Quality of Care and Profitability in Not-For-Profit Versus For-Profit Nursing Homes

Nursing home residents across the Unites States rely on quality care and effective services. Nursing homes provide skilled nurses and nursing aides who can provide services 24 hours a day for individuals that could not perform these tasks for themselves. Not-for-Profit (NFP) versus For-Profit (FP) nursing homes have been examined for utilization and efficacy, however, it has been shown that NFP nursing homes generally offer higher quality care and greater profit margins compared to FP nursing homes. The purpose of this research was to determine if NFP nursing homes provide enhanced quality care and a larger profit margin compared to FP nursing homes. Benefits and barriers in regards to financial stability and quality of care exist for both FP and NFP homes. Based on the findings of this review, it was suggested that NFP nursing homes have achieved higher quality of care due to a more effective balance of business aspects, as well as prioritizing resident well-being, and care quality over profit maximization in NFP homes

Evaluation of Glucose Monitoring Technologies for Cost Effective and Quality Control/Management of Diabetes

The diabetes epidemic in the United States (U.S.) has become a burden in regards to treatment, disease management, and associated costs. Key advancements in medical technology have been developed in efforts to mitigate this issue. We compare several types of glucose monitoring systems with respect to quality of care, management, and cost-effectiveness for type 1 and type 2 diabetics

Measurement of Steroid Concentrations in Brain Tissue: Methodological Considerations

It is well recognized that steroids are synthesized de novo in the brain (neurosteroids). In addition, steroids circulating in the blood enter the brain. Steroids play numerous roles in the brain, such as influencing neural development, adult neuroplasticity, behavior, neuroinflammation, and neurodegenerative diseases such as Alzheimer’s disease. In order to understand the regulation and functions of steroids in the brain, it is important to directly measure steroid concentrations in brain tissue. In this brief review, we discuss methods for the detection and quantification of steroids in the brain. We concisely present the major advantages and disadvantages of different technical approaches at various experimental stages: euthanasia, tissue collection, steroid extraction, steroid separation, and steroid measurement. We discuss, among other topics, the potential effects of anesthesia and saline perfusion prior to tissue collection; microdissection via Palkovits punch; solid phase extraction; chromatographic separation of steroids; and immunoassays and mass spectrometry for steroid quantification, particularly the use of mass spectrometry for “steroid profiling.” Finally, we discuss the interpretation of local steroid concentrations, such as comparing steroid levels in brain tissue with those in the circulation (plasma vs. whole blood samples; total vs. free steroid levels). We also present reference values for a variety of steroids in different brain regions of adult rats. This brief review highlights some of the major methodological considerations at multiple experimental stages and provides a broad framework for designing studies that examine local steroid levels in the brain as well as other steroidogenic tissues, such as thymus, breast, and prostate

Comparison of published core outcome sets with outcomes recommended in regulatory guidance from the US Food and Drug Administration and European Medicines Agency: cross sectional analysis

ObjectiveTo compare the outcomes in published core outcome sets with the outcomes recommended in corresponding guidance documents from the European Medicines Agency (EMA) and US Food and Drug Administration (FDA), matched by health condition.DesignCross sectional analysis.SettingUS and Europe.PopulationSample of core outcome sets related to drugs, devices, and gene therapy that involved patients in the consensus process, published between 1 January 2015 and 31 December 2019; and corresponding EMA and FDA guidance documents.Main outcome measuresThe extent of matches between outcomes included within core outcome sets and those recommended in corresponding EMA and FDA guidance documents were assessed. Matches were considered to be general (ie, non-specific) or specific (ie, exact). General matches were assessed to determine whether the core outcome set or guidance document outcome was narrower.ResultsRelevant guidance documents were found for for 38 (39%) of 98 eligible published core outcome sets. Among outcomes in core outcome sets, medians of 70% (interquartile range 48-86%) and 52% (33-77%) were matches with outcomes recommended in EMA and FDA documents, respectively. Medians of 46% (27-68%) and 26% (18-46%) were specific matches with outcomes in EMA and FDA documents, respectively. When outcomes were generally matched, the outcomes from core outcome sets were more frequently narrower than the regulatory outcomes (83% and 75% for EMA and FDA, respectively).ConclusionGreater adoption of, and reference to, core outcome sets in regulatory guidance documents can encourage clinical trialists, especially those in industry, to measure and report consistent and agreed outcomes and improve the quality of guidance. Given the overlap between outcomes in core outcome sets and regulatory guidance, and given that most core outcome sets now involve patients in the consensus process, these sets could serve as a useful resource for regulators when recommending outcomes for studies evaluating regulated products. Developers are encouraged to appraise recommended outcomes in salient regulatory documents when planning a core outcome set

