Parkview Health Research Repository
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Self-Proning in Non-Intubated Patients with COVID-19: A Strategy to Avoid Intubation.
No full textPatients with coronavirus disease (COVID-19) experiencing oxygen ation compromise often are admitted to medical units. Assessment of the impact of self-proning on oxygenation in patients with COVID-19 suggested early self-proning is a viable, nursedriven option to improve oxygenation, prevent transfer to intensive care, and decrease need for invasive mechanical ventilation
Increased Diagnosis of Hepatocellular Carcinoma in Hospitalized Patients with Alcohol Related Hepatitis after the Covid-19 Outbreak: A Global Multi-Center Propensity Matched Analysis.
No full textNational Trends in the Incidence of Sporadic Malignant Colorectal Polyps in Young Patients (20-49 Years): An 18-Year SEER Database Analysis
No full textIntroduction: Recent changes in the USPSTF guidelines recommend that CRC (Colorectal Cancer) screening in average-risk patients should commence at 45 years with the intent of finding sporadic premalignant or malignant polyps, allowing early endoscopic interventions to improve clinical outcomes. This study aims to find the incidence of sporadic malignant polyps in adult patients \u3c 50 years of age) from the National Cancer Institute\u27s SEER (Surveillance Epidemiology and End Results) database over a period of 18 years. Methods: We interrogated the SEER database (2000-2017) on patients aged 20-49 years diagnosed with at least a single malignant sporadic colorectal polyp. Data extraction was performed through a case listing session using SEER*Stat v8.3.9 on combined SEER 18 incidence registries using specific codes for CRC polyps with cancer (Table). Microsatellite instability (MSI-H) high lesions and adenomatous polyposis coli (APC) were excluded from the analysis. Descriptive statistical analysis was performed using SPSS v27 for Mac. Results: A total of 10,742 patients with a diagnosis of colorectal polyps with a malignant component were identified. Female patients comprised 42.9% of the cohort with a mean age of any malignant polyp incidence of 43.07 years (42.91-43.23, 95% CI). The annual mean age (95% CI) of incidence of new-onset malignant polyps over time is shown in Figure 1. Approximately 50% of malignant polyps were diagnosed between 45-49 years of age, and about 25-30% were diagnosed between 40-45 years of age (Table). The incidence of malignant villous adenomas decreased, whereas malignant adenomas and tubulovillous adenomas increased over time (Table). A rising temporal trend for the total number of patients diagnosed with malignant polyps was also observed. Serrated polyps with cancer were noted to be scarce in the population studied. Conclusion: Our results show the mean age of sporadic malignant colorectal polyp incidence occurrence at 43 years. Approximately half of the malignant polyps under age 50 occurred in patients under age 45, below the current screening threshold of 45 years. Also observed was a temporal change in the histological patterns of colorectal malignant polyps, with malignant tubulovillous and adenomatous adenomas increasing and villous adenomas decreasing with the scarcity of serrated polyps with cancer in this population. These results have profound implications for colorectal cancer screening
Does timing of endoscopy affect outcomes in patients with upper gastrointestinal bleeding: a systematic review and meta-analysis.
No full textBACKGROUND AND AIMS: The timing of esophagogastroduodenoscopy (EGD) for the management of upper gastrointestinal bleeding (UGIB) remains controversial. Early EGD (E-EGD) (within 24 h of presentation) has been compared to late EGD (L-EGD) (after 24 h) in numerous studies with conflicting results. The previous systematic review included three randomized controlled trials (RCTs); however, the cutoff time for performing EGD was arbitrary. We performed an updated systematic review and meta-analysis of the studies comparing the outcomes of E-EGD and L-EGD group.
METHODS: A comprehensive search of PubMed, EMBASE, Cochrane Library, and Web of Science was undertaken to include both RCTs and cohort studies. Primary outcomes including overall mortality and secondary outcomes (recurrent bleeding, need for transfusion, and length of stay) were compared. Risk ratios and standardized mean difference (SMD) with 95% confidence interval (CI) were calculated.
