Biological Insights from Schizophrenia-associated Loci in Ancestral Populations.

Large-scale genome-wide association studies of schizophrenia have uncovered hundreds of associated loci but with extremely limited representation of African diaspora populations. We surveyed electronic health records of 200,000 individuals of African ancestry in the Million Veteran and All of Us Research Programs, and, coupled with genotype-level data from four case-control studies, realized a combined sample size of 13,012 affected and 54,266 unaffected persons. Three genome-wide significant signals - near , , and - are the first to be independently identified in populations of predominantly African ancestry.

Understanding Pain in Alzheimer's Disease in Anesthesia.

The primary risk factor for developing Alzheimer's Disease (AD) is increasing age, meaning that certified registered nurse anesthetists (CRNAs) will most likely encounter patients with AD with increasing frequency. Patients with AD are a challenge for CRNAs to quickly create a comprehensive anesthetic because of the difficulty with self-reporting and understanding how the brain responds to pain in AD. New research about how the brain processes pain in patients with AD is available, which could prove helpful.

Is Time Spent on Prior Authorizations Associated With Approval?

Advanced practice providers increasingly assume responsibility for prior authorizations (PAs). We hypothesized that the time burden of PAs will be correlated with increased approval. We collected several variables (ie, type, method, time spent, use of peer to peer, and outcome) for all PAs completed by a departmental nurse practitioner in 1 region.

Ableism in Health Care.

Improving our knowledge of disability can reduce stereotypes and stigma.

U.S. physicians' perspectives on the complexities and challenges of permanent contraception provision.

Objectives: Evidence shows many misconceptions exist around permanent contraception, and there are numerous barriers to accessing the procedure. This qualitative study explored physician perspectives regarding patients' informational and decision-support needs, the complexities and challenges of counseling and access, and how these factors may differ for people living on lower incomes.

Study Design: We conducted 15 semistructured, telephone interviews with obstetrician-gynecologists in three geographic regions of the United States to explore their perspectives on providing permanent contraception counseling and care.

Implementation and Impact of a β-Lactam Allergy Assessment Protocol in a Veteran Population.

Background: Approximately 10% of the US population reports having a β-lactam allergy, although nearly 90% do not have a true immunoglobulin E (IgE)-mediated reaction. This misconception results in using nonpreferred antibiotics, leading to antimicrobial resistance and treatment failure. To evaluate, clarify, and clear β-lactam allergies, we implemented a pharmacist-driven β-lactam allergy assessment (BLAA) protocol and penicillin allergy clinic (PAC).

Reviewing acute hip fractures in adults.

Hip fractures are considered a significant public health issue, representing a substantial burden on our healthcare system and society. They are one of the leading causes of disability among older adults, especially women. Globally, an estimated 18% of women and 6% of men will be affected by hip fractures at some time in life.

Early pregnancy prediction of spontaneous preterm birth before 32 completed weeks of pregnancy using plasma RNA: transcriptome discovery and initial validation of an RNA panel of markers.

Objective: To compare the second-trimester plasma cell-free (PCF) transcriptome of women who delivered at term with that of women with spontaneous preterm birth (sPTB) at or before 32 weeks of gestation and identify/validate PCF RNA markers present by 16 weeks of gestation.

Design: Prospective case-control study.

Setting: Academic tertiary care centre.

Early clinical suspicion and treatment in a patient with anti-NMDA receptor encephalitis.

Anti-NMDA receptor encephalitis is a complicated disease associated with paraneoplastic syndromes and autoimmune conditions. This case report highlights the importance of early identification and reviews the common clinical manifestations, diagnostic studies, and treatment modalities for this potentially catastrophic disease.

Prenatal polyunsaturated fatty acids and child asthma: Effect modification by maternal asthma and child sex.

Background: Findings on prenatal polyunsaturated fatty acid (PUFA) intake and child wheeze and asthma have been inconsistent.

Objective: We sought to examine associations between prenatal PUFA status and child wheeze/asthma and modifying effects of maternal asthma/atopy, child sex, and maternal race.

Methods: Analyses included 1019 mother-child dyads with omega-3 (n-3) and omega-3 (n-6) PUFAs measured in second-trimester plasma; n-6/n-3 ratios were calculated.

Accuracy of Endoscopic Ultrasound in Staging of Early Rectal Cancer.

Endoscopic ultrasound can be highly accurate for the staging of neoplasms in early rectal cancer.

Liver Imaging Reporting and Data System in Patients at High Risk for Hepatocellular Carcinoma in the Memphis Veterans Affairs Population.

