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Find video protocols related to scientific articles indexed in Pubmed.
Hospital outcomes associated with guideline-recommended antibiotic therapy for pediatric pneumonia.
J Hosp Med
PUBLISHED: 05-21-2014
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Recent national guidelines recommend use of narrow-spectrum antibiotic therapy as empiric treatment for children hospitalized with community-acquired pneumonia (CAP). However, clinical outcomes associated with adoption of this recommendation have not been studied.
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Readmission rates due to venous thromboembolism in cancer patients after abdominopelvic surgery, a retrospective chart review.
Support Care Cancer
PUBLISHED: 03-06-2014
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Venous thromboembolism (VTE) is a known cause of morbidity in the oncology patient population. As hospital readmission rates are more frequently scrutinized, we sought to determine the most common causes of 30-day readmissions in the cancer patient following abdominopelvic surgery. Furthermore, due to the high risk of VTE, there have been guidelines established for prophylaxis. As guidelines are based on asymptomatic VTE, we studied the compliance rates of these guidelines in our institution and the rate of symptomatic VTE in the 30-day postoperative period.
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Using quality improvement to optimise paediatric discharge efficiency.
BMJ Qual Saf
PUBLISHED: 01-27-2014
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Bed capacity management is a critical issue facing hospital administrators, and inefficient discharges impact patient flow throughout the hospital. National recommendations include a focus on providing care that is timely and efficient, but a lack of standardised discharge criteria at our institution contributed to unpredictable discharge timing and lengthy delays. Our objective was to increase the percentage of Hospital Medicine patients discharged within 2 h of meeting criteria from 42% to 80%.
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Spot urine protein measurements in kidney transplantation: a systematic review of diagnostic accuracy.
Nephrol. Dial. Transplant.
PUBLISHED: 01-26-2014
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Quantification of proteinuria (albuminuria) in renal transplant recipients is important for diagnostic and prognostic purposes. Recent guidelines have recommended quantification of proteinuria by spot protein-to-creatinine ratio (PCR) or spot albumin-to-creatinine ratio (ACR). Validity of spot measurements remains unclear in renal transplant recipients.
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Predicting Kidney Transplantation Outcomes Using Proteinuria Ascertained From Spot Urine Samples Versus Timed Urine Collections.
Am. J. Kidney Dis.
PUBLISHED: 01-20-2014
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Proteinuria has been associated with transplant loss and mortality in kidney transplant recipients. Both spot samples (albumin-creatinine ratio [ACR] and protein-creatinine ratio [PCR]) and 24-hour collections (albumin excretion rate [AER] and protein excretion rate [PER]) have been used to quantify protein excretion, but which measurement is a better predictor of outcomes in kidney transplantation remains uncertain.
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Electronic cigarettes in Canada: prevalence of use and perceptions among youth and young adults.
Can J Public Health
PUBLISHED: 01-18-2014
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The goal of this study was to examine the prevalence and perceptions of electronic cigarette use among Canadian youth and young adults.
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Oral antibiotics at discharge for children with acute osteomyelitis: a rapid cycle improvement project.
BMJ Qual Saf
PUBLISHED: 12-17-2013
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Substantial evidence demonstrates comparable cure rates for oral versus intravenous therapy for routine osteomyelitis. Evidence adoption is often slow and in our centre virtually all patients with osteomyelitis were discharged on intravenous therapy.
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Intraskeletal isotopic compositions (?(13) C, ?(15) N) of bone collagen: Nonpathological and pathological variation.
Am. J. Phys. Anthropol.
PUBLISHED: 12-11-2013
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Paleodiet research traditionally interprets differences in collagen isotopic compositions (?(13) C, ?(15) N) as indicators of dietary distinction even though physiological processes likely play some role in creating variation. This research investigates the degree to which bone collagen ?(13) C and ?(15) N values normally vary within the skeleton and examines the influence of several diseases common to ancient populations on these isotopic compositions. The samples derive from two medieval German cemeteries and one Swiss reference collection and include examples of metabolic disease (rickets/osteomalacia), degenerative joint disease (osteoarthritis), trauma (fracture), infection (osteomyelitis), and inflammation (periostitis). A separate subset of visibly nonpathological skeletal elements from the German collections established normal intraindividual variation. For each disease type, tests compared bone lesion samples to those near and distant to the lesions sites. Results show that normal (nonpathological) skeletons exhibit limited intraskeletal variation in carbon- and nitrogen-isotope ratios, suggesting that sampling of distinct elements is appropriate for paleodiet studies. In contrast, individuals with osteomyelitis, healed fractures, and osteoarthritis exhibit significant intraskeletal differences in isotope values, depending on whether one is comparing lesions to near or to distant sites. Skeletons with periostitis result in significant intraskeletal differences in nitrogen isotope values only, while those with rickets/osteomalacia do not exhibit significant intraskeletal differences. Based on these results, we suggest that paleodiet researchers avoid sampling collagen at or close to lesion sites because the isotope values may be reflecting both altered metabolic processes and differences in diet relative to others in the population. Am J Phys Anthropol, 2013. © 2013 Wiley Periodicals, Inc.
