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1.
Urology ; 137: 44, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32115071
2.
Medicine (Baltimore) ; 99(9): e19272, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32118736

RESUMO

Approximately half of the surrogate decision makers of critically ill adults are at risk for negative emotional burden. Decision support and effective surrogate-clinician communication buffers against such experiences. The objective of this study is to evaluate the acceptability of a new surrogate-targeted educational tool that promotes engagement with clinicians and advocacy for 2 evidence-based practices in the provision of mechanical ventilation for acute respiratory failure: spontaneous awakening and breathing trials.A panel of 44 former patients and surrogates of a 20-bed medical intensive care unit in a large academic hospital responded to an online survey. Acceptability was measured on 3 dimensions: attitudes toward the content and delivery of information, objective knowledge translation, and subjective knowledge acquisition.More than 80% of participants found the tool to be easy to read, and over 90% felt that the tool provided actionable recommendations. A significant number of previously unsure participants were able to identify what spontaneous awakening and breathing trials are and when they occur, and 16% to 36% reported significant improvements in their subjective understanding of the target evidence-based practices, after being exposed to the educational tool.This line of work seeks to reduce surrogates' negative emotional burden while also promoting quality critical care. The educational tool provides a promising new way to promote surrogate-clinician communication, by increasing surrogates' knowledge about and encouraging advocacy for evidence-based practices in the provision of mechanical ventilation.


Assuntos
Diretivas Antecipadas , Estado Terminal , Técnicas de Apoio para a Decisão , Aceitação pelo Paciente de Cuidados de Saúde , Síndrome do Desconforto Respiratório do Adulto/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Unidades de Terapia Intensiva , Masculino , Michigan , Pessoa de Meia-Idade , Projetos Piloto , Respiração Artificial , Inquéritos e Questionários , Adulto Jovem
3.
Environ Monit Assess ; 192(4): 216, 2020 Mar 05.
Artigo em Inglês | MEDLINE | ID: mdl-32140849

RESUMO

The Pine River, in the central, Lower Peninsula region of Michigan, has a long history of contamination. Livestock facilities and manure application sites along the Pine River and its tributaries have led to elevated nutrient levels. In addition to nutrient loading and associated low levels of dissolved oxygen, the presence Escherichia coli bacteria have caused environmental and human health concerns. According to the Michigan Department of Health and Human Services, and the Michigan Department of Environment, Great Lakes, and Energy, E. coli counts in summer months consistently have exceeded safe levels for human contact since 2005. Though it is recommended that residents do not swim in the Pine River, there are no specific restrictions on recreational fishing which is prevalent. Few studies have evaluated whether or not E. coli accumulates in the mucus of fish and, if so, whether that provides a viable route of E. coli exposure for anglers. This study first evaluated the presence of fecal coliform and E. coli bacteria on hatchery-raised caged fish placed in the river as well as resident fish. Results showed that fecal coliform and E. coli bacteria accumulated both on caged and resident fish. This result led to further testing showing E. coli to be found on anglers' hands whether or not they handled or interacted with resident fish. This study suggests that fishing in rivers with heavy bacterial loading from agricultural runoff may expose anglers to potentially harmful E. coli.


Assuntos
Agricultura , Exposição Ambiental , Escherichia coli , Peixes , Microbiologia da Água , Animais , Monitoramento Ambiental , Humanos , Michigan , Rios , Estações do Ano
4.
Environ Monit Assess ; 192(4): 227, 2020 Mar 10.
Artigo em Inglês | MEDLINE | ID: mdl-32157442

RESUMO

Crayfishes (Decapoda) are common inhabitants of agricultural headwater streams in the Midwestern USA that have been impacted by physical habitat degradation and contamination by agricultural pollutants. The frequency and severity of injuries within crayfish communities are indicators of crayfish aggression, which is influenced by physical, chemical, and biotic factors. Previous studies have not evaluated the relationships of the frequency and severity of crayfish injuries with physical habitat quality, water quality, and biotic factors within agricultural headwater streams. Understanding these relationships will assist with determining if crayfish injury variables can serve as an indicator of physical habitat quality or water quality in these small degraded streams. We sampled crayfishes, documented the frequency and type of injuries, and measured instream habitat and water chemistry in 2014 and 2015 within 12 agricultural headwater streams in Indiana, Michigan, and Ohio. We documented five native crayfish species from 1641 adult captures. The most abundant species were Faxonius rusticus, Faxonius immunis, and Faxonius propinquus. Linear mixed effect model analyses indicated that four crayfish injury response variables were positively correlated (p < 0.05) with crayfish density, physical habitat quality, and water velocity diversity and that crayfish injury response variables were more strongly correlated with crayfish density than physical habitat quality or water quality. Our results indicate that response variables describing the severity and frequency of crayfish injuries can be effective indicators of physical habitat quality in agricultural headwater streams.


