Virtual Home Care for Patients With Acute Illness.

Importance: Recent evolutions in clinical care and remote monitoring suggest that some acute illnesses no longer require intravenous therapy and inpatient hospitalization.

Objective: To describe outcomes of patients receiving care in a new, outpatient, virtual, home-based acute care model called Safer@Home.

Design, Setting, And Participants: This retrospective cohort analysis, conducted from September 1, 2022, through August 31, 2023, included 2466 patients treated at a safety net hospital in Los Angeles County for 10 core illnesses and 24 other acute illnesses for which patients are commonly hospitalized.

Urinary Retention in Spinal Cord Injury.

A 43-year-old woman with paralysis and neurogenic bladder secondary to a gunshot wound presented with worsening urinary incontinence and urinary tract infections. On workup she was found to have two large bladder stones with diameters of around 11 cm. She was managed with antibiotics and surgical removal.

A 3-month, randomized, double-blind, placebo-controlled study to evaluate the safety and efficacy of a highly optimized, capacitively coupled, pulsed electrical stimulator in patients with osteoarthritis of the knee.

Objective: To investigate the efficacy and safety of a capacitively coupled, pulsed electrical stimulation device in treating knee osteoarthritis (OA).

Design: Fifty-eight outpatients with moderate to severe OA of the knee entered a 3-month, double-blind, placebo-controlled trial, using either an active or placebo device at home for 6 to 14 h/day. Outcome measures included a patient global evaluation, a patient report of knee pain severity, and the Western Ontario and McMaster Universities (WOMAC) questionnaire.

The efficacy and safety of epsilon-aminocaproic acid treatment in patients with cirrhosis and hyperfibrinolysis.

Background: Patients with decompensated cirrhosis are at risk for hyperfibrinolysis; this is potentially fatal. epsilon-aminocaproic acid has been used to treat patients with hyperfibrinolysis; however, the data about its benefit in the setting of cirrhosis are minimal.

Aim: To analyse the efficacy of epsilon-aminocaproic acid and its safety in cirrhotic patients with hyperfibrinolysis.

Factors predicting relapse and poor outcome in type I autoimmune hepatitis: role of cirrhosis development, patterns of transaminases during remission and plasma cell activity in the liver biopsy.

Aim: To determine factors predicting relapse and poor outcome in patients with type I autoimmune hepatitis (AIH).

Methods: Patients with AIH were retrospectively recruited. Definitions-remission: AST/ALT < 2 ULN; relapse: AST/ALT > or = 2 ULN; poor outcome: cirrhosis complications, transplantation (OLTx), and death; abnormal transaminases: AST/ALT > ULN but within the remission range; abnormal transaminases index (ATI): number of occasions AST/ALT abnormal/years of remission.

Heterotopic ossification complicating prolonged intubation: case report and review of the literature.

Background: Within the past decade several reports have been published concerning heterotopic ossification (HO) in adult respiratory distress syndrome patients subjected to prolonged mechanical ventilation. The knee has been the most common site of involvement, which tends to differentiate this entity of HO from those previously described.

Method: Case report and literature review.

Pentoxifylline improves short-term survival in severe acute alcoholic hepatitis: a double-blind, placebo-controlled trial.

Background & Aims: An earlier pilot study from our liver unit suggested benefit from treatment with pentoxifylline (PTX), an inhibitor of tumor necrosis factor (TNF), in severe acute alcoholic hepatitis. The aim of the present study was to evaluate this treatment in a larger cohort of patients.

Methods: One hundred one patients with severe alcoholic hepatitis (Maddrey discriminant factor > or = 32) entered a 4-week double-blind randomized trial of PTX (400 mg orally 3 times daily) vs.

Day-to-day particulate exposures and health changes in Los Angeles area residents with severe lung disease.

We measured particulate matter (PM2.5 and PM10) exposures, home temperature, arterial blood oxygen saturation, blood pressure, and lung function in 30 volunteer Los Angeles area residents during four-day intervals. Continuous Holter electrocardiograms were recorded in a subgroup on the first two days.

Scientific validation of two commercial pressure sensor systems for prosthetic socket fit.

The concept of measuring pressure at the interface between the stump and the prosthetic socket could provide valuable information in the process of prosthetic socket fabrication, modification, and fit. Two systems, the Rincoe Socket Fitting System (SFS) and Tekscan's F-Socket Pressure Measurement System, have been commercially designed for in situ interface pressure measurement over the past decade. Their use is not common in prosthetic practice, perhaps due to questions of cost effectiveness and the difficulties of interpreting the data.

Rancho Los Amigos Medical Center. A unique orthopaedic resource and teaching institution.

Rancho Los Amigos Medical Center, initially a poor farm in the County of Los Angeles, CA became a world renown medical institution because of the polio epidemics in the 1950s. Responding to the need for day to day inpatient care were an overflow of victims of polio who had spine and extremity weakness and were dependent on respirators. Team care, developed at the institution, was used by Vernon L.

The 21st century environment and air quality influences on asthma.

"Criteria" air pollutants are federally regulated pollutants that occur widely outdoors and have diverse sources, most often related to combustion. They include ozone (O3), particulate matter, sulfur dioxide (SO2), nitrogen dioxide (NO2), carbon monoxide (CO), and lead. All except lead may interfere with oxygen delivery, and so may be of special concern to asthmatics.

Quality of life in assisted living homes: a multidimensional analysis.

