Clinician Barriers to Ordering Pulmonary Function Tests for Adults with Suspected Asthma.

Background: Primary care clinicians do not adhere to national and international guidelines recommending pulmonary function testing (PFTs) in patients with suspected asthma. Little is known about why that occurs. Our objective was to assess clinician focused barriers to ordering PFTs.

Health Literacy in Patients Considering a Left Ventricular Assist Device: Findings From the DECIDE-LVAD Trial.

Objective: To assess the interaction of health literacy and a shared intervention concerning decision quality in patients considering the destination therapy of left ventricular assist device (DT LVAD) implantation.

Background: Evidence is limited for the use of decision aids by patients with low health literacy and with life-threatening illnesses.

Methods: We performed a secondary analysis of the DECIDE-LVAD Trial, a randomized, stepped-wedge trial conducted from 2015-2017 in the United States.

Prefusion F Protein-Based Respiratory Syncytial Virus Immunization in Pregnancy.

Background: Respiratory syncytial virus (RSV), a major cause of illness and death in infants worldwide, could be prevented by vaccination during pregnancy. The efficacy, immunogenicity, and safety of a bivalent RSV prefusion F protein-based (RSVpreF) vaccine in pregnant women and their infants are uncertain.

Methods: In a phase 2b trial, we randomly assigned pregnant women, at 24 through 36 weeks' gestation, to receive either 120 or 240 μg of RSVpreF vaccine (with or without aluminum hydroxide) or placebo.

Intramuscular AZD7442 (Tixagevimab-Cilgavimab) for Prevention of Covid-19.

Background: The monoclonal-antibody combination AZD7442 is composed of tixagevimab and cilgavimab, two neutralizing antibodies against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that have an extended half-life and have been shown to have prophylactic and therapeutic effects in animal models. Pharmacokinetic data in humans indicate that AZD7442 has an extended half-life of approximately 90 days.

Methods: In an ongoing phase 3 trial, we enrolled adults (≥18 years of age) who had an increased risk of an inadequate response to vaccination against coronavirus disease 2019 (Covid-19), an increased risk of exposure to SARS-CoV-2, or both.

Growing PEACHnet: Building a Practice-Based Research Network in Western Colorado.

Introduction: Practice-based research networks (PBRNs) have long sought to engage with communities and address questions relevant to multiple stakeholders and real-world primary care practice. Topic-generating processes that involve these stakeholders are crucial for identifying these questions. PBRNs often focus on certain populations or geographic areas.

Fifth Metatarsal Jones Fractures: Diagnosis and Treatment.

A Jones fracture, located at the metaphyseal-diaphyseal junction of the fifth metatarsal, is at an increased risk for nonunion and continued pain. Even with excellent surgical technique and postoperative management, a delayed union and refracture can occur. These complications in athletes can have deleterious effects on performance and delay return to sport.

Retrieving Family Medicine's Lost Literature: The 1974-1999 Archive.

The first repository of research in family medicine in the United States was the () (https://www.mdedge.com/familymedicine).

Inpatient Rehabilitation After COVID-19 Hospitalization in a Patient With Lung Transplant: A Case Study.

Severe acute respiratory syndrome coronavirus 2, also known as coronavirus 2019 (COVID-19), has impacted the lives of many older individuals, with those with comorbidities having the highest risk of severe disease. Specifically, immunosuppression and chronic obstructive pulmonary disease are two important risk factors. This case report describes the rehabilitation course of a 62-yr-old woman with a history of a double lung transplant for chronic obstructive pulmonary disease in 2016 who contracted a severe COVID-19 infection.

Opioid-Free Epidural-Free Anesthesia for Open Hepatectomy: A Case Report.

Opioid-free perioperative approaches hold promise to reduce opioid use after surgery and their associated side effects. Here, we report the perioperative analgesic plan of a patient who requested opioid-free care for an open partial hepatectomy. Opioid-free anesthesia care for abdominal surgery is usually dependent on epidural analgesia.

An Evaluation of Safety and Patient Outcomes for Hand Surgery following Prior Breast Cancer Treatment: Establishing New Recommendations in Lymphedema.

Background: Injuries to the upper extremity lymphatic system from cancer may require measures to prevent secondary lymphedema. Guidelines were established relating to the use of tourniquet and elective hand and upper extremity surgery. However, reports in the setting of hand surgery have indicated that prior guidelines may not be protective to the patient.

Systematic review of oxygenation and clinical outcomes to inform oxygen targets in critically ill trauma patients.

