A murine model for the development of melanocytic nevi and their progression to melanoma.

Acquired melanocytic nevi are commonly found in sun exposed and unexposed human skin, but the potential for their transformation into invasive melanoma is not clear. Therefore, a mouse model of nevus initiation and progression was developed in C3H/HeN mice using a modified chemical carcinogenesis protocol. Nevi develop due to DNA damage initiated by dimethylbenz(a) anthracene (DMBA) followed by chronic promotion with 12-O-tetradecanoyl-phorbol-13-acetate (TPA).

Formative research in the development of a care transition intervention in breast cancer survivors.

Purpose: The purpose of this qualitative study was to evaluate breast cancer survivors' (BCS) responses to a self-management survivorship care transition intervention in the formative development of such an intervention. The experience of BCS is marked by uncertainty and anxiety about subsequent care, and a desire for more information about future care needs and late effects of treatment. Self-management strategies have demonstrated improved outcomes in chronic illness, and may address the unmet needs of breast cancer survivors.

Parkinson's disease severity and use of dopaminergic medications.

Background: The effects of dopaminergic therapy in parkinson's disease (PD) can vary depending on the class of medication selected.

Objective: The aim of this post hoc study was to determine if the class of dopaminergic therapy correlated with disease severity in persons with early, treated PD.

Methods: A non-parametric global statistical test (GST) was used to assess the status of participants treated with dopamine agonist (DA) monotherapy, levodopa (LD) monotherapy or combined LD and DA therapy on multiple PD outcomes encompassing motor, cognitive, psychiatric and autonomic function, as well as disability and quality of life.

American association of clinical endocrinologists and american college of endocrinology consensus conference on obesity: building an evidence base for comprehensive action.

Objective/methods: The American Association of Clinical Endocrinologists/American College of Endocrinology "Consensus conference on obesity: building an evidence base for comprehensive action" convened March 23-25, 2014, in Washington, D.C. The premise of the conference was that by bringing together stakeholders in U.

Connecting the dots: like watching a movie…critically.

Acquisition of expertise in the diagnosis and management of patients requires years of practice; exposure to diverse clinical entities is critical as well as the myriad ways in which the same disease can present in a given patient. However, this repeated exposure has to be accompanied by two critical elements; first, the novice needs the guidance of an expert or master to appreciate the nuances and subtleties in making a diagnosis or taking a course of action. Second, and perhaps most importantly, the physician needs to acquire the habit of reflecting on and in actions during the clinical encounter.

Comparing homeless persons' care experiences in tailored versus nontailored primary care programs.

Objectives: We compared homeless patients' experiences of care in health care organizations that differed in their degree of primary care design service tailoring.

Methods: We surveyed homeless-experienced patients (either recently or currently homeless) at 3 Veterans Affairs (VA) mainstream primary care settings in Pennsylvania and Alabama, a homeless-tailored VA clinic in California, and a highly tailored non-VA Health Care for the Homeless Program in Massachusetts (January 2011-March 2012). We developed a survey, the "Primary Care Quality-Homeless Survey," to reflect the concerns and aspirations of homeless patients.

New tools for weight-loss therapy enable a more robust medical model for obesity treatment: rationale for a complications-centric approach.

Objective: Recent advances in lifestyle intervention programs, pharmacotherapy, and bariatric surgery have enabled the development of medical models for the treatment of obesity. Regarding pharmacotherapy, in 2012 the U.S.

Trajectories of drug use and mortality outcomes among adults followed over 18 years.

Background: For adults in general population community settings, data regarding long-term course and outcomes of illicit drug use are sparse, limiting the formulation of evidence-based recommendations for drug use screening of adults in primary care.

Objective: To describe trajectories of three illicit drugs (cocaine, opioids, amphetamines) among adults in community settings, and to assess their relation to all-cause mortality.

Design: Longitudinal cohort, 1987/88-2005/06.

Effect of fluticasone propionate/salmeterol on arterial stiffness in patients with COPD.

Background: COPD is associated with increased arterial stiffness which may in part explain the cardiovascular morbidity observed in the disease. A causal relationship between arterial stiffness and cardiovascular events has not been established, though their strong association raises the possibility that therapies that reduce arterial stiffness may improve cardiovascular outcomes. Prior studies suggest that fluticasone propionate/salmeterol (FSC) may improve cardiovascular outcomes in COPD and we hypothesized that FSC would reduce arterial stiffness in these patients.

Symptoms of combined prolapse and urinary incontinence in large surgical cohorts.

Objective: To estimate whether prolapse severity is a major contributor to urinary incontinence severity, as measured by validated incontinence questionnaires.

Methods: We analyzed data from two large female stress urinary incontinence (SUI) surgical cohorts: the Stress Incontinence Surgical Treatment Efficacy Trial (SISTEr) study (N=655) and the subsequent Trial of Mid-Urethral Slings (TOMUS) study (N=597). All participants completed a standardized baseline assessment including validated measures of symptom severity, quality of life, objective measures of urine loss (Urogenital Distress Inventory [UDI], Medical, Epidemiologic, and Social Aspects of Aging questionnaire, Incontinence Impact Questionnaire, and pad test), as well as the Pelvic Organ Prolapse Quantification assessment.

Patient complexity: more than comorbidity. the vector model of complexity.

Background: The conceptualization of patient complexity is just beginning in clinical medicine.

Objectives: This study aims (1) to propose a conceptual approach to complex patients; (2) to demonstrate how this approach promotes achieving congruence between patient and provider, a critical step in the development of maximally effective treatment plans; and (3) to examine availability of evidence to guide trade-off decisions and assess healthcare quality for complex patients.

Methods/results: The Vector Model of Complexity portrays interactions between biological, socioeconomic, cultural, environmental and behavioral forces as health determinants.

Brachytherapy for renal [corrected] artery in-stent restenosis.

Percutaneous transluminal angioplasty with stenting is now an established modality for treatment of atherosclerotic renal artery stenosis. However, the rate of restenosis can be as high as 20%. While intravascular brachytherapy has proven efficacy in coronary artery in-stent stenosis, its role in the treatment of renal artery in-stent stenosis is not well understood.

Assessing quality of diabetes care by measuring longitudinal changes in hemoglobin A1c in the Veterans Health Administration.

Context: A1c levels are widely used to assess quality of diabetes care provided by health care systems. Currently, cross-sectional measures are commonly used for such assessments.

Objective: To study within-patient longitudinal changes in A1c levels at Veterans Health Administration (VHA) facilities as an alternative to cross-sectional measures of quality of diabetes care.

Control of spontaneous B lymphocyte autoimmunity with adenovirus-encoded soluble TACI.

Objective: Serum B lymphocyte stimulator (BLyS) is increased in autoimmune diseases, both in animal models and in humans. This study examined the effect of BLyS blockade in 3 animal models of lupus.

Methods: Antibodies and lupus-like disease manifestations were examined in mice after administration of a single injection of an adenoviral construct for the transmembrane activator and CAML interactor receptor (AdTACI) that produces high serum levels of TACI-Fc fusion protein.

Porphyria presenting with bilateral radial motor neuropathy: evidence of a novel gene mutation.

The authors identified a novel mutation of the porphobilinogen deaminase (PBG-D) gene in a patient with acute intermittent porphyria presenting with severe and bilateral axonal radial motor neuropathy. Electrophysiologic studies revealed prominent involvement of distal radial nerves in the setting of mild polyneuropathy. Analysis of the PBG-D gene revealed a single base-pair insertion (887insA) in exon 14.