Green synthesis of surface-passivated carbon dots from the prickly pear cactus as a fluorescent probe for the dual detection of arsenic(iii) and hypochlorite ions from drinking water

Efforts were made to develop a simple new approach for the green synthesis of surface-passivated carbon dots from edible prickly pear cactus fruit as the carbon source by a one-pot hydrothermal route. Glutathione (GSH) was passivated on the surface of the CDs to form a sensor probe, which exhibited excellent optical properties and water solubility. The prepared sensor was successfully characterized by UV-visible spectrophotometry, fluorescence spectrophotometry, Fourier transform infrared spectroscopy (FT-IR), X-ray diffraction (XRD), scanning electron microscopy (SEM), and transmission electron microscopy (TEM). The simple sensing platform developed by the GSH-CDs was highly sensitive and selective with a “turn-off” fluorescence response for the dual detection of As³⁺ and ClO⁻ ions in drinking water. This sensing system exhibited effective quenching in the presence of As³⁺ and ClO⁻ ions to display the formation of metal complexes and surface interaction with an oxygen functional group. The oxygen-rich GSH-CDs afforded a better selectivity for As³⁺/ClO⁻ ions over other competitive ions. The fluorescence quenching measurement quantified the concentration range as 2–12 nM and 10–90 μM with the lower detection limit of 2.3 nM and 0.016 μM for the detection of As³⁺ and ClO⁻ ions, respectively. Further, we explored the potential applications of this simple, reliable, and cost-effective sensor for the detection of As³⁺/ClO⁻ ions in environmental samples for practical analysis.

Efforts were made to develop a simple new approach for the green synthesis of surface-passivated carbon dots from edible prickly pear cactus fruit as the carbon source by a one-pot hydrothermal route.

Does treadmill running performance, heart rate and breathing rate response during maximal graded exercise improve after volitional respiratory muscle training?

AIM

Maximal physical exertion in sports usually causes fatigue in the exercising muscles, but not in the respiratory muscles due to triggering of the Respiratory muscle metabo-reflex, a sympathetic vasoconstrictor response leading to preferential increment in blood flow to respiratory muscles.1 We planned to investigate whether a six week yogic pranayama based Volitional Respiratory Muscle Training (VRMT) can improve maximal Graded Exercise Treadmill Test (GXTT) performance in healthy adult recreational sportspersons.

METHODS

Consecutive, consenting healthy adult recreational sportspersons aged 20.56±2.49 years (n=30), volunteered to 'baseline recording' of resting heart rate (HR), blood pressure (BP), respiratory rate (RR), and Bruce ramp protocol maximal GXTT until volitional exhaustion providing total test time (TTT), derived VO2max, Metabolic Equivalent of Task (METs), HR and BP response during maximal GXTT and drop in recovery HR data. After six weeks of observation, they underwent 'pre-intervention recording' followed by supervised VRMT intervention for 6 weeks (30 minutes a day; 5 days a week) and then 'post-intervention recording'. Repeated measures ANOVA with pairwise t statistical comparison was used to analyse the data.

RESULTS

After supervised VRMT, we observed significant decrease in their resting supine RR (p<0.001), resting supine HR (p=0.001), HR after 5 minutes of assuming standing posture (p=0.003); significant increase in TTT (p<0.001), derived VO2max (p<0.001), METs (p<0.001) and drop in recovery HR (p=0.038); altered HR response and BP response during exercise.

CONCLUSIONS

We hypothesize that these changes are probably due to VRMT induced learnt behaviour to control the breathing pattern that improves breathing economy, improvement in respiratory muscle aerobic capacity, attenuation of respiratory muscle metabo-reflex, increase in cardiac stroke volume and autonomic resetting towards parasympatho-dominance. Yogic Pranayama based VRMT can be used in sports conditioning programme of athletes to further improve their maximal exercise performance, and as part of rehabilitation training during return from injury.

Barriers to and Facilitators of South Asian Indian-Americans' Engagement in Advanced Care Planning Behaviors

PURPOSE

To identify barriers to and facilitators of older South Asian Indian-Americans' (SAIAs') engagement in behaviors associated with advance care planning (ACP).

