Association Between Palliative Care and Patient and Caregiver Outcomes: A Systematic Review and Meta-analysis

The use of palliative care programs and the number of trials assessing their effectiveness have increased

Long-Term Benefits from Early Antiretroviral Therapy Initiation in HIV Infection

BACKGROUND: For people with HIV and CD4+ counts >500 cells/mm3, early initiation of antiretroviral therapy (ART) reduces serious AIDS and serious non-AIDS (SNA) risk compared with deferral of treatment until CD4+ counts are 500 cells/mm3, excess risk of AIDS and SNA associated with delaying treatment initiation was diminished after ART initiation, but persistent excess risk remained. (Funded by the National Institute of Allergy and Infectious Diseases and others.)

Does Teaching and Learning Change With Full Access to Word Processors?

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Counseling About the Maternal Health Benefits of Breastfeeding and Mothers’ Intentions to Breastfeed

Objectives To evaluate the impact of counseling regarding the maternal health effects of lactation on pregnant women's intentions to breastfeed. Methods Women seeking prenatal care at an urban university hospital completed surveys before and after receiving a 5-min counseling intervention regarding the maternal health effects of breastfeeding. The counseling was delivered by student volunteers using a script and one-page infographic. Participants were asked the likelihood that breastfeeding affects maternal risk of multiple chronic conditions using 7-point Likert scales. We compared pre/post changes in individual item responses and a summary score of knowledge of the maternal health benefits of lactation (MHBL) using paired t tests. Multivariable logistic regression was used to examine the impact of increases in knowledge of MHBL on participants' intentions to breastfeed. Results The average age of the 65 participants was 24 ± 6 years. Most (72 %) were African-American and few (9 %) had college degrees. Half (50 %) had previously given birth, but few (21 %) had previously breastfed. Before counseling, few were aware of any benefits of lactation for maternal health. After counseling, knowledge of MHBL increased (mean knowledge score improved from 19/35 to 26/35, p < 0.001). Improvement in MHBL knowledge score was associated with increased intention to try breastfeeding (aOR 1.20, 95 % CI 1.02-1.42), of wanting to breastfeed (aOR 1.45, 95 % CI 1.13-1.86), and feeling that breastfeeding is important (aOR 1.21, 95 % CI 1.03-1.42). Conclusions for Practice Brief structured counseling regarding the effects of lactation on maternal health can increase awareness of the maternal health benefits of breastfeeding and strengthen pregnant women's intentions to breastfeed

The Effect of Geographic Cohorting of Inpatient Teaching Services on Patient Outcomes and Resident Experience.

BACKGROUND: Geographic cohorting is a hospital admission structure in which every patient on a given physician team is admitted to a dedicated hospital unit. Little is known about the long-term impact of this admission structure on patient outcomes and resident satisfaction. OBJECTIVE: To evaluate the effect of geographic cohorting on patient outcomes and resident satisfaction among inpatient internal medicine teaching services within an academic hospital. DESIGN AND INTERVENTION: We conducted an interrupted time series analysis examining patient outcomes before and after the transition to geographic cohorting of our 3 inpatient teaching services within a 520-bed academic hospital in November 2017. The study observation period spanned from January 2017 to October 2018, allowing for a 2-month run-in period (November-December 2017). PARTICIPANTS: We included patients discharged from the inpatient teaching teams during the study period. We excluded patients admitted to the ICU and observation admissions. MAIN MEASURES: Primary outcome was 6-month mortality adjusted for patient age, sex, race, insurance status, and Charlson Comorbidity Index (CCI) analyzed using a linear mixed effects model. Secondary outcomes included hospital length of stay (LOS), 7-day and 30-day readmission rate, Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores, and resident evaluations of the rotation. KEY RESULTS: During the observation period, 1720 patients (mean age 64, 53% female, 56% white, 62% Medicare-insured, mean CCI 1.57) were eligible for inclusion in the final adjusted model. We did not detect a significant change in 6-month mortality, LOS, and 7-day or 30-day readmission rates. HCAHPS scores remained unchanged (77 to 80% top box, P = 0.19), while resident evaluations of the rotation significantly improved (mean overall score 3.7 to 4.0, P = 0.03). CONCLUSIONS: Geographic cohorting was associated with increased resident satisfaction while achieving comparable patient outcomes to those of traditional hospital admitting models

Food-Grade Titanium Dioxide Induces Toxicity in the Nematode <i>Caenorhabditis elegans</i> and Acute Hepatic and Pulmonary Responses in Mice

Food-grade titanium dioxide (E171) contains variable percentages of titanium dioxide (TiO2) nanoparticles (NPs), posing concerns for its potential effects on human and animal health. Despite many studies, the actual relationship between the physicochemical properties of E171 NPs and their interaction with biological targets is still far from clear. We evaluated the impact of acute E171 administration on invertebrate and vertebrate animals. In the nematode, Caenorhabditis elegans, the administration of up to 1.0 mg/mL of E171 did not affect the worm’s viability and lifespan, but significantly impaired its pharyngeal function, reproduction, and development. We also investigated whether the intravenous administration of E171 in mice (at the dose of 6 mg/kg/body weight) could result in an acute over-absorption of filter organs. A significant increase of hepatic titanium concentration and the formation of microgranulomas were observed. Interstitial inflammation and parenchymal modification were found in the lungs, coupled with titanium accumulation. This was probably due to the propensity of TiO2 NPs to agglomerate, as demonstrated by transmission electron microscopy experiments showing that the incubation of E171 with serum promoted the formation of compact clusters. Overall, these data emphasize the actual risk for human and animal exposure to E171