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A Review of Medications Listed in the 2023 Beers Criteria
Get PDFThe American Geriatrics Society’s (AGS) 2023 Beers Criteria identifies potentially inappropriate medications (PIMs) to use in geriatric patients defined as greater than or equal to 65 years of age. This population experiences pharmacokinetic and pharmacodynamic changes, which raise the risk of potentially harmful side effects. The Beers Criteria were developed as a clinical tool to help healthcare providers improve medication safety in this vulnerable population. The main focus of this article is on commonly seen medications and the rationale for recommended avoidance in geriatric patients. Additionally, a table of potentially clinically important drug-drug interactions that should be avoided in older adults is included
Moderate to High-Grade Blunt Liver and Spleen Injuries Warrant Repeat Imaging to Identify Treatable Complications: Results of the Radiographic Evaluation of Delayed Solid Organ Complications (REDSOC) EAST Multicenter Trial.
No full textOBJECTIVE: The aim of this study was to assess whether blunt liver (BLI) and blunt spleen (BSI) injury patients benefit from repeat imaging to identify injury-related complications.
BACKGROUND: No consensus guidelines exist regarding the necessity of, or optimal timing for, repeat imaging in BLI and BSI patients undergoing nonoperative management (NOM). We hypothesize that scheduled repeat imaging of patients undergoing NOM for moderate to high-grade BLI and BSI would result in identification of complications earlier than if repeat imaging is performed in response to a change in clinical condition.
METHODS: We performed a four-year, 43-center, multinational, prospective observational study of adult patients undergoing initial NOM of BLI and/or BSI. Patients were grouped by reason for repeat imaging: scheduled imaging (SI) or imaging performed for clinical change (CC), and by whether findings on repeat imaging resulted in procedural or operative intervention.
RESULTS: We identified 2,341 BLI and 2,143 BSI patients (528 concomitant BLI/BSI). Repeat imaging was performed in 822(35.1%) BLI patients [SI:457(55.5%),CC:365(44.5%)] and 758(27.9%) BSI patients [SI:478(63.1%),CC:280(37.0%)]. Complications were identified on repeat imaging in BLI:167(7.1%) [SI:72(43.1%),CC:95(56.9%)] and BSI:203(7.5%) [SI:91(44.8%),CC:112(55.2%)]. Of patients with BLI complications, 96(57.8%) [SI:37(38.5%),CC:59(61.5%)] underwent an intervention. Of patients with BSI complications, 133(65.5%) [SI:56(42.1%),CC:77(57.9%)] underwent an intervention. Our data demonstrate that in BLI and BSI, most complications were identified within 48-72 hours.
CONCLUSIONS: Scheduled repeat imaging for asymptomatic patients with BLI Grade 4-5 and BSI Grade 3-5 within 48-72 hours from time of diagnosis allows for identification of complications prior to a change in the patient\u27s clinical condition
Efficacy and safety of pyruvate kinase activator in treating hemolytic anemias: a systematic review.
No full textINTRODUCTION: Pyruvate kinase (PK) is an important glycolytic enzyme responsible for erythrocytic ATP production. PK allosteric activators have been shown to increase ATP and reduce 2,3-disphosphoglycerate among red blood cells leading to improved oxygen affinity, sickling, and hemolysis. In this systematic review, we aim to evaluate the efficacy and safety of PK activators in hemolytic anemias.
METHODS: This study was conducted following the PRISMA guidelines. A literature search was conducted using relevant keywords over PubMed/Medline, Google Scholar, Cochrane Library, and clinicaltrial.gov, till 29 September 2024. Relevant data was extracted into a spreadsheet and synthesized qualitatively.
RESULTS: The literature search yielded 7,153 results, with 7 studies ultimately included in the review. These studies involved 206 patients, 166 of whom received mitapivat and the rest received placebo. Hemoglobin response was achieved by 38.0% to 80.0% of participants receiving mitapivat, with an average increase of 0.4 to 1.7 g/dL. Most studies reported improvements in bilirubin, lactate dehydrogenase, haptoglobin, and reticulocyte levels. Adverse events (AEs) were experienced by 93.2% of participants, with rates of 93.97% and 89.7% in the intervention and control groups, respectively. However, most AEs were mild and transient, and 23.4% were graded as 3 or higher.
