Intestinal protozoa in returning travellers: a GeoSentinel analysis from 2007 to 2019.

Background: Prolonged diarrhoea is common amongst returning travellers and is often caused by intestinal protozoa. However, the epidemiology of travel-associated illness caused by protozoal pathogens is not well described.

Methods: We analysed records of returning international travellers with illness caused by Giardia duodenalis, Cryptosporidium spp.

Subcostal versus right lateral ultrasound measurements of inferior vena cava: Measurements obtained from these two views are not equivalent in non-ICU patients.

Objective: The objective of this study is to assess concordance between the subcostal and right lateral view for ultrasonographic inferior vena cava measurements including the end-inspiratory diameter, end-expiratory diameter and respiratory variation represented by the caval index in spontaneously breathing healthy adults.

Methods: We recruited a convenience sample of 33 healthy adults. A phased array ultrasound probe was used to obtain inferior vena cava measurements from a subcostal view in the sagittal plane and from a right lateral view in the coronal plane with B-mode ultrasound.

Comparison of Society Guidelines for the Management and Surveillance of Pancreatic Cysts: A Review.

Importance: The identification of incidental pancreas cystic lesions (PCLs) has increased in recent decades with the expanded use and improved sensitivity of cross-sectional imaging. Because the overall risk of malignancy associated with PCLs is low, yet the relative morbidity of pancreatic surgery is high, evidence-based guidelines are necessary for appropriate surveillance and management. Therefore, this article provides a review of existing guidelines regarding surveillance and management of PCLs and highlights recent advances in the diagnostic evaluation of cysts and the postresection management of mucinous lesions.

Implementation and Evaluation of a Novel High-Value Care Curriculum in a Single Academic Surgery Department.

Background: High value care (HVC), maximizing quality while minimizing cost, has become a major focus of surgical practice. Effective education in healthcare value concepts is critical during residency to ensure graduates are able to deliver high value surgical care and participate in interprofessional teams to improve the system.

Study Design: An HVC curriculum was implemented at a single academic medical center.

Self-Collected Anterior Nasal and Saliva Specimens versus Health Care Worker-Collected Nasopharyngeal Swabs for the Molecular Detection of SARS-CoV-2.

We prospectively compared health care worker-collected nasopharyngeal swabs (NPS) to self-collected anterior nasal swabs (ANS) and straight saliva for the diagnosis of coronavirus disease 2019 (COVID-19) in 354 patients. The percent positive agreement between NPS and ANS or saliva was 86.3% (95% confidence interval [CI], 76.

Travel-related hepatitis E: a two-decade GeoSentinel analysis.

Background: Hepatitis E virus (HEV) is widely distributed worldwide and is endemic in developing countries. Travel-related HEV infection has been reported at national levels, but global data are missing. Moreover, the global availability of HEV diagnostic testing has not been explored so far.

The Familiality of Rapid Renal Decline in Diabetes.

Sustained and rapid loss of glomerular filtration rate (GFR) is the predominant clinical feature of diabetic kidney disease and a requisite for the development of end-stage renal disease. Although GFR trajectories have been studied in several cohorts with diabetes and without diabetes, whether rapid renal decline clusters in families with diabetes has not been examined. To determine this, we estimated GFR (eGFR) from serum creatinine measurements obtained from 15,612 patients with diabetes at the University of Utah Health Sciences Center and established their renal function trajectories.

Implementation of an advance directive focus in a Chronic Multi-Organ Rare Disease Clinic.

Background: Education about an advance directive is frequently not addressed in the outpatient, ambulatory care setting. The objective of this study was to identify patients that do not have an advance directive in a Chronic Multi-Organ Rare Disease Clinic model, and define the role of a social worker in providing advance care planning (ACP).

Methods: The Chronic Multi-Organ Rare Disease Clinic in-corporates a multi-disciplinary team to provide outpatient care to over 600 patients.

Fetal Cardiac US: Techniques and Normal Anatomy Correlated with Adult CT and MR Imaging.

Congenital heart disease (CHD) is an important cause of childhood mortality. Despite the widespread use of ultrasonography (US) as a screening tool, the prenatal detection rate is suboptimal. Improvement of the initial screening examination, which is performed in low-risk populations and often interpreted by community radiologists, targets a point in the screening process that is likely to have the largest population effect.

Chronic Multiorgan Rare Disease: The Role of the Nurse Practitioner as a Leader of the Healthcare Team.

Value in healthcare must focus on accessibility, quality, and affordability. This article describes how a healthcare team provides value by meeting the needs of a rare disease patient and underscores the importance of a chronic multiorgan rare disease home. A nurse practitioner can ensure that barriers to evaluation are removed and communication is prioritized in order to provide accessible and affordable care to a patient with rare disease without jeopardizing quality of care.

Impact of computerized provider order entry (CPOE) on length of stay and mortality.

Objective: To examine changes in patient outcome variables, length of stay (LOS), and mortality after implementation of computerized provider order entry (CPOE).

