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1.
BMC Nephrol ; 21(1): 424, 2020 Oct 06.
Artigo em Inglês | MEDLINE | ID: mdl-33023489

RESUMO

BACKGROUND: Kidney disease accounts for more than 49 billion dollars in healthcare expenditures annually. Early detection and intervention may reduce the burden of disease. We describe a quality improvement project to develop a telenephrology dashboard that proactively monitors kidney disease. METHODS: One hundred eighty-four thousands Veterans within the Iowa City Veterans Affairs Health Care System were eligible for telenephrology consultation. The dashboard accessed the charts of 53,085 Veterans at risk for kidney disease. We utilized Lean-Six Sigma tools and principles and the Define-Measure-Analyze-Improve-Control Framework to develop and deploy a telenephrology dashboard in 4 community-based outpatient clinics (CBOCs). The primary measure was the number of days to complete consultation. Secondary measures included number of electronic consultations per month, distance and cost of Veteran travel saved, and number of steps for completion of consult. RESULTS: The data of 1384 Veterans at the 4 CBOCs were analyzed by the telenephrology dashboard, of which 459 generated telenephrology consults. The number of days to complete any type of consultation was unchanged (48.9 days in 2019, compared to 41.6 days in 2017). The average Veteran saved between $21.60 to $63.90 per trip to Iowa City. Between March 2019 and August 2019, there were 27.3 telenephrology consults per month. The number of steps needed to complete the consult request was decreased from 13 to 9. CONCLUSIONS: Utilization of the telenephrology dashboard system contributed to an increase in consultations completed through electronic means without decreasing face-to-face consults. Electronic consults now outnumber traditional face-to-face consultations at our institution. Telenephrology consultation improved early detection and identification of kidney disease and saved time and costs for Veterans in travel, but did not decrease the average number of days to complete consultation requests.

2.
J Family Med Prim Care ; 9(6): 2789-2793, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32984127

RESUMO

Background: Rheumatoid arthritis (RA) is an autoimmune disease, which mistakenly attacks the joints and induces the inflammatory changes that thicken the joints (the synovium) resulting in swelling and pain in and around the joints. It causes pain, joint deformity, and also affects the quality of life. The joint is affected symmetrically. It also can affect body systems, such as the cardiovascular, respiratory systems, or other systems, which manifest as extra-articular manifestations. Extra-articular manifestations of RA are documented less in India hence this study was undertaken to correlate RA with extra-articular manifestations as well as its relationship with serostatus in patients with extra-articular manifestations. Materials and Methods: Sixty patients (age between 18-60 years) attending Medicine/Rheumatology outpatient department were included in the study (12 months) who fulfilled the 2010 RA classification criteria laid down by American College of Rheumatology (ACR)/European League against Rheumatism (EULAR) for RA. All the subjects underwent a thorough history, clinical examination, and laboratory investigations. The relevant data were analyzed with appropriate statistical methods after 12 months' duration. Results: Nearly 68.33% of the subjects were found to have extra-articular manifestations mostly in the age group of 31-40 years with prevalence higher in the female. In the seropositive patients, early morning stiffness (EMS) constitutes 63.82% of the total extra-articular manifestations in the patients followed by anemia (38.29%) and peripheral neuropathy (34.04%). On the other hand, in the seronegative cases, EMS (61.53%) followed by anemia (23.07), peripheral neuropathy (15.38%), and keratoconjunctivitis sicca (15.38%). Extra-articular manifestations in seropositive patients have a statistically significant relationship with the increase in the duration of the disease. Conclusion: Extra-articular manifestations need to be looked carefully as it is associated with more severe disease. Seropositivity and extra-articular manifestations both usually indicate that the RA is more severe and may affect the quality of life.

3.
J Family Med Prim Care ; 9(6): 3154-3156, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32984190

RESUMO

We report a case of a 34-year-old male with a history of pulmonary tuberculosis and pathological fracture of shaft of long bone presented with symptoms of lower respiratory tract infection. The patient did not have any typical symptoms of multiple myeloma or hypercalcemia on presentation. Throughout his hospitalization, his serum globulin level was very high along with mild normocytic normochromic anemia and mild renal function derangement without apparent cause. Acute phase markers of inflammation, for example, erythrocyte sedimentation rate (ESR) were not elevated in this patient and there was no lytic lesion in bone radiographs. He was eventually diagnosed as a case of stage 3 multiple myeloma by immuno-fixation electrophoresis and bone marrow study. Multiple myeloma represents a pathology of diverse distribution and has varied unusual presenting symptoms. We consider it an underdiagnosed disease often missed especially in young because it is not considered by clinicians.

