Are Medicare's Nursing Home Compare Ratings Accurate Predictors of 90-Day Complications,Readmission, and Bundle Cost for Patients Undergoing Primary Total Joint Arthroplasty?

Background

Nursing Home Compare (NHC) ratings, created and maintained by Medicare, are used by both hospitals and consumers to aid in the skilled nursing facility (SNF) selection process. To date, no studies have linked NHC ratings to actual episode-based outcomes. The purpose of this study was to evaluate whether NHC ratings are valid predictors of 90-day complications, readmission, and bundle costs for patients discharged to an SNF after primary total joint arthroplasty (TJA).

Sympathetic stimulation with norepinephrine may come at a cost

<正>Norepinephrine (NE; also known as noradrenaline) is the body's primary adrenergic neurotransmitter which belongs to the catecholamine family. Norepinephrine has pharmacologic effects on theα1 (Suita et al.,2015),α2 (Schwartz,1997),β1,β2 andβ3(Tsukada et al., 2003) adrenoceptors. In the brain, norepinephrine increases arousal and alertness, promotes vigilance, enhances formation and retrieval of memory, and focuses attention. It also increases restlessness and anxiety. In the remainder of the body,     

Total bilirubin trend as a predictor of common bile duct stones in acute cholecystitis and symptomatic cholelithiasis

Background

We hypothesized that trends in total bilirubin in the context of cholecystitis and symptomatic cholelithiasis could be used to guide testing for the presence of common bile duct stones (CBDS).

Associations of metabolically healthy obesity with prevalence and progression of coronary artery calcification: Results from the Heinz Nixdorf Recall Cohort Study

Background and aims

There is controversy on the potentially benign nature of metabolically healthy obesity (MHO), i.e., obese persons with few or no metabolic abnormalities. So far, associations between MHO and coronary artery calcification (CAC), a measure of subclinical atherosclerosis, have mainly been studied cross-sectionally in Asian populations. We assessed cross-sectional and longitudinal MHO CAC associations in a Caucasian population.

Inpatient Versus Outpatient Arthroplasty: A Single-Surgeon,Matched Cohort Analysis of 90-Day Complications

Background

Although some prior work supports the safety of same-day arthroplasty performed in a hospital, concerns remain when these procedures are performed in a free-standing ambulatory surgery center. The purpose of this study is to compare 90-day complication rates between matched cohorts that underwent inpatient vs outpatient arthroplasty at an ambulatory surgery center.

Influence of Prior Psychiatric Disorders on the Treatment Course of Gynaecological Cancer – A Nationwide Cohort Study

Aims

To examine the influence of pre-existing psychiatric disorder on the choice of treatment in patients with gynaecological cancer.

Transmissible vaccines whose dissemination rates vary through time,with applications to wildlife

Transmission is a potential property of live viral vaccines that remains largely unexploited but may lie within the realm of many engineering designs. While likely unacceptable for vaccines of humans, transmission may be highly desirable for vaccines of wildlife, both to protect natural populations and also to limit zoonotic transmissions into humans. Defying intuition, transmission alone does not guarantee that a vaccine will perform well: the benefit of transmission over no transmission depends on and increases with the basic reproductive number of the vaccine, $R_0$. The $R_0$ of an infectious agent in a homogeneous population is typically considered to be a fixed number, but some evidence suggests that dissemination of transmissible vaccines may change through time. One obvious possibility is that transmission will be greater from hosts directly vaccinated than from hosts who acquire the vaccine passively, but other types of change might also accrue. Whenever transmission changes over time, the $R_0$ estimated from directly vaccinated hosts will not reflect the vaccine’s long term impact. As there is no theory on the consequences of changing transmission rates for a vaccine, we derive conditions for a transmissible vaccine with varying transmission rates to protect a population from pathogen invasion. Being the first in the transmission chain, the $R_0$ from directly vaccinated hosts has a larger effect than those from later steps in the chain. This mathematical property reveals that a transmissible vaccine with low long term transmission may nonetheless realize a big impact if early transmission is high. Furthermore, there may be ways to artificially elevate early transmission, thereby achieving high herd immunity from transmission while ensuring that the vaccine will ultimately die out.     

Effects of Mu-Opiate Receptor Gene Polymorphism rs1799971 (A118G) on the Antidepressant and Dissociation Responses in Esketamine Nasal Spray Clinical Trials

BackgroundAt ketamine and esketamine doses at which antidepressant doses are achieved, these agents are relatively selective, noncompetitive, N-methyl-D-aspartate receptor antagonists. However, at substantially higher doses, ketamine has shown mu-opioid receptor (MOR–gene symbol: OPRM1) agonist effects. Preliminary clinical studies showed conflicting results on whether naltrexone, a MOR antagonist, blocks the antidepressant action of ketamine. We examined drug-induced or endogenous MOR involvement in the antidepressant and dissociative responses to esketamine by assessing the effects of a functional single nucleotide polymorphism rs1799971 (A118G) of OPRM1, which is known to alter MOR agonist-mediated responses.MethodsParticipants with treatment-resistant depression from 2 phase III, double-blind, controlled trials of esketamine (or placebo) nasal spray plus an oral antidepressant were genotyped for rs1799971. Participants received the experimental agents twice weekly for 4 weeks. Antidepressant responses were rated using the change in Montgomery–Åsberg Depression Rating Scale (MADRS) score on days 2 and 28 post-dose initiation, and dissociative side effects were assessed using the Clinician-Administered Dissociative-States Scale at 40 minutes post-dose on days 1 and 25.ResultsIn the esketamine + antidepressant arm, no significant genotype effect of single nucleotide polymorphism rs1799971 (A118G) on MADRS score reductions was detected on either day 2 or 28. By contrast, in the antidepressant + placebo arm, there was a significant genotype effect on MADRS score reductions on day 2 and a nonsignificant trend on day 28 towards an improvement in depression symptoms in G-allele carriers. No significant genotype effects on dissociative responses were detected.ConclusionsVariation in rs1799971 (A118G) did not affect the antidepressant response to esketamine + antidepressant. Antidepressant response to antidepressant + placebo was increased in G-allele carriers, compatible with previous reports that release of endorphins/enkephalins may play a role in mediating placebo effect.Trial Registration{"type":"clinical-trial","attrs":{"text":"NCT02417064","term_id":"NCT02417064"}}NCT02417064 and {"type":"clinical-trial","attrs":{"text":"NCT02418585","term_id":"NCT02418585"}}NCT02418585; www.clinicaltrials.gov     

Long-term Implications of Tracheostomy in Cardiac Surgery Patients: Decannulation and Mortality

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