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Role of thoracic radiation in extensive stage small cell lung cancer: a NCDB analysis.
No full textPrognosis of extensive stage small cell lung cancer (ES-SCLC) remains poor. Previous randomized trials suggested consolidation chest radiation (CXRT) has a modest survival benefit; however, its role in subgroups of ES-SCLC, especially ipsilateral pleural effusion (IPE), is unknown. Using National Cancer Database (NCDB), 283,347 ES-SCLC cases diagnosed between 2004 and 2017 were screened. Eligible cases must have been staged with 7th edition of staging system and have information about clinical T and N stage, and minimum follow-up of one month. Role of CXRT was examined in M1a, M1b, and IPE subgroups. Surveillance, Epidemiology, and End Results Program (SEER) was analyzed as independent validation. Univariate, multivariate analyses were conducted with cox proportional hazard model. A P value \u3c 0.05 was considered as statistically significant. A total of 36,762 were analyzed. In both M1a and IPE groups, use of CXRT was significantly associated with younger age, female sex, non-academic institution, and clinical T stage. Both univariate and multivariate analyses showed that use of CXRT demonstrated significantly longer overall survival in all the groups, with lower hazard ratios in M1a and IPE groups than M1b (univariate hazard ratio 0.62, 0.56, and 0.72, respectively). Propensity score analysis of IPE group showed the survival advantage with hazard ratio of 0.54. Use of SEER data validated its survival advantage of CXRT in IPE group. This retrospective database analysis suggests M1a and IPE subgroups have more survival benefit of CXRT than M1b subgroup. Further studies are warranted to confirm the hypothesis
Social learning in the digital age: Associations between technoference, mother-child attachment, and child social skills.
No full textTechnoference refers to incidents in which technology use interferes with interpersonal exchanges (e.g., conversations, playing). Although research on technoference is in its infancy, there is preliminary evidence that mothers believe technoference has a detrimental impact on the social-emotional functioning of their child. The current study investigated the degree to which technoference was associated with attachment between mothers and their elementary-aged children. A second aim was to determine if the relationship between technoference and children\u27s social-emotional functioning may be moderated by mother-child attachment. Surveys were completed by a sample of 80 mothers and their elementary-aged children. This study is unique in asking elementary-aged children to report their perceptions of parental technoference and the impact it has on their relationship with their mother and their own social-emotional functioning. More frequent technoference was associated with less secure mother-child attachment as rated by children, but not as rated by mothers. That is, frequent technoference may not significantly influence a mother\u27s attachment to their child, but it is associated with a child\u27s attachment to their mother. More frequent technoference was associated with decreased ratings by mothers regarding their child\u27s social-emotional functioning. Furthermore, maternal attachment moderated the relationship between technoference and child externalizing behaviors, such that a more secure attachment served as a protective factor against the negative impact of technoference on child externalizing behaviors. However, attachment did not moderate the relationship between technoference and most social skills assessed in our study. Implications from this study are discussed, including ways to increase awareness of technoference among school personnel, parents, and youth
Short versus standard esophageal myotomy in achalasia patients: a systematic review and meta-analysis of comparative studies.
No full textBackground and study aims Despite the clinical efficacy of peroral endoscopic myotomy (POEM), postoperative symptomatic gastroesophageal reflux disease (GERD) remains a major concern. While it is known that length of the gastric myotomy affects postoperative GERD, the clinical relevance of variation in esophageal myotomy length is not well known. We performed a systematic review and meta-analysis of studies comparing outcomes of short versus standard myotomy length in patients with achalasia. Patients and methods We searched multiple databases from inception through November 2020 to identify studies that reported on outcomes of achalasia patients who underwent short compared with standard esophageal myotomy. Meta-analysis was performed to determine pooled odds ratio (OR) of clinical success, GERD outcomes, and adverse events with the two techniques. Results 5 studies with 474 patients were included in the final analysis (short myotomy group 214, standard myotomy group 260). There was no difference in clinical success (OR 1.17, 95 % confidence interval [CI] 0.54-2.52; I2 0 %; P = 0.69), postoperative symptomatic GERD (OR 0.87, 95 %CI 0.44-1.74; I2 29 %; P = 0.70), and overall adverse events (OR 0.52, 95 %CI 0.19-1.38; I2 40 %; P = 0.19), between the two groups. Incidence of postoperative erosive esophagitis as determined by endoscopy was lower in the short myotomy group (OR 0.50, 95 %CI 0.24-1.03; I2 0 %; P = 0.06). Conclusion Our analysis showed that performing POEM with short esophageal myotomy in achalasia was as safe and effective as standard myotomy, with lower incidence of postoperative erosive esophagitis
Aspirin for prevention of colorectal cancer in the elderly: friend or foe?
