Do Recipients of an Association-Sponsored Quality Award Program Experience Better Quality Outcomes Compared With Other Nursing Facilities Across the United States?

BACKGROUND: This study explores the relationship between recipients of an association-sponsored Quality Award Program and select measures of quality in U.S. nursing facilities, examined both cross-sectionally and over time. METHOD: Data used came from Quality Award Program recipients over 9 years (2003-2011) and a set of quality indicators from the Online Survey Certification and Reporting (OSCAR) database. These data were analyzed using a variety of multivariate regression techniques. RESULTS: Cross-sectionally, the award recipients demonstrated higher performance on most of the quality indicators, compared with both the broader field of nursing facilities and also a more stringent comparison group of facilities. Comparing quality from the 4 years before the award was received to the 4 years after the award, the majority of quality indicators demonstrated improvement in those facilities receiving an award. CONCLUSION: These results indicate that, in general, the nursing facilities that participate in and receive the Silver or Gold American Health Care Association (AHCA) and National Center for Assisted Living (NCAL) National Quality Award perform at a higher level of quality for residents and sustain that heightened performance over a period of time.

Effectiveness and safety of transforaminal lumbar interbody fusion in patients with previous laminectomy.

PURPOSE: To determine the efficacy and safety of transforaminal lumbar interbody fusion (TLIF) for revision lumbar spine surgery in patients with previous laminectomy. The secondary objective was to evaluate the clinical and radiological outcome after such a procedure. METHODS: Retrospective case series study. Eighty-two patients were included. There were 48 women (58.5 %) and 34 men (41.5 %) with a mean age of 51 years (range 26-84) at the time of index procedure. The outpatient and inpatient charts were reviewed to identify patients' demographic data, preoperative, perioperative, and postoperative data. The outcome measures were assessed by Oswestry Disability Index (ODI) and visual analog scale (VAS) for back and leg pain. An independent spine surgeon and musculoskeletal radiologist reviewed the imaging studies. RESULTS: The average operative time was 160 min (range 131-250). The average estimated blood loss was 652 cc (100-1,400 cc). Nineteen patients (23.1 %) required blood transfusion. Five patients (6 %) had dural tear. One patient (1.2 %) had a surgical site infection. Two patients (2.4 %) had thromboembolic events. The average hospital stay was 3.8 days (2-5 days). At a mean follow-up of 28 months, there were statically significant improvement in the ODI and VAS for back and leg pain. None of the patients' radiographs showed hardware failure or pedicle screw loosening and no patient returned to the operating room for pseudarthrosis. CONCLUSIONS: The current study confirmed that TLIF approach in patients with previous laminectomy is effective and safe with good outcomes.

Proteomic analysis of bovine nucleolus.

Nucleolus is the most prominent subnuclear structure, which performs a wide variety of functions in the eukaryotic cellular processes. In order to understand the structural and functional role of the nucleoli in bovine cells, we analyzed the proteomic composition of the bovine nucleoli. The nucleoli were isolated from Madin Darby bovine kidney cells and subjected to proteomic analysis by LC-MS/MS after fractionation by SDS-PAGE and strong cation exchange chromatography. Analysis of the data using the Mascot database search and the GPM database search identified 311 proteins in the bovine nucleoli, which contained 22 proteins previously not identified in the proteomic analysis of human nucleoli. Analysis of the identified proteins using the GoMiner software suggested that the bovine nucleoli contained proteins involved in ribosomal biogenesis, cell cycle control, transcriptional, translational and post-translational regulation, transport, and structural organization.

CT predictors for differentiating benign and clinically worrisome pneumatosis intestinalis in children beyond the neonatal period.

