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COVID-19 and Acute Esophageal Obstruction Management in the Emergency Department: An U.S. multicenter research network propensity-matched analysis
No full textIntroduction- The Coronavirus Disease-2019 (COVID-19) caused by the novel SARS-CoV-2 led to significant strain on the Emergency Department (ED) visits worldwide. Multiple stay-at-home orders were issued during the pandemic unless medical treatment was urgently needed1 . Acute esophageal obstruction (AEO) due to food/ foreign body impaction usually present to the ED, given its severe symptoms. Most esophageal foreign bodies pass through the gastrointestinal (GI) tract uneventfully, and related mortality is very low. Still, most of these patients receive endoscopic interventions (up to 76%)2 . The number of non-urgent endoscopies plummeted sharply during the pandemic to reduce exposure and preserve personal protective equipment. It is unclear if ED visits for AEO and their endoscopic management changed due to the COVID-19 pandemic in the United States (US). Methods- We utilized a federated cloud-based network database named TriNetX, which provides access to electronic medical records from 92 healthcare organizations from the US. The AEO adult patients hospitalized from January 1, 2020, to December 1, 2020, were compared to a similar timeline in 2019 from TriNetX. We used ICD-10 codes for food/foreign body in esophagus, causing other injury acute food impaction (T18.128 A, T18.12), foreign body esophagus (T18.198, T18.1, T18.19, T18.108, T18.108A). Outcomes of the study included utilization rates of esophagogastroduodenoscopy (EGD), esophageal perforation, inpatient hospitalization, and mortality. The outcomes were measured before and after 1:1 propensity matching of the groups based on the baseline demographics and comorbidities. Results- Prevalence of AEO among all ED visits in 2020 were 0.12% (5890 AEO ED visits among 4,672,024 total visits), compared to 0.17% (23,478 AEO ED visits among 14,199,648 total visits) in 2019. There was a small but significant decrease (0.05%) in AEO ED visits from pre-pandemic compared to pandemic times (P\u3c0.01). Patient with AEO had higher prevalence of eosinophilic esophagitis (mean 270 [4.6%] vs. 885 [3.8%], p=0.004) and alcohol-related disorders (mean 465 5 [7.9%] vs. 1659 [7.1%], p=0.03) in 2020 group vs. 2019 group. Patients in the 2020-group had a lower EGD utilization (RR 0.63,95%CI:0.58–0.67, p\u3c0.001) but esophageal perforation (RR 0.87,95%CI:0.41–1.82) and inpatient hospitalization rates (RR 0.92,95%CI:0.79-1.05) did not differ between two groups. Interestingly, during the pandemic, the AEO patients had a lower mortality rate (RR 0.23, 95%CI:0.17–0.31, p\u3c0.001) than in 2019. ConclusionWith the advent of COVID-19, multiple stay-at-home orders were issued in the US, with widespread healthcare services and utilization disruption. Patients have expressed concerns about visiting healthcare facilities due to the potential of the spread of SARS-CoV-2 3 . Many GI societies also recommended deferring elective procedures. This was due to a concern for potential transmission of the virus from aerosolization of GI secretions and judicious use of PPE, which resulted in an overall reduction in the number of endoscopies during the pandemic4 . Our study shows a small reduction (0.05%) of AEO ED visits in 2020 compared to 2019. However, EGD utilization plummeted to 63% for AEO in 2020. If this is due to spontaneous resolution of the food impaction or reduced presentations to the ED needs to be studied prospectively.
See: Table 1: Baseline characteristics, laboratory findings and clinical outcomes of the patients with Acute Esophageal Obstruction (AEO) ingestion during the COVID-19 pandemic (2020) when compared with pre-COVID time (2019
Successful Distancing: Telemedicine in Gastroenterology and Hepatology During the COVID-19 Pandemic.
