Curbside consultations are commonly requested during the care of hospitalized patients, but physicians perceive that the recommendations provided may be based on inaccurate or incomplete information.
...To compare the accuracy and completeness of the information received from providers requesting a curbside consultation of hospitalists with that obtained in a formal consultation on the same patients, and to examine whether the recommendations offered in the 2 consultations differed.
Prospective cohort.
University-affiliated, urban safety net hospital.
Proportion of curbside consultations with inaccurate or incomplete information; frequency with which recommendations in the formal consultation differed from those in the curbside consultation.
Curbside consultations were requested for 50 patients, 47 of which were also evaluated in a formal consultation performed on the same day by a hospitalist other than the one performing the curbside consultation. Based on information collected in the formal consultation, information was either inaccurate or incomplete in 24/47 (51%) of the curbside consultations. Management advice after formal consultation differed from that given in the curbside consultation for 28/47 patients (60%). When inaccurate or incomplete information was received, the advice provided in the formal versus the curbside consultation differed in 22/24 patients (92%, P < 0.0001).
Information presented during inpatient curbside consultations of hospitalists is often inaccurate or incomplete, and this often results in inaccurate management advice.
Community health improvement processes that yield community health assessments (CHAs) and community health improvement plans (CHIPs) provide data and a process to determine key community priorities ...and take action and are ideally collaborative endeavors. Nationally, increased focus on CHAs and CHIPs highlights the role that Academic Health Departments or other local health department (LHD)-academic linkages can play in completing CHAs and CHIPs. Drawn from the experiences of 5 LHD-academic partnerships that participated in a national demonstration and a detailed account of the experience of one, this article presents how such linkages can support CHA and CHIP work, ways to anticipate and overcome challenges, and the tangible benefits that may be realized for both the LHD and the academic partner. Community health improvement processes are ripe opportunities for LHD-academic linkages and can be fruitful and mutually beneficial partnerships to be used in completing CHAs and CHIPs to measurably improve the public’s health.
We investigated the relationship between parents' empathic responses prior to their children undergoing cancer treatment procedures and children's pain/distress during the procedures. We ...hypothesized: (1) parents' empathic distress would be positively associated with children's pain/distress, (2) parents' empathic concern would be negatively associated with children's pain/distress; and (3) parents' enduring dispositions and social support would be associated with their empathic responses. Parents completed: (1) measures of dispositions and perceived social support several weeks before their children underwent the procedures, and (2) state measures of empathic distress and empathic concern just before the procedures. Empathic distress was positively associated with children's pain; empathic concern was negatively associated with children's pain/distress. Predictions about dispositions and social support were also substantially confirmed.
Janus kinase 3 (JAK3) is a cytoplasmic tyrosine kinase required for T cell development and activated by cytokines that utilize the interleukin-2 (IL-2) receptor common gamma chain (gamma(c)). Genetic ...inactivation of JAK3 is manifested as severe combined immunodeficiency disease (SCID) in humans and mice. These findings have suggested that JAK3 represents a pharmacological target to control certain lymphoid-derived diseases. Here we provide novel evidence that AG-490 potently inhibits the autokinase activity of JAK3 and tyrosine phosphorylation and DNA binding of signal transducer and activator of transcription 5a and 5b (STAT5a/b). Similar inhibitory effects were observed with other cytokines that use gamma(c). AG-490 also inhibited IL-2-mediated proliferative growth in human T cells with an IC50) = 25 microM that was partially recoverable. Moreover, we demonstrate that this inhibitor prevented tetanus toxoid antigen-specific T cell proliferation and expansion but failed to block activation of Zap70 or p56Lck after anti-CD3 stimulation of human T cells. Taken together, these findings suggest that AG-490 inhibits the JAK3-mediated Type II signaling pathway but not the T cell receptor-derived Type I pathway and possesses therapeutic potential for T cell-derived pathologies such as graft-versus-host disease, allergy, and autoimmune disorders.
