1997 research outputs found
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Perceptions of Appointment Time and Associations with Patient Arrival and Reminder System Preferences
No full textContext: Patient reminder notifications have been widely utilized in the healthcare setting for several decades. Some clinics have even begun implementing “arrival time” notifications in lieu of the term “appointment time” in an effort to improve patient punctuality. There is little research on how these oft-used terms and practices are perceived by patients. Objective: The goal of this study was to identify patient perceptions of key event terminology, and the impact of these perceptions upon reminder system preferences. Design: We designed a paper-based survey to investigate patient perceptions of “appointment time” and preferences regarding proposed implementation of a reminder system in which an “arrival time” was provided instead of an “appointment time”. Setting: IU Health Methodist Family Medicine Center is an urban, academic primary care clinic located in Indianapolis. Survey responses were collected from 524 patients over 10 clinic days. Methods: The survey was piloted with several patients to ensure that the greater population could understand each question. Statistical methods included frequency and regression analyses. Results: The perception of the term “appointment time” varied among patients--50% interpreted it as being the time at which to enter the clinic; 14% believed it to be the time when the doctor enters the exam room. The proposal of a clinic implementing an “arrival time” reminder received significant satisfaction scores among the patient population that initially perceived “appointment time” as being earlier in the visit process (p = 0.02). Qualitative analyses of psychosocial and behavioral associations are in progress. Conclusions: There is lack of a standard definition for the term “appointment time” in the healthcare setting; perception of the term varies widely among patients. The relationship between patient perceptions of key events, punctuality, and clinic flow should be further explored before altering current reminder practices
Identification of Commercially Available Antibodies That Block Ligand-Binding by BMPR2
No full textThe Bone Morphogenetic Protein (BMP) signaling pathway comprises the largest subdivision of the Transforming Growth Factor (TGFβ) superfamily. BMP signaling plays essential roles in both embryonic development and postnatal tissue homeostasis. When dysregulated, BMP signaling underlies numerous human pathologies ranging from pulmonary arterial hypertension to heterotopic ossification. Thus, understanding the basic mechanisms by which BMP signaling occurs and is regulated is a highly important goal and may yield translational opportunities. Unfortunately, there are limited tools available to perform functional evaluation of this pathway and genetic approaches are frequently confounded by developmental requirements or ability of pathway components to compensate for one another. While significant progress has been made in developing pharmacological inhibitors for type 1 BMP receptors, specific inhibitors of type 2 receptor are poorly represented. For these reasons, we sought to identify and validate commercially available antibodies that neutralize the ligand-binding function of the Bone Morphogenetic Protein Receptor Type 2 (BMPR2) extracellular domain (ECD). Using a modified, cell-free immunoprecipitation assay quantified by ELISA, we examined the neutralizing ability of the mouse monoclonal antibody 3F6 and found a dose-dependent inhibition of BMPR2-ECD ligand-binding. We extended the results by examining the ability of 3F6 to block endogenous BMPR2 function in a BMP-responsive cell line and found that, consistent with the results of our cell-free system, pre-treatment of HEK293T cells with 3F6 leads to reduced sensitivity in response to BMP pathway activation by BMP2. These results provide important proof-of-concept data for future studies interrogating BMPR2 function in numerous physiological and pathophysiological contexts
The BMP Pathway and Its Inhibitors in the Skeleton
No full textBone morphogenetic proteins (BMPs) constitute the largest subdivision of the transforming growth factor-β family of ligands. BMPs exhibit widespread utility and pleiotropic, context-dependent effects, and the strength and duration of BMP pathway signaling is tightly regulated at numerous levels via mechanisms operating both inside and outside the cell. Defects in the BMP pathway or its regulation underlie multiple human diseases of different organ systems. Yet much remains to be discovered about the BMP pathway in its original context, i.e., the skeleton. In this review, we provide a comprehensive overview of the intricacies of the BMP pathway and its inhibitors in bone development, homeostasis, and disease. We frame the content of the review around major unanswered questions for which incomplete evidence is available. First, we consider the gene regulatory network downstream of BMP signaling in osteoblastogenesis. Next, we examine why some BMP ligands are more osteogenic than others and what factors limit BMP signaling during osteoblastogenesis. Then we consider whether specific BMP pathway components are required for normal skeletal development, and if the pathway exerts endogenous effects in the aging skeleton. Finally, we propose two major areas of need of future study by the field: greater resolution of the gene regulatory network downstream of BMP signaling in the skeleton, and an expanded repertoire of reagents to reliably and specifically inhibit individual BMP pathway components
The Role of α2δ1 in Mediating Extracellular Signaling in Retinal Cells
