Notes

Obsolete systems driven on their own by RUNX1 and GATA2 for hematopoietic growth.
Adverse events (AEs) after outpatient orthopaedic surgery are common, but difficult to detect. Electronic health records facilitate abstraction of large quantities of data, and may allow automated identification of 'triggers' or clues indicating the possibility of an AE. We evaluated electronic health record-based triggers to detect AEs after outpatient orthopaedic surgery.

The medical records of 1464 patients undergoing outpatient surgical procedures in one of five orthopaedic services at our institution were manually reviewed for the occurrence of 90-day postoperative AEs. We used electronic health records to identify triggers suggestive of an AE. Each trigger was evaluated for positive predictive value (PPV). We constructed a logistic regression model to determine triggers associated with AEs and used the beta coefficients derived from the model to produce a formula for the likelihood of identifying an AE in the medical record.

The overall rate of 90-day AEs was 10%, with surgical site infection being the most common (3.3%). Electronic triggers with the highest PPVs for the occurrence of 90-day AEs were antibiotic prescription (75%), emergency department visit (41%), bone/joint or blood culture (41%), repeat surgery (39%) and consult with infectious disease specialist (33%). Using our formula to predict the likelihood of identifying an AE in the medical record, a predicted probability of >0.10 had a specificity of 80% and sensitivity of 53% for actual AE.

Electronic health record-based triggers may facilitate quality-improvement efforts to monitor morbidity after outpatient orthopaedic surgery. Further research is needed to understand the optimal use of electronic triggers as surgical quality indicators and as screening tools to flag cases for manual review.

Level III, prognostic study.
Level III, prognostic study.
The proposed Centers for Medicare & Medicaid Services (CMS) 30-day readmission risk standardization models for inpatient rehabilitation facilities establish readmission risk for patients at admission based on a limited set of core variables. Considering functional recovery during the rehabilitation stay may help clinicians further stratify patient groups at high risk for hospital readmission.

The purpose of this study was to identify variables in the full administrative medical record, particularly in regard to physical function, that could help clinicians further discriminate between patients who are and are not likely to be readmitted to an acute care hospital within 30 days of rehabilitation discharge.

This study used an observational cohort with a 30-day follow-up of Medicare patients who were deconditioned and had medically complex diagnoses and who were receiving postacute inpatient rehabilitation in 2010 to 2011.

Patients in the highest risk quartile for readmission (N=25,908) were selected are easily monitored by health care providers may improve plans for care transition and reduce the risk of hospital readmission.
For older patients who are deconditioned and have medically complex diagnoses admitted to postacute inpatient rehabilitation, information on functional status measures that are easily monitored by health care providers may improve plans for care transition and reduce the risk of hospital readmission.
Autonomic symptoms and sleep disorders are common non-motor symptoms of Parkinson disease (PD), which are correlated with poor quality of life for patients.

To assess the frequency of autonomic symptoms in a consecutive series of PD patients and to correlate them with other motor and non-motor symptoms.

All consecutive non-demented PD patients who underwent an extensive evaluation including Hoehn and Yahr staging, Unified Parkinson's Disease Rating Scale, Beck's Depression Inventory, Neuropsychiatric Inventory, PDQ-39 Scale, the Parkinson's diseases Sleep Scale, the Epworth Sleepiness Scale and SCOPA-AUT scale were enrolled. Comorbidity has been also considered. Supine to standing position blood pressure and cardiac frequency changes were also measured.

135 PD patients were included (mean age at interview 67.7; mean disease duration 5.3 years). Patients were stratified according to mean SCOPA-AUT scale score (13.1). Those with higher SCOPA-AUT scale score were significantly older, had longer disease duration, worse disease stage, worse quality of sleep, were more severely affected, and were also taking a higher dosage of levodopa. At multivariate analysis, older age, longer disease duration, and worse quality of sleep were independently associated with higher SCOPA-AUT scale scores.

Our results remark the role of autonomic symptoms in PD. In our patient population, characterized by mild to moderate disease severity, most of the patients complained of autonomic nervous system involvement (84%). A significant association between autonomic symptoms and sleep disorders was also observed.
Our results remark the role of autonomic symptoms in PD. In our patient population, characterized by mild to moderate disease severity, most of the patients complained of autonomic nervous system involvement (84%). A significant association between autonomic symptoms and sleep disorders was also observed.
Aerobic fitness seems to provide extra protection to the cardiovascular system beyond changing the traditional risk factors, a phenomenon referred to as the risk factor gap model. Aerobic fitness may possibly lead to improved autonomic regulation. The Task Force of the American Heart Association supports a national campaign to reach specific cardiovascular health goals considering various metrics, including recommended physical activity (PA) volumes. It may be clinically relevant to assess whether autonomic remodeling occurs in those who adhere to the PA recommendations.