CONCLUSIONS: In this study, PK activators, particularly mitapivat, demonstrated promising efficacy and safety profiles in managing hemolytic anemias. These agents significantly improved hemoglobin levels, markers of hemolysis, and hematopoietic response, offering a beneficial therapeutic option for various hemolytic conditions, including pyruvate kinase deficiency, sickle cell disease, and thalassemia.
REGISTRATION: A protocol was registered at the International Prospective Register of Systematic Reviews (PROSPERO) before study initiation, CRD42024598980
Intracranial Pressure Monitor Insertion in Isolated Traumatic Brain Injury: Does Timing Matter?
No full textBackgroundIntracranial pressure monitoring (ICPM) is recommended in selected patients with severe traumatic brain injury (sTBI). Optimal timing of ICPM insertion after sTBI is not well studied. We aimed to evaluate if timing of ICPM insertion would impact outcomes.Materials and MethodsWe utilized data from 2018 to 2021 from the American College of Surgeons Trauma Quality Improvement Program. Patients ≥16 years from level 1 and 2 trauma centers with isolated blunt sTBI were included. Nonsurvivable brain injury (AIS-head = 6) and those needing emergent open cranial (OC) procedures within 2 hours of admission were excluded. Timing of ICPM insertion was categorized as follows: no ICPM insertion, ≤4 h, \u3e4 to ≤12 h, and \u3e12 h. Binary logistic regression analysis was used to assess variables associated with mortality.Results17 715 patients were included. 2525 (14%) had ICPM placed, 2613 (15%) underwent open cranial surgery, and 8757 (49%) died. There was no ICPM insertion in 86% while 8%, 4%, and 2% underwent ICPM insertion ≤4 h, \u3e4 to ≤12 h, and \u3e12 h, respectively. Compared to no ICPM, insertion ≤4 h (odds ratio [OR] 0.94 [0.82-1.09]), \u3e4 to ≤12 h (OR 1.18 [0.97-1.43]), and \u3e12 h (OR 1.02 [0.81-1.31]), respectively, were not associated with mortality. Open cranial procedure was associated with reduced risk of death (OR 0.40 [0.36-0.45]).DiscussionFor blunt isolated sTBI, Timing of ICPM insertion was not associated with mortality reduction. Early ICPM insertion may be less important than expeditious OC
457 Stop the BleedⓇ: A Resident-Run, Community Engagement Workshop Impacting Spanish Speaking Population
No full textStudy Objectives: Trauma is the leading cause of death in patients under 45 years old. Hemorrhagic death after traumatic injury accounts for more than sixty thousand (60,000) deaths yearly in the United States (US), and more than 1.5 million worldwide. Annually, more than twenty five (25%) of those 60,000 hemorrhagic deaths could have been prevented if the bleeding was controlled earlier. The Spanish-speaking population in the United States face language barriers and socioeconomic factors that hinder community readiness when adverse events occur. We aimed to assist in the education of hemorrhage management for Spanish-speaking individuals by providing native-language, culturally sensitive stop the bleeding training to workers of a landscaping company. Methods: Two sessions of Stop the BleedⓇ seminar were coordinated with Spanish-speaking participants from Berks Latino Workforce for education and training in bleeding assessment and control methods. Each session consisted of twenty participants. Spanish-speaking emergency medicine residents who are also certified as Spanish interpreters led the sessions and translated for the English-speaking residents who assisted in the training sessions. Participants were educated in scene safety assessment, recognition, and management of bleeding with multiple Stop the BleedⓇ techniques. Culturally sensitive training models facilitated the workshop to enable practice of bleeding tamponade with simple pressure, packing and tourniquet application. Participants were also involved in case-solving discussions to further engage their learning experience. Results: Forty Spanish-speaking participants attended the workshops, ranging from ages between eighteen to mid-sixties, led by two bilingual emergency medicine residents and English-speaking residents that assisted with the practical portions of the workshop sessions. All participants were trained in skills of direct pressure, packing and tourniquet application to stop hemorrhage, and received a Stop the BleedⓇ tourniquet kit with a certificate of completion. Conclusion: This Spanish-speaking Stop the BleedⓇ workshop achieved three primary results. First, we trained landscapers who are at risk of injury with life-saving techniques. Second, the Spanish-speaking community had the opportunity to become empowered while being able to ask questions and communicate with on-site native speaking emergency physicians. Finally, each Spanish speaking participant who completed the course is now a certified provider in hemorrhage control techniques, broadening the health care influence on our Spanish-speaking community. We have seen the impact of this training firsthand, after a participant from one of our educational sessions implemented their trained skills by placing a tourniquet after a traumatic extremity injury in the community. That patient was received by our trauma team with limb salvage treatment and a life saved. No, authors do not have interests to disclos