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Evaluating the impact of interactive and entertaining educational conferences.
Perspect Med Educ
PUBLISHED: 11-09-2013
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Adult learning theory suggests that meaningful engagement impacts learning. To evaluate the impact of resident-led interactive conferences on satisfaction, engagement and knowledge acquisition. A prospective study at a paediatric academic institution compared educational conferences in two formats. Control conferences were PowerPoint(®) lectures and intervention conferences included multimedia, audience participation and faculty mentorship. Learner and presenter satisfaction and learner engagement were assessed by post-conference surveys. Knowledge was assessed via pre- and post-conference open-ended questions; matched pre- and post-questions were analyzed. Control and intervention groups satisfaction and engagement were compared using the Wilcoxon rank-sum test. Comparison of proportion of learners with improved post-conference knowledge score was analyzed with the Chi square test. There were 181 control and 170 intervention surveys collected. Learners median satisfaction (4 vs. 5, p = .03) and engagement (4 vs. 5, p < .01) ratings improved in the intervention group. Presenters rated audience engagement higher during the intervention conferences (median 3 vs. 4, p = .01). Knowledge acquisition, compared for matched surveys only, was not significantly different between the groups. Learner and presenter satisfaction and learner engagement were higher for the interactive format. While knowledge acquisition was unchanged, greater satisfaction encourages the use of interactive conferences.
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Nutritional quality of food items on fast-food kids menus: comparisons across countries and companies.
Public Health Nutr
PUBLISHED: 10-24-2013
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To compare energy (calories), total and saturated fats, and Na levels for kids menu food items offered by four leading multinational fast-food chains across five countries.
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The perceptions of UK youth of branded and standardized, plain cigarette packaging.
Eur J Public Health
PUBLISHED: 10-08-2013
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Tobacco packaging is an important form of promotion. Standardizing cigarette packages (plain packaging) represents a novel tobacco control policy. This study examined perceptions of branded and standardized cigarette packages among British youth.
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Effect of a face sheet tool on medical team provider identification and family satisfaction.
J Hosp Med
PUBLISHED: 08-21-2013
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Resident duty hour restrictions may expose families to more trainees during hospitalization and hinder recognition of medical team members. This may negatively impact family satisfaction. Our study sought to determine the effects of a face sheet tool on families identification and satisfaction rating of the medical team. One of 2 general pediatric units at a large academic center was assigned to intervention; the other served as the concurrent control. Families on the intervention unit were given a face sheet tool with medical team members photos and role descriptions. Upon discharge, caregivers matched names, photos, and roles to providers they encountered, answered a 10-question satisfaction survey, and answered an overall hospital experience satisfaction question. Caregivers encountered a median of 8 (range, 3-14) medical team members. Caregivers in the intervention group were more likely to correctly identify providers by name (median correct, 25% vs 11% for controls; P?
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The protein kinase double-stranded RNA-dependent (PKR) enhances protection against disease cause by a non-viral pathogen.
PLoS Pathog.
