The cost of quality in health care.

The potential fiscal impact of improved quality on health care providers and organizations is substantial. In this era of dwindling health care resources, proposals that may limit cost increases while improving quality represent true win-win situations. There is a need for a substantial amount of health care research in this fertile area of quality improvement.     

The Evaluation and Management of Persistent Nocturia

Nocturia, or waking at night to void, is a common symptom that leads to substantial morbidity. Men and women are both affected across a wide age range, such that the objective evaluation of nocturia remains a challenge, due largely to its multifactorial etiology. While for some patients, nocturia is caused by common structural conditions such as prostatic obstruction, for others it is due to a complex interplay between multiple underlying systemic diseases. For this reason, persistent nocturia merits particularly careful consideration. The purpose of this review is to describe the most recent salient research in the field of nocturia, with a particular emphasis on its evaluation and management.     

Predictive validity of the HCR-20V3 in a sample of Australian forensic psychiatric patients

The Historical Clinical Risk Management-20 Version 3 is the latest iteration in the HCR-20 series, adopting novel changes such as the addition of Relevance ratings and non-requirement to include the Psychopathy Checklist–Revised. This study aimed to examine these changes and compare the predictive validity of the HCR-20^V3 to the HCR-20^V2. The sample comprised of 100 forensic psychiatric patients, retrospectively followed up for a maximum period of approximately 13 years post-discharge from the Thomas Embling Hospital. Recidivism data were sourced from official police records. Results indicated good to excellent inter-rater reliability. The HCR-20^V3 significantly predicted violent recidivism (area under the curve = .70 to .77), levels of accuracy that were not significantly different from the HCR-20^V2. HCR-20^V3 Relevance ratings failed to add incremental validity above Presence ratings; however, the PCL–R improved upon the HCR-20^V3’s validity. The study represented one of the first evaluations of the HCR-20^V3 in Australia.     

Temporal and venepuncture-related decline in circulating endothelial cell capture from mixed venous blood

Background: The quantification of circulating endothelial cells (CECs) in whole blood has evolved as a novel method for the assessment of endothelial function, although major methodological issues remain. We hypothesized that there is a temporal decline in CEC counts in static venesected blood and that venepuncture itself may lead to increased CEC detachment. Methods: CEC isolation was performed using the immunobead method. For the temporal decline experiment, we included 52 patients presenting with acute coronary syndrome (ACS). We performed CEC counts immediately and at 4 and 24 h later. For the venepuncture decline experiment, we studied 40 patients with stable cardiovascular disease (CVD). CEC counts were determined from the first 4 mL of aspirated venous blood and compared with counts obtained from a subsequent 4 mL sample of blood after at least 7.5 mL of blood had been collected. Results: Among the ACS patients there was a significant temporal decline in CEC counts in static venous blood over a 24 h period (p = 0.013). Among the patients with stable CVD, the median CEC counts obtained from the initial 4 mL of aspirated venous blood were significantly higher (by 32%) than that obtained from the later 4 mL of aspirated venous blood (p = 0.041). Conclusions: We demonstrated a significant temporal fall in CEC numbers in static venous blood over 24 h following venesection. Furthermore, we have shown that CEC counts are higher in the initial aspirated blood compared with that aspirated from the same needle subsequently. These data would have implications for how CEC determination is undertaken by researchers in studies related to ACS or CVD.     

The anatomy of the subscapularis tendon insertion as applied to rotator cuff repair

The tendons constituting the rotator cuff (RC) are often torn, and several techniques for their repair have been established. The existence of an extension of the supraspinatus tendon into that of the subscapularis has often been overlooked. The purpose of this study was to study this extension in human dissections. The possible posterolateral extension of the subscapularis tendon and the interdigitating of this extension with the supraspinatus tendon were addressed. A horizontal band of tissue 1 cm below the superior ridge of the greater tuberosity of the humerus was harvested from 43 cadavers and thus included tissue constituting the greater tuberosity, bicipital groove, and lesser tuberosity. The sample extended 2 cm medially along the lesser tuberosity and 1 cm laterally along the greater tuberosity. Macroscopic findings suggest a continuous band of tissue extending across the bicipital groove. High collagen content was microscopically confirmed at different sections, and the collagen was densely distributed along the horizontal axis of the tissue samples.     

DNA banking for epidemiologic studies: a review of current practices

To study genetic risk factors for common diseases, researchers have begun collecting DNA specimens in large epidemiologic studies and surveys. However, little information is available to guide researchers in selecting the most appropriate specimens. In an effort to gather the best information for the selection of specimens for these studies, we convened a meeting of scientists engaged in DNA banking for large epidemiologic studies. In this discussion, we review the information presented at that meeting in the context of recent published information. Factors to be considered in choosing the appropriate specimens for epidemiologic studies include quality and quantity of DNA, convenience of collection and storage, cost, and ability to accommodate future needs for genotyping. We focus on four types of specimens that are stored in these banks: (1) whole blood preserved as dried blood spots; (2) whole blood from which genomic DNA is isolated, (3) immortalized lymphocytes from whole blood or separated lymphocytes, prepared immediately or subsequent to cryopreservation; and (4) buccal epithelial cells. Each of the specimens discussed is useful for epidemiologic studies according to specific needs, which we enumerate in our conclusions.     

Virulence of a Bordetella pertussis strain expressing a mutant adenylyl cyclase with decreased calmodulin affinity

Bordetella pertussis, the pathogen responsible for whooping cough, produces a toxic calmodulin-sensitive adenylyl cyclase which enters animal cells and increases intracellular cAMP. A point mutant of B. pertussis with abolished adenylyl cyclase catalytic activity was over 1000-fold less pathogenic to newborn mice than wild-type bacteria, demonstrating the importance of the adenylyl cyclase for B. pertussis virulence (Gross et al. ). The B. pertussis adenylyl cyclase is highly sensitive to calmodulin with an apparent K_d for calmodulin of approximately 1 nM. The importance of this high-affinity calmodulin binding for virulence in vivo was examined by the creation of a B. pertussis point mutant (Trp-242 to Glu-242) with 200-fold lower calmodulin affinity than the native enzyme. This mutant B. pertussis strain retained its virulence in a newborn mouse model of pertussis, but the time course for establishment of a lethal infection in vivo was significantly delayed for the mutant strain. These data illustrate that high-affinity calmodulin binding is not obligatory for the activity of this toxin but is important for the rate for establishment of a lethal infection.