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Background To decrease hospital readmission rates, clinical practices create a transition of care (TOC) process to assess patients and coordinate care postdischarge. As current evidence suggests lack of universal benefit, this study's objectives are to determine what patient and process factors associate with hospital readmissions, as well as construct a model to decrease 30-day readmissions. Methods Three months of retrospective discharged patient data (n = 123) were analysed for readmission influences including: patient-specific comorbidities, admission-specific diagnoses, and TOC components. A structured intervention of weekly contact, the Care Coordination Cocoon (CCC), was created for multiply readmitted patients (MRPs), defined as ≥2 readmissions. Three months of postintervention data (n = 141) were analysed. Overall readmission rates and patient- and process-specific characteristics were analysed for associations with hospital readmission. Results Standard TOC lacked significance. Patient-specific comorbidities of cancer (odds ratio [OR] 6.27; 95% confidence interval [CI] 1.73–22.75) and coronary artery disease (OR 6.71; 95% CI 1.84–24.46), and admission-specific diagnoses within pulmonary system admissions (OR 7.20; 95% CI 1.96–26.41) were associated with readmissions. Post-CCC data demonstrated a 48-h call (OR 0.21; 95% CI 0.09–0.50), answered calls (OR 0.16; CI 0.07–0.38), 14-day scheduled visit (OR 0.20; 95% CI 0.07–0.54), and visit arrival (OR 0.39; 95% CI 0.17–0.91) independently associated with decreased readmission rate. Patient-specific (hypertension—OR 3.65; CI 1.03–12.87) and admission-specific (nephrologic system—OR 3.22; CI 1.02–10.14) factors associated with readmissions which differed from the initial analysis. Conclusions Targeting a practice's MRPs with CCC resources improves the association of TOC components with readmissions and rates decreased. This is a more efficient use of TOC resources. [ABSTRACT FROM AUTHOR]

Introduction: Both expressive and receptive language development begins early in life. While the benefits of reading to toddlers (over 12 months old) is well-established, benefits of reading to infants (birth to 12 months old) is less established. This study's objective is to determine if consistent reading to infants improves expressive and receptive language development during the first year of life. METHODS: We prospectively randomized infants at a family medicine clinic during their 2-week-old visits and gave them a collection of books. Group A (n = 16) received no instructions, while patients in Group B (n = 18) committed to read 1 book a day. Parents in Group C (n = 18) enrolled after 34 weeks gestation, committed to read 1 book a day, and watch an infant brain development video. We obtained average book counts and both expressive and receptive language testing at standard preventative visits through 12 months. RESULTS: Language scores did not differ between randomized groups. Always reading 7 books per week led to higher expressive, receptive and combined language scores at 9 months than sometimes reading fewer than 7 books per week ( P  = .025, 0.009 and 0.011 respectively). These differences increased by 12 months ( P  = .004, 0.002, and 0.003, respectively). Instructing parents to read daily encouraged parents to read more books per week at 4 months ( P  = .031) and 6 months ( P  = .049). DISCUSSION: Early, consistent reading demonstrates improved language scores as early as 9 months of age. Setting expectations of minimal daily reading impacted daily reading compliance early in life., Competing Interests: Conflicts of interest: None., (© Copyright by the American Board of Family Medicine.)

Despite its importance, the death rate of ovarian cancer has remained unchanged over the past five decades, demanding an improvement in prevention and treatment of this malignancy. With no known carcinogens, targeted prevention is currently unavailable, and efforts in early detection of this malignancy by screening biomarkers have failed. The inhibition of angiogenesis, also known as angioprevention, is a promising strategy to limit the growth of solid tumors, including ovarian cancers. Nobiletin, a polymethoxy flavonoid compound isolated from the tiansheng plant, has been shown to inhibit the growth of multiple types of human cancers. However, there are no reports involving the effect on nobiletin on human ovarian cancer. The present report shows that nobiletin potently decreases the viability of ovarian cancer cells in vitro. However, nobiletin does not affect the viability of normal ovarian epithelial cells at <40 µM. The antitumor activity of nobiletin was also observed in athymic mouse models and in chicken chorioallantoic membrane (CAM) models. The anti-neoplastic activity of nobiletin was due to its ability to inhibit angiogenesis. We also studied the molecular mechanisms by which nobiletin suppresses angiogenesis. We observed that nobiletin inhibits secretion of the key angiogenesis mediators, Akt, HIF-1α, NF-κB and vascular epithelial growth factor (VEGF) by ovarian cancer cells. Transient transfection experiments showed that nobiletin inhibits production of HIF-1α by downregulation of Akt. Such decreased levels of HIF-1α were responsible for nobiletin-induced suppression of VEGF. Our data suggest that nobiletin may be a promising anti-angiogenic agent relevant for therapy of ovarian cancers.