PUBLISHED: 08-01-2013
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PKR is well characterized for its function in antiviral immunity. Using Toxoplasma gondii, we examined if PKR promotes resistance to disease caused by a non-viral pathogen. PKR(-/-) mice infected with T. gondii exhibited higher parasite load and worsened histopathology in the eye and brain compared to wild-type controls. Susceptibility to toxoplasmosis was not due to defective expression of IFN-?, TNF-?, NOS2 or IL-6 in the retina and brain, differences in IL-10 expression in these organs or to impaired induction of T. gondii-reactive T cells. While macrophages/microglia with defective PKR signaling exhibited unimpaired anti-T. gondii activity in response to IFN-?/TNF-?, these cells were unable to kill the parasite in response to CD40 stimulation. The TRAF6 binding site of CD40, but not the TRAF2,3 binding sites, was required for PKR phosphorylation in response to CD40 ligation in macrophages. TRAF6 co-immunoprecipitated with PKR upon CD40 ligation. TRAF6-PKR interaction appeared to be indirect, since TRAF6 co-immunoprecipitated with TRAF2 and TRAF2 co-immunoprecipitated with PKR, and deficiency of TRAF2 inhibited TRAF6-PKR co-immunoprecipitation as well as PKR phosphorylation induced by CD40 ligation. PKR was required for stimulation of autophagy, accumulation the autophagy molecule LC3 around the parasite, vacuole-lysosomal fusion and killing of T. gondii in CD40-activated macrophages and microglia. Thus, our findings identified PKR as a mediator of anti-microbial activity and promoter of protection against disease caused by a non-viral pathogen, revealed that PKR is activated by CD40 via TRAF6 and TRAF2, and positioned PKR as a link between CD40-TRAF signaling and stimulation of the autophagy pathway.
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Evaluation of the clinical performance of the cobas 4800 HPV test in patients referred for colposcopy.
J. Clin. Microbiol.
PUBLISHED: 07-31-2013
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The clinical performance of the cobas human papillomavirus (HPV) test for detection of high-grade disease in a colposcopy-referred population was compared with that of Hybrid Capture 2 (HC2). The overall agreement between the tests was 92.3%. Clinical sensitivity and specificity for detection of cervical intraepithelial neoplasia grade 2 or greater (CIN2+) were 90.0% and 55.5% for cobas and 90.5% and 50.2% for HC2, respectively. In conclusion, both tests showed comparable performance for detection of CIN2+.
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Varenicline induced acute interstitial nephritis in the setting of idiopathic membranous glomerulonephritis.
BMC Nephrol
PUBLISHED: 06-03-2013
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Varenicline is a nicotinic receptor partial agonist indicated for the cessation of smoking. It is regarded as having no or minimal renal toxicity. A single case report has linked it to acute interstitial nephritis.
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Quality improvement methods increase appropriate antibiotic prescribing for childhood pneumonia.
Pediatrics
PUBLISHED: 04-15-2013
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In August 2011, the Pediatric Infectious Disease Society and Infectious Disease Society of America published an evidence-based guideline for the management of community-acquired pneumonia (CAP) in children ?3 months. Our objective was to evaluate if quality improvement (QI) methods could improve appropriate antibiotic prescribing in a setting without a formal antimicrobial stewardship program.
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Rapid adoption of Lactobacillus rhamnosus GG for acute gastroenteritis.
Pediatrics
PUBLISHED: 03-05-2013
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A 2007 meta-analysis showed probiotics, specifically Lactobacillus rhamnosus GG (LGG), shorten diarrhea from acute gastroenteritis (AGE) by 24 hours and decrease risk of progression beyond 7 days. In 2005, our institution published a guideline recommending consideration of probiotics for patients with AGE, but only 1% of inpatients with AGE were prescribed LGG. The objective of this study was to increase inpatient prescribing of LGG at admission to >90%, for children hospitalized with AGE, within 120 days.
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Carbon and nitrogen isotopic survey of northern peruvian plants: baselines for paleodietary and paleoecological studies.
PLoS ONE
PUBLISHED: 01-16-2013
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The development of isotopic baselines for comparison with paleodietary data is crucial, but often overlooked. We review the factors affecting the carbon (?(13)C) and nitrogen (?(15)N) isotopic compositions of plants, with a special focus on the carbon and nitrogen isotopic compositions of twelve different species of cultivated plants (n?=?91) and 139 wild plant species collected in northern Peru. The cultivated plants were collected from nineteen local markets. The mean ?(13)C value for maize (grain) was -11.8±0.4 ‰ (n?=?27). Leguminous cultigens (beans, Andean lupin) were characterized by significantly lower ?(15)N values and significantly higher %N than non-leguminous cultigens. Wild plants from thirteen sites were collected in the Moche River Valley area between sea level and ?4,000 meters above sea level (masl). These sites were associated with mean annual precipitation ranging from 0 to 710 mm. Plants growing at low altitude sites receiving low amounts of precipitation were characterized by higher ?(15)N values than plants growing at higher altitudes and receiving higher amounts of precipitation, although this trend dissipated when altitude was >2,000 masl and MAP was >400 mm. For C(3) plants, foliar ?(13)C was positively correlated with altitude and precipitation. This suggests that the influence of altitude may overshadow the influence of water availability on foliar ?(13)C values at this scale.
