Patient Experience at US Hospitals Following the Caregiver Advise, Record, Enable (CARE) Act.

Importance: Communication with caregivers is often not established or standardized during hospitalization. The Caregiver Advise, Record, Enable (CARE) Act is a state-level policy designed to facilitate communication among patients, caregivers, and clinical care teams during hospitalization to improve patient experience; 42 states have passed this policy since 2014, but whether it was associated with achieving these goals remains unknown.

Objective: To determine whether passage of the CARE Act was associated with improvements in patient experience.

Race, ethnicity, and gender representation in clinical case vignettes: a 20-year comparison between two institutions.

Background: The medical case vignette has long been used in medical student education and frequently includes demographic variables such as race, ethnicity and gender. However, inclusion of demographic variables without context may reinforce assumptions and biases. Yet, the absence of race, sexual orientation, and social determinants of health may reinforce a hidden curriculum that reflects cultural blindness.

Emergency medicine evaluation and management of the end stage renal disease patient.

Background: End stage renal disease (ESRD) is increasing in the U.S., and these patients demonstrate greater all-cause mortality, cardiovascular events, and hospitalization rates when compared to those with normal renal function.

Tyrosine for Mitigating Stress and Enhancing Performance in Healthy Adult Humans, a Rapid Evidence Assessment of the Literature.

Background: Tyrosine, a precursor of catecholamine neurotransmitters, may help alleviate physical/cognitive performance decrements in humans under conditions of high physical/psychological stress.

Objective: Determine whether supplemental tyrosine mitigates stress-induced decrements in cognitive and/or physical performance in healthy individuals using Samueli Institute's Rapid Evidence Assessment of the Literature methodology.

Methods: Key databases (PubMed/MEDLINE, CINAHL, Embase, PsycInfo, and Agricola) were searched for randomized controlled trials from inception to October 2012.

An analysis of the various chronic pain conditions captured in a systematic review of active self-care complementary and integrative medicine therapies for the management of chronic pain symptoms.

Objectives: Chronic pain management typically consists of prescription medications or provider-based, behavioral, or interventional procedures that are often ineffective, may be costly, and can be associated with undesirable side effects. Because chronic pain affects the whole person (body, mind, and spirit), patient-centered complementary and integrative medicine (CIM) therapies that acknowledge the patients' roles in their own healing processes have the potential to provide more efficient and comprehensive chronic pain management. Active self-care CIM therapies (ACT-CIM) allow for a more diverse, patient-centered treatment of complex symptoms, promote self-management, and are relatively safe and cost-effective.

Assessing the quality, efficacy, and effectiveness of the current evidence base of active self-care complementary and integrative medicine therapies for the management of chronic pain: a rapid evidence assessment of the literature.

Objectives: Chronic pain management typically consists of prescription medications or provider-based, behavioral, or interventional procedures that are often ineffective, may be costly, and can be associated with undesirable side effects. Because chronic pain affects the whole person (body, mind, and spirit), patient-centered complementary and integrative medicine (CIM) therapies that acknowledge the patients' roles in their own healing processes have the potential to provide more efficient and comprehensive chronic pain management. Active self-care CIM (ACT-CIM) therapies allow for a more diverse, patient-centered treatment of complex symptoms, promote self-management, and are relatively safe and cost-effective.

Effectiveness of active self-care complementary and integrative medicine therapies: options for the management of chronic pain symptoms.

Objectives: Chronic pain management typically consists of prescription medications or provider-based, behavioral, or interventional procedures that are often ineffective, may be costly, and can be associated with undesirable side effects. Because chronic pain affects the whole person (body, mind, and spirit), patient-centered complementary and integrative medicine (CIM) therapies that acknowledge the patients' roles in their own healing processes have the potential to provide more efficient and comprehensive chronic pain management. Active self-care CIM (ACT-CIM) therapies allow for a more diverse, patient-centered treatment of complex symptoms, promote self-management, and are relatively safe and cost-effective.

