Pub Date : 2023-10-01Epub Date: 2023-11-16DOI: 10.1080/21548331.2023.2266019
Hikmat Abdel-Razeq, Salah Abbasi, Ghadeer Abdeen, Hazem Abdulelah, Jamil Debs, Sarah Al Masri, Majdi H Aljadayeh, Abdalla Awidi
Background: This paper explores and discusses local challenges oncologists face for diagnosing and managing breast cancer patients with BRCA gene mutations in Jordan.
Methods: A task force involving key opinion leaders, experts in the management of breast cancer, and stakeholders in healthcare systems where genetic testing is available in Jordan discussed current evidence and local real-life practice. The task force then formulated recommendations to achieve better patient outcomes and satisfaction based on evidence-based medicine and their clinical experience in BRCA-mutated breast cancer management.
Results and conclusion: Eligibility of patients for genetic testing, physician acceptance and willingness to integrate genetic testing into routine practice is encouraging but remains restricted by testing availability and financial coverage. Until more data is available, genetic testing should be targeted for breast cancer patients based on tumor subtypes, as well as family and personal history of cancer, as per international guidelines. Whenever possible, genetic testing should aim to detect all actionable genes through a multigene panel including BRCA1/2. Major challenges faced in clinical practice in Jordan include fear of genetic discrimination and social stigmatization, as well as hesitancy toward risk-reducing surgery. Pre-testing counseling is therefore critical to promote acceptance of genetic testing. Since geneticists are in short supply in Jordan, genetic counseling can be offered through a specially trained genetic counselor or through a hybrid system that includes oncologist-based counselling. In addition to cancer prevention, germline genetic testing may assist in the selection of specific anti-cancer therapy, such as PARP inhibitors, in patients with BRCA1/2 mutation. Nationwide initiatives are also needed to ensure access to PARP inhibition therapy and provide financial coverage for genetic screening, mastectomies and reconstructive surgery across Jordan.
{"title":"Management of breast cancer patients with <i>BRCA</i> gene mutations in Jordan: perspectives and challenges.","authors":"Hikmat Abdel-Razeq, Salah Abbasi, Ghadeer Abdeen, Hazem Abdulelah, Jamil Debs, Sarah Al Masri, Majdi H Aljadayeh, Abdalla Awidi","doi":"10.1080/21548331.2023.2266019","DOIUrl":"10.1080/21548331.2023.2266019","url":null,"abstract":"<p><strong>Background: </strong>This paper explores and discusses local challenges oncologists face for diagnosing and managing breast cancer patients with BRCA gene mutations in Jordan.</p><p><strong>Methods: </strong>A task force involving key opinion leaders, experts in the management of breast cancer, and stakeholders in healthcare systems where genetic testing is available in Jordan discussed current evidence and local real-life practice. The task force then formulated recommendations to achieve better patient outcomes and satisfaction based on evidence-based medicine and their clinical experience in BRCA-mutated breast cancer management.</p><p><strong>Results and conclusion: </strong>Eligibility of patients for genetic testing, physician acceptance and willingness to integrate genetic testing into routine practice is encouraging but remains restricted by testing availability and financial coverage. Until more data is available, genetic testing should be targeted for breast cancer patients based on tumor subtypes, as well as family and personal history of cancer, as per international guidelines. Whenever possible, genetic testing should aim to detect all actionable genes through a multigene panel including BRCA1/2. Major challenges faced in clinical practice in Jordan include fear of genetic discrimination and social stigmatization, as well as hesitancy toward risk-reducing surgery. Pre-testing counseling is therefore critical to promote acceptance of genetic testing. Since geneticists are in short supply in Jordan, genetic counseling can be offered through a specially trained genetic counselor or through a hybrid system that includes oncologist-based counselling. In addition to cancer prevention, germline genetic testing may assist in the selection of specific anti-cancer therapy, such as PARP inhibitors, in patients with BRCA1/2 mutation. Nationwide initiatives are also needed to ensure access to PARP inhibition therapy and provide financial coverage for genetic screening, mastectomies and reconstructive surgery across Jordan.</p>","PeriodicalId":35045,"journal":{"name":"Hospital practice (1995)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71486826","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-01Epub Date: 2023-07-27DOI: 10.1080/21548331.2023.2241340
Elaina Wang, Steven Kim, Aaron Wang, Winston Jiang, Ankur Shah
Introduction: Dialysis is complicated in the setting of acute brain injury (ABI) due to several factors including acute solute shifts, acid base changes, need for anticoagulation, and changes in intracranial pressure. For these reasons, continuous renal replacement therapy (CRRT) is often the chosen modality for renal replacement needs in these patients. Peritoneal dialysis (PD) is less discussed but shares many of the benefits often attributed to CRRT. We describe, from both nephrology and neurosurgical perspectives, a case successfully managed with PD.
