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Background: Digital cognitive assessment solutions can overcome some barriers to cognitive screening in primary care by providing rapidly‐obtained objective insights without requiring specialty‐trained examiners. The Linus Health Digital Clock and Recall (DCR™) is a three‐part test consisting of three‐word immediate verbal acquisition, the Digital Clock Test (DCTclock™), and delayed recall of the three words. Our objective was to compare performance on the DCR to the Montreal Cognitive Assessment (MoCA; Nasreddine et al., 2005) and the Saint Louis University Mental Status (SLUMS; Tariq et al., 2006), two commonly used screening tests in primary care. Method: Comparative analyses of DCR, MoCA (Total Score and Memory Index Score [MIS]), and SLUMS results were conducted among 80 primary care patients – 65 years and older presenting for any reason – whose DCR performance was indicative of cognitive impairment. Result: Of the 80 patients (mean age 74.0 [±7.8]; 60% female) performing as impaired or borderline impaired on the DCR, 67 completed the MoCA and 13 completed the SLUMS. Comparison between the DCR and MoCA Total Score included 78% (52/67) concordance for identifying impairment (cutoff <26). While the remaining 15 of 67 patients (22%) had normal MoCA Total Scores (≥26), 13 (87%) missed points in at least one MoCA cognitive domain and 8 (53%) missed points in multiple MoCA domains (often language and delayed recall). Comparison between DCR and SLUMS revealed that all 13 patients receiving SLUMS assessment had DCR scores 0‐1 and SLUMS scores <27 (indicating cognitive impairment). See Tables 1 and 2 for breakdown of MoCA, MIS, and SLUMS stratified by DCR performance. Logistic regression found that DCTclock metrics of information processing (z = 2.00, p =.045) and spatial reasoning (z = 2.82 p =.005) discriminated cognitive impairment on MoCA Total Score (cutoff <26). Overall, ROC analysis revealed good accuracy of DCR to identify MoCA performance (AUC =.84; Figure 1). Conclusion: Screening in primary care using the DCR is feasible, takes less time to administer than MoCA or SLUMS, and shows concordant results with these more established screening tools in detecting cognitive impairment. Future research aims to investigate the criterion validity of the DCR among biomarkers for neurodegenerative disease. [ABSTRACT FROM AUTHOR]

Background: Blood‐based biomarker tests are critical tools with the potential to change pathways for dementia diagnosis and care. These tests are less invasive than PET scan or lumbar puncture, potentially more affordable, and thus more accessible across more care settings and in more countries. Utilization in primary care settings together with brief cognitive assessments provides a compelling use case that could transform diagnosis, assessment and care. A critical challenge to the widespread adoption of blood‐based biomarker testing is the issue of disclosure. To date, Alzheimer's Disease and Related Dementias (ADRD) biomarker disclosure recommendations have primarily focused on disclosure in research and/or specialized‐care settings. Primary care clinicians are well situated to conduct biomarker testing, but they are likely to need training and support to develop confidence and capacity to communicate results. Method: Review of literature findings involving biomarker disclosure and input from dementia researchers from six countries reflecting diverse health care systems informed development of a disclosure framework to support the inaugural project of the Davos Alzheimer's Collaborative's (DAC) Systems Preparedness (DAC‐SP) initiative. This project seeks to promote routine uptake of cognitive screening among people ≥ age 60 and, when cognitive impairment is identified, blood‐based biomarker testing. The biomarker testing is completed using a commercially available, CLIA‐certified test that measures the likelihood of amyloid pathology when cognitive impairment is identified. Result: The framework recognizes that biomarker disclosure is part of a comprehensive patient evaluation that includes cognitive assessment and a broader discussion of the patient's health and wellbeing. It divides disclosure into five phases: pre‐test education; consent for and administration of testing; disclosure of results and discussion of treatment plan; provision of educational materials; and follow up (Table 1). This general framework can be adapted for site‐specific factors such as health literacy, health systems operations, legal structures, and cultural relevance. Conclusion: As part of a pragmatic multisite implementation evaluation of a screening and early detection program including high and middle income countries, the authors have developed a framework to guide biomarker disclosure to patients in primary care settings. This provisional framework represents an important first step towards clinical consensus building on biomarker disclosure. [ABSTRACT FROM AUTHOR]

