Capsule endoscopy in suspected small bowel Crohn's disease:Economic impact of disease diagnosis and treatment

AIM: To model clinical and economic benef its of capsule endoscopy (CE) compared to ileo-colonoscopy and small bowel follow-through (SBFT) for evaluation of suspected Crohn’s disease (CD). METHODS: Using decision analytic modeling, total and yearly costs of diagnostic work-up for suspected CD were calculated, including procedure-related adverse events, hospitalizations, off ice visits, and medications. The model compared CE to SBFT following ileo-colonoscopy and secondarily compared CE to SBFT for initial evaluation. RESULTS: Aggregate charges for newly diagnosed, medically managed patients are approximately $8295. Patients requiring aggressive medical management costs are $29 508; requiring hospitalization, $49 074. At sensitivity > 98.7% and specifi city of > 86.4%, CE is less costly than SBFT. CONCLUSION: Costs of CE for diagnostic evaluationof suspected CD is comparable to SBFT and may be used immediately following ileo-colonoscopy.

Role of cardiac magnetic resonance imaging in the diagnosis and management of COVID-19 related myocarditis: Clinical and imaging considerations

There is a growing evidence of cardiovascular complications in coronavirusdisease 2019 (COVID-19) patients. As evidence accumulated of COVID-19 mediatedinflammatory effects on the myocardium, substantial attention has beendirected towards cardiovascular imaging modalities that facilitate this diagnosis.Cardiac magnetic resonance imaging (CMRI) is the gold standard for thedetection of structural and functional myocardial alterations and its role inidentifying patients with COVID-19 mediated cardiac injury is growing. Despiteits utility in the diagnosis of myocardial injury in this population, CMRI’s impacton patient management is still evolving. This review provides a framework for theuse of CMRI in diagnosis and management of COVID-19 patients from theperspective of a cardiologist. We review the role of CMRI in the management ofboth the acutely and remotely COVID-19 infected patient. We discuss patientselection for this imaging modality;T1, T2, and late gadolinium enhancementimaging techniques;and previously described CMRI findings in other cardiomyopathieswith potential implications in COVID-19 recovered patients.

Hashimoto Encephalopathy: Impact of Concussion

Patients with Hashimoto encephalitis may present with seizures, stroke-like episodes, transient focal and global neurological deficits, and a variety of neuropsychiatric disturbances. The encephalopathy evolves with elevated anti-thyroid peroxidase antibodies, independent of hormonal thyroid function. A teenager experienced repeated concussions antedating onset of Hashimoto encephalopathy. Neuroradiological studies showed overlapping areas of altered brain metabolism and vascular perfusion in the hippocampus, deemed most vulnerable in autoimmune encephalopathy. Concussive brain injury may be a contributing factor in the development of encephalopathy due to its capacity to alter the blood-brain barrier.

Mining twitter to understand the smoking cessation barriers

Smoking cessation is challenging and lack of positive support is a known major barrier to quitting cigarettes.Previous studies have suggested that social influences might increase smokers' awareness of social norms for appropriate behavior,which might lead to smoking cessation.Although social media use is increasing among young adults in the United States,research on the relationship between social media use and smoking cessation is lacking.Twitter has provided a rich source of information for researchers,but no overview exists as to how the field uses Twitter in smoking cessation research.To the best of our knowledge,this study conducted a data mining analysis of Twitter to assess barriers to smoking cessation.In conclusion,Twitter is a cost-effective tool with the potential to disseminate information on the benefits of smoking cessation and updated research to the Twitter community on a global scale.

Forgiveness education in fibromyalgia: A qualitative inquiry

The purpose of this qualitative study was to assess perspectives on the acceptability and the potential applicability of a forgiveness education in patients with fibromyalgia. The concept and tools of forgiveness were presented to thirteen women (age: 40 - 54 years) with a previous diagnosis of fibromyalgia. Subjects participated in 1 of 2 focus groups following a 90-minute education session in which forgiveness was presented as an emotion-focused coping strategy to deal with interpersonal stressors. Qualitative assessment of focus group discussions reveals 3 themes: 1) forgiveness is healthy and reduces pain, 2) forgiveness is within a patient’s personal control, and 3) forgiveness education is similar to other types of patient education and is well received. Our results suggest that forgiveness education is acceptable and feasible in patients with fibromyalgia. This justifies further exploration of forgiveness as an emotion-focused self- management strategy to decrease psychological distress.

