College of Medicine

: Anemia at Discharge and Risk of Readmission in Elderly Patients; Summary: Title: Anemia at Discharge and Risk of Readmission in Elderly Patients Authors: Yeshanew Teklie MD, Niraj Patel MD; Victoria Campdesuner DO; Kayla Marini DO; Yorlenis Rodriguez DO; Karen M. Hamad MD, FAAP, FACP; Mary E. Geary PhD, RN; and Wilhelmine Wiese-Rometsch MD, FACPAffiliation: Florida State University Internal Medicine Residency Program at Sarasota Memorial Hospital, 1700 South Tamiami Trail, Sarasota FL 34239, 941-917-7799Type of Project: Practice-based Quality ImprovementIntroduction: Anemia is defined by the World Health Organization (WHO) as a hemoglobin (Hb) concentration less than 12.0 g/dL for females and less than 13.0 g/dL for males. Objective of this quality improvement initiative was to test if anemia independently is associated with readmission in elderly patients discharged from the medicine service of a community teaching hospital. Methods: We conducted a retrospective cohort study declared exempt by our Institutional Review Board involving electronic medical record data from patients at least 65 years old hospitalized between September 2009 and June 2019 discharged not to hospice care. Severity of anemia classified by the WHO was applied for Hb concentrations obtained at hospital discharge for females as mild (11.0 – 11.9 g/dL), moderate (8.0 – 10.9 g/dL), severe (<8.0 g/dL); and males as mild (11.0 - 12.9 g/dL), moderate (8.0 - 10.9 g/dL), severe (<8.0 g/dL). Time to readmission after index hospitalization within 30d, 90d, and 180d with mild, moderate, severe, or no anemia was compared using Kaplan Meier survival curves with covariates (age; sex; multiple chronic conditions; length of stay; APR-DRG Severity of Illness and Risk of Mortality; and discharge destination) controlled using Cox Proportional Hazard modeling with relative impact assessed using Random Forest modeling. Readmission after 180d was considered a new index hospitalization. Continuous variables summarized as mean (SD) or median (interquartile range) were contrasted using Kruskal-Wallis ANOVA. Categorical variables summarized as proportions were compared using chi square or Fisher exact test. Statistical tests were two-tailed with p<.05 considered significant.Findings: Among 13,526 inpatients with 18,793 discharges median age of 78 (14) years was statistically similar by sex (49% females, 51% males) exhibiting an anemia distribution of no (31.0%), mild (20.5%), moderate (47.1%) and severe (1.4%). Race distributed as 89.9% white; 5.9% African American or Black; and 4.2% Other. Females differentiated distribution across anemia spectrum at no (95.7%) (p<0.001), mild (26.4%) (p<0.001), moderate (51.0%) and severe (43.5%). No, mild, moderate and severe anemia corrected for putative confounders impacted (p<0.001) respectively cumulative risk of readmission at 30 d (7.0%, 7.9%, 17.2%, 21.3%), 90 d (12.0%, 15.3%, 28.1%, 34.8%) and 180 d (16.4%, 20.7%, 34.4%, 42.6%).Conclusion: An essential patient-centric question is whether anemia in elderly inpatients affects poor outcomes and/or whether anemia is a surrogate marker for underlying overt and/or subclinical disease(s). Although present quality improvement initiative was not designed to unravel mechanisms of anemia, we controlled for putative severity of illness confounders while demonstrating readmission risk escalating with severity of anemia. Implications for Practice: Findings herald readmission risk associated with “no anemia” as defined by the World Health Organization. Tailored anemia care could offer clinical advantages to mitigate risk for readmission.Reference: WHO. Hemoglobin concentrations for the diagnosis of anemia. Accessed May 16, 2020 at https://www.who.int/vmnis/indicators/haemoglobin.pdf, Keywords: Discharge Anemia, Risk of Readmission, Elderly Anemia

