Patient Education for CKD and Decision Support in Primary Care: Findings From the EPIK Pilot Study.

Rationale & Objective: Chronic kidney disease affects millions of people in the United States, yet effective interventions to address gaps in patient knowledge and engagement are not well established. We sought to develop and pilot a brief educational decision aid for patients with CKD cared for in primary care settings.

Study Design: A pilot QI study of a decision aid intervention.

Guideline concordance of aspirin use for primary prevention in adult outpatients.

Recent guidelines have recommended a reduced role for primary prevention aspirin use, which is associated with an increased bleeding risk. This study aimed to characterize guideline-discordant aspirin use among adults in a community care setting. As part of a quality improvement initiative, patients at 1 internal medicine and 1 family medicine clinic affiliated with an academic hospital were sent an electronic survey.

Vectorcardiography Predicts Heart Failure in Patients Following ST Elevation Myocardial Infarction.

Background: Modeling outcomes, such as onset of heart failure (HF) or mortality, in patients following ST elevation myocardial infarction (STEMI) is challenging but clinically very useful. The acute insult following a myocardial infarction and chronic degeneration seen in HF involve a similar process where a loss of cardiomyocytes and abnormal remodeling lead to pump failure. This process may alter the strength and direction of the heart's net depolarization signal.

Quantitative Biomarkers of Diabetic Retinopathy Using Ultra-Widefield Fluorescein Angiography.

Introduction: Diabetic retinopathy (DR) is a leading cause of blindness. Retinal imaging is an important tool to monitor the progression of DR. While seven-standard retinal fields are the traditional method for evaluating DR, ultra-widefield (UWF) imaging allows for improved visualization of peripheral areas of nonperfusion (NP) and neovascularization (NV), which could be used as biomarkers to monitor and predict progression of DR.

Impact of PTSD treatment on postconcussive symptoms in veterans: A comparison of sertraline, prolonged exposure, and their combination.

Many Veterans who served in Iraq and Afghanistan struggle with posttraumatic stress disorder (PTSD) and the effects of traumatic brain injuries (TBI). Some people with a history of TBI report a constellation of somatic, cognitive, and emotional complaints that are often referred to as postconcussive symptoms (PCS). Research suggests these symptoms may not be specific to TBI.

Circulating Ectonucleotidases Signal Impaired Myocardial Perfusion at Rest and Stress.

Background Ectonucleotidases maintain vascular homeostasis by metabolizing extracellular nucleotides, modulating inflammation and thrombosis, and potentially, myocardial flow through adenosine generation. Evidence implicates dysfunction or deficiency of ectonucleotidases CD39 or CD73 in human disease; the utility of measuring levels of circulating ectonucleotidases as plasma biomarkers of coronary artery dysfunction or disease has not been previously reported. Methods and Results A total of 529 individuals undergoing clinically indicated positron emission tomography stress testing between 2015 and 2019 were enrolled in this single-center retrospective analysis.

Patient-Centered Outcomes With a Multidisciplinary CKD Care Team Approach: An Observational Study.

Rationale & Objective: Multidisciplinary chronic kidney disease (CKD) care has been associated with improved clinical outcomes in comparison to general nephrology care. However, there is little research examining the impact of multidisciplinary care on patient-centered outcomes. We examined if a multidisciplinary approach to CKD care was associated with 4 patient-centered outcomes.

Retinal neovascularization as self-organized criticality on ultra-widefield fluorescein angiography imaging of diabetic retinopathy.

Background/objectives: Do the distributions of surface area of non-perfusion (NP) and neovascularization (NV) on ultra-widefield fluorescein angiography (UWF FA) in patients with diabetic retinopathy (DR) differ significantly?

Subjects/methods: Inclusion criteria were patients who had a UWF FA taken for DR at the Kellogg Eye Center from January 2009 to May 2018. Exclusion criteria included previous panretinal photocoagulation and significant media opacity (e.g.

Extent of Extranodal Extension in Oral Cavity Squamous Cell Carcinoma is Not Independently Associated With Overall or Disease-Free Survival at a 2.0-mm Threshold.

Purpose: The presence of extranodal extension (ENE) conveys a poor prognosis in oral cavity squamous cell carcinoma (OSCC); however, there is no consensus regarding whether the histopathologic extent of ENE (e-ENE) may be a more discriminating prognostic indicator. The purpose of this study was to assess the impact of minor ENE (<2.0 mm) versus major ENE (≥ 2.