No full textTelemedicine involves delivering healthcare and preventative care services to patients without the need for in-person encounters. Traditionally, telemedicine has been used for acute events (e.g., stroke, used to relay essential information to the emergency department) and chronic disease management (e.g., diabetes and chronic kidney disease management). Though the utilization of telemedicine in gastroenterology and hepatology has been modest at best, especially for inflammatory bowel diseases and chronic liver disease management, since the onset of coronavirus disease 2019 (COVID-19) pandemic, utilization of telemedicine in gastroenterology increased by 4000% in the first two weeks, equivalent to the last six years of growth before the pandemic. The Center for Medicare and Medicaid (CMS) relaxed rules for the use of telemedicine with easing restrictions on reimbursements, location, licensing requirements (across state lines), and the need for a prior provider-patient relationship. These changes increased the use of telemedicine in inpatient and outpatient settings for gastroenterology-related referrals. The use of inpatient telephonic or video consults helps provide timely care during the pandemic while conserving personal protective equipment and decreasing provider and patient exposure. Nevertheless, telehealth use comes at the cost of no direct patient contact and lesser reimbursements. The appropriate use of technology and equipment, training of healthcare providers, use of platforms that can be integrated into the electronic health record while protecting the privacy and the flow of information are essential components of telemedicine. Furthermore, encouraging patients to seek medical care remotely with the proper equipment and improving digital literacy without the need for physical examinations is a challenge, further compounded in elderly or hard-of-hearing patients and in patients who are more comfortable with in-person visits. The authors will systematically review and discuss how telemedicine can be integrated into the practice of gastroenterology and hepatology, with emphasis placed on discussing barriers to success and the ways they can be mitigated
Endoscopic ultrasound-guided vascular interventions: Current insights and emerging techniques
No full textEndoscopic ultrasound (EUS) is one of the significant breakthroughs in the field of advanced endoscopy. In the last two decades, EUS has evolved from a diagnostic tool to a real-time therapeutic modality. The luminal gastrointestinal (GI) tract provides a unique opportunity to access multiple vascular structures, especially in the mediastinum and abdomen, thus permitting a variety of EUS-guided vascular interventions. The addition of the doppler and contrast-enhanced capability to EUS has further helped provide real-time visualization of blood flow in vessels through the GI tract. EUS-guided vascular interventions rely on standard endoscopic accessories and interventional tools such as fine-needle aspiration needles and fine-needle biopsy. EUS allows the visualization of various structures in real-time by differentiating tissue densities and vascularity, thus, avoiding radiation exposure. EUS-guided techniques also allow real-time microscopic examination after target biopsy. Furthermore, many necessary interventions can be done during the same procedure after diagnosis. This article provides an overview of EUS-guided vascular interventions such as variceal, non-variceal bleeding interventions, EUSguided portal vein (PV) access with the formation of an intrahepatic portosystemic shunt, and techniques related to diagnosis of GI malignancies. Furthermore, we discuss current insights and future outlook of therapeutic modalities like PV embolization, PV sampling, angiography, drug administration, and portal pressure measurement
Examining the roles of marital status and sex on communication with backburners on social media
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In this study, we examined the prevalence of and communication with backburners (romantic alternatives) within a sample of both married (n= 188) and casually dating (n = 230) men and women in the United States. We also examined the roles of relationship length, commitment, sex, and marital status in the number of backburners reported and their communication with backburners, generally, as well as their communication with their most desired backburner. Extending previous studies using undergraduates, we found that commitment level was unrelated to the number of reported backburners. However, commitment was negatively related to the amount of communication with all backburners. Meanwhile, married individuals reported having more backburners than those who were only casually dating, but they also reported communicating with their most desired backburner less frequently and seeing them less often. Finally, men reported significantly more backburners with whom they would have a sexual relationship and also interacted with their backburners more frequently than did women. Thus, although marriage and commitment do not keep individuals from having backburners, they do appear to provide some buffer against communicating with backburners on social media and seeing them in person
Technology use during evening routines, bedtime satisfaction, and impacts on individual and relational well-being
No full textAbstract
In this study, we examined the typical and ideal bedtime routines of 289 Americans in cohabiting relationships who were recruited from Amazon’s Mechanical Turk. Participants described their bedtime routines, indicated their frequency of sex with their partner, and completed surveys measuring their bedtime, sexual, relationship, and life satisfaction. There were some incongruencies between ideal and typical scenarios, with joint activities (both technological and non-technological) featured more often in the ideal scenarios, and more time alone featured in typical scenarios. Incongruence between the presence of physical intimacy in ideal and typical scenarios was predictive of bedtime satisfaction, as were the presence of emotional intimacy, going to bed together, and shared technology use (e.g., watching television together) during their typical time together. In turn, bedtime satisfaction predicted frequency of sex, and sexual, relationship, and life satisfaction. However, shared time together not engaged in technology and time apart (using technology or not) was not predictive of bedtime satisfaction. As bedtime is an opportunity for leisure together for many couples, going to bed together and engaging in activities that promote emotional intimacy (e.g., conversations) may be beneficial to couples. Additionally, discussions and compromise related to the presence of physical intimacy at bedtime may help couples experience greater bedtime satisfaction. Finally, in contrast to suggestions that technology use has a negative effect on relationships, shared technology use before bed may have a positive impact on individual and relational well-being
How Do Age, Sex, Political Orientation, Religiosity, and Sexism Affect Perceptions of Sex Assault/Harassment Allegations?