METHODS

Using a descriptive qualitative design guided by the transcultural nursing assessment model, data were collected in focus groups of community-dwelling older SAIA participants, SAIA family caregivers, and SAIA physicians. A directed approach using predetermined coding categories derived from the Transcultural Nursing Assessment model and aided by NVivo 10 software (Melbourne, Australia) facilitated the qualitative data analysis.

RESULTS

Eleven focus groups with 36 older SAIAs (61% female, 83% 70+ years old), 10 SAIA family caregivers, and 4 SAIA physicians indicated prior lack of awareness of ACP, good health status, lack of access to linguistically and health literacy-tailored materials, healthcare provider hesitation to initiate discussions on ACP, trust in healthcare providers' or oldest sons' decision making, busy family caregiver work routines, and cultural assumptions about filial piety and after-death rituals as major barriers to engaging in ACP. Introducing ACP using personal anecdotes in a neutral, group-based community setting and incentivizing ACP discussions by including long-term care planning were suggested as facilitators to engage in ACP.

CLINICAL RELEVANCE

The study's findings will guide development of culturally sensitive interventions to raise awareness about ACP among SAIAs and encourage SAIA older adults to engage in ACP.

Recommendations for the Implementation of Telehealth in Cardiovascular and Stroke Care: A Policy Statement From the American Heart Association

The aim of this policy statement is to provide a comprehensive review of the scientific evidence evaluating the use of telemedicine in cardiovascular and stroke care and to provide consensus policy suggestions. We evaluate the effectiveness of telehealth in advancing healthcare quality, identify legal and regulatory barriers that impede telehealth adoption or delivery, propose steps to overcome these barriers, and identify areas for future research to ensure that telehealth continues to enhance the quality of cardiovascular and stroke care. The result of these efforts is designed to promote telehealth models that ensure better patient access to high-quality cardiovascular and stroke care while striving for optimal protection of patient safety and privacy.

Quantum mechanical investigation into the electronic transport properties of a memantine-functionalized gold nanopore biosensor for natural and mutated DNA nucleobase detection

Quantum mechanical studies of the electronic transport properties of a memantine-functionalized gold nanopore biosensor for natural and mutated DNA nucleobase detection are reported.

A hybrid magnetic core–shell fibrous silica nanocomposite for a chemosensor-based highly effective fluorescent detection of Cu(ii)

Herein, a novel hybrid magnetic core–shell fibrous silica nanocomposite (RhB–Fe₃O₄/MnO₂/SiO₂/KCC-1) probe-based chemosensor was designed and its behaviour towards Cu(ii) metal ion was investigated using a fluorescence spectrometer.

Patient Health Goals Elicited During Home Care Admission: A Categorization

Home care agencies are initiating “patient health goal elicitation” activities as part of home care admission planning. We categorized elicited goals and identified “clinically informative” goals at a home care agency. We examined patient goals that admitting clinicians documented in the point-of-care electronic health record; conducted content analysis on patient goal data to develop a coding scheme; grouped goal themes into codes; assigned codes to each goal; and identified goals that were in the patient voice. Of the 1,763 patient records, 16% lacked a goal; only 15 goals were in a patient’s voice. Nurse and physician experts identified 12 of the 20 codes as clinically important accounting for 82% of goal occurrences. The most frequent goal documented was safety/falls (23%). Training and consistent communication of the intent and operationalization of patient goal elicitation may address the absence of patient voice and the less than universal recording of home care patients’ goals.

Interactive Digital e-Health Game for Heart Failure Self-Management: A Feasibility Study

OBJECTIVE

To develop and test the prototype of a serious digital game for improving community-dwelling older adults' heart failure (HF) knowledge and self-management behaviors. The serious game innovatively incorporates evidence-based HF guidelines with contemporary game technology.

MATERIALS AND METHODS

The study included three phases: development of the game prototype, its usability assessment, and evaluation of the game's functionality. Usability testing included researchers' usability assessment, followed by research personnel's observations of participants playing the game, and participants' completion of a usability survey. Next, in a pretest-post-test design, validated instruments-the Atlanta Heart Failure Knowledge Test and the Self Care for Heart Failure Index-were used to measure improvement in HF self-management knowledge and behaviors related to HF self-maintenance, self-management, and self-efficacy, respectively. A postgame survey assessed participants' perceptions of the game.

