We conclude that norovirus may be associated with exacerbations of IBD. When norovirus accompanies IBD it is more likely to be associated with hematochezia than when the infection occurs in the absence of IBD.

This article describes a nurse practitioner model utilized to decrease the length of stay and improve the quality of discharge planning for hospitalized trauma patients between 1999 and 2006. An observational method employing nurse practitioners to decrease length of stay for the trauma population during these years is described. Adding nurse practitioners to the trauma team has resulted in decreasing the length of stay in all 4 of the injury severity score groups. Adding nurse practitioners to the trauma team provides a core member in a revolving trauma service. Consequently, length of stay and discharge planning have been positively impacted.

A persistent sciatic artery (PSA) is a rare congenital anomaly, usually associated with hypoplasia of the iliofemoral system. In most cases, the sciatic artery is the main dominant inflow vessel to the lower extremity. Persistent sciatic artery is strongly associated with aneurysmal disease, with a high potential for thromboembolic events. Aneurysm formation complicates 40% to 61% of the PSA cases brought to medical attention. There are a variety of presentations, including lower extremity ischemia and pressure symptoms from sciatic nerve compression. We report a case of severe left lower extremity pain due to PSA with thromboembolic manifestation. This case was successfully treated with open and endovascular techniques.

Purpose To report on the implementation and clinical outcomes of a community-based pulmonary rehabilitation program in rural Appalachia. Methods Three rural health centers and a large referral hospital worked together to establish pulmonary rehabilitation services based on AACVPR guidelines. Each site hired at least 1 respiratory therapist. To measure clinical outcomes, a retrospective medical record study compared pre- and post-program values for the modified Medical Research Council dyspnea level, 6-minute walk test (6MWT), negative inspiratory force (NIF), respiratory disease knowledge, St George Respiratory Questionnaire (SGRQ), BODE index (body mass index, airflow obstruction, dyspnea and exercise capacity), and smoking status. The percentages of persons completing the program and participating in maintenance exercise after the program were recorded. Results During the first 20 months of the program, 195 unduplicated persons with qualifying chronic lung diseases started the program. Of these, 111 (57%) completed the program. Mean improvements for all 6 measures were highly significant (P < .001) and compared favorably with published results from hospital-based programs: dyspnea level, − 1.2; 6MWT, + 259 ft; NIF, + 11.3 cm H 2 O; knowledge test, + 1.9; SGRQ, − 6.2; BODE index, − 1.1. Of the 23 smokers, 5 quit by the end of the program. Conclusions Community-based pulmonary rehabilitation in rural health centers is feasible and achieves clinical outcomes similar to programs in large hospitals and academic centers. Furthermore, the addition of respiratory therapists to these primary care teams provides important collateral benefits for the evidence-based care of patients with chronic lung diseases.