Transitional care programs for trauma patients: A scoping review.

BACKGROUND: Transitional care programs establish comprehensive outpatient care after hospitalization. This scoping review aimed to define participant characteristics and structure of transitional care programs for injured adults as well as associated readmission rates, cost of care, and follow-up adherence. METHODS: We conducted a scoping review in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews standard. Information sources searched were Medline, the Cochrane Library, CINAHL, and Scopus Plus with Full Text. Eligibility criteria were systematic reviews, clinical trials, and observational studies of transitional care programs for injured adults in the United States, published in English since 2000. Two independent reviewers screened all full texts. A data charting process extracted patient characteristics, program structure, readmission rates, cost of care, and follow-up adherence for each study. RESULTS: A total of 10 studies described 9 transitional care programs. Most programs (60%) were nurse/social-worker-led post-discharge phone call programs that provided follow-up reminders and inquired regarding patient concerns. The remaining 40% of programs were comprehensive interdisciplinary case-coordination transitional care programs. Readmissions were reduced by 5% and emergency department visits by 13% among participants of both types of programs compared to historic data. Both programs improved follow-up adherence by 75% compared to historic data. CONCLUSION: Transitional care programs targeted at injured patients vary in structure and may reduce overall health care use.

Breath Versus Emotions: The Impact of Different Foci of Attention During Mindfulness Meditation on the Experience of Negative and Positive Emotions.

Mindfulness meditation yields beneficial effects on the processing of emotions. However, it is still unclear whether the focus of attention during meditation influences these effects. In the present study we aimed at comparing the effects of breathing meditation and emotion-focused meditation on the immediate and delayed processing of negative and positive emotions. The study included 65 adult novice meditators who were exposed to positively and negatively valenced film clips. Participants were randomly assigned to three conditions. While watching the films at t1, they were asked to mindfully focus on their breath (condition 1), on emotions (condition 2), or on nothing in particular (condition 3). Ten minutes later at t2, comparable film clips were shown but all participants watched them without taking up a mindful attitude. Dependent measures were emotional states at t1 and t2. Participants of both meditation conditions particularly showed a more preferable delayed emotional reaction to negative stimuli than participants of the control condition. Breathing meditation and emotion-focused meditation may constitute effective emotion regulation strategies to deal with negatively valenced emotional states.

Frailty screening and a frailty pathway decrease length of stay, loss of independence, and 30-day readmission rates in frail geriatric trauma and emergency general surgery patients.

BACKGROUND: Frail geriatric trauma and emergency general surgery (TEGS) patients have longer lengths of stay (LOS), more readmissions, and higher rates of postdischarge institutionalization than their nonfrail counterparts. Despite calls to action by national trauma coalitions, there are few published reports of prospective interventions. The objective of this quality improvement project was to first develop a frailty screening program, and, then, if frail, implement a novel frailty pathway to reduce LOS, 30-day readmissions, and loss of independence. METHODS: This was a before-after study of a prospective cohort of all geriatric (≥65-years-old) patients admitted to the TEGS service from October 2016 to October 2017. All patients were screened for frailty for 3 months (preintervention) to obtain baseline outcomes. Subsequently, frail patients were entered into our frailty pathway (postintervention). Nonparametric statistical tests were used to assess significant differences in continuous variables; χ and Fisher exact tests were used for categorical variables, where appropriate. Both process and outcome measures were evaluated. RESULTS: Of 239 geriatric TEGS patients screened, 70 (29.3%) were frail. All TEGS geriatric patients were screened within 24 hours of admission. Following frailty pathway implementation, median LOS for frail patients decreased from 9 to 6 days (p = 0.4), readmissions decreased from 36.4% to 10.2% (p = 0.04), and loss of independence decreased by 40%, (100% vs 60%; p = 0.01). Outcomes for nonfrail geriatric patients did not differ between cohorts. CONCLUSIONS: Screening for frailty followed by implementing a frailty pathway decreased LOS, loss of independence, and 30-day readmission rates for frail geriatric TEGS patients at a single urban academic institution. The pathway required no additional resources; rather, we shifted focus toward frail patients without negatively affecting outcomes in nonfrail geriatric TEGS patients. Implementation of this pathway with larger patient cohorts and in varied settings is needed to confirm a causal relationship between our intervention and improved outcomes. LEVEL OF EVIDENCE: Therapeutic study, level IV.