Assuntos
Astacoidea , Rios , Qualidade da Água , Animais , Ecossistema , Monitoramento Ambiental , Indiana , Michigan , Ohio
5.
Plant Dis ; 104(3): 951-957, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31891549

RESUMO

This research was conducted to identify species causing powdery mildew on cucurbits and to determine genetic variations among isolates of the pathogen. We collected 109 isolates from six cucurbit species hosts (Cucumis melo, Cucumis sativus, Cucurbita maxima, Cucurbita moschata, Cucurbita pepo, and Lagenaria siceraria) in California, Illinois, Indiana, Michigan, New York, Texas, Washington, and Wisconsin in the United States and in Italy. By sequencing the internal transcribed spacer region of the nuclear rDNA of these 109 isolates, Podosphaera xanthii was found as the only species causing powdery mildew on cucurbits in the United States. Genotyping-by-sequencing was applied to these 109 isolates to investigate their genetic diversity, which showed a trend of isolates clustering from New York and Italy. In addition, the virulence of 36 isolates was compared and a significant difference (P < 0.0001) was found among them. Furthermore, results of the virulence tests of 28 isolates from Illinois showed significant effects of collection years, hosts, and locations on the virulence of the isolates.


Assuntos
Variação Genética , Doenças das Plantas , California , Genótipo , Illinois , Itália , Michigan , New York , Texas , Washington , Wisconsin
6.
Water Res ; 171: 115442, 2020 Mar 15.
Artigo em Inglês | MEDLINE | ID: mdl-31927093

RESUMO

In the aftermath of the lead contamination crisis that plagued the water system in Flint, MI, more than 35,000 water samples were collected from the city's premises. The majority of these samples (>85%) were collected through a voluntary crowdsourced sampling campaign. The samples were analyzed for lead and copper concentrations by the Michigan Department of Environmental Quality (MDEQ). In this study, the crowdsourced sampling data was analyzed by means of spatial autocorrelation analysis to reveal the locations of statistically significant hotspot regions of high water lead levels (WLLs), and to track the spatiotemporal evolution of WLLs as the system recovered from lead contamination. The results showed that hotspot regions that experienced high WLLs were consistent with the areas where lead service line (LSL) density was the highest. Additionally, galvanized service lines and other lead-containing plumbing components could have also contributed to lead release in hotspot regions. The temporal trend exhibited by the crowdsourced sampling data did not reflect a consistent decrease in WLLs despite the interventions implemented by MDEQ and EPA. Instead, sampled WLLs remained high for several months after boosting the orthophosphate dose and launching a city-wide residential flushing campaign. The findings of this study suggest that this could be partially attributed to disproportionate sampling from premises in hotspot regions of high WLLs and LSL density.


Assuntos
Crowdsourcing , Água Potável , Poluentes Químicos da Água , Cidades , Chumbo , Michigan , Abastecimento de Água
7.
West J Emerg Med ; 21(2): 291-294, 2020 Jan 27.
Artigo em Inglês | MEDLINE | ID: mdl-31999248

RESUMO

INTRODUCTION: Detroit, Michigan, is among the leading United States cities for per-capita homicide and violent crime. Hospital- and community-based intervention programs could decrease the rate of violent-crime related injury but require a detailed understanding of the locations of violence in the community to be most effective. METHODS: We performed a retrospective geospatial analysis of all violent crimes reported within the city of Detroit from 2009-2015 comparing locations of crimes to locations of major hospitals. We calculated distances between violent crimes and trauma centers, and applied summary spatial statistics. RESULTS: Approximately 1.1 million crimes occurred in Detroit during the study period, including approximately 200,000 violent crimes. The distance between the majority of violent crimes and hospitals was less than five kilometers (3.1 miles). Among violent crimes, the closest hospital was an outlying Level II trauma center 60% of the time. CONCLUSION: Violent crimes in Detroit occur throughout the city, often closest to a Level II trauma center. Understanding geospatial components of violence relative to trauma center resources is important for effective implementation of hospital- and community-based interventions and targeted allocation of resources.


Assuntos
Crime , Homicídio , Centros de Traumatologia , Violência/estatística & dados numéricos , Adulto , Assistência à Saúde , Feminino , Acesso aos Serviços de Saúde , Humanos , Masculino , Michigan , Estudos Retrospectivos , Centros de Traumatologia/estatística & dados numéricos , Estados Unidos
8.
Chemosphere ; 241: 125091, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31683442

RESUMO

Soil columns were collected from a blueberry field, and insecticide solutions were allowed to leach through these columns. Insecticides from four different chemical classes were applied at two different rates: the concentration at which the insecticides wash off blueberries under rainfall conditions and the labeled field rate at which they are sprayed. The soil columns were divided into thirds; top, middle and bottom. Soil bioassays using Eisenia foetida Savigny, as an indicator species, were set up to determine the toxicity of the insecticides at a top, middle and bottom layer of the soil column. The mass of E. foetida was also measured after the bioassay experiment was completed. The concentrations at which insecticides wash-off of blueberries from rainfall were not lethal to E. foetida. In order to support mortality data, insecticide residues were quantified in the soil layers for each insecticide. Under field rate leaching conditions, carbaryl showed the high levels of toxicity in the top and middle layers of soil suggesting that it has the highest risk to organisms from leaching. This study will help blueberry growers make informed decisions about insecticide use, which can help minimize contamination of the environment.


