Parkview Health Research Repository
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Innovations in Diabetes Care for a Better New Normal Beyond COVID-19.
No full textThe coronavirus disease pandemic has created opportunities for innovation in diabetes care that were not possible before. From the lens of this new normal state, we have an opportunity to rapidly implement, test, and iterate models of diabetes care to achieve the quadruple aim of improving medical outcomes, patient experience, provider satisfaction, and reducing costs. In this perspective, we discuss several innovative diabetes models of care which promote collaborative care models and improve access to high-quality specialty diabetes care. We discuss ongoing threats to diabetes care innovation, and offer practical solutions to foster evolution and sustain current strides made during the pandemic
Active Nursing Research Studies as of 9-21-2021 (Study summaries)
No full textValidation of an evidence-based, nurse-designed fall risk assessment tool: Study 2
The ADAPT Fall Risk Assessment Tool was designed with the goal of decreasing instances of avoidable falls by providing nursing with the tools necessary to determine each patient’s risk of falling and to readily act upon these risk factors. The inter-rater reliability (IRR) of the ADAPT Fall Risk Assessment Tool will be evaluated in a real-world nursing setting.
Nursing and Support Staff Perceptions of Inpatient MyChart Utilization
The primary objective of this study is to assess MyChart use barriers identified by the nursing and patient care tech (PCT) workforce at Parkview using a workforce survey. The secondary aim is to identify facilitators that may increase patient MyChart utilization initiated by the nursing workforce. These objectives may inform strategies for increasing Patient MyChart use and future patient outcomes research as it relates to MyChart utilization.
Effect of Warming IV Fluids During MICU Transport on Patient Comfort and Temperature
To determine if during the transport of critically ill patients receiving intravenous fluids (IVF) at a rate of 100 ml/hour or greater, the use of an IVF warmer during transport of critically ill patients can: Increase comfort, reduce pain, prevent hypothermia.
Influence of Music Therapy on Length of Stay in Surgery Patient
The goal of this study is to assess the efficacy and feasibility of music therapy sessions on pre-elective surgical patients for its impact on time to discharge in the outpatient setting
Endobariatric procedures for obesity: clinical indications and available options.
No full textObesity remains a growing public health epidemic that has increased healthcare costs and related comorbidities. Current treatment guidelines encourage a multidisciplinary approach starting from patient selection, interventions, and long-term follow-up to maintain weight loss. However, these conservative interventions are largely ineffective at reducing body weight due to low adherence to the treatment regimen. Recently, endoscopic bariatric therapies have become an attractive alternative to traditional invasive bariatric surgeries due to their improved efficacy, safety, and cost-effectiveness. Endoscopic bariatric therapies include intragastric balloon placement, endoscopic sleeve gastroplasty, gastric bypass revision, and aspiration therapy. These procedures fall into two separate categories depending on the primary mechanism involved: restrictive or malabsorptive. Restrictive methods, such as the Orber
Emerging Role of Fascin-1 in the Pathogenesis, Diagnosis, and Treatment of the Gastrointestinal Cancers.
No full textGastrointestinal (GI) cancers, including esophageal, gastric, colorectal, liver, and pancreatic cancers, remain as one of the leading causes of death worldwide, with a large proportion accounting for fatalities related to metastatic disease. Invasion of primary cancer occurs by the actin cytoskeleton remodeling, including the formation of the filopodia, stereocilia, and other finger-like membrane protrusions. The crucial step of actin remodeling in the malignant cells is mediated by the fascin protein family, with fascin-1 being the most active. Fascin-1 is an actin-binding protein that cross-links filamentous actin into tightly packed parallel bundles, giving rise to finger-like cell protrusions, thus equipping the cell with the machinery necessary for adhesion, motility, and invasion. Thus, fascin-1 has been noted to be a key component for determining patient diagnosis and treatment plan. Indeed, the overexpression of fascin-1 in GI tract cancers has been associated with a poor clinical prognosis and metastatic progression. Moreover, fascin-1 has received attention as a potential therapeutic target for metastatic GI tract cancers. In this review, we provide an up-to-date literature review of the role of fascin-1 in the initiation of GI tract cancers, metastatic progression, and patients\u27 clinical outcomes
Gastrointestinal Bleeding Risk and Endoscopy Utilization in COVID-19 Patients on Therapeutic Anticoagulation: A Multicentric Study
No full textIntroduction- Patients affected with coronavirus disease 2019 (COVID-19) can lead to severe hypercoagulability. Many of these patients receive therapeutic anticoagulation because of a very high risk of thromboembolism. However, data about the risk of gastrointestinal bleeding (GIB) in these patients on therapeutic anticoagulation is scarce. Additionally, endoscopy utilization among these GIB patients need further studies. This study aims to evaluate the rates of GIB bleeding in COVID-19 patients and the endoscopy utilization for the same from a national research network database.