Case: A 25-year-old male with history of end-stage kidney disease (ESKD) secondary to focal segmental glomerulosclerosis on continuous cycling PD for 5 years presented to the hospital with headache and altered mental status. Initial imaging revealed a large intraventricular hemorrhage extending to the fourth ventricle. He underwent an emergent right depressive hemicraniectomy and clot evacuation. Post-operative imaging revealed worsening cerebral edema, intraventricular hemorrhage, and hydrocephalus. The decision was made to continue PD, noting that it retains many of the benefits of CRRT (which it is in fact, a form of) which he tolerated well until the need for a percutaneous gastrostomy tube arose. He was transiently transitioned to hemodialysis but returned to PD once his gastrostomy healed. He continued PD for 1 year without complication and eventually received a kidney transplant.
Discussion: In managing patients with ABI undergoing dialysis, a number of considerations must be undertaken including avoidance of hypotension to maintain cerebral perfusion pressure and minimize ischemia reperfusion injury, avoidance of anticoagulants that can precipitate or worsen bleeding, the potential for cerebral edema due to rapid solute clearance and osmotic dissipation of therapeutic hypernatremia, and the mitigation of intracellular acidosis from bicarbonate delivery. Although underutilized, PD may potentially serve as a viable option for dialysis in the setting of ABI as demonstrated by the case presented.
{"title":"Peritoneal dialysis in the setting of acute brain injury: an underappreciated modality.","authors":"Elaina Wang, Steven Kim, Aaron Wang, Winston Jiang, Ankur Shah","doi":"10.1080/21548331.2023.2241340","DOIUrl":"10.1080/21548331.2023.2241340","url":null,"abstract":"<p><strong>Introduction: </strong>Dialysis is complicated in the setting of acute brain injury (ABI) due to several factors including acute solute shifts, acid base changes, need for anticoagulation, and changes in intracranial pressure. For these reasons, continuous renal replacement therapy (CRRT) is often the chosen modality for renal replacement needs in these patients. Peritoneal dialysis (PD) is less discussed but shares many of the benefits often attributed to CRRT. We describe, from both nephrology and neurosurgical perspectives, a case successfully managed with PD.</p><p><strong>Case: </strong>A 25-year-old male with history of end-stage kidney disease (ESKD) secondary to focal segmental glomerulosclerosis on continuous cycling PD for 5 years presented to the hospital with headache and altered mental status. Initial imaging revealed a large intraventricular hemorrhage extending to the fourth ventricle. He underwent an emergent right depressive hemicraniectomy and clot evacuation. Post-operative imaging revealed worsening cerebral edema, intraventricular hemorrhage, and hydrocephalus. The decision was made to continue PD, noting that it retains many of the benefits of CRRT (which it is in fact, a form of) which he tolerated well until the need for a percutaneous gastrostomy tube arose. He was transiently transitioned to hemodialysis but returned to PD once his gastrostomy healed. He continued PD for 1 year without complication and eventually received a kidney transplant.</p><p><strong>Discussion: </strong>In managing patients with ABI undergoing dialysis, a number of considerations must be undertaken including avoidance of hypotension to maintain cerebral perfusion pressure and minimize ischemia reperfusion injury, avoidance of anticoagulants that can precipitate or worsen bleeding, the potential for cerebral edema due to rapid solute clearance and osmotic dissipation of therapeutic hypernatremia, and the mitigation of intracellular acidosis from bicarbonate delivery. Although underutilized, PD may potentially serve as a viable option for dialysis in the setting of ABI as demonstrated by the case presented.</p>","PeriodicalId":35045,"journal":{"name":"Hospital practice (1995)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9875466","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-01Epub Date: 2023-11-16DOI: 10.1080/21548331.2023.2268012
Haris Patail, Tanya Sharma, Wilbert Aronow, Syed Abbas Haidry
Though an infrequent cause of acute coronary syndrome, spontaneous coronary artery dissection is an increasingly recognized cardiovascular condition predominantly seen in middle-aged females. Its pathophysiology is defined by separation of coronary arterial wall layers which cause acute coronary syndrome-like presentations with relatively high recurrence rates. Overall, there is a lack of reported literature and understanding of the short- and long-term management for spontaneous coronary artery dissection. Therapeutic approaches include, but are not limited to, percutaneous coronary intervention, surgical revascularization, antithrombotic therapy, and beta-blocker therapy. There is a significant absence of randomized control trials to help guide both interventional and medical management for spontaneous coronary artery dissection. This review is aimed to review the current literature regarding risk factors and considerations for the short- and long-term management of spontaneous coronary artery dissection.
