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American Society for Gastrointestinal Endoscopy guideline on the diagnosis and management of GERD: summary and recommendations.
No full textThis clinical practice guideline from the American Society for Gastrointestinal Endoscopy (ASGE) provides an evidence-based approach for strategies to diagnose and manage GERD. This document was developed using the Grading of Recommendations Assessment, Development, and Evaluation framework and serves as an update to the 2014 ASGE guideline on the role of endoscopy in the management of GERD. This updated guideline addresses the indications for endoscopy in patients with GERD as well as in the emerging population of patients who develop GERD after sleeve gastrectomy or peroral endoscopic myotomy. It also discusses how to endoscopically evaluate gastroesophageal junctional integrity in a comprehensive and uniform manner. Importantly, this guideline also discusses management strategies for GERD including the role of lifestyle interventions, proton pump inhibitors (PPIs), and endoscopic antireflux therapy (including transoral incisionless fundoplication [TIF], radiofrequency energy, and combined hiatal hernia repair and TIF [cTIF]) in the management of GERD. The ASGE suggests upper endoscopy for the evaluation of GERD in patients with alarm symptoms, with multiple risk factors for Barrett\u27s esophagus, and with a history of sleeve gastrectomy. The ASGE recommends careful endoscopic evaluation, reporting, and photo-documentation of objective GERD findings with attention to gastroesophageal junction landmarks and integrity in patients who undergo upper endoscopy to improve care. In patients with GERD symptoms, the ASGE recommends lifestyle modifications. In patients with symptomatic and confirmed GERD with predominant heartburn symptoms, the ASGE recommends medical management including PPIs at the lowest dose for the shortest duration possible while initiating discussion about long-term management options. In patients with confirmed GERD with small hiatal hernias (≤2 cm) and Hill grade I or II who meet specific criteria, the ASGE suggests evaluation for TIF as an alternative to chronic medical management. In patients with persistent GERD with large hiatal hernias (\u3e 2cm) and Hill grade III or IV, the ASGE suggests either cTIF or surgical therapy based on multidisciplinary review. This document summarizes the methods, analyses, and decision processes used to reach the final recommendations and represents the official ASGE recommendations on the above topics
March 2025: Region 10 Emerging Special Pathogen Treatment Center (RESPTC) at Providence Sacred Heart Medical Center & Children’s Hospital
No full textREGION 10 SPECIAL PATHOGENS NEWSLETTERhttps://digitalcommons.providence.org/special_pathogens_newsletters/1009/thumbnail.jp
Geno4ME Study: implementation of whole genome sequencing for population screening in a large healthcare system.
No full textThe Genomic Medicine for Everyone (Geno4ME) study was established across the seven-state Providence Health system to enable genomics research and genome-guided care across patients\u27 lifetimes. We included multi-lingual outreach to underrepresented groups, a novel electronic informed consent and education platform, and whole genome sequencing with clinical return of results and electronic health record integration for 78 hereditary disease genes and four pharmacogenes. Whole genome sequences were banked for research and variant reanalysis. The program provided genetic counseling, pharmacist support, and guideline-based clinical recommendations for patients and their providers. Over 30,800 potential participants were initially contacted, with 2716 consenting and 2017 having results returned (47.5% racial and ethnic minority individuals). Overall, 432 (21.4%) had test results with one or more management recommendations related to hereditary disease(s) and/or pharmacogenomics. We propose Geno4ME as a framework to integrate population health genomics into routine healthcare
Outcomes of Mothers and Infants Affected by COVID-19.
No full textThe long-term effects of the novel coronavirus disease 2019 (COVID-19) infection during pregnancy are poorly characterized in mothers and their infants. The aim of this study was to assess the physical, mental, and emotional well-being of mothers and infants in the first year postpartum who were exposed to and/or diagnosed with COVID-19 infection.This direct-to-participant cohort study recruited 96 mother-infant pairs delivering at Pediatrix Medical Group sites, where mothers tested positive for COVID-19 during their pregnancy or birth hospitalization and/or infants tested positive for COVID-19 prior to hospital discharge. Main outcome measures included scored responses to surveys administered at 6 and 12 months postpartum and infant health status from newborn admission through the first year after birth.Mothers with COVID-19 infection during pregnancy often reported persistent physical, mental, and emotional stress affecting both themselves and their infants. Scores assessing infant temperament were higher than reported in prior literature. Infants were relatively healthy throughout their first year after birth.The experience of COVID-19 infection during pregnancy may create a unique set of circumstances that affects the well-being of infants and their mothers separately as well as the child-caregiver relationship. Early life events have the potential to generate lasting consequences; therefore, it is important to identify these issues to maximize support and intervene if indicated. · Experiencing COVID-19 in pregnancy is unique.. · Possible effects on temperament, and relationships.. · This impact may persist for at least 1 year postpartum.