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Missense mutation in the second RNA binding domain reveals a role for Prkra (PACT/RAX) during skull development.
PLoS ONE
PUBLISHED: 11-10-2011
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Random chemical mutagenesis of the mouse genome can causally connect genes to specific phenotypes. Using this approach, reduced pinna (rep) or microtia, a defect in ear development, was mapped to a small region of mouse chromosome 2. Sequencing of this region established co-segregation of the phenotype (rep) with a mutation in the Prkra gene, which encodes the protein PACT/RAX. Mice homozygous for the mutant Prkra allele had defects not only in ear development but also growth, craniofacial development and ovarian structure. The rep mutation was identified as a missense mutation (Serine 130 to Proline) that did not affect mRNA expression, however the steady state level of RAX protein was significantly lower in the brains of rep mice. The mutant protein, while normal in most biochemical functions, was unable to bind dsRNA. In addition, rep mice displayed altered morphology of the skull that was consistent with a targeted deletion of Prkra showing a contribution of the gene to craniofacial development. These observations identified a specific mutation that reduces steady-state levels of RAX protein and disrupts the dsRNA binding function of the protein, demonstrating the importance of the Prkra gene in various aspects of mouse development.
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SOCS3 deletion in B cells alters cytokine responses and germinal center output.
J. Immunol.
PUBLISHED: 11-09-2011
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B cell behavior is fine-tuned by internal regulatory mechanisms and external cues such as cytokines and chemokines. Suppressor of cytokine signaling 3 (SOCS3) is a key regulator of STAT3-dependent cytokine responses in many cell types and has been reported to inhibit CXCL12-induced retention of immature B cells in the bone marrow. Using mice with SOCS3 exclusively deleted in the B cell lineage (Socs3(?/?)mb1cre(+)), we analyzed the role of SOCS3 in the response of these cells to CXCL12 and the STAT3-inducing cytokines IL-6 and IL-21. Our findings refute a B cell-intrinsic role for SOCS3 in B cell development, because SOCS3 deletion in the B lineage did not affect B cell populations in naive mice. SOCS3 was strongly induced in B cells stimulated with IL-21 and in plasma cells exposed to IL-6. Its deletion permitted excessive and prolonged STAT3 signaling following IL-6 stimulation of plasma cells and, in a T cell-dependent immunization model, reduced the number of germinal center B cells formed and altered the production of Ag-specific IgM and IgE. These data demonstrate a novel regulatory signal transduction circuit in plasma cells, providing, to our knowledge, the first evidence of how these long-lived, sessile cells respond to the external signals that mediate their longevity.
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The estimation, measurement, and relevance of the glomerular filtration rate in stage 5 chronic kidney disease.
Semin Dial
PUBLISHED: 09-15-2011
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The glomerular filtration rate (GFR) is considered the best index of overall kidney function. The level of GFR is used in patients with chronic kidney disease (CKD) to classify them into CKD stages. Stage 5 CKD encompasses patients with a GFR below 15 ml/minute/1.73 m(2) and those requiring chronic dialysis. Preservation of GFR, even at its very low level, is of great importance in both dialysis and non-dialysis stage 5 CKD patients. Residual GFR is considered in the prescription of both hemodialysis and peritoneal dialysis and interventions to preserve residual GFR are an active area of clinical research. The application of traditional methods of estimating and measuring GFR can be problematic in this patient population. This review will focus on the methods available to quantify GFR in stage 5 CKD and their use in both clinical and research settings.
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Trimethoprim, creatinine and creatinine-based equations.
Nephron Clin Pract
PUBLISHED: 08-11-2011
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Co-trimoxazole is a frequently prescribed antibiotic worldwide. It is composed of both trimethoprim and sulfamethoxazol (Sfx) and is used in the treatment and prophylaxis of urinary tract and Pneumocystis jirovecii infections. The Sfx component appears to be nephrotoxic at high doses or doses inappropriately adjusted for glomerular filtration rate (GFR). The trimethoprim component, even at recommended doses, inhibits tubular creatinine secretion, leading to a rapid but ultimately reversible increase in serum creatinine independent of any changes in GFR. This translates into a falsely low estimated GFR when creatinine-based equations are used. This review focuses on evidence of the differential effects of trimethoprim and Sfx on serum creatinine concentrations and GFR and their relevance to clinical practice, with particular attention to kidney transplantation.