4.
Semin Arthritis Rheum ; 50(5): 1191-1201, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32931985

RESUMO

INTRODUCTION: COVID-19 is an acute respiratory viral infection that threatens people worldwide, including people with rheumatic disease, although it remains unclear to what extent various antirheumatic disease therapies increase susceptibility to complications of viral respiratory infections. OBJECTIVE: The present study undertakes a scoping review of available evidence regarding the frequency and severity of acute respiratory viral adverse events related to antirheumatic disease therapies. METHODS: Online databases were used to identify, since database inception, studies reporting primary data on acute respiratory viral infections in patients utilizing antirheumatic disease therapies. Independent reviewer pairs charted data from eligible studies using a standardized data abstraction tool. RESULTS: A total of 180 studies were eligible for qualitative analysis. While acknowledging that the extant literature has a lack of specificity in reporting of acute viral infections or complications thereof, the data suggest that use of glucocorticoids, JAK inhibitors (especially high-dose), TNF inhibitors, and anti-IL-17 agents may be associated with an increased frequency of respiratory viral events. Available data suggest no increased frequency or risk of respiratory viral events with NSAIDs, hydroxychloroquine, sulfasalazine, methotrexate, azathioprine, mycophenolate mofetil, cyclophosphamide, or apremilast. One large cohort study demonstrated an association with leflunomide use and increased risk of acute viral respiratory events compared to non-use. CONCLUSION: This scoping review identified that some medication classes may confer increased risk of acute respiratory viral infections. However, definitive data are lacking and future studies should address this knowledge gap.


Assuntos
Antirreumáticos/farmacologia , Infecções por Coronavirus , Pandemias , Pneumonia Viral , Doenças Reumáticas , Betacoronavirus , Comorbidade , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Humanos , Hospedeiro Imunocomprometido , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Doenças Reumáticas/tratamento farmacológico , Doenças Reumáticas/epidemiologia , Medição de Risco , Índice de Gravidade de Doença
6.
J Clin Rheumatol ; 2020 Jul 09.
Artigo em Inglês | MEDLINE | ID: mdl-32658045

RESUMO

BACKGROUND/OBJECTIVE: Physician well-being is being increasingly recognized for its important role in high-quality patient care, integrity of the healthcare system, and vitality of the workforce. However, little is known about well-being, resiliency, and burnout among rheumatologists, particularly early-career rheumatologists. In this qualitative study, the investigators explore these concepts among early-career rheumatologists. METHODS: We performed a qualitative study using semistructured phone interviews of rheumatologists who completed fellowship in 2017. Participants were recruited through purposive sampling. Twenty questions were devised by the investigators, covering sample demographics, exploring definitions of well-being, resiliency, and burnout, and probing potential solutions.Interviews were recorded and transcribed independently and verified for consistency. The investigators used grounded theory to code the transcripts and iteratively derive categories, subthemes, and themes until reaching theoretical sufficiency. RESULTS: Sixty-four rheumatologists were interviewed, accounting for 30.6 hours of material. Seven major themes were identified: (1) well-being as a holistic state where an individual is able to translate one's potential to maximal performance, (2) work-family balance as a dynamic equilibrium changing over time, (3) inadequacy of training in addressing self-doubt over autonomy, (4) uncertainty over career development and progression, (5) excessive administrative burdens, (6) protective nature of longitudinal relationships, and (7) addressing burnout requires a multifaceted approach at multiple levels. CONCLUSIONS: New rheumatologists face a series of challenges as they enter the workforce. Investments into well-being can help reduce the risk of burnout and enlarge our community. Our results highlight drivers and potential solutions, as identified by recent fellowship graduates.

8.
J Family Med Prim Care ; 9(3): 1628-1632, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32509663

RESUMO

Background: Vitamin D is an important vitamin required to maintain an important physiological function of the body. The body should maintain an optimal level of vitamin D to maintain skeletal and metabolic functions. It was observed that inverse relationship is maintained by vitamin D level in the body with musculoskeletal symptoms and metabolic disorders. Objective: The study is conducted to associate between serum levels of vitamin D with self-reported symptoms (musculoskeletal) and blood pressure. Material and Methods: Venous blood sample was collected from 126 adults with musculoskeletal symptoms. The subjects were stratified based on their vitamin D levels. Groups were tested for the frequency of symptoms and the relationship of different parameters with vitamin D. Results: The frequency of subjects in the study was more in the deficient category (<20 ng/dL). In the study, vitamin D was found to have a significant association with "weakness." Body mass index (BMI), systolic blood pressure (SBP), and diastolic blood pressure (DBP) were found to have an inverse relation with serum vitamin D level. Conclusion: The study showed the effect of vitamin D level in musculoskeletal symptoms and inverse association of vitamin D with BMI and blood pressure.

