Top Ten Tips Palliative Care Clinicians Should Know About Leveraging the Electronic Health Record for Data Collection and Quality Improvement.

As palliative care (PC) programs rapidly grow and expand across settings, the need to measure, improve, and standardize high-quality PC has also grown. The electronic health record (EHR) is a key component of these efforts as a central hub of care delivery and a repository of patient and system data. Deliberate efforts to leverage the EHR for PC quality improvement (QI) can help PC programs and health systems improve care for patients with serious illnesses.

Hospital palliative care consult improves value-based purchasing outcomes in a propensity score-matched cohort.

Background: Hospital-based palliative care consultation is consistently associated with reduced hospitalization costs and more importantly with improved patient quality of life. As healthcare systems move toward value-based purchasing rather than fee-for-service models, understanding how palliative care consultation is associated with value-based purchasing metrics can provide evidence for expanded health system support for a greater palliative care presence.

Aim: To understand how a palliative care consultation impacts rates of patient readmission and hospital-acquired infections associated with value-based purchasing metrics.

Control of apoptosis in Epstein Barr virus-positive nasopharyngeal carcinoma cells: opposite effects of CD95 and CD40 stimulation.

The expression and function of CD95 and CD40 were investigated in malignant cells from EBV-positive undifferentiated nasopharyngeal carcinomas (NPCs). Large amounts of CD95 and CD40 expression were detected in 15 of 16 EBV-positive NPC specimens. In contrast, CD95 was not detected in two biopsies from patients with EBV-negative differentiated NPCs.

Chromosome 11q13 gene amplifications in oral and oropharyngeal carcinomas: no correlation with subclinical lymph node invasion and disease recurrence.

Gene amplifications in the q13 band of chromosome 11 are among the most frequent genetic alterations in head and neck squamous cell carcinomas. Previous studies have suggested that such amplification is a marker of aggressive tumor evolution. Their potential for predicting subclinical lymph node invasion or disease recurrence was investigated in a prospective series of 50 oral and oropharyngeal carcinomas.

Chromosome-11q13 gene amplifications in head and neck squamous-cell carcinomas - relation with lymph-node invasion.

Gene amplifications occurring in the q13 band of chromosome 11 are frequently observed in head and neck squamous cell carcinomas. In order to determine the relative frequency of amplification in 5 distinct 11q13 loci and their relation with clinical data, tumor DNAs from 31 patients - including 26 who had undergone neck dissection (lymph node histology available) - were evaluated by Southern blot. Specific probes were used for the D11S833E, FGF3, CYCD1, D11S97 and GST-pi loci.

Toxoplasmic scleritis.

Although toxoplasmosis is the most common infectious cause of posterior intraocular inflammation, it is rarely described in association with scleritis. The authors present five cases of toxoplasmosis with scleritis. Two of the five cases were diagnosed clinically and serologically as having toxoplasmosis.

Basic mechanisms underlying the production of photochemical lesions in the mammalian retina.

Extended exposure (100s) of the macaque retina to blue light (400-500nm) produces a photochemical type or types of lesion. The basic mechanisms responsible for such photic damage are unknown but the toxic combination of light and oxygen leading to the free radicals O-.2, H2O2, OH.

Normal intraocular pressure during enucleation for choroidal melanoma.

A simple surgical technique for maintaining normal intraocular pressure during enucleation of eyes with a malignant melanoma of the choroid consists of making an incision into the anterior chamber through clear cornea with a microvitreo-retinal blade, followed by the introduction of a No. 21-gauge scalp vein needle or a No. 23-gauge sidewall-holed needle attached to a closed system filled with balanced salt solution.

Persistence of benzo[alpha]pyrenediolepoxide DNA adduct in mouse skin.

The covalently bound products of [3H]benzo[alpha]pyrene (BP) were determined in the DNA isolated from the skin of mice 3 weeks after application of the carcinogen. In the relatively rapidly proliferating skin the persistence of BP-DNA adducts was observed, 50% of which were unmodified nucleosides. Small amounts of (7R) BPDE I-dG adduct (5% from the initial formation) were found after 3 weeks.

Action spectrum for retinal injury from near-ultraviolet radiation in the aphakic monkey.

We found that the action spectrum for retinal damage (determined by the fundus photographic appearance of a minimal lesion immediately after exposure) extends into the near-ultraviolet by exposing three aphakic eyes from rhesus monkeys to 405-, 380-, 350-, and 320-nm wavelengths produced by a 2,500-W xenon lamp equipped with quartz optics and 10-nm interference filters. Exposure times were 100 and 1,000 seconds and the spot diameter on the retina was 500 micrometers. The retina was six times more sensitive to 350- and 325-nm wavelengths than to blue light (441 nm).

[Demonstration of "hydroxylase" and "epoxide hydrase" activities in preparations of nucleoli isolated from rat liver].

Aryl hydrocarbon hydroxylase (AHH) activity and epoxyde hydrase (EH) activity have been found in Rat liver nucleoli obtained from untreated (C) and methylcholanthrene (MC) pretreated Rats. Electron microscopic observations of nucleolar preparations did not reveal significant contamination either by intact nuclei or by nuclear membranes. Very low but detectable activity of NADPH cytochrome C reductase was found in the nucleoli.

Diffuse unilateral subacute neuroretinitis.

Thirty-six young healthy patients developed a peculiar clinical syndrome affecting only one eye. The early stage of the disease was characterized by visual loss, vitritis, mild papilledema, and successive crops of multiple, evanescent, gray-white, deep, retinal lesions. Over a period of many months there developed widespread, diffuse and focal depigmentation of the pigment epithelium, retinal arterial narrowing, optic atrophy, severe visual loss, and electroretinographic changes.

Choroidal Osteoma.

Choroidal osteomas caused visual symptoms in four healthy young women. A positive 32P test led to enucleation and histopathologic confirmation of the diagnosis in one patient. The characteristic ophthalmoscopic findings in these patients included the following: (1) slightly and irregularly elevated, yellow-white, juxtapapillary, choroidal tumor and well-defined geographic borders; (2) diffuse and mottled depigmentation of the overlying pigment epithelium; and (3) multiple small vascular networks on the tumor surface.

Carcinoma of supernumerary breast of vulva with bilateral mammary cancer.

Primary mammary cancer often develops at multiple sites in either one or both breasts, evidently the result of a common carcinogen acting in multicentric loci. The occurrence of carcinoma in accessory breast tissue has been recorded, including carcinoma in supernumerary breast tissue within the labium, although the latter is rare. A 62-year-old woman developed carcinoma of the right breast which was followed nearly five and one half years later by the occurrence of adenocarcinoma in supernumerary breast tissue within the left labium majus.

Paranasal sinus carcinoma causing orbital mucocele.

Three patients presented with typical orbital mucoceles. However, subsequent histopathologic study revealed paranasal sinus concomitant squamous cell carcinoma in all three cases. Careful histologic investigation is necessary before considering orbital mucocele a benign process.