Materials And Methods: A 5-year retrospective pre-post study evaluated 66 186 patients and 104 153 admissions (49 683 pre-CPOE, 54 470 post-CPOE) at an academic medical center. Generalized linear mixed statistical tests controlled for 17 potential confounders with 2 models per outcome.

The pharmacist and the EHR.

The adoption of electronic health records (EHRs) across the United States has impacted the methods by which health care professionals care for their patients. It is not always recognized, however, that pharmacists also actively use advanced functionality within the EHR. As critical members of the health care team, pharmacists utilize many different features of the EHR.

Clinical effectiveness and safety outcomes associated with prothrombin complex concentrates.

Prothrombin complex concentrates (PCCs) are indicated for urgent reversal of warfarin and used for reversal of novel oral anticoagulants, in patients with acute major bleeding or need for an urgent procedure. The research goal was to evaluate effectiveness and safety outcomes with PCC usage at our institution. A retrospective review of electronic medical records identified patients that received a PCC commercially available in the United States (KCentra(®) or Profilnine(®)) at twelve hospitals in a tertiary care health system from July 1, 2013 to April 30, 2014.

The Suspected Infected Prosthetic Joint: Clinical Acumen and Added Value of Laboratory Investigations.

Consensus definitions have emerged for the discrimination between infected and uninfected prosthetic joints but diagnostic uncertainty often occurs. We examined the accuracy of orthopaedic surgeons' assessments to diagnose the infected prosthetic hip or knee and elucidated the added value of laboratory parameters. A prospective cohort study of patients undergoing revision arthroplasty of hip or knee was conducted over a one-year period.

Internal fixation of osteoporotic fractures.

Osteoporosis leads to bone fragility and increased risk of fracture. Despite advances in diagnosis and treatment, the prevalence continues to rise. Osteoporotic fracture treatment has a unique set of difficulties related to poor bone quality and traditional approaches, and implants may not perform well.

Thyroid fine needle aspiration cytology: a review of the National Cancer Institute state of the science symposium.

In October 2007, the National Cancer Institute (NCI) of the United States sponsored a conference reviewing the state of the science of thyroid fine needle aspiration (FNA). Multiple issues were reviewed including pre-FNA requirements, training specifications, criteria for the selection of patients to undergo FNA, diagnostic categories and criteria, ancillary testing and post-FNA follow-up and treatment options. A summation of conclusions covering three of these topics, followed by a question and answer session, was subsequently presented at the 35th European Congress of Cytology (ECC) in Lisbon, Portugal in September of 2009.

Thyroid aspiration cytology: current status.

In the adult population, thyroid nodules are common and are increasingly detected by ultrasound examination or other scanning techniques. Depending on their size and ultrasonographic features, these nodules may require further investigation, including tissue diagnosis. Fine-needle aspiration (FNA) has become the predominant method to obtain tissue for microscopic analysis.

A new way to assess pain in laboring women: replacing the rating scale with a "coping" algorithm.

In 2001, the Joint Commission introduced a compliance guideline designed to improve pain care for all patients. In response, most hospitals created a pain policy that was intended to be implemented for all hospital patients. This article describes how nurses in a busy labor and delivery unit created a pain management policy that met the Joint Commission's goals and also supported their desire to assist laboring women in the most appropriate way possible.

Post-thyroid FNA testing and treatment options: a synopsis of the National Cancer Institute Thyroid Fine Needle Aspiration State of the Science Conference.

The National Cancer Institute (NCI) sponsored the NCI Thyroid Fine Needle Aspiration (FNA) State of the Science Conference on October 22-23, 2007 in Bethesda, MD. The 2-day meeting was accompanied by a permanent informational Web site and several on-line discussion periods between May 1 and December 15, 2007 (http://thyroidfna.cancer.

Epidermal growth factor receptor gene amplification and protein expression in glioblastoma multiforme: prognostic significance and relationship to other prognostic factors.

Epidermal growth factor receptor (EGFR) overexpression occurs in a significant percentage of cases of glioblastoma multiforme (GBM), and amplification has been found in approximately 40% of these neoplasms. Controversy exists as to the prognostic significance of EGFR gene amplification: some reports have indicated that amplification is associated with a poor prognosis, while other authors have reported no relationship between gene amplification and prognosis. Some reports have found a poor prognosis to be associated with amplification of the EGFR gene in patients of all ages with GBM, while other authors have found EGFR amplification to be an independent predictor of prolonged survival in patients with GBM who are older than 60 years of age.

Evaluation of scheduled J-pouch irrigations on decreasing stool frequency after ileoanal pull-through and ileostomy closure.

This study was intended to determine whether J-pouch irrigations through the efferent limb of the protective ileostomy stoma after ileoanal pull-through are effective in decreasing high stool frequency after ileostomy closure. Patients undergoing ileoanal pull-through may have high stool frequency after ileostomy closure. J-pouch irrigations through the efferent ileostomy stoma may decrease stool frequency by increasing J-pouch volume, improving storage capacity.