{"title":"Current challenges in treatment and management of spontaneous coronary artery dissection.","authors":"Haris Patail, Tanya Sharma, Wilbert Aronow, Syed Abbas Haidry","doi":"10.1080/21548331.2023.2268012","DOIUrl":"10.1080/21548331.2023.2268012","url":null,"abstract":"<p><p>Though an infrequent cause of acute coronary syndrome, spontaneous coronary artery dissection is an increasingly recognized cardiovascular condition predominantly seen in middle-aged females. Its pathophysiology is defined by separation of coronary arterial wall layers which cause acute coronary syndrome-like presentations with relatively high recurrence rates. Overall, there is a lack of reported literature and understanding of the short- and long-term management for spontaneous coronary artery dissection. Therapeutic approaches include, but are not limited to, percutaneous coronary intervention, surgical revascularization, antithrombotic therapy, and beta-blocker therapy. There is a significant absence of randomized control trials to help guide both interventional and medical management for spontaneous coronary artery dissection. This review is aimed to review the current literature regarding risk factors and considerations for the short- and long-term management of spontaneous coronary artery dissection.</p>","PeriodicalId":35045,"journal":{"name":"Hospital practice (1995)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41170440","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-01Epub Date: 2023-08-01DOI: 10.1080/21548331.2023.2241342
Sagar B Dugani, Karen M Fischer, Darrell R Schroeder, Holly L Geyer, Michael J Maniaci, Margaret Paulson, Ivana T Croghan, M Caroline Burton
Objective: The Coronavirus Disease-19 (COVID-19) pandemic caused a decline in hospitalist wellness. The COVID-19 pandemic has evolved, and new outbreaks (i.e. Mpox) have challenged healthcare systems. The objective of the study was to assess changes in hospitalist wellness and guide interventions.
Methods: We surveyed hospitalists (physicians and advanced practice providers [APPs]), in May 2021 and September 2022, at a healthcare system's 16 hospitals in four US states using PROMIS® measures for global well-being, anxiety, social isolation, and emotional support. We compared wellness score between survey periods; in the September 2022 survey, we compared wellness scores between APPs and physicians and evaluated the associations of demographic and hospital characteristics with wellness using logistic (global well-being) and linear (anxiety, social isolation, emotional support) regression models.
Results: In May 2021 vs. September 2022, respondents showed no statistical difference in top global well-being for mental health (68.4% vs. 57.4%) and social activities and relationships (43.8% vs. 44.3%), anxiety (mean difference: +0.8), social isolation (mean difference: +0.5), and emotional support (mean difference: -1.0) (all, p ≥ 0.05). In September 2022, in logistic regression models, APPs, compared with physicians, had lower odds for top (excellent or very good) global well-being mental health (odds ratio [95% CI], 0.31 [0.13-0.76]; p < 0.05). In linear regression models, age <40 vs. ≥40 years was associated with higher anxiety (estimate ± standard error, 2.43 ± 1.05; p < 0.05), and concern about contracting COVID-19 at work was associated with higher anxiety (3.74 ± 1.10; p < 0.01) and social isolation (3.82 ± 1.21; p < 0.01). None of the characteristics showed association with change in emotional support. In September 2022, there was low concern for contracting Mpox in the community (4.6%) or at work (10.0%).