9.
BMC Med Educ ; 20(1): 175, 2020 Jun 02.
Artigo em Inglês | MEDLINE | ID: mdl-32487056

RESUMO

BACKGROUND: With the increasing recognition that leadership skills can be acquired, there is a heightened focus on incorporating leadership training as a part of graduate medical education. However, there is considerable lack of agreement regarding how to facilitate acquisition of these skills to resident, chief resident, and fellow physicians. METHODS: Articles were identified through a search of Ovid MEDLINE, EMBASE, CINAHL, ERIC, PsycNet, Cochrane Systemic Reviews, and Cochrane Central Register of Controlled Trials from 1948 to 2019. Additional sources were identified through contacting authors and scanning references. We included articles that described and evaluated leadership training programs in the United States and Canada. Methodological quality was assessed via the MERSQI (Medical Education Research Study Quality Instrument). RESULTS: Fifteen studies, which collectively included 639 residents, chief residents, and fellows, met the eligibility criteria. The format, content, and duration of these programs varied considerably. The majority focused on conflict management, interpersonal skills, and stress management. Twelve were prospective case series and three were retrospective. Seven used pre- and post-test surveys, while seven used course evaluations. Only three had follow-up evaluations after 6 months to 1 year. MERSQI scores ranged from 6 to 9. CONCLUSIONS: Despite interest in incorporating structured leadership training into graduate medical education curricula, there is a lack of methodologically rigorous studies evaluating its effectiveness. High-quality well-designed studies, focusing particularly on the validity of content, internal structure, and relationship to other variables, are required in order to determine if these programs have a lasting effect on the acquisition of leadership skills.

11.
Nanomaterials (Basel) ; 10(4)2020 Apr 08.
Artigo em Inglês | MEDLINE | ID: mdl-32276478

RESUMO

Zirconia and 10%, 20%, and 30% cerium-doped zirconia nanoparticles (ZCO), ZCO-1, ZCO-2, and ZCO-3, respectively, were prepared using auto-combustion method. Binary nanohybrids, ZrO2@rGO and ZCO-2@rGO (rGO = reduced graphene oxide), and ternary nanohybrids, ZrO2@rGO@MoS2 and ZCO-2@rGO@MoS2, have been prepared with an anticipation of a fruitful synergic effect of rGO, MoS2, and cerium-doped zirconia on the tribo-activity. Tribo-activity of these additives in paraffin oil (PO) has been assessed by a four-ball lubricant tester at the optimized concentration, 0.125% w/v. The tribo-performance follows the order: ZCO-2@rGO@MoS2 > ZrO2@rGO@MoS2 > ZCO-2@rGO > ZrO2@rGO > MoS2 > ZrO2 > rGO > PO. The nanoparticles acting as spacers control restacking of the nanosheets provided structural augmentation while nanosheets, in turn, prevent agglomeration of the nanoparticles. Doped nanoparticles upgraded the activity by forming defects. Thus, the results acknowledge the synergic effect of cerium-doped zirconia and lamellar nanosheets of rGO and MoS2. There is noncovalent interaction among all the individuals. Analysis of the morphological features of wear-track carried out by scanning electron microscopy (SEM) and atomic force microscopy (AFM) in PO and its formulations with various additives is consistent with the above sequence. The energy dispersive X-ray (EDX) spectrum of ZCO-2@rGO@MoS2 indicates the existence of zirconium, cerium, molybdenum, and sulfur on the wear-track, confirming, thereby, the active role played by these elements during tribofilm formation. The X-ray photoelectron spectroscopy (XPS) studies of worn surface reveal that the tribofilm is made up of rGO, zirconia, ceria, and MoS2 along with Fe2O3, MoO3, and SO42- as the outcome of the tribo-chemical reaction.

