Ultrasound evaluation of appendicitis: importance of the 3 × 2 table for outcome reporting.

Introduction: Despite a relatively high frequency of appendix nonvisualization when using ultrasound to diagnose appendicitis, many studies either fail to report these results or inconsistently analyze outcomes.

Objectives: The objective of this study is to determine the most transparent and accurate way of reporting and analyzing ultrasound results for the diagnosis of appendicitis.

Methods: This was an observational cohort study of emergency department patients age 18 years or older who underwent right lower quadrant ultrasonography from September 2010 to October 2011.

An observational study of emergency department utilization among enrollees of Minnesota Health Care Programs: financial and non-financial barriers have different associations.

Background: Emergency department (ED) use is costly, and especially frequent among publicly insured populations in the US, who also disproportionately encounter financial (cost/coverage-related) and non-financial/practical barriers to care. The present study examines the distinct associations financial and non-financial barriers to care have with patterns of ED use among a publicly insured population.

Methods: This observational study uses linked administrative-survey data for enrollees of Minnesota Health Care Programs to examine patterns in ED use-specifically, enrollee self-report of the ED as usual source of care, and past-year count of 0, 1, or 2+ ED visits from administrative data.

A multidimensional home-based care coordination intervention for elders with memory disorders: the maximizing independence at home (MIND) pilot randomized trial.

Objectives: To assess whether a dementia care coordination intervention delays time to transition from home and reduces unmet needs in elders with memory disorders.

Design: 18-month randomized controlled trial of 303 community-living elders.

Setting: 28 postal code areas of Baltimore, MD.

Derivation and validation of a simple calculator to predict home discharge after surgery.

Background: Surgical patients and their physicians currently have tools to provide individualized prognostication for morbidity and mortality. For improved shared decision making, formal prediction of patient-centered outcomes is necessary. We derived and validated a simple, interview-based method to predict discharge home after surgery.

Development and validation of the Emergency Department Assessment of Chest pain Score and 2 h accelerated diagnostic protocol.

Objective: Risk scores and accelerated diagnostic protocols can identify chest pain patients with low risk of major adverse cardiac event who could be discharged early from the ED, saving time and costs. We aimed to derive and validate a chest pain score and accelerated diagnostic protocol (ADP) that could safely increase the proportion of patients suitable for early discharge.

Methods: Logistic regression identified statistical predictors for major adverse cardiac events in a derivation cohort.

Dystonia as a network disorder: what is the role of the cerebellum?

The dystonias are a group of disorders defined by sustained or intermittent muscle contractions that result in involuntary posturing or repetitive movements. There are many different clinical manifestations and causes. Although they traditionally have been ascribed to dysfunction of the basal ganglia, recent evidence has suggested dysfunction may originate from other regions, particularly the cerebellum.

Subtle microstructural changes of the cerebellum in a knock-in mouse model of DYT1 dystonia.

The dystonias are a group of disorders characterized by involuntary twisting and repetitive movements. DYT1 dystonia is an inherited form of dystonia caused by a mutation in the TOR1A gene, which encodes torsinA. TorsinA is expressed in many regions of the nervous system, and the regions responsible for causing dystonic movements remain uncertain.

Trends in computed tomography utilization rates: a longitudinal practice-based study.

Objectives: Computed tomography (CT) use has increased dramatically over the past 2 decades, leading to increased radiation exposure at the population level. We assessed trends in CT use in a primary care (PC) population from 2000 to 2010.

Methods: Trends in CT use from 2000 to 2010 were assessed in an integrated, multi-specialty group practice.

Triple rule-out computed tomographic angiography for chest pain: a diagnostic systematic review and meta-analysis.

Objectives: The objective was to compare the image quality, diagnostic accuracy, radiation exposure, and contrast volume of "triple rule-out" (TRO) computed tomography (CT) to other diagnostic modalities commonly used to evaluate patients with nontraumatic chest pain (dedicated coronary, pulmonary embolism [PE], and aortic dissection CT; invasive coronary angiography; and nuclear stress testing).

Methods: Four electronic databases were searched, along with reference lists and contacted content experts, for relevant studies from inception until October 2012. Eligible studies enrolled patients with nontraumatic chest pain, shortness of breath, suspected acute coronary syndrome (ACS), PE, or aortic dissection; used at least 64-slice CT technology; and compared TRO CT to another diagnostic modality.

A home-based intervention to reduce depressive symptoms and improve quality of life in older African Americans: a randomized trial.

Background: Effective care models for treating older African Americans with depressive symptoms are needed.

Objective: To determine whether a home-based intervention alleviates depressive symptoms and improves quality of life in older African Americans.

Design: Parallel, randomized trial stratified by recruitment site.

Electronic medical records and physician stress in primary care: results from the MEMO Study.

Background: Little has been written about physician stress that may be associated with electronic medical records (EMR).

Objective: We assessed relationships between the number of EMR functions, primary care work conditions, and physician satisfaction, stress and burnout.

Design And Participants: 379 primary care physicians and 92 managers at 92 clinics from New York City and the upper Midwest participating in the 2001-5 Minimizing Error, Maximizing Outcome (MEMO) Study.

"Sick" or "not-sick": accuracy of System 1 diagnostic reasoning for the prediction of disposition and acuity in patients presenting to an academic ED.

