Opioid utilization following cervical spine surgery: trends and factors associated with long-term use

Limited or no data exist evaluating risk-factors associated with prolonged opioid use following cervical arthrodesis.

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New tRNA contacts facilitate ligand binding in a Mycobacterium smegmatis T box riboswitch [Genetics]

T box riboswitches are RNA regulatory elements widely used by organisms in the phyla Firmicutes and Actinobacteria to regulate expression of amino acid-related genes. Expression of T box family genes is down-regulated by transcription attenuation or inhibition of translation initiation in response to increased charging of the cognate tRNA. Three...

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Split cGAL, an intersectional strategy using a split intein for refined spatiotemporal transgene control in Caenorhabditis elegans [Genetics]

Bipartite expression systems, such as the GAL4-UAS system, allow fine manipulation of gene expression and are powerful tools for interrogating gene function. Recently, we established cGAL, a GAL4-based bipartite expression system for transgene control in Caenorhabditis elegans, where a single promoter dictates the expression pattern of a cGAL driver, which...

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EMS inventions: Where did they come from?

Hard to believe, but there was a time we were without the most necessary EMS tools. That all changed, thanks to these creative minds.

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Depression During Pregnancy and Its Association with Birth Outcomes: Authors’ Reply

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Specifying What We Study and Implement in Rehabilitation: Comments on the Reporting of Clinical Research

Publication date: Available online 9 April 2018
Source:Archives of Physical Medicine and Rehabilitation
Author(s): John Whyte, Marcel P. Dijkers, Jarrad H. Van Stan, Tessa Hart
Several guidelines have been published with the goal of increasing the usefulness of reports of clinical research. Although such guidelines may clarify key features of study design, the way in which rehabilitation treatments, themselves, are described continues to be problematic and to limit the ability to replicate research, synthesize evidence across studies, or apply these treatments in practice. Lohse, et al report little improvement in the description of rehabilitation treatments in recent years, with particular limitations in the description of comparison or standard-of-care treatments. This commentary explores the kind of published treatment descriptions that would be most useful in supporting evidence synthesis and clinical implementation, and examines the degree to which a developing conceptual framework – the Rehabilitation Treatment Specification System (RTSS) -- might support improvements in research reporting.



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Mandated quality of care metrics for Medicare patients: Examining new or worsened pressure ulcers and rehabilitation outcomes in United States inpatient rehabilitation facilities

Publication date: Available online 9 April 2018
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Margaret A. DiVita, Carl V. Granger, Richard Goldstein, Paulette M. Niewczyk, Jo L. Freudenheim
ObjectiveTo examine the association between the Medicare pressure ulcer quality indicator (the development of new or worsened pressure ulcers), with rehabilitation outcomes among Medicare patients seen in an inpatient rehabilitation facility (IRF). Data collection on the pressure ulcer quality indicator began in October of 2012, however, the value of this indicator is not known.DesignRetrospective descriptive study.SettingIRFs subscribed to the Uniform Data System for Medical Rehabilitation. Participants: Nearly 500,000 IRF Medicare patients who were discharged between January 2013 and September 2014 were examined.InterventionNA.Main Outcome MeasuresFunctional independence, functional change (gain), and discharge destination.ResultsThe pressure ulcer quality indicator was associated with poorer rehabilitation outcomes; patients were less likely to achieve functional independence (OR 0.47, 95% CI 0.44 - 0.51), less likely to be discharged to a community setting (OR 0.88, 95% CI: 0.82 - 0.95) and made less functional gain during their IRF stay (a difference of 6 FIM points).ConclusionThese results support that the pressure ulcer quality indicator is associated with lower quality of rehabilitation outcomes; however given that those patients with a new or worsened pressure injury still made functional gains and most were discharged to the community, the risk of pressure injury development should not preclude the admission of these cases to an IRF.



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Associations between muscle synergies and treatment outcomes in cerebral palsy are robust across clinical centers

