How strong is the relationship between scabies and acute rheumatic fever? An analysis of neighbourhood factors.

AIM: Recent studies have linked scabies with acute rheumatic fever (ARF). We explored the relationship, by neighbourhood, between permethrin dispensing as an indicator of scabies prevalence and ARF cases over the same period. METHODS: Incident cases of ARF notified to public health between September 2015 and June 2018 and the annual incidence of prescribing by neighbourhood over the same period were analysed. Evidence of an association between permethrin and ARF was obtained by carrying out Poisson regression of the rate of ARF in terms of permethrin rate at the census area unit level, with adjustment for ethnicity and socio-economic deprivation. RESULTS: A total of 413 neighbourhoods were included. The incidence of ARF varied between 0 and 102 per 100 000 people per year (mean 4.3). In contrast, the annual incidence of dispensing of permethrin varied between 0 and 3201 per 100 000 people per year (mean 771). A strong association was observed between the two variables. In an adjusted quasi-Poisson model, permethrin-dispensing rates were strongly associated with ARF incidence, with a change from the 16th to the 84th centile associated with a 16.5-fold increase in incidence (95% confidence interval: 3.82-71.6). CONCLUSIONS: Permethrin prescribing as an indicator of scabies is strongly associated with the incidence of ARF. Considered together with other studies, this evidence suggests that improving scabies control may reduce the burden of ARF in New Zealand.

Hard Internet Truths: 34,748 Online Reviews Reveal What Patients Really Want from Doctors.

For all of us living in the Internet age, it's hard to underestimate the power of online reviews. Before booking a reservation at a new hotel or restaurant, who doesn't consult websites such as TripAdvisor and Open Table? Who would gamble $100 on a dinner out or $200 on a hotel stay before first seeing what other diners and patrons had to say about their experiences? Patients who are looking for a healthcare provider are no different than those customers looking for a restaurant or a hotel; they want opinions from others who have previously availed themselves of that restaurant or hotel. This article addresses the importance of online reputation management and offers ideas and suggestions for healthcare providers to control and protect their online reputations.

Advancing the Science of Healthcare Service Delivery: The NHLBI Corporate Healthcare Leaders' Panel.

There is a growing gap between available science and evidence and the ability of service providers to deliver high-quality care in a cost-effective way to the entire population. We believe that the chasm between knowledge and action is due to a lack of concerted effort among all organizations that deliver health care services across the life span of patients. Broad participation is needed and necessitates a far more explicit and concerted public-private partnership focused on large-scale transformation. In this context, the National Heart, Lung, and Blood Institute convened a panel made up of leaders of corporate health care entities, including academic health centers, and government agency representatives to inform contemporary strategic partnerships with health care companies. This article provides insights from the meeting on how to execute a transformative innovation research agenda that will foster improvements in health care service delivery by leveraging the translation of biomedical research evidence in real-world settings.

Variation in care among spinal deformity surgeons: results of a survey of the Shriners hospitals for children.

STUDY DESIGN: Survey. OBJECTIVE: To understand the variation in scoliosis surgery and perioperative care among spinal deformity surgeons. SUMMARY OF BACKGROUND DATA: While variation in care has been well described in many spinal disorders, the degree of variation has not been described for spinal deformity. METHODS: Clinical histories and radiographs of 4 typical spinal deformity patients were sent to spinal deformity surgeons for review. The cases consisted of idiopathic thoracolumbar, double major, and right thoracic curves and a neuromuscular lumbar curve. The survey queried choice of surgical approach, levels fused and instrumented, type of instrumentation, preoperative testing, intraoperative neurologic monitoring, blood and antibiotic use, and postoperative care, including pain control and patient mobilization. Cost estimates for each case were obtained from the individual hospitals' pricing. RESULTS: There was wide variation in the specific fusion levels and instrumentation for the idiopathic curves. The variation was greatest for the thoracolumbar curve. The double major and right thoracic curves differed primarily in their choice of instrumenting secondary curves. The neuromuscular curve had the least variation. Costs estimates were widely disparate between centers. Perioperative care had much less disparity. CONCLUSIONS: Agreement appears common in areas with readily identifiable outcomes such as shorter length of stay and rapid postoperative mobilization. However, agreement is poor in areas where outcomes are difficult to measure and require long-term follow-up such as instrumentation fusion and levels.