RESULTS: A total of 13 observational studies (with over 1.8 million patients) were included in the final analysis. No significant difference in overall mortality (risk ratio: 0.97; CI, 0.74-1.27), recurrent bleeding (risk ratio: 1.12; CI, 0.62-2.00), and length of stay (SMD: -0.07, CI, -0.31 to 0.18) was observed for E-EGD group compared to L-EGD group. The possibility of endoscopic intervention was higher in E-EGD group (risk ratio: 1.70, CI, 1.28-2.27). Consistent results were obtained for subgroup analysis of studies with 100% nonvariceal bleed (NVB) patient (risk ratio: 1.12; CI, 0.84-1.50).
CONCLUSION: Given the outcomes and limitations, our meta-analysis did not demonstrate clear benefit of performing EGD within 24 h of presentation for UGIB (particularly NVB)
Relational impacts of capitalization in early parenthood.
No full textRelationship difficulties are common during the transition to parenthood and may persist for years. Strategies that enhance couples\u27 daily relational experiences early in the parenting years may serve a protective role. In general, engaging in a capitalization attempt (i.e., sharing personal good news) with one\u27s romantic partner and perceiving the partner to be responsive are associated with better relationship outcomes among committed couples. However, it is unknown whether these relational benefits extend to the early parenting years or to other relational domains such as coparenting, which plays a central role in family functioning. The current study examined same-day associations between couples\u27 capitalization process and relationship closeness and perceived coparenting support in a dyadic context during the first year of parenthood. A subsample of primarily non-Hispanic White coresident mixed-gender couples who participated in a randomized controlled trial of a transition to parenthood program
Simmering on the Back Burner or Playing with Fire? Examining the Consequences of Back-Burner Digital Communication Among Ex-Partners.
No full textAbstract
Back burners are people with whom one communicates to potentially establish a future romantic or sexual relationship, and these relationships are common among college students. Using a sample of noncollege adults currently in committed relationships (N = 246) obtained via Amazon\u27s MTurk, this study examines how a prior relationship role with a desired back burner (i.e., whether a back burner was an ex-partner or not) affects digital communication and sexual activity with back burners, and participants\u27 negative affect. Sequential mediation analysis revealed that when the most-desired back burner was also an ex-partner (vs. not), participants digitally communicated more, increased communication was positively related to sexual activity with that back burner, and sexual activity was associated with negative affect in the participant. Even in the absence of sexual activity, both increased digital communication and simply having an ex-partner as one\u27s most-desired back burner were associated with negative affect. Limitations and implications for staying in touch with ex-partners are discussed
Assessing learner engagement with virtual educational events: Development of the Virtual In-Class Engagement Measure (VIEM).
No full textBACKGROUND: The COVID-19 pandemic has necessitated virtual education, but effects on learner engagement are unknown. We developed a virtual in-class engagement measure (VIEM) to assess learner engagement in online surgical education events.
METHODS: Using the STROBE, an observer collected tool to document student engagement, as a template an ASE committee workgroup developed the VIEM. The VIEM had two parts: observer assessment and learner self-assessment of engagement. Trained observers collected engagement data from two institutions using the VIEM. Surgical attendings, fellows and residents were observed during virtual learning events. Educator attitudes towards online teaching were also assessed via survey.
RESULTS: 22 events with 839 learners were observed. VIEM distinguished between sessions with low and high engagement. 20% of learners pretended to participate. Half of instructors were comfortable with virtual teaching, but only 1/3 believed was as effective as in-person. 2/3 of teachers believed video learners were more engaged than audio learners.
CONCLUSIONS: Virtual platforms do not automatically translate into increased engagement. Standard tools such as VIEM may help with assessment of engagement during virtual education
Evaluation of Calcitonin Use for Hypercalcemia at Parkview Health
No full text2021 ASHP Midyear Clinical Meeting / Poster
Objective: Evaluate the appropriateness of calcitonin use for hypercalcemia at Parkview Health, a not-for-profit community hospital health system
Role of Immunotherapy in Stage IV Large Cell Neuroendocrine Carcinoma of the Lung.
No full textBACKGROUND: Despite approvals of immune checkpoint inhibitors in both small cell and non-small cell lung cancers, the role of immunotherapy in large cell neuroendocrine carcinoma (LCNEC) in lung is undefined.
METHODS: Using the National Cancer Database (NCDB), Stage IV lung LCNEC cases diagnosed from 2014 to 2016 were analyzed. Information regarding cancer treatment was limited to first course of therapy, including surgery for primary lesion, radiation, chemotherapy, and immunotherapy. Survival analysis was performed using Kaplan-Meier curves and Log-rank tests. Cox proportional hazard model was used for multivariate analysis.