Conclusion: In hospitalists, concern about contracting COVID-19 at work was associated with higher anxiety and social isolation. The unchanged wellness scores between survey periods identified opportunities for intervention. Mpox had apparently minor impact on wellness.
{"title":"Global well-being, anxiety, social isolation, and emotional support among hospitalists during COVID-19 and Mpox outbreaks.","authors":"Sagar B Dugani, Karen M Fischer, Darrell R Schroeder, Holly L Geyer, Michael J Maniaci, Margaret Paulson, Ivana T Croghan, M Caroline Burton","doi":"10.1080/21548331.2023.2241342","DOIUrl":"10.1080/21548331.2023.2241342","url":null,"abstract":"<p><strong>Objective: </strong>The Coronavirus Disease-19 (COVID-19) pandemic caused a decline in hospitalist wellness. The COVID-19 pandemic has evolved, and new outbreaks (i.e. Mpox) have challenged healthcare systems. The objective of the study was to assess changes in hospitalist wellness and guide interventions.</p><p><strong>Methods: </strong>We surveyed hospitalists (physicians and advanced practice providers [APPs]), in May 2021 and September 2022, at a healthcare system's 16 hospitals in four US states using PROMIS® measures for global well-being, anxiety, social isolation, and emotional support. We compared wellness score between survey periods; in the September 2022 survey, we compared wellness scores between APPs and physicians and evaluated the associations of demographic and hospital characteristics with wellness using logistic (global well-being) and linear (anxiety, social isolation, emotional support) regression models.</p><p><strong>Results: </strong>In May 2021 vs. September 2022, respondents showed no statistical difference in top global well-being for mental health (68.4% vs. 57.4%) and social activities and relationships (43.8% vs. 44.3%), anxiety (mean difference: +0.8), social isolation (mean difference: +0.5), and emotional support (mean difference: -1.0) (all, <i>p</i> ≥ 0.05). In September 2022, in logistic regression models, APPs, compared with physicians, had lower odds for top (excellent or very good) global well-being mental health (odds ratio [95% CI], 0.31 [0.13-0.76]; <i>p</i> < 0.05). In linear regression models, age <40 vs. ≥40 years was associated with higher anxiety (estimate ± standard error, 2.43 ± 1.05; <i>p</i> < 0.05), and concern about contracting COVID-19 at work was associated with higher anxiety (3.74 ± 1.10; <i>p</i> < 0.01) and social isolation (3.82 ± 1.21; <i>p</i> < 0.01). None of the characteristics showed association with change in emotional support. In September 2022, there was low concern for contracting Mpox in the community (4.6%) or at work (10.0%).</p><p><strong>Conclusion: </strong>In hospitalists, concern about contracting COVID-19 at work was associated with higher anxiety and social isolation. The unchanged wellness scores between survey periods identified opportunities for intervention. Mpox had apparently minor impact on wellness.</p>","PeriodicalId":35045,"journal":{"name":"Hospital practice (1995)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10775116/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10260455","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-01Epub Date: 2023-07-07DOI: 10.1080/21548331.2023.2232501
Malissa A Mulkey, Paloma Hauser Paloma Hauser, Julia Aucoin
Objectives: Delirium may be associated with neuroinflammation and reduced blood-brain barrier (BBB) stability. ACE Inhibitors (ACEIs) and Angiotensin Receptor Blockers (ARBs) reduce neuroinflammation and stabilize the BBB, thus slowing the progression of memory loss in patients with dementia. This study evaluated the effect of these medications on delirium prevalence.
Methods: This was a retrospective study of data from all patients admitted to a Cardiac ICU between 1 January 2020-31 December 2020. The presence of delirium was determined based on the International Classification of Diseases (ICD) 10 codes and nurse delirium screening.
Results: Of the 1684 unique patients, almost half developed delirium. Delirious patients who did not receive either ACEI or ARB had higher odds (odds ratio [OR] 5.88, 95% CI 3.7-9.09, P < .001) of in-hospital death and experienced significantly shorter ICU lengths of stay (LOS) (P = .01). There was no significant effect of medication exposure on the time to delirium onset.
Conclusions: While ACEIs and ARBs have been shown to slow the progression of memory loss for patients with Alzheimer's disease, we did not observe a difference in time to delirium onset.