Multisite Retrospective Review of Outcomes in Renal Replacement Therapy for Neonates with Inborn Errors of Metabolism.

Objective: To assess the outcomes of neonates in a contemporary multi-institutional cohort who receive renal replacement therapy (RRT) for hyperammonemia.

Study Design: We performed a retrospective analysis of 51 neonatal patients with confirmed inborn errors of metabolism that were treated at 9 different children's hospitals in the US between 2000 and 2015.

Results: Twenty-nine patients received hemodialysis (57%), 21 patients received continuous renal replacement therapy (41%), and 1 patient received peritoneal dialysis (2%).

Evaluation of a clinical decision support tool to predict permanence of retrievable inferior vena cava filters.

Objective: To evaluate the usefulness of a published clinical decision support tool to predict the likelihood of a retrievable inferior vena cava (IVC) filter being maintained as a permanent device.

Methods: This multicenter retrospective cohort study included 1498 consecutive patients (852 men and 646 women; median age, 60 years; range, 18-98 years) who underwent retrievable IVC filter insertion between January 2012 and December 2019. The indications for IVC filtration, baseline neurologic disease, history of venous thromboembolism (VTE), and underlying malignancy were recorded.

Safety and Effectiveness of Advanced Retrieval Techniques for Inferior Vena Cava Filters Compared with Standard Retrieval Techniques: A Systematic Review of the Literature and Meta-Analysis.

Purpose: To investigate the pooled safety and effectiveness of advanced retrieval techniques for inferior vena cava (IVC) filters compared with standard retrieval techniques through a systematic review of the literature and meta-analysis.

Materials And Methods: A systematic search of retrievable IVC filters between 1980 and 2020 was conducted. Studies were included if both standard and advanced retrieval techniques were utilized in the same cohort, retrieval success rates and adverse event rates were described for each technique, and advanced techniques were employed after the failure of standard techniques.

Change in posttraumatic stress disorder-related thoughts during treatment: Do thoughts drive change when pills are involved?

Posttraumatic negative thoughts about one's self and the world are related to posttraumatic stress disorder (PTSD) symptom severity and change in cognitive behavioral treatment (CBT), but little is known about this association when CBT is delivered with medication. The current study presents a planned comparison of changes in negative posttraumatic thoughts during (a) prolonged exposure (PE) plus pill placebo (PE+PLB), (b) sertraline plus enhanced medication management (SERT+EMM), and (c) PE plus sertraline (PE+SERT) as part of a randomized clinical trial in a sample of 176 veterans. Lagged regression modeling revealed that change in posttraumatic negative thoughts was associated with PTSD symptom change in the conditions in which participants received sertraline, ds = 0.

Virtual Externship Programs Can Serve as a Viable Alternative to In-Person Externship Experiences in Oral and Maxillofacial Surgery.

Purpose: The purpose of this study is to describe a model for a virtual externship program in oral-maxillofacial surgery (OMS); to quantify the value of a virtual externship in increasing understanding of the program structure, scope, and commitment to diversity; and to offer qualitative feedback on structural components.

Methods: A retrospective study was completed comparing dental student perceptions of an OMS program and the virtual externship experience prior to and following an OMS residency virtual externship event. An electronic survey was distributed to registrants and included 25 questions: 5 related to demographics, 17 ascertaining understanding of various components of the residency and perception of virtual externships, and 3 text-based response queries.

Patient Electronic Health Record Portal Use and Patient-Centered Outcomes in CKD.

Rationale & Objective: Electronic health record portals are increasingly emphasized in chronic kidney disease (CKD). However, associations of portal use with clinical and patient-centered outcomes remain unknown.

Study Design: Cross-sectional survey (April 2015 to March 2018).

Outcomes of cystic fibrosis pulmonary exacerbations treated with antibiotics with activity against anaerobic bacteria.

Background: Obligate and facultative anaerobic bacteria are prevalent in cystic fibrosis (CF) airways. Increases in anaerobe relative abundance have been associated with CF pulmonary exacerbations (PEx); however, the impact of antibiotic treatment of anaerobes during PEx is unknown. We hypothesized that PEx treated with antibiotics with activity against anaerobes would improve outcomes compared to antibiotics without anaerobic activity.

An In-House Computer-Aided Design and Computer-Aided Manufacturing Workflow for Maxillofacial Free Flap Reconstruction is Associated With a Low Cost and High Accuracy.

