Although dystonias are a common group of movement disorders the mechanisms by which brain dysfunction results in dystonia are not understood. Rapid-onset Dystonia-Parkinsonism is a hereditary dystonia caused by mutations in the ATP1A3 gene. Affected subjects can be symptom free for years but rapidly develop persistent dystonia and parkinsonism-like symptoms after a stressful experience. Using a mouse model here we show that an adverse interaction between the cerebellum and basal ganglia can account for the symptoms of the patients. The primary instigator of dystonia is the cerebellum whose aberrant activity alters basal ganglia function which in turn causes dystonia. This adverse interaction between the cerebellum and basal ganglia is mediated through a di-synaptic thalamic pathway which when severed is effective in alleviating dystonia. Our results provide a unifying hypothesis for the involvement of cerebellum and basal ganglia in generation of dystonia and suggest therapeutic strategies for the treatment of RDP.

Venous thromboembolism is associated with substantial morbidity and mortality and is largely preventable. Despite this fact, appropriate prophylaxis is vastly underutilized. To improve compliance with best practice prophylaxis for VTE in hospitalized trauma patients, we implemented a mandatory computerized provider order entry-based clinical decision support tool. The system required completion of checklists of VTE risk factors and contraindications to pharmacologic prophylaxis. With this tool, we were able to determine a patient's risk stratification level and recommend appropriate prophylaxis. To evaluate the effect of our mandatory computerized provider order entry-based clinical decision support tool on compliance with prophylaxis guidelines for venous thromboembolism (VTE) and VTE outcomes among admitted adult trauma patients.

Background All hospitalized patients should be assessed for VTE risk factors and prescribed appropriate prophylaxis. To improve best-practice VTE prophylaxis prescription for all hospitalized patients, we implemented a mandatory computerized clinical decision support (CCDS) tool. The tool requires completion of checklists to evaluate VTE risk factors and contraindications to pharmacologic prophylaxis, and then recommends the risk-appropriate VTE prophylaxis regimen. Objectives To examine the effect of a quality improvement intervention on race- and gender-based healthcare disparities across two distinct clinical services. Research Design Retrospective cohort study of a quality improvement intervention Subjects 1942 hospitalized medical patients and 1599 hospitalized adult trauma patients Measures Proportion of patients prescribed risk-appropriate, best-practice VTE prophylaxis Results Racial disparities existed in prescription of best-practice VTE prophylaxis in the pre-implementation period between black and white patients on both the trauma (70.1% vs. 56.6%, p=0.025) and medicine (69.5% vs. 61.7%, p=0.015) services. After implementation of the CCDS tool, compliance improved for all patients and disparities in best-practice prophylaxis prescription between black and white patients were eliminated on both services: trauma (84.5% vs. 85.5%, p=0.99) and medicine (91.8% vs. 88.0%, p=0.082). Similar findings were noted for gender disparities in the trauma cohort. Conclusions Despite the fact that risk-appropriate prophylaxis should be prescribed equally to all hospitalized patients regardless of race and gender, practice varied widely prior to our quality improvement intervention. Our CCDS tool eliminated racial disparities in VTE prophylaxis prescription across two distinct clinical services. Health information technology approaches to care standardization are effective to eliminate healthcare disparities.

Background Mastectomy flap necrosis is the source of considerable morbidity and cost following breast reconstruction. A great deal of effort has been put forth to predicting and even preventing its incidence intraoperatively. Methods A review of the literature was performed evaluating the evidence of mastectomy skin flap perfusion technologies. Results Multiple technologies have leveraged spectroscopy and/or angiography to provide real-time assessment of flap perfusion, including indocyanine green, fluorescein, and light-based devices. Conclusion This manuscript endeavors to review the evidence on mastectomy skin flap perfusion analysis, highlighting the benefits, and downsides of the current technologies and identifying exciting areas of future research and development.