Transitional care management visits to improve coordination of care.

OBJECTIVES: This report aimed to determine whether transitional care management (TCM) services, provided by Inspira Care Connect, LLC (ICC), a Track 1 Medicare Shared Savings Program accountable care organization, were effective in reducing 30-day readmission rates, observation stay days, and emergency department visits, along with mortality rates, total costs, and frequency of primary care physician (PCP) visits among Medicare beneficiaries served by ICC. STUDY DESIGN: In accordance with TCM programming, ICC contacted the majority of patients telephonically within 48 business hours after discharge from an inpatient setting and scheduled a face-to-face visit with the patient's PCP within 1 to 14 days after discharge from an inpatient setting. The patients were provided with non-face-to-face services as needed throughout the 30-day period. METHODS: The effectiveness of the TCM model was measured using a retrospective propensity score matching design, which allowed for an accurate comparison between those who received TCM and similar ICC Medicare beneficiaries who did not. The analysis utilized Medicare parts A and B claims from January 1, 2016, to December 31, 2017. RESULTS: Patients who received TCM had lower 30-day readmission rates than those who did not (P < .05). CONCLUSIONS: The services provided to ICC Medicare patients through the TCM model may have enhanced the ability to identify problems at an earlier stage, resulting in the prevention of complications and unnecessary utilization of costly health care services.

Ginsenoside Re reduces insulin resistance through activation of PPAR-γ pathway and inhibition of TNF-α production.

ETHNOPHARMACOLOGICAL RELEVANCE: Panax ginseng is a well-known traditional Chinese medicine and has been used for treatment of various diseases for more than four thousand years in Asia. Ginseng saponins or ginsenosides, the active constituents are reported to possess antidiabetic activity, but their antihyperglycemic mechanisms are not fully elucidated. In the present study, the mechanisms of action of ginsenoside Re were investigated in vitro models. MATERIALS AND METHODS: 3T3-L1 cells were chosen as the model to investigate the molecular mechanisms of action of ginsenoside Re. Influence of ginsenoside Re on the adipogenesis was examined by determining TG levels in 3T3-L1 adipocytes by the method of TG oxidation enzyme. Glucose uptake in 3T3-L1 cells stimulated by insulin in the absence or presence of ginsenoside Re were quantified by measuring (3)H-2-deoxy-d-glucose levels. Cytokine proteins released into the medium including adiponectin and TNF-α were tested using respective ELISA kits. In addition, real time RT-PCR was conducted to investigate the expression changes of PPAR-γ and its responsive genes, ap2, adiponectin, IRS-1, GLUT4 and TNF-α. And western blot analysis was performed to determine the translocation of GLUT4. Finally, effects of ginsenoside Re on NO production in 3T3-L1 adipocytes and in macrophages were investigated through measurement of nitrite concentration by Griess reagent. RESULTS: Ginsenoside Re induced adipogenesis of 3T3-L1 adipocytes by accumulating TG, increased glucose uptake and up-regulated PPAR-γ2, IRS-1, ap2 and adiponectin genes expressions. Meanwhile, Re also increased production and release of adiponectin. Although having no effects on GLUT4 gene expression, Re facilitated GLUT4 protein translocation to the membranes. In addition, Re inhibited the expression and release of TNF-α. Finally, Re did not show inhibitory effects on NO production both in 3T3-L1 cells stimulated by LPS, TNF-α and IFN-γ and in LPS-stimulated mouse peritoneal macrophages. CONCLUSIONS: Ginsenoside Re exhibited the action of reducing insulin resistance through activation of PPAR-γ pathway by directly increasing the expressions of PPAR-γ2 and its responsive genes, adiponectin, IRS-1, ap2, inhibiting TNF-α production and facilitating the translocation of GLUT4 to promote glucose uptake and disposal in 3T3-L1 adipocytes.

Preventing avoidable hospitalizations.

To reduce avoidable hospital readmissions and improve transitions between healthcare settings, Virtua Home Care implemented a Transitions of Care Program based on the Transitional Care Model developed at the University of Pennsylvania School of Nursing. Home care nurses were educated to be transitional care nurses and provided intensive education and follow-up for patients with chronic diseases who were identified as having a high risk of readmission. This program, which provides services to patients enrolled in fee-for-service (FFS) Medicare and who are eligible to receive the home health benefit, has successfully reduced hospital readmissions. This article describes Virtua Home Care's journey in adapting and implementing an evidence-based care transitions model.

Longitudinal associations between dual sensory impairment and everyday competence among older adults.

Given the prevalence of sensory impairment in older adults, the relationship of sensory impairment to everyday competence among older adults is gaining attention. Dual impairment, or concurrent impairments of vision and hearing, affects anywhere from 5% to 21% of older adults. Using Longitudinal Study on Aging data, we examined the longitudinal associations of self-reported dual sensory impairment with everyday competence in self-reported activities of daily living among adults aged 70 and older (N = 5,151). Self-reported dual sensory impairment was associated with higher levels of self-reported functional disability at baseline and at the 2-year follow-up interview, but the effect gradually diminished over time. However, self-reported dual sensory impairment was not associated with greater levels of self-reported disability as compared with self-reported visual impairment alone. Findings highlight the importance of vision and aural rehabilitation programs for older adults to mitigate the loss of competence in later life due to sensory impairment.

Dual sensory loss and its impact on everyday competence.