Between-year and spatial variation in body condition across the breeding cycle in a pelagic seabird, the Red-billed Tropicbird

Body condition in pelagic seabirds impacts key fitness-related traits such as reproductive performance and breeding frequency. Regulation of body condition can be especially important for species with long incubation periods and long individual incubation shifts between foraging trips. Here, we show that body condition of adult Red-billed Tropicbirds (Phaethon aethereus) at St Helena Island, South Atlantic Ocean, exhibited considerable variation between years (2013–2017) and between different stages of the breeding cycle. Females took the first incubation shift following egg laying, after which males and females alternated incubation shifts of varying length, ranging from <1 to 12 days. Body condition declined in both sexes during an incubation shift by an average of 22 g (2.83% of starting mass) per day and over the incubation period; mass loss was significantly greater during longer incubation shifts, later within a shift and later in the total incubation period. There was also significant differences in incubation behaviour and body condition between years; in 2015, coinciding with a moderate coastal warming event along the Angolan-Namibian coastlines, adults on average undertook longer incubation shifts than in other years and had lower body condition. This suggests that substantial between-year prey fluctuations in the Angola Benguela upwelling system may influence prey availability, in turn affecting incubation behaviour and regulation of body condition. Adults rearing chicks showed a significant reduction in body condition when chicks showed the fastest rate of growth. Chick growth rates during 2017 from two localities in the Atlantic Ocean: an oceanic (St Helena) versus neritic (Cabo Verde) population were similar, but chicks from St Helena were overall heavier and larger at fledging. Results from this multi-year study highlight that flexibility and adaptability in body condition regulation will be important for populations of threatened species to optimise resources as global climate change increasingly influences prey availability

Gene Expression Signatures That Predict Radiation Exposure in Mice and Humans

BACKGROUND: The capacity to assess environmental inputs to biological phenotypes is limited by methods that can accurately and quantitatively measure these contributions. One such example can be seen in the context of exposure to ionizing radiation. METHODS AND FINDINGS: We have made use of gene expression analysis of peripheral blood (PB) mononuclear cells to develop expression profiles that accurately reflect prior radiation exposure. We demonstrate that expression profiles can be developed that not only predict radiation exposure in mice but also distinguish the level of radiation exposure, ranging from 50 cGy to 1,000 cGy. Likewise, a molecular signature of radiation response developed solely from irradiated human patient samples can predict and distinguish irradiated human PB samples from nonirradiated samples with an accuracy of 90%, sensitivity of 85%, and specificity of 94%. We further demonstrate that a radiation profile developed in the mouse can correctly distinguish PB samples from irradiated and nonirradiated human patients with an accuracy of 77%, sensitivity of 82%, and specificity of 75%. Taken together, these data demonstrate that molecular profiles can be generated that are highly predictive of different levels of radiation exposure in mice and humans. CONCLUSIONS: We suggest that this approach, with additional refinement, could provide a method to assess the effects of various environmental inputs into biological phenotypes as well as providing a more practical application of a rapid molecular screening test for the diagnosis of radiation exposure

Pancreatite: fisiopatologia, diagnóstico e manejo terapêutico / Pancreatitis: pathophysiology, diagnosis and therapeutic management

O presente estudo analisa as justificativas contidas na literatura atual, no que tange ao aumento da incidência de pancreatite ao longo do tempo. Foram elencados, de forma completa, todos os aspectos fisiopatológicos e manejo terapêutico que a pancreatite aguda está envolvida. Para isso, foram buscados critérios de avaliação dessa doença, para identificação, não só de suas versões mais leves, bem como de suas manifestações mais graves (pancreatite aguda e idiopática), de modo a estabelecer a melhor propedêutica possível. Nesse artigo, há uma abordagem das características epidemiológicas de tal afecção, mostrando a sua incidência e prevalência na conjuntura atual mundial. Foi possível analisar os aspectos fisiopatológicos que a pancreatite está envolvida, enumerando os sinais e sintomas clínicos conhecidos anteriormente na literatura, bem como aqueles descobertos nos estudos recentemente publicados na comunidade científica médica. Para tal, foi feito um amplo estudo revisional fisiopatológico capaz de descrever todos os processos anormais presentes na pancreatite, que culminam em suas manifestações clínicas e, consequentemente, resultam em prejuízo à saúde do indivíduo. Não obstante, para ter maior vigor no diagnóstico da pancreatite, foram analisados e listados os principais diagnósticos diferenciais existentes dessa afecção. Portanto, dada a significativa morbimortalidade implicada nas diversas nuances da pancreatite, sobretudo a forma aguda, foram abordados os aspectos inerentes à sua fisiopatologia, seu diagnóstico e seu manejo terapêutico