Rumination and symptom reports in children and adolescents: results of a cross-sectional and experimental study.

This study explores the relationship between a ruminative response style and symptom reports in children and adolescents of grades 5, 7 and 9 from German secondary schools. Questionnaires were used to assess rumination and symptom reports. A group of children and adolescents (N = 140) were asked to think first about the items before responding to them (increased attention condition), while a second group (N = 260) served as control group (standard condition). The assumption was that rumination and also additional attention to the symptoms by instruction would increase the reported frequency of experiencing somatic and psychological symptoms. The results showed significant relations between symptom reports and rumination, which increased with grade. There were sex differences for somatic symptom reports with increased symptom frequencies in girls, which were mediated by rumination. Moreover, instructing participants to think first about the items led to an increase in reported symptoms. It is concluded that an increased attention to symptoms of distress increases symptom reports, which may be induced momentarily by instruction and also more generally by a ruminative response style. Conclusions regarding prevention and concerning instructions in symptom report questionnaires are outlined.

Solution-phase synthesis of branched DNA hybrids via H-phosphonate dimers.

A method for the solution-phase synthesis of branched oligonucleotides with tetrahedral or pseudo-octahedral geometry is described that involves the coupling of 3'-H-phosphonates of protected dinucleoside phosphates and organic core molecules. The dimer building blocks are produced by a synthesis that requires no chromatographic purification and that produces the dimer H-phosphonates in up to 44% yield in less than three days of laboratory work. A total of seven different branched hybrids were prepared, including a new hybrid of the sequence (CG)(4)TBA, where TBA stands for tetrakis(p-hydroxybiphenyl)adamantane that assembles into a material from micromolar aqueous solution upon addition of MgCl(2).

Bioconjugation via azide-Staudinger ligation: an overview.

Bioconjugation techniques using organic azides are compared in this critical review. A particular focus is on chemical ligation reactions and their application to chemical biology (179 references).

Antitumor activity of ribonuclease multimers created by site-specific covalent tethering.

Site-specific cross-linking can generate homogeneous multimeric proteins of defined valency. Pancreatic-type ribonucleases are an especially attractive target, as their natural dimers can enter mammalian cells, evade the cytosolic ribonuclease inhibitor (RI), and exert their toxic ribonucleolytic activity. Here, we report on the use of eight distinct thiol-reactive cross-linking reagents to produce dimeric and trimeric conjugates of four pancreatic-type ribonucleases. Both the site of conjugation and, to a lesser extent, the propinquity of the monomers within the conjugate modulate affinity for RI, and hence cytotoxicity. Still, the cytotoxicity of the multimers is confounded in vitro by their increased hydrodynamic radius, which attenuates cytosolic entry. A monomeric RI-evasive variant of bovine pancreatic ribonuclease (RNase A) inhibits the growth of human prostate and lung tumors in mice. An RI-evasive trimeric conjugate inhibits tumor growth at a lower dose and with less frequent administration than does the monomer. This effect is attributable to an enhanced persistence of the trimers in circulation. On a molecular basis, the trimer is ∼300-fold more efficacious and as well tolerated as erlotinib, which is in clinical use for the treatment of lung cancer. These data encourage the development of mammalian ribonucleases for the treatment of human cancers.

Four-fold click reactions: Generation of tetrahedral methane- and adamantane-based building blocks for higher-order molecular assemblies.

A modular concept for the generation of achiral and chiral non-racemic tetrahedral tectons from common precursors was developed. The tectons presented here are based on tetraphenylmethane or 1,3,5,7-tetraphenyladamantane core structures. They are obtained through high-yielding four-fold click reactions, using either the tetraazido or the tetraalkyne precursors. In most cases, the tetratriazoles are obtained as pure products after simple washing with water and methanol. The side chains of the tectons prepared include a self-complementary DNA dimer, obtained from a 3'-azidonucleoside and a phosphoramidite. The concept allows for a variation of the "sticky ends", leading to tecton or ligand libraries.

Stable organic azides based on rigid tetrahedral methane and adamantane structures as high energetic materials.

A four-folded azidation of tetrakis(4-iodophenyl)methane and -adamantane leads to stable organic azides, but yet energetic materials, measured by differential scanning calorimetry (DSC). The rigid and symmetrical structures can be useful for new polymer and nanomaterial developments in material sciences as well as bioconjugations, after 1,3-dipolar cycloaddition reactions with terminal alkynes to 1,2,3-triazoles.