Publication date: Available online 10 April 2018
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Benjamin R. Shuman, Marije Goudriaan, Kaat Desloovere, Michael H. Schwartz, Katherine M. Steele
ObjectiveTo determine whether patient-specific differences in motor control quantified using muscle synergy analysis were associated with changes in gait after treatment in cerebral palsy across two clinical centers with different treatments and clinical protocols.DesignRetrospective Cohort Study.SettingClinical Medical Center.ParticipantsCenter 1: 473 children with cerebral palsy and 84 typically-developing children. Center 2: 163 children with cerebral palsy and 12 typically-developing children.InterventionsStandard clinical care at each center.Outcome MeasuresThe dynamic motor control index during walking (walk-DMC) was computed from electromyography data during gait using muscle synergy analysis. Regression analysis was used to evaluate whether pre-treatment walking speed or kinematics, muscle synergies, treatment group, prior treatment, or age were associated with post-treatment changes in gait at both clinical centers.ResultsWalk-DMC was significantly associated with changes in speed and kinematics after treatment with similar regression models at both centers. Children with less impaired motor control were more likely to have improvements in walking speed and gait kinematics after treatment, independent of treatment group.ConclusionsDynamic motor control evaluated with synergy analysis was associated with changes in gait after treatment at both centers, despite differences in treatments and clinical protocols. This study further supports the finding that walk-DMC provides additional information, not captured in traditional gait analysis, that may be useful for treatment planning.



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Genotype imputation performance of three reference panels using African ancestry individuals

Abstract

Genotype imputation estimates unobserved genotypes from genome-wide makers, to increase genome coverage and power for genome-wide association studies. Imputation has been successful for European ancestry populations in which very large reference panels are available. Smaller subsets of African descent populations are available in 1000 Genomes (1000G), the Consortium on Asthma among African ancestry Populations in the Americas (CAAPA) and the Haplotype Reference Consortium (HRC). We compared the performance of these reference panels when imputing variation in 3747 African Americans (AA) from two cohorts (HCV and COPDGene) genotyped using Illumina Omni microarrays. The haplotypes of 2504 (1000G), 883 (CAAPA) and 32,470 individuals (HRC) were used as reference. We compared the number of variants, imputation quality, imputation accuracy and coverage between panels. In both cohorts, 1000G imputed 1.5–1.6× more variants than CAAPA and 1.2× more than HRC. Similar findings were observed for variants with imputation R² > 0.5 and for rare, low-frequency, and common variants. When merging imputed variants of the three panels, the total number was 62–63 M with 20 M overlapping variants imputed by all three panels, and a range of 5–15 M variants imputed exclusively with one of them. For overlapping variants, imputation quality was highest for HRC, followed by 1000G, then CAAPA, and improved as the minor allele frequency increased. 1000G, HRC and CAAPA provided high performance and accuracy for imputation of African American individuals, increasing the number of variants available for subsequent analyses. These panels are complementary and would benefit from the development of an integrated African reference panel.

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Inpatient Care for the Cancer Survivor: Opportunities to Develop and Deliver Standards for Care

Cancer continues to evolve from a terminal diagnosis to a chronic medical condition. With improved survivorship rates, opportunities exist to deliver rehabilitation care throughout the oncology continuum. By definition, inpatient rehabilitation is generally considered post-acute care (PAC), and is provided either in inpatient rehabilitation facilities (IRF), skilled nursing facilities (SNF), or long-term care hospitals (LTCH). Each institution is subject to specific regulations and legislation that help define appropriateness for admission based on diagnosis, medical necessity, and functional need. However, these criteria may present barriers to access care for the oncology survivor. As the healthcare landscape changes, and reimbursement structures shift from fee-for-service (FFS) to those that emphasize effectiveness and efficiency in care, inpatient rehabilitation has a unique opportunity to improve value in terms of outcomes and cost. With the implementation of the IMPACT Act, standardization of measures throughout PAC may allow for a more consistent approach to delivery of inpatient rehabilitation care. Further work will be necessary to define the parameters by which oncology survivors should be gauged in this framework. Correspondence: Vishwa S.Raj, Department of Physical Medicine & Rehabilitation, Carolinas Rehabilitation, 1100 Blythe Boulevard, Charlotte, NC 28203, e-mail: Vishwa.raj@carolinashealthcare.org Disclosures: The authors have no disclosures to report. Funding Information: No funding was received for this project. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Physiatry Reviews for Evidence in Practice (PREP) Second Order Peer Reviews of Clinically Relevant Articles for the Physiatrist: Is pregabalin effective in the treatment of “radiating low back pain into the leg?