目的:谵妄可能与神经炎症和血脑屏障(BBB)稳定性降低有关。ACE抑制剂(ACEIs)和血管紧张素受体阻滞剂(ARBs)可减少神经炎症并稳定血脑屏障,从而减缓痴呆症患者记忆丧失的进展。本研究评估了这些药物对谵妄患病率的影响。方法:这是一项回顾性研究,收集了2020年1月1日至2020年12月31日期间入住心脏ICU的所有患者的数据。根据国际疾病分类(ICD) 10代码和护士谵妄筛查确定谵妄的存在。结果:在1684例独特的患者中,几乎一半发生谵妄。未接受ACEI或ARB治疗的谵妄患者有更高的风险(优势比[or] 5.88, 95% CI 3.7-9.09, P P = 0.01)。药物暴露对谵妄发作时间无显著影响。结论:虽然ACEIs和arb已被证明可以减缓阿尔茨海默病患者记忆丧失的进展,但我们没有观察到谵妄发作时间的差异。
{"title":"Relationship between in-hospital angiotensin converting enzyme inhibitors and Angiotensin receptor blockers administration and delirium in the cardiac ICU.","authors":"Malissa A Mulkey, Paloma Hauser Paloma Hauser, Julia Aucoin","doi":"10.1080/21548331.2023.2232501","DOIUrl":"10.1080/21548331.2023.2232501","url":null,"abstract":"<p><strong>Objectives: </strong>Delirium may be associated with neuroinflammation and reduced blood-brain barrier (BBB) stability. ACE Inhibitors (ACEIs) and Angiotensin Receptor Blockers (ARBs) reduce neuroinflammation and stabilize the BBB, thus slowing the progression of memory loss in patients with dementia. This study evaluated the effect of these medications on delirium prevalence.</p><p><strong>Methods: </strong>This was a retrospective study of data from all patients admitted to a Cardiac ICU between 1 January 2020-31 December 2020. The presence of delirium was determined based on the International Classification of Diseases (ICD) 10 codes and nurse delirium screening.</p><p><strong>Results: </strong>Of the 1684 unique patients, almost half developed delirium. Delirious patients who did not receive either ACEI or ARB had higher odds (odds ratio [OR] 5.88, 95% CI 3.7-9.09, <i>P</i> < .001) of in-hospital death and experienced significantly shorter ICU lengths of stay (LOS) (<i>P</i> = .01). There was no significant effect of medication exposure on the time to delirium onset.</p><p><strong>Conclusions: </strong>While ACEIs and ARBs have been shown to slow the progression of memory loss for patients with Alzheimer's disease, we did not observe a difference in time to delirium onset.</p>","PeriodicalId":35045,"journal":{"name":"Hospital practice (1995)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10771528/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9948972","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-01Epub Date: 2023-08-02DOI: 10.1080/21548331.2023.2241341
Erica Daniels, Geoffrey C Lamb, Anna Beckius
Introduction: Evidence suggests inappropriate oxygenation may be harmful to patients. To improve oxygen use in our hospital, we initiated a quality improvement project with a goal to reduce the percentage of inappropriate utilization of oxygen by 50% within a year.
Methods: Nasal cannula (NC) oxygen use data for medicine inpatients was abstracted weekly for chart review. A multidisciplinary team developed a guideline for use. Initiation of NC O2 with a baseline SPO2 > 92% was deemed inappropriate and 3+ consecutive SPO2 > 96% was defined as over-supplementation. Formal interventions included an oxygen use guideline, updated EMR order, unit-specific feedback, and magnetic placards. Progress was tracked by control charts.
Results: Baseline data revealed 40% of patients were inappropriately placed on oxygen and 55% of patients had one instance of excessive supplementation. Only half of all improper uses of oxygen had charted medical reasoning, and 30% had a corresponding order. Instances of proper oxygen use had orders 48% of the time. Run charts revealed inappropriate initiation was significantly reduced to 27.1% (p < 0.0001) and excessive oxygenation decreased significantly to 34.4% (p < 0.0001) following interventions with no effect on other variables.
