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Miller J.,Ford Motor Company | Lieberman L.,Wayne State University | Nahab B.,Ford Motor Company | Hurst G.,Ford Motor Company | And 4 more authors.
Journal of Trauma and Acute Care Surgery | Year: 2015

BACKGROUND A significant population of elderly Americans on warfarin is at risk for immediate and delayed intracranial hemorrhage. This qualitative systematic review ascertains the delayed intracranial hemorrhage risk associated with minor head injury and preinjury warfarin use. METHODS A systematic review using MEDLINE, EMBASE, and the Cochrane Library was performed in August 2014. Cohort studies evaluating delayed intracranial hemorrhage in patients with minor head injuries on warfarin were eligible for inclusion. The definition of delayed hemorrhage was any intracranial bleeding detected subsequent to initial negative brain imaging result following the head injury. Three authors screened and abstracted the data and evaluated methodological quality. Data abstraction also included clinical characteristics that could identify risk factors for delayed intracranial hemorrhage. RESULTS The search retrieved 294 unique articles, of which 5 studies constituted the final review. The studies included data on 1,257 patients. Among higher-quality studies, the incidence of delayed intracranial hemorrhage ranged from 5.8 to 72 per 1,000 cases of patients on warfarin with minor head injury. Population age was an influential factor in this range of incident rates. International normalized ratio levels had no clear association with individual risk for delayed intracranial hemorrhage. CONCLUSION The incidence of delayed intracranial hemorrhage is low among patients on warfarin with minor head injury. Trauma centers should consider the characteristics of the population they serve compared with the published studies when determining management strategies for these patients. LEVEL OF EVIDENCE Systematic review, level III. Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved. Source


Segraves R.T.,MetroHealth
Academic Psychiatry | Year: 2010

Objective: This article examines the positive and negative aspects of psychiatry encompassing sexual medicine within its purview. Methods; MEDLINE searches for the period between 1980 to the present were performed with the terms "psychiatry," "sexual medicine," and "sexual dysfunction." In addition, sexual medicine texts were reviewed for chapters relevant to this topic. Results; Psychiatry, the only medical discipline trained to integrate both biological and psychological factors in making treatment decisions, has been minimally involved in the evolution of the multidisciplinary field known as sexual medicine. Conclusion; If psychiatry is to maintain a role in the diagnosis and treatment of sexual disorders, it is critical that its training programs include training in sexual medicine. Copyright © 2010 Academic Psychiatry. Source


Greenberg A.E.,George Washington University | Hays H.,Cerner Corporation | Castel A.D.,George Washington University | Subramanian T.,Cerner Corporation | And 17 more authors.
Journal of the American Medical Informatics Association | Year: 2016

Objective Electronic medical records (EMRs) are being increasingly utilized to conduct clinical and epidemiologic research in numerous fields. To monitor and improve care of HIV-infected patients in Washington, DC, one of the most severely affected urban areas in the United States, we devel- oped a city-wide database across 13 clinical sites using electronic data abstraction and manual data entry from EMRs. Materials and Methods To develop this unique longitudinal cohort, a web-based electronic data capture system (Discovere®) was used. An Agile software development methodology was implemented across multiple EMR platforms. Clinical informatics staff worked with information technology specialists from each site to abstract data electronically from each respective site's EMR through an extract, transform, and load process. Results Since enrollment began in 2011, more than 7000 patients have been enrolled, with longitudinal clinical data available on all patients. Data sets are produced for scientific analyses on a quarterly basis, and benchmarking reports are generated semi-annually enabling each site to com- pare their participants' clinical status, treatments, and outcomes to the aggregated summaries from all other sites. Discussion Numerous technical challenges were identified and innovative solutions developed to ensure the successful implementation of the DC Cohort. Central to the success of this project was the broad collaboration established between government, academia, clinics, community, information technology staff, and the patients themselves. Conclusions Our experiences may have practical implications for researchers who seek to merge data from diverse clinical databases, and are applicable to the study of health related issues beyond HIV. © The Author 2015. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. Source


Lee H.J.,MetroHealth | Hota P.K.,MetroHealth | Chugha P.,MetroHealth | Guo H.,Rammelkamp Research | And 8 more authors.
Structure | Year: 2012

The sterile alpha motif (SAM) for protein-protein interactions is encountered in over 200 proteins, but the structural basis for its interactions is just becoming clear. Here we solved the structure of the EphA2-SHIP2 SAM:SAM heterodimeric complex by use of NMR restraints from chemical shift perturbations, NOE and RDC experiments. Specific contacts between the protein surfaces differ significantly from a previous model and other SAM:SAM complexes. Molecular dynamics and docking simulations indicate fluctuations in the complex toward alternate, higher energy conformations. The interface suggests that EphA family members bind to SHIP2 SAM, whereas EphB members may not; correspondingly, we demonstrate binding of EphA1, but not of EphB2, to SHIP2. A variant of EphB2 SAM was designed that binds SHIP2. Functional characterization of a mutant EphA2 compromised in SHIP2 binding reveals two previously unrecognized functions of SHIP2 in suppressing ligand-induced activation of EphA2 and in promoting receptor coordinated chemotactic cell migration. © 2012 Elsevier Ltd. Source

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