Get PDFVoltage sensitive calcium channels (VSCCs) are key components in coordinating extracellular signaling that influence calcium (Ca2+) influx and subsequent downstream signaling in a variety of tissues including bone. Previous work involving inhibition or genetic deletion of VSCCs impaired bone formation and responses to loading. These studies focused on the pore-forming α1 subunit of VSCCs. In addition to α1, VSCC complexes contain auxiliary subunits, including α2δ1, that influence channel function. The role of the α2δ1 subunit of VSCCs are underappreciated in specific types of neuronal tissue, particularly retinal cells. Clinically, the α2δ1 subunit is pharmacologically targeted by gabapentin, blocking the channel to increase synaptic GABA concentration to aid in modulating nociception. Recently, gabapentin treatment has been associated with cases of macular edema. The purpose of our study was to characterize in vitro models of retinal α2δ1 expression and examine if changes in intraocular pressure are mediated via VSCCs. Two immortalized rat retinal cell lines, R28 and RMC-1, were characterized for α2δ1/4 expression under both static and oscillatory fluid shear stress (OFSS) conditions. Initial Western blot data support that both R28 and RMC-1s are responsive to OFSS as quantified by the phosphorylation of ERK. Ongoing studies are focused on further characterization of the R28 and RMC-1 cells lines for changes in α2δ1/4 expression under static and OFSS conditions. Future studies will include treating R28 and RMC-1 cells with gabapentin to examine its capability of modulating α2δ1 function in retinal cells
Building an Epigenetic Database: Reproducibility and Orthogonal Targets
Get PDFOdds ratios are one of the methods in statistics to quantify how strongly the presence or absence of a property correlates with the presence or absence of another property in a given population. In the biomedical sciences they are an effective way to investigate the effectiveness of medical interventions towards desired outcomes and the strength with which certain factors influence the risk of a particular disease. Our goal is to collate the significant amount of data that has been published regarding interventions and risk factors using odds ratios into a single database that can be used by the public to compare their effectiveness and importance in influencing desired outcomes in medicine
Don’t bug me…I’m taking a bath! A Case Study on Hot Tub Lung
Get PDFHypersensitivity pneumonitis is a unique form of interstitial lung disease that is diverse in its presentation and etiology. • Hypersensitivity pneumonitis is mediated by an inflammatory reaction to inhalation of an environmental antigen. It is described as a mixed III/IV hypersensitivity reaction that is characterized by lymphocyte predominance and high CD4:CD8 ratio. • Hot tub lung is one etiology of hypersensitivity pneumonitis which can occur from exposure to mycobacterium antigens in water-related contamination, most notably hot tubs. • It most commonly presents with patients who have underlying lung disease or are immunocompromised. However, there has recently been an increase in hot tub lung in otherwise healthy individuals.
58-year old African American female with a history of hypertension and stage 3 breast cancer status post 3 cycles of cyclophosphamide/docetaxel presented to the Emergency Department (ED) with persistent dyspnea, dry cough, and fever. She was discharged earlier that day with a diagnosis of dyspnea with suspicion of pneumonitis after 2 day admission and extensive work-up. Upon discharge, she reported worsening dyspnea with exertion, dry cough, and fever, and returned.
While the patient’s vague symptoms of dyspnea and fever did not point to a specific diagnosis, the additional history revealed possible exposure to mycobacterium antigen through “hot tub like” contamination. • Repeating the history to dig deeper into the patient\u27s daily activities revealed an essential piece of information that led to the diagnosis. • This case is one of the first cases to document hot tub lung in a bathtub
A searchable database of medical education objectives - creating a comparable gold standard.
Get PDFBACKGROUND: Medical school curricula strives to teach as much material as can be retained in a limited amount of time. A common gold standard resource used building curricula are medical objectives suggested by national societies. Unfortunately these objectives suffer from several functional limitations such as limited accessibility to society members, non-searchable formats (such as nested tables or pdf images), and inability to compare and search across societal objectives for redundancy or gaps. The shift towards integrated curriculums in medical school also highlights the need to access suggested content across classical discipline categories.
MAIN BODY: We have codified recommendations from national societies in the United States for medical school objectives in a common tabular format and developed an open access database which can be searched across disciplines and societies. A front end website that allows for searching objectives by keyword while filtering on society or discipline was created. The objectives returned from the initial search can be subsearched by a second term. There is a large range in the format, age, breadth, quantity, and quality of objectives from different societies. Some unique disciplines have overlapping suggested content though most of the content does seem binnable by discipline. The choice of metadata for objectives from each given society was also very inconsistent.
CONCLUSION: A free and searchable database of medical content to deliver during medical school has been developed with over 13,000 objectives from 18 societies and 22 disciplines at http://data.medobjectives.marian.edu/ . The normalization of the different disciplines\u27 objectives into a common database allows a platform to standardize objectives moving forward. Future work could include adding user accounts to access the database, submission of new objectives, voting up and down suggested objectives, and adding answers mapped to objectives. Keyword tagging could allow import of content (e.g. PowerPoints) and outputting of suggested objectives, which would also allow comparison of curriculum across medical schools
