Search

Aim:Sepsis is a top contributor to in-hospital mortality and, healthcare expenditures and telehealth have been shown to improve short-term sepsis care in rural hospitals. This study will evaluate the effect of provider-to-provider video telehealth in rural emergency departments (EDs) on healthcare costs and long-term outcomes for sepsis patients. Materials & methods:We will use Medicare administrative claims to compare total healthcare expenditures, mortality, length-of-stay, readmissions, and category-specific costs between telehealth-subscribing and control hospitals. Results:The results of this work will demonstrate the extent to which telehealth use is associated with total healthcare expenditures for sepsis care. Conclusion:These findings will be important to inform future policy initiatives to improve sepsis care in rural EDs.Clinical Trial Registration: NCT05072145(ClinicalTrials.gov)

While age-related cognitive decline may affect all stages in the response process—comprehension, retrieval, judgment, response selection, and response reporting—the associations between objective cognitive tests and the agreement between self-reports and Medicare claims has not been assessed. We evaluate those associations using the Survey on Assets and Health Dynamics among the Oldest Old (AHEAD).

Concordance between survey reports and claims data is not well established. We compared them for disease histories, preventative, and other health services use in a large, nationally representative sample of older Medicare beneficiaries with special attention given to evaluating age, aging, memory, and respondent status effects.

Previous studies of very low birth weight (VLBW) hospital volume effects on in-hospital mortality have used standard risk-adjusted models that only account for observable confounders but not for self-selection bias due to unobservable confounders.

Few large, international series of enteropathy-associated T-cell lymphoma (EATL) have been reported. We studied a cohort of 62 patients with EATL among 1153 patients with peripheral T-cell or natural killer (NK)–cell lymphoma from 22 centers worldwide. The diagnosis was made by a consensus panel of 4 expert hematopathologists using World Health Organization (WHO) criteria. Clinical correlations and survival analyses were performed. EATL comprised 5.4% of all lymphomas in the study and was most common in Europe (9.1%), followed by North America (5.8%) and Asia (1.9%). EATL type 1 was more common (66%) than type 2 (34%), and was especially frequent in Europe (79%). A clinical diagnosis of celiac sprue was made in 32.2% of the patients and was associated with both EATL type 1 and type 2. The median overall survival was only 10 months, and the median failure-free survival was only 6 months. The International Prognostic Index (IPI) was not as good a predictor of survival as the Prognostic Index for Peripheral T-Cell Lymphoma (PIT). Clinical sprue predicted for adverse survival independently of the PIT. Neither EATL subtype nor other biologic parameters accurately predicted survival. Our study confirms the poor prognosis of patients with EATL and the need for improved treatment options.

Few large, international series of enteropathy-associated T-cell lymphoma (EATL) have been reported. We studied a cohort of 62 patients with EATL among 1153 patients with peripheral T-cell or natural killer (NK)–cell lymphoma from 22 centers worldwide. The diagnosis was made by a consensus panel of 4 expert hematopathologists using World Health Organization (WHO) criteria. Clinical correlations and survival analyses were performed. EATL comprised 5.4% of all lymphomas in the study and was most common in Europe (9.1%), followed by North America (5.8%) and Asia (1.9%). EATL type 1 was more common (66%) than type 2 (34%), and was especially frequent in Europe (79%). A clinical diagnosis of celiac sprue was made in 32.2% of the patients and was associated with both EATL type 1 and type 2. The median overall survival was only 10 months, and the median failure-free survival was only 6 months. The International Prognostic Index (IPI) was not as good a predictor of survival as the Prognostic Index for Peripheral T-Cell Lymphoma (PIT). Clinical sprue predicted for adverse survival independently of the PIT. Neither EATL subtype nor other biologic parameters accurately predicted survival. Our study confirms the poor prognosis of patients with EATL and the need for improved treatment options.

