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Two detection methods for H. pylori infections, i.e. serological antibody titer measurements by Hp-ELISA and histological scoring by HE staining, have been compared to investigate the relationship between the diagnosis methods, to clarify the application scope of each diagnosis method and to determine its influencing factors. In the 7,241 subjects who participated in gastric cancer screening, H. pylori infection rate was 70.14% by the Hp-HE method and 41.87% by the Hp-ELISA method when 34EIU was recognized as the cut-off value. The IgG titers increased with the elevation of HE scores; however, the two methods were not closely correlated among those in different gastric disease status. Age, gender and drinking status did not have significant impact on the relationship between the two methods; however, smoking status seemed to significantly influence the correlation of the two diagnosis methods. In conclusion, it was necessary to reevaluate the cut-off value when using ELISA test kits in different population groups. In most cases, the results of two H. pylori infection diagnosis methods show high correlation. However, this relationship can be affected by smoking and gastric diseases status. Additionally, the dynamic change of H. pylori antibody titers is an indicator of gastric disease development.

Chronic heart failure (CHF) is an ongoing clinical syndrome with cardiac dysfunction that can be traced to alterations in cardiac metabolism. The identification of metabolic biomarkers in easily accessible fluids to improve the early diagnosis of CHF has been elusive to date. In this study, we took multidimensional analytical techniques to discover potentially new diagnostic biomarkers by focusing on the dynamic changes of metabolites in serum during the progression of CHF. Using mass-spectrometry-based untargeted metabolomics, we identified 23 cardiac metabolites that were altered in a rat model of myocardial infarction induced CHF. Among these differential metabolites, branched-chain amino acids (BCAAs) in serum, especially leucine and valine, showed a high capability to differentiate between CHF and sham-operated rats, of which area under the receiver operating characteristic curve was greater than 0.75. Combining with targeted analysis of the amino acids and related proteins and genes, we confirmed that BCAA metabolic pathway was significantly inhibited in rat failing hearts. On the basis of the time series data of serum samples, we characterized the fluctuation pattern of circulating BCAAs by the disease progression model. Finally, the time-resolved diagnostic potential of serum BCAAs was evaluated by the machine-learning-based classifier, and high diagnostic accuracy of 93.75% was achieved within 3 weeks after surgery. These findings provide a promising metabolic signature that can be further exploited for CHF early diagnostic development.

Although approximately one in five Medicare beneficiaries are discharged from hospital acute care to postacute care at skilled nursing facilities (SNFs), little is known about access to timely medical care for these patients after they are admitted to a SNF. Our analysis of 2,392,753 such discharges from hospitals under fee-for-service Medicare in the period January 2012-October 2014 indicated that first visits by a physician or advanced practitioner (a nurse practitioner or physician assistant) for initial medical assessment occurred within four days of SNF admission in 71.5 percent of the stays. However, there was considerable variation in days to first visit at the regional, facility, and patient levels. We estimated that in 10.4 percent of stays there was no physician or advanced practitioner visit. Understanding the underlying reasons for, and consequences of, variability in timing and receipt of initial medical assessment after admission to a SNF for postacute care may prove important for improving patient outcomes and particularly relevant to current efforts to promote value-based purchasing in postacute care. As US health care moves toward value-based payment, hospitals are being held accountable for patient outcomes after discharge. Medicare's Hospital Readmissions Reduction Program, for example, made reducing hospital readmissions a national priority by applying financial penalties to hospitals with excess readmission rates. Skilled nursing facilities (SNFs), which provide postacute care for one in five Medicare beneficiaries, 1,2 represent an important discharge destination for patients who require rehabilitation or skilled nursing after an acute hospital stay. These patients are medically complex and at high risk of poor outcomes, with

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Objective To measure the association between clinician specialization in nursing home (NH) practice and outcomes of patients who received postacute care in skilled nursing facilities (SNFs). Data Sources Medicare claims and NH assessments for 2 118 941 hospital discharges to 14 526 SNFs in January 2012‐October 2014 and MD‐PPAS data for 52 379 clinicians. Study Design Generalist physicians and advanced practitioners with ≥ 90 percent of claims for NH‐based care were considered NH specialists. The primary clinician during each SNF stay was determined based on plurality of claims during that stay. We estimated the effect of being treated by a NH specialist on 30‐day rehospitalizations, successful discharge to community, and 60‐day episode‐of‐care Medicare payments (Parts A and B). All models included patient demographics, clinical variables, and SNF fixed effects. Principal Findings Nursing home specialists' patients were less likely to be rehospitalized (14.71 percent vs 16.23 percent; adjusted difference, −1.51 percent, 95% CI −1.78 to −1.24), more likely to be successfully discharged to community (56.33 percent vs 55.49 percent; adjusted difference, 0.84 percent, 95% CI 0.54 to 1.14), but had higher 60‐day Medicare payments ($31 628 vs $31 292; adjusted difference, $335; 95% CI $242 to $429). Conclusions Clinicians who specialize in NH practice may achieve better postacute care outcomes at slightly higher costs.

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Key Points Question Does inpatient consultative care by medical subspecialists represent a potential opportunity for cost savings during an episode of hospitalization for nonsurgical conditions? Findings In this cross-sectional study of 735 627 hospital discharges among Medicare beneficiaries 65 years or older extrapolated to the population of Medicare fee-for-service beneficiaries, substantial variation in Medicare payments for medicine subspecialty consultations suggested inefficiencies. Subspecialty consultative care accounted for more than $1.3 billion dollars of Medicare spending in 2014. Meaning Although whether patients have improved outcomes as a result of these consultations remains unclear, efforts to constrain the unnecessary use of consultative care during a hospitalization represent a potential area for savings.