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"Wallace, Karen"
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Born to be a butterfly
Simple text and photographs describe the stages by which a butterfly develops from an egg.
Book
Management and Outcomes of Adults Diagnosed with Acute Pulmonary Embolism in Primary Care: Community-Based Retrospective Cohort Study
Background
The management and outcomes of patients diagnosed with acute pulmonary embolism in primary care have not been characterized.
Objective
To describe 30-day outcomes stratified by initial site-of-care decisions
Design
Multicenter retrospective cohort study
Participants
Adults diagnosed with acute pulmonary embolism in primary care in a large, diverse community-based US health system (2013–2019)
Main Measures
The primary outcome was a composite of 30-day serious adverse events (recurrent venous thromboembolism, major bleeding, and all-cause mortality). The secondary outcome was 7-day pulmonary embolism–related hospitalization, either initial or delayed.
Key Results
Among 652 patient encounters (from 646 patients), median age was 64 years; 51.5% were male and 70.7% identified as non-Hispanic white. Overall, 134 cases (20.6%) were sent home from primary care and 518 cases (79.4%) were initially referred to the emergency department (ED) or hospital. Among the referred, 196 (37.8%) were discharged home from the ED without events. Eight patients (1.2%; 95% CI 0.5–2.4%) experienced a 30-day serious adverse event: 4 venous thromboemboli (0.6%), 1 major bleed (0.2%), and 3 deaths (0.5%). Seven of these patients were initially hospitalized, and 1 had been sent home from primary care. All 3 deaths occurred in patients with known metastatic cancer initially referred to the ED, hospitalized, then enrolled in hospice following discharge. Overall, 328 patients (50.3%) were hospitalized within 7 days: 322 at the time of the index diagnosis and 6 following initial outpatient management (4 clinic-only and 2 clinic-plus-ED patients).
Conclusions
Patients diagnosed with acute pulmonary embolism in this primary care setting uncommonly experienced 30-day adverse events, regardless of initial site-of-care decisions. Over 20% were managed comprehensively by primary care. Delayed 7-day pulmonary embolism-related hospitalization was rare among the 51% treated as outpatients. Primary care management of acute pulmonary embolism appears to be safe and could have implications for cost-effectiveness and patient care experience.
Journal Article
Diving dolphin
A young dolphin's life is full of adventure! He wants to explore, but can he escape the killer whales?
Book
Processive bidirectional motion of dynein-dynactin complexes in vitro
Cytoplasmic dynein is the primary molecular motor responsible for transport of vesicles, organelles, proteins and RNA cargoes from the periphery of the cell towards the nucleus along the microtubule cytoskeleton of eukaryotic cells. Dynactin, a large multi-subunit activator of dynein, docks cargo to the motor and may enhance dynein processivity. Here, we show that individual fluorescently labelled dynein-dynactin complexes exhibit bidirectional and processive motility towards both the plus and minus ends of microtubules. The dependence of this activity on substrate ATP concentration, nucleotide analogues and inhibitors suggests that bidirectional motility is an active energy-transduction property of dynein-dynactin motor mechano-chemistry. The unique motility characteristics observed may reflect the flexibility of the dynein structure that leads to an enhanced ability to navigate around obstacles in the cell.
Journal Article
Trauma Informed Teaching through Play Art Narrative
Trauma Informed Teaching through Play Art Narrative (PAN) provides ideas, insight, and activities to guide teachers in helping children and youth work through trauma in a creative reparative process.
eBook
An Evolving Therapy – Dural Venous Sinus Stenting for Idiopathic Intracranial Hypertension
CT head was normal, and lumbar puncture yielded increased opening pressure (26 cm H20) but was otherwise unremarkable. Pre-procedural cerebral angiography shows severe stenosis of the confluence of the right sigmoid and transverse sinus with a 25-mmHg pressure gradient: lateral view (E), anterior–posterior view (F), and 3D reconstruction from cone beam CT (G). Post-procedural cerebral angiography following placement of a Precise Pro RX carotid stent (8 x 40 mm) across the stenotic segment of the right sigmoid and transverse sinus shows resolution of stenosis, improved venous drainage, and resolution of gradient pressure: lateral view (H) and anterior–posterior view (I and J).
Journal Article
Overactive bladder
Overactive bladder syndrome is highly prevalent, and increasingly so with aging. It is characterized by the presence of urinary urgency, and can be associated with incontinence, increased voiding frequency, and nocturia. Assessment needs to exclude serious medical disorders that might present with similar symptoms, and a bladder diary is an invaluable part of understanding the presentation. Initial management is conservative, comprising education, bladder training, and advice on fluid intake. Drug therapy options include antimuscarinic medications and beta-3 adrenergic receptor agonists. Persistent overactive bladder syndrome, despite initial therapy, requires a review of the patient's understanding of conservative management and compliance, and adjustment of medications. For refractory cases, specialist review and urodynamic testing should be considered; this may identify detrusor overactivity or increased filling sensation, and needs to exclude additional factors, such as stress incontinence and voiding dysfunction. Botulinum neurotoxin-A bladder injections can be used in severe overactivity, provided the patient is able and willing to do intermittent self-catheterisation, which is necessary in about 5% of treated patients. Sacral nerve stimulation and tibial nerve stimulation are other approaches. Major reconstructive surgery, such as augmentation cystoplasty, is rarely undertaken in modern practice but remains a possibility in extreme cases.
Journal Article