The coronavirus disease 2019 (COVID-19) pandemic has challenged researchers performing clinical trials to develop innovative approaches to mitigate infectious risk while maintaining rigorous safety ...monitoring.
In this report we describe the implementation of a novel exclusively remote randomized clinical trial (ClinicalTrials.gov NCT04354428) of hydroxychloroquine and azithromycin for the treatment of the SARS-CoV-2-mediated COVID-19 disease which included cardiovascular safety monitoring. All study activities were conducted remotely. Self-collected vital signs (temperature, respiratory rate, heart rate, and oxygen saturation) and electrocardiographic (ECG) measurements were transmitted digitally to investigators while mid-nasal swabs for SARS-CoV-2 testing were shipped. ECG collection relied on a consumer device (KardiaMobile 6L, AliveCor Inc.) that recorded and transmitted six-lead ECGs via participants' internet-enabled devices to a central core laboratory, which measured and reported QTc intervals that were then used to monitor safety.
Two hundred and thirty-one participants uploaded 3245 ECGs. Mean daily adherence to the ECG protocol was 85.2% and was similar to the survey and mid-nasal swab elements of the study. Adherence rates did not differ by age or sex assigned at birth and were high across all reported race and ethnicities. QTc prolongation meeting criteria for an adverse event occurred in 28 (12.1%) participants, with 2 occurring in the placebo group, 19 in the hydroxychloroquine group, and 7 in the hydroxychloroquine + azithromycin group.
Our report demonstrates that digital health technologies can be leveraged to conduct rigorous, safe, and entirely remote clinical trials.
Children with cancer and their parents report that treatment-related procedures are more traumatic and painful than cancer itself. Competing hypotheses have emerged regarding relations between ...parents' social support and child pain and distress. Little is known about caregivers' use of nonverbal immediacy behaviors that may function as social support messages. This study describes caregivers' interpersonal distance and touch behaviors during painful pediatric oncology procedures and examines relations between those behaviors and children's pain and distress. Caregivers' total touch time and instrumental (task-oriented) touch time, but not supportive touch time, during the actual procedure covaried with children's procedural pain and distress. PUBLICATION ABSTRACT
Archives bring to mind rooms filled with old papers and dusty artifacts. But for scientists, the detritus of the past can be a treasure trove of material vital to present and future research: fossils ...collected by geologists; data banks assembled by geneticists; weather diaries trawled by climate scientists; libraries visited by historians. These are the vital collections, assembled and maintained over decades, centuries, and even millennia, which define the sciences of the archives.With Science in the Archives, Lorraine Daston and her co-authors offer the first study of the important role that these archives play in the natural and human sciences. Reaching across disciplines and centuries, contributors cover episodes in the history of astronomy, geology, genetics, philology, climatology, medicine, and more—as well as fundamental practices such as collecting, retrieval, and data mining. Chapters cover topics ranging from doxology in Greco-Roman Antiquity to NSA surveillance techniques of the twenty-first century. Thoroughly exploring the practices, politics, economics, and potential of the sciences of the archives, this volume reveals the essential historical dimension of the sciences, while also adding a much-needed long-term perspective to contemporary debates over the uses of Big Data in science.
Background: Community mental health teams (CMHTs) receive high numbers of referrals and staff who work in these teams are under constant pressure to take on more patients. Local CMHT staff expressed ...the need for a more accurate way to represent their workload than purely reporting numbers of clients on their caseload.
Aims: The project aimed to develop a brief case weighting scale (CWS) specifically to rate cases in CMHTs for older people in Leicestershire.
Methods: An eight-item scale was designed to include the main aspects of a client case that contribute to increased work input by CMHT members. A multiple regression model was used to assign different weightings to each of the items in order to predict time spent on the case over a four week period.
Results: The items on the scale together "accounted for" 58% of the variation in time spent on client cases. The re-test and inter-rater reliability of the scale were shown to be good. Agreement with the HoNOS 65+ was investigated.
Conclusions: The CWS can be used to rate both current client cases and new referrals following first assessment, and aims to provide CMHT staff with a useful and useable indicator of their clinical workload.
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