We studied 39 healthy subjects (22 males and 17 females), subdivided into two groups, according to whether they were meeting or not meeting PA recommendations (150 min/week of moderate aerobic activity, or 75 min/week of vigorous aerobic activity, or a combination of both). For each group, we evaluated aerobic capacity (VO2 Peak), body composition (Fat Mass) and autonomic nervous system profile, by way of mono and bivariate spectral analysis of cardiovascular beat by beat variability.

Subjects following PA recommendations show higher RR period, higher RR variance, greater absolute power of the respiratory component of RR variability (HFRR) and higher index alpha (a measure of spontaneous baroreflex). Moreover, as expected, the group that was meeting or exceeding current PA recommendations had higher VO2 peak, less fat mass and greater weekly energy expenditure.

Data show that subjects meeting current PA recommendations present a phenotype suggestive of enhanced parasympathetic drive to the SA node. This finding is compatible with the hypothesis that a more favorable autonomic profile is part of the mechanisms of the risk factor gap.
Data show that subjects meeting current PA recommendations present a phenotype suggestive of enhanced parasympathetic drive to the SA node. This finding is compatible with the hypothesis that a more favorable autonomic profile is part of the mechanisms of the risk factor gap.
Parkinson disease, an α-synucleinopathy, is associated with reduced insulin sensitivity, impaired glucose tolerance, and diabetes mellitus. Importantly, these metabolic alterations have been shown to contribute to disease progression. The purpose of this study was to determine if reduced insulin sensitivity is also present in other α-synucleinopathies associated with autonomic failure.

We studied 19 patients with multiple system atrophy and 26 patients with pure autonomic failure. Osimertinib For comparison, we studied 8 healthy controls matched for body mass index. Insulin sensitivity and beta cell function were calculated using fasting glucose and insulin levels according to the homeostatic model assessment 2. A multiple linear regression model was performed to determine factors that predict insulin sensitivity in autonomic failure.

There was a significant difference in insulin sensitivity among groups (P = 0.048). This difference was due to lower insulin sensitivity in multiple system atrophy patients 64% [interquartile range (IQR), 43 to 117] compared to healthy controls 139% (IQR, 83 to 212), P = 0.032. The main factor that contributed to the reduced insulin sensitivity was the presence of supine hypertension and residual sympathetic tone.

Multiple system atrophy patients have reduced insulin sensitivity that is associated with residual sympathetic activation and supine hypertension. These patients may therefore be at high risk for development of impaired glucose tolerance and diabetes mellitus.
Multiple system atrophy patients have reduced insulin sensitivity that is associated with residual sympathetic activation and supine hypertension. These patients may therefore be at high risk for development of impaired glucose tolerance and diabetes mellitus.An association between the CSF chromogranin A (CgA) and orthostatic blood pressure changes was investigated in 20 patients in the early stage of Parkinson disease (PD). There was a positive correlation between the CSF CgA and diastolic blood pressure change, when CSF CgA levels were lower in patients with orthostatic hypotension (OH). Decreased CSF CgA may be useful in predicting OH in the early stage of PD.
In April/2009, the UK National Health Service initiated four Better Care Better Value (BCBV) prescribing indicators, one of which encouraged the prescribing of cheaper angiotensin-converting enzyme inhibitors (ACEIs) instead of expensive angiotensin receptor blockers (ARBs), with 80 % ACEIs/20 % ARBs as a proposed, and achievable target. The policy was intended to save costs without affecting patient outcomes. However, little is known about the actual impact of the BCBV indicator on ACEIs/ARBs utilisation and cost-savings. Therefore, this study aimed to evaluate the impact of BCBV policy on ACEIs/ARBs utilisation and cost-savings, including exploration of regional variations of the policy's impact.

This cross-sectional study used data from the UK Clinical Practice Research Datalink. Segmented time-series analysis was applied to monthly ACEIs prescription proportion, adjusted number of ACEIs/ARBs prescriptions and costs.

Overall, the proportion of ACEIs prescription decreased during the study period fromth any savings. This study represents a case study of a failed or ineffective policy and thus provides key learning lessons for other healthcare authorities. Given the existing opportunity of potential cost-savings from achieving the 80 % target, specific measures would be needed to enhance the policy implementation and uptake; however, this must be balanced against other cost-saving policies in other high-priority areas.
ACEIs/ARBs utilisation was not affected by the BCBV policy. The small increase in post-policy ACEIs prescription proportion was not associated with any savings. This study represents a case study of a failed or ineffective policy and thus provides key learning lessons for other healthcare authorities. Given the existing opportunity of potential cost-savings from achieving the 80 % target, specific measures would be needed to enhance the policy implementation and uptake; however, this must be balanced against other cost-saving policies in other high-priority areas.
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