No abstract available

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PMR Role on Notalgia Paresthetica: Case Report and Treatment Review

Notalgia paresthetica (NP) is a rarely reported T2–T6 sensory neuropathy whose etiology and treatment are not fully established. Although it is believed to be common in dermatological practice, it remains under-recognized, under-diagnosed, and therefore under-reported. This case-report provides a physical medicine and rehabilitation (PMR) perspective on NP diagnosis and treatment. This article presents a case report of a 39-year-old woman with pain, pruritus, and a hyperpigmented area in the right dorsal infra scapular region. The diagnosis of NP was established. She was successfully treated with topical anesthetics, postural corrective exercises, scapular muscle strengthening and pectoral muscle stretching. In this context, different treatment options were reviewed. A small set of pharmacological and non-pharmacological techniques were identified. Several of these modalities belong to the PMR field of action. Corresponding Author: Cristina Miranda da Cruz, Sete Fontes - São Victor, 4710-243 Braga, cristina@dacruz.pt Author Disclosures: The authors have no conflicts of interest to declare. The authors did not receive any funding, grants, equipment or financial benefit from any source. This paper was not previously presented in any form Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Ultrasound Imaging for Muscle Variations: Digastric Flexor Carpi Ulnaris, Gastrocnemius Tertius and Supernumerary Fibularis Longus in an Asymptomatic Family – Case Report

Anatomical variations of the muscles are seen with different frequencies. Although most of them are asymptomatic; in certain cases, their existence requires attention as regards entrapment syndromes, mass lesions, botulinum toxin injections and tendon transfers. Herein, since ultrasound imaging is a convenient method for muscle imaging, it can easily be used in daily practice for prompt understanding of such muscular variations. In this report, we demonstrated and discussed a similar scenario in an asymptomatic individual (and his close family members) using ultrasound imaging for scanning the digastric flexor carpi ulnaris, gastrocnemius tertius and supernumerary fibularis longus muscles. Corresponding author: Ayşe Merve Ata, Viranşehir State Hospital, Şanliurfa/Turkey, amerveata@hotmail.com Author Disclosures: None of the authors has any conflict of interest to disclose. There is no funding or grants or equipment provided for the project from any source. There is no financial benefits to the authors. The manuscript has not been presented anywhere in any form. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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A Risk Scoring System for the Prediction of Functional Deterioration, Institutionalization, and Mortality among Medicare Beneficiaries

Objective We sought to develop a risk scoring system for predicting functional deterioration, institutionalization, and mortality. Identifying predictors of poor health outcomes informs clinical decision-making, service provision, and policy development to address the needs of persons at greatest risk for poor health outcomes. Design Cohort study with 21,257 community-dwelling Medicare beneficiaries aged 65 years and older who participated in the 2001-2008 Medicare Current Beneficiary Survey. Derivation of the model was conducted in 60% of the sample and validated in the remaining 40%. Multinomial logistic regression model generated β-coefficients which were utilized to create a risk scoring system. Our outcome was instrumental activity of daily living stage transitions (stable/improved function and functional deterioration), institutionalization, or mortality over two years of follow-up. Results A total of 18 factors were identified for functional deterioration (p

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Anesthesiology’s Future with Specialists in Population Health

Publication date: Available online 9 April 2018
Source:Anesthesiology Clinics
Author(s): Mike Schweitzer

Teaser

In population health medicine, often it is not primary care, but rather the specialists' care teams that are responsible for the most overall spending for health care. Engaging specialists in population health medicine is a prerequisite to be successful in improving the quality of care by reducing complications, unnecessary utilization, avoidable Emergency Department visits/readmissions, and total cost of care. Creating patient-centric, physician-lead, interdisciplinary care teams to redesign the delivery of care across the continuum of the episode of care (eg, shadow bundle) is a successful approach to commercial or Centers for Medicare and Medicaid Services value-based payments.


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Perioperative Surgical Home for the Patient with Chronic Pain

Publication date: Available online 9 April 2018
Source:Anesthesiology Clinics
Author(s): Talal W. Khan, Smith Manion

Teaser

The management of acute pain for the phenotypically different patient who suffers from chronic pain is challenging. The care of these patients is expensive and siloed. The physician-led, multidisciplinary, patient-centric, care coordination framework of the perioperative surgical home is an optimal vehicle for the management of these patients. The engagement of physician anesthesiologists in the optimization, in-hospital management, and postdischarge care of the patient with chronic pain will lead to improved outcomes, reduced health care expenditures, and improve the health of this challenging population.


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Challenges in Outcome Reporting

Publication date: Available online 9 April 2018
Source:Anesthesiology Clinics
Author(s): Avery Tung

Teaser

Although measuring outcomes is an integral part of medical quality improvement, large-scale outcome reporting efforts face several challenges. Among these are difficulties in establishing consensus definitions for outcome measurement; classifying gray outcomes, such as postoperative respiratory failure; and adequately adjusting for patient comorbidities and severity of illness. Unintended consequences of outcome reporting can also distort care in undesirable ways, and clinician reluctance to care for high-risk patients may occur with reporting programs. Ultimately, clinicians need not compare outcomes to improve and should recognize that even outcomes that cannot be precisely quantitated can still be improved.