The International Peripheral T-Cell Lymphoma Project is a collaborative effort designed to gain better understanding of peripheral T-cell and natural killer (NK)/T-cell lymphomas (PTCLs). A total of 22 institutions in North America, Europe, and Asia submitted clinical and pathologic information on PTCLs diagnosed and treated at their respective centers. Of the 1314 eligible patients, 181 had anaplastic large-cell lymphoma (ALCL; 13.8%) on consensus review: One hundred fifty-nine had systemic ALCL (12.1%) and 22 had primary cutaneous ALCL (1.7%). Patients with anaplastic lymphoma kinase–positive (ALK+) ALCL had a superior outcome compared with those with ALK−ALCL (5-year failure-free survival [FFS], 60% vs 36%; P= .015; 5-year overall survival [OS], 70% vs 49%; P= .016). However, contrary to prior reports, the 5-year FFS (36% vs 20%; P= .012) and OS (49% vs 32%; P= .032) were superior for ALK−ALCL compared with PTCL, not otherwise specified (PTCL-NOS). Patients with primary cutaneous ALCL had a very favorable 5-year OS (90%), but with a propensity to relapse (5-year FFS, 55%). In summary, ALK−ALCL should continue to be separated from both ALK+ALCL and PTCL-NOS. Although the prognosis of ALK−ALCL appears to be better than that for PTCL-NOS, it is still unsatisfactory and better therapies are needed. Primary cutaneous ALCL is associated with an indolent course.

The International Peripheral T-Cell Lymphoma Project is a collaborative effort designed to gain better understanding of peripheral T-cell and natural killer (NK)/T-cell lymphomas (PTCLs). A total of 22 institutions in North America, Europe, and Asia submitted clinical and pathologic information on PTCLs diagnosed and treated at their respective centers. Of the 1314 eligible patients, 181 had anaplastic large-cell lymphoma (ALCL; 13.8%) on consensus review: One hundred fifty-nine had systemic ALCL (12.1%) and 22 had primary cutaneous ALCL (1.7%). Patients with anaplastic lymphoma kinase–positive (ALK+) ALCL had a superior outcome compared with those with ALK− ALCL (5-year failure-free survival [FFS], 60% vs 36%; P = .015; 5-year overall survival [OS], 70% vs 49%; P = .016). However, contrary to prior reports, the 5-year FFS (36% vs 20%; P = .012) and OS (49% vs 32%; P = .032) were superior for ALK− ALCL compared with PTCL, not otherwise specified (PTCL-NOS). Patients with primary cutaneous ALCL had a very favorable 5-year OS (90%), but with a propensity to relapse (5-year FFS, 55%). In summary, ALK− ALCL should continue to be separated from both ALK+ ALCL and PTCL-NOS. Although the prognosis of ALK− ALCL appears to be better than that for PTCL-NOS, it is still unsatisfactory and better therapies are needed. Primary cutaneous ALCL is associated with an indolent course.

Motor vehicle crash (MVC) mortality rates are inversely related to population density. The purpose of this study was to analyze if there is a regional variation in the risk of MVC death after controlling for injury severity.

We examined differences in health care ratings and reported health care experiences for active duty uniform services personnel using health care plans other than military treatment facilities.

Objective:This study investigated the relationships of plasma vitamins A, E, and carotenoids with age, BMI and former/non-smoking history after adjusting for wheat bran supplementation.Methods:All 39 African American women in the church-based, volunteer sample, 40–70 years old, supplemented their daily diets for 5–6 wks. with 1/2 cup of a riboflavin-spiked wheat bran cereal.Results:Urinary riboflavin concentrations increased from 0.8 ± 0.1 mg/day at baseline to 7.5 ± 0.5 mg/day after supplementation, confirming the 99.2 ± 10.5% self-reported adherence. Plasma nutrient concentrations did not change significantly with supplementation nor was never/former smoking history related to diet. Plasma retinol and serum cholesterol were significantly higher (p< 0.0002) in persons older than 55 years compared to younger adults. Plasma retinol (μg/dL) but not serum cholesterol was associated significantly with menopausal status and hormone replacement therapy (HRT; p = 0.05); progressive increases in retinol concentrations were found in the women after adjusting for pre/post supplementation: lowest in pre-menopause (47.7 ± 4.8); intermediate concentrations in post-menopause on HRT (54.6 ± 3.0); highest level in post-menopause without HRT (61.1 ± 3.0). Similarly, a progressive increase was found in lipid-unadjusted α-tocopherol concentrations and menopausal status with or without HRT. Vitamin A and cholesterol intakes were not significantly different by age group. Plasma carotenoids were not significantly different by age or fiber supplementation, but α- and β-carotene and β-cryptoxanthin were significantly lower with BMI ≥ 30. In contrast to carotenoids, both plasma levels of γ-tocopherol and lipid-adjusted γ-tocopherol were significantly higher with obesity compared to those with BMI < 30.Conclusion:Plasma α- and β-carotene and β-cryptoxanthin were negatively associated with obesity, whereas γ-tocopherol measures were consistently elevated with high BMI. The increase in age-associated plasma retinol in postmenopausal women was likely related to decreased estrogen concentrations in the African American women. Smoking history was not influential in this study.