RESULTS

During usability testing, with seven participants, 100%, 100%, and 86% found the game easy to play, enjoyable, and helpful for learning about HF, respectively. In the subsequent functionality testing, with 19 participants, 89% found the game interesting, enjoyable, and easy to play. Playing the game resulted in a significant improvement in HF self-management knowledge, a nonsignificant improvement in self-reported behaviors related to HF self-maintenance, and no difference in HF self-efficacy scores. Participants with lower education level and age preferred games to any other medium for receiving information.

CONCLUSION

It is feasible to develop a serious digital game that community-dwelling older adults with HF find both satisfying and acceptable and that can improve their self-management knowledge.

Studying Associations Between Heart Failure Self-Management and Rehospitalizations Using Natural Language Processing

This study developed an innovative natural language processing algorithm to automatically identify heart failure (HF) patients with ineffective self-management status (in the domains of diet, physical activity, medication adherence, and adherence to clinician appointments) from narrative discharge summary notes. We also analyzed the association between self-management status and preventable 30-day hospital readmissions. Our natural language system achieved relatively high accuracy ( F-measure = 86.3%; precision = 95%; recall = 79.2%) on a testing sample of 300 notes annotated by two human reviewers. In a sample of 8,901 HF patients admitted to our healthcare system, 14.4% ( n = 1,282) had documentation of ineffective HF self-management. Adjusted regression analyses indicated that presence of any skill-related self-management deficit (odds ratio [OR] = 1.3, 95% confidence interval [CI] = [1.1, 1.6]) and non-specific ineffective self-management (OR = 1.5, 95% CI = [1.2, 2]) was significantly associated with readmissions. We have demonstrated the feasibility of identifying ineffective HF self-management from electronic discharge summaries with natural language processing.

The Knowing–Doing Gap in Advance Directives in Asian Americans: The Role of Education and Acculturation

Objectives:

The purposes of the present study were (1) to explore the completion rate of advance directives (ADs) in a sample of Asian Americans and (2) to examine the direct and moderating effects of knowledge of AD, education, and acculturation in predicting AD completion. Education and acculturation were conceptualized as moderators in the link between knowledge and completion of ADs.

Methods:

Using data from 2609 participants in the 2015 Asian American Quality of Life survey (aged 18-98), logistic regression analyses on AD completion were conducted, testing both direct and moderating effects.

Results:

The overall AD completion rate in sample was about 12%. The AD knowledge and acculturation independently predicted AD completion. No direct effect of education was found; however, it interacted with AD knowledge. The AD knowledge was more likely to be translated into completion in the group with higher education.

Conclusions:

The AD completion rate observed in the present sample of Asian Americans was much lower than that of the US general population (26%-36%). The interactive role of education helps to explain the gap between AD knowledge and completion and suggests intervention strategies.

The Impact of Race and Neighborhood Racial Composition on Preventable Readmissions for Diabetic Medicare Home Health Beneficiaries

BACKGROUND

The recommended home health financial penalty program for preventable readmission does not factor race/ethnicity and neighborhood racial compositions into the determination of preventable readmission rates. Home health agencies may avoid beneficiaries from certain racial/ethnic groups and neighborhoods if these two factors have an effect on preventable readmissions. We examined the association between preventable readmissions with race/ethnicity and neighborhood racial composition.

METHODS

Several 2009 national data were used, such as the Master Beneficiary Summary File, Medicare Provider Analysis and Review File, and Outcome Assessment Information Set. Our sample consisted of diabetic Medicare home health beneficiaries (African-Americans and Whites only). We analyzed predictors of time-to-first 30-day preventable readmission, including short/long-term diabetic complications, chronic obstructive pulmonary disease/asthma, bacterial pneumonia, dehydration, urinary tract infection, hypertension, heart failure, angina without procedure, uncontrolled diabetes, and lower-extremity amputation.