Assuntos
Mirtilos Azuis (Planta)/crescimento & desenvolvimento , Inseticidas/análise , Inseticidas/toxicidade , Oligoquetos/efeitos dos fármacos , Poluentes do Solo/toxicidade , Animais , Carbaril/análise , Carbaril/toxicidade , Produtos Agrícolas/crescimento & desenvolvimento , Ecotoxicologia , Michigan , Resíduos de Praguicidas/análise , Chuva , Solo/química , Poluentes do Solo/análise
9.
Vasc Endovascular Surg ; 54(2): 135-140, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31769352

RESUMO

PURPOSE: Ultrasound-facilitated, catheter-directed, low-dose fibrinolysis (USAT) appears to provide promising results for the management of acute submassive pulmonary embolisms (ASMPEs) at tertiary care centers. This study assessed outcome measures at a community-based hospital systems and compared results to known studies. MATERIALS AND METHODS: This is a single-center, retrospective study assessing clinical outcomes of the EkoSonic Endovascular System intervention for ASMPEs performed by three surgical 3 subspecialties (interventional radiology, interventional cardiology, and vascular surgery) part of a pulmonary embolism response team (PERT). We reviewed 146 PERT activations from June 2013 to December 2017. Eighty-three patients with ASMPEs underwent USAT. RESULTS: Our study showed greater differences (P = .01) between baseline and follow-up pulmonary artery systolic pressures (20.9 ± 9.8 mm Hg [n = 14]) compared to the ULTIMA study (12.3 ± 10 mm Hg [n = 30]). Our length-of-stay measures were shorter (6.1 ± 5.1 [n = 83]; P = .0001) compared to the SEATTLE II study (8.8 ± 5.0 [n = 150]). Preprocedure transthoracic echocardiograms (TTEs) were performed for 54 (65%) of 83 patients. Postprocedure TTEs at 48 hours was performed for 52 (62%) of 83 patients. Use of TTEs before and after intervention did not change outcomes. Intracranial hemorrhage was not observed in our patient population. There was no difference in outcomes between the three subspecialties in our study. CONCLUSIONS: Use of USAT in a community-based hospital PERT has similar outcomes to tertiary care centers. Furthermore, similar outcomes were observed between the three subspecialties suggesting development of a comprehensive care team for management of ASMPEs.


Assuntos
Cateterismo Periférico , Fibrinolíticos/administração & dosagem , Hospitais Comunitários , Embolia Pulmonar/terapia , Terapia Trombolítica/métodos , Terapia por Ultrassom , Doença Aguda , Adulto , Idoso , Cardiologistas , Cateterismo Periférico/efeitos adversos , Feminino , Fibrinolíticos/efeitos adversos , Humanos , Infusões Intra-Arteriais , Masculino , Michigan , Pessoa de Meia-Idade , Embolia Pulmonar/diagnóstico por imagem , Embolia Pulmonar/fisiopatologia , Radiologistas , Estudos Retrospectivos , Especialização , Cirurgiões , Terapia Trombolítica/efeitos adversos , Fatores de Tempo , Resultado do Tratamento , Terapia por Ultrassom/efeitos adversos
10.
World Neurosurg ; 133: e619-e626, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31568914

RESUMO

OBJECTIVE: Although postoperative urinary retention (POUR) is common after spine surgery, the association of this adverse event with other morbidities and patient-reported outcomes is not fully understood. We sought to examine the sequelae of POUR after lumbar spine surgery. METHODS: The Michigan Spine Surgery Improvement Collaborative (MSSIC) is a large prospective multicenter registry. MSSIC was queried with multivariate analysis for factors that are associated with POUR, the association of POUR with 90-day adverse events, and the effect of POUR on 2-year patient-reported outcomes and satisfaction. RESULTS: Multivariate analysis identified hardware revision (odds ratio [OR], 0.61), 1 operative level (OR, 0.74), and ambulation on postoperative day zero (OR, 0.65) to be protective for POUR. Factors associated with POUR included age (OR, 1.19), male gender (OR, 1.58), body mass index <25 (OR, 1.22), diabetes (OR, 1.28), coronary artery disease (OR, 1.20), fusion surgery (OR, 1.27), and longer surgery (OR, 1.11). Patients who had POUR were more likely to be readmitted, develop a urinary tract infection, and develop an infection (P < 0.001). POUR was associated with decreased likelihood of achieving Oswestry Disability Index minimal clinically important difference at 90 days (P < 0.001), but not at 1 year after surgery. POUR was associated with dissatisfaction with surgery at 90 days (P < 0.001), 1 year (P = 0.004), and 2 years after surgery (P = 0.011). CONCLUSIONS: POUR is common after lumbar spine surgery, and the demographic, diagnostic, and surgical factors that are associated with POUR are identified. POUR is associated with several adverse events, and patients who have POUR were less likely to be satisfied with surgery up to 2 years after surgery.