: Change In Five-factor Model Personality Traits During The Acute Phase Of The Coronavirus Pandemic; The rapid spread of the coronavirus and the strategies to slow it have disrupted just about every aspect of our lives. Such disruption may be reflected in changes in psychological function. The present study used a pre-posttest design to test whether Five Factor Model personality traits changed with the coronavirus outbreak in the United States. Participants (N= 2,137) were tested in early February 2020 and again during the President's 15 Days to Slow the Spread guidelines. In contrast to the preregistered hypotheses, Neuroticism decreased across these six weeks, particularly the facets of Anxiety and Depression, and Conscientiousness did not change. Interestingly, there was some evidence that the rapid changes in the social context had changed the meaning of an item. Specifically, an item about going to work despite being sick was a good indicator of conscientiousness before COVID-19, but the interpretation of it changed with the pandemic. In sum, the unexpected small decline in Neuroticism suggests that, during the acute phase of the coronavirus outbreak, feelings of anxiety and distress may be attributed more to the pandemic than to one's personality., impact, age, life events, The publisher's version of record is availible at https://doi.org/10.1371/journal.pone.0237056

: Clinical Characteristics, Management Practices, And In-hospital Outcomes Among Trauma Patients With Venous Thromboembolism; Background: We aimed to assess the clinical characteristics, management practices, and inhospital outcomes of venous thromboembolism (VTE) among trauma patients. Methods: A retrospective analysis of all trauma patients with documented venous thromboembolic events in a level 1 trauma center was conducted. Patients were categorized into two groups based on the primary initial presentation postinjury (deep-vein thrombosis [DVT] or pulmonary embolism [PE]). Results: Across the study period, a total of 662 patients were confirmed to have DVT and 258 patients were diagnosed with acute PE. Among them, 84 patients were identified to have trauma-associated VTE; 56 (8.5%) had DVT and 28 (10.9%) had PE. Two patients who initially presented with DVT developed PE on follow-up. There were 38 females and 46 males with a mean age of 46 +/- 18 years. Abnormal coagulation profile was reported as 7 protein C deficiencies, 5 protein S deficiencies, 6 homocystinemia, 4 antithrombin III deficiency, 4 lupus anticoagulant, and 2 Factor V Leiden. Age, sex, obesity, D-dimer level, and treatment (except for heparin) were comparable between the two groups; whereas protein S deficiency, prior history of PE, bedridden status, congestive heart failure, and history of recent surgery, were more evident in the PE group. The incidence of postthrombotic syndrome was significantly higher in the DVT group. Overall mortality rate was 8.3% (DVT; 8.9% vs. PE; 7.1%, respectively = 0.78). Conclusion: Coagulation profile plays an important role in posttraumatic thromboembolic disease. A thorough assessment for features of thromboembolic disorders is warranted in polytrauma patients to avoid missing this potentially life-threatening diagnosis. Larger studies are needed for better understanding and management of VTE in trauma., impact, trauma, frequency, risk-factors, prevention, d-dimer, deep-vein thrombosis, japanese patients, manifestation, Outcomes, pulmonary-embolism, risk factors, utility, venous thromboembolism, The publisher's version of record is availible at https://doi.org/10.4103/JETS.JETS_83_19