RESULTS

There were 86,567, 17,262, and 11,392 observations in neighborhoods with low (6 % African-Americans), moderate (35 % African-Americans), and high (76 % African-Americans) density of African-Americans, respectively. Using Cox regression models, we found that in neighborhoods with moderate and high density of African-Americans, African-Americans had 21 % (hazard ratio (HR) 1.21; 95 % confidence interval (CI) 1.04-1.39) and 24 % (HR 1.24; 95 % CI 1.01-1.52) significantly higher hazards of 30-day preventable readmissions than Whites, respectively.

CONCLUSION

Race and neighborhood racial compositions are beyond home health providers' control. These two factors should be considered as covariates for the preventable readmissions in the recommended home health financial penalty program.

Visual Analytics for Pattern Discovery in Home Care. Clinical Relevance for Quality Improvement

BACKGROUND

Visualization can reduce the cognitive load of information, allowing users to easily interpret and assess large amounts of data. The purpose of our study was to examine home health data using visual analysis techniques to discover clinically salient associations between patient characteristics with problem-oriented health outcomes of older adult home health patients during the home health service period.

METHODS

Knowledge, Behavior and Status ratings at discharge as well as change from admission to discharge that was coded using the Omaha System was collected from a dataset on 988 de-identified patient data from 15 home health agencies. SPSS Visualization Designer v1.0 was used to visually analyze patterns between independent and outcome variables using heat maps and histograms. Visualizations suggesting clinical salience were tested for significance using correlation analysis.

RESULTS

The mean age of the patients was 80 years, with the majority female (66%). Of the 150 visualizations, 69 potentially meaningful patterns were statistically evaluated through bivariate associations, revealing 21 significant associations. Further, 14 associations between episode length and Charlson co-morbidity index mainly with urinary related diagnoses and problems remained significant after adjustment analyses. Through visual analysis, the adverse association of the longer home health episode length and higher Charlson co-morbidity index with behavior or status outcomes for patients with impaired urinary function was revealed.

CONCLUSIONS

We have demonstrated the use of visual analysis to discover novel patterns that described high-needs subgroups among the older home health patient population. The effective presentation of these data patterns can allow clinicians to identify areas of patient improvement, and time periods that are most effective for implementing home health interventions to improve patient outcomes.

Barriers and Facilitators for Sustainability of Tele-Homecare Programs: A Systematic Review

OBJECTIVE

To identify the barriers and facilitators for sustainability of tele-homecare programs implemented by home health nursing agencies for chronic disease management.

DATA SOURCES

English-language articles on home telehealth in the CINAHL, PubMed/MEDLINE, PsychInfo, Web of Science, and Cochrane Reviews databases published from January 1996 to December 2013.

STUDY DESIGN

We performed a systematic literature review. Data extraction using PRISMA guidelines and quality appraisal using the Mixed Methods Appraisal Tool (MMAT) were conducted on relevant empirical studies. Thematic analysis across the studies and narrative summaries were used to synthesize the findings from the included studies.

PRINCIPAL FINDINGS

Of the initial 3,920 citations, we identified 16 articles of moderate quality meeting our inclusion criteria. Perceptions on effectiveness of tele-homecare programs for achieving intended outcomes; tailoring of tele-homecare programs to patient characteristics and needs; relationship and communication between patient, nurse, and other health care professional users of tele-homecare; home health organizational process and culture; and technology quality, capability, and usability impacted the sustainability of tele-homecare programs.

CONCLUSIONS

The findings of this systematic review provide implications for sustained usage of tele-homecare programs by home health nursing agencies and can help such programs realize their potential for chronic disease management.

Effective Teaching-Learning Strategies for the Omaha System

Home healthcare clinicians can benefit from the use of interprofessional standardized terminologies to more efficiently document and assess patient problems, describe and present clinician interventions, and measure the outcomes of care. The Omaha System is a research-based, comprehensive standardized terminology that can enable users to describe and measure the impact of nursing and healthcare services on patient care and outcomes. In this article, we (1) describe effective strategies for teaching the Omaha System to home healthcare agency staff, and (2) illustrate those strategies' effectiveness by presenting an example from an Omaha System Basic Workshop conducted in 2015. The 12 participants included home healthcare nursing administrators and clinicians, software developers from several companies, nursing educators, and nursing researchers. The role-playing and unfolding case studies that we report here represent teaching strategies that can provide opportunities for home healthcare users to practice using the Omaha System. Quantitative evaluation consisted of comparing the participants' pretest and posttest scores on the survey. Qualitative evaluation involved analyzing participants' feedback and comments on a form distributed at the end of the workshop. Participants found the workshop beneficial in improving their understanding of the Omaha System and its application to their practice.