Assuntos
Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Fusão Vertebral/efeitos adversos , Retenção Urinária/epidemiologia , Retenção Urinária/etiologia , Adulto , Idoso , Estudos de Coortes , Feminino , Humanos , Vértebras Lombares , Masculino , Michigan , Pessoa de Meia-Idade , Sistema de Registros , Fatores de Risco
11.
Plant Dis ; 104(1): 246-254, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31644390

RESUMO

Species within clade 2 of the Fusarium solani species complex (FSSC) are significant pathogens of dry bean (Phaseolus vulgaris) and soybean (Glycine max), causing root rot and/or sudden death syndrome (SDS). These species are morphologically difficult to distinguish and often require molecular tools for proper diagnosis to a species level. Here, a TaqMan probe-based quantitative PCR (qPCR) assay was developed to distinguish Fusarium brasiliense from other closely related species within clade 2 of the FSSC. The assay displays high specificity against close relatives and high sensitivity, with a detection limit of 100 fg. This assay was able to detect F. brasiliense from purified mycelia, infected dry bean roots, and soil samples throughout Michigan. When multiplexed with an existing qPCR assay specific to Fusarium virguliforme, accurate quantification of both F. brasiliense and F. virguliforme was obtained, which can facilitate accurate diagnoses and identify coinfections with a single reaction. The assay is compatible with multiple qPCR thermal cycling platforms and will be helpful in providing accurate detection of F. brasiliense. Management of root rot and SDS pathogens in clade 2 of the FSSC is challenging and must be done proactively, because no midseason management strategies currently exist. However, accurate detection can facilitate management decisions for subsequent growing seasons to successfully manage these pathogens.


Assuntos
Fusarium , Doenças das Plantas , Reação em Cadeia da Polimerase , Soja , Fusarium/genética , Michigan , Doenças das Plantas/microbiologia , Raízes de Plantas/microbiologia , Microbiologia do Solo , Soja/microbiologia , Especificidade da Espécie
12.
Urology ; 136: 63-69, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31618657

RESUMO

OBJECTIVE: To understand patient and practice-level factors impacting postoperative imaging use after ureteroscopy (URS) for urinary stone disease. METHODS: The Michigan Urological Surgery Improvement Collaborative's Reducing Operative Complications from Kidney Stones (MUSIC ROCKS) initiative is a consortium of 52 urologists from 11 practices in Michigan. From June 2016 to July 2017, we prospectively collected clinical data for patients undergoing URS for stone treatment by MUSIC ROCKS participants. We measured the proportion of these patients who underwent US, AXR, and/or CT within the first 60 days after their procedure. We then assessed variation in the use of post-URS imaging according to patient characteristics and across MUSIC ROCKS practices. RESULTS: During the 13-month study period, we identified 2850 patients who were treated with URS for stone disease. Overall, only 47.6% of these patients underwent postoperative imaging. AXR was the most common modality used (55.0% of patients), followed by US (21.9%) and CT (11.1%). As shown in the Figure, use of post-URS imaging varied widely across participating practices (23.7%-73.6%; P <.01). Imaging receipt did not differ by patient age, gender, or insurance status. However, patients with more comorbidities, renal stones and those with larger stones were more likely to receive post-URS imaging (P <.05 for each comparison). CONCLUSION: Fewer than half of patients in Michigan undergo postoperative imaging after URS for stone disease. Moreover, there is substantial variation across providers in post-URS imaging use. These findings help identify opportunities to improve the quality of care for patients with urinary stone disease in the State.


Assuntos
Cálculos Renais/cirurgia , Cuidados Pós-Operatórios/estatística & dados numéricos , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/prevenção & controle , Padrões de Prática Médica/estatística & dados numéricos , Utilização de Procedimentos e Técnicas/estatística & dados numéricos , Melhoria de Qualidade , Ureteroscopia , Urologia , Adulto , Idoso , Feminino , Humanos , Masculino , Michigan , Pessoa de Meia-Idade , Estudos Prospectivos
13.
Dis Colon Rectum ; 63(1): 84-92, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31633600