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The impact of interlaboratory differences in cystatin C assay measurement on glomerular filtration rate estimation.
Clin J Am Soc Nephrol
PUBLISHED: 07-28-2011
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Cystatin C (CysC) is a promising marker of GFR. Several equations have been derived to estimate GFR from its serum concentration. Heterogeneity in the performance of these equations exists in validation studies even when the same CysC assay from the same manufacturer is utilized. This study was designed to examine the differences in CysC and GFR estimation (eGFR) using Siemens nephelometric immunoassay and the Mayo Clinic equation. The ability of the eGFRs to predict measured GFR was also examined.
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Phosphatidylinositol 3-kinase signaling delays sendai virus-induced apoptosis by preventing XIAP degradation.
J. Virol.
PUBLISHED: 03-02-2011
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Sendai virus (SeV) infection causes apoptosis, which is manifested only late after infection; however, inhibition of phosphatidylinositol 3-kinase (PI3K) dramatically accelerates the process. We report here that rapid apoptosis uses the same mitochondrial apoptotic pathway as slow apoptosis. Cytoplasmic cytochrome c (cyt c) was released early in both cases, but the antiapoptotic protein XIAP prevented early activation of the caspases in cells with active PI3K. When the enzyme was inhibited, XIAP was degraded rapidly in infected cells, allowing cyt c to cause caspase activation and early apoptosis. Thus, SeV infection-mediated apoptosis is temporally regulated by the prevention of XIAP degradation by PI3K.
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Utilising improvement science methods to optimise medication reconciliation.
BMJ Qual Saf
PUBLISHED: 02-11-2011
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In 2005, The Joint Commission included medication reconciliation as a National Patient Safety Goal to reduce medication errors related to omissions, duplications and interactions. Hospitals continue to struggle to implement successful programmes that meet these objectives.
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REO-10: a phase I study of intravenous reovirus and docetaxel in patients with advanced cancer.
Clin. Cancer Res.
PUBLISHED: 10-06-2010
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REOLYSIN (Oncolytics Biotech) consists of a wild-type oncolytic reovirus, which has selective cytotoxicity for tumor cells while sparing normal cells. In a phase I study as a single agent, repeated infusions of reovirus were safe with evidence of antitumor activity. Preclinical studies indicate potential for synergy between reovirus and chemotherapeutic agents. A multicenter, phase I dose escalation study was designed to assess the safety of combining reovirus with docetaxel chemotherapy in patients with advanced cancer.
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Polycythemia due to obstructive sleep apnea in a patient on hemodialysis.
Hemodial Int
PUBLISHED: 07-24-2010
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Both anemia and sleep disordered breathing are common in patients with dialysis-dependent stage 5 chronic kidney disease. Erythrocytosis resulting from obstructive sleep apnea (OSA) is rare in the general population and has never been described in the hemodialysis population. We present a case of asymptomatic isolated erythrocytosis and elevated serum erythropoietin level in an otherwise well and previously erythropoietin-dependent chronic hemodialysis patient with chronic kidney disease secondary to ischemic nephropathy. There was no history or symptoms of cardio-pulmonary or hepatic diseases nor any relevant family history. Screening work-up for malignancies was negative. The clinical history was highly suggestive of OSA and severe OSA (respiratory disturbance index of 59) was confirmed by polysomnographic studies. Successful treatment of the OSA with continuous positive airway pressure resulted in permanent stabilization of the hemoglobin to levels below 13 g/dL without the need for repeated phlebotomies and in dramatic lowering of serum erythropoietin levels. To our knowledge, this is the first case of OSA mediated erythrocytosis in a dialysis patient documented in the literature.
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Therapeutic effect of sodium iodide symporter gene therapy combined with external beam radiotherapy and targeted drugs that inhibit DNA repair.
Mol. Ther.