Mining Clinicians' Electronic Documentation to Identify Heart Failure Patients with Ineffective Self-Management: A Pilot Text-Mining Study

Effective self-management can decrease up to 50% of heart failure hospitalizations. Unfortunately, self-management by patients with heart failure remains poor. This pilot study aimed to explore the use of text-mining to identify heart failure patients with ineffective self-management. We first built a comprehensive self-management vocabulary based on the literature and clinical notes review. We then randomly selected 545 heart failure patients treated within Partners Healthcare hospitals (Boston, MA, USA) and conducted a regular expression search with the compiled vocabulary within 43,107 interdisciplinary clinical notes of these patients. We found that 38.2% (n = 208) patients had documentation of ineffective heart failure self-management in the domains of poor diet adherence (28.4%), missed medical encounters (26.4%) poor medication adherence (20.2%) and non-specified self-management issues (e.g., "compliance issues", 34.6%). We showed the feasibility of using text-mining to identify patients with ineffective self-management. More natural language processing algorithms are needed to help busy clinicians identify these patients.

Reduced Toxicity Conditioning and Allogeneic Hematopoietic Progenitor Cell Transplantation for Recessive Dystrophic Epidermolysis Bullosa

Recessive dystrophic epidermolysis bullosa is a severe, incurable, inherited blistering disease caused by COL7A1 mutations. Emerging evidence suggests hematopoietic progenitor cells (HPCs) can be reprogrammed into skin; HPC-derived cells can restore COL7 expression in COL7-deficient mice. We report two children with recessive dystrophic epidermolysis bullosa treated with reduced-toxicity conditioning and HLA-matched HPC transplantation.

Improving diabetic patient transition to home healthcare: leading risk factors for 30-day readmission

OBJECTIVES

To identify risk factors of 30-day readmissions due to ambulatory care-sensitive conditions (ACSCs) for diabetic Medicare home healthcare beneficiaries in order to improve transition from hospital-based care to home healthcare.

STUDY DESIGN

We analyzed diabetic Medicare beneficiaries who received home healthcare within 14 days of hospital discharges in 2009. The unit of analysis is the home health episode for post acute care.

METHODS

The conceptual framework was guided by Andersen's Behavioral Model of Health Services. Data sources included: Medicare Beneficiary Summary File, Medicare Provider Analysis Review, Outcome Assessment Information Set, Home Health Agency Research Identifiable File, Hospital Readmissions Reduction Program Supplemental Data File, Provider of Services File, and Area Health Resources File. The dependent variable was time to first 30-day ACSC-related readmission. Proportional hazards regression was used for the statistical analyses.

RESULTS

The 30-day ACSC-related readmission rate was approximately 6% in our study sample, costing the Medicare program about $62 million. Predictors of readmissions due to ACSCs within 30 days of hospital discharge were: being aged 75 to 84 years, being an African American, requiring assistance in medication management, and having 1 or more of the following clinical conditions: congestive heart failure, peripheral vascular disease, chronic obstructive pulmonary disease, renal failure, deficiency anemia, fluid and electrolyte diseases, depression and/or anxiety, and pressure or stasis ulcer. Patients with chronic obstructive pulmonary disease or renal failure had a 40% higher risk of 30-day ACSC-related readmissions than their counterparts.

CONCLUSIONS

Knowing the risk factors identified above, hospital providers can improve care planning and transition of care to the home healthcare providers.

A novel trial of topotecan, ifosfamide, and carboplatin (TIC) in children with recurrent solid tumors

BACKGROUND

Ifosfamide, carboplatin, and etoposide (ICE) in children with refractory or recurrent solid tumors and lymphomas has resulted in good overall response rates (ORR). Etoposide, a topoisomerase-II inhibitor, however, has been associated with a significant increase in secondary leukemia. The rationale for substituting topotecan, a topoisomerase-I inhibitor, for etoposide in this regimen, a topoisomerase-II inhibitor, includes its limited toxicity profile and decreased leukemogenicity. Furthermore, topotecan in combination with both alkylators and platinating agents are additive and/or synergistic against a variety of solid tumors.