: Department of Biomedical Sciences

: Department of Clinical Sciences

: Department of Family Medicine and Rural Health

: Department of Geriatrics

: Disparities In Secure Messaging Uptake Between Patients And Physicians; Background: Emails securely exchanged between patients and clinicians offer the promise of improved access to care and indirectly improved health outcomes. Yet research to date is mixed on who-among both patients and clinicians-is using secure messaging. Objective: Using data from two large nationally representative cross-sectional surveys, this study aimed to compare the prevalence of secure messaging use among patients and their access to the functionality through their physicians, and to explore the clinical practice and physician characteristics and patient sociodemographic characteristics associated with the use of secure messaging. Methods: We conducted regression analyses to identity statistical associations between self-reported secure messaging use and access, and the patient, practice, and physician characteristics from the National Health Interview Survey (NHIS) and the National Ambulatory Medical Care Survey (NAMCS). The NHIS data collected between 2013 and 2018, with approximately 150,000 adult individuals, were used to evaluate patient characteristics associated with email communication with clinicians. The NAMCS data included 7340 physicians who reported on secure messaging use between 2013 and 2016 and provided context on physician specialty, use of certified health information technology (IT), and practice size and ownership associated with secure messaging access and use. Results: By 2016, two-thirds of ambulatory care visits were conducted by a physician who reported using secure messaging, up from 40.70% in 2013. The percentage of US residents who reported sending an email to their clinician, however, only increased from 7.22% to 16.67% between 2013 and 2018. We observed a strong positive association between certified health IT use and secure messaging use (odds ratio [OR] 11.46, 95% CI 7.55-17.39). Individuals who were black, had lower levels of education, had Medicaid or other public payer insurance, or those who were uninsured had reduced odds for using email to communicate with clinicians. No differences were observed in secure messaging use based on physician specialty, but significant differences were observed by practice size (OR 0.46, 95% CI 0.35-0.60 in solo practices vs nonsolo practices) and practice ownership (P<.001 for the different categories). Conclusions: This study is the first to use two large nationally representative surveys to produce longitudinal estimates on the access and use of patient-clinician email communication in the United States. The survey findings complement each other: one provides the patient perspective of their use and the other indicates potential patient access to secure messaging based on the use of the functionality by the physicians providing treatment. This study provides nationally representative data on the characteristics of patients and physicians who have access to and are using secure messaging. This information can be used to target interventions to promote adoption and use of secure messaging., quality, providers, care, growth, access, e-mail communication, electronic health records, electronic mail, health communication, The publisher's version of record is availible at https://doi.org/10.2196/12611

: Educational Case; The following fictional case is intended as a learning tool within the Pathology Competencies for Medical Education (PCME), a set of national standards for teaching pathology. These are divided into three basic competencies: Disease Mechanisms and Processes, Organ System Pathology, and Diagnostic Medicine and Therapeutic Pathology. For additional information, and a full list of learning objectives for all three competencies, see .(1), disease, acid-fast bacilli, diagnostic medicine, Kinyoun stain, Lowenstein-Jensen media, microbiology, mycobacteria, mycobacteriology, pathology competencies, tuberculosis, The publisher's version of record is availible at https://doi.org/10.1177/2374289520901827

: Indusem Position Paper On The Emerging Electronic Waste Management Emergency; Electronic waste or e-waste is a serious and concerning issue globally. Exponential increase in the production of these instrument have created a man-made problem of e-waste; United Nations has called it as "tsunami of e-waste." Informal management and unsafe disposals have compounded the problem further. The hazardous chemicals, metals, and organic pollutants released from e-waste can lead to serious health consequences such as organ damage, genetic defects, neuropsychiatric illness, and cancer. Problem of e-waste is colossal and should be seen as major public health emergency. In India, use of electronic instrument has increased considerably with less focus on formal waste management and safe disposal. This has created a major health hazard. International health agencies, Indian Council of Medical Research, e-waste regulating bodies, academic institutes, and various government and non-government organizations should join hands together to effectively manage the problems of e-waste. Swacch Bharat Abhiyan started by the honorable Prime Minster should consider e-waste as the top most priority in terms of its safe management and disposal., health, risk, metals, soil, lead, Electronic waste, health hazard, recycling, recycling area, research, waste management, The publisher's version of record is availible at https://doi.org/10.4103/JETS.JETS_139_19

: Internal Medicine Residency Program

: Maguire Medical Library

: PLAID

: Program in Neuroscience

: Safer Roads To School; Any and all advances made by medical science cannot solve the problem of road traffic injuries (RTIs) in school-going children, especially if the only concerned people are those of the medical fraternity. Children are a vulnerable part of the traveling population and thus have been persistent due to the callous nature of the citizens and policy makers toward road safety and injury prevention. In our multicultural and multilingual country, there is a need for multistakeholder initiative with a countrywide presence if we are to stem the rise of mortality and morbidity due to these accidents. The first question we need to ask is how to prevent road traffic accidents and improve the condition of our roads. Pediatric RTIs are eternal problem of industrial revolution with complications and effects that may affect individual and society with increase in the number of motorized communications. Dedicated capacity building is urgently need who should be able to provide the necessary care to the injured children at the road crash spot as well as should be informed where to take the injured child and whom to contact in the dedicated injury care center while transporting the victims of situations., adolescents, interventions, young-children, trauma, epidemiology, trends, biomechanics, brain-injury, cervical-spine, Pediatric, pediatric head-injury, pediatric trauma, road safety, road traffic accidents, school-aged children, traumatic brain injury, The publisher's version of record is availible at https://doi.org/10.4103/JETS.JETS_71_19