3.42 Assessing Functional Outcomes in Individuals With Phenylketonuria: Insights From the Weiss Functional Impairment Rating Scale
No full textObjectives: Individuals with phenylketonuria (PKU) have a higher prevalence of neuropsychiatric symptoms, which could lead to impairment in daily functioning. Currently, there is no standardized protocol to assess functional impairment in individuals with PKU. Assessment of daily functioning is further hindered by a lack of easily accessible tools and time limitations in clinical settings. This retrospective study evaluated the use of the Weiss Functional Impairment Rating Scale (WFIRS), a brief self-report scale, in measuring degrees of functional impairment in daily living for older adolescents and adults with PKU. Methods: This IRB-approved study included a retrospective review of medical records for approximately 80 individuals receiving care in a hospital-based PKU/metabolic clinic. Demographic variables, concurrent phenylalanine (Phe) levels, and scores from the WFIRS, Generalized Anxiety Disorder 7 scale (GAD-7), Patient Health Questionnaire depression scale (PHQ-9), and Adult ADHD Self-Report Scale (ASRS) were analyzed using SPSS. Results: A total N = 30; mean age = 29.23 (+11.12; 17 to 56 years of age); 12 females/17 males; and mean concurrent Phe levels = 13.98 (+4.55) mg/dL (the normal range is \u3c 2 mg/dL and the recommended treatment range is \u3c 6 mg/dL) participated in this study. Blood Phe levels correlated significantly with the WFIRS total score (r = 0.501, p = .006), and the WFIRS total score also correlated significantly with GAD-7 (r = 0.726, p = .001), PHQ-9 (r = 0.875, p = .001), and ASRS total (r = 0.783, p = .001) scores. Conclusions: We studied the utility of using WFIRS, a brief self-report tool previously developed for ADHD populations, to assess aspects of daily functioning in individuals with PKU, a rare inherited metabolic disorder. There is a paucity of information about the impact of metabolic control and functional outcomes in this population. The WFIRS was sensitive to the impact of blood Phe levels, which reflect differences in metabolic control, and functional impairment on the WFIRS was also strongly associated with patient-reported neuropsychiatric symptoms. Current findings suggest that the WFIRS provides a practical and feasible alternative for assessing problems with daily functioning in individuals with PKU. ADOL, G
TCT-1197 High-Dose Statin Preloading in Acute Coronary Syndrome Patients Prior to PCI: Impact on Long-Term Clinical Outcomes
No full textBackground: High-dose statin therapy prior to percutaneous coronary intervention (PCI) has been hypothesized to reduce periprocedural myocardial injury and improve long-term outcomes in acute coronary syndrome (ACS) patients. This study evaluates the effectiveness of statin preloading in the emergency room (ER) before coronary angiography and PCI versus no statin preloading on long-term cardiovascular outcomes. Methods: We conducted a pooled meta-analysis of randomized controlled trials and large-scale observational studies involving ACS patients undergoing PCI. A total of 8,912 patients were included: 4,431 received high-dose statin therapy (atorvastatin 80 mg or rosuvastatin 40 mg) in the ER prior to PCI, and 4,481 did not receive statin preloading. The primary endpoint was the incidence of major adverse cardiovascular events (MACE) at 12 months. Secondary endpoints included all-cause mortality, non-fatal myocardial infarction (MI), stent thrombosis, and target lesion revascularization (TLR). Patient demographics were balanced between groups. Results: Statin preload was associated with a significant reduction in 12-month MACE (10.2% vs 13.9%, p=0.002), all-cause mortality (2.6% vs 4.1%, p=0.01), non-fatal MI (3.9% vs 5.5%, p=0.02), stent thrombosis (0.7% vs 1.5%, p=0.03), and TLR (5.1% vs 6.8%, p=0.04). Baseline characteristics including age (mean 61.8 vs 62.1 years, p=0.32), gender, diabetes, hypertension, and LDL-C were statistically similar across groups. Conclusion: High-dose statin administration in the ER prior to PCI in ACS patients significantly improves long-term cardiovascular outcomes, including reductions in MACE, mortality, and stent-related complications. These findings support guideline-recommended statin preloading as a routine component of early ACS management. Categories: CORONARY: Pharmacology/Pharmacotherap
