50 research outputs found
STARTing to bridge the evidence gap: management of cancer-associated thrombosis with concomitant thrombocytopenia
No full textJ Thromb Haemost
No full textBackground:When compared with warfarin, low-molecular-weight heparin (LMWH) reduces the incidence of recurrent venous thromboembolism (VTE) in cancer. However, a survival benefit of LMWH over warfarin for the treatment of cancer-associated VTE has not been established.Methods:Using the Surveillance, Epidemiology and End Results (SEER) and Medicare linked database from 2007 through 2016, we identified Medicare beneficiaries (aged 6566 years) who were: (1) diagnosed with primary gastric, colorectal, pancreatic, lung, ovarian, or brain cancer; (2) diagnosed with cancer-associated VTE; and (3) prescribed LMWH or warfarin within 30 days. The primary outcome was overall survival (OS). Patients were matched 1:1 using exact matching for cancer stage and propensity scored matching for cancer diagnosis, age, year of VTE, and time from cancer diagnosis to index VTE. Cox proportional-hazards regression was performed to estimate hazard ratios (HR) and 95% confidence intervals (95% CI).Results:A total of 9,706 patients were included. Warfarin was associated with a significant improvement in OS compared to LMWH (median OS, 9.8 months [95%CI, 9.1 to 10.4] versus 7.2 months [95%CI, 6.8 to 7.8]; HR, 0.86; 95% CI 0.83 to 0.90; P<0.001). The survival advantage was most pronounced in pancreatic (HR 0.82 [95% CI, 0.74 to 0.90], P<0.001) and gastric cancers (HR 0.82 [95% CI, 0.68 to 0.98], P=0.03). The observed differences in survival were consistent across subgroups including cancer stage, age, comorbidity burden, and year of VTE.Conclusions:In this population-based study, warfarin was associated with improved OS compared to LMWH for the treatment of cancer-associated VTE.HHSN261201000140C/CA/NCI NIH HHSUnited States/HHSN261201000035C/CA/NCI NIH HHSUnited States/U01 HL143365/HL/NHLBI NIH HHSUnited States/HHSN261201000035I/CA/NCI NIH HHSUnited States/HHSN261201000034C/CA/NCI NIH HHSUnited States/U58 DP003862/DP/NCCDPHP CDC HHSUnited States/P30 CA006516/CA/NCI NIH HHSUnited States/T32 HL007917/HL/NHLBI NIH HHSUnited States
Predicting risk of venous thromboembolism in hospitalized cancer patients: Utility of a risk assessment tool
No full textM protein and the evolving spectrum of platelet-activating anti-PF4 disorders and MGTS and their linkage
No full textAdverse clinical outcomes associated with sickle cell trait at high altitude.
No full textSickle cell trait (SCT) is a prevalent condition affecting more than 300 million individuals
worldwide. Although formerly regarded as a benign carrier state, with complications rarely
occurring outside of high-altitude or extreme physiologic conditions, recent population-level
data has revealed an increased risk for chronic kidney disease (CKD) and pulmonary
embolism (PE) in general populations. In this study, we sought to evaluate whether chronic,
moderately high altitude exposure can increase the breadth and severity of SCT
complications compared to sea-level cohorts. We used data from Colorado, which has the
highest mean elevation of any State in the USA (2,070 m). We found that the risk for known
SCT complications such as CKD and PE, as well as other clinical outcomes in which prior
evidence was either weak or mixed, were significantly increased. In the latter category,
adverse pregnancy outcomes including pre-eclampsia and intra-uterine death were
particularly notable. The strength of the associations observed in this study generally
exceeds prior reports and suggests that SCT patients living at high-altitude are at greater
risk for morbidity than their sea-level counterparts
Practicing Communication Skills For Responding to Emotionally Charged Questions
No full textObjective: To assess the impact of a 1-hour communication skills workshop highlighting the “ask more and summarize technique” (AMST) to teach residents an effective way to respond to emotionally charged questions. Methods: From December 2015 to January 2017, residents on an inpatient oncology or palliative medicine rotation attended a mandatory 1-hour workshop on AMST involving a short introduction to the technique followed by skills practice. A survey (S1) was administered to the residents during the first session to assess their self-reported attitudes and practices. A follow-up survey (S2) was e-mailed at the end of the rotation to assess the usefulness of AMST. Results: Twenty-one participants completed S1, and 12 participants completed S2. A total of 62% (13/21) reported the workshop was “very useful.” There was a reported increased frequency of “summarizing back” between surveys ( P = .01). Addressing fear and anxiety (75%, 9/12) and responding to patients who were angry/upset (67%, 8/12) were the situations where AMST was found to be the most useful. Fifty-four percent of respondents (7/12) felt they could have used AMST more. Conclusion: A 1-hour communication skills workshop targeting residents on an inpatient oncology or palliative rotation increased the use of summary statements in challenging situations. Practice Implications: A short skills practice workshop can be incorporated into a busy clinical curriculum to achieve changes in trainee behaviors and attitudes. </jats:sec
Adverse clinical outcomes associated with sickle cell trait at high altitude
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