PROCEDURE

Patients with relapsed/refractory solid tumors received ifosfamide (9 g/m² ) and carboplatin (area under the curve: 3 mg/ml/min). Topotecan was also administered at 0.5 mg/m² /day × 3 days (N = 12) and in a small cohort (N = 3) at 0.75 mg/m² /day.

RESULTS

Fifteen patients were entered onto study. Two patients developed seizures/encephalitis secondary to ifosfamide. One patient had dose-limiting thrombocytopenia secondary to TIC that resolved with supportive care. Patients received a median of three cycles (1-3) of TIC. Of the 14 evaluable patients for response, 4/14 had a complete response (CR), 2/14 had a partial response (PR), and 1/14 patients had stable disease (SD). The ORR (CR + PR) was 43%.

CONCLUSION

TIC chemotherapy is feasible and tolerable in children and adolescents with refractory/recurrent solid tumors and lymphomas and results in a 43% excellent ORR in this poor-risk group of patients. A larger cohort of patients, especially in Wilms tumor and central nervous system (CNS) tumors, should be studied in the future to attempt to confirm these preliminary findings. Pediatr Blood Cancer 2015;62:274-278. © 2014 Wiley Periodicals, Inc.

Adapting heart failure guidelines for nursing care in home health settings: challenges and solutions

BACKGROUND

Nurses provide most of home health services for patients with heart failure, and yet there are no evidence-based practice guidelines developed for home health nurses.

PURPOSE

The purpose of this article was to review the challenges and solutions for adapting generally available HF clinical practice guidelines to home health nursing.

METHODS

Appropriate HF guidelines were identified and home health nursing-relevant guidelines were extracted by the research team. In addition, a team of nursing academic and practice experts evaluated the extracted guidelines and reached consensus through Delphi rounds.

RESULTS

We identified 172 recommendations relevant to home health nursing from the American Heart Association and Heart Failure Society of America guidelines. The recommendations were divided into 5 groups (generic, minority populations, normal ejection fraction, reduced ejection fraction, and comorbidities) and further subgroups. Experts agreed that 87% of the recommendations selected by the research team were relevant to home health nursing and rejected 6% of the selected recommendations. Experts' opinions were split on 7% of guideline recommendations. Experts mostly disagreed on recommendations related to HF medication and laboratory prescription as well as HF patient assessment. These disagreements were due to lack of patient information available to home health nurses as well as unclear understanding of scope of practice regulations for home health nursing. After 2 Delphi rounds over 8 months, we achieved 100% agreement on the recommendations. The finalized guideline included 153 recommendations.

CONCLUSIONS

Guideline adaptation projects should include a broad scope of nursing practice recommendations from which home health agencies can customize relevant recommendations in accordance with available information and state and agency regulations.

National epilepsy surgery support activity

While there are over one million people with drug-resistant epilepsy in India, today, there are only a handful of centers equipped to undertake presurgical evaluation and epilepsy surgery. The only solution to overcome this large surgical treatment gap is to establish comprehensive epilepsy care centers across the country that are capable of evaluating and selecting the patients for epilepsy surgery with the locally available technology and in a cost-effective manner. The National Epilepsy Surgery Support Activity (NESSA) aims to provide proper guidance and support in establishing epilepsy surgery programs across India and in neighboring resource-poor countries, and in sustaining them.