No full textCancer is the leading cause of death among men and women aged 60-79 years. Colorectal cancer is the third most common cancer in males and the second most common in females, with about 0.8 million deaths worldwide per year. Individuals older than 50 years account for 20-50% of colonic adenomas. Several measures have been proposed to decrease colorectal cancer risks, such as an increase in dietary fiber, use of aspirin, and physical activity. Nonsteroidal anti-inflammatory drugs have been proposed as protective agents against the development of colorectal cancer and colorectal adenomas. Aspirin was the first pharmacological agent endorsed by the United States Preventive Services Task Force screening for colorectal cancer chemoprevention. Although studies have shown up to 40% colorectal cancer risk reduction in individuals at average risk, data regarding this benefit are inconsistent. Several recent studies show that prophylactic use of aspirin in elderly subjects may not be beneficial in preventing the occurrence of colorectal cancers. Given the risks associated with aspirin, such as non-fatal and fatal bleeding events, aspirin\u27s role should be redefined, especially in individuals at risk of bleeding. This review provides a discussion of the recent studies on the role of aspirin use in elderly individuals at risk of colorectal cancer
How “Dirty” Are the Endoscope Channels? A Systematic Review and Meta-Analysis of Reprocessed Endoscopes
No full textIntroduction: The duodenoscope elevator mechanism has been considered a culprit for multiple outbreaks from contaminated reusable patient-ready duodenoscopes. These outbreaks necessitated FDA to issue various Safety Communications and recommend endoscopy units to transition to duodenoscopes with innovative designs that ease or eliminate reprocessing. However, numerous studies have documented microbes in the channels of reprocessed gastrointestinal (GI) endoscopes, including duodenoscopes and linear echoendoscopes. Our aim is to estimate the channel contamination rate of patient-ready reprocessed GI endoscopes based on the currently available data. Methods: We searched PubMed, Web of Science, and Embase from January 1, 2010, until October 10, 2020, for studies investigating contamination rates of channels of patient-ready flexible GI endoscopes by following the PRISMA guidelines. A random-effects model based on the proportion distribution was used to calculate pooled total contamination rate. A subgroup analysis was carried out for studies originating from North America (USA and Canada). We used the meta-package (metafor) in RStudio version 3.6.2 to conduct the statistical analyses. Heterogeneity between the included studies was analyzed using the inconsistency index (I2) statistics. Publication bias was assessed using funnel plots and Egger’s regression tests. Results: We identified 1,230 peer-reviewed studies after duplicates were removed. Finally, 20 studies fulfilled the inclusion criteria, including 1,059 positive cultures from 7,903 samples. The total weighted contamination rate was 19.98% ± 0.024 (95% Cl: 15.29%-24.68%; I2=98.6%) (figure 1a). Subgroup analysis amongst studies from North America (n=7) showed a contamination rate of 6.01% ± 0.011 (95% Cl: 3.88%-8.15%; I2=89.3%) (figure 1b). I2 indicated high heterogeneity. Egger’s regression test indicated no significant publication bias for both groups (Egger’s test of publication bias: p=0.0531 and p=0.0655). Conclusion: Our analysis demonstrates that 19.98% of reprocessed patient-ready GI endoscopes may be contaminated. The contamination rate was lower amongst US studies, which may be attributed to the actions taken in the US to overcome this issue. However, our findings highlight that the elevator mechanism is not the only obstacle when reprocessing endoscopes. More studies are needed to fully determine the role of contaminated endoscope channels in the cross-transmission between the patients
Spontaneous Bacterial Empyema in Cirrhosis Patients - A Systematic Review and Meta-Analysis
No full textIntroduction: Spontaneous bacterial empyema (SBE), defined as spontaneous infection of the pleural fluid, represents a distinct and often underdiagnosed complication of hepatic hydrothorax in patients with cirrhosis. Although the transudative nature of hepatic hydrothorax is well established, the characteristics and risk factors for SBE have not been well investigated. We performed a systematic review and meta-analysis on the incidence and risk factors for this elusive entity. Methods: A systematic and detailed search was run in June 2021 with the assistance of a medical librarian for studies reporting on the incidence, associations, and outcomes of SBE in cirrhosis patients. Meta-analysis was performed using random-effects model and results were expressed in terms of pooled proportions along with relevant 95% confidence intervals (CI). Results: Eight studies with 8899 cirrhosis patients were included in the final analysis. Mean age ranged from 41.2 to 69.7 years. Majority of the patients were Child-Pugh B and C. The diagnostic criteria of SBE were positive pleural fluid culture and polymorphonuclear leukocytes (PMN) count \u3e250 cells/mm3 or negative pleural fluid culture and PMN count \u3e500 cells/mm3, without evidence of pneumonia/parapneumonic effusion on imaging. A total of 1334 patients had pleural effusions and the pooled incidence of SBE was 15.6% (CI 12.6-19; I2 50). A total of 2636 patients had ascites and pooled incidence of SBP among these patients was 22.2% (CI 9.9-42.7; I2 97.8). Interestingly, the pooled incidence of SBE in patients without concomitant ascites was 9.5% (CI 3.6-22.8; I2 82.5). Conclusion: Bacterial infections account for about 30%-50% deaths in patients with cirrhosis and clinicians should have a high index of suspicion for the timely diagnosis and treatment of SBE. Although this entity is thought to arise through the flow of infected ascites from the peritoneal to the pleural cavity via defects in the diaphragm owing to negative intrathoracic pressure, we found that SBE can occur even in the absence of concomitant ascites. Our results suggest that a diagnostic thoracentesis with subsequent analysis of pleural fluid should be performed in cirrhosis patients presenting with pleural effusions