PURPOSE: To determine whether computed tomographic (CT) findings can help differentiate between benign and clinically worrisome causes of pneumatosis intestinalis (PI) in children. MATERIALS AND METHODS: This retrospective study was approved by the institutional review board, and requirement for informed consent was waived. Data were stored in a secured and HIPAA-compliant fashion. CT reports from an 8-year period (July 2000-July 2008) were reviewed to determine all cases with a diagnosis of PI. In these cases, demographic information, clinical presentation, underlying medical condition, and CT findings were reviewed. The cases were grouped into one of two final diagnostic groups: clinically worrisome versus benign PI (diagnosis of exclusion, resolution documented at serial imaging without therapeutic intervention). In each case, the CT findings reviewed included distribution (small bowel, large bowel), extent (mild, moderate, extensive), and morphologic characteristics (linear, cystic, both) of the PI and associated findings such as soft-tissue bowel wall thickening, periintestinal soft-tissue stranding, free air, free fluid, portal venous gas, small-bowel obstruction, and bowel dilatation. Associations between CT findings and benign or clinically worrisome PI were assessed with logistic regression models. RESULTS: There were 44 cases identified. Final diagnostic categories for PI included benign (n = 15) and associated underlying bowel disease (n = 29; definitive in 26 and suspected but not defined in three). The following findings were significant (expressed as percentage of clinically worrisome PI vs percentage of benign): soft-tissue bowel wall thickening (51.2% vs 13.3%, P = .0167), free peritoneal fluid (82.8% vs 33.3%, P = .002), extent of PI (extensive 17.2% vs 69%, P < .001), and periintestinal soft-tissue stranding (55.2% vs 20.0%, P = .0228). Distribution, free peritoneal air, and characteristic morphology (linear vs cystic) were not associated with clinically worrisome PI (all P > .05). CONCLUSION: The cystic or linear pattern of pneumatosis in children is not a useful CT sign to differentiate benign from clinically worrisome PI. CT findings that include soft-tissue thickening of the bowel wall, free fluid, periintestinal soft-tissue stranding, and the extent of PI can be useful in differentiating these entities.

CT findings in children with Meckel diverticulum.

BACKGROUND: Approximately 0.04% of the general population will present with a complication related to Meckel diverticulum. The classic teaching is that symptomatic children with Meckel diverticulum present with painless rectal bleeding and are evaluated with a radionuclide scan. Our subjective experience is that we see children with Meckel diverticulum who present with abdominal pain and are evaluated by CT. OBJECTIVE: We reviewed the findings on CT in children with pathologically proven Meckel diverticulum to identify characteristic patterns of presentation. MATERIALS AND METHODS: Databases were searched (2004-2008) for all children who had a pathologic diagnosis of Meckel diverticulum and a CT scan performed prior to surgery. Demographics, pathology, and CT features were reviewed. CT features reviewed included: soft-tissue stranding, abnormal calcifications, bowel obstruction, free air, free peritoneal fluid, cystic mass, intussusception, obvious lead point, location, and whether a normal appendix was identified. The frequency of Meckel diverticulum encountered on CT scans was compared to that found during the same period of time on technetium pertechnetate studies. RESULTS: The review identified 16 subjects (mean age 9.5 years, M:F 9:7). CT findings included: soft-tissue stranding in nine (56%), small-bowel obstruction (SBO) in nine (56%), intussusception in three (19%), free fluid in ten (63%), cystic mass in four (25%), calcification in none (0%), free air in one (6%), and no abnormalities in two (13%). A normal appendix was identified in only five children (31%). There were three basic patterns of presentation of abnormalities: SBO only in five, intussusception with SBO in three, or cystic mass with inflammatory stranding in four (one with SBO). Also, 2.3 times more Meckel diverticulum was encountered on CT than on technetium pertechnetate studies. CONCLUSION: Meckel diverticulum is currently more commonly encountered in children on CT performed for abdominal pain than on technetium pertechnetate studies. There are three categories of appearance on CT: SBO only, intussusception, or a cystic inflammatory mass.

The soluble metal-binding domain of the copper transporter ATP7B binds and detoxifies cisplatin.

Wilson disease ATPase (ATP7B) has been implicated in the resistance of cancer cells to cisplatin. Using a simple in vivo assay in bacterial culture, in the present study we demonstrate that ATP7B can confer resistance to cisplatin by sequestering the drug in its N-terminal metal-binding domain without active drug extrusion from the cell. Expression of a protein fragment containing four N-terminal MBRs (metal-binding repeats) of ATP7B (MBR1-4) protects cells from the toxic effects of cisplatin. One MBR1-4 molecule binds up to three cisplatin molecules at the copper-binding sites in the MBRs. The findings of the present study suggest that suppressing enzymatic activity of ATP7B may not be an effective way of combating cisplatin resistance. Rather, the efforts should be directed at preventing cisplatin binding to the protein.

Cardiac high molecular weight calmodulin-binding protein is homologous to calpastatin I and calpastatin II.

Calpastatin is an endogenous inhibitor of calpain, which has been implicated in various physiological and pathological processes. In the present study we determined the molecular and inhibitory properties of HMWCaMBP, calpastatin I, and calpastatin II. Western blot analysis with antibodies raised against either full length HMWCaMBP or internal peptides that are common to all isoforms showed that all three homologs have common antigenic epitopes. However, additional Western blot analysis with N-terminal specific antibodies showed that all three proteins are different at the N-terminal end. HMWCaMBP is clearly different from two other homologues, calpastatin I and II, at the N-terminal end. In addition, HMWCaMBP also showed the same affinities for m-calpain as calpastatin I and calpastatin II. Our findings suggest that HMWCaMBP is the homolog of calpastatin and may be a CaM-binding form of calpastatin.

