Provision of a personalized survivorship care plan and its impact on cancer-related health literacy among childhood cancer survivors in Hong Kong.

Purpose: To evaluate the short-term effectiveness of a personalized survivorship care plan (SCP) in improving cancer-related literacy among childhood cancer survivors, and to identify characteristics of survivors who demonstrated minimal gain from the intervention.

Methods: We recruited survivors diagnosed with cancer at ≤18 years old and were >2 years post treatment. The intervention included a personalized SCP and 30-minute health risk counseling.

The Association of Gender and Mortality in Geriatric Trauma Patients.

Unlabelled: The association of gender with mortality in trauma remains a subject of debate. Geriatric trauma patients have a higher risk of mortality compared to younger patients. We sought to evaluate the association of gender with mortality in a group of geriatric trauma patients presenting to an academic level 1 trauma center (trauma center designated by New York State capable of handling the most severe injuries and most complex cases).

The Safety of Fat Grafting: An Institutional Retrospective Review.

Background: Autologous fat grafting is a popular technique for volume replacement in the breast and face. The efficacy, safety, and complication rate of this technique at the division of plastic surgery at the University of Alabama at Birmingham will be described in this review.

Methods: An institutional review board-approved retrospective review of patients undergoing fat grafting procedures from January 2015 to July 2018 was performed.

Fellow Designations of Interest to Nurse Leaders.

Achieving fellow designation is commonly a career goal for nurse leaders. The path to achievement can be confusing, and once a goal is set, choosing the right designation is important. This column outlines the background of fellow designation, clarifies differences between fellow designation and other career advancement options, and presents ideas for consideration by nurse leaders as they pursue career advancement through fellow designation.

Ending Racial Bias in American Medicine: A Call for Help from the AMA, NMA, AAMC, and the Rest of Us.

Bias based on skin color, religion, immigrant status, gender, and ethnicity are deeply rooted in American culture and have existed within the infrastructure of American medicine from the beginning. Now, medical educators are struggling to find curriculum and experiences that effectively address explicit and implicit bias among our increasingly diverse group of students, house staff, and practitioners. The leadership, experience, and lessons learned needed to scrub present medical school curricula of racial bias, to develop an antiracist curriculum, and to test its effectiveness already lies with the American Medical Association (AMA), the Association of American Medical Colleges (AAMC), and the National Medical Association (NMA).

Exploring Production Pressure and Normalization of Deviance and Their Relationship to Poor Patient Outcomes.

Production pressure and/or normalization of deviance contribute to poor patient outcomes. The purpose of this study was to explore the relationship between production pressure and normalization of deviance to poor patient outcomes. A team of experienced qualitative researchers conducted a metasynthesis of all qualitative closed claims studies that used the American Association of Nurse Anesthetists (AANA) Foundation Closed Claims database and were accepted for publication at the time of the study.

New applications for independent activities of daily living in measuring disability in multiple sclerosis.

Background: Disability outcome measures in multiple sclerosis (MS) focus heavily on ambulation; however, limitations in performing everyday activities encompass another type of disability.

Objectives: The aim of this study was to examine the ability of instrumental activities of daily living (IADL) scale to discriminate between different levels of disability and to predict disability progression.

Methods: The North American Research Committee on Multiple Sclerosis (NARCOMS) registry fall 2006 semi-annual survey asked participants to complete the RAND-12, Performance Scales, Patient Determined Disease Steps (PDDS), and IADL questionnaires.

Use of Technology in the Management of Obesity: A Literature Review.

Technology is intended to assist with diagnosing, treating, and monitoring patients remotely. Little is known of its impact on health outcomes or how it is used for obesity management. This study reviewed the literature to identify the different types of technologies used for obesity management and their outcomes.

An Increasing Neutrophil-to-Lymphocyte Ratio Trajectory Predicts Organ Failure in Critically-Ill Male Trauma Patients. An Exploratory Study.

Although the association of neutrophil proportions with mortality in trauma patients has recently been shown, there is a paucity of research on the association with other outcomes. We sought to investigate the association of neutrophil proportions with organ failure in critically-ill trauma patients. We reviewed a randomly-selected group of trauma patients admitted to our level-1 trauma intensive care unit between July 2007 and December 2016.

Rats! Hantavirus: A Case Report of a Suspected Case in Eastern Tennessee.

Introduction: Hantavirus is an RNA virus that is transmitted to humans by inhalation of aerosolized excrement from infected rodents. This case report demonstrates the value of taking a thorough social history and highlights the challenges associated with early diagnosis of this viral infection.