A comparison of bronchoalveolar lavage versus lung biopsy in pediatric recipients after stem cell transplantation

Bronchoalveolar lavage (BAL) has been a useful initial diagnostic tool in the evaluation of pulmonary complications after hematopoietic stem cell transplantation (HSCT); however, the diagnostic sensitivity, prevalence, and outcome after BAL versus lung biopsy (LB) in pediatric HSCT patients remains to be determined. We reviewed 193 pediatric HSCT recipients who underwent a total of 235 HSCTs. Sixty-five patients (34%) underwent a total of 101 BALs for fever, respiratory distress, and/or pulmonary infiltrates on chest radiograph and/or computed tomography scan. The 1-year probability of undergoing BAL was 43.0% after allogeneic stem cell transplantation (alloSCT) and 8.5% after autologous stem cell transplantation (autoSCT) (P = .001). Sixteen of the 193 patients (8%) patients underwent 19 LBs. The probability of undergoing LB at 1 year after HSCT was 9.3%. No grade III or IV adverse events related to either procedure were observed. Of the 101 BALs performed, 40% (n = 40) were diagnostic, with a majority revealing a bacterial pathogen. Among the 19 LBs performed, 94% identified an etiology. In multivariate analysis, myeloablative conditioning alloSCT conferred the highest risk of requiring a BAL (hazard ratio [HR],8.5; P = .0002). The probability of 2-year overall survival was 20.2% in patients who underwent BAL, 17.5% for patients who underwent biopsy, and 67.4% for patients who had neither procedure. In multivariate analysis, only the requirement of a BAL was independently associated with an increased risk of mortality (HR, 2.96; P < .0001). In summary, in this cohort of pediatric HSCT recipients, BAL and LB were used in approximately 35% and 8% of pediatric HSCTs with diagnostic yields of approximately 40% and 94%, respectively, and were both associated with poor long-term outcomes.

Direct synthesis of 5- and 6-substituted 2-aminopyrimidines as potential non-natural nucleobase analogues

A series of 2-aminopyrimidine derivatives, substituted at 5- and 6-positions, were synthesized.

A retrospective study on patient characteristics and telehealth alerts indicative of key medical events for heart failure patients at a home health agency

OBJECTIVE

To explore association of patient characteristics and telehealth alert data with all-cause key medical events (KMEs) of emergency department (ED) visits and hospitalizations as well as cardiac-related KMEs of ED visits, hospitalizations, and medication changes.

MATERIALS AND METHODS

A 6-month retrospective study was conducted of electronic patient records of heart failure (HF) patients using telehealth services at a Massachusetts home health agency. Data collected included patient demographic, psychosocial, disease severity factors and telehealth vital signs alerts. Association between patient characteristics and KMEs was analyzed by Generalized Estimating Equations.

RESULTS

The sample comprised 168 patients with a mean age of 83 years, 56% females, and 96% white. Ninety-nine cardiac-related KMEs and 87 all-cause KMEs were recorded for the subjects. Odds of a cardiac-related KME increased by 161% with the presence of valvular co-morbidity (p=0.001) and 106% with increased number of telehealth alerts (adjusted p<0.0001). Odds of an all-cause KME increased by 124% (p=0.02), 127% (p=0.01), and 70% (adjusted p<0.0001) with the presence of cancer co-morbidity, anxiety, and increased number of telehealth alerts, respectively. Overall, only 3% of all telehealth alerts were associated with KMEs.

CONCLUSIONS

The very low proportion of telehealth vital sign alerts associated with KMEs indicates that telehealth alerts alone cannot inform the need for intervention within the larger context of HF care delivery in the homecare setting. Patient-relevant data such as psychosocial and symptom status, involvement with HF self-management, and presence of co-morbidities could further inform the need for interventions for HF patients in the homecare setting.

Use of a homecare electronic health record to find associations between patient characteristics and re-hospitalizations in patients with heart failure using telehealth

Data from homecare electronic health records were used to explore the association of patient characteristics with re-hospitalizations of patients with heart failure (HF) during a 60-day period of telemonitoring following hospital discharge. Data from 403 Medicare patients with HF who had used telehealth from 2008 to 2010 were analysed. There were 112 all-cause (29%) and 73 cardiac-related (19%) re-hospitalizations within 60 days of the start of telemonitoring. In adjusted analyses, the patients' number of medications and type of cardiac medications were significantly (P < 0.05) associated with an increased risk of re-hospitalization. After stratifying the sample by illness severity, age and gender, other significant (P < 0.05) predictors associated with an increased risk of all-cause and cardiac re-hospitalization were psychiatric co-morbidity, pulmonary and obesity co-morbidities within gender, beta blocker prescription in females and primary HF diagnosis in the oldest age stratum. The study's findings may assist homecare agencies seeking to allocate resources without compromising patient care.