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Bundled Payments and Hidden Costs

Publication date: Available online 9 April 2018
Source:Anesthesiology Clinics
Author(s): Stanley W. Stead, Sharon K. Merrick

Teaser

In a fee-for-service environment, anesthesiologists are paid for the volume of services billed, with little relation to the cost of delivering the services. In bundled payments, anesthesiologists are paid a set fee for an episode of care inclusive of all the anesthesia, pain medicine, and related services for the surgical episode and a period of time after the initial procedure to cover complications and redo procedures. When calculating a bundled payment, all the services typically used by a patient must be counted when calculating both the costs and expected payment.


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Measuring Clinical Productivity

Publication date: Available online 9 April 2018
Source:Anesthesiology Clinics
Author(s): Mark E. Hudson, Evan E. Lebovitz

Teaser

Productivity measurements have been used to evaluate and compare physicians and physician practices. Anesthesiology is unique in that factors outside anesthesiologist control impact opportunity for revenue generation and make comparisons between providers and facilities challenging. This article uses data from the multicenter University of Pittsburgh Physicians Department of Anesthesiology to demonstrate factors influencing productivity opportunity by surgical facility, between department divisions and subspecialties within multispecialty divisions, and by individuals within divisions. The complexities of benchmarking anesthesiology productivity are demonstrated, and the potential value of creating a productivity profile for facilities and groups is illustrated.


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Integrating Academic and Private Practices

Publication date: Available online 9 April 2018
Source:Anesthesiology Clinics
Author(s): Aviva Regev, Aman Mahajan

Teaser

As health care reform shifts toward value over volume, academic medical centers, known for highly specialized, high-cost care, will suffer from erosion of their traditional funding sources. Academic medical centers have undertaken mergers and partnerships with community medical centers, to maintain a more diversified, cost-effective, and competitive presence in their markets. These consolidations have seen varying results. Cultural factors are frequently cited as a cause of dysfunction and disintegration. Anesthesiology groups integrating academic and private practice physicians are likely to face many of the same challenges. Appropriate attention to culture and other key issues may help realize numerous benefits.


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Measuring Quality for Individual Anesthesia Clinicians

Publication date: Available online 9 April 2018
Source:Anesthesiology Clinics
Author(s): John Allyn, Craig Curry

Teaser

A robust quality management system (QMS) will provide value to patients, providers, and hospitals or systems by focusing on system performance. The QMS must remain independent of provider-specific measures used for privileging. Some outcome measures may be used to assess system performance; they must not be used to assess individual provider performance. All anesthesia providers, especially leaders, must be guardians of an organization's safety culture.


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Value Proposition and Anesthesiology

Publication date: Available online 9 April 2018
Source:Anesthesiology Clinics
Author(s): Joseph W. Szokol, Keith J. Chamberlin

Teaser

Health care in general and anesthesia in particular have seen dramatic changes in the economic landscape. It is vital if anesthesia groups wish to survive and prosper in this new environment to understand the changes occurring in health care and be flexible and proactive in taking on these challenges. More than ever anesthesia groups must be good corporate citizens and seek ways in which to enhance their value to the organization, whether in the operating room or out of operating room locations, and be a proactive partner with the hospital.


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Advanced dynamic statistical parametric mapping with MEG in localizing epileptogenicity of the bottom of sulcus dysplasia

Publication date: June 2018
Source:Clinical Neurophysiology, Volume 129, Issue 6
Author(s): Midori Nakajima, Simeon Wong, Elysa Widjaja, Shiro Baba, Tohru Okanishi, Lynne Takada, Yosuke Sato, Hiroki Iwata, Maya Sogabe, Hikaru Morooka, Robyn Whitney, Yuki Ueda, Tomoshiro Ito, Kazuyori Yagyu, Ayako Ochi, O. Carter Snead, James T. Rutka, James M. Drake, Sam Doesburg, Fumiya Takeuchi, Hideaki Shiraishi, Hiroshi Otsubo
ObjectiveTo investigate whether advanced dynamic statistical parametric mapping (AdSPM) using magnetoencephalography (MEG) can better localize focal cortical dysplasia at bottom of sulcus (FCDB).MethodsWe analyzed 15 children with diagnosis of FCDB in surgical specimen and 3 T MRI by using MEG. Using AdSPM, we analyzed a ±50 ms epoch relative to each single moving dipole (SMD) and applied summation technique to estimate the source activity. The most active area in AdSPM was defined as the location of AdSPM spike source. We compared spatial congruence between MRI-visible FCDB and (1) dipole cluster in SMD method; and (2) AdSPM spike source.ResultsAdSPM localized FCDB in 12 (80%) of 15 children whereas dipole cluster localized six (40%). AdSPM spike source was concordant within seizure onset zone in nine (82%) of 11 children with intracranial video EEG. Eleven children with resective surgery achieved seizure freedom with follow-up period of 1.9 ± 1.5 years. Ten (91%) of them had an AdSPM spike source in the resection area.ConclusionAdSPM can noninvasively and neurophysiologically localize epileptogenic FCDB, whether it overlaps with the dipole cluster or not.SignificanceThis is the first study to localize epileptogenic FCDB using MEG.



