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October 1st, 2025: An Internist\u27s Guide to Immune Checkpoint Inhibitor Toxicity
No full texthttps://knowledgeconnection.mainehealth.org/medicine_gr/1047/thumbnail.jp
Who is Completing Patient-Reported Outcome Measures following Total Hip Arthroplasty? An Investigation of Completion Characteristics to Inform the Age of Mandatory Reporting Rates.
No full textBACKGROUND: The Centers for Medicare and Medicaid Services has mandated at least 50% institutional compliance of patient-reported outcome-based performance measures (PRO-PMs) for Medicare fee-for-service patients undergoing inpatient, elective total joint arthroplasty. The purpose of this study was to evaluate characteristics of patients undergoing primary total hip arthroplasty to identify risk factors for patient-reported outcome measures (PROMs) noncompletion using the Hip Dysfunction and Osteoarthritis Joint Replacement Outcome Score as a marker PROM.
METHODS: A retrospective review was performed of patients undergoing primary total hip arthroplasty at a single large academic center between January 2013 and August 2020. Demographics, operative variables, hospital outcomes, and PROMs were compared between patients achieving and not achieving PRO-PM requirements and multivariable analysis was performed.
RESULTS: A total of 5691 patients were included; 2547 patients did not complete either PROM, 2201 completed the preoperative PROM within 90 days of surgery, and 943 completed the PROM preoperatively and at 365 ± 60 days postoperatively. Demographics and outcomes between groups varied; patients not completing the PROM more often had a length of stay \u3e48 hours (
CONCLUSIONS: PRO-PM completion is necessary for compliance with the new Centers for Medicare and Medicaid Services mandate. We report on the characteristics of patients completing and not completing a marker PROM as well as risk factors for noncompletion from the era before this mandate, before substantial efforts were undertaken to increase response rate, to provide an organic overview of the patients at risk for noncompletion to guide further initiatives
How Do Youth Interpret Self-Report Questions Screening for Psychosis? Insights From Cognitive Interviewing
No full textINTRODUCTION: Early detection of psychosis can facilitate earlier intervention and improve mental health outcomes. However, self-report screens probing specific and non-specific experiences related to psychosis and psychosis risk can yield high rates of false positive screens. We conducted cognitive interviews with youth who had completed a self-report psychosis screen to explore item misunderstanding as a reason for these false positives. METHODS: We interviewed 13 racially and ethnically diverse patients ages 14-21 from an urban adolescent and young adult medicine clinic. Master\u27s-level clinicians asked participants to rate the degree to which they thought they understood each item and to describe the item in their own words. Two independent raters used deductive coding to rate participant understanding and inductive coding to identify types of understanding and misunderstanding. RESULTS: Participants had high confidence that they understood the items (mean of 8.1 out of 10) but were rated as understanding items as intended only 42% of the time. Two major types of misunderstanding were identified: (1) as a non-psychotic mental health experience and (2) as a developmentally or contextually normative experience. CONCLUSION: Our results identify sources of misunderstanding that may lead youth to falsely endorse self-reported psychosis screening items. Unless or until items are known to be well-understood, it is imperative that positive screens receive clinical follow-up to explore the responses in light of each person\u27s medical, developmental and social context. Future research is needed to improve item wording for readability and clarity and to test strategies for minimising risk of false positive screening results
Early Ambulation in Post-Operative Medical-Surgical Patients
No full textIn adult post-operative patients on a medical surgical floor, does initiating early ambulation during the night shift, compared with delaying ambulation until daytime, lead to improved recovery outcomes such as reduced postoperative complications or shortened?https://knowledgeconnection.mainehealth.org/nurseresidency/1148/thumbnail.jp
\u3ci\u3eBartonella\u3c/i\u3e Endocarditis Unmasking Heart Failure, Nephrotic Syndrome, and Pancytopenia in Repaired Tetralogy of Fallot: A Case Report
No full textIntroduction: Bartonella species are notable causes of culture-negative endocarditis, particularly in patients with prosthetic valves or congenital heart disease. These infections can present insidiously, mimicking other systemic illnesses and posing considerable diagnostic challenges due to their fastidious nature.
Clinical Findings: A person in their 30’s with repaired tetralogy of Fallot and a Melody pulmonary valve presented with acute biventricular heart failure, nephrotic-range proteinuria, and pancytopenia. Initial assessments suggested cardiorenal syndrome. Despite negative routine cultures, persistent renal abnormalities and hypocomplementemia raised suspicion for glomerulonephritis. Subsequent polymerase chain reaction analysis of blood returned positive for Bartonella henselae, and positron emission tomography-computed tomography revealed focal uptake at the Melody valve, confirming prosthetic valve endocarditis.