Case Presentation: We highlight a case of suspected hantavirus infection with subtle gastrointestinal and pulmonary symptoms that challenged the initial diagnosis.

An Electronic Health Record Data-driven Model for Identifying Older Adults at Risk of Unintentional Falls.

Screening for risk of unintentional falls remains low in the primary care setting because of the time constraints of brief office visits. National studies suggest that physicians caring for older adults provide recommended fall risk screening only 30 to 37 percent of the time. Given prior success in developing methods for repurposing electronic health record data for the identification of fall risk, this study involves building a model in which electronic health record data could be applied for use in clinical decision support to bolster screening by proactively identifying patients for whom screening would be beneficial and targeting efforts specifically to those patients.

Population Variations in Rheumatoid Arthritis Treatment and Outcomes, Northern California, 1998-2009.

Objective: To assess variations in rheumatoid arthritis treatment and outcomes at the community level from 1998 through 2009.

Methods: The study used computerized data from 16 Kaiser Permanente Northern California Medical Centers. Mixed modeling was used to assess patterns across time and clinic.

Successful closure of pharyngo-cutaneous and phayryngo-tracheal fistulas using removable hypopharyngeal stent after laryngectomy for laryngeal carcinoma.

Placement of removable stents to close pharyngo-cutaneous and tracheo-pharyngeal fistulas after laryngectomy has not been reported before. This case presents the feasibility of removable esophageal stent in closing pharyngo-cutaneous and tracheo-pharyngeal fistulas after laryngectomy for laryngeal cancer. Consecutive patients who underwent placement of removable esophageal stent for closing pharyngo-cutaneous and tracheo-pharyngeal fistulas after laryngectomy for laryngeal cancer.

Bilateral adrenal gland enlargement secondary to histoplasmosis mimicking adrenal metastases: diagnosis with EUS-guided FNA.

While adrenal gland histoplasmosis has been previously diagnosed by fine needle aspiration utilizing the percutaneous approach, EUS-FNA has not been employed in the diagnosis of this infection affecting both adrenal glands. We report a patient with massive bilateral adrenal enlargement due to histoplasmosis that was diagnosed by EUS-FNA. Trans-duodenal and trans-gastric fine needle aspiration biopsy of both adrenal glands was performed.

Novel removable internally fully covered self-expanding metal esophageal stent: feasibility, technique of removal, and tissue response in humans.

Objectives: Internally fully covered self-expandable metal stents (FCSEMSs) have recently become available offering the possibility of removal. However, to our knowledge, the feasibility, techniques for endoscopic removal, and tissue reaction to FCSEMS have not been reported in humans. Our aims are (1) to report reasons for and success of FCSEMS removal in consecutive patients, (2) to describe methods of esophageal stent retrieval, and (3) to describe stent reactions induced by FCSEMS in humans.

Roles and challenges of the health information management educator: a national HIM faculty survey.

Health information technology initiatives created the framework for a national health information infrastructure that concomitantly fostered a need to build intellectual capacity within our current and future health information management (HIM) work force. Results from the 2008 HIM Educator Survey are discussed. Developed for voluntary electronic participation, the survey comprised a series of questions about educators' professional interests and responsibilities.

Feasibility of combined EUS-FNA and ERCP for obstructive jaundice from presumed pancreatic malignancy.

The management of patients with pancreatic cancer begins with confirmation of the diagnosis by cytology, which is followed by accurate preoperative staging and biliary drainage. Endoscopic ultrasonography with fine-needle aspiration (EUS-FNA) followed by endoscopic retrograde cholangiopancreatography (ERCP) helps to achieve these goals and primes the patient for various treatment options. We discuss the findings of a study by Ross and colleagues that aimed to determine the feasibility and outcomes of combining EUS-FNA and therapeutic ERCP in a single session.

The emerging role of primary care in genetics.

Purpose Of Review: Advances in genetics are occurring at a rapid pace. It will ultimately be the primary care pediatrician who assimilates this knowledge and applies it to patient care. This article is written in a patient encounter format with which the pediatrician is familiar.

The lateral notch sign associated with acute anterior cruciate ligament disruption.

We prospectively studied all of the patients with anterior cruciate ligament disruptions who sought treatment at the senior author's office during a 36-month period. Plain radiographs identified depressions measuring 2 mm or more in the lateral femoral condyle (lateral notch sign) in 9 of 120 knees (7.5%) with acute anterior cruciate ligament disruption and in 2 of 44 knees (4.