RESUMO

BACKGROUND: There is increased focus on the value of surgical care. Postoperative complications decrease value, but it is unknown whether high-value hospitals spend less than low-value hospitals in cases without complications. Previous studies have not evaluated both expenditures and validated outcomes in the same patients, limiting the understanding of interactions between clinical performance, efficient utilization of services, and costliness of surgical episodes. OBJECTIVE: This study aimed to identify payment differences between low- and high-value hospitals in colectomy cases without adverse outcomes using a linked data set of multipayer claims and validated clinical outcomes. DESIGN: This is a retrospective observational cohort study. We assigned each hospital a value score (ratio of cases without adverse outcome to mean episode payment). We stratified hospitals into tertiles by value and used analysis of variance tests to compare payments between low- and high-value hospitals, first for all cases, and then cases without adverse outcome. SETTING: January 2012 to December 2016, this investigation used clinical registry data from 56 hospitals participating in the Michigan Surgical Quality Collaborative, linked with 30-day episode payments from the Michigan Value Collaborative. PATIENTS: A total of 2947 patients undergoing elective colectomy were selected. MAIN OUTCOME MEASURES: The primary outcome measured was risk-adjusted, price-standardized 30-day episode payments. RESULTS: The mean adjusted complication rate was 31% (±10.7%) at low-value hospitals and 14% (±4.6%) at high-value hospitals (p < 0.001). Low-value hospitals were paid $3807 (17%) more than high-value hospitals ($22,271 vs $18,464, p < 0.001). Among cases without adverse outcome, payments were still $2257 (11%) higher in low-value hospitals ($19,424 vs $17,167, p = 0.04). LIMITATIONS: This study focused on outcomes and did not consider processes of care as drivers of value. CONCLUSIONS: In elective colectomy, high-value hospitals achieve lower episode payments than low-value hospitals for cases without adverse outcome, indicating mechanisms for increasing value beyond reducing complications. Worthwhile targets to optimize value in elective colectomy may include enhanced recovery protocols or other interventions that increase efficiency in all phases of care. See Video Abstract at http://links.lww.com/DCR/B56. LOGRANDO LA COLECTOMÍA DE ALTO VALOR: PREVINIENDO COMPLICACIONES O MEJORANDO LA EFICIENCIA: Hay un mayor enfoque en el valor de la atención quirúrgica. Las complicaciones postoperatorias disminuyen el valor, pero se desconoce si en los casos sin complicaciones, los hospitales de alto valor gastan menos que los hospitales de bajo valor. Estudios anteriores no han evaluado ambos gastos y validado resultados en los mismos pacientes, limitando la comprensión de las interacciones entre el rendimiento clínico, utilización eficiente de los servicios y costos de los episodios quirúrgicos.Identificar las diferencias de pago entre los hospitales de alto y bajo valor, en casos de colectomía sin resultados adversos, utilizando un conjunto de datos vinculados de reclamos de pago múltiple y resultados clínicos validados.Estudio de cohorte observacional retrospectivo. Asignamos a cada hospital una puntuación de valor (proporción de casos sin resultado adverso al pago medio del episodio). Estratificamos los hospitales por valor en terciles y utilizamos el análisis de pruebas de varianza para comparar los pagos entre hospitales de bajo y alto valor, primero para todos los casos y luego casos sin resultados adversos.De enero del 2012 a diciembre del 2016, utilizando datos de registro clínico de 56 hospitales que participan en el Michigan Surgical Quality Collaborative, vinculado con pagos de episodios de 30 días, del Michigan Value Collaborative.Un total de 2947 pacientes con colectomía electiva.Pagos por episodio de 30 días, ajustados al riesgo y estandarizados por precio.La tasa media de complicación ajustada fue de 31% (±10.7%) en hospitales de bajo valor y 14% (±4.6%) en hospitales de alto valor (p < 0.001). A los hospitales de bajo valor se les pagó $3807 (17%) más que a los hospitales de alto valor ($22,271 frente a $18,464, p < 0.001). Entre los casos sin resultados adversos, los pagos fueron de $2257 (11%) más altos en hospitales de bajo valor ($19,424 vs $17,167, p = 0.04).Este estudio se centró en los resultados y no se consideraron a los procesos de atención, como impulsores de valor.En la colectomía electiva, los hospitales de alto valor logran pagos de episodios más bajos, que en los hospitales de bajo valor con casos sin resultados adversos, indicando mecanismos para aumentar el valor, más allá que la reducción de complicaciones. Objetivos valiosos para optimizar el valor de la colectomía electiva, pueden incluir mejoras en los protocolos de recuperación, así como otras intervenciones que aumenten la eficiencia en todas las fases de la atención. Vea el resumen del video en http://links.lww.com/DCR/B56.


Assuntos
Colectomia/normas , Hospitais/normas , Complicações Pós-Operatórias/prevenção & controle , Melhoria de Qualidade , Idoso , Colectomia/métodos , Procedimentos Cirúrgicos Eletivos/normas , Feminino , Seguimentos , Humanos , Incidência , Masculino , Michigan/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Fatores de Risco
14.
Dis Colon Rectum ; 63(1): 53-59, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31633602