PUBLISHED: 06-29-2010
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Adenoviral (AdV) transfer of sodium iodide symporter (NIS) gene has translational potential, but relatively low levels of transduction and subsequent radioisotope uptake limit the efficacy of the approach. In previous studies, we showed that combining NIS gene delivery with external beam radiotherapy (EBRT) and DNA damage repair inhibitors increased viral gene expression and radioiodide uptake. Here, we report the therapeutic efficacy of this strategy. An adenovirus expressing NIS from a telomerase promoter (Ad-hTR-NIS) was cytotoxic combined with relatively high-dose (50 microCi) (131)I therapy and enhanced the efficacy of EBRT combined with low-dose (10 and 25 microCi) (131)I therapy in colorectal and head and neck cancer cells. Combining this approach with ataxia-telangiectasia mutated (ATM) or DNA-dependent protein kinase (DNA-PK) inhibition caused maintenance of double-stranded DNA breaks (DSBs) at 24 hours and increased cytotoxicity on clonogenic assay. When the triplet of NIS-mediated (131)I therapy, EBRT, and DNA-PKi was used in vivo, 90% of mice were tumor-free at 5 weeks. Acute radiation toxicity in the EBRT field was not exacerbated. In contrast, DNA-PKi did not enhance the therapeutic efficacy of EBRT plus adenovirus-mediated HSVtk/ganciclovir (GCV). Therefore, combining NIS gene therapy and EBRT represents an ideal strategy to exploit the therapeutic benefits of novel radiosensitizers.
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Two-stage phase I dose-escalation study of intratumoral reovirus type 3 dearing and palliative radiotherapy in patients with advanced cancers.
Clin. Cancer Res.
PUBLISHED: 05-18-2010
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To determine the safety and feasibility of combining intratumoral reovirus and radiotherapy in patients with advanced cancer and to assess viral biodistribution, reoviral replication in tumors, and antiviral immune responses.
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Use of kidney function end points in kidney transplant trials: a systematic review.
Am. J. Kidney Dis.
PUBLISHED: 01-20-2010
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Clinical trials in kidney transplantation are beginning to include markers of kidney function as end points now that traditional outcomes, such as acute rejection, become increasingly rare events. The frequency and type of kidney function end points used are unknown.
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Estimating glomerular filtration rate in kidney transplantation: is the new chronic kidney disease epidemiology collaboration equation any better?
Clin. Chem.
PUBLISHED: 12-03-2009
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The new Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation was developed to address the systematic underestimation of the glomerular filtration rate (GFR) by the Modification of Diet in Renal Disease (MDRD) Study equation in patients with a relatively well-preserved kidney function. The performance of the new equation for kidney transplant recipients (KTRs) is unknown.
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Estimating GFR using serum beta trace protein: accuracy and validation in kidney transplant and pediatric populations.
Kidney Int.
PUBLISHED: 07-22-2009
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The limitations of estimates of glomerular filtration rate (GFR) based only on serum creatinine measurements have spurred an interest in more sensitive markers of GFR. Beta-trace protein (BTP), a low-molecular-weight glycoprotein freely filtered through the glomerular basement membrane and with minimal non-renal elimination, may be such a marker. We have recently derived two GFR estimation equations based on BTP. To validate these equations, we measured BTP and the plasma clearance of (99)mTc-DTPA in 92 adult kidney transplant recipients and 54 pediatric patients with impaired kidney function. GFR was estimated using the serum creatinine-based Modification of Diet in Renal Disease (MDRD) Study equation for adults, the Schwartz and updated Schwartz equations in children, and 4 novel BTP-derived equations (our 2 equations and 2 proposed by Poge). In adults, our BTP-based equations had low median bias and high accuracy such that 89-90% of estimates were within 30% of measured GFR. In children, the median bias of our 2 equations was low and accuracy was high such that 78-83% of estimates were within 30% of measured GFR. These results were an improvement compared to the MDRD and Schwartz equations, both of which had high median bias and reduced accuracy. The updated Schwartz equation also performed well.
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All together now? Evolving antitrust approaches to bundled discounting.
J Health Life Sci Law
PUBLISHED: 06-03-2009
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Many sellers in the United States offer bundled discounts, or package deals. Consumers generally welcome the ability to get more for less in return for purchasing multiple goods or services together. In the healthcare industry, payors and providers commonly negotiate such arrangements. Although bundled discounts often create a win-win for buyers and sellers, they can be anticompetitive when used by a monopolist to exclude a smaller competitor. In recent years, several antitrust lawsuits have addressed the legality of particular bundled discount arrangements. Two federal circuit courts of appeal have established divergent, and somewhat elusive, standards for evaluating the arrangements under the antitrust laws--and the law likely will remain in a state of flux until the Supreme Court steps in to hear the issue. This article explains the underlying economic rationale for antitrust concerns with bundled discounts, and surveys various standards that courts have applied to such arrangements as well as proposed standards that have not yet been adopted. It also discusses the practical implications of these standards for sophisticated healthcare entities that may seek to bundle a range of products or services. The article concludes with a checklist of questions that sellers should ask in conducting a preliminary evaluation of potential antitrust risk associated with a particular discount arrangement.