Population Risk Predictors of Major Adverse Kidney Events in Patients with Focal Segmental Glomerulosclerosis from the CURE-CKD Registry.
No full textBackground: Predictors of major adverse kidney events (MAKE) in focal segmental glomerulosclerosis (FSGS) have not been previously explored within large, real-world populations. The study aim was to evaluate population-level predictors of MAKE for patients with FSGS from health system data.
Methods: The study population was derived from electronic health records from Providence and University of California Los Angeles Health. Cox proportional hazards models were used to estimate the effects of clinical and non-clinical variables including age, gender, race and ethnicity, health system, health insurance, healthcare utilization, estimated glomerular filtration rate (eGFR), diabetes, hypertension, and prescription medications as predictors of MAKE defined as: ≥40% eGFR decline, kidney failure (eGFR \u3c 15 mL/min/1.73 m2, administrative codes for kidney failure, dialysis, or transplant) and death.
Results: Adults with FSGS (N=629) were 54% (n=342) men and 53±17 (mean±SD) years old. Baseline eGFR was 60±30 mL/min/1.73 m2, while median (interquartile range) urine albumin/creatinine ratio (UACR) and urine protein/creatinine ratio (UPCR) were 1,430 (520-2,630) mg/g and 1.6 (0.5-3.9) g/g, respectively. Angiotensin converting enzyme inhibitors or angiotensin receptor blockers were prescribed to 76% (n=475), while corticosteroids and other immunomodulators were prescribed in 47% (n=297) and 12% (n=74), respectively. MAKE were observed in 42% (n=262) of study participants over a median of 2.9 (1.4-4.5) years. Higher hazard for MAKE was associated with above-median UACR or UPCR (HR [95% CI] (3.46 [2.28-5.23]) in patients with available measures, prescription for non-corticosteroid immunomodulator (1.87 [1.32-2.65]), non-commercial health insurance (1.78 [1.36-2.33]), hospitalization (1.64 [1.25-2.15]), lower eGFR per 10 mL/min/1.73 m2 1.25 [1.18-1.32]), number of outpatient visits (1.03 [1.01-1.05]) and lower hazard for MAKE was associated with older age (0.89 [0.82-0.98]).
Conclusions: Substantial loss of kidney function or kidney failure occurred in more than four in ten patients with FSGS by a median of three years. MAKE were predicted by unique population level factors, such as healthcare utilization and insurance type, which may help to identify patients with FSGS, who could most benefit from diagnostic testing and interventions to improve clinical outcomes
The conundrum of finding an optimal spondylodiscitis treatment pathway: how do treatments affect readmission rates?
No full textObjective: The rising incidence of spondylodiscitis (SD) poses a challenge to healthcare systems worldwide. Treatment approaches are inconsistent, devoid of standardized algorithms and lack evidence-based guidelines. To date there is a knowledge gap relative to treatment, readmission rates and efficacy for different SD management strategies. This study aims to assess the 90-day all-cause readmission rates for SD relative to treatment pathways.
Methods: Using the 2020 Nationwide Readmissions Database we screened adult patients (\u3e 18 years) for primary diagnosis of SD by ICD-10 Codes. Demographic/clinical data, and treatments was extracted. The cohort was divided into two groups by treatment at initial admission. Descriptive and comparative analysis, with a multivariate regression to identify independent risk factors for readmission, were performed.
Results: Out of 6,139 patients, 1,258 patients (20.5%) receiving surgical treatment. The overall, readmission rate was 35%. Surgically treated patients had a significantly lower readmission rate and a shorter time to readmission (29.3%; 41.65 days (± 22.84)). Those receiving surgical care during both stays (0.8%) had the longest time to readmission at 50.85 days (± 24.27). A change in treatment upon readmission was observed in 8.4%. Surgical management at index admission was identified as a protective factor against readmission.
Conclusion: SD management remains challenging. We showed that primary surgical treatment of SD resulted in a significantly lower readmission rate with a longer time interval until readmission compared to non-surgically treatment. Surgery at initial admission was identified as a protective factors against readmission. A more definitive initial approach towards SD might lower unexpected readmissions.
