Protocol-Driven Allied Health Post-Discharge Transition Clinic to Reduce Hospital Readmissions in Heart Failure.

Background: Heart failure (HF) patients have high rates of hospitalization and rehospitalization.

Methods And Results: A protocol-driven clinic staffed by an allied health care team was designed for patients discharged from the hospital with a diagnosis of congestive HF. The clinic provided follow-up visits 1 week and 4 to 6 weeks after hospital discharge.

Gene expression profiling for molecular staging of cutaneous melanoma in patients undergoing sentinel lymph node biopsy.

Background: A gene expression profile (GEP) test able to accurately identify risk of metastasis for patients with cutaneous melanoma has been clinically validated.

Objective: We aimed for assessment of the prognostic accuracy of GEP and sentinel lymph node biopsy (SLNB) tests, independently and in combination, in a multicenter cohort of 217 patients.

Methods: Reverse transcription polymerase chain reaction (RT-PCR) was performed to assess the expression of 31 genes from primary melanoma tumors, and SLNB outcome was determined from clinical data.

Patients' expectations about total knee arthroplasty outcomes.

Objective: The aim of this study was to ascertain Patients' pre-operative expectations of total knee arthroplasty (TKA) recovery.

Methods: Two hundred and thirty-six patients with knee osteoarthritis (OA) who underwent TKA completed self-administered questionnaires before their surgery. Patients' expectations of time to functional recovery were measured using an ordinal time-response scale to indicate expected time to recovery for each of 10 functional activities.

Development of a prognostic genetic signature to predict the metastatic risk associated with cutaneous melanoma.

Purpose: The development of a genetic signature for the identification of high-risk cutaneous melanoma tumors would provide a valuable prognostic tool with value for stage I and II patients who represent a remarkably heterogeneous group with a 3% to 55% chance of disease progression and death 5 years from diagnosis.

Experimental Design: A prognostic 28-gene signature was identified by analysis of microarray expression data. Primary cutaneous melanoma tumor tissue was evaluated by RT-PCR for expression of the signature, and radial basis machine (RBM) modeling was performed to predict risk of metastasis.

Urodynamics in the evaluation of the patient with multiple sclerosis: when are they helpful and how do we use them?

Multiple sclerosis (MS) is an autoimmune inflammatory disease that results in damage to the myelin sheaths of the nerves in the central nervous system. Urinary urgency, frequency, and urgency incontinence are the most common symptoms, occurring in 37% to 99% of patients. Voiding symptoms (hesitancy, feeling of incomplete bladder emptying, and occasionally urinary retention) are also common in this population, occurring in 34% to 79% of patients.

Rubella monitoring in pregnancy as a means for evaluating a possible reemergence of rubella.

Objective: Although it is commonly accepted that rubella is well-controlled, a recent reemergence of both pertussis and measles might also predict a reemergence of rubella. This study was designed to estimate the current incidence of rubella exposure in pregnancy.

Study Design: This was a prospective, descriptive study, conducted in Houston, TX, at The Woman's Hospital of Texas.

Radiographic changes around humeral components in shoulder arthroplasty.

Background: Our purposes were to analyze radiographic changes around humeral components and to determine the influence of these changes on the clinical outcome of shoulder arthroplasty.

Methods: Three hundred and ninety-five shoulders with primary osteoarthritis were treated with a shoulder replacement and were analyzed clinically and radiographically with a standardized protocol. Radiographs were evaluated for osteolysis and stress-shielding of the proximal part of the humerus and loosening of the humeral and glenoid components.

Chemotactic chemokines are important in the pathogenesis of irritable bowel syndrome.

Irritable bowel syndrome (IBS) is one of the most frequently diagnosed disorders, affecting about 20% of the general population in Western countries. This syndrome poses an enormous socio-economic burden, impairs the quality of life substantially, and increases healthcare costs. IBS can be classified as either idiopathic (ID-IBS) with unknown etiology or post-infectious (PI-IBS), which develops after a bout of acute diarrhea or gastroenteritis.

Intrapartum antibiotic prophylaxis for Group B Streptococcus: has the time come to wait more than 4 hours?

Despite progress in preventing infant group B streptococcal disease, group B streptococcus remains the leading cause of early-onset neonatal sepsis in the United States. Fortunately, most women who are colonized with group B streptococcus receive therapy and antibiotic prophylaxis is effective. However, the only factor associated with missed chemoprophylaxis is the short duration of time between hospital admission and delivery.

Evaluation of the aspartate aminotransferase/platelet ratio index and enhanced liver fibrosis tests to detect significant fibrosis due to chronic hepatitis C.

Background: The assessment of liver fibrosis in chronic hepatitis C patients is important for prognosis and making decisions regarding antiviral treatment. Although liver biopsy is considered the reference standard for assessing hepatic fibrosis in patients with chronic hepatitis C, it is invasive and associated with sampling and interobserver variability. Serum fibrosis markers have been utilized as surrogates for a liver biopsy.

