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The Effect of Heterogeneous Definitions of Massive Transfusion on Using Blood Component Thresholds to Predict Futility in Severely Bleeding Trauma Patients
No full textIn the trauma resuscitation literature, there are inconsistent definitions of what constitutes massive transfusion and a unit of blood, complicating the use of transfusion cut-points to declare futility. This is problematic as it can lead to the inefficient use of blood products, further exacerbating current blood product shortages. Previous studies have used various transfusion cut-points per hour to define futility in retrospective analyses but have not accurately defined futility at the bedside due to patient survival even at large rates and volumes of blood transfused. In an attempt to use transfusion cut-points as a marker to help define futility, guidelines have been proposed to limit blood product waste in transfusions for severely bleeding trauma patients, such as Suspension of Transfusion and Other Procedures (STOP) for patients older than 15 and the Futility of Resuscitation Measure (FoRM), used to determine futility in patients older than 60. In an effort to construct effective bedside futile resuscitation criteria with 100% positive predictive value and specificity, this review proposes the use of specific blood component transfusion cut-points combined with parameters from both STOP and FoRM to allow for a comprehensive and accurate method of declaring futility in severely bleeding trauma patients
Efficacy of Infliximab Versus Vedolizumab in the Management of Immune Checkpoint Inhibitor-Induced Colitis: A Systematic Review and Meta-Analysis
No full textBACKGROUND: Immune checkpoint inhibitors (ICIs) can cause severe gastrointestinal immune-related adverse events (irAEs), often leading to treatment interruption and increased morbidity. Immune-mediated colitis (IMC) ranges from mild diarrhea to life-threatening colitis, sometimes requiring urgent intervention. While corticosteroids are the first-line treatment, selective immunosuppressive therapy (SIT) with either infliximab or vedolizumab is used for steroid-refractory or dependent cases. However, standardized practices are lacking, and treatment decisions are largely left to provider discretion. This study compares infliximab and vedolizumab for IMC, focusing on remission rates, recurrence, SIT dosing, and systemic steroid exposure duration.
METHODS: We identified six retrospective cohort studies that compared infliximab with vedolizumab in the treatment of IMC through a systematic search of PubMed, EMBASE, Cochrane Library, Scopus, CINAHL, Google Scholar, and Web of Science in English from inception until October 2024. From the identified literature, we extracted pertinent data such as remission and recurrence of IMC. Pooled analysis and heterogeneity analysis were performed using R Studio version 4.4.1. The risk of bias was assessed using the Newcastle-Ottawa Scale.
RESULTS: A total of six studies with 645 patients were included. In ICI-associated colitis, vedolizumab was associated with lower recurrence rates (odds ratio (OR): 0.29, 95% confidence interval (CI): 0.15 - 0.54) and shorter systemic steroid exposure (mean difference (MD): -16.88 days, 95% CI: -20.47 to -13.30) compared to infliximab. While vedolizumab showed improved remission, there was no statistically significant difference in remission rates between vedolizumab and infliximab monotherapy (OR: 3.16, 95% CI: 0.29 - 34.01). Remission was achieved with fewer doses of infliximab than vedolizumab (MD: 1.16, 95% CI: 0.09 - 2.22). The mean number of vedolizumab doses was 2.57 (raw mean score (MRAW): 2.57, 95% CI: 1.43 - 2.71), while the mean number of infliximab doses was 1.36 (MRAW: 1.36, 95% CI: 0.69 - 2.02).
CONCLUSIONS: Among patients with ICI-induced colitis, vedolizumab demonstrated superiority over infliximab by being associated with lower rates of colitis recurrence and decreased systemic steroid exposure, although it required a higher number of doses compared to infliximab
Health-Care Leadership and Orthopaedic Surgeons: Exploring the Value of an Advanced Degree
No full textAs the field of health care continues to evolve, it requires physician leaders who are not only clinically strong but also knowledgeable in business, public health, health-care administration, and medical law. In this article, we investigate the benefits and challenges of pursuing advanced graduate-level education for orthopaedic surgeons. Advanced training can assist clinicians in the development of leadership skills and career advancement opportunities and deepen their understanding of the modern complexities of health-care systems. Key takeaways include the importance of strategic thinking, emotional intelligence, and the ability to navigate complex health-care environments. The decision to pursue an advanced degree should align with an individual\u27s career goals and personal circumstances. Advanced degrees and leadership programs may provide the requisite competencies and valuable tools for physicians to lead effectively in an increasingly dynamic health-care environment
Effect of postoperative NSAID use on opioid consumption after rotator cuff repair
No full textBACKGROUND: Opioid consumption following rotator cuff repair (RCR) remains a significant concern in post-surgical pain management. The use of nonsteroidal anti-inflammatory drugs (NSAIDs) has been proposed as a multimodal analgesic approach to reduce opioid use and improve recovery. However, the impact of NSAIDs on opioid consumption and clinical outcomes following RCR remains unclear, with conflicting findings from previous studies. The purpose of this study is to compare opioid consumption in patients prescribed a short course of NSAIDs after RCR versus those who were not prescribed NSAIDs.
METHODS: A retrospective cohort study was conducted including 125 patients who underwent primary arthroscopic RCR between 2012 and 2022. Patients were categorized into two groups based on the surgeon\u27s practice change in May 2017: those who were not prescribed NSAIDs post-surgery and those who were prescribed NSAIDs for six weeks post-surgery. Data on opioid prescription, the need for opioid and NSAID refills, postoperative complications, and patient-reported outcomes (PROs) were collected and analyzed.