RESULTS: Among 661 eligible cases, 37 patients were treated with immunotherapy. No significant association between use of immunotherapy and clinical demographics was observed except for use of chemotherapy (p=0.0008). Chemotherapy was administered in 34 (92%) and 406 (65%) in immunotherapy and non-immunotherapy groups, respectively. Use of immunotherapy was associated with improved overall survival (Log-rank p=0.0018). Landmark analysis in the immunotherapy group showed 12 and 18-month survivals of 34.0% and 29.1%, respectively, whereas those in the non-immunotherapy group were 24.1% and 15.0%, respectively. Multivariate analysis demonstrated that female sex (HR=0.79, p=0.0063), liver metastases (HR=0.75, p=.0392), surgery (HR= 0.50, p
CONCLUSION: This retrospective study using NCDB suggests that use of immunotherapy may improve survival of LCNEC patients
Pembrolizumab Plus Concurrent Chemoradiation Therapy in Patients With Unresectable, Locally Advanced, Stage III Non-Small Cell Lung Cancer: The Phase 2 KEYNOTE-799 Nonrandomized Trial
No full textImportance: Administration of pembrolizumab plus concurrent chemoradiation therapy (cCRT) may provide treatment benefit to patients with locally advanced, stage III non-small cell lung cancer (NSCLC).
Objective: To evaluate treatment outcomes and safety of pembrolizumab plus cCRT in stage III NSCLC.
Design, setting, and participants: The phase 2, nonrandomized, 2-cohort, open-label KEYNOTE-799 study enrolled patients between November 5, 2018, and July 31, 2020, from 52 academic facilities and community-based institutions across 10 countries. As of October 28, 2020, median (range) follow-up was 18.5 (13.6-23.8) months in cohort A and 13.7 (2.9-23.5) months in cohort B. Of 301 patients screened, 216 eligible patients with previously untreated, unresectable, and pathologically/radiologically confirmed stage IIIA/IIIB/IIIC NSCLC with measurable disease per Response Evaluation Criteria in Solid Tumors, version 1.1 (RECIST v1.1) were enrolled.
Interventions: Patients in cohort A (squamous/nonsquamous) received 1 cycle (3 weeks) of carboplatin (area under the curve [AUC] 6 mg/mL/min), paclitaxel (200 mg/m2), and pembrolizumab (200 mg), followed by carboplatin (AUC 2 mg/mL/min) and paclitaxel (45 mg/m2) once weekly for 6 weeks and 2 cycles of pembrolizumab plus standard thoracic radiotherapy. Patients in cohort B (nonsquamous) received 3 cycles of cisplatin (75 mg/m2), pemetrexed (500 mg/m2), and pembrolizumab (200 mg) every 3 weeks and thoracic radiotherapy in cycles 2 and 3. Patients received 14 additional cycles of pembrolizumab.
Main outcomes and measures: Coprimary end points were objective response rate per RECIST v1.1 by blinded independent central review and incidence of grade 3 to 5 pneumonitis.
Results: A total of 112 patients received treatment in cohort A (76 men [67.9%]; median [range] age, 66.0 [46-90] years; 66 patients [58.9%] with programmed cell death ligand 1 [PD-L1] tumor proportion score ≥1%) and 102 patients received treatment in cohort B (62 men [60.8%]; median [range] age, 64.0 [35-81] years; 40 patients [39.2%] with PD-L1 tumor proportion score ≥1%). Objective response rate was 70.5% (79 of 112; 95% CI, 61.2%-78.8%) in cohort A and 70.6% (72 of 102; 95% CI, 60.7%-79.2%) in cohort B. Median duration of response was not reached, but 79.7% and 75.6%, respectively, had response duration of 12 months or longer. Grade 3 or higher pneumonitis occurred in 9 of 112 patients (8.0%) in cohort A and 7 of 102 (6.9%) in cohort B. Grade 3 to 5 treatment-related adverse events occurred in 72 of 112 (64.3%) and 51 of 102 (50.0%) patients, respectively.
Conclusions and relevance: The findings of this phase 2, nonrandomized, 2-cohort study suggest promising antitumor activity of pembrolizumab plus cCRT and manageable safety in patients with previously untreated, locally advanced, stage III NSCLC