Multimodal, integrative therapies for the self-management of chronic pain symptoms.

Objectives: Chronic pain management typically consists of prescription medications or provider-based, behavioral, or interventional procedures which are often ineffective, may be costly, and can be associated with undesirable side effects. Because chronic pain affects the whole person (body, mind, and spirit), patient-centered complementary and integrative medicine (CIM) therapies that acknowledge the patients' roles in their own healing processes have the potential to provide more efficient and comprehensive chronic pain management. Active self-care CIM therapies (ACT-CIM) allow for a more diverse, patient-centered treatment of complex symptoms, promote self-management, and are relatively safe and cost-effective.

Sensory art therapies for the self-management of chronic pain symptoms.

Objectives: Chronic pain management typically consists of prescription medications or provider-based, behavioral, or interventional procedures which are often ineffective, may be costly, and can be associated with undesirable side effects. Because chronic pain affects the whole person (body, mind, and spirit), patient-centered complementary and integrative medicine (CIM) therapies that acknowledge the patients' roles in their own healing processes have the potential to provide more efficient and comprehensive chronic pain management. Active self-care CIM therapies (ACT-CIM) allow for a more diverse, patient-centered treatment of complex symptoms, promote self-management, and are relatively safe and cost-effective.

Physically oriented therapies for the self-management of chronic pain symptoms.

Objectives: Chronic pain management typically consists of prescription medications or provider-based, behavioral, or interventional procedures that are often ineffective, may be costly, and can be associated with undesirable side effects. Because chronic pain affects the whole person (body, mind, and spirit), patient-centered complementary and integrative medicine (CIM) therapies that acknowledge the patients' roles in their own healing processes have the potential to provide more efficient and comprehensive chronic pain management. Active self-care CIM (ACT-CIM) therapies allow for a more diverse, patient-centered treatment of complex symptoms, promote self-management, and are relatively safe and cost-effective.

Movement therapies for the self-management of chronic pain symptoms.

Objectives: Chronic pain management typically consists of prescription medications or provider-based, behavioral, or interventional procedures which are often ineffective, may be costly, and can be associated with undesirable side effects. Because chronic pain affects the whole person (body, mind, and spirit), patient-centered complementary and integrative medicine (CIM) therapies that acknowledge the patients' roles in their own healing processes have the potential to provide more efficient and comprehensive chronic pain management. Active self-care CIM therapies (ACT-CIM) allow for a more diverse, patient-centered treatment of complex symptoms, promote self-management, and are relatively safe and cost-effective.

Mind-body therapies for the self-management of chronic pain symptoms.

Objectives: Chronic pain management typically consists of prescription medications or provider-based, behavioral, or interventional procedures which are often ineffective, may be costly, and can be associated with undesirable side effects. Because chronic pain affects the whole person (body, mind, and spirit), patient-centered complementary and integrative medicine (CIM) therapies that acknowledge the patients' roles in their own healing processes have the potential to provide more efficient and comprehensive chronic pain management. Active self-care complementary and integrative medicine (ACT-CIM) therapies allow for a more diverse, patient-centered treatment of complex symptoms, promote self-management, and are relatively safe and cost-effective.

The current state of the science for active self-care complementary and integrative medicine therapies in the management of chronic pain symptoms: lessons learned, directions for the future.

Objectives: Chronic pain management typically consists of prescription medications or provider-based, behavioral, or interventional procedures which are often ineffective, may be costly, and can be associated with undesirable side effects. Because chronic pain affects the whole person (body, mind, and spirit), patient-centered complementary and integrative medicine (CIM) therapies that acknowledge the patients' roles in their own healing processes have the potential to provide more efficient and comprehensive chronic pain management. Active self-care CIM (ACT-CIM) therapies allow for a more diverse, patient-centered treatment of complex symptoms, promote self-management, and are relatively safe and cost-effective.