{"title":"Reducing inappropriate oxygen use in hospitalized medicine patients.","authors":"Erica Daniels, Geoffrey C Lamb, Anna Beckius","doi":"10.1080/21548331.2023.2241341","DOIUrl":"10.1080/21548331.2023.2241341","url":null,"abstract":"<p><strong>Introduction: </strong>Evidence suggests inappropriate oxygenation may be harmful to patients. To improve oxygen use in our hospital, we initiated a quality improvement project with a goal to reduce the percentage of inappropriate utilization of oxygen by 50% within a year.</p><p><strong>Methods: </strong>Nasal cannula (NC) oxygen use data for medicine inpatients was abstracted weekly for chart review. A multidisciplinary team developed a guideline for use. Initiation of NC O2 with a baseline SPO2 > 92% was deemed inappropriate and 3+ consecutive SPO2 > 96% was defined as over-supplementation. Formal interventions included an oxygen use guideline, updated EMR order, unit-specific feedback, and magnetic placards. Progress was tracked by control charts.</p><p><strong>Results: </strong>Baseline data revealed 40% of patients were inappropriately placed on oxygen and 55% of patients had one instance of excessive supplementation. Only half of all improper uses of oxygen had charted medical reasoning, and 30% had a corresponding order. Instances of proper oxygen use had orders 48% of the time. Run charts revealed inappropriate initiation was significantly reduced to 27.1% (<i>p</i> < 0.0001) and excessive oxygenation decreased significantly to 34.4% (<i>p</i> < 0.0001) following interventions with no effect on other variables.</p><p><strong>Conclusions: </strong>Our interventions significantly decreased improper oxygen initiation and excessive supplementation.</p>","PeriodicalId":35045,"journal":{"name":"Hospital practice (1995)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9973100","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-08-01DOI: 10.1080/21548331.2023.2225977
Dale Terasaki, Rebecca Hanratty, Christian Thurstone
Substance use disorders (SUDs) are ubiquitous among medical, surgical, and psychiatric admissions in hospitals across the United States, and many staff are not specifically trained to provide trauma-informed, evidence-based SUD care. To address this need, some hospitals – particularly in urban, academic institutions – have implemented an inpatient addiction consult service (ACS). These specialized, multidisciplinary teams can provide timely pharmacologic, psychotherapeutic, and carelinkage interventions during the ‘reachable’ moment of hospitalization [1]. In the August 2022 edition of the New England Journal of Medicine, authors Englander & Davis published a thorough and mobilizing call for hospitals and policymakers to establish a new standard of care for patients with SUDs, including via support for inpatient ACS teams [2]. Patient care outcomes such as addiction severity [3], readmission risk [4], treatment follow-up [5], evidence-based medication initiation [6], and inpatient antibiotic treatment completion [6] have been shown to improve with ACS involvement – in no small part related to medications for addiction treatment (MAT). But there are also many benefits to an ACS that extend beyond patient care outcomes. In this article, we highlight our first-hand experience at a safety-net hospital that expanded its ACS to great effect, particularly in terms of 1) staff recruitment and retention, 2) widespread trainee education, 3) quality improvement, and 4) pragmatic clinical research. Direct quotations from key informants are included (with explicit permission when possible) as well as results from a staff survey regarding perceptions of the ACS.
{"title":"More than MAT: lesser-known benefits of an inpatient addiction consult service.","authors":"Dale Terasaki, Rebecca Hanratty, Christian Thurstone","doi":"10.1080/21548331.2023.2225977","DOIUrl":"https://doi.org/10.1080/21548331.2023.2225977","url":null,"abstract":"Substance use disorders (SUDs) are ubiquitous among medical, surgical, and psychiatric admissions in hospitals across the United States, and many staff are not specifically trained to provide trauma-informed, evidence-based SUD care. To address this need, some hospitals – particularly in urban, academic institutions – have implemented an inpatient addiction consult service (ACS). These specialized, multidisciplinary teams can provide timely pharmacologic, psychotherapeutic, and carelinkage interventions during the ‘reachable’ moment of hospitalization [1]. In the August 2022 edition of the New England Journal of Medicine, authors Englander & Davis published a thorough and mobilizing call for hospitals and policymakers to establish a new standard of care for patients with SUDs, including via support for inpatient ACS teams [2]. Patient care outcomes such as addiction severity [3], readmission risk [4], treatment follow-up [5], evidence-based medication initiation [6], and inpatient antibiotic treatment completion [6] have been shown to improve with ACS involvement – in no small part related to medications for addiction treatment (MAT). But there are also many benefits to an ACS that extend beyond patient care outcomes. In this article, we highlight our first-hand experience at a safety-net hospital that expanded its ACS to great effect, particularly in terms of 1) staff recruitment and retention, 2) widespread trainee education, 3) quality improvement, and 4) pragmatic clinical research. Direct quotations from key informants are included (with explicit permission when possible) as well as results from a staff survey regarding perceptions of the ACS.","PeriodicalId":35045,"journal":{"name":"Hospital practice (1995)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10213988","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objectives: This systematic review was conducted to investigate the characteristics and effects of clinical decision support systems (CDSSs) on clinical and process-of-care outcomes of patients with kidney disease.