Purpose: In-house computer-aided surgical design and computer-aided manufacturing (CAD/CAM) can be used in oral and maxillofacial surgery for virtual surgical planning and 3-dimensional printing of patient-specific models. The purpose of this study was to measure the cost and accuracy of an in-house CAD/CAM workflow for maxillofacial free flap reconstruction.

Materials And Methods: A retrospective cohort study of patients undergoing mandibular resection and free flap reconstruction was performed between July 2017 and March 2018 in which in-house CAD/CAM was used.

Quality improvement initiative to improve pulmonary function in pediatric cystic fibrosis patients.

Background: Our Cystic Fibrosis (CF) Center initiated a Quality Improvement (QI) project in November 2017 with the goal of improving our patients' forced expiratory volume in 1 second (FEV1) percent predicted (pp) and continued for 1 year. Our specific aim was to increase the relative mean FEV1 pp by 5% in 12 months for CF patients 6 to 21 years old with FEV1 ≤ 80 pp.

Methods: We identified patients with FEV1 ≤ 80 pp, developed cause and effect diagrams (fishbones) to identify contributing factors to FEV1 ≤ 80 pp, and created flowcharts to address barriers.

Cortisol awakening response in PTSD treatment: Predictor or mechanism of change.

PTSD is associated with abnormalities in hypothalamic-pituitary-adrenal (HPA) axis activity. This includes enhanced HPA axis negative feedback, attenuated cortisol awakening response, and attenuated cortisol response to personal trauma script. Whether HPA axis function predicts treatment response or treatment related symptom reduction in PTSD remains unclear.

Quantification of Retinal Nonperfusion and Neovascularization With Ultrawidefield Fluorescein Angiography in Patients With Diabetes and Associated Characteristics of Advanced Disease.

Importance: Quantification of nonperfusion (NP) and neovascularization (NV) in diabetic retinopathy (DR) may identify better biomarkers of disease progression.

Objective: To identify demographic risk factors and markers of advanced DR that are associated with increased areas of NP and NV in eyes with disease ranging from no DR but diagnosed as having diabetes to proliferative DR (PDR) and to calculate a threshold total area of NP that may be associated with an increased risk of PDR.

Design, Setting, And Participants: This retrospective case series was performed on ultrawidefield fluorescein angiography (UWF FA) images from January 2009 to May 2018 at the University of Michigan Kellogg Eye Center.

Oral Lichen Planus-Associated Oral Cavity Squamous Cell Carcinoma Is Associated With Improved Survival and Increased Risk of Recurrence.

Purpose: We investigated the overall survival (OS), disease-specific survival (DSS), and disease-free survival among patients with oral lichen planus-associated oral cavity squamous cell carcinoma (OLP-OCSCC). The secondary objective was to assess the annual risk of tumor recurrence or second primary tumor (SPT).

Materials And Methods: A comparative retrospective study was performed of patients with OLP-OCSCC presenting between June 2007 and December 2018 to the Department of Oral and Maxillofacial Surgery, Michigan Medicine (Ann Arbor, MI) and patients with OCSCC in the National Cancer Institute Surveillance, Epidemiology, and End Results (SEER) database (1973 to 2015).

Efficacy of Prolonged Exposure Therapy, Sertraline Hydrochloride, and Their Combination Among Combat Veterans With Posttraumatic Stress Disorder: A Randomized Clinical Trial.

Importance: Meta-analyses of treatments for posttraumatic stress disorder (PTSD) suggest that trauma-focused psychotherapies produce greater benefits than antidepressant medications alone.

Objective: To determine the relative efficacy of prolonged exposure therapy plus placebo, prolonged exposure therapy plus sertraline hydrochloride, and sertraline plus enhanced medication management in the treatment of PTSD.

Design, Setting, And Participants: The Prolonged Exposure and Sertraline Trial was a randomized, multisite, 24-week clinical trial conducted at the Veterans Affairs Ann Arbor Healthcare System, Veterans Affairs San Diego Healthcare System, Ralph H.

Risk Assessment of Hepatocellular Carcinoma in Patients with Hepatitis C in China and the USA.

Background: Hepatitis C (HCV) infection is an increasingly common cause of hepatocellular carcinoma (HCC) in China.

Aims: We aimed to determine differences in demographic and behavioral profiles associated with HCC in HCV+ patients in China and the USA.

Methods: Consecutive HCV+ patients were recruited from centers in China and the USA.