Clinical Course: The patient received aggressive diuresis, targeted antibiotic therapy with intravenous doxycycline and rifampin (later changed to ceftriaxone due to hepatoxicity) and multidisciplinary supportive care for multisystem organ dysfunction. Despite showing some clinical improvement over 32 days of hospitalization, the patient elected for self-directed discharge.
Conclusions: This case illustrates the diagnostic difficulty of Bartonella endocarditis when it manifests with a complex triad of heart failure, nephrotic syndrome, and pancytopenia. The presentation can delay diagnosis by mimicking non-infectious systemic disorders. The utility of specific molecular diagnostics and advanced imaging is crucial in such culture-negative scenarios. Bartonella infection warrants consideration in patients with prosthetic cardiac materials who develop unexplained multisystem dysfunction
American Society of Hematology 2025 guidelines for treating newly diagnosed acute myeloid leukemia in older adults
No full textOlder adults with acute myeloid leukemia (AML) represent a cancer population in whom disease-based risk factors, comorbidities, patient goals, and treatment risks and benefits influence treatment recommendations. These evidence-based guidelines from the American Society of Hematology (ASH) are intended to support patients, clinicians and other health professionals in their decisions about management of AML in older adults. ASH formed a multidisciplinary guideline panel, including patient representatives, that minimized bias from conflicts of interest. Clarity Research Group at McMaster University supported the guideline development process, including updating or performing systematic evidence reviews. The panel prioritized questions and outcomes according to their importance for clinicians and patients. The panel used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach, including Evidence-to-Decision frameworks, to assess evidence and make recommendations. The panel agreed on 9 critical clinical recommendations for managing AML in older adults, mirroring real-time practitioner-patient conversations: the decision to pursue antileukemic treatment vs. best supportive management; traditional induction and post-remission therapy vs. hypomethylating agent or low-dose cytarabine, or combinations with venetoclax; the role and duration of post-remission therapy; combinations with venetoclax vs. monotherapy; the use of targeted therapy, including IDH and FLT3 inhibitors, in appropriate patients; the role of hematopoietic stem cell transplantation in non-favorable prognosis AML; and the role of transfusion support for patients no longer receiving antileukemic therapy. Key recommendations of these guidelines include treatment over best supportive care; venetoclax-based regimens over monotherapies; and incorporation of FLT3 inhibitors into traditional induction and post-remission therapy
Retinoic acid promotes expression of inflammatory factors in proliferative adult human heart cells
No full textRetinoid signaling is increased in the hearts of patients with coronary artery disease and during acute myocardial infarction (MI). The effects of retinoids on cardiac repair after injury remain incompletely understood. Our laboratory has derived proliferative cardiac cell clones from adult human left ventricle biopsies and is investigating how these cells might participate in cardiac repair in heart failure. We treated clones isolated from unique individuals with retinoic acid (RA) and performed unbiased proteomics, bioinformatic analyses, and targeted follow-up experiments to identify and confirm RA-regulated factors and processes. RA increased the expression of well-known pro-inflammatory proteins including Interleukin-1 (IL1A & B) and inducible cyclooxygenase COX2, while decreasing expression of extracellular matrix (ECM) factors such as Thrombospondin 1 and collagens. Additionally, we found that basal expression of retinoid metabolizing enzymes (e.g., ALDH1A3) significantly correlated with expression of cytokines and inflammatory mediators including IL1A/B and COX2 across clones from different donors. Secretion of IL1B by clones was found to respond to physiological and pharmacological doses of RA, and monocyte migration in vitro responded to secretions from RA-treated clones. Our findings suggest a mechanism by which retinoids promote inflammation and contribute to adverse cardiac remodeling in the injured heart, providing a potential avenue to regulate myocardial inflammation and remodeling processes
Confronting nihilism and stigma in lung cancer: The nurse practitioner\u27s role in restoring hope and trust
No full textLung cancer remains the leading cause of cancer-related mortality in the United States, yet profound advances in screening, diagnosis, treatment, and survivorship have redefined what is possible for patients. Despite this progress, nihilism, fatalism, and stigma continue to shape public and professional perceptions, discouraging screening and delaying help-seeking. Nurse practitioners occupy a central and trusted position across the lung cancer continuum and are uniquely equipped to counter these barriers through compassionate, stigma-informed communication. This perspective article synthesizes current evidence to illuminate how nurse practitioners can translate empathy, equity, and behavioral science into tangible practice actions that reduce stigma and nihilism and instill compassion and hope. Key strengths-language, empathy, tobacco treatment integration, social context awareness, community engagement, and hope-form the Permission to Hope framework. By leveraging these strengths, nurse practitioners can transform everyday interactions into opportunities to rebuild trust, improve screening participation, and redefine what survivorship means in lung cancer care
