23834 research outputs found
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Virtual patient-PCP-hospitalist care transition meeting before hospital discharge
Full text linkIMPORTANCE: The fragmented health care system presents significant challenges to promoting trust with hospitalized patients.
OBJECTIVE: To test the feasibility and perceptions of a digital connection tool for communication among patients, hospitalists, and primary care practitioners (PCPs).
DESIGN, SETTING, AND PARTICIPANTS: This quality improvement study was conducted as a feasibility pilot study from September 2022 to June 2023 on medical floors across 3 hospitals. Participants included adult inpatients, the hospitalists who managed their care, and the patients\u27 PCPs. Data were analyzed from September 2023 to April 2025.
EXPOSURE: Structured, video-mediated interaction among the patient, family caregiver (if available), hospitalist, and PCP, conducted before discharge.
MAIN OUTCOMES AND MEASURES: Outcomes of interest were patient perceptions, assessed using the Consultation and Relational Empathy (CARE) measure. Open-ended question sought patients\u27 feedback. Hospitalists\u27 and PCPs\u27 perceptions were evaluated using Acceptability of Intervention Measure (AIM), Intervention Appropriateness Measure (IAM), and Feasibility of Intervention Measure (FIM) surveys.
RESULTS: The study sample included 106 participants (mean [SD] age, 63.2 [14.9] years; 55 [51.9%] male). Bedside video meetings were a mean (SD) of 8 (2.8) minutes. Overall score for CARE questions showed a significant improvement, increasing from 40.9 (95% CI, 39.5-42.2) to 47.5 (95% CI, 46.5-48.5) (P \u3c .001). Of clinicians, 50 of 95 PCPs (52.6%) and 42 of 56 hospitalists (75.0%) completed surveys. PCPs reported more positive perceptions than hospitalists regarding acceptability (4.1 [95% CI, 3.90-4.38] vs 3.6 [95% CI, 3.34-3.84]; P = .006) and appropriateness (4.1 [95% CI, 3.86-4.35] vs 3.7 [95% CI, 3.41-3.94]; P = .03). Qualitative feedback highlighted improved information sharing, communication, and collaborative discharge planning. Patients felt more cared for and were more confident about follow-up steps.
CONCLUSIONS AND RELEVANCE: Findings of this quality improvement study highlighted the value of patient-hospitalist-PCP virtual meetings in addressing gaps in information exchange, increasing patient confidence, and improving clinician perceptions of care coordination. These results supported the feasibility and potential of incorporating such interventions as part of routine discharge procedures. The Centers for Medicare & Medicaid Services could consider incorporating a direct interaction component with hospitalists, patients, and PCPs before hospital discharge into the requirements for Transitional Care Management billing or allow current billing codes to be applied in the hospital setting
Artificial intelligence-assisted compressed sensing CINE enhances the workflow of cardiac magnetic resonance in challenging patients
Full text linkBACKGROUND: A key cardiac magnetic resonance (CMR) challenge is breath-holding duration, difficult for cardiac patients.
AIM: To evaluate whether artificial intelligence-assisted compressed sensing CINE (AI-CS-CINE) reduces image acquisition time of CMR compared to conventional CINE (C-CINE).
