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Background and Objectives Obesity is increasing among people residing in nursing homes, and resident obesity substantially affects services needed, equipment and facilities provided, and morbidity in this setting. The purpose of this article is to describe the scope and depth of evidence regarding the impact of obesity among nursing home residents in the United States. Research Design and Methods A systematic literature review was performed in PubMed, EMBASE, CINAHL, and Web of Science databases as well as additional hand-searched documents. Included articles were published from 1997 to March 2017. The characteristics and content of the included articles were systematically reviewed and reported. Results Twenty-eight studies met inclusion criteria for review. The median study size was 636 residents (interquartile range 40–11,248); 18 (64%) studies were retrospective and 10 (36%) were prospective in nature. Ten (36%) studies examined medical and functional morbidity, 10 (36%) examined health system effects, and 5 (18%) examined the risk of admission to nursing homes. Most studies found that obesity poses serious issues to resident health and the provision of health care, as well as broad health system and nursing challenges in the provision of high-quality nursing home care and services. Discussion and Implications Although obesity affects about one in four nursing home residents in the United States, relatively limited evidence exists on the complex challenges of obesity for their residents and their care. A continued focus on resident quality of life, health system improvement, and nursing best practices for properly caring for individuals with obesity is needed. [ABSTRACT FROM AUTHOR]

We investigated an effect of end-stage renal disease (ESRD) on the visual system by measuring the ability of 21 patients to perceive depth in the random dot stereograms and circles of the Randot Test. To control for other factors which might influence performance on the tests of stereopsis, patients were compared with healthy controls matched for age, years of education, IQ, and general cognitive ability. Vernier acuity (thought to reflect mainly central processing) and Landolt acuity (more sensitive to retinal and optical abnormalities) were also measured, but the study did not include a formal ophthalmological examination. All controls could perceive depth in random dot stereograms, whereas 9/21 patients could not. Patients who could perceive depth had worse stereoacuity than did their matched controls. The patient group as a whole had worse Vernier and Landolt acuities than the controls. The stereoblind patient subgroup had similar Vernier acuity to the stereoscopic subgroup, but worse Landolt acuity, and was more likely to have peripheral vascular disease. We conclude that ESRD had affected structures both within the eye, and within the visual brain. However, the similarity of Vernier acuity and difference of Landolt acuity in the stereoblind and stereoscopic patient subgroups suggest that the differences in stereoscopic ability arise from abnormalities in the eyes rather than in the brain. [ABSTRACT FROM AUTHOR]

Objective: To determine if the use of intraoperative hemostatic agents was a risk factor for post-operative adverse events within 30 days of patients undergoing hysterectomy.Method: A population-based retrospective cohort study included data from patients undergoing hysterectomy for any indication between January 1, 2013, and December 31, 2014, at 52 hospitals in Michigan, USA. Any individuals with missing covariate data were excluded, and multivariable logistic regression and propensity score-matching were used to estimate the rate of post-operative adverse events associated with intra-operative hemostatic agents independent of demographic and surgical factors.Results: There were 17 960 surgical procedures included in the analysis, with 4659 (25.9%) that included the use of hemostatic agents. Hemostatic agent use was associated with an increase in predicted hospital re-admissions (P=0.007). Among all hysterectomy approaches, and after adjusting for demographic and surgical factors, hemostatic agent use during robotic-assisted laparoscopic hysterectomy was associated with an increased predicted rate of blood transfusions (P=0.019), an increased predicted rate of pelvic abscess diagnoses (P=0.001), an increased predicted rate of hospital re-admission (P=0.001), and an increased predicted rate of re-operation (P=0.021).Conclusion: Hemostatic agents should be used carefully owing to associations with increased post-operative re-admissions and re-operations when used during hysterectomy. [ABSTRACT FROM AUTHOR]

The article offers information on a study to develop international consensus over a core outcome set for vitiligo trials that is acceptable to healthcare professionals, patients and their caregivers. Topics discussed include use of Delphi technique for the study, patients' views on the effectiveness of a treatment for vitiligo, and quality of life of patients with vitiligo.

