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Lipid Management in Patients with Endocrine Disorders: An Endocrine Society Clinical Practice Guideline.
Get PDFOBJECTIVE: This guideline will provide the practicing endocrinologist with an approach to the assessment and treatment of dyslipidemia in patients with endocrine diseases, with the objective of preventing cardiovascular (CV) events and triglyceride-induced pancreatitis. The guideline reviews data on dyslipidemia and atherosclerotic cardiovascular disease (ASCVD) risk in patients with endocrine disorders and discusses the evidence for the correction of dyslipidemia by treatment of the endocrine disease. The guideline also addresses whether treatment of the endocrine disease reduces ASCVD risk.
CONCLUSION: This guideline focuses on lipid and lipoprotein abnormalities associated with endocrine diseases, including diabetes mellitus, and whether treatment of the endocrine disorder improves not only the lipid abnormalities, but also CV outcomes. Based on the available evidence, recommendations are made for the assessment and management of dyslipidemia in patients with endocrine diseases
Role of T0 status in overall survival for unresectable stage III non-small cell lung cancer: A NCDB analysis.
No full textOBJECTIVES: Occult primary non-small cell lung cancer (NSCLC) with mediastinal involvement is a known but rare clinical condition. Very limited retrospective data are available in the literature. Its prognosis and response to systemic chemotherapy have not been investigated with large scale data.
MATERIALS AND METHODS: Using National Cancer Database (NCDB), cases that had undergone radiation therapy without surgery for N2-3M0 NSCLC were selected. Demographics and survival data were compared between T0 and T1-4 groups. Survival analyses were conducted with Kaplan-Meier and log-rank tests. Cox proportional hazard models were used for univariate and multivariate analyses.
RESULTS: Between 2004 and 2016, 84,263 and 458 cases met criteria for unresectable stage III NSCLC with T1-4 and T0 stage, respectively. T0 status was associated with younger age, recent diagnosis (year 2010-2016), adenocarcinoma histology, N3 stage, and use of chemotherapy. Survival analysis demonstrated that those with T0 status had prolonged overall survival as compared to T1-4 counterparts in both overall and chemotherapy groups (p \u3c 0.0001 for each). Five-year overall survival rates for T0 and T1-4 groups were 30.5% and 12.7% in all groups, and 33.6% and 14.6% in chemotherapy groups, respectively. Propensity score matching also demonstrated a statistically significant difference in overall survival (p \u3c 0.0001). These findings are confirmed by independent analysis using Surveillance, Epidemiology, and End Results Program (SEER).
CONCLUSION: This large hospital-based study demonstrates the favorable prognosis for T0 status in the setting of unresectable stage III NSCLC. Researchers may consider it as distinct stage (e.g., stage IIC) for future studies
Parkview Health leads COVID fight innovations
Get PDFIn the ongoing battle against COVID-19, a Fort Wayne-based hospital group is leading the innovation drive to prevent the virus’ spread — and ultimately — to save lives.
The Parkview Hospital Innovation Team is doing its best to create new Personal Protective Equipment (PPE) and other technology needed to combat the novel coronavirus locally and nationally.
Original online article her
Identification of Postpartum Hemorrhage Risk Factors and Quantified Blood Loss after Vaginal Deliveries
Get PDFThe objective of this study is to identify risk factors related to postpartum hemorrhage and QBL after vaginal deliveries. Current practice is to assess every vaginal delivery patient at PRMC FBC for postpartum hemorrhage risk factors on admission, with assessments, and PRN. QBL is obtained on all vaginal deliveries for the 2-hour recovery period and then PRN nursing judgement during the postpartum inpatient hospital stay. This study will further investigate which risk factors lead to higher QBL after vaginal deliveries.
