. This month we highlight agents that target and deplete immunosuppressive regulatory T cells, which are produced by tumor cells to hinder innate immunity against, or chemotherapies targeting, tumor-associated antigens. Antiviral treatments for respiratory syncytial virus, a severe and prevalent infection in children, are limited due to their side effect profiles and cost.

The year's new drugs and biologics--2006.

This annual series presents new drugs and biologics that were launched or approved for the first time during the previous year. In 2006, 41 new medicines--this figure includes both drugs and biologics for therapeutic use as well as new diagnostic agents and, for the first time this year, an important new herbal medicine--reached their first markets. Drug repositioning continues to have a significant impact, with line extensions (new indications, new formulations and new combinations of previously marketed products) accounting for more than 20 of the new medicines launched in 2006.

The role of statins in erectile dysfunction.

Erectile dysfunction is a common disorder that involves impairment of the vascular endothelium and has been associated with cardiovascular disease. Despite the general effectiveness of phosphodiesterase type 5 (PDE5) inhibitors, some erectile dysfunction patients are resistant to or do not tolerate treatment with them, thus requiring further treatment alternatives. Statins have emerged as a promising therapeutic option due to their multiple modes of action.

Chronicles in drug discovery.

Chronicles in Drug Discovery features special interest reports on advances in drug discovery and development. This month we focus on the progress of the ongoing search for safe and effective chemopreventive agents. Chemoprevention is a strategy to decrease the risk of developing cancer by using agents that prevent or abrogate carcinogenic processes.

"Glucometrics"--assessing the quality of inpatient glucose management.

Background: For patients with diabetes, the quality of outpatient glycemic control is readily assessed by hemoglobin A1c. In contrast, standardized measures for assessing the quality of blood glucose (BG) management in hospitalized patients are lacking. Because of recent studies demonstrating the benefits of strict glycemic control in critically ill patients, hospitals nationwide are dedicating resources to address this important issue.

Spotlight on tNOX: a tumor-selective target for cancer therapies.

Tumor-associated NOX (tNOX) is a novel cell surface ECTO-NOX protein that represents a promising target for selective antitumor therapy. Studies have confirmed the unique presence of tNOX on the cell surface of invasive human cancers and in the sera of cancer patients. Furthermore, as there is a resolute difference between tNOX and the drug-resistant constitutive NOX isoform constitutive NOX, it represents an attractive target for drug, vaccine and diagnostic strategies for cancer.

Frozen extracellular matrix preserves its thrombogenicity after thawing, while Matrigel induces a poor platelet response.

Two putative substitutes for fresh endothelial cell (EC) extracellular matrix (ECM), frozen ECM and Matrigel, were studied using a parallel-plate perfusion system and platelet deposition was evaluated morphometrically. Coverslips covered with ECM were stored frozen at-30 C for 0 (fresh ECM), 1, 2, 3 or 4 weeks. The ability of frozen ECM to support platelet adhesion after freezing was analyzed under three experimental approaches, perfusing blood: (i) at different shear rates; (ii) on a highly reactive ECM obtained from stimulated EC; and (iii) on ECM incubated with a monoclonal antibody against laminin (LM).

Argatroban: a direct thrombin inhibitor with reliable and predictable anticoagulant actions.

Pharmacological strategies aimed at the prevention of thrombotic complications are in continuous development. Argatroban is a synthetic small molecule derived from l-arginine with specific antithrombotic activity. Argatroban is a direct thrombin inhibitor that binds avidly and reversibly to the catalytic site of thrombin and that does not require other cofactors to exert its antithrombotic action.