TCT-359 Intravascular Imaging-Guided Versus Angiography-Guided Percutaneous Coronary Intervention for Bifurcation Lesions: A Systematic Review and Meta-Analysis
No full textBackground: Percutaneous coronary intervention (PCI) for bifurcation lesions remains a complex procedure associated with higher risks of restenosis and adverse events. The role of intravascular imaging (IVI)—intravascular ultrasound (IVUS) or optical coherence tomography (OCT)—in optimizing bifurcation PCI is increasingly recognized, but its comparative effectiveness versus angiography-guidance alone remains under investigation. Methods: A systematic search of PubMed, Embase, and Cochrane Library databases was conducted for studies comparing IVI-guided versus angiography-guided PCI for bifurcation lesions. Outcomes assessed included major adverse cardiac events (MACE), target lesion failure (TLF), target vessel revascularization (TVR), and stent thrombosis. Hazard ratios (HRs) and 95% confidence intervals (CIs) were extracted or calculated. Results: This meta-analysis included 12 studies with 13,742 patients undergoing PCI for bifurcation lesions (6,809 IVI-guided; 6,933 angiography-guided). Intravascular imaging guidance significantly reduced the risk of major adverse cardiac events (MACE) at 1 year (6.4% vs. 9.3%; HR: 0.68; 95% CI: 0.55–0.83; p \u3c 0.001), target lesion failure (5.7% vs. 8.6%; HR: 0.71; p = 0.002), and target vessel revascularization (3.1% vs. 5.2%; HR: 0.61; p = 0.004). Stent thrombosis was significantly lower in the IVI-guided group (0.6% vs. 1.5%; HR: 0.43; p = 0.017), along with reduced all-cause mortality (2.9% vs. 4.1%; HR: 0.72; p = 0.031). Benefits were more pronounced in patients with left main bifurcation lesions and those treated with a two-stent strategy. Conclusion: Intravascular imaging-guided PCI is associated with significantly lower rates of MACE, TLF, TVR, and stent thrombosis compared with angiography-guided PCI in patients with coronary bifurcation lesions. These findings support the routine use of IVUS or OCT in complex bifurcation interventions, particularly in left main disease and when a two-stent strategy is employed. Categories: CORONARY: Complex and Higher Risk Procedures for Indicated Patients (CHIP
TCT-1042 Comparative Long-term Clinical Outcomes of Invasive Versus Noninvasive Treatments for Pulmonary Embolism in Women and Men: A Meta-Analysis and Review of the Literature
No full textBackground: Pulmonary embolism (PE) is a major cause of cardiovascular morbidity and mortality. The choice of treatment — invasive (thrombolytic therapy, percutaneous thrombectomy) or noninvasive (anticoagulation) — may influence outcomes, with sex-specific differences in response and complications. Methods: We performed a systematic review of the literature to compare long-term clinical outcomes following invasive and noninvasive treatments for PE in women and men. We extracted data from large registries, observational studies, and trial reports to compute odds ratios (OR), hazard ratios (HR), p-values, and 95% confidence intervals (CIs) for mortality, complications, and recurrence by sex and treatment. Results: Anticoagulation was associated with significantly lower 30-day (OR 0.81; p \u3c 0.05) and 90-day (OR 0.83; p \u3c 0.01) mortality in women, although major bleeding was higher (OR 1.31; p \u3c 0.01) in comparison to men. Thrombolytic therapy provided a mortality benefit in men (p = 0.03) but not in women (p = 0.18), with women experiencing greater complications (RR 2.68; p = 0.005). Percutaneous thrombectomy was associated with higher procedural complications and in-hospital mortality in women (adjusted OR 1.9; p = 0.003) alongside a reduced likelihood of discharge to home (adjusted OR 0.7; p = 0.04). Women with high-risk PE who underwent advanced interventions had greater in-hospital mortality (adjusted OR 1.18; p \u3c 0.001) than their male counterparts. Conclusion: Anticoagulation under standard care is generally more effective and safer in women with PE, while invasive strategies carry greater procedural complications and higher mortality. Our data highlight the necessity for sex-specific consideration and a tailored approach to PE treatment, especially in high-risk cases. Categories: ENDOVASCULAR: Pulmonary Embolism and Pulmonary Hypertensio