PI: Lisa Smith, MSN, RN, NP-C, AGCNS-BC, RNC-OB
Contact: [email protected]
Patient responses to daily cardiac resynchronization therapy device data: a pilot trial assessing a novel patient-centered digital dashboard in everyday life
No full textBackground Heart failure (HF) is a growing public health problem in the United States. Implantable cardiac resynchronization therapy (CRT) devices reduce mortality and morbidity; remote monitoring (RM) of these devices improves outcomes. However, patient RM adherence is low, due in part to lack of access to their RM data. Providing these data to patients may increase engagement, but they must be appropriately tailored to ensure understanding. Objective To examine patients’ experiences interacting with their RM data through a novel digital dashboard as part of daily life. Methods In this mixed methods pilot study, 10 patients with implantable CRT defibrillators were given access to a patient-centered RM data dashboard, updated daily for 6-12 months. Pre and post health literacy, engagement, electronic portal (MyChart®) logins, and RM adherence were measured; system usability scores were collected at exit; and dashboard views were tracked. Exit interviews were conducted to elucidate patients’ experiences. Results Participants (100% white, 60% male, ages 34-80 [mean=62.0, SD=13.4]) had adequate health literacy, increased MyChart logins (p = 0.0463), and non-significant increase in RM adherence. Participants viewed their dashboards 0-42 times (mean=14.9, SD=12.5). Interviews revealed participants generally appreciated access to their data, understood it, and responded to changes; however, there were remaining questions and concerns regarding data interpretation and visualization. Conclusion Preliminary findings support potential future integration of a CRT RM data dashboard in HF patients’ daily care. With appropriate informational support and personalization, sharing RM data with patients in a tailored dashboard may improve health engagement
The association of COMT genotype with buproprion treatment response in the treatment of major depressive disorder.
No full textBACKGROUND: Pharmacodynamics and pharmacogenetics are being explored in pharmacological treatment response for major depressive disorder (MDD). Interactions between genotype and treatment response may be dose dependent. In this study, we examined whether MDD patients with Met/Met, Met/Val, and Val/Val COMT genotypes differed in their response to bupropion in terms of depression scores.
METHODS: This study utilized a convenience sample of 241 adult outpatients (≥18 years) who met DSM-5 criteria for MDD and had visits at a Midwest psychopharmacology clinic between February 2016 and January 2017. Exclusion criteria included various comorbid medical, neurological, and psychiatric conditions and current use of benzodiazepines or narcotics. Participants completed genetic testing and the 9 question patient-rated Patient Health Questionnaire (PHQ-9) at each clinic visit (M = 3.8 visits, SD = 1.5) and were prescribed bupropion or another antidepressant drug. All participants were adherent to pharmacotherapy treatment recommendations for \u3e2 months following genetic testing.
RESULTS: Participants were mostly Caucasian (85.9%) outpatients (154 female and 87 male) who were 44.5 years old, on average (SD = 17.9). For Val carriers, high bupropion doses resulted in significantly lower PHQ-9 scores than no bupropion (t(868) = 5.04, p \u3c .001) or low dose bupropion (t(868) = 3.29, p = .001). Val carriers differed significantly from Met/Met patients in response to high dose bupropion (t(868) = -2.03, p = .04), but not to low dose bupropion.
CONCLUSION: High-dose bupropion is beneficial for MDD patients with Met/Val or Val/Val COMT genotypes, but not for patients with Met/Met genotype. Prospective studies are necessary to replicate this pharmacodynamic relationship between bupropion and COMT genotypes and explore economic and clinical outcomes
Survival benefit from immunocheckpoint inhibitors in stage IV non-small cell lung cancer patients with brain metastases: A National Cancer Database propensity-matched analysis.
