Considerations of Left Ventricular Assist Device Therapy in the United States' Prison System.

Left ventricular assist device therapy for advanced heart failure is contraindicated if a patient lives in an unsafe environment and recent guidelines declare that "legal history is pertinent for determining personal constraints or financial responsibilities due to parole requirements, pending charges, and possible imprisonment," implying that incarceration would be a contraindication. International guidelines and precedent in the United States establish that medical care for incarcerated persons should match access in the community. We present a case example and practical considerations for advanced heart failure programs faced with the challenge of partnering with patients with heart failure who may be incarcerated and their correctional health systems in the care of their chronic condition.

Alanyl-glutamine supplementation for infection treatment (ACT): a double-blind randomised controlled trial study protocol.

Introduction: is the leading cause of healthcare-associated infections in the USA, with an estimated 1 billion dollars in excess cost to the healthcare system annually. infection (CDI) has high recurrence rate, up to 25% after first episode and up to 60% for succeeding episodes. Preliminary in vitro and in vivo studies indicate that alanyl-glutamine (AQ) may be beneficial in treating CDI by its effect on restoring intestinal integrity in the epithelial barrier, ameliorating inflammation and decreasing relapse.

Human Immunodeficiency Virus (HIV) and Aging: Multimorbidity in Older People With HIV in One Nonurban Southeastern Ryan White HIV/AIDS Program Clinic.

Background: Age-related chronic conditions are becoming more concerning for people with human immunodeficiency virus (PWH). We aimed to identify characteristics associated with multimorbidity and evaluate for association between multimorbidity and human immunodeficiency virus (HIV) outcomes.

Methods: Cohorts included PWH aged 45-89 with ≥1 medical visit at one Ryan White HIV/AIDS Program (RWHAP) Southeastern HIV clinic in 2006 (Cohort 1) or 2016 (Cohort 2).

Evidence From a Multistate Cohort: Enrollment in Affordable Care Act Qualified Health Plans' Association With Viral Suppression.

Background: Healthcare delivery changes associated with viral suppression (VS) could contribute to the United States' "Ending the HIV Epidemic" (EtHE) initiative. This study aims to determine whether Qualified Health Plans (QHPs) purchased by AIDS Drug Assistance Programs (ADAPs) are associated with VS for low-income people living with HIV (PLWH) across 3 states.

Methods: A multistate cohort of ADAP clients eligible for ADAP-funded QHPs were studied (2014-2015).

Validating Performance of a Hospital Discharge Planning Decision Tool in Community Hospitals.

Purpose Of Study: The Early Screen for Discharge Planning (ESDP) is a decision support tool developed in an urban academic medical center. High ESDP scores identify patients with nonroutine discharge plans who would benefit from early discharge planning intervention. We aimed to determine the predictive performance of the ESDP in a different practice setting.

Exploring indicators of use of costly health services in community-dwelling adults with multiple chronic conditions.

Unlabelled: Although experts recognize that including patient functional and social variables would improve models predicting risk of using costly health services, these self-reported variables are not widely used.

Purpose Of Study: Explore differences in predisposing characteristics, enabling resources, patient-perceived need for care and professionally evaluated need for care variables between patients receiving primary care within a Health Care Home who did and did not use hospital, emergency department, or skilled nursing facility services in a 3-month period of time.

Primary Practice Setting(s): Primary care.

Preemptive genotyping for personalized medicine: design of the right drug, right dose, right time-using genomic data to individualize treatment protocol.

Objective: To report the design and implementation of the Right Drug, Right Dose, Right Time-Using Genomic Data to Individualize Treatment protocol that was developed to test the concept that prescribers can deliver genome-guided therapy at the point of care by using preemptive pharmacogenomics (PGx) data and clinical decision support (CDS) integrated into the electronic medical record (EMR).

Patients And Methods: We used a multivariate prediction model to identify patients with a high risk of initiating statin therapy within 3 years. The model was used to target a study cohort most likely to benefit from preemptive PGx testing among the Mayo Clinic Biobank participants, with a recruitment goal of 1000 patients.

Developing a community care team: lessons learned from the community connections program, a health care home-community care team partnership.