Biomedical research involving human participants is highly regulated and subject to stringent ethical requirements. Clinical research ethics, regulation and policy have tended to focus almost exclusively on the protection of participants' interests against harms that might result from taking part in research. Less consideration, however, has been given to the interests that patients may themselves have in research participation, even in trials that may be beyond the bounds of current clinical research practice. In this paper, we consider the case of a suggested extension to clinical trial protocols to explore the ethics of participation in 'risky' research. We argue that patients may have a strong interest in taking part in research, and that even when greater-than-usual risks may be present, such research can be both ethically and scientifically justified. Finally, we suggest that there might be scope in some cases to assert a right to participate in research, and that the possibility of such a right merits further consideration. [ABSTRACT FROM AUTHOR]

We propose a method of predicting intrauterine pressure (IUP) from external electrohysterograms (EHG) using a causal FIR Wiener filter. IUP and 8-channel EHG data were collected simultaneously from 14 laboring patients at term, and prediction models were trained and tested using 10-min windows for each patient and channel. RMS prediction error varied between 5–14 mmHg across all patients. We performed a 4-way analysis of variance on the RMS error, which varied across patients, channels, time (test window) and model (train window). The patient-channel interaction was the most significant factor while channel alone was not significant, indicating that different channels produced significantly different RMS errors depending on the patient. The channel-time factor was significant due to single-channel bursty noise, while time was a significant factor due to multichannel bursty noise. The time-model interaction was not significant, supporting the assumption that the random process generating the IUP and EHG signals was stationary. The results demonstrate the capabilities of optimal linear filter in predicting IUP from external EHG and offer insight into the factors that affect prediction error of IUP from multichannel EHG recordings. [ABSTRACT FROM AUTHOR]

Venous duplex ultrasound scanning (VDUS) has been shown to be an accurate non-invasive means to diagnose symptomatic deep venous thrombosis (DVT). The aim of our study was to determine whether bilateral VDUS is necessary in patients who present with symptoms of DVT. We retrospectively reviewed the results of bilateral lower extremity VDUS performed on 1029 inpatients at Royal Prince Alfred Hospital in the 24 months from 1 January 1998 to 31 December 1999. Of the 1029 patients, 705 (69%) presented with unilateral symptoms and 324 (31%) with bilateral symptoms. The overall incidence of DVT was 168 (16% of 1029 patients). In 705 patients with unilateral symptoms the diagnosis of DVT was confirmed in 120 (17.0%), of whom 20 (16.7%) had unsuspected bilateral DVT. There were 12 patients (1.7% of the 705 patients) who had DVT in the asymptomatic limb, without DVT identified in the symptomatic limb. Overall there were 32 (5% of 705) patients with unilateral symptoms who had unsuspected DVT in the asymptomatic limb. Of the 20 patients with bilateral DVT, only one patient had more extensive DVT in the asymptomatic limb than in the symptomatic limb, that was therefore likely to alter treatment. Bilateral symptoms of DVT were present in 324 (31.5%) patients, 48 (14.8%) of whom were found to have DVT. Nineteen (39.6%) of these DVTs were bilateral. Overall the diagnostic yield of VDUS was low in this study, with an incidence of 16% of DVT detected in symptomatic patients. Techniques that improve the diagnostic yield of VDUS in symptomatic patients are required. A significant proportion (23%) of the DVT detected in this study were bilateral, and a small but significant proportion (10%) of DVT found in patients presenting with unilateral symptoms were only in the asymptomatic contralateral limb. Our study supports bilateral VDUS in symptomatic inpatients, as the detection of DVT in asymptomatic limbs aids future patient management if symptoms develop in the asymptomatic limb. [ABSTRACT FROM AUTHOR]

Reports on a seventh kindred with hereditary pancreatitis. Number of patients with definite pancreatitis; Mode of genetic transmission; Characteristics of the disease.

The article discusses several medical-related studies published in the journal in 1940, 1965 and 1990. The topics of the studies include the development of thyreotoxicosis in patients with liver damage, the association between prolonged solar exposure and skin collagen degeneration and the diagnosis of non-accidental injuries in physically abused children.

The article presents perspectives of various authors about diseases published from the previous issues of the ANZ Journal of Surgery. It states that the article of S.A. Deane and colleagues in 1988 said that injuries morbidity and mortality have been recognized as major public health issues. In addition, G.W. Milton and colleagues made a survey on 127 patients diagnosed with appendicitis, published in 1963. It says that P.G. Cecil's article in 1938 deals with surgeon's knowledge about disease.

