Successful electronic implementation of discharge referral decision support has a positive impact on 30- and 60-day readmissions.

In a quasi-experimental study, decision support software was installed in three hospitals to study the ability to scale (spread) its use from one hospital on paper to three hospitals as software, and to examine the effect on 30- and 60-day readmissions. The Discharge Decision Support System (D2S2) software analyzes data collected by nurses on admission with a proprietary risk assessment tool, identifies patients in need of post-acute care, and alerts discharge planners. On six intervention units, with a concurrent comparison group of 76 units, we examined the implementation experience and compared readmission outcomes before and after implementation.

Incidental gonadal tumors at the time of gonadectomy in women with Swyer syndrome: a case series.

Background: Swyer syndrome (46XY complete gonadal dysgenesis) is an uncommonly encountered condition in our population. Gonadectomy is recommended upon diagnosis due to a significant risk of malignant transformation of the dysgenetic gonads, typically to dysgerminoma.

Cases: We present 3 cases of women who underwent gonadectomy following a diagnosis of Swyer syndrome.

SBRT for the Primary Treatment of Localized Prostate Cancer: The Effect of Gleason Score, Dose and Heterogeneity of Intermediate Risk on Outcome Utilizing 2.2014 NCCN Risk Stratification Guidelines.

Purpose: To report an update of our previous experience using stereotactic body radiation therapy (SBRT) for the primary treatment of prostate cancer, risk stratified by the updated National Comprehensive Cancer Network (NCCN) version 2.2014, reporting efficacy and toxicity in a community hospital setting.

Methods: From 2007 to 2012, 142 localized prostate cancer patients were treated with SBRT using CyberKnife.

Factor analysis of the modified Sexual Adjustment Questionnaire-Male.

Background And Purpose: The Sexual Adjustment Questionnaire (SAQ) is used in National Cancer Institute-sponsored clinical trials as an outcome measure for sexual functioning. The tool was revised to meet the needs for a clinically useful, theory-based outcome measure for use in both research and clinical settings. This report describes the modifications and validity testing of the modified Sexual Adjustment Questionnaire-Male (mSAQ-Male).

Use of imiquimod for residual acral melanoma.

Recent reports suggest that topical imiquimod cream is an effective treatment option for certain types of melanomas. No reports exist on the efficacy of using imiquimod cream to treat melanoma located on the plantar surface of the foot. We present two patients with a melanoma of the foot who had residual melanoma following surgical excision with acceptable margins.

Characteristics of the NICU work environment associated with breastfeeding support.

Purpose: The provision of breastfeeding support in the neonatal intensive care unit (NICU) may assist a mother to develop a milk supply for the NICU infant. Human milk offers unique benefits and its provision unique challenges in this highly vulnerable population. The provision of breastfeeding support in this setting has not been studied in a large, multihospital study.

AAV vectors expressing LDLR gain-of-function variants demonstrate increased efficacy in mouse models of familial hypercholesterolemia.

Rationale: Familial hypercholesterolemia is a genetic disorder that arises because of loss-of-function mutations in the low-density lipoprotein receptor (LDLR) and homozygous familial hypercholesterolemia is a candidate for gene therapy using adeno-associated viral vectors. Proprotein convertase subtilisin/kexin type 9 (PCSK9) and inducible degrader of LDLR (IDOL) negatively regulate LDLR protein and could dampen adeno-associated viral vector encoded LDLR expression.

Objective: We sought to create vectors expressing gain-of-function human LDLR variants that are resistant to degradation by human PCSK9 (hPCSK9) and IDOL and thereby enhance hepatic LDLR protein abundance and plasma LDL cholesterol reduction.

Comparison of evidence-based interventions on outcomes of hospitalized, cognitively impaired older adults.

Aim: This article reports the effects of three evidence-based interventions of varying intensity, each designed to improve outcomes of hospitalized cognitively impaired older adults.

Materials & Methods: In this comparative effectiveness study, 202 older adults with cognitive impairment (assessed within 24 h of index hospitalization) were enrolled at one of three hospitals within an academic health system. Each hospital was randomly assigned one of the following interventions: Augmented Standard Care (ASC; lower dose: n = 65), Resource Nurse Care (RNC; medium dose: n = 71) or the Transitional Care Model (TCM; higher dose: n = 66).

Feasibility and potential utility of multicomponent exhaled breath analysis for predicting development of radiation pneumonitis after stereotactic ablative radiotherapy.

Introduction: In this prospective pilot study, we evaluated the feasibility and potential utility of measuring multiple exhaled gases as biomarkers of radiation pneumonitis (RP) in patients receiving stereotactic ablative radiotherapy (SABR) for lung tumors.

