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Fr247 BUDESONIDE VS. MESALAMINE IN MICROSCOPIC COLITIS: A SYSTEMATIC REVIEW AND META-ANALYSIS OF EFFICACY AND ADVERSE EVENTS
No full textPoster Presentation: BUDESONIDE VS. MESALAMINE IN MICROSCOPIC COLITIS: A SYSTEMATIC REVIEW AND META-ANALYSIS OF EFFICACY AND ADVERSE EVENT
Safety of Glucagon Use During Endoscopic Retrograde Cholangiopancreatography: A Retrospective Multicentric Study
No full textIntroduction- Injectable glucagon inhibits gastrointestinal (GI) and duodenal motility by relaxing smooth muscles, decreasing the frequency and amplitude of phasic activity of the sphincter of Oddi. This enables endoscopists to enhance biliary cannulation and extract small bile duct stone. Additionally, glucagon can potentially worsen underlying hyperglycemia and hyperkalemia especially in patients with diabetes. It is unclear if glucagon impacts the adverse events of Endoscopic Retrograde Cholangiopancreatography (ERCP) such as rates of GI bleeding, GI perforation, post-ERCP pancreatitis (PEP) and in patient hospitalizations.
Methods We used TriNetX, a federated cloud-based network comprising of 92 healthcare organizations (HCOs) across the US. All adult patients who underwent ERCP with utilization of glucagon (ERCP w glucagon group) were compared with patients without use of glucagon (ERCP wo glucagon group). The primary outcomes were rates of rates of GI bleeding, GI perforation, post-ERCP pancreatitis (PEP), inpatient hospitalizations and 30- day overall mortality. The clinical outcomes were measured after 1:1 propensity matching of the groups based on the baseline demographics and comorbidities.
Results A total of 9,008 patients were included in ERCP w glucagon group compared to 256,597 in ERCP wo glucagon group. Comorbidites of these patients at presentation, imaging, medications and clinical outcomes are noted in Table 1. Mean age at presentation was 67.7 years (SD- 11.1), with female predominance (54.9%). ERCP w glucagon group patients had higher rates of utilization of opioid agents and indomethacin. After matching, ERCP w glucagon patient had lower rates of GI bleeding (risk ratio [RR]- 0.68 (CI- 0.52 – 0.86)), PEP (RR- 0.64 (CI- 0.58 – 0.71), inpatient hospitalization (RR- 0.34 (CI- 0.32 – 0.36)) and overall mortality (RR- 0.81 (CI- 0.66 – 0.99)). The rates of GI perforation (RR- 0.64 (CI- 0.34 – 1.19)), hyperkalemia (RR- 0.83 (CI- 0.64 – 1.09)) and hyperglycemia (RR- 0.65 (CI- 0.41 – 1.03)) did not differ between two groups.
Discussio- Injectable glucagon during ERCP procedure appears safe with lower rates of GI bleeding, PEP, inpatient hospitalization and overall mortality. Rates of hyperkalemia and hyperglycemia did not different between two groups. This was noted after matching for diabetes, indomethacin use, obesity and chronic kidney disease. Large prospective studies are needed to confirm these findings
Continued Aspirin Use and Bleeding Risk After Endoscopic Submucosal Dissection of Gastric Neoplasms: A Meta-Analysis
No full textIntroduction: With the development of endoscopic technologies, the detection rate of early gastric cancer (EGC) and precancerous lesions is gradually increasing. As an effective minimally invasive therapy, endoscopic submucosal dissection (ESD) has been accepted as a standard treatment for EGC and dysplasia. However, postprocedural bleeding is one of the most common complications of ESD, with a reported incidence of 5.1%. Moreover, the effect of continued low-dose aspirin (LDA) on bleeding during the peri-ESD period is not clear. Methods: We searched the OVID/Medline and Google Scholar databases through June 2021 to find studies relating to continued LDA use in patients undergoing ESD. Studies reporting bleeding rates in patients undergoing ESD with and without continued LDA were included. Postoperative bleeding rates were compared between those who continued LDA during the procedure and those who did not; a random-effects model was used to calculate pooled odds ratio for bleeding risk with continued LDA use. A p-value \u3c 0.05 was considered statistically significant. Results: The initial search identified 2023 studies; after excluding duplicates, review articles, and studies not meeting inclusion criteria, 9 studies (all were retrospective observational studies) were finally included in the analysis. The total number of patients undergoing ESD procedure was 7978, out of which 703 continued LDA during the procedure. Pooled analysis comparing the post-operative bleeding rates between people with and without continued use of LDA revealed that aspirin use during ESD translated into higher postoperative bleeding rates compared to those who did not. (Pooled OR 1.720 , 95%CI: 1.121-2.641, P= 0.01). No interstudy heterogeneity was observed (I2=0). Conclusion: The results of our meta-analysis demonstrated that LDA continuation significantly increased the risk of post-ESD bleeding. Therefore, the physicians should individualize the decision of continuing LDA in patients undergoing ESD based on their thrombotic risk
Assessing Consistency with Standards of Care Recommendations for Patients with Type 2 Diabetes at Hospital Discharge
No full text2021 ASHP Midyear Clinical Meeting / Poster ID#1129514
Objective: To assess the number of patients prescribed diabetic regimens consistent with American Diabetes Association (ADA) Standards of Care recommendations upon hospital discharge
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.