: Sex Differences in Effects of Ketamine on Behavior, Spine Density, and Synaptic Proteins in Socially Isolated Rats.; The mechanistic underpinnings of sex differences in occurrence of depression and efficacy of antidepressant treatments are poorly understood. We examined the effects of isolation stress (IS) and the fast-acting antidepressant ketamine on anhedonia and depression-like behavior, spine density, and synaptic proteins in male and female rats. We used a chronic social IS paradigm to test the effects of ketamine (0, 2.5 mg/kg, and 5 mg/kg) on behavior and levels of synaptic proteins synapsin-1, postsynaptic density protein 95, and glutamate receptor 1 in male rats and female rats in diestrus. Medial prefrontal cortex spine density was also examined in male rats and female rats that received ketamine during either the diestrus or the proestrus phase of their estrous cycle. Male rats showed anhedonia and depression-like behavior after 8 weeks of IS, concomitant with decreases in spine density and levels of synapsin-1, postsynaptic density protein 95, and glutamate receptor 1 in the medial prefrontal cortex; these changes were reversed by a single injection of ketamine (5 mg/kg). After 11 weeks of IS, female rats showed depression-like behavior but no signs of anhedonia. Although both doses of ketamine rescued depression-like behavior in female rats, the decline observed in synaptic proteins and spine density in IS and in diestrus female rats could not be reversed by ketamine. Spine density was higher in female rats during proestrus than in diestrus. Our findings implicate a role for synaptic proteins synapsin-1, postsynaptic density protein 95, and glutamate receptor 1 and medial prefrontal cortex spine density in the antidepressant effects of ketamine in male rats subjected to IS but not in female rats subjected to IS, suggesting dissimilar underlying mechanisms for efficacy of ketamine in the two sexes., Keywords: Anhedonia, Depression, Ketamine, Sex difference, Social isolation, MPFC, Grant Number: R01 MH087583, R01 MH099085, Publication Note: This NIH-funded author manuscript originally appeared in PubMed Central at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4940294.

: Studying The Clinical Data Of Covid Positive Patients Admitted To A Tertiary Care Academic Hospital; Background: As the time this data was studied in Florida, USA was expecting a surge in number of COVID patients. We are hereby presenting analysis of clinical data collected from the first 30 COVID positive patients admitted to our teaching hospital in Sarasota Florida. Methods: The present study was conducted at a not-for-profit 839-bed level-2 regional trauma center, level-3 neurointensive intensive care unit (ICU), and comprehensive stroke and cardiovascular center located on Florida's Central Gulf Coast. It was a single-center, retrospective review of the first 30 patients with reverse transcriptase-polymerase chain reaction confirmed 2019-nCoV infection between March and April 2020. Deidentified patient demographic data, abnormal admission laboratory and radiology findings, treatment medications received, need for mechanical ventilation, complications, and final outcome were recorded. Results: A total of 30 patients were included who were admitted during the study period. Majority of the patients (86%) were elderly, males were 57%, and the average age was 70 years (range, 38-90). About 43% had any travel history outside the region and most (83%) had a comorbidity. Fever, cough, and shortness of breath were common presenting symptoms. About 33% of the patients required ICU at presentation. Abnormal imaging on presentation was present in 80% of the patients and 42% of them had nonspecific bilateral opacities. Complications seen included acute hypoxic respiratory failure (43%), renal failure (13%), septic shock (10%), cytokine storm (3%), and cardiomyopathy (3%). All nonsurvivors developed acute respiratory distress syndrome prior to death. Of the survivors, 21 (70%) were relieved and were discharged. Conclusion: The most common presenting symptoms included fever, cough, and shortness of breath. Patients who required ICU admission at presentation had a worse prognosis. Those with greater severity of symptoms were mainly elderly patients among which the most common comorbidity was hypertention followed by cardiac disease., covid, geriatric, geriatric population, wuhan, The publisher's version of record is availible at https://doi.org/10.4103/JETS.JETS_67_20