Methods: Breath analysis was performed for 26 patients receiving SABR for lung tumors. Concentrations of exhaled nitric oxide (eNO), carbon monoxide (eCO), nitrous oxide (eN2O), and carbon dioxide (eCO2) were measured before and immediately after each fraction using real-time, infrared laser spectroscopy.

CPAP, weight loss, or both for obstructive sleep apnea.

Background: Obesity and obstructive sleep apnea tend to coexist and are associated with inflammation, insulin resistance, dyslipidemia, and high blood pressure, but their causal relation to these abnormalities is unclear.

Methods: We randomly assigned 181 patients with obesity, moderate-to-severe obstructive sleep apnea, and serum levels of C-reactive protein (CRP) greater than 1.0 mg per liter to receive treatment with continuous positive airway pressure (CPAP), a weight-loss intervention, or CPAP plus a weight-loss intervention for 24 weeks.

Development and initial psychometric properties of the Pulmonary Arterial Hypertension Symptom Scale (PAHSS).

Aims: The aim of this study is to report the development and psychometric properties of the Pulmonary Arterial Hypertension Symptom Scale (PAHSS).

Background: Patients with pulmonary arterial hypertension (PAH) experience multiple symptoms such as dyspnea, fatigue and chest pain, yet there is no comprehensive, validated symptom assessment tool to date.

Methods: This study used a cross sectional design.

Quantitative analysis of the nonlinear displacement-load behavior of the lumbar spine.

There is currently no universal model or fitting method to characterize the visco-elastic behavior of the lumbar spine observed in displacement versus load hysteresis loops. In this study, proposed methods for fitting these loops, along with the metrics obtained, were thoroughly analyzed. A spline fitting technique was shown to provide a consistent approximation of spinal kinetic behavior that can be differentiated and integrated.

Sleep disturbance, symptoms, psychological distress, and health-related quality of life in pulmonary arterial hypertension.

Background: Pulmonary arterial hypertension (PAH) is a devastating disease characterized by elevated pulmonary pressures that lead to right heart failure and premature mortality. Patients experience multiple symptoms including dyspnea, fatigue and chest pain, but little is known about sleep disturbance, PAH symptoms, psychological distress and health-related quality of life (HRQOL) in PAH.

Aim: The purpose of this study was to describe the occurrence of sleep disturbance and compare PAH symptoms, psychological distress, and HRQOL across severity of sleep disturbance.

The effect of arm position on the dosimetry of thoracic stereotactic ablative radiation therapy using volumetric modulated arc therapy.

Purpose: Patient comfort and positioning stability may be improved in the arms down (AD) compared with the typical arms up (AU) position in thoracic stereotactic ablative radiation therapy (SABR). We compared plan quality for AD vs AU when using volumetric modulated arc therapy (VMAT), and evaluated the sensitivity of AD plans to arm positioning variability.

Methods And Materials: We took plans of 14 patients with 17 lung tumors treated with thoracic SABR using VMAT in the AD position and simulated the same treatments in the AU position by re-optimizing after digitally removing the ipsilateral arm.

Do medical trainees feel confident communicating with low health literacy patients?

Background: Medical trainees infrequently use health literacy (HL) skills and overestimate their use of plain language and teach back skills. The aim of this study is to assess if level of training impacts the perception of medical trainees around HL knowledge and skills.

Methods: A structured questionnaire consisting of 5 questions assessing the respondents' perception of their confidence in their HL knowledge, ability to identify and communicate with low HL patients, and use of relevant resources was completed by medical students and residents of 2 community-based internal medicine programs in Pennsylvania and Maryland between July 2012 and January 2013.

Veterinarian challenges to providing a multi-agency response to farm animal welfare problems in Ireland: responding to the human factor.

In 2012, the authors undertook a study of the challenges facing government and private veterinarians in responding to the human element of farm animal welfare incidents (i.e. the personal problems and difficulties of farmers that can result in farm animal neglect).

The effects of quetiapine on sleep in recovering alcohol-dependent subjects: a pilot study.

Objective: The aim of this hypothesis-generating pilot study was to assess prospectively the objective and subjective effects of treatment with quetiapine XR on sleep during early recovery from alcohol dependence (AD).

Methods: Recovering subjects with AD and sleep disturbance complaints were treated with quetiapine XR (n = 10) or matching placebo pills (n = 10) for 8 weeks. Polysomnography was used to assess sleep objectively, and the Insomnia Severity Index and Pittsburgh Sleep Quality Index were used to measure subjective insomnia.

The Social Health Intervention Project (SHIP): protocol for a randomized controlled clinical trial assessing the effectiveness of a brief motivational intervention for problem drinking and intimate partner violence in an urban emergency department.