12.
Nanoscale ; 12(18): 9969-9979, 2020 May 14.
Artigo em Inglês | MEDLINE | ID: mdl-32167113

RESUMO

To establish an ultimate energy conversion system consisting of a water-splitting photocatalyst and a fuel cell, it is necessary to further increase the efficiencies of the hydrogen evolution reaction (HER), the oxygen evolution reaction (OER), and the oxygen reduction reaction (ORR). Recently, it was demonstrated that thiolate (SR)-protected gold clusters, Aun(SR)m, and their related alloy clusters can serve as model catalysts for these three reactions. However, as the previous data have been obtained under different experimental conditions, it is difficult to use them to gain a deep understanding of the means to attain higher activity in these reactions. Herein, we measured the HER, OER, and ORR activities of Aun(SR)m and alloy clusters containing different numbers of constituent atoms, ligand functional groups, and heteroatom species under identical experimental conditions. We obtained a comprehensive set of results that illustrates the effect of each parameter on the activities of the three reactions. Comparison of the series of results revealed that decreasing the number of constituent atoms in the cluster, decreasing the thickness of the ligand layer, and substituting Au with Pd improve the activities in all reactions. Taking the stability of the cluster into consideration, [Au24Pd(PET)18]0 (PET = 2-phenylethanethiolate) can be considered as a metal cluster with high potential as an HER, OER, and ORR catalyst. These findings are expected to provide clear design guidelines for the development of highly active HER, OER, and ORR catalysts using Aun(SR)m and related alloy clusters, which would allow realization of an ultimate energy conversion system.

14.
Acad Med ; 95(7): 1037, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-31977342
15.
J Healthc Qual ; 42(3): 166-174, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31385855

RESUMO

Pneumonia is a major cause of morbidity and mortality in the United States. Therefore, prevention of pneumococcal pneumonia by administering effective and well-tolerated vaccines is an important goal, especially in the immunocompromised patients who are at an increased risk of infections. At a large Midwestern Veterans Affairs Rheumatology Clinic, an internal audit revealed a baseline immunization rate of 3%. Through the Lean Six Sigma approach, the investigators sought to increase the rate to 70%. An interprofessional approach incorporating provider education, reinforcement at the point of care, and workflow simplification was sequentially implemented. Lean Six Sigma tools, including process mapping, voice of the customer, and statistical process control charts were utilized. These interventions increased the percentage of eligible patients receiving vaccinations from 3% (n = 19/687) to 23% (n = 11/48) and decreased the vaccine administration time from 15 to 7 minutes. No adverse reactions were reported. This was balanced by an increase in appointment time by 4 minutes in those who received vaccines. The Lean Six Sigma approach was critical to reducing waste and improving value for patients and providers by increasing pneumococcal vaccination rates among the immunocompromised veteran population in a Midwestern Veterans Affairs Rheumatology Clinic.

16.
Technol Health Care ; 28(2): 165-173, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31594266

RESUMO

BACKGROUND: The antibacterial properties are beneficial and desired for dental restorative composite materials. The incorporation of various antimicrobial agents into resin composites may compromise their physical and mechanical properties hence limiting their applications. OBJECTIVE: The aim of the current study is to evaluate the antibacterial activity and the hardness of microhybrid and flowable resin based composites (RBCs) modified using novel antimicrobial agent chitosan (CS). METHODS: The antibacterial activity of microhybrid and flowable RBCs modified with 0, 0.25, 0.5 and 1% w/w chitosan (CS) against Actinomyces viscous bacteria was explored using agar diffusion test and direct contact methods. The hardness of control and experimental RBCs was determined by Vickers hardness (VH) tester. RESULTS: The results revealed that control and experimental flowable and microhybrid RBCs did not demonstrate growth inhibition zone in the lawn growth of Actinomyces viscous. The direct contact test revealed that colony forming unit (CFU) count of Actinomyces viscous was comparable among the experimental and control materials. The flowable RBCs containing 1% CS had significantly higher VH compared to control and other experimental flowable RBC groups. The microhybrid RBCs consisting of 0.50% CS exhibited significantly higher VH compared to experimental microhybrid RBC group containing 1% CS.

17.
Curr Eye Res ; 45(3): 313-326, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31670974

RESUMO

Purpose: This review aims to provide an understanding of the history of research on, the biological processes governing the different forms of, and an overview of more recent work on lens regeneration as they will likely prove vital in bringing the study of lens regeneration into the clinic.Methods: A review of the literature on lens regeneration research was conducted.Results: Lens regeneration is characterized by the regrowth or repair of the lens following the removal of either a portion or of the entire lens. A brief history of research on lens regeneration is provided, from the discovery in early antiquity of the ability of some animals to regenerate lost tissue, to the systematic cataloguing of the mechanisms of lens regeneration in the 19th century, until the more modern unraveling of the genetic and biochemical processes governing lens regeneration. The anatomy and physiology of the lens as well as the mechanisms by which the lens develops inform its regenerative capabilities by determining the processes that must occur in order to regrow a new lens or repair a damaged one. Lens regeneration occurs by one of several species-dependent methods: some amphibians can regrow a new lens after complete removal of the old one while some mammals can only repair a damaged lens. This review provides an overview of the mechanisms controlling the different types of lens regeneration.Conclusion: The development and growth of the intact lens influence the mechanisms that govern lens regeneration. Recent advances in the field have begun to apply concepts of the field in the clinic and have made significant progress towards realizing the goal of using lens regeneration to repair a damaged lens in the clinic.