Calmodulin-dependent cyclic nucleotide phosphodiesterase (PDE1) splice variants from bovine cardiac muscle.

Calmodulin-dependent cyclic nucleotide phopshodiesterase (PDE1) has been extensively characterized and is a key enzyme involved in the complex interaction between cyclic nucleotide and Ca(2+) second-messenger systems. It is well established that PDE1 exists in different isozymes. For example, bovine brain tissue has two PDE1 isozymes (PDE1A2 and PDE1B1) whereas only one form (PDE1A1) is reported in bovine cardiac tissue. In this study, we report the cloning of two cDNA splice variants of PDE1: PDE1-small and PDE1-large, from bovine cardiac tissue. Their amino acid sequence similarity to PDE1 sequences from other mammalian species showed that all are very conserved, suggesting their importance in cellular functions. Interestingly, compared to other mammalian species, bovine PDE1A, PDE-small and PDE-large show a deletion at the C-terminal end of the catalytic domain of the gene. Although the significance of this deletion at this crucial location of the gene is not known, we have successfully over-expressed both PDE1-small and PDE1-large splice variants in E. coli and these splice variants are characterized in terms of Western blot, biotinylated calmodulin overlay and peptide mass fingerprinting. Results from these studies suggested that these two splice variants belong to the PDE1 superfamily. To our knowledge, this is the first report on cloning and characterization of these cDNA variants from bovine cardiac tissue. Since there are at least two isoforms of PDE1 in bovine heart tissue, this merits further in-depth study.

Characterization of the anti-fungal activity of a Bacillus spp. associated with sclerotia from Sclerotinia sclerotiorum.

Sclerotinia sclerotiorum fruiting bodies (sclerotia) were found to harbour bacteria that possess anti-fungal activity. Among 1,140 bacterial isolates collected, 32 were found to inhibit the growth of four common fungal pathogens of canola, S. sclerotiorum, Rhizoctonia solani, Alternaria brassicae and Leptosphaeria maculans. One of these broad-spectrum isolates, LEV-006, was found to be closely related to Bacillus subtilis based on 16S rRNA analysis. The anti-fungal activities were purified and found to be associated with a low molecular weight peptide complex consisting mostly of the cyclic lipopeptide fengycin A and B, as revealed by matrix-assisted laser desorption/ionization time-of-flight and post-source decay analysis, as well as two proteins of 20 and 55 kDa. Peptide mass fingerprinting revealed that the 55-kDa protein was similar to vegetative catalase 1; however, when the enzyme was expressed in Escherichia coli, it exhibited catalase but not anti-fungal activity. The sequences of several peptides from the 20-kDa protein were obtained and indicated that it was a unique anti-fungal protein.

Effect of core body temperature on ventilator-induced lung injury.

OBJECTIVE: Ventilator-induced lung injury is a risk in patients requiring elevated ventilatory support pressures. We hypothesized that thermal stress modulates the development of ventilator-induced lung injury. DESIGN: Experimental study. SETTING: University laboratory. SUBJECTS: Anesthetized rabbits. INTERVENTIONS: Two experimental studies were designed to determine the role of temperature as a cofactor in ventilator-induced lung injury. In the first study, three groups of anesthetized rabbits were randomized to be ventilated for 2 hrs at core body temperatures of 33, 37, or 41 degrees C while ventilated with pressure control ventilation of 15/3 cm H2O (noninjurious settings-control) or 35/3 cm H2O (potentially injurious settings-experimental). To exclude effects arising from cardiac output fluctuations or from extrapulmonary organs, an isolated lung model was used for the second study, perfused at a fixed rate and studied at either 33 degrees C or 41 degrees C. MEASUREMENTS AND MAIN RESULTS: In the first study, the hyperthermic group compared with the hypothermic animals had significantly reduced mean PaO2 (-114 vs. + 14 mm Hg, p <.05), increased lung edema formation (mean wet weight/dry weight ratio of 8.1 vs. 5.7), and altered pressure-volume curves. The hyperthermic isolated, perfused lungs had an increased ultrafiltration coefficient, formed more edema, and experienced greater alveolar hemorrhage than hypothermic lungs. CONCLUSIONS: In two studies of ventilator-induced lung injury in rabbits, maintaining hyperthermia compared with hypothermia augmented the development of lung injury. Similar results from both the in vivo and isolated, perfused lung studies suggest that the observed effects were not due to cardiovascular factors or consequences of heating nonpulmonary organs.