Background: There is a strong reciprocal association between two highly prevalent public health problems: intimate partner violence and heavy drinking, both of which remain major sources of morbidity and mortality. Brief interventions in the Emergency Department setting have been found to be effective in reducing alcohol-related injury but neither classic intimate partner violence nor substance abuse interventions have adequately integrated assessment and treatment for these co-occurring conditions. The overall goal of this study is to determine whether a motivational intervention delivered at the time of an Emergency Department visit will reduce heavy drinking and improve the safety of women experiencing intimate partner violence.

Impact of frontloading of skilled nursing visits on the incidence of 30-day hospital readmission.

Hospitalization among older adults receiving skilled home health services continues to be prevalent. Frontloading of skilled nursing visits, defined as providing 60% of the planned skilled nursing visits within the first two weeks of home health episode, is one way home health agencies have attempted to reduce the need for readmission among this chronically ill population. This was a retrospective observational study using data from five Medicare-owned, national assessment and claim databases from 2009.

The impact of ethics and work-related factors on nurse practitioners' and physician assistants' views on quality of primary healthcare in the United States.

Purpose: Nurse practitioners (NPs) and physician assistants (PAs) provide primary care services for many American patients. Ethical knowledge is foundational to resolving challenging practice issues, yet little is known about the importance of ethics and work-related factors in the delivery of quality care. The aim of this study was to quantitatively assess whether the quality of the care that practitioners deliver is influenced by ethics and work-related factors.

The cutting edge of skin cancer in transplant recipients: scientific retreat of international transplant Skin Cancer Collaborative and Skin Cancer in Organ Transplant Patients Europe.

The International Transplant Skin Cancer Collaborative (ITSCC) is an organization of more than 300 physicians and scientists focused on the study of dermatologic changes following solid organ transplantation. Transplant patients have a 100-fold increased risk of developing skin cancer. In October 2012, ITSCC and its European counterpart Skin Cancer in Organ Transplant Patients Europe held a joint biennial retreat in Essex, MA to discuss novel findings in the pathogenesis and management of skin cancer in solid organ transplant recipients.

Risk assessment for CPAP nonadherence in adults with newly diagnosed obstructive sleep apnea: preliminary testing of the Index for Nonadherence to PAP (I-NAP).

Purpose: Identification of risk for continuous positive airway pressure therapy (CPAP) nonadherence prior to home treatment is an opportunity to deliver targeted adherence interventions. Study objectives included the following: (1) test a risk screening questionnaire to prospectively identify CPAP nonadherence risk among adults with newly diagnosed obstructive sleep apnea (OSA), (2) reduce the questionnaire to a minimum item set that effectively identifies 1-month CPAP nonadherence, and (3) examine the diagnostic utility of the screening index.

Methods: A prospective, longitudinal study at two clinical sleep centers in the USA included adults with newly diagnosed OSA (n=97; AHI≥5 events/h) by polysomnogram (PSG) consecutively recruited to participate.

Burden in caregivers of cognitively impaired elderly adults at time of hospitalization: a cross-sectional analysis.

Objectives: To describe the factors associated with burden that caregivers of cognitively impaired older adults (dementia, delirium, or both) at the time of hospitalization experienced.

Design: Cross-sectional data analyses.

Setting: Three hospitals-one academic tertiary hospital and two associated community hospitals.

A population-based comparative effectiveness study of radiation therapy techniques in stage III non-small cell lung cancer.

Purpose: Concerns have been raised about the potential for worse treatment outcomes because of dosimetric inaccuracies related to tumor motion and increased toxicity caused by the spread of low-dose radiation to normal tissues in patients with locally advanced non-small cell lung cancer (NSCLC) treated with intensity modulated radiation therapy (IMRT). We therefore performed a population-based comparative effectiveness analysis of IMRT, conventional 3-dimensional conformal radiation therapy (3D-CRT), and 2-dimensional radiation therapy (2D-RT) in stage III NSCLC.

Methods And Materials: We used the Surveillance, Epidemiology, and End Results (SEER)-Medicare database to identify a cohort of patients diagnosed with stage III NSCLC from 2002 to 2009 treated with IMRT, 3D-CRT, or 2D-RT.

The Benefit of Chemotherapy in Esophageal Cancer Patients With Residual Disease After Trimodality Therapy.

Introduction: The objective of this retrospective study was to determine the potential benefits of chemotherapy in esophageal cancer patients treated with chemoradiation followed by surgery.

Materials And Methods: At our institution, 145 patients completed trimodality therapy from 1993 to 2009. Neoadjuvant treatment predominantly consisted of 5-fluorouracil and cisplatin with a concurrent median radiation dose of 50.