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Profiling a Multidisciplinary Team in Making a Change in Pharmaceutical Practice: Lessons Learned.
No full textThis column describes 1 systems effort to use multidisciplinary team members to eliminate the use of intravenous acetaminophen (APAP IV). The goal of the initiative was to ensure appropriate use of APAP by limiting the overuse of the IV formulation unnecessarily in patients who can take medications orally, while ensuring its availability to the small subset of patients who would benefit from the IV formulation. This column describes the process used and outcomes achieved from a successful multiyear collaboration
Prognostic Impact of Adjuvant Immunotherapy in Patients with High-Risk Upper Tract Urothelial Cancer: Results from the ROBUUST 2.0 Collaborative Group.
No full textImpact of Unmet Social Needs on Access to Breast Cancer Screening and Treatment: An Analysis of Barriers Faced by Patients in a Breast Cancer Navigation Program.
No full textBACKGROUND: Unmet structural and social needs create barriers to breast cancer screening and treatment. The impact of the intersection of these barriers on screening participation and timeliness of breast cancer care remains poorly understood.
METHODS: People identifying as women participating in a breast cancer navigation program for screening or treatment were included. Patient navigators administered survey questions that addressed potential barriers to care access using the Health Leads Screening Toolkit. Odds ratios were calculated for unadjusted bivariate associations, and Cox proportional hazards were used to examine the relationship between barriers and time to treatment.
RESULTS: A total of 2804 women (mean age, 53 years) enrolled in navigation for screening or cancer treatment participated in the survey about barriers to care. Of those, 435 (16%) reported unstable housing, 610 (23%) reported poor health literacy, and 164 (6%) reported feeling depressed. Limited transportation was significantly associated with unstable housing (odds ratio [OR] = 26.5, 95% confidence interval [CI] 19.9-35.4, p \u3c 0.00001), poor health literacy (OR = 11.5, 95% CI 9.3-14.2, p \u3c 0.0001), and depression (OR = 2.9, 95% CI 2.1-4.0, p \u3c 0.00001). Individual barriers were not associated with a longer time to treatment, but an increasing number of barriers was associated with a longer time to treatment (Coef = 0.9, p \u3c 0.05).
CONCLUSIONS: Compounding structural and social barriers limit participation in breast cancer screening, and women with increasing unmet social needs face delays in treatment for breast cancer. Navigation programs may help women overcome barriers to care; however, understanding and targeting the intersectionality of unmet needs is essential for targeted interventions through breast cancer care navigation programs to be effective
Use of Histotripsy to Rapidly Relieve Biliary Obstruction in a Patient With Recurrent Hilar Cholangiocarcinoma.
No full textHilar cholangiocarcinoma (HCCA) is a rare, aggressive cancer often diagnosed at an unresectable stage. Patients commonly require systemic therapy and biliary stenting to manage symptoms and maintain liver function. Histotripsy is a novel, non-invasive, mechanical ablation technique recently FDA-approved for liver tumors. We report the case of a 77-year-old woman with recurrent HCCA who experienced progressive biliary obstruction despite chemotherapy and irreversible electroporation. She underwent 2 staged histotripsy treatments targeting tumors in the left and right biliary systems. Procedures were well-tolerated, with no complications, and led to normalization of bilirubin within 72 hours. Imaging at 6 months showed stable disease and sustained biliary patency, with only 1 stent exchange needed. This case highlights the potential role of histotripsy in relieving biliary obstruction and controlling local disease in patients with HCCA
Risk of Long COVID in hospitalized individuals treated with remdesivir for acute COVID-19.
No full textLong COVID comprises a multisystem syndrome occurring after COVID-19. This retrospective cohort study investigated whether remdesivir given during acute COVID-19 is associated with reduced incidence of Long COVID, including in immunocompromised subgroups. The HealthVerity database of hospital chargemaster data linked to closed claims was queried for patients aged ≥ 12 years hospitalized for ≥ 2 days with COVID-19 between May 1, 2020, and September 30, 2021. Relative risk between remdesivir-exposed and unexposed patients was calculated for 16 individual Long COVID outcomes and a composite of any Long COVID outcome, occurring 90-270 days after hospital admission. Subgroup analyses occurred in immunocompromised patients. Regression models accounted for censoring, competing risks, and treatment assignment weights; statistical inferences were adjusted for multiple comparisons. Among 3,661,303 hospitalized patients, 52,006 with COVID-19 were included; 20,246 (38.9%) were immunocompromised. In the overall and immunocompromised populations, respectively, 33.0% and 29.5% received remdesivir; the composite of ≥ 1 Long COVID outcome occurred in 55.5% and 62.9%. Patients administered remdesivir experienced lower risk of any Long COVID outcome (risk ratio, 0.96; 95% CI 0.94-0.97; adjusted P \u3c 0.001). Risk for several individual Long COVID outcomes was lower in those receiving remdesivir in the overall and immunocompromised populations. In conclusion, exposure to remdesivir was associated with a lower risk of Long COVID
Safety of thrombolysis in acute ischemic stroke patients with previous aortic abdominal aneurysm repair.
No full textOBJECTIVE: Intravenous thrombolysis is the standard treatment for acute ischemic stroke (AIS), but its safety in patients with a history of abdominal aortic aneurysm (AAA) repair remains unclear. Many contraindications for thrombolysis stem from populations excluded in pivotal clinical trials, leaving uncertainty about the risk of AAA repair rupture. This study aims to assess the safety of intravenous thrombolysis in AIS patients with prior AAA repair.
METHODS: This is a retrospective study of patients with a prior history of AAA repair who received intravenous thrombolysis for AIS between 2013 and 2023. Data collected included demographic and clinical characteristics, details of aneurysm repair, abdominal computed tomography angiography (CTA), and patient outcomes.
RESULTS: Sixteen patients with a history of AAA repair who received intravenous thrombolysis for AIS were included. The median age was 86.5 years (IQR 80.8-89.8). Most patients (92.3 %) had undergone endovascular repair, with a median time of 10 years (IQR 4.4-14.8) between AAA repair and thrombolysis. No patients underwent abdominal CTA prior to thrombolysis; two patients had post-thrombolysis CTA, both revealing endoleaks, one of which led to aneurysm rupture. Only one patient (6 %) experienced AAA rupture post-thrombolysis. The median mRS was 3 (IQR 1.8-4) at three months.
CONCLUSIONS: The incidence of AAA rupture after thrombolytic therapy in patients with prior repair was low. Larger studies are needed to determine whether rapid abdominal CTA could identify high-risk features and prevent life-threatening complications
Wearable-derived Sleep Measurements are Associated with Long-COVID in the RECOVER Adult Cohort.
No full textWearables yield a wide array of sleep-related measures that are relevant to Long COVID. We leveraged wearables-derived sleep measures (WDSM) to identify differences between individuals with Long COVID (LC) versus individuals with possible or no LC in the RECOVER adult cohort. We found significant associations between LC and reduced heart rate variability measured during sleep and increased nightly variability in sleep duration after adjusting for confounders. Moreover, LC was independently associated with lower sleep efficiency, greater variability of nighttime sleep timing, higher resting heart rate, lower respiratory rate during rapid eye movement (REM) sleep, prolonged REM sleep onset latency, worse global physical and mental health. Cluster analysis identified distinct multidimensional patterns of WDSM that are associated with LC and quality of life. Together, the strong association between WDSM, or WDSM clusters, with LC provides a potential biomarker for future validation efforts to detect LC and monitor treatment effectiveness