Highlights: [•] Melanocytes from vitiligo patients display features of elevated cellular stress. [•] Stressed cells produce damage-associated molecular patterns (DAMPs). [•] DAMPs activate innate immune cell populations through pattern recognition receptors. [•] Activated innate immune cells can promote adaptive immunity in vitiligo. [•] Activated stress pathways appear to play a role in organ-specific autoimmunity. [ABSTRACT FROM AUTHOR]

Severe obesity in nursing home (NH) residents is associated with specialized care needs, limited mobility, and challenges in daily living. The COVID-19 pandemic strained NH resources and exacerbated staffing shortages. This study aimed to assess the ability of US NHs to accept and care for residents with severe obesity post-COVID, as well as associated NH factors. Cross-sectional nationwide survey of NH administrators (2021-2022). 290 NHs from a national sample (n = 224) and a targeted sample in Massachusetts and New Jersey (n = 66). A survey designed to assess how NHs approach admitting and caring for people with severe obesity before and after COVID was fielded from 2021 to 2022. Responses were linked to facility information from the Certification and Survey Provider Enhanced Reports, Minimum Data Set, Nursing Home Compare, Area Health Resources File, and US Diabetes Surveillance System. Multivariable logistic regression was used to assess the effect of organizational and survey response variables. Of the 2503 surveys sent to US NHs, 1923 were sent to the national NH stratified sample, and 580 were sent to the MA/NJ sample. Overall, 12% (301 of 2503) of NHs surveyed responded. The response rates were similar between the 2 samples. Of 290 NHs with complete data, 34% reported being unlikely to accept residents with severe obesity after COVID-19, compared with 25% before the pandemic (P <.001). The main barriers to acceptance were staffing shortages and difficulties meeting equipment and space needs. NHs with higher proportions of Black residents were more likely to admit individuals with severe obesity. The decline in acceptance of residents with severe obesity during and after COVID-19 highlights potential challenges that this population faces in accessing care. Our results also raise concerns that an intersection of disparities may exist in Black patients with severe obesity. [ABSTRACT FROM AUTHOR]

Background: Terminology and classifications are the vehicles by which pathologic conditions are identified and understood. It is critically important for the patient admitted with suspected blunt thoracic aortic injury that admitting physicians have a thorough knowledge of acute traumatic aortic tear and its natural history. Objectives: The objectives of this review were as follows: (1) to introduce a pathology-based terminology and classification of acute traumatic aortic injuries that unambiguously defines each, and (2) to emphasize the clinical relevance of acute traumatic tear to post-hospital admission deaths in blunt thoracoabdominally injured patients. Methods: This is a literature review of 32 refereed articles pertaining to acute traumatic thoracic aortic injury published from 1957 to the present. Results: The terminology used to describe aortic injury is inconsistent. Several terms are often loosely interchanged: tear, laceration, transection, and rupture. Furthermore, classifications of aortic injuries have been proposed based on microscopic or gross pathologic or computed tomography scan results. While microscopically-based classifications have little or no clinical application, a classification based on gross pathology provides information useful for aortic injury prognosis and management. Conclusion: Reduction of post-hospital death caused by acute aortic tear requires knowledge and understanding of the pathology of acute traumatic aortic tear and its natural history. Such understanding of pathology of acute traumatic aortic tear and its natural history is enhanced by terminology that defines the aortic injury. Therefore, we present our proposed terminology and classification of acute traumatic injuries. [ABSTRACT FROM AUTHOR]

Background: To determine whether deferoxamine prevents the complications of transfusional iron overload in thalassemia major, we evaluated 59 patients (30 were female and 29 male; age range, 7 to 31 years) periodically for 4 to 10 years or until death. Methods: At each follow-up visit, we performed a detailed clinical and laboratory evaluation and measured hepatic iron stores with a noninvasive magnetic device. Results: The body iron burden as assessed by magnetic measurement of hepatic iron stores was closely correlated (R = 0.89, P<0.001) with the ratio of cumulative transfusional iron load to cumulative deferoxamine use (expressed in millimoles of iron per kilogram of body weight, in relation to grams of deferoxamine per kilogram, transformed into the natural logarithm). Each increase of one unit in the natural logarithm of the ratio (transfusional iron load to deferoxamine use) was associated with an increased risk of impaired glucose tolerance (relative risk, 19.3; 95 percent confidence interval, 4.8 to 77.4), diabetes mellitus (relative risk, 9.2; 95 percent confidence interval, 1.8 to 47.7), cardiac disease (relative risk, 9.9; 95 percent confidence interval, 1.9 to 51.2), and death (relative risk, 12.6; 95 percent confidence interval, 2.4 to 65.4). All nine deaths during the study occurred among the 23 patients who had begun chelation therapy later and used less deferoxamine in relation to their transfusional iron load (P<0.001). Conclusions: The early use of deferoxamine in an amount proportional to the transfusional iron load reduces the body iron burden and helps protect against diabetes mellitus, cardiac disease, and early death in patients with thalassemia major. (N Engl J Med 1994;331:567-73.) [ABSTRACT FROM AUTHOR]