Get PDFIMPORTANCE: 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
Work-related technoference at home and feelings of work spillover, overload, life satisfaction and job satisfaction
No full textPurpose
The purpose of this study is to examine whether work-related technology use outside of work and around family members could produce technoference or phubbing, where time spent with family members is interrupted by or intruded upon by technology use. The authors also examined its impact on work-to-family spillover, feelings of overload, life satisfaction and job satisfaction for workers. Design/methodology/approach
Via an online survey, the authors assessed the frequency of technoference due to work, work-to-family spillover, feelings of overload, life satisfaction and job satisfaction. The authors’ analytic sample included US parents (95 fathers and 88 mothers) who worked for pay and experienced technoference in their relationships, which was at least sometimes due to work. Findings
Results reveal possible impacts of technoference related to work on employee feelings of work-to-family spillover, greater feelings of overload, lower life satisfaction and lower job satisfaction. Research limitations/implications
Data are from a cross-sectional online survey, and results are correlational. Although the authors have theoretical/conceptual evidence for the impacts of technoference, it is possible that the direction of effects could be reversed or even bidirectional. Experimental/intervention work could further examine whether changes in technology use at home due to work improve employee well-being. Practical implications
The authors’ findings suggest that organizational policies which promote healthy boundaries and work-life balance are likely fundamental to employee well-being and that employers should be mindful of employees\u27 work-related technology use at home. Originality/value
This study examines technoference and phubbing due to work while at home, as opposed to focusing on the at-work context
2020 Institutional Repository (IR) Report
No full textA brief report of information and statistics on the globally accessible IR. This is managed and compiled by the Parkview Health Resource Librarians. Top downloads, usage metrics, readership distribution, and related metrics
Mass Casualty Mini Drills on Trauma Surgery Department Staff Knowledge: An Educational Improvement Study.
No full textBACKGROUND: Over the last decade, the United States has witnessed an increase in mass casualty incidents (MCIs). The outcome of an MCI depends upon hospital preparedness, yet many hospitals are unfamiliar with their facility MCI procedure. Educational training drills may be one method to improve staff knowledge of policy and procedure.
OBJECTIVE: This study aimed to improve knowledge gained through educational MCI mini drills of institutional mass casualty policy and procedure in surgery department staff at a level II trauma center.
METHODS: A pre-/posttest design was utilized. The hospital implemented MCI mini training drills as a quality improvement project using Plan-Do-Study-Act iterative cycles with prospective data collection. Knowledge scores were measured using a 12-item surgery department MCI policy and procedure questionnaire that was developed by the author and leadership.
RESULTS: A one-way analysis of covariance analysis in participants that mini drilled more than once indicated significant effect on mean cycle score differences among three cycles F(2,21) = 12.96, p = .00. Multiple comparison using Games-Howell indicated the mean score for Cycle 4 (M = 96.15, SD = 6.54) was significantly different from Cycle 3 (M = 59.71, SD = 25.15). Gender, shift, and credentials of participants influenced knowledge improvement.
CONCLUSION: Implementation of hospital MCI mini drills improved staff knowledge of institutional mass casualty policy and procedure in the surgery department and may be applied to surgery departments with similar policy, procedure, and participant characteristics. Hospital mass casualty response education and preparation is essential to saving lives