RESUMO

BACKGROUND: Total mesorectal excision is associated with decreased local recurrence and improved disease-free survival following rectal cancer resection. The extent to which total mesorectal excision has been adopted in the United States is unknown. OBJECTIVE: We sought to assess trends in total mesorectal excision performance and grading in Michigan hospitals. DESIGN: This is a retrospective cohort study from the Michigan Surgical Quality Collaborative. Trends in total mesorectal excision performance and grade assignment were analyzed by using χ tests and linear regression. SETTINGS: Participating hospitals (initially 14 hospitals, now 38) abstracted medical records data for rectal cancer cases from 2007 to 2016. PATIENTS: Patients who underwent rectal cancer resection were included. MAIN OUTCOME MEASURE: The main outcome measures were surgeon-documented total mesorectal excision performance and pathologist-reported total mesorectal excision grade. RESULTS: Of 510 rectal cancer cases, 367 (72.0%) had surgeon-reported total mesorectal excision performance and 78 (15.3%) had pathologist-reported total mesorectal excision grade. Between-hospital variability in total mesorectal excision performance ranged from 0% to 97% and total mesorectal excision grading ranged from 0% to 90%. Total mesorectal excision grading was associated with a higher likelihood of also having adequate lymph node assessment (88.5% versus 71.9%, p = 0.002). There has been a statistically significant trend toward an increase in total mesorectal excision grading in the original 14 hospitals (p = 0.001), but not in the complete cohort of all hospitals (p = 0.057). LIMITATIONS: This is a retrospective cohort design with sampled rectal cancer cases. In addition, there is insufficient granularity to capture all factors associated with total mesorectal excision performance or grade assignment. CONCLUSIONS: The rates of total mesorectal excision performance and grade assignment are widely variable throughout the state of Michigan. Overall, grade assignment remains very low. This suggests an opportunity for quality improvement projects to increase total mesorectal excision performance and grading, involving both the surgeons and pathologists for effective implementation. See Video Abstract at http://links.lww.com/DCR/B53. IMPLEMENTACIÓN DE LA ESCISIÓN MESORRECTAL TOTAL Y LA CLASIFICACIÓN POR ESCISIÓN MESORRECTAL TOTAL PARA EL CÁNCER RECTAL: UN ESTUDIO A NIVEL ESTATAL.: La escisión mesorrectal total se asocia con una menor recurrencia local y una mejor supervivencia libre de enfermedad después de la resección del cáncer rectal. Se desconoce hasta que punto se ha adoptado la escisión mesorrectal total en los Estados Unidos.Se intento evaluar las tendencias en el rendimiento y la clasificación de la escisión mesorrectal total en los hospitales de Michigan.Este es un estudio de cohorte retrospectivo de la "Michigan Surgical Quality Collaborative". Las tendencias en el rendimiento de la escisión mesorrectal total y la asignación de grado se analizaron mediante pruebas de chi-cuadrada y regresión lineal.Los hospitales participantes (inicialmente 14 hospitales, ahora 38) extrajeron datos de registros médicos de los casos de cáncer rectal desde 2007 hasta 2016.Pacientes que se sometieron a resección de cáncer rectal.Las principales medidas de resultado fueron el rendimiento de la escisión mesorrectal total documentado por el cirujano y el grado de escisión mesorrectal total informada por el patólogo.De 510 casos de cáncer rectal, 367 (72.0%) tenían un rendimiento de escisión mesorrectal total reportado por el cirujano y 78 (15.3%) tenían un grado de escisión mesorrectal total reportado por el patólogo. La variabilidad entre hospitales en el rendimiento de la escisión mesorrectal total varió del 0 al 97% y la clasificación de la escisión mesorrectal total varió del 0 al 90%. La clasificación de la escisión mesorrectal total se asoció con una mayor probabilidad de tener también una evaluación adecuada de los ganglios linfáticos (88.5% versus 71.9%, p = 0.002). Ha habido una tendencia estadísticamente significativa hacia un aumento en la clasificación de la escisión mesorrectal total en los 14 hospitales originales (p = 0.001), pero no en la cohorte completa de todos los hospitales (p = 0.057).Diseño de cohorte retrospectivo con casos de cáncer rectal muestreados. Además, no hay suficiente granularidad para capturar todos los factores asociados con el rendimiento de la escisión mesorrectal total o la asignación de grados.Las tasas de rendimiento de escisión mesorrectal total y asignación de grado son muy variables en todo el estado de Michigan. En general, la asignación de calificaciones sigue siendo muy baja. Esto sugiere una oportunidad para que los proyectos de mejora de la calidad aumenten el rendimiento y la clasificación de la escisión mesorrectal total, involucrando tanto a los cirujanos como a los patólogos para una implementación efectiva. Vea el resumen del video en http://links.lww.com/DCR/B53.


Assuntos
Gradação de Tumores/métodos , Protectomia/métodos , Melhoria de Qualidade , Neoplasias Retais/cirurgia , Reto/cirurgia , Feminino , Seguimentos , Humanos , Incidência , Masculino , Michigan/epidemiologia , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/epidemiologia , Neoplasias Retais/diagnóstico , Reto/diagnóstico por imagem , Estudos Retrospectivos , Resultado do Tratamento
15.
Med Educ Online ; 25(1): 1686949, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31672119

RESUMO

Background: The transition from a traditional lecture-based curriculum to a competency-based curriculum poses significant challenges to both students and faculty in medical schools, especially when the curriculum is implemented in a flipped learning environment. Self-regulated learning (SRL) has been proven to be beneficial for competency-based learning and flipped classroom learning, but medical educators cannot expect our entering medical students to bring in these learning skills automatically.Methods: This study took place in the Michigan State University College of Human Medicine. A new competency-based curriculum was implemented in the fall 2016, focusing on the integration of basic science and clinical experience. Participants in this study were 26 first- and second-year students. By interviewing each student about the learning strategies they use in independent learning before class, we investigated how students use SRL strategies in different phases of learning, and how their adoption of SRL strategies differ across self-perceived achievement groups and years.Results: We found that students frequently use strategies in the stages of planning and reflection, but less frequently during the learning or monitoring phase. Students who perceive themselves as high achieving, and students in their second year of medical school do use more learning strategies during the monitoring stage than their counterparts.Conclusions: Students who lack self-regulation strategies may fail to comprehend or connect ideas in their pre-class learning, which could lead to ineffective learning outcomes during in-class activities. Our study indicated that while medical students, who tend to be successful learners in their undergraduate study, were able to use learning strategies to plan and reflect on their learning, they need more explicit instruction in how to monitor their own learning.