This article describes the development of the Community Connections Program (CCP), a community care team, within a health care home (HCH), as a short-term, intensive, team-based service planning and coordination program for older adults with multiple chronic health conditions. Three proven approaches were combined to support patient's self-management, nurse care coordination, the Wraparound process, and use of community services. Particzpants'responses to the CCP demonstrated the success of the community care team in connecting patients and nurse care coordinators (NCCs) with community service providers, thus supplying primary care providers with important information regarding the development of a community care team to support patient-centered care within a HCH.

Enhancing patient-centered care: pilot study results of a community care team intervention.

Health care reform focuses on primary care and development of Health Care Homes to improve patient-centered chronic illness care. This pilot study evaluated a community care team intervention that linked chronically ill older patients, support persons, and nurse care coordinators from a Health Care Home with community resources using an adaptation of the Wraparound process. A pragmatic clinical trial design was used.

Increased adherence to prenatal group B streptococcal screening guidelines through a paired electronic reminder and education intervention.

The 2010 Centers for Disease Control and Prevention (CDC) update on perinatal group B streptococcal (GBS) prevention advises universal vaginal-rectal GBS screening of pregnant women in the 35th through 37th week of gestation. Because GBS colonization is transient, a test performed more than 5 weeks before delivery may not have sufficient negative predictive value to be clinically useful. Our objective was to increase rates of quality-improved, CDC-adherent GBS screening and decrease repeat screening.

Does the "office nurse" level of training matter in the family medicine office?

Background: The "office nurse" or clinical associate (registered nurse [RN], licensed practical nurse[LPN], or medical assistant [MA]) is a key member of the family medicine care team, but little is known about the influence of their level of training on team performance.

Methods: The performance of the clinical dyad (clinician and associate) was studied in relation to the level of training of the nurse. The dyad's performance was measured by the performance indicators of diabetes scores, patient satisfaction, and productivity.

A cross-sectional survey of the relationship between walking, biking, and the built environment for adults aged over 70 years.

Purpose: Determine the relationship between walkability scores (using the Walk Score(®)) and activity levels (both bicycle and walking) in adults aged between 70 and 85 years in Rochester, Minnesota.

Patients And Methods: This was a self-reported cross-sectional survey in adults aged over 70 years living in Rochester, Minnesota. Analysis used t-tests or chi-square analysis as appropriate.

Effect of vascular burden as measured by vascular indexes upon vascular dementia: a matched case-control study.

Background: Vascular dementia (VaD) is a challenging illness that affects the lives of older adults and caregivers. It is unclear how multiple vascular risk factor exposures (polyvascular disease) affect VaD.

Purpose: To determine the relationship between multiple vascular risk exposures, as counted on an index in cases with VaD, compared with healthy age-/gender-matched controls.

Effect of alcohol and tobacco use on vascular dementia: a matched case control study.

Background: Vascular dementia is the second most common type of dementia in the United States. The underlying association of tobacco and alcohol with vascular dementia is not completely understood.

Purpose: Determine the relationship of tobacco and alcohol use with the development of vascular dementia (VaD).

Impact of a housing first program on health utilization outcomes among chronically homeless persons.

The authors examined the impact of a Housing First program on the use of specific health services, detoxification services, and criminal activity of long-term homeless individuals. The study sample consisted of eligible members of the inception cohort (18 enrollees) in the Single Adults Residential Assistance program (SARA) in Minneapolis, Minnesota. Analyses examined participant housing stability after enrollment in SARA and compared the use of a county medical center, detoxification programs, and criminal activity in the 2 years before and after enrollment in SARA.

A retrospective cohort study of factors that affect healing in long-term care residents with chronic wounds.

Chronic ulcers such as pressure, ischemic, and venous ulcers are common in long-term care (LTC) and frequently do not heal. A retrospective medical records review of all LTC residents referred to a wound consultative service between April 1999 and January 2007 was conducted to assess predictors of 6-month healing outcome. Variables abstracted and analyzed included wound, resident demographic, and laboratory values at diagnosis and comorbid medical illnesses.

The association of transient ischemic attack symptoms with memory impairment among elderly participants of the Third US National Health and Nutrition Examination Survey.