Background: With the emergence of novel therapeutics, the importance of early identification of people at risk of developing Alzheimer's disease is more critical than ever. Most asymptomatic at‐risk individuals are primary care patients, who often have limited access to specialty care. Therefore, development of feasible, acceptable, and scalable ways to identify early cognitive impairment in the primary care setting is essential. The DAVOS Alzheimer's Collaborative DIGITAL Demonstration Project was conducted to understand the feasibility, acceptability, and implementation of digital cognitive screening in primary care. Methods: Patients ≥65 years presenting for any issue to one of six Indiana University Health primary care sites between June and December 2022 were asked to complete the Linus Health Digital Clock and Recall (DCR™) cognitive assessment screening tool. Scores on the DCR™ range 0‐5, with 0‐1 categorized as cognitively impaired, 2‐3 as likely cognitively unimpaired, and 4‐5 as cognitively unimpaired. Data regarding number of DCR™ screening attempts that were refused, incomplete, or completed was collected. This pragmatic demonstration project allowed patients to be approached multiple times and complete the screening multiple times within the project time frame. Patients first completed screening test results were analyzed using descriptive statistics. Results: Over the 7‐month project, 3,343 screening attempts were made. The screening test was refused by patients (54.6%) 1,825 times and was attempted but incomplete 64 (1.9%) times. 1,454 (43%) screenings were completed, which represents 1,405 unique patients. Among these, 172 (12%) scored positive for cognitive impairment, 506 (36%) scored likely cognitively impaired, 628 (45%) scored cognitively unimpaired, and 99 (7%) results were unanalyzable. Conclusions: Using the DCR™, cognitive screening was successfully completed in nearly half of the primary care patients approached, regardless of their presenting concern, with 48% scoring either impaired or likely impaired. This cognitive screening approach appears to have utility in developing early detection for cognitive impairment in primary care, which will be an initial step towards identifying patients who could benefit from disease‐modifying therapeutics. [ABSTRACT FROM AUTHOR]

Background: Transaminase elevations can occur from liver injury or in the setting of rhabdomyolysis. The goal of this study is to evaluate indices that could differentiate acetaminophen toxicity from muscle injury in the setting of transaminase elevations.Methods: A retrospective chart review of consecutive cases reported to our regional poison center. Patients with transaminase (AST and ALT) elevation were grouped as those with acetaminophen exposure (AT) and those with elevated creatine phosphokinase (CPK) without evidence of acetaminophen exposure (RHB).Results: Of the 345 patients included in the study, elevated AST/ALT levels were attributed to rhabdomyolysis in 168 patients and attributed to acetaminophen toxicity in 177 patients. The median AST: ALT values also differed between groups, with patients in the RHB group had higher median ratios (p < 0.001). Using an AST: ALT value of 2.02 as a diagnostic cutoff produced a specificity of 0.52 (95% CI: 0.37, 0.64) and sensitivity of 0.84 (95% CI: 0.73, 0.94) for acetaminophen detection in the test dataset (N = 104).Conclusions: Elevated transaminases due to liver injury from acetaminophen ingestion had a different pattern than elevated transaminases due to rhabdomyolysis. Lower AST:ALT ratios were found in acetaminophen cases, however, the specificity using a ratio threshold of ≤1 would be 83%. [ABSTRACT FROM AUTHOR]

The article offers information on the implementation of antimicrobial resistance prevention and control in U.S. hospitals. The National Foundation for Infectious Diseases and Centers for Disease Control and Prevention has proposed strategies to control antimicrobial agents. It is suggested that there should be an optimization of antibiotic use, and the prevention of the spread of antimicrobial resistance and control transmission. It is cited that a study is conducted, in which 448 infection control professionals were surveyed.

Bacterial meningitis is a serious, acute infection of the meninges. Definitive diagnosis is made by analysis of cerebral spinal fluid (CSF) culture. Diagnostic clues of bacterial meningitis on the CSF include pleocytosis, an elevation in the white blood cell (WBC) count. We report a 3-year-old white male who presented to the emergency department (ED) secondary to two febrile seizures. He was ultimately diagnosed with fulminant bacterial meningitis secondary to CSF culture confirmed Neiserria meningitidis. The patient's CSF obtained on admission to the ED did not have pleocytosis. Within 5 hours of initial presentation, he became hypotensive, altered and went into disseminated intravascular coagulation. He expired within 24 hours of presentation. Bacterial meningitis without CSF pleocytosis, later determined to be culture positive, has been reported in both adult and pediatric patients but is extremely rare. However, these patients are more likely to have poorer outcomes. If bacterial meningitis is suspected, empiric antibiotics should be administered regardless of initial WBC count on lumbar puncture. [ABSTRACT FROM AUTHOR]