Assuntos
Currículo , Aprendizagem , Aprendizagem Baseada em Problemas , Estudantes de Medicina , Educação Médica , Feminino , Humanos , Entrevistas como Assunto , Masculino , Michigan , Pesquisa Qualitativa , Ensino
16.
Urology ; 137: 38-44, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31843621

RESUMO

OBJECTIVE: To understand how treatment of patients with urinary stones by shockwave lithotripsy (SWL) aligns with current published practice guidelines. METHODS: We used the Michigan Urologic Surgery Improvement Collaborative Reducing Operative Complications for Kidney Stones registry to understand SWL use in the state of Michigan. This prospectively maintained clinical registry includes data from community and academic urology practices and contains clinical and operative data for patients undergoing SWL and ureteroscopy (URS). We identified patients undergoing SWL from 2016 to 2019. In accordance with AUA guidelines, we evaluated practice patterns in relation to recommendations for treatment selection for SWL as well as clinical implications of guideline nonadherence. RESULTS: Four thousand, two hundred and nine SWL procedures performed across 34 practices were analyzed. Perioperative antibiotics were administered to 61.3% of patients undergoing SWL. A ureteral stent was placed at the time of SWL in 2.7% of patients. For lower pole renal stones >1 cm or large (>2 cm) renal stones in the registry, 32.2% and 58.9% of patients, respectively, underwent SWL, while the remainder were treated with URS. In these instances, SWL was associated with inferior stone-free rate (SFR) relative to URS. In patients with residual stones after SWL, 34.6% were treated with repeat SWL with lower SFR than those treated with subsequent URS. Postoperatively, 42.1% of patients were prescribed alpha-blockers with no benefit seen in terms of SFR. CONCLUSION: Substantial variation exists among urology practices with regard to SWL use. These data serve to inform quality improvement efforts regarding appropriateness criteria for SWL in Michigan.


Assuntos
Fidelidade a Diretrizes/estatística & dados numéricos , Cálculos Renais/terapia , Litotripsia/estatística & dados numéricos , Utilização de Procedimentos e Técnicas/estatística & dados numéricos , Humanos , Michigan , Estudos Prospectivos , Sociedades Médicas , Estados Unidos , Urologia
17.
BMC Public Health ; 19(1): 1669, 2019 Dec 11.
Artigo em Inglês | MEDLINE | ID: mdl-31829165

RESUMO

BACKGROUND: Race and place intersect to produce location-based variation in disease distributions. We analyzed the geographic distribution of tuberculosis (TB) incidence in Michigan, USA to better understand the complex interplay between race and place, comparing patterns in Detroit, Wayne County and the state of Michigan as a whole. METHODS: Using cross-sectional TB surveillance data from the Michigan Department of Health and Human Services, multivariable statistical models were developed to analyze the residence patterns of TB incidence from 2007 through 2012. Two-way interactions among the residence location and race of cases were assessed. RESULTS: Overall, Detroit residents experienced 58% greater TB incidence than residents of Wayne County or the state of Michigan. Racial inequalities were less pronounced in Detroit compared to both Wayne County and the state of Michigan. Blacks in Detroit had 2.01 times greater TB incidence than Whites, while this inequality was 3.62 times more in Wayne County and 8.72 greater in the state of Michigan. CONCLUSION: Our results highlight how race and place interact to influence patterns of TB disease, and the ways in which this interaction is context dependent. TB elimination in the U.S. will require strategies that address the local social environment, as much as the physical environment.


Assuntos
Afro-Americanos/estatística & dados numéricos , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Disparidades nos Níveis de Saúde , Tuberculose/etnologia , Saúde da População Urbana/estatística & dados numéricos , Adulto , Estudos Transversais , Feminino , Humanos , Incidência , Masculino , Michigan/epidemiologia , Pessoa de Meia-Idade , Fatores de Risco , Meio Social , Fatores Socioeconômicos , Adulto Jovem
18.
Gynecol Oncol ; 155(3): 461-467, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31706666

RESUMO

OBJECTIVE: Although a high proportion of women with advanced stage ovarian cancer die within five years, approximately 30% will survive longer than this. The factors contributing to exceptional survival are currently poorly understood. The viewpoints of ovarian cancer survivors were qualitatively explored to determine the factors they felt have influenced their exceptional ovarian cancer survival. METHODS: Four focus groups, one each in Los Angeles (California), Ann Arbor (Michigan), New York (New York) and Edmonton (Alberta, Canada), were conducted with women who had survived at least five years. Physical activity, diet, meditation, prayer, treatment, complementary medicine, and side effects were explored in semi-structured discussions. The audiotaped sessions were transcribed and coded and then analyzed using Dedoose Version 8.0.35, a qualitative analysis software. RESULTS: Of the 26 women who participated, 23 had advanced stage disease. Three overarching themes emerged: (a) survivors had improved their 'lifestyles', including but not limited to fitness and diet; (b) survivors were able to draw on strong support systems, which included family, friends, support groups, faith communities, and healthcare workers; and (c) survivors had a strong life purpose, which manifested as positivity, taking charge of their lives, and advocating for themselves. CONCLUSIONS: Long-term survivors have varying experiences with their cancer, but identified lifestyle modification, motivation and persistence, strong life purpose, and strong support systems as key elements in their better survival. These preliminary findings indicate the need for further prospective studies to determine whether meaningful differences exist between short term and long term survivors on these characteristics.