Objective: System 1 decision-making is fast, resource economic, and intuitive (eg, "your gut feeling") and System 2 is slow, resource intensive, and analytic (eg, "hypothetico-deductive"). We evaluated the performance of disposition and acuity prediction by emergency physicians (EPs) using a System 1 decision-making process.

Methods: We conducted a prospective observational study of attending EPs and emergency medicine residents.

Animal models for dystonia.

Symptomatic animal models have clinical features consistent with human disorders and are often used to identify the anatomical and physiological processes involved in the expression of symptoms and to experimentally demonstrate causality where it would be infeasible in the patient population. Rodent and primate models of dystonia have identified basal ganglia abnormalities, including alterations in striatal GABAergic (ie, transmitting or secreting γ-aminobutyric acid) and dopaminergic transmission. Symptomatic animal models have also established the critical role of the cerebellum in dystonia, particularly abnormal glutamate signaling and aberrant Purkinje cell activity.

Correlates of quality of life for individuals with dementia living at home: the role of home environment, caregiver, and patient-related characteristics.

Objectives: To examine prevalence of modifiable risk factors and their contribution to patient quality of life (QoL) as rated by dementia patients and family caregivers.

Design: Cross-sectional.

Setting: Home environment.

Instability at the FRA8I common fragile site disrupts the genomic integrity of the KIAA0146, CEBPD and PRKDC genes in colorectal cancer.

Specific patterns of genomic aberrations have been associated with different types of malignancies. In colorectal cancer, losses of chromosome arm 8p and gains of chromosome arm 8q are among the most common chromosomal rearrangements, suggesting that the centromeric portion of chromosome 8 is particularly sensitive to breakage. Genomic alterations frequently occur in the early stages of tumorigenesis at specific genomic regions known as common fragile sites (cFSs).

Antihypertensive medication use is associated with increased organ system involvement and hospitalization in emergency department patients with anaphylaxis.

Background: Risk factors for increased anaphylaxis severity are poorly understood. Angiotensin-converting enzyme (ACE) inhibitors have been associated with severe anaphylactic reactions in patients with hymenoptera venom allergy. Studies evaluating the association between beta-blockers and severe anaphylaxis have been conflicting.

Low p14ARF expression in neuroblastoma cells is associated with repressed histone mark status, and enforced expression induces growth arrest and apoptosis.

The TP53 tumor suppressor pathway is abrogated by TP53 mutations in the majority of human cancers. Increased levels of wild-type TP53 in aggressive neuroblastomas appear paradox but are tolerated by tumor cells due to co-activation of the TP53 ubiquitin ligase, MDM2. The role of the MDM2 antagonist, p14(ARF), in controlling the TP53-MDM2 balance in neuroblastoma is unresolved.

Subtle microstructural changes of the striatum in a DYT1 knock-in mouse model of dystonia.

The dystonias are comprised of a group of disorders that share common neurological abnormalities of involuntary twisting or repetitive movements and postures. The most common inherited primary dystonia is DYT1 dystonia, which is due to loss of a GAG codon in the TOR1A gene that encodes torsinA. Autopsy studies of brains from patients with DYT1 dystonia have revealed few abnormalities, although recent neuroimaging studies have implied the existence of microstructural defects that might not be detectable with traditional histopathological methods.

Shared decision making in patients with stable coronary artery disease: PCI choice.

Background: Percutaneous coronary intervention (PCI) and optimal medical therapy (OMT) are comparable, alternative therapies for many patients with stable angina; however, patients may have misconceptions regarding the impact of PCI on risk of death and myocardial infarction (MI) in stable coronary artery disease (CAD).

Methods And Results: We designed and developed a patient-centered decision aid (PCI Choice) to promote shared decision making for patients with stable CAD. The estimated benefits and risks of PCI+OMT as compared to OMT were displayed in a decision aid using pictographs with natural frequencies and text.

Outcomes in Canadian emergency department syncope patients--are we doing a good job?

Background: Little is known about the outcomes of adults with syncope seen in Canadian Emergency Departments (EDs).

Objectives: We sought to determine the frequency, timing, and type of serious adverse outcomes occurring in these patients, and the proportion that occur outside the hospital.

Methods: We conducted a health records review of syncope patients presenting to a tertiary care ED over an 18-month period.

Neuropathology of cervical dystonia.

The aim of this study was to search for neuropathological changes in postmortem brain tissue of individuals with cervical dystonia (CD). Multiple regions of formalin-preserved brains were collected from patients with CD and controls and examined with an extensive battery of histopathological stains in a two-stage study design. In stage one, 4 CD brains underwent a broad screening neuropathological examination.

Effect of a physician assistant as triage liaison provider on patient throughput in an academic emergency department.

Objectives: Overcapacity issues plague emergency departments (EDs). Studies suggest that triage liaison providers (TLPs) may shorten patient length of stay (LOS) and reduce the proportion of patients who leave without being seen (LWBS), but these results are not universal. Previous studies used physicians as TLPs.

Transforming the emergency department observation unit: a look into the future.

Many institutions have developed outpatient observation units as an alternative to short-stay inpatient admissions. In this article, we highlight evidence to support the efficacy of EDOU care for chest pain and identify areas in which additional research is needed. Evidence-based protocols and collaborative approaches to care have potential to achieve similar clinical and improved economic outcomes compared with hospital admission.