18.
BMC Med Educ ; 19(1): 436, 2019 Nov 21.
Artigo em Inglês | MEDLINE | ID: mdl-31752808

RESUMO

BACKGROUND: Program directors are often perceived as strong and independent leaders within the academic medical environment. However, they are not as omnipotent as they initially appear. Indeed, PDs are beholden to a variety of different agents, including trainees (current residents, residency applicants, residency alumni), internal influencers (departmental faculty, hospital administration, institutional graduate medical education), and external influencers (the Accreditation Council for Graduate Medical Education (ACGME), medical education community, and society-at-large). Altogether, these agents form a complex ecosystem whose dynamics and relationships shape the effectiveness of program directors. MAIN BODY: This perspective uses management theory to examine the characteristics of effective PD leadership. We underline the importance of authority, accessibility, adaptability, authenticity, accountability, and autonomy as core features of successful program directors. Additionally, we review how program directors can use the six power bases (legitimacy, referent, informational, expert, reward, and coercive) to achieve positive and constructive change within the complexity of the academic medical ecosystem. Lastly, we describe how local and national institutions can better structure power relationships within the ecosystem so that PD leadership can be most effective. CONCLUSION: Keen leadership skills are required by program directors to face a variety of challenges within their educational environments. Understanding power structures and relationships may aid program directors to exercise leadership judiciously towards fulfilling the educational missions of their departments.


Assuntos
Pessoal Administrativo , Educação Médica , Relações Interprofissionais , Liderança , Humanos , Autonomia Profissional , Avaliação de Programas e Projetos de Saúde , Responsabilidade Social
19.
Phys Rev E ; 100(3-1): 032404, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31640048

RESUMO

We have studied the kinetics of the interaction between antimicrobial peptide nisin and Langmuir monolayers of phospholipids DPPC and DPPG at the air-water interface using the surface manometry technique. The charge on the nisin and the lipid molecules is controlled by varying the pH of the subphase, and the interactions between them are studied by measuring the surface pressure of the lipid monolayer as a function of time after injecting the nisin in the subphase. A model based on the diffusion of particles under the influence of a constant force is developed to obtain an analytical expression for surface pressure as a function of time. The expression was found to fit well with the experimental data. The average hydrodynamic radius and the translational diffusion constant of the nisin molecules are calculated from the fit parameters for the different subphase pH solutions.


Assuntos
1,2-Dipalmitoilfosfatidilcolina/química , Nisina/química , Fosfatidilgliceróis/química , Ar , Difusão , Concentração de Íons de Hidrogênio , Cinética , Modelos Moleculares , Conformação Molecular , Pressão , Ligação Proteica , Água/química
20.
Indian J Pharmacol ; 51(4): 236-242, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31571709

RESUMO

BACKGROUND: To improve the public health and promote instant adverse drug reaction (ADR) reporting, a need to develop an ADR Pharmacovigilance Programme of India (PvPI) mobile app was identified by the National Coordination CentrePvPI (NCCPvPI) to serve the Pan India ADR reporting. The objective of this study was to develop an indigenous Googlebased Android mobile application known as "ADR PvPI" and to analyze the ADRrelated data reported through this mobile application on pilot basis. MATERIALS AND METHODS: The ADR PvPI mobile application was indigenously developed by NCCPvPI officials within 6 months. The study of spontaneous ADR reporting was carried out between September 2017 and September 2018. This article provides an overview of the salient features of ADR PvPI mobile application, guides on how to fillin ADRs, reporting trends of ADR, types of ADR as per System Organ Class and pharmacological classes of drugs. RESULTS: Till date, >5500 users have downloaded the app with an average rating of 4.26. In that tenure, 262 reports have been received through ADR PvPI mobile app. During the year 2017, 3.55% of reports were received through ADR PvPI mobile app and the percentage of reports received by 2018 was 96.45%. CONCLUSION: The frequency of ADR reporting has significantly increased over the past 1 year and should be promoted further through awareness and training programs.


Assuntos
Sistemas de Notificação de Reações Adversas a Medicamentos , Aplicativos Móveis , Farmacovigilância , Feminino , Humanos , Índia , Masculino
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