Dermatite atópica pediátrica: fisiopatologia e manejo terapêutico / Pediatric atopic dermatitis: pathophysiology and therapeutic management

A dermatite atópica (DA), conhecida também como eczema atópico, é uma condição inflamatória crônica recidivante que acomete o tecido cutâneo. No que tange às estatísticas gerais, a incidência de DA aumentou de 2 a 3 vezes nos países industrializados, afetando aproximadamente 15% a 20% das crianças e 1% a 3% dos adultos em todo o mundo. A DA, em termos fisiopatológicos, é uma afecção inflamatória crônica recidivante da pele, multifacetada, comumente associada a outras manifestações atópicas, como alergia alimentar, rinite alérgica e asma. O início da doença é mais comum aos 5 anos de idade, sendo o diagnóstico e o tratamento precoces essenciais para evitar complicações da DA e melhorar a qualidade de vida. Há muitas condições de pele que podem mimetizar essa doença, sendo possível até mesmo coexistirem e/ou agravarem a DA, que devem ser excluídas ao diagnosticá-la, tais como: dermatite seborreica, sarna, dermatite de contato, psoríase, linfoma cutâneo de células T, dentre outras afecções cutâneas. O tratamento da DA objetiva condutas multifatoriais, das quais dependem da associação de medidas não farmacológicas e farmacológicas, sendo prescrita de acordo com o grau da doença. É imprescindível que os portadores de DA sejam esclarecidos e aderentes às medidas não farmacológicas para prevenção de crises agudas. Nesse sentido, cita-se a necessidade do uso de hidratantes neutros em toda a pele após banhos diários, evitando cremes e sabonetes com produtos alérgenos, além de não se submeterem a extremos de calor, frio ou umidade. Associado a essas medidas, o tratamento farmacológico tem se mostrado muito eficaz em casos mais graves e recidivantes

Câncer de ovário: fisiopatologia e manejo terapêutico

O câncer de ovário (CO) é uma neoplasia maligna atualmente classificada como de maior morbimortalidade e letalidade dentre os tumores que afetam o sistema ginecológico da mulher. A etiopatogenia para tal afecção não é totalmente conhecida, ainda assim, a explicação mais aceita para o tipo de neoplasia mais recorrente é a “hipótese tubária”. No que tange à epidemiologia, essa enfermidade teve uma estimativa para o ano de 2020 de aproximadamente 308.069 pacientes com CO, com índices associados à mortalidade chegando a cerca de 47%. Também, a prevalência do subtipo câncer epitelial de ovário, um carcinoma seroso de alto grau, originário principalmente na porção distal das tubas uterinas, correspondendo a 90% dos casos. Tendo em vista o lugar primário da malignidade, nem sempre é uma missão possível designar qual o local de origem e regiões metastáticas, entretanto, sabe-se que a mais comum de disseminação é o peritônio. Os sintomas do CO expressam-se de forma insidiosa, bem como, apresentam similaridades entre os quadros iniciais e avançados da doença, tais quais: sinais gastrointestinais, urinários ginecológicos e distúrbios alimentares. Além disso, o CO não é uma doença única, o qual possui uma miscelânea de tipos histológicos, correlacionados aos mais diversos fatores biofísicos e de microambiente, tornando mais difícil o diagnóstico precoce. Tendo em vista tais fatos, na maioria das vezes, o CO é identificado já em estágios avançados e cerca de dois terços diagnosticados tardiamente. Tal agravante interfere na propedêutica, reduzindo opções terapêuticas e no prognóstico dos pacientes. Por fim, o tratamento padrão para o CO é a citorredução cirúrgica máxima, seguida de quimioterapia à base de platina, ressaltando também os tratamentos mais inovadores da atualidade, citando-se a quimioterapia intraperitoneal hipertérmica