METHODS: Cardio-oncology patients (
RESULTS: In 89 participants (58.5 ± 16.8 years, 42 males, 47 females), total AI-CS-CINE acquisition and reconstruction time (37 seconds) was 84% faster than C-CINE (238 seconds). C-CINE required repeats in 23% (20/89) of cases (approximately 8 minutes lost), while AI-CS-CINE only needed one repeat (1%; 2 seconds lost). AI-CS-CINE had slightly lower contrast but preserved structural clarity. Bland-Altman plots and ICC (0.73 ≤
CONCLUSION: AI-CS-CINE accelerated CMR image acquisition and reconstruction, preserved anatomical detail, and diminished impact of patient-related motion. Quantitative AI-CS-CINE metrics agreed closely with C-CINE in cardio-oncology patients, including the cardiac amyloidosis cohort, as well as healthy volunteers regardless of left and right ventricular size and function. AI-CS-CINE significantly enhanced CMR workflow, particularly in challenging cases. The strong analytical concordance underscores reliability and robustness of AI-CS-CINE as a valuable tool
Spatial proteomics of Onchocerca volvulus with pleomorphic neoplasms shows local and systemic dysregulation of protein expression
Full text linkOnchocerca volvulus is the agent of onchocerciasis (river blindness) and targeted by WHO for elimination though mass drug administration with ivermectin. A small percentage of adult female worms develop pleomorphic neoplasms (PN) which occur more frequently after ivermectin treatment. Worms with PN have a lower life expectancy and improved understanding of proteins expressed in PN and their impact on different tissues could help elucidate the mechanisms of macrofilaricidal activity of ivermectin. Within paraffin embedded nodules removed after ivermectin treatment, we detected 24 (5.6%) O. volvulus females with PN. To assess the protein inventory of the PN and identify proteins potentially linked with tumor development, we used laser capture microdissection and highly sensitive mass spectrometry analysis. Three female worms were used to compare the protein profiles of three tissue types (body wall, uterus, and intestine) to the PN, and then to healthy female worms without PN. The healthy females showed all normal embryogenesis. In PN worms, 151 proteins were detected in the body wall, 215 proteins in the intestine, 47 proteins in the uterus and 1,577 proteins in the PN. Only the uterus of one PN female with some stretched intrauterine microfilariae had an elevated number of proteins (601) detectable, while in the uteri of the healthy females 1,710 proteins were detected. Even in tissues that were not directly affected by PN (intestine, body wall), fewer proteins were detected compared to the corresponding tissue of the healthy controls. Immunolocalization of calcium binding protein OvDig-1 (OVOC8391), which was identified through mass spectrometry as one of the proteins with the highest spectral counts in the PN tissue triplicates, allowed us to confirm the results using an independent method. In conclusion we identified proteins that are potentially linked to the development of PN, and systemic dysregulation of protein expression may contribute to worm mortality
Left atrial and ventricular remodeling in chronic mitral regurgitation
Full text linkOBJECTIVE: This study describes the structural and mechanical changes in the left atrium and left ventricle in a canine model of chronic mitral regurgitation in an attempt to identify markers linked to the onset of atrial tachyarrhythmias or left ventricle dysfunction.
METHODS: Animals underwent baseline and terminal echocardiography and cardiac magnetic resonance imaging. Under echocardiographic guidance, chordae tendinae were avulsed until there was severe mitral regurgitation, defined by regurgitant jet area to left atrium area more than 70%. At terminal surgery, rapid atrial pacing was performed to test inducibility of atrial tachyarrhythmias.
RESULTS: Twelve canines underwent mitral valve chordae avulsion and were kept alive for an average of 8.8 ± 1.3 months. Left atrium volume increased more than 111% (P \u3c .01), left ventricle end-systolic volumes increased more than 57% (P \u3c .01), and left ventricle end-diastolic volumes increased more than 48% (P \u3c .01). Increased left ventricle mass was negatively correlated to ejection fraction (P = .01). During rapid atrial pacing, 6 canines developed inducible atrial arrhythmias. There were no differences in left atrium volume, function, or left ventricle strain between canines with atrial tachyarrhythmias and those without. Independently, 6 developed left ventricle dysfunction with an average decrease in ejection fraction of 16% ± 4%. Canines with reduced ejection fraction experienced markedly increased left atrial volume at minimal filling (P = .02) and impaired left ventricle global radial strain (P = .05).