Angioedema from instant coffee.

Acute allergic angioedema is an abrupt-onset, unpredictable inflammatory reaction of the skin and mucous membranes. Without treatment, the condition may resolve within hours; however, when swallowing or breathing is affected, emergent medical attention is required. We report an atypical presentation of this condition, with a unique dietary cause.

The role of direct renin inhibition in clinical practice: focus on combination therapy.

Monotherapy with most antihypertensive agents reduces systolic BP by about 10 mmHg ('Rule of 10'). Thus, the majority of hypertensive patients require combination therapy to achieve BP goals. In this review, we provide a brief overview of the renin-angiotensin-aldosterone system (RAAS) and discuss the rationale, clinical evidence, and shortcomings related to the use of angiotensin-converting enzyme (ACE) inhibitors in combination with angiotensin II type 1 receptor antagonists (angiotensin receptor blockers [ARBs]).

Role of simple biomarkers in predicting fibrosis progression in HCV infection.

Aim: To examine the accuracy of the aspartate aminotransferase (AST)/Platelet Ratio Index (APRI) and FIB-4, in predicting longitudinal changes in liver histology in hepatitis C virus (HCV) patients.

Methods: Patients that underwent repeat liver biopsies at least 1 year apart from 1999 to 2007 were identified. Liver fibrosis was staged on needle core biopsies evaluated by a single expert liver pathologist.

Improving influenza immunization in pregnant women and healthcare workers.

Objective: To evaluate the effect of several strategies to increase influenza immunization in a multispecialty clinic.

Study Design: Retrospective electronic database analysis of influenza vaccinations in a 6-year period at Kelsey-Seybold Clinic in Houston, Texas.

Methods: We evaluated immunization rates in pregnant women and healthcare workers during 6 influenza seasons (2003-2004 to 2008-2009) after implementing the following strategies for pregnant women: assessing baseline immunization rates for obstetric providers, followed by direct encouragement and behavior modeling; implementing standing orders for influenza vaccination in pregnancy; and offering vaccination training to obstetricians and nurses.

Decreased range of motion following arthroscopic remplissage.

The Hill-Sachs lesion is an impression fracture of the posterolateral margin of the humeral head that commonly results from impaction with the anterior glenoid rim during subluxation or dislocation of the shoulder. This bony defect has been implicated as an etiology of recurrent instability of the shoulder. The "remplissage" technique described by Wolf is an arthroscopic method of filling the Hill-Sachs defect via infraspinatus tenodesis and posterior capsulodesis.

Repair integrity and clinical outcome after arthroscopic rotator cuff repair using single-row anchor fixation: a prospective study of single-tendon and two-tendon tears.

This prospective study determined whether single-row anchor fixation would reliably improve clinical outcome and maintain structural integrity after arthroscopic repair of single-tendon and 2-tendon rotator cuff tears. In 39 patients, 21 shoulders had single-tendon tears and 18 had 2-tendon tears. Mean follow-up was 38 months (minimum, 24 months).

Clinical results of revision shoulder arthroplasty for glenoid component loosening.

We retrospectively reviewed 32 patients who underwent glenoid revision surgery after total shoulder arthroplasty to compare the results of revision total shoulder arthroplasty with those of revision hemiarthroplasty and to identify factors associated with poor results after revision shoulder arthroplasty for glenoid component loosening. Results were reviewed at a mean follow-up of 4 years (range, 2-8 years). Glenoid reimplantation resulted in significant pain relief (P < .

Use of the cervical cerclage: comparison of a community and university hospital setting.

Objective: To compare the use of cervical cerclage between a community hospital and a university teaching hospital to estimate if the rate of cervical cerclage placement differs and if indications selected for cervical cerclage placement vary by institution type.

Methods: A review of medical records from January 1, 2000, through December 31, 2004, of women undergoing cervical cerclage was performed at a community hospital and a university teaching hospital. The rate of cerclage and indications for placement were estimated.

Arthroscopic repair of partial-thickness tears of the rotator cuff.

This study prospectively evaluated the clinical outcome of 41 patients who underwent arthroscopic repair of a significant (>50% thickness) partial-thickness supraspinatus tear. Tears were converted to full-thickness lesions and repaired with suture anchors and simple sutures. Of the tears, 80% (33/41) involved the articular surface.

Preoperative epoetin alfa vs autologous blood donation in primary total knee arthroplasty.

This prospective randomized trial compared preoperative autologous blood donation (PAD) with epoetin alfa in patients undergoing primary total knee reconstruction. Fifty adult patients with pretreatment hemoglobin level of 100 to 130 g/L were randomized to either epoetin alfa 40,000 U at preoperative days 14 and 7 or to a standard PAD protocol. Patient characteristics and operative blood loss were similar between groups.