Eating Disorders: Identification and Management in General Medical and Psychiatric Settings.

OBJECTIVE: Eating disorders (EDs) are serious, complex illnesses with both behavioral and physical health features. EDs have high rates of medical and psychiatric morbidity, and a 6% mortality rate, the highest of any mental illness. Early detection of EDs offers the best opportunity for recovery; yet, estimates are that as few as one in 10 individuals with an ED receive treatment. The purpose of this article is to provide an ED identification and management overview for inpatient nurse clinicians in general psychiatric and medical settings, helping to facilitate timely recognition and care. METHOD: An overview of ED diagnostic criteria and two evidence-based ED tools are introduced for consideration. RESULTS: Opportunities to identify and help manage an ED are numerous. Most individuals with an ED make several health care visits in either medical or psychiatric settings without ever being screened for an ED. General ED screening and assessment tool familiarization can facilitate a treatment trajectory for these patients, improve overall quality of life, and may potentially result in a life-saving intervention for this often-deadly cluster of medical and psychiatric disorders. CONCLUSION: Screening and assessment in general clinical settings, identifying patients with undiagnosed EDs, beginning basic treatment plans, and referrals for appropriate follow-up care, have the potential to reduce ED recidivism and related health care costs. Simultaneously, and most important, long-term outcomes for patients with EDs may improve.

The feasibility and safety of same-day discharge after robotic-assisted hysterectomy alone or with other procedures for benign and malignant indications.

OBJECTIVE: This study aimed to report the feasibility and safety of same-day discharge after robotic-assisted hysterectomy. METHODS: Same-day discharge after robotic-assisted hysterectomy was initiated 07/2010. All cases from then through 12/2012 were captured for quality assessment monitoring. The distance from the hospital to patients' homes was determined using http://maps.google.com. Procedures were categorized as simple (TLH+/-BSO) or complex (TLH+/-BSO with sentinel node mapping, pelvic and/or aortic nodal dissection, appendectomy, or omentectomy). Urgent care center (UCC) visits and readmissions within 30days of surgery were captured, and time to the visit was determined from the initial surgical date. RESULTS: Same-day discharge was planned in 200 cases. Median age was 52years (range, 30-78), BMI was 26.8kg/m(2) (range, 17.4-56.8), and ASA was class 2 (range, 1-3). Median distance traveled was 31.5miles (range, 0.2-149). Procedures were simple in 109 (55%) and complex in 91 (45%) cases. The indication for surgery was: endometrial cancer (n=82; 41%), ovarian cancer (n=5; 2.5%), cervical cancer (n=8; 4%), and non-gynecologic cancer/benign (n=105; 53%). One hundred fifty-seven (78%) had successful same-day discharge. Median time for discharge for these cases was 4.8h (range, 2.4-10.3). Operative time, case ending before 6pm, and use of intraoperative ketorolac were associated with successful same-day discharge. UCC visits occurred in 8/157 (5.1%) same-day discharge cases compared to 5/43 (11.6%) requiring admission (P=.08). Readmission was necessary in 4/157 (2.5%) same-day discharge cases compared to 3/43 (7.0%) requiring admission (P=.02). CONCLUSIONS: Same-day discharge after robotic-assisted hysterectomy for benign and malignant conditions is feasible and safe.

An Artificial-Intelligence-Discovered Functional Ingredient, NRT_N0G5IJ, Derived from Pisum sativum, Decreases HbA1c in a Prediabetic Population.

The prevalence of prediabetes is rapidly increasing, and this can lead to an increased risk for individuals to develop type 2 diabetes and associated diseases. Therefore, it is necessary to develop nutritional strategies to maintain healthy glucose levels and prevent glucose metabolism dysregulation in the general population. Functional ingredients offer great potential for the prevention of various health conditions, including blood glucose regulation, in a cost-effective manner. Using an artificial intelligence (AI) approach, a functional ingredient, NRT_N0G5IJ, was predicted and produced from Pisum sativum (pea) protein by hydrolysis and then validated. Treatment of human skeletal muscle cells with NRT_N0G5IJ significantly increased glucose uptake, indicating efficacy of this ingredient in vitro. When db/db diabetic mice were treated with NRT_N0G5IJ, we observed a significant reduction in glycated haemoglobin (HbA1c) levels and a concomitant benefit on fasting glucose. A pilot double-blinded, placebo controlled human trial in a population of healthy individuals with elevated HbA1c (5.6% to 6.4%) showed that HbA1c percentage was significantly reduced when NRT_N0G5IJ was supplemented in the diet over a 12-week period. Here, we provide evidence of an AI approach to discovery and demonstrate that a functional ingredient identified using this technology could be used as a supplement to maintain healthy glucose regulation.

The utility of BRAFV600E mutation-specific antibody for colon cancers with microsatellite instability.

This study's objective was to assess the performance of immunohistochemical staining with the BRAF mutation-specific antibody (clone VE1) in tissue from colon cancers, including those with a high degree of microsatellite instability (MSI-H). VE1 was applied to tissue microarrays of 152 colon cancers with known MSI status. Results of immunohistochemical analyses were scored as negative, positive, or equivocal. The results of VE1 immunohistochemical analysis were compared with BRAF mutation analysis by PCR. Fifteen of the 152 cases (10%) were positive with VE1 immunohistochemical analysis, 8 were equivocal, and 129 were negative. There was a single false-negative case and no false positives were identified when 74 VE1-positive or VE1-negative cases were tested by the BRAF PCR testing. Of the 8 equivocal VE1 cases identified, 3 were BRAF-positive. In the 17 MSI-H colon cancers, VE1 immunohistochemical analysis resulted in 7 true-positive, 9 true-negative, and 1 false-negative case when compared with PCR results. The sensitivity and specificity of VE1 in the MSI-H colon cancer group were determined to be 88% and 100%, respectively. The BRAF positivity rate by VE1 immunohistochemical analysis in MSI-H colon cancers is consistent with that of published cohorts, which use molecular assays, and the accuracy of positive or negative VE1 staining is high. A small subset of equivocal cases (5% in our cohort) with heterogenous staining requires confirmation by the BRAF mutation analysis. We propose a testing algorithm for Lynch syndrome screening in MSI-H colorectal cancers that incorporates VE1 immunohistochemical analysis with PCR testing for equivocal cases.