CONCLUSIONS: Our experimental canine model replicated electrophysiological and hemodynamic consequences of clinical mitral regurgitation. Although left atrium function and left ventricle strain did not associate with atrial tachyarrhythmia inducibility, left atrial volume at minimal filling, left ventricle mass, and left ventricle global radial strain emerged as potential indicators of left ventricle dysfunction. These markers may have clinical value in guiding timely surgical intervention
Testing job wellbeing indicators among community behavioral health workers: Community-based participatory research
Full text linkMany community behavioral health organizations (CBHOs) continue to struggle with their employees\u27 reduced job wellbeing and job disengagement (i.e., turnover intentions, actual turnover). Understanding employees\u27 job wellbeing priorities in their organizational contexts is essential to address the challenges, especially for workers in diverse work settings such as CBHOs. We used community-based participatory research (CBPR) strategies to develop and test job wellbeing indicators. The current study implemented 11 indicators with 168 people employed at a CBHO through initial and 6-month follow-up surveys. Positive endorsement of job wellbeing indicators differed based on employees\u27 demographic (e.g., race, education, marital status) and job (e.g., exempt status, clinical positions) characteristics. Several indicators declined from the initial to the follow-up surveys (e.g., communication, job fairness, decision-making involvement, expectation alignment, supervisory support, career development opportunities). The change rates also varied by employee characteristics (e.g., work years, race, exempt status, full-time). The current study illustrates the utility of CBPR strategies to implement job wellbeing indicators based on employees\u27 priorities and diverse job wellbeing experiences among employee subpopulations. Further, the developed indicators revealed job wellbeing heterogeneity by employee subpopulations within an organization that is often overlooked. Efforts to understand varying job wellbeing characteristics among diverse employees may eventually help develop organization-tailored interventions to improve job wellbeing and reduce turnover
Multi-parametric quantitative evaluation of murine cervical remodeling during pregnancy and postpartum
Full text linkCervical remodeling during pregnancy is a critical process that, if untimely, can lead to complications such as preterm birth (PTB). This study introduces a novel multi-parametric approach combining non-invasive imaging modalities to quantify cervical tissue changes during pregnancy and postpartum in a murine model. By integrating ultrasound-based measurements of cervical length, photoacoustic imaging of the collagen-to-water ratio, and elastography for tissue elasticity alongside histological assessments, this method provides a comprehensive evaluation of cervical remodeling. The findings reveal that combining these parameters significantly improves the accuracy of gestational age prediction compared to individual measurements, with a tri-parametric model achieving 85.3% prediction accuracy compared to 65.4% accuracy with histological analysis alone. This approach not only enhances the understanding of cervical remodeling but also holds potential as a minimally invasive, point-of-care diagnostic tool for early detection of cervical ripening and PTB risk. Ultimately, these advancements could inform clinical strategies for pregnancy management and labor induction, improving maternal and neonatal outcomes
The gain-of-function UBE3AQ588E variant causes Angelman-like neurodevelopmental phenotypes in mice
Full text linkMutations in the E3 ubiquitin ligase UBE3A that cause enzymatic gain-of-function result in disease phenotypes which differ from classic Angelman syndrome. However, these phenotypes are highly heterogeneous raising questions about the mechanistic basis of such phenotypic diversity. Here, we characterize a mouse model harboring a Ube3
Treatment of overactive KATP channels with glibenclamide in a zebrafish model and a clinical trial in humans with Cantú syndrome
Full text linkThis study explores the efficacy of glibenclamide, a
Whole genome sequencing analysis of body mass index identifies novel African ancestry-specific risk allele
Full text linkObesity is a major public health crisis associated with high mortality rates. Previous genome-wide association studies (GWAS) investigating body mass index (BMI) have largely relied on imputed data from European individuals. This study leveraged whole-genome sequencing (WGS) data from 88,873 participants from the Trans-Omics for Precision Medicine (TOPMed) Program, of which 51% were of non-European population groups. We discovered 18 BMI-associated signals (P \u3c 5 × 1
Cerebrospinal fluid proteomics identification of biomarkers for amyloid and tau PET stages
Full text linkAccurate staging of Alzheimer\u27s disease (AD) pathology is crucial for therapeutic trials and prognosis, but existing fluid biomarkers lack specificity, especially for assessing tau deposition severity, in amyloid-beta (Aβ)-positive patients. We analyze cerebrospinal fluid (CSF) samples from 136 participants in the Alzheimer\u27s Disease Neuroimaging Initiative using more than 6,000 proteins. We apply machine learning to predict AD pathological stages defined by amyloid and tau positron emission tomography (PET). We identify two distinct protein panels: 16 proteins, including neurofilament heavy chain (NEFH) and SPARC-related modular calcium-binding protein 1 (SMOC1), that distinguished Aβ-negative/tau-negative (A-T-) from A+ individuals and nine proteins, such as HCLS1-associated protein X-1 (HAX1) and glucose-6-phosphate isomerase (GPI), that differentiated A+T+ from A+T- stages. These signatures outperform the established CSF biomarkers (area under the curve [AUC]: 0.92 versus 0.67-0.70) and accurately predicted disease progression over a decade. The findings are validated in both internal and external cohorts. These results underscore the potential of proteomic-based signatures to refine AD diagnostic criteria and improve patient stratification in clinical trials