Methods: A comprehensive systematic search was conducted in electronic databases to identify relevant studies published until November 2020. Randomized clinical trials evaluating the effects of using electronic CDSS on at least one clinical or process-of-care outcome in patients with kidney disease were included in this study. The characteristics of the included studies, features of CDSSs, and effects of the interventions on the outcomes were extracted. Studies were appraised for quality using the Cochrane risk-of-bias assessment tool.
Results: Out of 8722 retrieved records, 11 eligible studies measured 32 outcomes, including 10 clinical outcomes and 22 process-of-care outcomes. The effects of CDSSs on 45.5% of the process-of-care outcomes were statistically significant, and all the clinical outcomes were not statistically significant. Medication-related process-of-care outcomes were the most frequently measured (54.5%), and CDSSs had the most effective and positive effect on medication appropriateness (18.2%). The characteristics of CDSSs investigated in the included studies comprised automatic data entry, real-time feedback, providing recommendations, and CDSS integration with the Computerized Provider Order Entry system.
Conclusion: Although CDSS may potentially be able to improve processes of care for patients with kidney disease, particularly with regard to medication appropriateness, no evidence was found that CDSS affects clinical outcomes in these patients. Further research is thus required to determine the effects of CDSSs on clinical outcomes in patients with kidney diseases.
{"title":"Effects and characteristics of clinical decision support systems on the outcomes of patients with kidney disease: a systematic review.","authors":"Nasim Mirpanahi, Ehsan Nabovati, Reihane Sharif, Shahrzad Amirazodi, Mahtab Karami","doi":"10.1080/21548331.2023.2203051","DOIUrl":"https://doi.org/10.1080/21548331.2023.2203051","url":null,"abstract":"<p><strong>Objectives: </strong>This systematic review was conducted to investigate the characteristics and effects of clinical decision support systems (CDSSs) on clinical and process-of-care outcomes of patients with kidney disease.</p><p><strong>Methods: </strong>A comprehensive systematic search was conducted in electronic databases to identify relevant studies published until November 2020. Randomized clinical trials evaluating the effects of using electronic CDSS on at least one clinical or process-of-care outcome in patients with kidney disease were included in this study. The characteristics of the included studies, features of CDSSs, and effects of the interventions on the outcomes were extracted. Studies were appraised for quality using the Cochrane risk-of-bias assessment tool.</p><p><strong>Results: </strong>Out of 8722 retrieved records, 11 eligible studies measured 32 outcomes, including 10 clinical outcomes and 22 process-of-care outcomes. The effects of CDSSs on 45.5% of the process-of-care outcomes were statistically significant, and all the clinical outcomes were not statistically significant. Medication-related process-of-care outcomes were the most frequently measured (54.5%), and CDSSs had the most effective and positive effect on medication appropriateness (18.2%). The characteristics of CDSSs investigated in the included studies comprised automatic data entry, real-time feedback, providing recommendations, and CDSS integration with the Computerized Provider Order Entry system.</p><p><strong>Conclusion: </strong>Although CDSS may potentially be able to improve processes of care for patients with kidney disease, particularly with regard to medication appropriateness, no evidence was found that CDSS affects clinical outcomes in these patients. Further research is thus required to determine the effects of CDSSs on clinical outcomes in patients with kidney diseases.</p>","PeriodicalId":35045,"journal":{"name":"Hospital practice (1995)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9844673","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-08-01DOI: 10.1080/21548331.2023.2206270
Brandon Stretton, Joshua Kovoor, Stephen Bacchi, Andrew Booth, Sam Gluck, Andrew Vanlint, Mohamed Afzal, Christopher Ovenden, Aashray Gupta, Rajiv Mahajan, Suzanne Edwards, Yvonne Brennan, Jir Ping Boey, Benjamin Reddi, Guy Maddern, Mark Boyd
Background: There is little evidence to guide the perioperative management of patients on a direct oral anticoagulant (DOAC) in the absence of a last known dose. Quantitative serum titers may be ordered, but there is little evidence supporting this.