Methods- We used a federated cloud-based network database named TriNetX, comprising of 50 healthcare organizations (HCOs) across the US to identify all adults patients who were on therapeutic anticoagulation (warfarin, therapeutic dose-heparin [enoxaparin, unfractionated heparin], direct thrombin inhibitors, direct acting factor Xa inhibitors 3-months prior to COVID-19 diagnosis. Patients with the use of anticoagulants for thromboprophylaxis were excluded. Patients with the above characteristics were studied from January 1, 2020, to June 15, 2021, were divided into the anticoagulation (COVID with AC) and without anticoagulation (COVID w/o AC) groups.The primary outcomes were rates of GIB (melena/hematemesis), inpatient hospitalizations, endoscopy (EGD/colonoscopy) utilization, number of packed red blood cell (PRBC) transfusions, and 30-day all-cause mortality. The outcomes were measured after 1:1 propensity matching of the groups based on the baseline demographics and comorbidities.
Results- A total of 104,946 patients in COVID with AC and 591,273 patients in COVID w/o AC groups were compared. The patient comorbidities at presentation, laboratory findings, and clinical outcomes are noted in Table 1. After matching, COVID with AC patients had a higher risk of GIB (risk ratio [RR]- 1.62 (CI- 1.45 - 1.82)), inpatient hospitalization rates (RR- 4.53 (CI- 4.42 - 4.65)), PRBC transfusions (RR 3.67 (CI-3.35 - 4.02)), overall mortality (RR 3.93 (3.75 - 4.12)). Despite the increased presence of GIB, endoscopy utilization was lower (RR0.85 (0.78 - 0.93)).
Discussion- Rates of GIB, inpatient hospitalization, and overall mortality increased in COVID-19 patients on therapeutic anticoagulation. However, endoscopy utilization remained low, probably due to fear of infection transmission. If the increased mortality is related to the underlying severity of COVID-19 or unidentified comorbidities need to be further evaluated
Peptic Ulcer With Adherent Clot—Treat It or Leave It: A Systematic Review and Metanalysis of Randomized Trials
No full textIntroduction: Peptic ulcer diseases (PUD) remain the most common cause of hospitalized upper GI bleeding patients (30%-60%). Upper endoscopy is needed for diagnosis, stratification, and endoscopic hemostatic therapy of these ulcers depending on the presence of stigmata of increased risk of rebleeding. PUDs with adherent clot (Forrest classification IIb) are at 20-30% risk of rebleeding with a 7% mortality rate. Recent ACG guidelines could not reach a recommendation for or against endoscopic interventions for ulcers with adherent clot resistant to vigorous irrigation. This systematic review and meta-analysis aims to analyze the randomized studies for the treatment of PUD with adherent clot. Methods: The OVID/Medline and Google Scholar databases were screened through June 2021 for randomized studies reporting outcomes (rebleeding and mortality rates) in patients with adherent clot undergoing either endoscopic or medical intervention. Random effects models were used for the meta-analysis. I2 statistics were used to interpret heterogeneity, with I2\u3e75% indicating substantial inter-study variation. A sensitivity analysis was performed using the leave one out method. A p-value \u3c 0.05 was considered statistically significant. Results: Initial database search yielded 1568 articles, of which 8 randomized studies were finally included (Table 1). The total sample size consisted of 713 patients with adherent clot; of which 359 underwent endoscopic intervention while 354 were treated with medical therapy alone (proton pump inhibitors). Meta-analysis of re-bleeding and mortality rates between endoscopic and medical treatment groups revealed a decreased risk of rebleeding with endoscopic intervention (OR 0.247, 95%CI: 0.122-0.498, P=\u3c 0.001) (Figure 1A). Mortality rates (OR 0.573, 95% CI: 0.273-1.204, P=0.151) (Figure 1B), and rates of surgery did not differ significantly between the two cohorts (OR 1.177, 95%CI: 0.598-2.317, P=0.638). However, there was heterogeneity in the type of endoscopic interventions used. Conclusion: The results of our meta-analysis show that endoscopic interventions could benefit patients presenting to the hospital with UGIB due to PUD with adherent clot by decreasing risk of rebleeding. However, there was no effect of endoscopic therapy on mortality. Further, high-quality randomized controlled studies are needed to guide the endoscopists about managing PUD with adherent clot
Predictors and outcomes of acute respiratory failure in hospitalised patients with acute pancreatitis.
