Improving patient notification of solid abdominal viscera incidental findings with a standardized protocol

BACKGROUND: The increasing use of computed tomography (CT) scans in the evaluation of trauma patients has led to increased detection of incidental radiologic findings. Incidental findings (IFs) of the abdominal viscera are among the most commonly discovered lesions and can carry a risk of malignancy. Despite this, patient notification regarding these findings is often inadequate. METHODS: We identified patients who underwent abdominopelvic CTs as part of their trauma evaluation during a recent 1-year period (9/2011-8/2012). Patients with IFs of the kidneys, liver, adrenal glands, pancreas and/or ovaries had their charts reviewed for documentation of the lesion in their discharge paperwork or follow-up. A quality improvement project was initiated where patients with abdominal IFs were verbally informed of the finding, it was noted on their discharge summary and/or were referred to specialists for evaluation. Nine months after the implementation of the IF protocol, a second chart review was performed to determine if the rate of patient notification improved. RESULTS: Of 1,117 trauma patients undergoing abdominopelvic CT scans during the 21 month study period, 239 patients (21.4%) had 292 incidental abdominal findings. Renal lesions were the most common (146 patients, 13% of all patients) followed by hepatic (95/8.4%) and adrenal (38/3.4%) lesions. Pancreatic (10/0.9%) and ovarian lesions (3/0.3%) were uncommon. Post-IF protocol implementation patient notification regarding IFs improved by over 80% (32.4% vs. 17.7% pre-protocol, p = 0.02). CONCLUSION: IFs of the solid abdominal organs are common in trauma patients undergoing abdominopelvic CT scan. Patient notification regarding these lesions is often inadequate. A systematic approach to the documentation and evaluation of incidental radiologic findings can significantly improve the rate of patient notification

Risks factors for significant injury after geriatric falls

Elderly falls are a healthcare epidemic. We aimed to identify risk factors of serious falls by linking data on functional status from the Global Longitudinal Study of Osteoporosis in Women (GLOW) and our institutional trauma registry. 124 of 5,091 local women enrolled in GLOW were evaluated by our trauma team for injuries related to a fall during the study period. Median injury severity score was 9. The most common injuries were intertrochanteric femur fracture (n = 25, 9.8%) and skin contusion/hematoma to face (n = 12, 4.7%). Injured women were older than the uninjured cohort (median 80 versus 68 years), more likely to have cardiovascular disease and osteoarthritis, and less likely to have high cholesterol. Prospectively collected Short Form 36 (SF-36) baseline activity status revealed greater limitation in all assessed activities in women evaluated for fall-related injuries in our trauma center. In multivariable analysis, age (per 10 year increase) and two or more self-reported falls in the baseline survey were the strongest predictors of falling (both HR 2.4, p <0.0001 and p<0.001 respectively), followed by history of osteoarthritis (HR 1.6, p= 0.01). Functional status was no longer associated with risk of fall when adjusting for these factors.Functional status appears to be a surrogate marker for frailty. With the aging of the US population and long lifespan of American women, this finding has important implications for both fall prevention strategies and research intended to better understand why aging women fall as burdensome validated metrics may not be the best indicators of fall risk. The authors have no conflict of interests to declare. Funding statement: This work was partially supported by grants from NIH (8KL2TR000160-03), AHRQ (R01HS22694), and PCORI (ME-1310-07682) to HS

The Public Repository of Xenografts enables discovery and randomized phase II-like trials in mice

More than 90% of drugs with preclinical activity fail in human trials, largely due to insufficient efficacy. We hypothesized that adequately powered trials of patient-derived xenografts (PDX) in mice could efficiently define therapeutic activity across heterogeneous tumors. To address this hypothesis, we established a large, publicly available repository of well-characterized leukemia and lymphoma PDXs that undergo orthotopic engraftment, called the Public Repository of Xenografts (PRoXe). PRoXe includes all de-identified information relevant to the primary specimens and the PDXs derived from them. Using this repository, we demonstrate that large studies of acute leukemia PDXs that mimic human randomized clinical trials can characterize drug efficacy and generate transcriptional, functional, and proteomic biomarkers in both treatment-naive and relapsed/refractory disease