: Understanding Factors Leading To Primary Cesarean Section And Vaginal Birth After Cesarean Delivery In The Friuli-venezia Giulia Region (north-eastern Italy), 2005-2015; Although there is no evidence that elevated rates of cesarean sections (CS) translate into reduced maternal/child perinatal morbidity or mortality, CS have been increasingly overused almost everywhere, both in high and low-income countries. The primary cesarean section (PCS) has become a major driver of the overall CS (OCS) rate, since it carries intrinsic risk of repeat CS (RCS) in future pregnancies. In our study we examined patterns of PCS, pl compared with planned TO LAC anned PCS (PPCS), vaginal birth after 1 previous CS (VBAC-1) and associated factors in Friuli Venezia Giulia (FVG), a region of North-Eastern Italy, collecting data from its 11 maternity centres (coded from A to K) during 2005-2015. By fitting three multiple logistic regression models (one for each delivery mode), we calculated the adjusted rates of PCS and PPCS among women without history of CS, whilst the calculation of the VBAC rate was restricted to women with just one previous CS (VBAC-1). Results, expressed as odds ratio (OR) with 95% confidence interval (95%CI), were controlled for the effect of hospital, calendar year as well as several factors related to the clinical and obstetric conditions of the mothers and the newborn, the obstetric history and socio-demographic background. In FVG during 2005-2015 there were 24,467 OCS (rate of 24.2%), 19,565 PCS (19.6%), 7,736 PPCS (7.7%) and 2,303 VBAC-1 (28.4%). We found high variability of delivery mode (DM) at hospital level, especially for PCS and PPCS. Breech presentation was the strongest determinant for PCS as well as PPCS. Leaving aside placenta previa/abuptio placenta/ante-partum hemorrhage, further significant factors, more importantly associated with PCS than PPCS were non-reassuring fetal status and obstructed labour, followed by (in order of statistical significance): multiple birth; eclampsia/pre-eclampsia; maternal age 40-44 years; placental weight 600-99 g; oligohydramios; pre-delivery LoS 3-5 days; maternal age 35-39 years; placenta weight 1,000-1,500 g; birthweight < 2,000 g; maternal age >= 45 years; pre-delivery LoS >= 6 days; mother's age 30-34 years; low birthweight (2,000-2,500 g); polyhydramnions; cord prolaspe; >= 6 US scas performed during pregnancy and pre-term gestations (33-36 weeks). Significant factors for PPCS were (in order of statistical significance): breech presentation; placenta previa/abruptio placenta/ante-partum haemorrhage; multiple birth; pre-delivery LoS >= 3 days; placental weight >= 600 g; maternal age 40-44 years; >= 6 US scans performed in pregnancy; maternal age >= 45 and 35-39 years; oligohydramnios; eclampsia/pre-eclampsia; mother's age 30-34 years; birthweight, outcomes, labor, women, trial, maternal morbidity, mode, multiple, placenta-accreta, uterine rupture, vbac, The publisher's version of record is availible at https://doi.org/10.1038/s41598-019-57037-y

: Zika Virus Infects Human Cortical Neural Progenitors and Attenuates Their Growth.; The suspected link between infection by Zika virus (ZIKV), a re-emerging flavivirus, and microcephaly is an urgent global health concern. The direct target cells of ZIKV in the developing human fetus are not clear. Here we show that a strain of the ZIKV, MR766, serially passaged in monkey and mosquito cells efficiently infects human neural progenitor cells (hNPCs) derived from induced pluripotent stem cells. Infected hNPCs further release infectious ZIKV particles. Importantly, ZIKV infection increases cell death and dysregulates cell-cycle progression, resulting in attenuated hNPC growth. Global gene expression analysis of infected hNPCs reveals transcriptional dysregulation, notably of cell-cycle-related pathways. Our results identify hNPCs as a direct ZIKV target. In addition, we establish a tractable experimental model system to investigate the impact and mechanism of ZIKV on human brain development and provide a platform to screen therapeutic compounds., Grant Number: R37 NS047344, R21 AI111250, R21 NS095348, R21 AI119530, R56 NS047344, R01 NS048271, R01 NS047344, R01 MH102690, Publication Note: This NIH-funded author manuscript originally appeared in PubMed Central at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5299540.

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