Putting patients at the center of kidney care transitions: PREPARE NOW, a cluster randomized controlled trial

Care for patients transitioning from chronic kidney disease to kidney failure often falls short of meeting patients' needs. The PREPARE NOW study is a cluster randomized controlled trial studying the effectiveness of a pragmatic health system intervention, 'Patient Centered Kidney Transition Care,' a multi-component health system intervention designed to improve patients' preparation for kidney failure treatment. Patient-Centered Kidney Transition Care provides a suite of new electronic health information tools (including a disease registry and risk prediction tools) to help providers recognize patients in need of Kidney Transitions Care and focus their attention on patients' values and treatment preferences. Patient-Centered Kidney Transition Care also adds a 'Kidney Transitions Specialist' to the nephrology health care team to facilitate patients' self-management empowerment, shared-decision making, psychosocial support, care navigation, and health care team communication. The PREPARE NOW study is conducted among eight [8] outpatient nephrology clinics at Geisinger, a large integrated health system in rural Pennsylvania. Four randomly selected nephrology clinics employ the Patient Centered Kidney Transitions Care intervention while four clinics employ usual nephrology care. To assess intervention effectiveness, patient reported, biomedical, and health system outcomes are collected annually over a period of 36 months via telephone questionnaires and electronic health records. The PREPARE NOW Study may provide needed evidence on the effectiveness of patient-centered health system interventions to improve nephrology patients' experiences, capabilities, and clinical outcomes, and it will guide the implementation of similar interventions elsewhere.

TRIAL REGISTRATION

NCT02722382.

[Acute presentation in oral schwannoma]

OBSERVATION

We report an unusual presentation of an acute septic maxillary vestibular schwannoma in a 19-year-old female patient. The anatomopathological examination of the tumor showed Schwann cell proliferation and ulceration of infectious origin.

DISCUSSION

Intraoral schwannomas are uncommon. They generally induce local pain on percussion and dysesthesia. Isolated intraoral schwannomas are very rarely linked with type I neurofibromatosis. They do not require any specific follow-up after exeresis.

[Lingual osteoma. Apropos of a case]

The authors present a case of osteoma of the tongue. This tumor was discovered without any functional symptom. Surgical resection with histological examination gives the diagnostic. This choristoma is rare, benign and clinically poor. Osteoma of the tongue is a heterotopic bone tissue and his main differential diagnosis are lingual thyroid and thyroglossal cyst. There are several opinions concerning the histogenesis of this choristoma, but an embryological anomaly is probable. Surgical removal of the tumor is curative, without any reported local recurrence.

[The Bichat ball. The surgical value of oro-sinus communications]

Bichat's ball is a mass of adipose tissue used to fill communications between the buccal cavity and the sinus. The anatomy of the structure is presented. it has a body and 6 extensions. A surgical technique is proposed in comparison with previously described methods. At 6 weeks, there has been no recurrence of buccal-sinus communication in a series of approximately 300 cases operated over a period of 15 years.

Effects of carbon monoxide and hypoxia on cleft lip in A/J mice

Epidemiologic evidence indicates an increase in cleft lip with or without cleft palate [CL(P)] in infants of mothers who smoke cigarettes. It appears that the principle mechanism is through carbon monoxide (CO) decreasing the oxygen (O2) available to the embryo. Previous studies have shown that maternal respiratory hypoxia can increase the incidence of CL(P) in mice. The present investigation was designed to analyze the effects of altered levels of CO and O2 in respiratory gases on the incidence of CL(P) in genetically susceptible A/J mice. Results from blood gas analysis, after a 24-hour exposure of pregnant mice during the time of primary palate development, showed that CO levels of 180 ppm in air decrease oxyhemoglobin (%O2Hb) and increased carboxyhemoglobin (%COHb) to slightly above the high end of the range found in human studies of cigarette smokers. Interestingly, the control COHb levels were higher in our CL(P) sensitive mouse strain compared with those of the range of increases found in human smokers, versus nonsmoker studies, and that the increase for treated mice (3x) was at the low end of the range for smokers. Decreasing O2 levels to 10% from 21% (normal percentage in air) more severely decreased %O2Hb and moderately decreased %COHb. At 24 hours of exposure, the incidence of CL(P) and resorption was approximately the same for both the CO and the control groups, but there were significant increases in the incidence of resorptions in the hypoxia group and of CL(P) in relation to the CO group.(ABSTRACT TRUNCATED AT 250 WORDS)

The role of dental canal fillings in the development of Aspergillus sinusitis. A report of 85 cases

Radiopaque concretions in the maxillary sinus in cases of sinusitis are often observed in infections with aspergillosis. For several authors, such features are considered to be typical of these infections. For us this foreign body in most cases is believed to be related to overfilling of the teeth. We have previously drawn attention to this fact. We report 85 cases of aspergillosis of the maxillary sinus. Cases involving immunosuppressed patients were excluded because of very different clinical conditions. A radiopaque foreign body was seen in 94% of the cases. Of this group, 85% were believed to be related to overfilling of maxillary teeth with dental paste, particularly since evidence for endodontic treatment was found in the premolar/molar region. An image of intrasinus dental paste was demonstrated in 12% of the cases as a direct extension of filling paste from affected teeth. The nature of the dental paste is important because the zinc contained can stimulate the growth of Aspergillus fumigatus. In vitro studies in our laboratory also showed that the growth of A. fumigatus was stimulated with a low concentration of zinc.

[Use of very high doses of haloperidol in the treatment of acute psychotic episodes. Clinical and pharmacokinetic analysis apropos of 15 cases]

High-dosage haloperidol treatment was administered during three weeks in a rapid neuroleptization technique to fifteen patients suffering from acute psychotic episodes. Haloperidol plasma levels were determined by radioimmunoassay. The efficacy of such a therapeutic design seemed fairly good, particularly the rapid improvement during the first week. Yet, tolerance appeared to be low, with a high incidence of adverse effects, some of them unexpected. A very good correlation was observed between haloperidol plasma levels and haloperidol oral doses. By contrast, there was no correlation between plasma levels and clinical improvement. In the same way, the occurrence of adverse effects did not seem to be related to haloperidol plasma levels.

[The mineral phase of Malherbe's calcifying tumor]

The mineral phase of a calcified tumour of Malherbe (pilomatrixoma) was studied using microradiography, chemical analysis and X-ray diffraction. It was compared with the mineral phase of a piece of human mandibular bone from a matched subject with respect to age and sex. The main part of the mineral phase of the pilomatrixoma belonged to the biological apatite system; an additional whitlockite phase was found. In the homogeneous areas of the tumour, the radioopacity was similar to that of bone.

[Facial manifestations of suppurative trichophytosis]

Several cases of facial suppurative Trichophytia described by the authors lead to a review of the clinical, mycological and pathological features of this disorder which is on the increase in the region of Nantes.

[A rare dental abnormality: "the phantom tooth" or "odontodysplasia". Apropos of a case]

"Phantom tooth" or "odontodysplasia" is one of the most unusual and rare of dental abnormalities, being characterised: Clinically, by the topography of the lesions, the involvement of both sets of teeth and abnormalities in the size and form of the teeth which remain unrupted or only partially evolved. Radiologically, by transparency of the teeth to X-rays. Histologically, by disorganisation of the dental structures and a highly characteristic appearance of the enamel and, in particular, dentine. On the basis of one case, the authors review in detail each aspect of these characteristics, paying special attention to histology and the information obtained using the sweep electron microscope.