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Decreasing Adverse Events through Night Talks: An Interdisciplinary, Hospital-Based Quality Improvement Project.
Perm J
PUBLISHED: 05-22-2009
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Background: The majority of medical adverse events are secondary to errors in communication. The Joint Commission (known until 2007 as the Joint Commission on the Accreditation of Healthcare Organizations) reports that 70% of sentinel events are the result of communication failures. Review of nonperioperative adverse events at Cincinnati Childrens Hospital Medical Center in 2007 found similar statistics: 57% were related to failure to recognize abnormal vital signs and to communicate or address parents or nurses concerns.Objective: To increase by 80% the number of days between near misses in pediatric neurosurgical patients because of failure to address abnormal vital signs or parents or nurses concerns during the night shift.Materials and Methods: Baseline data on near misses from the previous night were collected with the use of a written questionnaire completed the next morning by the interns, patient-care facilitators or charge nurse, and attending physicians. Laminated cards with three standardized questions were created to guide a late-evening review of patients status by residents, attending physicians, and nurses: the Night Talks discussion. After initiation of Night Talks, data were collected for issues addressed by Night Talks as well as for preventable adverse events.Main Outcome Measure: Number of days between near misses.Results: During a two-month period before the introduction of Night Talks, there was an average of 3.8 days between near misses on neurosurgery patients. After the initiation of Night Talks, days between near misses due to the failure to address abnormal vital signs or parents or nurses concerns increased to 201 days, a 5360% change.Conclusion: Instituting standardized Night Talks substantially reduced near misses in neurosurgical patients at our institution at night.
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Genome-wide identification of H-NS-controlled, temperature-regulated genes in Escherichia coli K-12.
J. Bacteriol.
PUBLISHED: 04-03-2009
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DNA microarrays demonstrate that H-NS controls 69% of the temperature regulated genes in Escherichia coli K-12. H-NS is shown to be a common regulator of multiple iron and other nutrient acquisition systems preferentially expressed at 37 degrees C and of general stress response, biofilm formation, and cold shock genes highly expressed at 23 degrees C.
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Yttrium-90 ibritumomab tiuxetan doses calculated to deliver up to 15 Gy to critical organs may be safely combined with high-dose BEAM and autologous transplantation in relapsed or refractory B-cell non-Hodgkins lymphoma.
J. Clin. Oncol.
PUBLISHED: 03-02-2009
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To determine the maximum-tolerated radiation-absorbed dose (RAD) to critical organs delivered by yttrium-90 ((90)Y) ibritumomab tiuxetan in combination with high-dose carmustine, etoposide, cytarabine, and melphalan (BEAM) chemotherapy with autologous transplantation.
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Effect of clinical variables and immunosuppression on serum cystatin C and beta-trace protein in kidney transplant recipients.
Am. J. Kidney Dis.
PUBLISHED: 02-06-2009
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Cystatin C and beta-trace protein (BTP) are low-molecular-weight proteins that have generated interest as alternative endogenous markers of glomerular filtration rate (GFR). Studies examining the effect of demographic, biometric, clinical, and biochemical variables on cystatin C levels have yielded conflicting results, perhaps because of the reliance on inferior methods of GFR determination. The aim of this study is to examine the independent effect of various clinical parameters on serum concentrations of creatinine, cystatin C, and BTP in kidney transplant recipients.
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The effect of cigarette branding and plain packaging on female youth in the United Kingdom.
J Adolesc Health
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Cigarette packaging is the most prominent form of tobacco marketing remaining in countries such as the United Kingdom. The current study examined perceptions of cigarette packaging among female youth and the potential impact of "plain" cigarette packaging regulations.
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Accuracy of cystatin C-based estimates of glomerular filtration rate in kidney transplant recipients: a systematic review.
Nephrol. Dial. Transplant.
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As with creatinine, cystatin C can be incorporated into a formula to estimate the glomerular filtration rate (GFR). The overall performance of cystatin C-based equations in kidney transplantation is unclear with conflicting results between studies.