Get PDFBackground and aim: Acute pancreatitis (AP) is associated with organ failures and systemic complications, most commonly acute respiratory failure (ARF) and acute kidney injury. So far, no studies have analysed the predictors and hospitalisation outcomes, of patients with AP who developed ARF. The aim of this study was to measure the prevalence of ARF in AP and to determine the clinical predictors for ARF and mortality in AP.
Methods: This is a retrospective cohort study using the Nationwide Inpatient Sample database from the year 2005-2014. The study population consisted of all hospitalisations with a primary or secondary discharge diagnosis of AP, which is further stratified based on the presence of ARF. The outcome measures include in-hospital mortality, hospital length of stay and hospitalisation cost.
Results: In our study, about 5.4% of patients with AP had a codiagnosis of ARF, with a mortality rate of 26.5%. The significant predictors for ARF include sepsis, pleural effusion, pneumonia and cardiogenic shock. Key variables that were associated with a higher risk of mortality include mechanical ventilation, age more than 65 years, sepsis and cancer (excluding pancreatic cancer). The presence of ARF increased hospital stay by 8.3 days and hospitalisation charges by US$103 460.
Conclusion: In this study, we demonstrate that ARF is a significant risk factor for increased hospital mortality, greater length of stay and higher hospitalisation charges in patients with AP. This underlines significantly higher resource utilisation in patients with a dual diagnosis of AP-ARF
Prospective evaluation of an assessment tool for technical performance of duodenoscopes.
No full textOBJECTIVE: While single-use and detachable-tip duodenoscopes have been recently developed to overcome risks of infection transmission, there are no reliable tools to objectively assess their technical performance. We evaluated the reliability and validity of a newly developed tool to assess the technical performance of reusable duodenoscopes.
METHODS: An assessment tool was developed to measure duodenoscope performance based on three distinct criteria: maneuverability, mechanical/imaging characteristics and ability to perform requisite interventions. The assessment tool was tested prospectively on duodenoscopes used in endoscopic retrograde cholangiopancreatography (ERCP) procedures at nine academic medical centers over a 6-month period. The main outcome was reliability of the duodenoscope assessment tool, which was estimated using Cronbach\u27s coefficient alpha (α). The secondary outcome was validity of the assessment tool.
RESULTS: The assessment tool evaluated technical performance of reusable duodenoscopes in 1080 ERCP procedures. Indications were biliary in 92.8% and pancreatic in 7.2% procedures. The overall Cronbach\u27s coefficient α for maneuverability was 0.81, assessment of mechanical/imaging characteristics was 0.92, and ability to perform requisite interventions was 0.87. On multiple linear regression analysis, prolonged procedure duration, older patient age and pancreatic interventions were significantly positively associated with higher (worse) scores.
CONCLUSIONS: The newly developed assessment tool appears reliable and valid for evaluating the technical performance of duodenoscopes. Registration: ClinicalTrials.gov Identifier: NCT04004533
Fanning the flames of back burner relationships electronically: Prevalence and implications for romances and well-being among adults.
No full textBack burners are prospective romantic and/or sexual partners with whom one communicates, often using digital communication channels, for purposes of potentially developing a sexual and/or romantic relationship. The current study explores the consequences of back burner communication on relationship commitment and personal stress. Moreover, early back burner studies relied primarily on college student samples; it is unknown whether these findings generalize to older adults. We examined the relationships among digital communication with back burners, relationship commitment, and stress, using a sample of non-collegiate adults (N = 263). Consistent with earlier research, the majority reported having at least one back burner. Also, number of back burners correlated negatively with commitment. However, only number of back burners predicted commitment when considered alongside frequency of sexual communication and frequency of stating one’s future intentions. Social media infidelity-related behaviors mediated the relationship between number of back burners and stress. Findings have implications for relational and personal well-being