Transrectal Ultrasound Guided Prostate Biopsy Antibiotic Prophylaxis: Standard vs. Augmented Antibiotic Regimens, and the Role for Pre-Biopsy Rectal Swab Cultures

Objectives: To evaluate peri-procedural antibiotic prophylaxis regimens based on pre-procedural rectal swab cultures. To evaluate infection rates between transrectalbiopsy patients receiving FQs alone and those receiving ceftriaxone or gentamicin in addition to FQs.https://jdc.jefferson.edu/patientsafetyposters/1056/thumbnail.jp

Concluding Remarks

Shira Goodman is the Executive Director of CeaseFirePA, a statewide organization to take a stand against gun violence. She has extensive experience in the nonprofit world and joined the organization following ten years as a public policy advocate working for better courts in Pennsylvania and a career in labor law. She is involved in the Philadelphia, Pennsylvania and American Bar Associations, and serves on the board of the Legal Intelligencer and several community nonprofits. Thomas Farley is Commissioner of Health for the City of Philadelphia. From 2009 to 2014, Dr. Farley was Commissioner of the New York City Department of Health and Mental Hygiene. As Health Commissioner, Dr. Farley advocated for innovative public health policies, including making the city’s parks and beaches smoke-free, prohibiting price discounting of cigarettes, raising the legal sales age of tobacco to 21, capping the portion size of sugary drinks sold in restaurants at 16 ounces, and restricting the burning of air-polluting dirty fuels to heat buildings. He is coauthor of Prescription for a Healthy Nation (Beacon Press) with RAND Senior Scientist Deborah Cohen, and author of Saving Gotham: A billionaire mayor, activist doctors, and the fight for 8 million lives (W.W. Norton)

Addressing the Key Drivers of Burnout: Transforming Ambulatory Practice

Clinician burnout is associated with a number of factors, including clinicians spending a great deal of time doing work that is below their level of training and thus unsatisfying and inefficient. One structural antidote to these factors is the building of teams that truly share the care with clinicians. Professional team members - in particular nurses, pharmacists and behaviorists - are capable of independently caring for many patients in a typical ambulatory practice panel. Unlicensed team members, in particular medical assistants - if at least two are available per clinician and if properly trained - can assume responsibility for electronic medical records (EMR) documentation, population management, and health coaching. Some exemplar primary care practices have succeeded in creating effective teams that reduce burnout and have constructed a business case to support those teams. Lessons from primary care can help to inform transformation in specialty ambulatory practices.https://openworks.mdanderson.org/hrc_burnout_presentations/1002/thumbnail.jp

Wnt5a causes ROR1 to complex and activate cortactin to enhance migration of chronic lymphocytic leukemia cells.

Chronic lymphocytic leukemia cells (CLL) migrate between the blood and lymphoid tissues in response to chemokines. Such migration requires structured cytoskeletal-actin polymerization, which may involve the protein cortactin. We discovered that treatment of CLL cells with Wnt5a causes Receptor tyosin kinase-like orphan receptor 1 (ROR1) to bind cortactin, which undergoes tyrosine phosphorylation at Y421, recruits ARHGEF1, and activates RhoA, thereby enhancing leukemia-cell migration; such effects could be inhibited by cirmtuzumab, a humanized mAb specific for ROR1. We transfected the CLL-cell-line MEC1 with either full-length ROR1 or various mutant forms of ROR1 to examine the structural features required for binding cortactin. We found that the proline-rich domain (PRD) was necessary for ROR1 to recruit cortactin. We generated MEC1 cells that each expressed a mutant form of ROR1 with a single amino-acid substitution of alanine (A) for proline (P) in potential SH3-binding sites in the ROR1-PRD at positions 784, 808, 826, 841, or 850. In contrast to wild-type ROR1, or other ROR1P=>A mutants, ROR1P(841)A failed to complex with cortactin or ARHGEF1 in response to Wnt5a. Moreover, Wnt5a could not induce MEC1-ROR1P(841)A to phosphorylate cortactin or enhance CLL-cell F-actin polymerization. Taken together, these studies show that cortactin plays an important role in ROR1-dependent Wnt5a-enhanced CLL-cell migration

Seasonal Affective Disorder: SAD or Fad?

Seasonal affective disorder (SAD) and phototherapy have recently been the subject of a great deal of interest in the psychiatric literature. First described in 1984 (I), SAD is now defined as a cyclic illness characterized by recurrent episodes of fall/winter depression alternating with periods of spring/summer euthymia (normal mood) or hypomania (mild elation and behavioral activation) (2) . Recent findings indicate that there may be at least two additional patterns of seasonal depressions, one characterized by annual summer depressions with euthyrnic, hypomanic or manic symptoms in the winter, and the other characterized by depressive episodes occurring in both winter and summer (3-6)

Resistant Somatoform Symptoms: Try CBT and Antidepressants. Preferred Strategy for ‘Mismatched’ Category of Illnesses.

This articles describes: debate about how to categorize somatoform disorders--as psychological or physiologic evidence supporting psychotherapy and antidepressants to help patients with treatment-resistant somatoform disorders