Trauma-Induced Coagulopathy Is Associated with a Complex Inflammatory Response in the Rat.

Severe trauma can lead to a coagulopathy in patients, which is associated with increased mortality. We developed a rat polytrauma model that demonstrates a similar progression of coagulopathy. Because coagulation is influenced by changes in inflammation, and this interrelationship is poorly understood, we have studied the progression of inflammation, and its correlation with coagulation, in this rat model of severe polytrauma.

Can hospices predict which patients will die within six months?

Objective: To determine whether it is possible to predict, at the time of hospice enrollment, which patients will die within 6 months.

Design: Electronic health record-based retrospective cohort study.

Setting: Patients admitted to 10 hospices in the CHOICE network (Coalition of Hospices Organized to Investigate Comparative Effectiveness).

All hospice patients are not equal: development of a visit-based acuity index.

Background: Although hospices need to be able to anticipate patient acuity, there are currently no published models that predict the frequency of visits that a new hospice patient is likely to receive.

Objectives: To identify patient characteristics that are associated with the frequency of health care provider visits in the first 8 days of hospice care.

Methods: An electronic health record (EHR)-based retrospective cohort study was conducted in seven hospice programs in the United States.

Acute coagulopathy of trauma in the rat.

Introduction: Acute coagulopathy of trauma (aCOT) is a state of disordered coagulation developing soon after severe injury and blood loss and has been defined in the clinical literature as an elevation in prothrombin time (PT) and activated partial thromboplastin time (aPTT).

Objective: The purpose of this study was to develop a rat model of aCOT resulting from polytrauma and hemorrhage and showing an elevation in PT and aPTT.

Methods: Sprague-Dawley rats (300-400 g) were anesthetized with isoflurane.

Patterns of functional decline in hospice: what can individuals and their families expect?

Objectives: To describe the trajectory of functional decline after an individual is referred to hospice.

Design: Electronic health record-based retrospective cohort study.

Setting: Three hospice programs in the U.

Antihypertensive effect of passion fruit peel extract and its major bioactive components following acute supplementation in spontaneously hypertensive rats.

Extracts from leaves, peels or flowers of Passiflora are noted for their medicinal effects. Passiflora edulis peel extract (PFPE) has been proposed to lower blood pressure (BP); however, only indirect measurement techniques have been employed. To more accurately measure the effect of PFPE on hemodynamic parameters and determine the minimal effective dose, hemodynamic parameters were directly measured in spontaneously hypertensive rats (SHR) implanted with radiotelemeters.

Effect of the Medicare face-to-face visit requirement on hospice utilization.

Background: Although many patients enter hospice close to death, some enroll for more than six months. In 2011 the U.S.

Which hospice patients with cancer are able to die in the setting of their choice? Results of a retrospective cohort study.

Purpose: To determine which hospice patients with cancer prefer to die at home and to define factors associated with an increased likelihood of dying at home.

Methods: An electronic health record-based retrospective cohort study was conducted in three hospice programs in Florida, Pennsylvania, and Wisconsin. Main measures included preferred versus actual site of death.

The art versus science of predicting prognosis: can a prognostic index predict short-term mortality better than experienced nurses do?

Objective: To determine whether a prognostic index could predict one-week mortality more accurately than hospice nurses can.

Method: An electronic health record-based retrospective cohort study of 21,074 hospice patients was conducted in three hospice programs in the Southeast, Northeast, and Midwest United States. Model development used logistic regression with bootstrapped confidence intervals and multiple imputation to account for missing data.

Burn enhances toll-like receptor induced responses by circulating leukocytes.

Burn and toll-like receptors (TLR) are associated with innate immune system activation, but the impact of burn on TLR-induced inflammation responses by circulating leukocytes is unknown. To study this, C57BL/6 mice were subjected to burn (3(rd) degree, 25% TBSA) or sham procedure and 1-7 days later blood was collected. Whole blood cell suspensions were incubated for 24 hr in the presence of zymosan (TLR-2 agonist) or LPS (TLR-4 agonist).