No full textAbstract: The recent #MeToo movement empowered female sexual harassment and assault victims to publicly share their stories, using social media as the primary platform. Though the goals of the movement included de-stigmatization and support for victims, the discourse that followed often resulted in highly varied responses to reported incidents. In this study, we examined American adult (n = 512) perceptions about #MeToo and whether gender and ideological beliefs, including sexism, religiosity, and political affiliation, as well as pre-allegation likability of the alleged perpetrator, influenced respondents\u27 assessments of the incidents. We focused our examination on two very different, high-profile examples of sexual misconduct allegations, specifically against film producer Harvey Weinstein and comedian Aziz Ansari. We found that personal characteristics of respondents related to individuals\u27 negative assessments of alleged sexual assault perpetrators. Regression analyses showed that higher age and stronger beliefs that sexism exists in our culture predicted harsher judgments of Weinstein, but stronger beliefs that sexism exists in our culture, male gender, lower levels of pre-allegation favorability for Ansari, and higher levels of social religiosity predicted harsher judgments of Ansari. Practical implications of these disparate findings are discussed
Communication and Algorithmic Decision Making in a Virtual Healthcare Context.
No full textThis qualitative study draws on interviews and observations with nurses working in a virtual intensive care unit and using algorithms to track patient progress. It overviews how health practitioners navigate algorithmic systems to build relationships with other providers and patients, with attention to strategies for accountability and advocacy in virtual healthcare contexts. CCS Concepts: • Applied computing → Health care information systems DOI: https://doi.org/10.1145/3472714.3473669SIGDOC \u2721: The 39th ACM International Conference on Design of Communication, Virtual Event, USA, October 202
Prognostic Impact of Single and Multiple Descriptors in Pathologically Staged T3N0M0 NSCLC
No full textIntroduction T components of the current eighth edition of lung cancer American Joint Commission on Cancer (AJCC) staging assignment include size of primary tumor and others such as chest wall invasion. The role of the presence of multiple T3 descriptors in prognosis remains unknown. Methods Using the National Cancer Database and the AJCC seventh edition, pathologically staged (R0) N0M0 NSCLC cases diagnosed in 2010 to 2016 were analyzed. The selected cases had primary size larger than 5 cm or staged as T3 by the AJCC seventh edition despite the size of less than 5 cm. T3 descriptor status according to the eighth edition was defined as single descriptor (“T3-single”) with primary size of 5 to 7 cm or size less than 5 cm and T3 based on the seventh edition (“T3-other”) or multiple descriptor (“T3-multi”) with presence of both descriptors. Survival analysis was performed with validation of multivariate analyses. Results Of the 108,632 surgically resected pathologically staged N0M0R0 NSCLC cases, 9931 met the following criteria: 8955 as T3-single (4381 as T3-size, 4574 as T3-other) and 884 as T3-multi. Univariate and multivariate analyses revealed that T3-multi had significantly worse overall survival than T3-single with a median survival of 37.3 versus 69.3 months, respectively. Propensity score matching analysis validated the statistical significance. Exploratory analysis also revealed that the survival of the T3-multi group is similar to that of the T4 groups. Conclusions Our retrospective analysis using the National Cancer Database suggests that prognosis of patients with multiple T3 descriptors is substantially worse than those with single descriptors. Further research may be required to accurately define the prognosis of NSCLC for future staging update
Enteral Nutrition With High-Dose Vasopressors.
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Q Initiation and advancement of enteral nutrition (EN) are often delayed clinically because of the use of “high-dose” vasopressors. Are there standards for high-dose vasopressors? Does their use require delaying either initiation or advancement of EN?
A Jan Powers, PhD, RN, CCNS, CCRN, NE-BC, replies:
This question is a relevant one that many have struggled with for decades. Enteral nutrition (EN) has many positive benefits in critically ill patients, and early initiation of EN leads to fewer complications and improved patient outcomes. Just a few of the benefits of EN include improved wound healing, less loss of lean muscle mass, and maintenance of structural and functional gut integrity, which helps to bolster immunity and reduce infection. Even consuming only 20% of nutrition via EN can provide to a patient protective functions through innate immunity, for example, by attenuating the loss of function of..
Organizational Models for Cardiac Implantable Electronic Device Remote Monitoring: Current and Future Directions
No full textKey points
The use of remote monitoring (RM) of cardiac implantable electronic devices (CIEDs) has been shown to improve clinical and economic outcomes. The explosion of data from RM transmissions will require the use of advanced technologies (machine learning/artificial intelligence) to relieve the cognitive burden on the CIED team and ensure quality care. Standardization of reports across implantable CIED vendors will improve clinic performance and minimize errors (professional societies, such as the Heart Rhythm Society, should provide guidance, credentialing opportunities, and other support toward standardization). Development of reporting of CIED data output that is tailored to individuals will improve patient engagement and support patient–provider shared decision making about disease management