Background: Oxygen therapy is frequently administered to critically ill trauma patients to avoid hypoxia, but optimal oxygenation strategies are not clear.

Methods: We conducted a systematic review of oxygen targets and clinical outcomes in trauma and critically ill patients. We searched Ovid MEDLINE, Cochrane Library, Embase, and Web of Science Core Collection from 1946 through 2017.

Artificial Intelligence and Applications in PM&R.

Artificial intelligence methods are being applied broadly in society and increasingly in health care and research. Machine learning, a subset of artificial intelligence, represents the study of algorithms that improve automatically with experience. This article provides a basic overview of artificial intelligence, machine learning categories, common applications in the business sphere, advantages and disadvantages of using this technology, and example applications in rehabilitation and other fields for contextual purposes.

All-cause Healthcare Costs and Mortality in Patients with Systemic Sclerosis with Lung Involvement.

Objective: Patients with systemic sclerosis (SSc) often develop interstitial lung disease (ILD) and/or pulmonary arterial hypertension (PAH). The effect of ILD and PAH on healthcare costs among patients with SSc is not well described. The objective of this analysis was to describe healthcare costs in patients with newly diagnosed SSc and SSc patients newly diagnosed with ILD and/or PAH in the United States.

Validation of Polygenic Scores for QT Interval in Clinical Populations.

Background: Polygenic risk scores (PGS) enable rapid estimation of genome-wide susceptibility for traits, which may be useful in clinical settings, such as prediction of QT interval. In this study, we sought to validate PGS for QT interval in 2 real-world cohorts of European ancestry (EA) and African ancestry (AA).

Methods And Results: Two thousand nine hundred and fifteen participants of EA and 366 of AA in the MGH CAMP study (Cardiology and Metabolic Patient) were genotyped on a genome-wide array and imputed to the 1000 Genomes reference panel.

Biomarker Testing for Personalized Therapy in Lung Cancer in Low- and Middle-Income Countries.

There have been many important advances in personalized therapy for patients with lung cancer, particularly for those with advanced disease. Molecular testing is crucial for implementation of personalized therapy. Although the United States and many Western countries have come far in the implementation of personalized therapy for lung cancer, there are substantial challenges for low- and middle-income countries (LMICs).

How Can We Use Computational Modeling to Improve Total Knee Arthroplasty? Modeling Stability and Mobility in the Implanted Knee.

Validated computational models promise a virtual platform to create optimal articular surfaces that best achieve desired implant characteristics. Today, designers can parametrically define the primary geometric features of an implant, and automatically modify design variables until stability/mobility performance objectives are best achieved. This preclinical, virtual design iteration minimizes the development cycle compared with testing physical prototypes and, by evaluating a broader scope of design concepts, likely improves the clinical performance of the final product.

Ticagrelor versus Clopidogrel in Symptomatic Peripheral Artery Disease.

Background: Peripheral artery disease is considered to be a manifestation of systemic atherosclerosis with associated adverse cardiovascular and limb events. Data from previous trials have suggested that patients receiving clopidogrel monotherapy had a lower risk of cardiovascular events than those receiving aspirin. We wanted to compare clopidogrel with ticagrelor, a potent antiplatelet agent, in patients with peripheral artery disease.

Public Opinion Regarding Whether Speaking With Patients About Firearms Is Appropriate: Results of a National Survey.

Background: Health care providers have been encouraged to discuss firearms with patients; whether patients view these discussions as appropriate is unclear.

Objective: To estimate, in a national sample, the perceived appropriateness of provider discussions about firearms.

Design: Probability-based online survey conducted in April 2015.

Selective Laser Trabeculoplasty: An Update.

Selective laser trabeculoplasty (SLT) is an effective treatment option for the reduction of intraocular pressure (IOP) in patients with ocular hypertension or open-angle glaucoma. The mechanism by which SLT lowers IOP is not completely understood and is likely multifactorial. Published studies indicate that SLT is at least as effective as argon laser trabeculoplasty or medications at lowering IOP in many forms of glaucoma.

RibScore: A novel radiographic score based on fracture pattern that predicts pneumonia, respiratory failure, and tracheostomy.

Background: There is currently no scoring system for rib fractures that relates detailed anatomic variables to patient outcomes. Our objective was to develop and validate a radiographic rib fracture scoring system based on computed tomographic chest findings.

Methods: We reviewed our trauma registry from September 2012 to April 2014 for all blunt trauma patients with one or more rib fractures visualized on chest computed tomography.