PURPOSE: This study examined the relation of dual and single sensory impairments, within the context of cognitive function, by using the framework of everyday competence in terms of the probability of difficulty with specific personal and instrumental activities of daily living (ADLs and IADLs, respectively). DESIGN AND METHODS: The Longitudinal Study on Aging, composed of individuals aged 70 and older in 1984 (N = 5,151), provided data for the present analyses. In each IADL and ADL domain, binary logistic regressions assessed the probability of difficulty associated with sensory impairment and cognitive status after sociodemographic and physical health covariates were controlled for. RESULTS: One fifth of older adults reported dual sensory impairment, which was associated with greater IADL than ADL task difficulty compared with single sensory loss. Further, high levels of dual impairment were shown to increase the risk of difficulty in three of six IADL tasks (preparing meals, shopping, and using the telephone) over vision impairment alone. Overall, cognitive status was a significant predictor of both ADL and IADL difficulties, which was not expected from the everyday competence framework. IMPLICATIONS: Findings highlight the importance of sensory resources for everyday competence and suggest the need for effective vision and hearing rehabilitation to assist older adults in improving or maintaining their functional independence.

Relationship between antibacterial activity of chitosan and surface characteristics of cell wall.

AIM: Five representative waterborne pathogens were used to illustrate the relationship between chitosan's antibacterial activity and the surface characteristics of the bacterial cell wall. METHODS: Chitosan was prepared with averaged 75% or 95% deacetylated degree to examine its antibacterial activity against waterborne pathogens. Fresh microbial inoculants for the antibacterial assessment were prepared on nutrient agar at 37 degrees for 24 h. The evaluation items of antibacterial mechanism included hydrophilicity and negative charge analysis of cell surface, and adsorptive characteristics of chitosan to bacterial cell. All the experiments were applied in triplicate tests at least. RESULTS: Although cell wall hydrophilicity was similar among Gram-negative bacteria, the distribution of negative charge on their cell surfaces was quite different. More negatively charged cell surfaces had a greater interaction with chitosan, a phenomenon further confirmed by transmission electron micrography (TEM). CONCLUSION: Results showed the hydrophilicity in Gram-negative bacteria was much higher than in Gram-positive ones. The correlation coefficient 0.988 between the amount of absorbed chitosan and its inhibition efficiency indicated a close relationship.

Protective role of metallothionein (I/II) against pathological damage and apoptosis induced by dimethylarsinic acid.

AIM: To better clarify the main target organs of dimethylarsinic acid toxicity and the role of metallothionein (MTs) in modifying dimethylarsinic acid (DMAA) toxicity. METHODS: MT-I/II null (MT(-/-)) mice and the corresponding wild-type mice (MT(+/+)), six in each group, were exposed to DMAA (0-750 mg/kg body weight) by a single oral injection. Twenty four hours later, the lungs, livers and kidneys were collected and undergone pathological analysis, induction of apoptotic cells as determined by TUNEL and MT concentration was detected by radio-immunoassay. RESULTS: Remarkable pathological lesions were observed at the doses ranging from 350 to 750 mg/kg body weight in the lungs, livers and kidneys and MT(+/+) mice exhibited a relatively slight destruction when compared with that in dose matched MT(-/-) mice. The number of apoptotic cells was increased in a dose dependent manner in the lungs and livers in both types of mice. DMAA produced more necrotic cells rather than apoptotic cells at the highest dose of 750 mg/kg, however, no significant increase was observed in the kidney. Hepatic MT level in MT(+/+) mice was significantly increased by DMAA in a dose-dependent manner and there was no detectable amount of hepatic MT in untreated MT(-/-) mice. CONCLUSION: DMAA treatment can lead to the induction of apoptosis and pathological damage in both types of mice. MT exhibits a protective effect against DMAA toxicity.

Reducing fatigue of athletes following oral administration of huangqi jianzhong tang.

AIM: To study the effect of Huangqi Jianzhong Tang in reducing fatigue improvement in athletes. METHODS: Twelve athletes were randomly separated into a control group, whose members were administered with placebos, and the experimental group, whose members were administered with Huangqi Jianzhong Tang. During the eight weeks of the experiment, test subjects continued exercise as usual. Preliminary and final exhaustion times, anaerobic thresholds, and kinetic energies were determined. RESULTS: Huangqi Jianzhong Tang might increase exhaustion time, positively influence anaerobic threshold, and also enhance recovery from fatigue. CONCLUSION: Huangqi Jianzhong Tang reduced fatigue by increasing the oxygen uptake and the systemic utility of oxygen.

Body mass index and disability in adulthood: a 20-year panel study.

OBJECTIVES: This study examined whether body mass index (BMI) or change in BMI raises the risk of disability in adulthood. METHODS: The relation between BMI and upper- and lower-body disability was examined among adult subjects from a national longitudinal survey (n = 6833). Tobit regression models were used to examine the effect of BMI on disability 10 and 20 years later. RESULTS: Obesity (BMI > or = 30) at baseline or becoming obese during the study was associated with higher levels of upper- and, especially, lower-body disability. In persons who began the study with a BMI of 30 or more and became normal weight, disability was not reduced. Underweight persons (BMI < 18.5) also manifested higher disability in most instances. CONCLUSIONS: Disability risk was higher for obese persons, but overweight was not consistently associated with higher disability.