Quality of life outcomes in patients presenting for evaluation of CNS tumors.

Background: We describe patient-reported outcomes (PROs) in adults with CNS tumors and evaluate their correlation with physician-reported functional status.

Methods: We completed a retrospective cohort study of patients managed at a high-volume CNS tumor institute between September 2013 and September 2014. PROs were measured using 6 domains from the PROs Measurement Information System (PROMIS): anxiety, physical function, pain interference, sleep disturbance, fatigue, and satisfaction with social roles.

Prevalence and Predictors of Depression Among Patients With Epilepsy, Stroke, and Multiple Sclerosis Using the Cleveland Clinic Knowledge Program Within the Neurological Institute.

Background: Neurological conditions carry a high risk of depression. Given this risk, the Neurological Institute (NI) at Cleveland Clinic has initiated systematic screening for depression using the 9-item Patient Health Questionnaire-9 (PHQ-9) embedded within its electronic medical record and its data capture system, the Knowledge Program (KP).

Objective: We sought to (1) estimate the prevalence of depression among patients with epilepsy, stroke, and multiple sclerosis (MS); (2) identify risk factors for depression within each disease; and (3) determine differential risks and predictors across neurological disorders.

Scale Linking to Enable Patient-Reported Outcome Performance Measures Assessed with Different Patient-Reported Outcome Measures.

Background: Patient-reported outcome performance measures (PRO-PMs) incorporate outcomes from the patient's perspective into performance measures and may have great potential to impact health care. The various patient-reported outcome measures (PROMs) used to assess the same outcome challenge widespread use of PRO-PMs. A potential solution is to statistically link PROMs to provide equivalent PRO-PM conclusions to be drawn regardless of which PROM was used.

Depression and Age at First Neurology Appointment Associated with Receipt of Behavioral Medicine Services Within 1 Year in a Multiple Sclerosis Population.

Background: Patients with multiple sclerosis (MS) newly seen by a neurologist may benefit from early psychological intervention owing to the reciprocal relationship between stress and disease progression. However, it is uncertain what factors contribute to patients' receiving these services.

Methods: Logistic regression analysis of prospectively gathered data evaluated how demographic and disease characteristics and emotional/physical health factors contributed to referral to receive behavioral medicine (BM) services within 1 year of their first neurology appointment at the Mellen Center for Multiple Sclerosis at the Cleveland Clinic.

Failed Removal of Indwelling Urinary Catheters in Patients With Acute Stroke: Incidence and Risk Factors.

Background: Reducing the incidence of indwelling urinary catheter (IUC) use and early removal of the devices that are inserted are appropriate priorities for quality patient care. Just like symptomatic bacteriuria, failed catheter removal as a complication of IUC use is associated with considerable morbidity. In the ideal setting, patients who need IUCs have them, and patients who do not need them will have them removed safely, with the goal of reducing medical complications and facilitating the rehabilitation phase of care.

Sustained improvements in pain, mood, function and opioid use post interdisciplinary pain rehabilitation in patients weaned from high and low dose chronic opioid therapy.

Increased prescribing of opioids for chronic noncancer pain is associated with significant social costs, including overdose and addiction. In this context, there is interest in interdisciplinary chronic pain rehabilitation programs focusing on self-management and minimizing opioid use. This study examined outcomes of patients weaned from opioids in an ICPRP from 2007 to 2012.

The PROMIS physical function scale: A promising scale for use in patients with ischemic stroke.

Objective: To evaluate the performance of the Patient Reported Outcomes Measurement Information System (PROMIS) physical function (PF) scale compared to the validated Stroke Impact Scale-16 (SIS-16) in ischemic stroke patients seen in an ambulatory cerebrovascular clinic.

Methods: This was a retrospective cohort study. PROMIS PF (computer adaptive testing version) and SIS-16 measures were electronically collected on 1,946 ischemic stroke patients seen in a cerebrovascular clinic using an electronic platform from September 12, 2012, to June 16, 2015.

Bridging a clinical gap in psychogenic nonepileptic seizures: Mental health provider preferences of biopsychosocial assessment approaches.

Management of psychogenic nonepileptic seizures (PNES) is complex, requiring multidisciplinary care. A standardized assessment and formulation approach to PNES is lacking, yet use of a comprehensive model may alleviate problems such as mental health aftercare noncompliance. Although a biopsychosocial (BPS) approach to PNES balancing predisposing, precipitating, and perpetuating (PPP) variables has been described and has been recently tested in pilot form, it is unclear how this assessment style is perceived among community mental health practitioners such as psychotherapists (including psychologists, counselors, and social workers).

Electronic Stroke CarePath: Integrated Approach to Stroke Care.

We describe the development, implementation, and outcomes of the first 2 years of the Electronic Stroke CarePath, an initiative developed for management of ischemic stroke patients in an effort to improve efficiency and quality of care for patients. The CarePath consists of care pathways for ischemic stroke that are integrated within the electronic health record. Patient-reported outcomes are collected using an external software platform.

The Challenges of Data Quality Evaluation in a Joint Data Warehouse.

Introduction: The use of clinically derived data from electronic health records (EHRs) and other electronic clinical systems can greatly facilitate clinical research as well as operational and quality initiatives. One approach for making these data available is to incorporate data from different sources into a joint data warehouse. When using such a data warehouse, it is important to understand the quality of the data.

A new Elixhauser-based comorbidity summary measure to predict in-hospital mortality.

Background: Recently, van Walraven developed a weighted summary score (VW) based on the 30 comorbidities from the Elixhauser comorbidity system. One of the 30 comorbidities, cardiac arrhythmia, is currently excluded as a comorbidity indicator in administrative datasets such as the Nationwide Inpatient Sample (NIS), prompting us to examine the validity of the VW score and its use in the NIS.

Methods: Using data from the 2009 Maryland State Inpatient Database, we derived weighted summary scores to predict in-hospital mortality based on the full (30) and reduced (29) set of comorbidities and compared model performance of these and other comorbidity summaries in 2009 NIS data.

Arabidopsis SCARs function interchangeably to meet actin-related protein 2/3 activation thresholds during morphogenesis.

During polarized growth and tissue morphogenesis, cells must reorganize their cytoplasm and change shape in response to growth signals. Dynamic polymerization of actin filaments is one cellular component of polarized growth, and the actin-related protein 2/3 (ARP2/3) complex is an important actin filament nucleator in plants. ARP2/3 alone is inactive, and the Arabidopsis thaliana WAVE complex translates Rho-family small GTPase signals into an ARP2/3 activation response.