RESULTS: No significant differences were observed between the two groups regarding demographic characteristics or preoperative MRI findings. The NSAID group demonstrated a significant reduction in opioid prescription compared to the non-NSAID group, receiving less morphine milligram equivalents (MME) on the day of surgery (306.7 ± 30.2 vs. 1007.4 ± 302.1, p \u3c 0.001). Furthermore, patients in the NSAID group required fewer opioid refills (21.6 % vs. 37.5 %), though this difference did not reach statistical significance (p = 0.085). Both groups showed similar functional outcomes, with no significant differences in postoperative complications or clinical rotator cuff healing failures.
CONCLUSION: This study demonstrates that a short course of NSAIDs following rotator cuff repair reduces opioid consumption without negatively affecting functional outcomes or tendon healing. These findings support the potential role of NSAIDs in reducing opioid reliance post-surgery and advocate for their inclusion in multimodal pain management protocols for RCR
From embedded interprofessional clinics to expanded alcohol-associated liver disease programs
No full textHazardous alcohol use remains a major contributor to acute and chronic liver disease, while alcohol-associated liver disease (ALD) is a leading indication for liver transplantation. In recent years, embedded, interprofessional ALD clinics have improved access to alcohol use disorder care within hepatology and liver transplantation, but more work is needed to meet this challenge. The literature is lacking regarding scaling procedures to provide services for increasingly large ill patient populations. This article begins to fill this gap by describing expanded ALD care : broad, innovative, longitudinal, interprofessional care delivery strategies surpassing standalone clinics. Drawing from analogous patient populations served by collaborative models in primary care and comprehensive eating disorder treatment, the expanded ALD care framework proposes practical strategies toward specific innovations: equipoise between biomedical and psychosocial care elements, increased clinician number and reach, long-term patient relationships, harm reduction and palliative care, outreach to external agencies and clinicians, and enhanced support for patients and families. The article also defines attributes of innovative healthcare systems that support expanded ALD care
Impact of patisiran on polyneuropathy of hereditary transthyretin amyloidosis in patients with a V122I or T60A variant: a phase IV multicenter study
No full textBACKGROUND: This study assessed the effectiveness and safety of patisiran in patients with V122I/T60A variant transthyretin (ATTRv) amyloidosis with polyneuropathy. These variants have been under-represented in previous trials of gene-silencing agents.
METHODS: This was a multicenter, phase IV study conducted at 27 sites in the USA. Patients were ≥ 18 years, diagnosed with ATTRv amyloidosis with polyneuropathy and a documented V122I or T60A variant. Patisiran-treated patients were enrolled prospectively, ambispectively, and retrospectively. The primary endpoint was the proportion of patients with a stable or improved polyneuropathy disability (PND) score at 12 months vs. baseline. Safety was monitored throughout the trial.
RESULTS: Sixty-seven patients were enrolled, of whom 58 received ≥ 1 dose of patisiran. In the efficacy population, 42/45 (93.3%) patients demonstrated stable or improved PND scores from baseline to Month 12. Patients also showed stable or improved quality of life, health status, autonomic symptoms, and cardiac function vs. baseline. Adverse events occurred in 13/42 (31.0%) patients in the prospective and ambispective cohorts; most were mild or moderate. No deaths or cardiac hospitalizations were considered related to patisiran.
CONCLUSIONS: Patisiran demonstrated a consistent positive effect across multiple endpoints in patients with V122I/T60A ATTRv amyloidosis, including polyneuropathy manifestations
Trajectories and risk factors of depressive symptomatology following hysterectomy
No full textOBJECTIVES: Hysterectomy is the second most common gynecological surgery performed on reproductive aged women in the United States. It is not known if some groups of women are more susceptible to depression after hysterectomy.
METHODS: Participants were scheduled for hysterectomy for benign causes and not undergoing a concomitant urogynecological procedure. Patient Health Questionnaire-9 (PHQ-9) was collected 2 weeks before, and 1, 4, and 6 weeks, and 3, 6, and 12 months post-hysterectomy to understand depressive symptoms associated with surgery. PHQ-9 patterns were identified with latent class analyses. Multivariable multinomial logistic regression was used to estimate relative risk ratios (RRR) and 95% CIs of associations between baseline sociodemographic, clinical, and operative-related characteristics and PHQ-9 class.
RESULTS: Three latent classes (C) were identified from their PHQ-9 score patterns among 455 participants: high and increasing (C1, 15.6%), high and decreasing (C2, 27.7%), and persistently low PHQ-9 trajectory (C3, 56.7%). Insurance type, financial toxicity, pain level, and surgical decision satisfaction before surgery were statistically significantly associated with class membership. At surgery, C1 members were more likely to have public insurance (RRR=2.04, CI: 1.02-4.08), worse finances (0.92, 0.89-0.96), and higher pain (1.22, 1.10-1.35) than members of C3. C2 members were more likely to have worse finances (0.94, 0.91-0.96) than C3 members. C1 members tended to have higher pain (1.14, 1.02-1.26) than C2 members.
CONCLUSIONS: Depression symptomology after hysterectomy may be associated with presurgical insurance type, financial toxicity, current pain level, and satisfaction. More research is needed to investigate whether these factors can be incorporated into preoperative counseling and screening tools to guide shared decision-making regarding depression and surgery
Enhancing Patient Safety and Efficiency: The IV Smart Pump Integration Project at Henry Ford Health
No full texthttps://scholarlycommons.henryford.com/nursresconf2025/1012/thumbnail.jp
Influencing Outcomes through and Evidence Based Nurse Driven Telemetry Discontinuation Protocol
No full texthttps://scholarlycommons.henryford.com/nursresconf2025/1019/thumbnail.jp
No One Dies Alone
No full texthttps://scholarlycommons.henryford.com/nursresconf2025/1027/thumbnail.jp