Assuntos
Sobreviventes de Câncer/psicologia , Neoplasias Ovarianas/psicologia , Alberta/epidemiologia , California/epidemiologia , Feminino , Grupos Focais , Estilo de Vida Saudável , Humanos , Michigan/epidemiologia , Pessoa de Meia-Idade , Estadiamento de Neoplasias , New York/epidemiologia , Neoplasias Ovarianas/mortalidade , Neoplasias Ovarianas/patologia , Neoplasias Ovarianas/terapia , Apoio Social
19.
Environ Pollut ; 255(Pt 3): 113350, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31671370

RESUMO

A study was undertaken to test the hypothesis that the presence of fly ash and other artifactual materials (AMs) significantly increases the toxicity of urban soil and street dust. AMs were distinguished as artifacts (artificial particles > 2 mm in size), and particulate artifacts (≤2 mm in size); street dust was the <63 µm fraction of street sediments. Reference artifacts, street dusts, and topsoils representing different land use types in Detroit, Michigan were analyzed for miscellaneous radionuclides, trace elements, magnetic susceptibility (MS), and acetic acid-extractable (leachable) Pb. Background levels were established using native glacial sediments. Street sediments were found to have a roadside provenance, hence street dusts inherited their contamination primarily from local soils. All soils and dusts had radionuclide concentrations similar to background levels, and radiological hazard indices within the safe range. Artifacts, fly ash-impacted soils and street dusts contained elevated concentrations of toxic trace elements, which varied with land use type, but none produced a significant amount of leachable Pb. It is inferred that toxic elements in AMs are not bioavailable because they are occluded within highly insoluble materials. Hence, these results do not support our hypothesis. Rather, AMs contribute to artificially-elevated total concentrations leading to an overestimation of toxicity. MS increased with increasing total concentration, hence proximal sensing can be used to map contamination level, but the weak correlation between total and leachable Pb suggests that such maps do not necessarily indicate the associated biohazard. Home site soils with total Pb concentrations >500 mg kg-1 were sporadically toxic. Thus, these results argue against street dust as the local cause of seasonally elevated blood-Pb levels in children. Lead-bearing home site soil tracked directly indoors to form house dust is an alternative exposure pathway.


Assuntos
Monitoramento Ambiental , Poluentes do Solo/toxicidade , Criança , Cidades , Poeira/análise , Humanos , Metais Pesados/análise , Michigan , Medição de Risco/métodos , Solo , Poluentes do Solo/análise , Urbanização
20.
Environ Entomol ; 48(6): 1469-1480, 2019 12 02.
Artigo em Inglês | MEDLINE | ID: mdl-31701140

RESUMO

Arthropods provide a variety of critical ecosystem services in agricultural landscapes; however, agricultural intensification can reduce insect abundance and diversity. Designing and managing habitats to enhance beneficial insects requires the identification of effective insectary plants that attract natural enemies and provide floral resources. We tested the attractiveness of 54 plant species with tolerance to dry soils, contrasting perennial forbs and shrubs native to the Great Lakes region to selected non-native species in three common garden experiments in Michigan during 2015-2016. Overall, we found 32 species that attracted significantly more natural enemies than associated controls. Among these, Achillea millefolium and Solidago juncea were consistently among the most attractive plants at all three sites, followed by Solidago speciosa, Coreopsis tripteris, Solidago nemoralis, Pycnanthemum pilosum, and Symphyotrichum oolantangiense. Species which attracted significantly more natural enemies at two sites included: Asclepias syriaca, Asclepias tuberosa, Monarda fistulosa, Oligoneuron rigidum, Pycnanthemum virginianum, Dasiphora fruticosa, Ratibida pinnata, Asclepias verticillata, Monarda punctata, Echinacea purpurea, Helianthus occidentalis, Silphium integrifolium, Silphium terebinthinaceum, Helianthus strumosus, and Symphyotrichum sericeum. Two non-native species, Lotus corniculatus, and Centaurea stoebe, were also attractive at multiple sites but less so than co-blooming native species. Parasitic Hymenoptera were the most abundant natural enemies, followed by predatory Coleoptera and Hemiptera, while Hemiptera (Aphidae, Miridae, and Tingidae) were the most abundant herbivores. Collectively, these plant species can provide floral resources over the entire growing season and should be considered as potential insectary plants in future habitat management efforts.


Assuntos
Artrópodes , Animais , Secas , Ecossistema , Great Lakes Region , Michigan
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