Abstract: In recent reports, investigators have described a variant of adult sclerosing rhabdomyosarcoma (RMS) that is characterized by a hyalinizing, matrix-rich stroma. To determine whether this variant occurs in children we investigated this phenomenon in a recent series of 1207 pediatric patients who had RMS accessioned by the Intergroup Rhabdomyosarcoma Study Group, now part of Children's Oncology Group. Thirteen patients had features of sclerosing RMS; 9 had been diagnosed with alveolar RMS (ARMS), 3 with embryonal RMS (ERMS),FKHR). Cytogenetic testing in 2 patients who had ARMS-like foci demonstrated mild hyperdiploidy in both patients and a near-tetraloid clone in 1 patient. Sclerosing RMS may arise in children, have mixed ERMS-ARMS histology, originate from the head and neck, and lack strong myogenin staining

Background.This study was undertaken to evaluate the long-term smoking cessation efficacy of varying doses of transdermal nicotine delivery systems 4 to 5 years post-quit day.

AbstractHigh dietary fiber intake has been hypothesized to lower blood estrogen concentrations, an effect thought to be beneficial for decreasing breast cancer risk This study investigated the association between dietary supplementation of wheat bran and circulating estrogen levels in postmenopausal African‐American women participating in a community intervention trial. Seventeen postmenopausal women (aged 63 ± 1.6 yr) participated in the study. Nutritional status was assessed and blood and 24‐hour urine samples were collected before and after five to six weeks of daily supplementation of the diet with 35 g of wheat bran cereal (11.6 g insoluble dietary fiber) marked with 28 mg of riboflavin. Riboflavin confirmed that all postmenopausal participants adhered to the intervention protocol. Nine of the 17 postmenopausal women were taking some form of estrogen replacement therapy (PM‐ERT). Baseline hormone levels in the PM‐ERT group did not significantly change after the dietary intervention. Estradiol (96.8±20.3 vs. 113.8 ± 23.3 pg/ml), androstenedione (0.47 ± 0.06 vs. 0.45 ± 0.06 ng/ml), and sex hormone‐binding globulin (SHBG, 107 ± 13.5 vs. 106.6 ± 13.3 nmol/l) levels remained constant. In the eight postmenopausal women who were not receiving exogenous hormones (PM), wheat bran consumption was not associated with predicted decreased levels of estradiol (25.7 ± 2.7 vs. 31.0 ± 1.9 pg/ml), estrone (38.3 ± 10.1 vs. 39.3 ± 10.6 pg/ml), and androstenedione (0.78 ± 0.08 vs. 0.68 ±0.11 ng/ml) or with increased concentrations of SHBG (35.2 ± 6.4 vs. 34.8 ± 6.5 nmol/l). Participants receiving ERT had baseline and postin‐tervention levels of estradiol and SHBG significantly higher and androstenedione significantly lower than those not receiving ERT. No association between wheat bran supplementation and hormone levels was found in PM or PM‐ERT African‐American participants. These results in postmenopausal women are in contrast to findings of earlier studies in premenopausal women indicating that wheat bran fiber decreases serum sex hormones. Estrogen levels in postmenopausal women are only 5–10% of those in premenopausal women; therefore, a high wheat bran fiber diet alone may not be sufficient to depress these low levels even further.

Abstract: The lengths of time adults are without health insurance have increased since 1988, as shown by data from 1,235 household interviews completed during 1992 in Nebraska. Rural residents without insurance have experienced longer such spells than their urban counterparts. Thus, while rates of uninsurance are nearly the same between urban and rural residents, important differences exist. The relationship between insurance status and physician utilization is consistent during the five years (1989 to 1993) covered in this study. Continuously insured persons have the most physician visits, followed by those intermittently insured, followed by those continuously uninsured. The number of physician visits was expected to increase when respondents moved from uninsured to insured status. However, among urban respondents, the number of visits declined; among residents in rural frontier counties (fewer than six persons per square mile) and for respondents in rural nonfrontier counties, there was no significant difference. This study points out some differences between rural and urban populations regarding insurance status, even when the overall rates of uninsurance are equal.