What is the current state of patient education after Clostridioides difficile infection?

In a survey of hospitals and of patients with Clostridioides difficile infection (CDI), we found that most facilities had educational materials or protocols for education of CDI patients. However, approximately half of CDI patients did not recall receiving education during their admission, and knowledge deficits regarding CDI prevention were common.

Aortic Valve Reoperation After Stentless Bioprosthesis: Short- and Long-Term Outcomes.

BACKGROUND: Limited data are available regarding outcomes for stentless aortic valve reoperation. The reported reoperative mortality has been unacceptably high. METHODS: Between 1997 and 2017, a retrospective analysis was performed on 143 patients who underwent open aortic valve reoperations for failed stentless aortic valve bioprostheses. We evaluated both short-term and long-term outcomes on this cohort of patients. RESULTS: Bicuspid aortic valve was present in 107 of 143 patients (75%) at the time of the initial Freestyle (Medtronic, Minneapolis, MN) procedure, and 120 of 143 patients (84%) underwent a modified inclusion aortic root replacement procedure. The interval from first operation to reoperation was 9 years (range, 5.4 to 11.8), which was significantly shorter for patients with infectious endocarditis (4.1 years; range, 1.8 to 7.1) compared with patients with structural valvular deterioration (10.4 years; range, 8.1 to 12.4, p < 0.001). The median age at the time of reoperation was 59 years (range, 50 to 67). Aortic valve reoperation was performed for structural valve deterioration in 68% cases compared with 32% for infectious prosthetic valve endocarditis. Concomitant surgery included coronary artery bypass (13%), mitral valve surgery (4%), and ascending aorta and arch replacement (42%). The 30-day and inhospital mortality was 1% and 2%, respectively. The composite outcome including myocardial infarction, stroke, new-onset renal failure on hemodialysis, and operative mortality was 4%. The 5-year and 10-year Kaplan-Meier survival after reoperation for failed stentless valve was 83% (95% confidence interval: 73% to 89%) and 57% (95% confidence interval: 36% to 74%). CONCLUSIONS: Aortic valve reoperation after stentless valve implantation can be performed with low operative mortality and favorable long-term survival.

Effect of a Medical Student-Led Curriculum on Teen Health Knowledge and Intentions: An Evaluation of the MiHealth Pilot Program.

INTRODUCTION: Adolescents are often thought of as a healthy population, however, they routinely engage in high-risk behaviors that can lead to health problems. Medical students designed MiHealth, a program in which medical students teach health lessons in the high school classroom to help address these behaviors. METHODS: A series of six lessons were created and implemented in the classroom for this pilot study focused on sexual health, intimate partner violence, mental health, smoking and marijuana, nutrition, and physical fitness. High school students in grades nine through twelve at a public high school in southeast Michigan receiving the MiHealth curriculum (N=52) or the standard health education curriculum (N=61) were surveyed on health knowledge, attitudes, and intentions before and after the program. RESULTS: Six weeks after program completion, high school students who received the MiHealth curriculum scored significantly higher on health knowledge ( P=0.007), and expressed significantly healthier attitudes and intentions toward risk behavior compared to controls (P=0.025). Among individual themes, MiHealth resulted in significant knowledge gains in sexual health ( P=0.001) and mental health (P<0.025), and significantly healthier attitudes regarding sexual health (P=0.047), nutrition (P=0.040), and smoking and marijuana (P=0.012). CONCLUSIONS: MiHealth demonstrated promising improvements in health knowledge retention and attitude changes in adolescents 6 weeks after program completion. An interactive curriculum targeting key adolescent health topics given by near-peer medical student educators may provide benefits beyond traditional high school health curricula.

The impact of concomitant pulmonary hypertension on early and late outcomes following surgery for mitral stenosis.

OBJECTIVES: To provide initial evidence on the management of mitral stenosis and pulmonary hypertension (PH) based on short-term and long-term outcomes following mitral valve surgery. METHODS: Consecutive patients with mitral stenosis (n = 317) who had undergone mitral valve surgery between 1992 and 2014 with recorded pulmonary artery pressure (PAP) data were reviewed. PH severity, based on systolic PAP, was categorized as mild (35 to 44 mm Hg), moderate (45 to 59 mm Hg), or severe (>60 mm Hg). Primary outcomes were 30-day mortality and long-term survival. RESULTS: There were no significant between-group differences in age or preoperative comorbidities. Mitral valve surgery included mitral valve replacement (78%) and repair (22%). The severe PH group had more mitral valve replacement (81%; P = .04), severe tricuspid valve regurgitation (31%; P = .003), right heart failure (17%; P = .02), and concomitant tricuspid valve procedures (46%; P < .001). For severe PH, 30-day mortality was 9%, with no significant group differences. Ten- and 12-year survival were significantly worse in the moderate-severe PH group (58% and 51%, respectively) compared with the normal PAP-mild PH group (83% and 79%, respectively) with a hazard ratio of 2.98 (95% confidence interval, 1.55-5.75; P = .001). Ten-year survival after mitral valve surgery for mitral stenosis was inversely associated with preoperative PAP. CONCLUSIONS: Mitral valve surgery can be performed with acceptable 30-day mortality for patients with mitral stenosis and moderate to severe PH, but long-term survival is impaired by moderate to severe PH. Patients with mitral stenosis and mild PH (systolic PAP 35-44 mm Hg) should be considered for mitral valve surgery.

Epidermal growth factor receptor (EGFR) contributes to fetal lung fibroblast injury induced by mechanical stretch.

CONTEXT: Epidermal growth factor receptor (EGFR) is critical for normal fetal lung development. However, the role of this receptor in lung injury induced by mechanical ventilation is controversial. OBJECTIVE: To investigate in vitro whether EGFR plays a protective role or contributes to stretch-induced lung injury. METHODS: Fetal lung fibroblasts were isolated from wild-type and EGFR knockout mice and exposed to physiologic stretch (2.5% elongation) or injurious stretch (20% distention). Cells were evaluated for necrosis, apoptosis, proliferation and inflammation. RESULTS: Injurious stretch increased lactate dehydrogenase (LDH) release to similar degree in wild-type and knockout cells. In contrast, 20% stretch increased cleaved caspase-3 and decreased proliferating cell nuclear antigen (PCNA) only in wild-type cells. Furthermore, 20% stretch increased macrophage inflammatory protein-2 (MIP-2) and monocyte chemotactic protein-1 (MCP-1) by 3-5 fold in wild-type cells. In contrast, in knockout cells MIP-2 decreased by 50% and MCP-1 only increased by 60% when compared to physiologic stretch. CONCLUSION: Our data show a decrease of apoptosis and inflammation and absence of decreased proliferation after injurious stretch of fetal fibroblasts lacking EGFR. These data suggest that EGFR contributes to lung injury mediated by stretch. We speculate that EGFR may contribute to the arrest of lung development observed after mechanical ventilation by decreasing the population of lung fibroblasts.