Project #4: The Effects of a Pharmacist-Led Transitions of Care Program after Hospital Discharge

Our program is designed to help facilitate the transitions of care (TOC) of select patients discharged from Henry Ford Hospital (HFH) with the aim of preventing 30-day readmissions, as well as improving cost avoidance measures. TOC, as defined by the Centers of Medicare and Medicaid, is a complex process requiring several actions and multiple disciplines to work together to ensure effective communication and coordination of care. Transitioning from the hospital setting to home, specifically, exposes vulnerability within our health systems, and errors have a high chance of occurring. Medication management and follow-up care are included in “the seven essential elements” needed for successful TOC. According to Burke and colleagues, an ideal framework for establishing successful transitions of care includes 10 domains, amongst which are: medication safety, educating patients to promote self-management, enlisting help of social and community supports, coordinating care among team members and monitoring and managing symptoms after discharge and outpatient follow-up, all of which are embedded into our program.https://scholarlycommons.henryford.com/qualityexpo2022/1000/thumbnail.jp

Chronic Mercury Intoxication Masquerading as Systemic Disease: A Case Report and Review of the Literature

Background: Mercury is a highly toxic environmental metal that exists in three different forms: elemental, inorganic and organic. Intoxication occurs in either occupational or non-occupational settings, mainly after the inhalation of vapour and fumes in work places, laboratories or homes. Chronic mercury toxicity ranges from mild and insignificant to severe and life-threatening. We describe the case of a young male patient who presented with multiple organ dysfunction after chronic mercury exposure. Case presentation: We report the case of 28-year-old male artisanal gold miner who was admitted to hospital for severe neurological impairment associated with inflammatory bowel disease-like symptoms and a skin rash after mercury exposure. Symptomatic treatment and corticosteroid administration assured rapid clinical improvement. Chronic mercury poisoning can masquerade as an autoimmune or systemic inflammatory disease. Conclusion: Physicians should be aware that low exposure to mercury, even from artisanal gold mining, may be harmful to health. Management can be simple without the need for aggressive or invasive therapeutic measures. Larger case series are required in order to establish a clear management plan

Twelve-month observational study of children with cancer in 41 countries during the COVID-19 pandemic

Introduction Childhood cancer is a leading cause of death. It is unclear whether the COVID-19 pandemic has impacted childhood cancer mortality. In this study, we aimed to establish all-cause mortality rates for childhood cancers during the COVID-19 pandemic and determine the factors associated with mortality. Methods Prospective cohort study in 109 institutions in 41 countries. Inclusion criteria: children <18 years who were newly diagnosed with or undergoing active treatment for acute lymphoblastic leukaemia, non-Hodgkin's lymphoma, Hodgkin lymphoma, retinoblastoma, Wilms tumour, glioma, osteosarcoma, Ewing sarcoma, rhabdomyosarcoma, medulloblastoma and neuroblastoma. Of 2327 cases, 2118 patients were included in the study. The primary outcome measure was all-cause mortality at 30 days, 90 days and 12 months. Results All-cause mortality was 3.4% (n=71/2084) at 30-day follow-up, 5.7% (n=113/1969) at 90-day follow-up and 13.0% (n=206/1581) at 12-month follow-up. The median time from diagnosis to multidisciplinary team (MDT) plan was longest in low-income countries (7 days, IQR 3-11). Multivariable analysis revealed several factors associated with 12-month mortality, including low-income (OR 6.99 (95% CI 2.49 to 19.68); p<0.001), lower middle income (OR 3.32 (95% CI 1.96 to 5.61); p<0.001) and upper middle income (OR 3.49 (95% CI 2.02 to 6.03); p<0.001) country status and chemotherapy (OR 0.55 (95% CI 0.36 to 0.86); p=0.008) and immunotherapy (OR 0.27 (95% CI 0.08 to 0.91); p=0.035) within 30 days from MDT plan. Multivariable analysis revealed laboratory-confirmed SARS-CoV-2 infection (OR 5.33 (95% CI 1.19 to 23.84); p=0.029) was associated with 30-day mortality. Conclusions Children with cancer are more likely to die within 30 days if infected with SARS-CoV-2. However, timely treatment reduced odds of death. This report provides crucial information to balance the benefits of providing anticancer therapy against the risks of SARS-CoV-2 infection in children with cancer

Painful white plaques of the folds revealing papular acantholytic dyskeratosis

Papular acantholytic dyskeratosis (PAD) is a challenging diagnosis for both dermatologist and pathologist. It predominantly affects female patients, but men can present less frequently the disease. Histopathology is required to confirm the diagnosis and to exclude other acantholytic dermatoses. We present a rare case of PAD in a young male patient, diagnosed by histopathology, and responded well to oral retinoids