Imaging and Management of Thoracic Trauma

Thoracic injury results from penetrating and blunt trauma and is a major contributor to overall trauma morbidity and mortality in the United States. Modern imaging algorithms utilize ultrasound, chest radiograph, and computed tomography with intravenous contrast to accurately diagnose and effectively treat patients with acute thoracic trauma. This review focuses on the etiologies, signs and symptoms, imaging, and management of several life-threatening thoracic injuries including tracheobronchial rupture, pulmonary parenchymal injury, hemothorax, pneumothorax, diaphragmatic rupture, and axial skeleton injury

Resonance Induced Properties in Monothiocarbamates Derived from Aromatic Amines: Comparison of the Coordination Chemistry of Indole and Indoline Monothiocarbamates

The syntheses of two new monothiocarbamate ligands and selected transition element complexes of each are reported. The complexes of indoline-N-carbothioate (intc) prepared are: NiL2·1.5H2O, ZnL2, NiL2·2py, ZnL2·2py. The complexes of indole N-carbothioate (iltc) are: NiL′2, ZnL′2, Cul′. IR spectral results support a bidentate ligand behavior for both new monothiocarbamates except in ZnL2·2py. Comparison of the IR spectral features of bis(indolylcarbamoyl)-disulfide with that of coordinated indole-N-carbothioate allowed an assignment of the C-S and C-O vibrational frequencies. Evidence for differences in major resonance contributions to the electronic structures of each new ligand are presented. The crystal structure of thebis(indolylcarbamoyl)disulphide is also presented and a comparison is made to pyrrole-N-carbothioate, another aromatic amine monothiocarbamate. The disulphide crystallizes in the centrosymmetric monoclinic space group P21/c with a = 15.64(4)Å, b = 5.228(1)Å,c = 19.271(7)Å, β = 97.20(2)°, V = 1564(1)Å3, d(obsd)(calcd) = (1.50)(1.52) for a molecular weight = 356.1 and Z = 4. Diffraction data were collected with a Syntex Pdiffractiometer with CuKα radiation. Least squares refinement resulted in Rf = 7.0% for all 1213 non zero reflections have (I)\u3e 3σ(I)

Coordination Chemistry of New Sulfur-Containing Ligands. 22. Synthesis and Structure of bis(pyridine)bis(pyrrole-N-carbothioato)nickel(II), Ni(SOCNC4H4)2(C5H5N)2. Evidence for New Resonance Forms in Monothiocarbamates

This bis(pyridine) adduct of the Ni(II) complex of pyrrole-N-carbothioate, Ni(ptc)2(py)2 has been synthesized by the addition of pyridine to a THF solution of Ni2(ptc)4·3THF. The crystal and molecular structure of the title compound has been solved by a single-crystal X-ray diffraction study at room temperature. The compound crystallizes in the centrosymmetric monoclinic space group P21/c with a = 11.423 (5) Å, b = 9.415 (4) Å, c = 21.651 (11) Å, β = 112.92 (3)°, V = 2145 (2) Å, and dcbod (dcalcd) = 1.46 (1.45) g/cm3 for a mol wt = 469.2 and Z = 4. Diffraction data were collected with a Syntex P1 diffractometer using Mo Kα radiation (λ = 0.71069 Å). The nickel atom was located from a Patterson synthesis, and all other nonhydrogen atoms were located via difference Fourier techniques. Hydrogens were placed in calculated positions whenever necessary. Least-squares refinement resulted in RF = 6.9% and “goodness-of-fit” = 1.28 for all 1469 reflections having I ≥ 3σ(I) with 5° \u3c 2θ \u3c 42°. The molecules are well separated and monomeric. The coordination geometry about the Ni atom is best described as a distorted octahedron. The arrangement of the nitrogen, sulfur, and oxygen donor atoms is discussed in terms of the trans influence. In addition, bond distances and angles indicate little or no contribution from the resonance form usually associated with monothiocarbamates. Comparisons between this new (aromatic) monothiocarbamate and dialkylmonothiocarbamates are made