Background And Purpose: Stroke is a well-known risk factor for vascular dementia. However, the association of transient ischemic attacks with cognitive impairment is less well-established.

Methods: Records from Third National Health and Nutrition Examination Survey were abstracted for demographic and medical information for participants with an age >or=60 years who reported being free of stroke.

The association between pressure ulcers and endothelial dysfunction in a cohort of community elderly.

Vascular disease is a known risk factor for pressure ulcer development, but the underlying mechanisms of this association are less established. The authors evaluated the relationship between endothelial function (EF) and history of pressure ulcers in a nested case-control study of community-dwelling elderly, 60 years and older. Endothelial function was measured using peripheral arterial tonometry, and persons with a history of pressure ulcers in the past 5 years (n = 7) were matched 2:1 by age and gender to controls with no history of pressure ulcers (n = 14).

B-type natriuretic peptides in heart failure: update on clinical applications and limitations.

Heart failure remains an important clinical and public health problem with significant mortality, morbidity and economic consequences. The identification of natriuretic peptides and the large number of investigations that followed have led to a better understanding of the neurohormonal pathophysiology of heart failure. The clinical usefulness of natriuretic peptides in heart failure diagnosis, prognosis and treatment guidance remains to be fully clarified but B-type natriuretic peptides and N-terminal pro-BNP appear to have an emerging role.

Nelfinavir monotherapy increases naïve T-cell numbers in HIV-negative healthy young adults.

Although patients treated with HIV protease inhibitor (PI) containing regimens manifest increases in naïve T cell number, it is unclear whether this is due to reduction in viral replication or a direct drug effect. We questioned whether Nelfinavir monotherapy directly impacted naïve T-cell number in HIV-negative individuals. HIV-negative volunteers received Nelfinavir, 1250 mg orally, BID for 3 weeks, and T-cell receptor recombination excision circles (TREC) content in peripheral blood were assessed.

Pneumococcal vaccination in adults: recommendations, trends, and prospects.

The US Centers for Disease Control and Prevention recommends vaccination against Streptococcus pneumoniae for all people age 65 and older and also for younger people at high risk. However, experts continue to debate the efficacy of the vaccine; most observational studies found it beneficial, while clinical trials were inconclusive as a group. Although pneumococcal vaccination may or may not protect against pneumonia or death from any cause, it does significantly decrease the risk of invasive pneumococcal disease and is worthwhile for this reason.

Why is evidence-based medicine so harsh on vaccines? An exploration of the method and its natural biases.

Vaccines have been hailed as one of the greatest success stories of public health in the 20th century. The 20th century also produced a call for evidence-based medicine (EBM) with applications inclusive of preventive health. Since then, several major EBM analyses have called into question vaccine practices well-accepted by physicians, public health officials, and even the lay public.

A taxonomy of reasoning flaws in the anti-vaccine movement.

In a scholarly analysis of widely held misconceptions, Gilovich provides a classification scheme of common flaws in reasoning seen in contemporary society. He broadly categorizes these flaws as having cognitive determinants or in having motivational and social determinants. In this survey, the authors examine the various claims against routine childhood and adult vaccines as made by the more public and more organized entities of the anti-vaccine movement as well as those made apparent by surveys of parents and other groups of individuals.

Meta-analyses in vaccinology.

The use of meta-analysis as a method for systematic review of the literature has grown substantially since its appearance in 1988. We obtained and reviewed 134 meta-analyses cited in Current Contents, MEDLINE, EMBASE, and the Cochrane Database of Systematic Reviews reporting original meta-analyses in human subjects regarding vaccines directed against infectious diseases and their sequelae. More than a fifth of the meta-analyses concerned influenza vaccines and almost a sixth concerned pneumococcal vaccines.

Avian and pandemic influenza: an overview.

Influenza A/H5N1 (avian influenza) has now caused 258 human infections (as of November 13, 2006), with an approximate 50% mortality rate. Because the virus is novel in terms of antigenic type and causes infection and illness, and because humans have no pre-existing immunity, the conditions for a possible pandemic exist. Additionally, wild migratory birds appear to be spreading the virus across ever larger geographic areas, and newer clade 2 influenza A/H5N1 viruses have begun to emerge.