Improved Resection Rates in Locally Advanced Pancreatic Cancer (LAPC) Following EUS-FNI of Large Surface Area Microparticle Paclitaxel (LSAM Pac)
No full textIntroduction: LAPC is generally defined as unresectable disease without evidence of metastatic spread, and reports suggest between 8-25% of these patients may become resectable following current standard of care (SOC) therapy. EUS-FNI allows for the delivery of drug therapies directly into the tumor, which led to the development of LSAM pac currently being evaluated in LAPC and other solid tumors by means of direct injection, where the particles of pure drug act as a depot releasing paclitaxel over several weeks. Methods: Clinical study [NCT # 03077685] enrolled patients with LAPC, confirmed non-surgical despite SOC therapy, to additionally receive LSAM pac (NanOlogy, Inc) via EUS-FNI into the tumor during a dose-escalation phase followed by a second phase where 2 doses of 15 mg/mL LSAM pac were administered 1 month apart. The aim was to determine safety and tolerability of LSAM pac when injected directly into the lesion and assess the impact on the lesion by means of imaging assessments every 3 months following first injection. Parkview Cancer Institute (Ft Wayne, IN) enrolled 13 of the 22 subjects in the second phase of the trial. Results: There were no safety concerns identified. Of the 13 subjects from Parkview, seven (54%) were restaged becoming eligible for surgery following LSAM pac injections. Of the seven, 6 proceeded to surgery, 1 opted to receive alternate treatment. Five resulted in successful R0 resections, the 6th resulted in R1 resection (Table 1). Multiplex immunofluorescence analysis of biopsy samples from pre-LSAM pac and surgical specimens in 5 subjects (one pending analysis) demonstrated an increase in the density of adaptive and innate immune cells and an increase in NK cells in the tumor microenvironment, and a decrease in the myeloid/MDSC populations. Conclusion: Approximately 30% of pancreatic cancer patients are considered non-surgical due to involvement of local arterial or venous structures. Existing treatment options are relatively ineffective in producing changes in the tumor to allow for conversion, and surgery still provides the best outcome. We present early findings in a series of 13 subjects with a conversion rate of 54%. LSAM pac increased the rate of conversion to resectable in these subjects without increasing toxicities associated with systemic chemotherapy. Due to theses promising results, the clinical trial is ongoing, enrolling subjects to receive up to 4 injections one month apart
Charting the Unknown: Challenges in the Clinical Assessment of Patients’ Technology Use Related to Eating Disorders
No full textCHI \u2721: Proceedings of the 2021 CHI Conference on Human Factors in Computing Systems
A growing body of research in HCI focuses on understanding how social media and other social technologies impact a given user’s mental health, including eating disorders. In this paper, we review the results of an interview study with 10 clinicians spanning various specialties who treat people with eating disorders, in order to understand the clinical contexts of eating disorders and social media use. We found various tensions related to clinician comfort and education into the (mis)use of technologies and balancing the positive and negative aspects of social media use within active disease states as well as in recovery. Understanding these tensions as well as the variation in the current process of diagnosing patients is a critical component in connecting HCI research focused on eating disorders to clinical practice and ultimately assessing how digital self-harm could be addressed clinically in the future.
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Intimate Partner Violence Screening in Perinatal Facilities Throughout Parkview Health
No full textPresented at Indiana University Medical Student Program for Research and Scholarship (IMPRS) Abstract
Background and Objective: Intimate partner violence (IPV) is physical, sexual, and psychological abuse, and controlling behaviors perpetrated by a current or former partner or spouse and can compromise maternal and neonatal health if occurring during the perinatal period. Standardized IPV screening has not been universally implemented in pregnant populations. This study aims to assess the current state of IPV screening in perinatal facilities within Parkview health.
Methods: Five maternal healthcare providers were recruited for semi-structured interviews assessing the current IPV screening practices. Interviews were recorded and transcribed. Transcripts were qualitatively analyzed via the framework method, applying an inductive approach. Themes focused on the processes associated with IPV screening within the Women’s and Children’s service line at Parkview Health.
Results: Participants described having minimal access to data associated with IPV. They addressed barriers to screening such as time constraints and feelings of judgement. IPV screening occurs at least once during the pregnancy, though frequency and timing is variable between facilities. Participants were unaware if IPV screening tools currently being used have been validated. Screening for IPV is less prioritized than screening for other social determinants of health. Participants favor standardization of IPV screening but believe the patients’ narratives may be compromised if nuances of need are not addressed.
Conclusion and Potential Implications: This study revealed IPV screening in pregnant women is not standardized at Parkview, and these findings are consistent with those reported in literature. Standardization of this process may lead to improved maternal and neonatal health outcomes. The findings of this study can be used to inform an intervention to increase IPV screening of perinatal patients and subsequently improving health outcomes. IPV screening can be improved by adopting a team-based effort to streamline screening processes. Facilities should also decide how often screening occurs and how the patient’s needs are prioritized