Warm-ups for military fitness testing: rapid evidence assessment of the literature.

Introduction: Warm-up exercises are commonly used before exercise as a method to physiologically prepare for strenuous physical activity. Various warm-up exercises are often implemented but without scientific merit and, at times, may be detrimental to performance.

Purpose/objective: To date, no systematic reviews have examined the effectiveness of warm-up exercises for military physical fitness test (PFT) or combat fitness test (CFT).

The effectiveness of acupuncture research across components of the trauma spectrum response (tsr): a systematic review of reviews.

Background: Co-morbid symptoms (for example, chronic pain, depression, anxiety, and fatigue) are particularly common in military fighters returning from the current conflicts, who have experienced physical and/or psychological trauma. These overlapping conditions cut across the boundaries of mind, brain and body, resulting in a common symptomatic and functional spectrum of physical, cognitive, psychological and behavioral effects referred to as the 'Trauma Spectrum Response' (TSR). While acupuncture has been shown to treat some of these components effectively, the current literature is often difficult to interpret, inconsistent or of variable quality.

Comparative sensitivity of six scleractinian corals to temperature and solar radiation.

Scleractinian corals were exposed to 6 combinations of temperature and solar radiation to evaluate effects on coral bleaching, survival, and tissue surface area changes during and after exposure. A recirculating coral exposure system was coupled to a solar simulator to allow laboratory testing of 6 species of Caribbean corals (Diploria clivosa, Montastraea faveolata, Porites divaricata, Stephanocoenia intersepta, Siderastrea radians, and Siderastrea siderea). Significant bleaching occurred in all of the corals exposed to high irradiance except S.

Deterring gun crime materially using forensic coatings.

Surface coatings that can help deter and solve gun crime are described. These nanoengineered coatings have been applied and evaluated on brass cartridge cases, where they increase associative forensic evidence through nanotag donation to the handler and the retention of handler's DNA. In future we expect this approach to be used for other surfaces and conditions.

Aerococcus urinae and trimethoprim-sulfamethoxazole.

Aerococcus urinae has been described as resistant to trimethoprim-sulfamethoxazole (SXT), but the test medium may affect this observation. Twenty-seven clinical isolates of A. urinae tested susceptible to SXT in cation-adjusted Mueller-Hinton broth (CAMHB) plus lysed horse blood and resistant in CAMHB plus lysed sheep blood.

Reduction of radiation during fluoroscopic urodynamics: analysis of quality assurance protocol limiting fluoroscopic images during fluoroscopic urodynamic studies.

Objective: To evaluate whether the decrease in fluoroscopic images after initiation of a quality assurance (QA) protocol to decrease the amount of fluoroscopy during fluoro urodynamics (FUDS) translates into a significant reduction in radiation.

Methods: The number of spot films, fluoroscopy time, air kerma, and dose area product from FUDS performed by our division during the 3 months before the conceptualization of the QA protocol were compared with the parameters of FUDS performed by our division 3 months after the initiation of the protocol. To ensure the protocol did not adversely affect the analysis of FUDS, 10 FUDS studies were evaluated by 4 fellowship-trained female urologists who compared the interpretation when only the images per QA protocol were reviewed with that when the additional images were reviewed.

Older adults with multi-morbidity: medication management processes and design implications for personal health applications.

Background: Older adults often have multiple chronic problems requiring them to manage complex medication regimens overseen by various clinicians. Personal health applications (PHAs) show promise assisting in medication self-management, but adoption of new computer technologies by this population is challenging. Optimizing the utility of PHAs requires a thorough understanding of older adults' needs, preferences, and practices.

Exploring physician decisions about end-of-life opiate prescribing: a qualitative study.

Background: Opiates are commonly used for symptoms at the end of life (EOL). Little is known about the decision-making process physicians go through when deciding to prescribe opiates for their EOL patients. The study's objective was to explore physician factors affecting EOL opiate prescribing.