A prospective evaluation of the WeeFIM in patients with cerebral palsy undergoing orthopaedic surgery.

PURPOSE: Although frequently used in pediatric rehabilitation settings, the WeeFIM has not been tested in surgical pediatric orthopaedic patients. METHODS: The WeeFIM was administered to patients with surgical cerebral palsy at defined intervals preoperatively and at both 6 and 12 months postoperatively. The age-adjusted change scores from baseline to follow-up were tested both parametrically and nonparametrically. RESULTS: Four hundred sixty-eight patients had baseline evaluations. There were 161 six-month follow-up assessments and 108 twelve-month follow-up assessments. The baseline WeeFIM was able to separate children with different patterns of cerebral palsy. Hemiplegic patients had higher scores than diplegic and tetraplegic patients. Overall age-adjusted scores were improved at both 6 (mean increase 2.0) and 12 months (mean increase 2.2). The instrument showed significant ceiling effects for diplegic and hemiplegic patients with lower or upper extremity surgery and limited responsiveness for lower extremity surgery in tetraplegic patients. Parametrically, it showed improvements in mobility for both rhizotomy and tetraplegic upper extremity surgery. Nonparametric tests were not significant for rhizotomy mobility improvement. CONCLUSIONS: Although the WeeFIM adequately reflects the severity of neurological involvement in pediatric orthopaedic patients with cerebral palsy, it has a significant ceiling effect in diplegic and hemiplegic patients limiting responsiveness and lacks content validity for tetraplegic patients. The instrument may have some use in tetraplegic patients with upper extremity surgery and in rhizotomy patients. We recommend against its general use for orthopaedic surgery in patients with cerebral palsy lower extremity or spine surgery and in hemiplegic patients with upper extremity surgery.

Identification of a potent and selective 5-HT1B receptor antagonist.

An SAR study around the mixed 5-HT1ABD receptor antagonist SB-272183 found that introduction of cis-2,6-dimethyl substitution onto the piperazine ring was a key structural change, which imparted a combination of both excellent selectivity over the 5-HT1A and 5-HT1D receptors and low intrinsic activity. This led to the identification of the selective 5-HT1B receptor antagonist SB-616234.

Regional variations in asthma hospitalisations among Maori and non-Maori.

AIM: To examine regional patterns of asthma hospitalisations in Maori and non-Maori. METHODS: We studied asthma hospitalisations in Maori and non-Maori during 1994-2000. Hospitalisation rates for Maori and non-Maori were calculated for ages 5-34 years in each of the 74 territorial authorities (TAs), of which 15 are urban and 59 predominantly rural. The data were also analysed separately for Maori and non-Maori in the age groups 0-4, 5-14, 15-34 and 35-74 years. RESULTS: For Maori, the highest hospitalisation rates were in Tauranga, Invercargill, Wanganui, South Wairarapa and Gisborne; the lowest rates were in Rodney, Tasman, Franklin, Waitaki and North Shore City. The rate of asthma hospitalisation was higher in Maori than non-Maori in each age-group: 0-4 years relative risk (RR) = 1.43; 5-14 years RR = 1.08; 15-34 years RR = 1.31; 35-74 years RR = 2.97. The differences were higher in rural areas (RR 1.65, 1.17, 1.34 and 3.13 respectively) than in urban areas (RR 1.25, 1.00, 1.22, 2.79 respectively). CONCLUSIONS: These analyses confirm previous evidence that asthma hospitalisation rates are higher in Maori than in non-Maori, despite the fact that asthma prevalence is similar in Maori and non-Maori children. They also indicate that this excess of hospitalisations is higher in rural than in urban areas, although the difference is not large.