No full textImmunocheckpoint inhibitors (ICIs) have become a standard pharmacological therapy in non-small cell lung cancer (NSCLC). Because brain metastases (BMs) have historically been listed as exclusion criteria in previous clinical trials involving ICIs in advanced NSCLC, the survival benefit from ICI in NSCLC patients with BMs remains unclear. The National Cancer Database was queried for stage IV NSCLC patients with or without BMs between 2014 and 2015. Overall survival (OS) of stage IV NSCLC patients who received immunotherapy and that of stage IV NSCLC patients who did not receive immunotherapy were compared according to the presence or absence of BMs. Multivariable logistic analyses identified the clinical characteristics predictive of overall survival. A propensity score analysis was conducted with the aim of adjusting the potential biases arising from the clinical characteristics. This study included 42,512 patients with stage IV NSCLC; 11,810 patients with BMs and 30,702 patients without BMs. In univariate analysis, stage IV NSCLC patients with BMs treated with immunotherapy had a significantly longer OS than those without immunotherapy after propensity score matching (median OS: 12.8 vs 10.1 months, hazard ratio [HR]: 0.80, 95% confidence interval [CI]: 0.72-0.89, p \u3c 0.0001). Multivariable Cox modeling after propensity score matching confirmed the survival benefit from ICI for stage IV NSCLC patients with BMs (HR: 0.75, 95% CI: 0.67-0.83, p \u3c 0.0001). The HR in NSCLC patients without BMs treated with ICI compared with those without ICI was 0.77 (95% CI: 0.73-0.82, p \u3c 0.0001). Survival in stage IV NSCLC patients with BMs was significantly improved by ICI treatment at levels comparable to those without BMs using a retrospective database. ICI may be one of the promising treatment options for stage IV NSCLC patients with BMs. These findings should be validated in future prospective studies
A First in Human Multi-center, Open Label, Prospective Study to Evaluate Safety, Usability and Performance of the VisONE System for Heart Failure with a Reduced Left Ventricular Ejection Fraction
No full textIntroduction Synchronized Diaphragmatic Stimulation (SDS) produces localized diaphragmatic contractions gaited to the cardiac cycle that transiently modulate intra-thoracic pressure, thereby affecting ventricular preload and afterload. This study prospectively evaluated the safety and effectiveness of delivering SDS therapy in HFrEF (NCT03484780). Hypothesis Chronic SDS therapy improves symptoms, exercise capacity and hemodynamics in patients with HFrEF. Methods Symptomatic patients with an LVEF\u3c= 35% who were in sinus rhythm, but did not have ventricular dyssynchrony, underwent laparoscopic implantation of the VisONE SDS system, comprising an implantable pulse generator and leads affixed to the inferior side of the diaphragm. Other exclusion criteria included severe COPD and contraindications to laparoscopy. Therapy was programmed to deliver SDS at imperceptible outputs. Patients were followed at 1, 3, 6 and 12-months to observed effects on symptoms, quality of life (SF36), exercise capacity (6-minute walk test), cardiac function (echocardiography) and safety. Results Nineteen patients were screened and 15 men (60 [56, 67] years, LV EF 27 [23, 33] %, 100% ischemic etiology, NYHA class II [53%] / III [47%], QRSd 117 [100, 125] ms, NT-proBNP 1779 [911, 2072] pg/ml) were enrolled and successfully implanted. For all patients, a threshold SDS stimulus that caused imperceptible localized diaphragmatic contraction could be identified. All patients were discharged without therapy-related complications. No procedure or therapy related AEs occurred through 12 months. Between discharge with SDS off and SDS on at 3, 6 and 12 months, improvements were seen in exercise capacity, SF-36 and LVEF with larger effects when diaphragmatic synchronization was \u3e80% (Figure). Conclusions These encouraging effects on symptoms and exercise capacity should now be investigated in adequately powered randomized trials
Determining the Prevalence and Impact of Bullying and Cyberbullying as a Contributing Factor in Patients Who Have Been Admitted Into an Inpatients Facility.
Get PDFPresented in APNA 33rd Annual Conference, October 2-5, 2019, New Orleans, Louisiana: Mini Concurrent Session Abstracts.
Parkview Project: Cyberbullyin
The incidence of chemotherapy extravasation in the inpatient and ambulatory infusion areas of a community cancer center
Get PDFFew studies have been conducted in non-National Cancer Institute (non-NCI) designated cancer centers and even less have included both the inpatient and outpatient settings. This study is being conducted in order to establish a benchmark for the incidence of chemotherapy extravasation in an inpatient oncology unit and outpatient infusion center at a non-NCI-designated community cancer center. This retrospective review is to determine the common chemotherapy agents involved in extravasation, patient factors contributing to the extravasation, and severity of extravasations.
PI: Nancy Ehmke MN, RN, AOCN
Contact: [email protected]