The psychological impact of COVID-19 in a socio-politically unstable environment: protective effects of sleep and gratitude in Lebanese adults

Abstract Background The COVID-19 global pandemic initiated an unprecedented medico-psychological turmoil. Our study investigates the psychological impact of the viral spread and austere lockdown, and focuses mostly on potential protective factors in a politically and economically unstable society. Methods A cross-sectional design was used to evaluate rates of mental distress in a sample of 348 Lebanese adults. Participants filled questionnaires of perceived stress (PSS), depression (PHQ-9), anxiety (GAD-7), PTSD (IES-22), as well as sleep (PSQi) and gratitude (GQ-6) immediately after 3 months of strict quarantine. Demographics included gender, age, employment and infection statuses. Correlations and regression models were used. Results Results indicated a very high prevalence of mental distress, in addition to major alterations in sleep quality and quantity. Younger age and unemployment correlated with more severe symptoms. Sleep was found to be a protective factor against all studied psychological distress, and gratitude further mitigated effects of depression. Conclusions Mental health significantly degrades post-COVID lockdown, even in the absence of direct viral threat. Yet simple behavioral and cognitive changes like sleep and attitude of gratitude could provide protective factors against these psychological distresses. Such changes should be further explored and advocated as cost-efficient self-care practices to buffer this devastating public health burden, especially in unstable socio-political environments

[C–H⋯anion] interactions mediate the templation and anion binding properties of topologically non-trivial metal–organic structures in aqueous solutions

[Abstract] Two synthetic approaches—temperature variation and anion templation—allowed for the selective formation of a [2]catenane ([2]C4+) or a trefoil knot (TK6+), or for the enhanced formation of a Solomon link (SL8+), all from a simple set of starting materials (Zn(II) acetate, diformylpyridine (DFP) and a diamino-2,2′-bipyridine (DAB)) in mixed aqueous solutions. The catenane formed exclusively at 90 °C in a 1 : 1 mixed solvent of D2O and MeOD. In the presence of bromide ion as template, TK6+ formed exclusively at 50 °C in the same solvent. In the solid state, TK6+ hosts two bromide ions in its central cavity by forming six Csp2–H hydrogen bonds. In D2O, TK6+, which was originally prepared as a trifluoroacetate (TFA) salt, was found to exchange two TFA counterions for two monovalent anions of different sizes and shapes, which lodged within the knot's central cavity. In contrast to bromide, the larger triflate anion (CF3SO3−) promoted the formation of SL8+, which was characterized by 1H NMR spectroscopy and mass spectrometry. Two dimensional heteronuclear 19F-1H-HOSEY NMR experiments detected CH⋯F interactions inside the cavity of SL8+. Thus, the product distribution of this dynamic link forming system is sensitive to temperature and the size and shape of the anion template, and one of the products, TK6+, is capable of binding a variety of monovalent anions in D2O with high affinity (with log β2 values of 4 to 6 being typical)

The pro-apoptotic effect of a Terpene-rich Annona cherimola leaf extract on leukemic cell lines

Background The edible fruit Annona cherimola has previously shown many nutritional and medicinal properties. The current study evaluates the anti-cancer and anti-proliferative properties of Annona cherimola ethanolic leaf extract (AELE) on Acute Myeloid Leukemia (AML) cell lines cultured in vitro (Monomac-1 and KG-1). Methods The anti-proliferative effect of A. cherimola ethanolic leaf extract was evaluated via cell viability assay. Its pro-apoptotic effect was assessed through Cell Death ELISA and dual Annexin V/PI staining. To further investigate the molecular mechanism by which the extract promoted apoptosis and inhibited the proliferation of the AML cells used, apoptotic protein expression was determined through western blots. Extract composition was elucidated by Gas Chromatography-Mass Spectrometry (GC-MS). Results Our results showed that the treatment with A. cherimola ethanolic leaf extract exhibited an inhibitory effect on the proliferation of both cancer cell lines used in a dose- and time-dependent manner, with no toxic effects on normal mononuclear cells (MNCs) isolated from human bone marrow. This effect was mediated by DNA fragmentation and apoptosis, as revealed by Cell Death ELISA and dual Annexin V/PI staining. Western blot analysis revealed a Bax/Bcl2 dependent mechanism of apoptosis, as well as PARP cleavage, confirming the apoptotic results observed previously. These effects may be attributed to the presence of terpenes which constitute a large component of the leafy extract, as revealed via GC-MS. Conclusion All the data presented in our study show that the terpene-rich A. cherimola ethanolic leaf extract exhibits an anti-proliferative and pro-apoptotic effect on the AML cell lines used