在加利福尼亚Kaiser早产儿医疗护理规划中的中度早产儿的出院时间早于与之相匹配的马萨诸塞州及英国婴儿

Objective:To compare gestational age at discharge between infants born at 30-34+6 weeks gestational age who were admitted to neonatal intensive care units (NICUs) in California,Massachusetts,and the United Kingdom. Design:Prospective observational cohort study. Setting:Fifty four United Kingdom,five California,and five Massachusetts NICUs. Subjects:A total of 4359 infants who survived to discharge home after admission to an NICU. Main outcome measures:Gestational age at discharge home. Results:The mean (SD) postmenstrual age at discharge of the infants in California,Massachusetts,and the United Kingdom were 35.9 (1.3),36.3 (1.3),and 36.3(1.9)weeks respectively (p = 0.001). Compared with the United Kingdom,adjusted discharge of infants occurred 3.9 (95%confidence interval (CI) 1.4 to 6.5) days earlier in California,and 0.9 (95%CI -1.2 to 3.0) days earlier in Massachusetts. Conclusions:Infants of 30-34+6 weeks gestation at birth admitted and cared for in hospitals in California have a shorter length of stay than those in the United Kingdom. Certain characteristics of the integrated healthcare approach pursued by the health maintenance organisation of the NICUs in California may foster earlier discharge. The California system may provide opportunities for identifying practices for reducing the length of stay of moderately premature infants.

Acute pancreatitis associated with intravenous administration of propofol:evaluation of causality in a systematic review of the literature

Acute pancreatitis(AP)associated with intravenous administration of propofol has been described with unknown causal relation.We therefore assessed this causality in a systematic review.Multiple databases were searched on 16 August 2017;studies were appraised and selected by two reviewers based on a priori criteria.Propofol causality was evaluated with the Naranjo scale and Badalov classification.We identified 18 studies from 11 countries with a total of 21 patients,and the majority had adequate methodological quality.The median age was 35 years(range,4–77)and 10(48%)were males.Overall,propofol was administrated in 8 patients as sedative along with induction/maintenance of anesthesia in 13 patients;median dose was 200 mg,with intermediate latency(1–30 days)in 14(67%).Serum triglycerides were>1000 mg/dL in four patients.Severe AP was observed in four patients(19%).AP recurrence occurred in one out of two patients who underwent rechallenge.Mortality related to AP was 3/21(14%).Propofol was the probable cause of AP according to the Naranjo scale in 19 patients(89%).Propofol-induced AP has a probable causal relation and evidence supports Badalov class Ib.Hypertriglyceridemia is not the only mechanism by which propofol illicit AP.Propofol-induced AP was severe in 19%of patients with a mortality rate related to AP of 14%.Future research is needed to delineate whether this risk is higher if combined with other procedures that portend inherent risk of pancreatitis such as endoscopic retrograde cholangiopancreatography.

2型糖尿病患者强化血糖控制的利与弊

糖尿病是全球主要的健康问题,治疗花费高,有较高的发病率、致残率和死亡率,显著影响患者生活质量。绝大多数糖尿病患者属于2型糖尿病。从既往研究看,减少2型糖尿病并发症的主要策略是加强血糖控制。然而大量证据表明,除了降低非致死性心肌梗死的发生率外,强化(相对于适度)血糖控制对重要的微血管和大血管并发症预后没有显著获益。但是,严格的血糖控制却会增加严重低血糖的风险,并会增加药物种类、副作用和成本等额外负担。此外,来自心血管结局研究的数据表明,使用特定类别的降糖药可大大改善心血管、肾脏和死亡的结果,而这些效应在很大程度上不是由降糖作用带来的。因此,为2型糖尿病患者提供基于循证医学的、以患者为中心的诊疗,需要转变范式并脱离以血糖为中心的糖尿病管理观点。与其优先考虑加强血糖控制,不如将重点放在确保患者获得足够的糖尿病照护,使血糖目标和患者的目标与情况保持一致,最大程度地减少短期和长期并发症,减轻治疗负担以及改善生活质量上。

美国使用烟草印花税以防止和减少烟草非法交易

在美国,吸烟是导致很多疾病发生和死亡的主要原因。提高烟草产品的单位价格是减少和管控烟草消费的最有效的措施。非法的烟草交易通过提供廉价产品来削弱高昂的烟草价格。在美国,非法烟草交易主要表现为在低消费税或零消费税司法管辖区购买烟草,并在高消费税的司法管辖区出售。对烟草产品加盖税印,不仅是完税凭证,也是打击非法烟草交易的重要手段。