Nitric oxide synthase, ADMA, SDMA, and nitric oxide activity in the paraventricular nucleus throughout the etiology of renal wrap hypertension.

Within the paraventricular nucleus (PVN), there is a balance between the excitatory and inhibitory neurotransmitters that regulate blood pressure; in hypertension, the balance shifts to enhanced excitation. Nitric oxide (NO) is an atypical neurotransmitter that elicits inhibitory effects on cardiovascular function. We hypothesized that reduced PVN NO led to elevations in blood pressure during both the onset and sustained phases of hypertension due to decreased NO synthase (NOS) and increased asymmetrical dimethylarginine (ADMA; an endogenous NOS inhibitor) and symmetric dimethylarginine (SDMA).

Transfusion-related acute lung injury in a rat model of trauma-hemorrhage.

Background: Major trauma often causes hemorrhage and predisposes to transfusion-related acute lung injury (TRALI). TRALI is a leading cause of transfusion-related deaths; however, its pathophysiology is uncertain. In the existing two-event models of TRALI, infection (lipopolysaccharide injection) is followed by the infusion of aged blood products.

Vascular arginase contributes to arteriolar endothelial dysfunction in a rat model of hemorrhagic shock.

Background: Hemorrhagic shock causes hypoperfusion of peripheral tissues and promotes endothelial dysfunction, which may lead to further tissue injury. Trauma increases extrahepatic activity of arginase, an enzyme which competes for l-arginine with nitric oxide synthase, and plays a key role in the development of endothelial dysfunction during aging, hypertension, and diabetes. However, the role of arginase in hemorrhage-induced endothelial dysfunction has not been studied.

Effects of early and late chronic pressure overload on extracellular matrix remodeling.

The left ventricle (LV) remodels with age and in response to pressure overload. While aging and pressure overload are superimposed in the clinical context, the structural and functional consequences of the individual processes are not well-understood. Accordingly, the objective of this study was to compare the effects of both early and late chronic hypertension on extracellular matrix (ECM) remodeling.

Estrogen effects on MMP-13 and MMP-14 regulation of left ventricular mass in Dahl salt-induced hypertension.

Background: Female Dahl salt-sensitive (DS) rats fed a low-salt diet develop hypertension at 6 months of age. Ovariectomy at 2 months of age accelerates the development of hypertension, and estrogen replacement delays it. Although acute pressure overload induces structural changes in the left ventricle (LV) further effects of gradual hypertension on LV remodeling have not been examined in the DS rat model.

Effect of ovariectomy on renal estrogen receptor-alpha and estrogen receptor-beta in young salt-sensitive and -resistant rats.

This study evaluated the effect of ovariectomy on renal estrogen receptor (ER)-alpha and ERbeta expression in young female Dahl salt-sensitive and salt-resistant rats. Our hypothesis was that estrogen depletion results in an imbalance in ERalpha and ERbeta expression in salt-sensitive rats. Rats were subjected to sham surgery (intact), ovariectomy, and ovariectomy with estrogen replacement.

Ovariectomy augments hypertension in aging female Dahl salt-sensitive rats.

The ovariectomized (OVX) Dahl salt-sensitive (DS) rat fed a low-salt diet is a model of postmenopausal hypertension. In addition to estrogen loss, aging can also contribute to postmenopausal hypertension. We hypothesized that: (1) female DS rats on a low-salt diet become hypertensive with age; (2) ovariectomy accelerates age-dependent hypertension in the DS rat caused by estrogen depletion; and (3) this hypertension correlates with increased type 1 angiotensin receptor (AT1R) number (Bmax).

Clinical care & finance: can this marriage be saved?

Financial staff and clinical staff do not necessarily see eye-to-eye. However, mutual understanding of one another's areas of expertise is essential to the success of a hospice. Financial and clinical staff can work together to streamline employee reporting, such as on time sheets and during annual reviews, to ensure that important data is being collected and staff don't waste time reporting on and analyzing extraneous data.