Using Wearable Biosensors to Predict Length of Stay for Patients with IBD After Bowel Surgery

Digestive Diseases and Sciences - It remains unknown whether ambulation or sleep predicts postoperative length of stay for patients with IBD. We aim to identify the utility of wearable biosensors...     

Clinical effects of antiplatelet drugs and statins on D‐dimer levels

Background

Acute pulmonary embolism may be ruled out by combining nonhigh clinical probability and a normal D‐dimer level. Both antiplatelet drugs and HMG‐CoA reductase inhibitors (statins) have been associated with effects on thrombus formation, potentially influencing D‐dimer levels in this setting, leading to a higher rate of false‐negative tests. Therefore, we determined whether D‐dimer levels in patients with suspected pulmonary embolism are affected by concomitant use of antiplatelet drugs and/or statins and evaluated whether the effect of antiplatelet drugs or statins might affect diagnostic accuracy.

Materials and methods

We performed a posthoc analysis in the YEARS diagnostic study, comparing age‐ and sex‐adjusted D‐dimer levels among users of antiplatelet drugs, statins and nonusers. We then reclassified patients within the YEARS algorithm by developing a model in which we adjusted D‐dimer cut‐offs for statin use and evaluated diagnostic accuracy.

Results

We included 156 statins users, 147 antiplatelet drugs users and 726 nonusers of either drugs, all with suspected pulmonary embolism . Use of antiplatelet drugs did not have a significant effect, whereas statin use was associated with 15% decrease in D‐dimer levels (95% CI, ?28% to ?0.6%). An algorithm with lower D‐dimer thresholds in statin users yielded lower specificity (0.42 compared to 0.33) with no difference in false‐negative tests.

Conclusions

We conclude that use of statins but not of antiplatelet agents is associated with a modest decrease in D‐dimer levels. Adjusting D‐dimer cut‐offs for statin use did, however, not result in a safer diagnostic strategy in our cohort.

     

Maternal inheritance of familial hypercholesterolemia caused by the V408M low-density lipoprotein receptor mutation increases mortality

Objective

Fetal exposure to maternal hypercholesterolemia increases the extent of fatty-streak formation in fetal aortas as well as the rate of progression, and may therefore increase coronary heart disease (CHD) risk later in life. We hypothesized that the risk of CHD in untreated individuals with familial hypercholesterolemia (FH) is more extreme when the disease is transmitted maternally.

Methods

In a large Dutch pedigree carrying the V408M mutation in the low-density lipoprotein (LDL) receptor gene, 161 individuals over seven generations were identified for which FH status and parent of origin of FH were known. We calculated standardized mortality ratios (SMR) and compared the consequences of maternal and paternal inheritance of FH by Poisson regression analysis.

Results

Maternally inherited FH was associated with significantly higher excess mortality than FH transmitted by fathers (relative risk 2.2; p = 0.048): the SMR of maternal inheritance was 2.49 (95% confidence interval (CI) 1.45–3.99; p = 0.001), whereas it was not significantly increased in paternally inherited FH (SMR 1.30, 95% CI 0.65–2.32; p = 0.234).

Conclusion

Mortality rates are more increased when FH is inherited through the mother, supporting the fetal origin of adulthood disease hypothesis with all cause death, the most indisputable outcome measure. Future research should explore safe options for cholesterol-lowering therapy of pregnant women with FH in order to prevent unfavourable (epigenetic) consequences leading to atherosclerosis in their children.     

fMRI item analysis in a theory of mind task

Conventional analyses of functional magnetic resonance imaging (fMRI) data compare the brain's response to stimulus categories (e.g., pictures of faces, stories about beliefs) across participants. In order to infer that effects observed with the specific items (a particular set of pictures or stories) are generalizable to the entire population (all faces, or all stories about beliefs), it is necessary to perform an "item analysis." Item analyses may also reveal relationships between secondary (non-hypothesized) features of the items and functional activity. Here, we perform an item analysis on a set of stories commonly used for localizing brain regions putatively involved in Theory of Mind (ToM): right and left temporo-parietal junction (RTPJ/LTPJ), precuneus (PC), superior temporal sulcus (STS) and medial prefrontal cortex (MPFC). We address the following questions: Do brain regions that comprise the ToM network respond reliably across items (i.e. different stories about beliefs)? Do these brain regions demonstrate reliable preferences for items within the category? Can we predict any region's response to individual items, by using other features of the stimuli? We find that the ToM network responds reliably to stories about beliefs, generalizing across items as well as subjects. In addition, several regions in the ToM network have reliable preferences for individual items. Linguistic features of the stimuli did not predict these item preferences.     

Providers’ Note-Writing Practices for Post-traumatic Stress Disorder at Five United States Veterans Affairs Facilities

The capacity of electronic health records (EHRs) to capture desired information depends on the practices of health care providers. These practices have not been well studied in relation to post-traumatic stress disorder (PTSD). This qualitative study investigated how providers write EHR notes on PTSD through 38 interviews with providers working at five Veterans Affairs (VA) hospitals across the United States of America. Two overarching themes were prominent in the results. Providers used progress notes primarily to remember and access details for direct patient care, but only rarely for care coordination. Providers infrequently recorded information not judged to directly contribute to improved care, sometimes deliberately omitting information perceived to jeopardize patients’ access to, or quality of, care. Omitted information frequently included sexual or non-military trauma. Understanding providers’ thought processes can help clinicians be aware of the limitations of EHR notes as a tool for learning the histories of new patients. Similarly, researchers relying on EHR data for PTSD research should be aware of likely areas of missing data.     

Mothers', fathers', and children's perceptions of parental diabetes responsibility in adolescence: examining the roles of age, pubertal status, and efficacy

Objectives To examine how perceptions of parental responsibilityfor diabetes management are associated with age, pubertal status,adolescents’ self-efficacy, and parental perceptions ofadolescents’ efficacy, and if parental responsibilityis associated with better metabolic control as a function ofadolescents’ self-efficacy and parental perceptions ofadolescents’ efficacy. Methods Questionnairesassessing parental responsibility, pubertal status, adolescents’self-efficacy, and parental perceptions of adolescents’efficacy were given to 185 adolescents with type 1 diabetes,185 mothers, and 145 fathers. Results Greater parentalresponsibility was negatively associated with age, perceptionsof pubertal status, and efficacy for all reporters. Interactionsbetween parental responsibility and parental perceptions ofadolescents’ efficacy indicated that parental responsibilitywas associated with better metabolic control when adolescentswere perceived to have lower efficacy. Conclusions Adolescents’and parents’ perceptions of parental responsibility arerelated to multiple factors. Metabolic control is best whenhigh parental responsibility is maintained among adolescentswith lower efficacy.