Journal of the American College of Surgeons
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Primary aldosteronism (PA) is the most common cause of secondary hypertension, yet screening remains startlingly infrequent. We describe (1) PA screening practices in a large, diverse health system, (2) the development of a computable phenotype for PA screening, and (3) the design and pilot deployment of an electronic health record (EHR)-based active choice nudge to recommend PA screening. ⋯ PA screening rates are low. This pilot study suggests an EHR-based nudge leveraging a precise computable phenotype can dramatically increase appropriate PA screening.
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Prolonged field care is a military adaptation of tactical combat casualty care providing extended prehospital management during delayed extrication. Effects of addition of valproic acid (VPA) to fresh-frozen plasma (FFP) in a prolonged field care model of hemorrhagic shock and traumatic brain injury are not known. We hypothesized that VPA is associated with decreased neurological impairment, and its protective changes are detected at the transcriptomic level. ⋯ The addition of FFP to the resuscitation protocol resulted in a significant reduction in crystalloid requirements. Both the NS + FFP and NS + FFP + VPA groups showed improved neurological recovery compared with NS alone and had distinctive transcriptomic profiles in injured brains at 72 hours. The mitochondrially encoded ATP synthase membrane subunit 8 gene, involved in worsening ischemia following brain injury, was downregulated in VPA-treated animals.