Although hepatocellular carcinoma can be difficult to detect, use of the LI-RADS algorithm could lead to earlier identification in at-risk patients.

A Survey-based Study of Pharmacist Acceptance and Resistance to Health Information Technology.

Purpose: Because user acceptance and resistance to the use of health information technology (HIT) affects system utilization and previous studies in this area have typically excluded pharmacists, this study specifically addresses the response of institutional pharmacists to HIT.

Methods: A survey investigating pharmacists' responses to electronic medical record (EMR) system use was developed using questions modified from previously validated research. The survey was distributed electronically to the mailing list for pharmacy preceptors for the University of Tennessee College of Pharmacy.

Blistering Disease During the Treatment of Chronic Hepatitis C With Ledipasvir/Sofosbuvir.

Hepatitis C virus-associated porphyria cutanea tarda can result from viral-induced inhibition of uroporphyrinogen decarboxylase and the subsequent accumulation of uroporphyrins and associated metabolites in urine.

Management and treatment of animal bites.

Animal bites account for 1% of ED visits and more than $50 million in healthcare costs annually in the United States. Managing bite wounds can be challenging and providers must consider the patient's tetanus status, species of animal inflicting the bite, and infection risk. This article describes treatment and care of bites and when rabies prophylaxis is indicated.

A Strategy for Risk-adjusted Ranking of Surgeons and Practices Based on Patient-reported Outcomes After Elective Lumbar Surgery.

Study Design: This study retrospectively analyzes prospectively collected data.

Objective: The primary aim of this study is to present a scheme for patient-reported outcome (PRO)-based, risk-adjusted rankings of spine surgeons and sites that perform elective lumbar surgery, using the Quality and Outcomes Database (QOD).

Summary Of Background Data: There is currently no means of determining which spine surgeons or centers are positive or negative outliers with respect to PROs for elective lumbar surgery.

Predictive Model for Medical and Surgical Readmissions Following Elective Lumbar Spine Surgery: A National Study of 33,674 Patients.

Study Design: This study retrospectively analyzes prospectively collected data.

Objective: Here we aim to develop predictive models for 3-month medical and surgical readmission after elective lumbar surgery, based on a multi-institutional, national spine registry.

Summary Of Background Data: Unplanned readmissions place considerable stress on payers, hospitals, and patients.

The Role of Proton Pump Inhibitors in the Management of Upper Gastrointestinal Disorders.

Proton pump inhibitors (PPIs) have been in use since the early 1990s and play a crucial role in the management of a number of conditions affecting the upper gastrointestinal tract, including gastroesophageal reflux disease, Barrett esophagus, eosinophilic esophagitis, and dyspepsia. PPIs also play an important role in the treatment of infection and in the prevention of upper gastrointestinal tract ulcers and bleeding among patients taking antiplatelet therapy and/or nonsteroidal anti-inflammatory drugs. Despite recent concerns regarding the long-term safety of PPIs, their risk-benefit profiles strongly favor their appropriate use in patients who have genuine indications for them.

Unit-Level Changes in Central Line-Associated Bloodstream Infection Before and After Implementation of the Affordable Care Act and Mandatory Reporting Legislation.

Background: Central line-associated bloodstream infection (CLABSI) prevention efforts have increased over the past decade because of implications of the Affordable Care Act and mandatory reporting laws. These legislative measures allow for reduced reimbursement to hospitals with high level of CLABSIs and other health care-associated infections.

Objective: The aim of this study was to explore the impact of legislation and mandatory reporting on CLABSI rates and reporting.

Penetrating aortic ulcer leading to aortic dissection.

Rarely, penetrating atherosclerotic ulcers can rupture into the wall of the aorta, resulting in acute aortic dissection. This article describes a woman with an incidental diagnosis of type A aortic dissection secondary to a penetrating atherosclerotic ulcer of the ascending aorta. Although surgical repair of the aortic root was recommended, the patient refused treatment and left against medical advice.

Bilateral Large Pneumothoraxes Following Implantable Cardioverter-Defibrillator Generator Change: A Case Report of an Uncommon Event Complicating a Common Procedure.

Introduction: A bilateral large spontaneous pneumothorax to our knowledge has never been reported after a device implantation. We report an unusual case of a patient developing spontaneous bilateral large pneumothoraxes after an implantable cardioverter-defibrillator generator and lead revision without evidence of any obvious traumatic cardiac injury.

Case Presentation: A 79-year-old white man was scheduled for implantable cardioverter-defibrillator generator change and addition of an atrial lead.