Need for a national epilepsy control program

This article briefly outlines the proposed national epilepsy control program. The content of the article is based on four meetings held by invitation of the Ministry of Health. Invitees by ministry – Drs. D. C. Jain, M. Gourie Devi, V. Saxena, S. Jain, P. Satish. Chandra, M. Gupta, K. Bala, V. Puri, K. S. Anand, S. Gulati, S. Johri, P. S. Chandra, M. Behari, K. Radhakrishnan, D. Bachani. Presentations were made by Dr. M. Tripathi.The program will involve all neurologists across the country in teaching and training at state levels and a central monitoring committee.

Low day 100 transplant-related mortality (TRM) and relapse rate following clofarabine (CLO) in combination with cytarabine, total body irradiation (TBI), and allogeneic stem cell transplantation (AlloSCT) in children, adolescents, and young adults (CAYA) with poor-risk acute leukemia

6537

Background: CAYA with ALL or AML in third complete remission (CR3), refractory relapse (RR) or induction failure (IF) have an extremely poor prognosis, <20% EFS (Gaynon, BJH, 2005;Wells, JCO, 2003). CLO, an inhibitor of DNA polymerase and ribonucleotide reductase, has significant activity in CAYA with relapsed ALL/AML (Jeha, JCO 2006,2009) and synergy with cytarabine (Faderl, Blood, 2005). We sought to determine safety, day-100 TRM, and overall survival (OS) associated with CLO, cytarabine and TBI followed by AlloSCT in CAYA with poor-risk ALL/AML. Methods: This is a multi-center phase I/II trial of a novel conditioning regimen of CLO (dose escalation: 40mg/m2 [n=3], 46 mg/m2 [n=3], 52 mg/m2 [n=19]) x5d, sequential (4 hrs later) cytarabine 1000 mg/m2 x6d and TBI (1200cGy) followed by AlloSCT from matched related or unrelated donors in CAYA with ALL/AML in CR3, RR or IF. Patients with unrelated donors received R-ATG. GVHD prophylaxis consisted of tacrolimus and MMF (Bhatia/Cairo, BBMT, 2009). Kaplan-Meier method was used to determine the probabilities of engraftment, GVHD, TRM and OS. Results: 25 pts, median age: 11.3 yrs (1.5-20.7); M:F: 19:6, ALL/AML: 22:3 (10 CR3, 3 RR, 12 IF), 10 related donors, 15 unrelated donors (9 BM/PBSCs, 6 UCB). Median TNC and CD34 dose was 4.47x108/kg and 4.84x106/kg for BM/PBSCs and 4.0x107/kg and 2.8x105/kg for UCB, respectively. Probabilities of neutrophil, platelet engraftment and grade II-IV aGVHD were 100%, 92.9% and 47.5%, respectively. CLO dose was tolerable at 52mg/m2/d x5d without dose limiting toxicity. Probability of Day 100 TRM was only 4.3%. Probability of 1-yr PFS and OS were 51% (CI95: 28-71%), and 43% (CI95: 22-63%) respectively. Conclusions: Preliminary results suggest this novel regimen followed by AlloSCT is safe and well tolerated in CAYA with poor-risk ALL/ AML with CLO dose 52 mg/m2. Results are encouraging with respect to low risk of day 100 TRM and leukemic relapse associated with this conditioning regimen in this poor-risk population.

Perceptions on the Use of Telehealth by Homecare Nurses and Patients With Heart Failure

The purpose of this study was to explore perceptions on effectiveness of telehealth for Heart Failure (HF) management beyond the initial acceptance phase in a home care setting. Participants included 31 home care nurses for surveys, 9 nurses for focus groups and 4 patients with HF and the telehealth nurse for interviews. Telehealth was perceived to benefit by contributing objective assessments, timely information regarding patient status, a sense of security, and patient accountability. However, barriers to use of telehealth included inadequate staff training, lack of guidelines for client referrals and integration of telehealth in nursing workflow, lack of trust in equipment’s accuracy, and certain patient characteristics. The study exposed the role played by inadequate systemic guidelines and patient characteristics as factors affecting long-term use of telehealth for HF.