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Improving situation awareness to reduce unrecognized clinical deterioration and serious safety events.
Pediatrics
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Failure to recognize and treat clinical deterioration remains a source of serious preventable harm for hospitalized patients. We designed a system to identify, mitigate, and escalate patient risk by using principles of high-reliability organizations. We hypothesized that our novel care system would decrease transfers determined to be unrecognized situation awareness failures events (UNSAFE). These were defined as any transfer from an acute care floor to an ICU where the patient received intubation, inotropes, or ? 3 fluid boluses in first hour after arrival or before transfer.
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The potential impact of plain packaging of cigarette products among Brazilian young women: an experimental study.
BMC Public Health
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Tobacco use is responsible for 5.4 million deaths every year worldwide and is a leading cause of preventable death. The burden of these deaths is rapidly shifting to low and middle-income countries, such as Brazil. Brazil has prohibited most forms of tobacco advertising; however, the cigarette pack remains a primary source of marketing. The current study examined how tobacco packaging influences brand appeal and perceptions of health risk among young women in Brazil.
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Reovirus exerts potent oncolytic effects in head and neck cancer cell lines that are independent of signalling in the EGFR pathway.
BMC Cancer
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Reovirus exploits aberrant signalling downstream of Ras to mediate tumor-specific oncolysis. Since ~90% squamous cell carcinomas of the head and neck (SCCHN) over-express EGFR and SCCHN cell lines are sensitive to oncolytic reovirus, we conducted a detailed analysis of the effects of reovirus in 15 head and neck cancer cell lines. Both pre- and post-entry events were studied in an attempt to define biomarkers predictive of sensitivity/resistance to reovirus. In particular, we analysed the role of EGFR/Ras signalling in determining virus-mediated cytotoxicity in SCCHN.
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Spot urine protein measurements: are these accurate in kidney transplant recipients?
Transplantation
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Proteinuria and albuminuria are important markers of allograft pathology and are associated with graft loss and cardiovascular disease. Traditionally, these have been quantified using a 24-hr urine collection, but spot urine measurements (albumin-creatinine and protein-creatinine ratios) have become popular because of convenience. Aside from tests of correlation, there has been little evaluation of these measurements in kidney transplantation.
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Tetanus toxoid reactive lymphadenopathy masquerading as T-cell lymphoma.
Future Oncol
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We report a case in which a patient with persistent reactive lymphadenopathy post-tetanus toxoid vaccination was initially diagnosed as having T-cell lymphoma/leukemia. A florid CD4+ T-cell proliferation and pathology interpretation, in the absence of complete clinical information, that these cells co-expressed CD8 led to the initial diagnosis. Better integration of the clinical and pathologic data may have led more rapidly to the final diagnosis. Postvaccination responses can mimic lymphoma.
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Stable isotope biogeochemistry of seabird guano fertilization: results from growth chamber studies with maize (Zea mays).
PLoS ONE
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Stable isotope analysis is being utilized with increasing regularity to examine a wide range of issues (diet, habitat use, migration) in ecology, geology, archaeology, and related disciplines. A crucial component to these studies is a thorough understanding of the range and causes of baseline isotopic variation, which is relatively poorly understood for nitrogen (?(15)N). Animal excrement is known to impact plant ?(15)N values, but the effects of seabird guano have not been systematically studied from an agricultural or horticultural standpoint.
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Utilizing improvement science methods to improve physician compliance with proper hand hygiene.
Pediatrics
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In 2009, The Joint Commission challenged hospitals to reduce the risk of health care-associated infections through hand hygiene compliance. At our hospital, physicians had lower compliance rates than other health care workers, just 68% on general pediatric units. We used improvement methods and reliability science to increase compliance with proper hand hygiene to >95% by inpatient general pediatric teams.
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What is Visualize?

JoVE Visualize is a tool created to match the last 5 years of PubMed publications to methods in JoVE's video library.

How does it work?

We use abstracts found on PubMed and match them to JoVE videos to create a list of 10 to 30 related methods videos.

Video X seems to be unrelated to Abstract Y...

In developing our video relationships, we compare around 5 million PubMed articles to our library of over 4,500 methods videos. In some cases the language used in the PubMed abstracts makes matching that content to a JoVE video difficult. In other cases, there happens not to be any content in our video library that is relevant to the topic of a given abstract. In these cases, our algorithms are trying their best to display videos with relevant content, which can sometimes result in matched videos with only a slight relation.