The Frequency of V122I Transthyretin Mutation in a Cohort of African American Individuals With Bilateral Carpal Tunnel Syndrome

IntroductionHereditary transthyretin amyloidosis (hATTR) can cause multisystem organ disorders including polyneuropathy and cardiomyopathy. Amongst the many known pathologic mutations of the transthyretin (TTR) gene, the Val122Ile (V122I) mutation can be found in 3–4% of African Americans. Up to 47% of patients with the V122I hATTR cardiomyopathy had a history of carpal tunnel syndrome (CTS). This raises the question should we screen for this mutation in African Americans with bilateral CTS for the purpose of preventing advanced disease associated with hATTR. This is a prospective pilot study to determine the likelihood of African Americans with bilateral CTS having the V122I mutation and whether various clinical factors contribute to that probability.MethodologyAdult African American patients without prior history of amyloidosis diagnosed with bilateral CTS were recruited for the study. They received genetic testing to screen for a TTR mutation. They also completed questionnaires to screen for symptoms of cardiomyopathy and neuropathy, other risk factors for CTS, and family history of CTS and cardiomyopathy.ResultTwo of the sixteen patients (12.5%) in this cohort were found to have the V122I mutation. The absence of polyneuropathy and cardiomyopathy symptoms, presence of other CTS risk factors, and absence of family history of CTS and cardiomyopathy did not decrease the likelihood of V122I mutation in this cohort.ConclusionThe frequency of V122I transthyretin mutation in African Americans with bilateral CTS may be higher than 3–4%. The presence of bilateral CTS alone may be a justification to screen for TTR mutation in this population

Socioeconomic Status, Race and Parental Initial Response to Children’s Mental Illness

To examine how socioeconomic status (SES) and race affect parents\u27 initial response (IR) to their child’s mental illness (MI) including 1. Parental confidant(s); 2. Lag time in professional help-seeking; and 3. Referral source. 70 parents of patients new to a Child Psychiatry clinic completed a survey to assess their IR to their child’s MI. SES was determined using the United States Census Bureau median income by zip codes. Summary statistics are frequencies and percentages for categorical data, and medians and quartiles for continuous data. Twenty-five percent of parents reported low SES and 31% Non-Caucasian Children (NCC). Confidants of Caucasian and NCC were Pediatrician (77% vs 50%, p = 0.03), and family (73% vs 32%, p = 0.002). Comparing help-seeking Lag Times 66% reported a delay of 1 year or more (p = 0.040). Overall Pediatricians were the leading confidant. Lag times were one year or more with stronger trends in NCC

Practice Transformation: Using Team-Based Care Training to Improve Diabetes Outcomes

Background: One of the key factors of the patient-centered medical home (PCMH) transformation require shifting mental models at the individual level and culture change at the practice level on how clinicians and support staff work together. This culture shift requires a reeducation on the roles and communication strategies within the medical practice. The objective of this project was to implement a team-based care training program based on the AHRQ TeamSTEPPS framework in 6 primary care practices affiliated with a Primary Care Practice Based Research Network to increase communication and performance of the care teams. Methods: Clinicians and staff from these sites received external facilitation by a certified TeamSTEPPS master trainer, who is a physician specializing in diabetes care, over a 1-year period. An analysis of their established diabetes patients’ hemoglobin A1c and low-density lipoprotein cholesterol before the training program and posttraining was performed using the paired t test and verified using the Wilcoxon sign rank test. Results: There was a statistically significant decrease in the mean hemoglobin A1c levels from 7.48% to 7.32% ( P < .001) and low-density lipoprotein cholesterol from 92.34 to 88.34 mg/dL ( P = .002) for all the practices combined but only 3 practices saw significant improvement individually. Conclusions: Even though the practices participating in this training are PCMHs and are part of a larger primary care network, they have achieved different levels of success, partly due to leadership and buy-in by staff. Practice leaders and team members need to fully embrace team care concepts and continuously monitor teamwork experiences to support effective team-based care

Gunshot wound incidence as a persistent, tragic symptom of area deprivation

Background: More than 30,000 Americans die every year of firearm-related injuries. Gun violence is frequently addressed by law enforcement and policing, as opposed to public health interventions that might address poverty or deprivation. Our goal was to evaluate the past 20 years of gunshot wound injury demographics seen at our level I academic trauma center and create a risk map model correlating gunshot wound incidence with area deprivation. Methods: Patients admitted for gunshot wound-related injuries between 1996 and 2017 were identified using our trauma registry. Demographic and injury data were extracted and analyzed. Multivariable logistic regression models were created to identify predictors of mortality. Geographic information system mapping of incident location and home address was completed to identify zip code hot spots of high gunshot wound incidence. Area Deprivation Indices, which reflect local income or poverty, housing, education, and employment were used as a marker of relative economic disadvantage. Spearman rank correlation was used to determine the relationship between Area Deprivation Indices score and gunshot wound rate. Results: A total of 2,413 patients with gunshot wounds were evaluated. The cohort had a mean age of 28.8 ± 11.5 and was 89.6% male. Mean Injury Severity Score was 11 ± 12.5. gunshot wounds were most frequently a result of assault (91.1%), followed by unintentional injury (3.4%). Geographic information systems mapping revealed significant clustering of gunshot wounds. The areas with highest per capita incidence of gunshot wounds was strongly correlated with Area Deprivation Indices (0.594, P \u3c .001). Conclusion: Geographic regions of known lower socioeconomic resources have higher incidence of gunshot wounds in our community. Both Area Deprivation Indices and gunshot wound incidents in these distressed communities remained unchanged throughout the past 20 years, despite law enforcement crime suppression efforts. Gunshot wounds appear to be a symptom of area deprivation, similar to failing schools and poor health outcomes. Efforts to decrease poverty and community capacity-building may help alleviate this area deprivation

Patient-related factors may influence nursing perception of sleep in the Intensive Care Unit.

OBJECTIVE:There exist conflicting data regarding the accuracy of ICU nurses accurately assessing patient sleep using validated questionnaires. Using the Richards-Campbell Sleep Questionnaire (RSQ), we hypothesize that patient factors might influence nursing perception of their sleep. METHODS:Patients in the ICU who met the inclusion criteria were asked to complete the sleep questionnaire, as were their nurses and intraclass correlation analysis was done. RESULTS:38 paired patient-nurse surveys were included for analysis. The mean difference in total average score of the RSQ was not significantly different between patients and nurses. There was fair intraclass correlation by patient age, black race, and admission for respiratory illnesses. A good intraclass correlation existed for non-blacks and admission for non-respiratory reasons. Most striking was the intraclass correlation by sex, with poor intraclass correlation for women compared to an excellent correlation for men. CONCLUSION:The results of our study confirm that patients in our ICU have poor sleep with a fair intraclass correlation. When examined by patient related factor, the greatest divergence between patient and nursing perception of sleep in the ICU using the RCSQ was patient female sex. More research is needed in this area to better understand the divergence and improve sleep in the ICU