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Sliding window averaging in normal and pathological motor unit action potential trains

Publication date: June 2018
Source:Clinical Neurophysiology, Volume 129, Issue 6
Author(s): Armando Malanda-Trigueros, Javier Navallas, Javier Rodriguez-Falces, Ignacio Rodriguez-Carreño, Sonia Porta, Miguel Fernández-Martínez, Luis Gila
ObjectiveTo evaluate the performance of a recently proposed motor unit action potential (MUAP) averaging method based on a sliding window, and compare it with relevant published methods in normal and pathological muscles.MethodsThree versions of the method (with different window lengths) were compared to three relevant published methods in terms of signal analysis-based merit figures and MUAP waveform parameters used in the clinical practice. 218 MUAP trains recorded from normal, myopathic, subacute neurogenic and chronic neurogenic muscles were analysed. Percentage scores of the cases in which the methods obtained the best performance or a performance not significantly worse than the best were computed.ResultsFor signal processing figures of merit, the three versions of the new method performed better (with scores of 100, 86.6 and 66.7%) than the other three methods (66.7, 25 and 0%, respectively). In terms of MUAP waveform parameters, the new method also performed better (100, 95.8 and 91.7%) than the other methods (83.3, 37.5 and 25%).ConclusionsFor the types of normal and pathological muscle studied, the sliding window approach extracted more accurate and reliable MUAP curves than other existing methods.SignificanceThe new method can be of service in quantitative EMG.



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LncRNA Gm2044 highly expresses in spermatocyte and inhibits Utf1 translation by interacting with Utf1 mRNA

Abstract

Spermatogenesis is a process which includes the following phases: spermatogonial stem cell proliferation and differentiation, spermatogonia, spermatocyte, spermatid and mature sperm. Spermatogenic failure is the important factor resulting in male infertility. Recent studies showed that long noncoding RNA (lncRNA) have been found to be involved in the regulation of male reproduction. However, lncRNA associated with spermatogenesis and their mechanisms of action are unclear. The aim of this study is to explore the role and molecular mechanism of lncRNA in spermatogenesis. LncRNA microarray of germ cells and bioinformatic analysis showed lncRNA Gm2044 may play potential roles in spermatogenesis. The expression level of RNA and protein were analyzed by RT-qPCR and western blotting, respectively. The interaction of lncRNA with mRNA was detected by RNA pull down and cellular proliferation was measured using CCK-8 reagent. Testis-enriched lncRNA Gm2044 is abundant in mouse spermatocytes. Gm2044 can suppress the translation of adjacent spermatogenesis-related gene Utf1 by interacting with Utf1 mRNA. Furthermore, the proliferation of mouse spermatogonia GC-1 cell line and spermatocyte GC-2 cell line was inhibited by Gm2044. CONCLUSION: LncRNA Gm2044 was identified to inhibit Utf1 mRNA translation and play important roles in spermatogenesis.

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Identification of runt family genes involved in planarian regeneration and tissue homeostasis

Publication date: Available online 9 April 2018
Source:Gene Expression Patterns
Author(s): Zimei Dong, Yibo Yang, Guangwen Chen, Dezeng Liu
The runt family genes play important roles in physiological processes in eukaryotic organisms by regulation of protein transcription, such as hematopoietic system, proliferation of gastric epithelial cells and neural development. However, it remains unclear about the specific functions of these genes. In this study, the full-length cDNA sequences of two runt genes are first cloned from Dugesia japonica, and their roles are investigated by WISH and RNAi. The results show that: (1) the Djrunts are conserved during evolution; (2) the Djrunts mRNA are widely expressed in intact and regenerative worms, and their expression levels are up-regulated significantly on day 1 after amputation; (3) loss of Djrunts function lead to lysis or regeneration failure in the intact and regenerating worms. Overall, the data suggests that Djrunts play important roles in regeneration and homeostatic maintenance in planarians.



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