This study examined the impact of four domains upon the quality of life (QOL) of senior residents living in assisted living homes: (a) demographic characteristics and health status, (b) social involvement, (c) facility characteristics, and (d) the social climate. Participants were 201 residents with functional impairments living in 55 different assisted living facilities in California. QOL was measured with three scales of depression, life satisfaction, and facility satisfaction.

The effect of pulsed electromagnetic fields on osteoporosis at the knee in individuals with spinal cord injury.

The purpose of this study was to determine the effects of pulsed electromagnetic fields on osteoporotic bone at the knee in individuals with chronic spinal injury. The study consisted of 6 males with complete spinal cord injury at a minimum of 2 years duration. Bone mineral density (BMD) was obtained at both knees at initiation, 3 months, 6 months, and 12 months using dual energy X-ray absorptiometry.

Natural history of vascular dementia.

Knowledge about the natural history of vascular dementia (VaD) provides one context for assessing efficacy in pharmacological drug trials. We reviewed the literature for original studies reporting either (a) duration of survival or (b) cognitive status following a diagnosis of multi-infarct dementia (MID). Among 13 papers (combined sample size = 470; mean duration of follow-up = 4.

Long term non-invasive ventilation in the community for patients with musculoskeletal disorders: 46 year experience and review.

Background: A study was undertaken to assess the long term physiological and clinical outcome in 79 patients with musculoskeletal disorders (73 neuromuscular, six of the chest wall) who received non-invasive ventilation for chronic respiratory failure over a period of 46 years.

Methods: Vital capacity (VC) and carbon dioxide tension (PCO(2)) before and after initiation of ventilation, type and duration of ventilatory assistance, the need for tracheostomy, and mortality were retrospectively studied in 48 patients who were managed with mouth/nasal intermittent positive pressure ventilation (M/NIPPV) and 31 who received body ventilation. The two largest groups analysed were 45 patients with poliomyelitis and 15 with Duchenne's muscular dystrophy.

Cognitive predictors of young children's readiness for powered mobility.

Independent mobility in early childhood has been associated with the development of various cognitive and psychosocial skills. However, children with physical disabilities are not always able to move independently and may be at risk for delays in these areas. Early provision of powered mobility can offer young children an opportunity for independent mobility.

The energy expenditure of normal and pathologic gait.

Physiological energy expenditure measurement has proven to be a reliable method of quantitatively assessing the penalties imposed by gait disability. The purpose of this review is to outline the basic principles of exercise physiology relevant to human locomotion; detail the energy expenditure of normal walking; and summarize the results of energy expenditure studies performed in patients with specific neurologic and orthopedic disabilities. The magnitude of the disabilities and the patients' capacity to tolerate the increased energy requirements are compared.

Three dimensional upper extremity motion during manual wheelchair propulsion in men with different levels of spinal cord injury.

This investigation compared three dimensional upper extremity motion during wheelchair propulsion in persons with 4 levels of spinal cord injury: low paraplegia (n=17), high paraplegia (n=19), C7 tetraplegia (n=16), and C6 tetraplegia (n=17). Upper extremity motion was recorded as subjects manually propelled a wheelchair mounted on a stationary ergometer. For all motions measured, subjects with paraplegia had similar patterns suggesting that the wheelchair backrest adequately stabilizes the trunk in the absence of abdominal musculature.

Surgical decompression of the first part of vertebral artery for ischemic brainstem dysfunction.

Background: Ischemic brainstem dysfunction can be caused by extrinsic compression or kinking of the proximal vertebral artery. This is a retrospective survey of operated patients comparing neurologic examinations done postoperatively with preoperative neurologic evaluation. No patient with arteriosclerotic obstruction of the proximal vertebral artery treated by endarterectomy is included in this series.

Depression and life satisfaction among people ageing with post-polio and spinal cord injury.

Purpose And Background: Attention has recently begun to focus on the ageing of individuals with disability, not only as a long-term follow-up issue but as a unique developmental issue itself. The majority of individuals with an onset of disability before age 30 can now expect to live into their 60s, 70s and beyond. Most of the secondary medical conditions that foreshortened life expectancy have been controlled and improved rehabilitation techniques have evolved over the last 50 years.

The efficacy of single-stage surgical management of multiple pressure sores in spinal cord-injured patients.

The practice of multiple-stage management in the treatment of patients with multiple pressure ulcers has long represented the standard of care in many specialty centers. The authors have observed that an aggressive surgical approach has proved necessary for control of this devastating problem in these patients. Their experience with one-stage reconstruction of multiple pressure sores over a 10-year period (between 1986 and 1996) in 120 spinal cord-injured patients has revealed certain advantages of this comprehensive method of surgical management.

Cerebral amyloid angiopathy in Alzheimer disease is associated with apolipoprotein E4 and cortical neuron loss.

Pathological correlations were sought between cerebral amyloid angiopathy (CAA) and other classical neurodegenerative changes in 101 consecutive cases of autopsy-confirmed Alzheimer disease (AD). Some degree of CAA was found in at least one area of the brain in 81% of the cases; severe CAA was found in at least one brain region in 29% of the cases. In a subset of 42 cases for which genomic DNA was available, greater severity of CAA was associated more with cases that were homozygous for apolipoprotein epsilon4 than in cases with only one or no epsilon4 alleles (Fisher's exact test, p = 0.

Energy cost of propulsion in standard and ultralight wheelchairs in people with spinal cord injuries.

Background And Purpose: Wheelchair- and subject-related factors influence the efficiency of wheelchair propulsion. The purpose of this study was to compare wheelchair propulsion in ultralight and standard wheelchairs in people with different levels of spinal cord injury.

Subjects: Seventy-four subjects (mean age=26.