Aims: This multi-center retrospective cohort study of consecutive surgical in-patients with a DOAC assay, performed over a five-year period, aimed to characterize preoperative DOAC assay orders and their impact on perioperative outcomes.
Materials and methods: Patients prescribed regular DOAC (both prophylactic and therapeutic dosing) with a preoperative DOAC assay were included. The DOAC assay titer was evaluated against endpoints. Further, patients with an assay were compared against anticoagulated patients who did not receive a preoperative DOAC assay. The primary endpoint was major bleeding. Secondary endpoints included perioperative hemoglobin change, blood transfusions, idarucizumab or prothrombin complex concentrate administration, postoperative thrombosis, in-hospital mortality and reoperation. Adjusted and unadjusted linear regression models were used for continuous data. Binary logistic models were performed for dichotomous outcomes.
Results: 1065 patients were included, 232 had preoperative assays. Assays were ordered most commonly by Spinal (11.9%), Orthopedics (15.4%), and Neurosurgery (19.4%). For every 10 ng/ml increase in titer, the hemoglobin decreases by 0.5066 g/L and the odds of a preoperative reversal increases by 13%. Compared to those without an assay, patients with preoperative DOAC assays had odds 1.44× higher for major bleeding, 2.98× higher for in-hospital mortality and 16.3× higher for receiving anticoagulant reversal.
Conclusion: A preoperative DOAC assay order was associated with worse outcomes despite increased reversal administration. However, the DOAC assay titer can reflect the patient's likelihood of bleeding.
{"title":"Impact of perioperative direct oral anticoagulant assays: a multicenter cohort study.","authors":"Brandon Stretton, Joshua Kovoor, Stephen Bacchi, Andrew Booth, Sam Gluck, Andrew Vanlint, Mohamed Afzal, Christopher Ovenden, Aashray Gupta, Rajiv Mahajan, Suzanne Edwards, Yvonne Brennan, Jir Ping Boey, Benjamin Reddi, Guy Maddern, Mark Boyd","doi":"10.1080/21548331.2023.2206270","DOIUrl":"https://doi.org/10.1080/21548331.2023.2206270","url":null,"abstract":"<p><strong>Background: </strong>There is little evidence to guide the perioperative management of patients on a direct oral anticoagulant (DOAC) in the absence of a last known dose. Quantitative serum titers may be ordered, but there is little evidence supporting this.</p><p><strong>Aims: </strong>This multi-center retrospective cohort study of consecutive surgical in-patients with a DOAC assay, performed over a five-year period, aimed to characterize preoperative DOAC assay orders and their impact on perioperative outcomes.</p><p><strong>Materials and methods: </strong>Patients prescribed regular DOAC (both prophylactic and therapeutic dosing) with a preoperative DOAC assay were included. The DOAC assay titer was evaluated against endpoints. Further, patients with an assay were compared against anticoagulated patients who did not receive a preoperative DOAC assay. The primary endpoint was major bleeding. Secondary endpoints included perioperative hemoglobin change, blood transfusions, idarucizumab or prothrombin complex concentrate administration, postoperative thrombosis, in-hospital mortality and reoperation. Adjusted and unadjusted linear regression models were used for continuous data. Binary logistic models were performed for dichotomous outcomes.</p><p><strong>Results: </strong>1065 patients were included, 232 had preoperative assays. Assays were ordered most commonly by Spinal (11.9%), Orthopedics (15.4%), and Neurosurgery (19.4%). For every 10 ng/ml increase in titer, the hemoglobin decreases by 0.5066 g/L and the odds of a preoperative reversal increases by 13%. Compared to those without an assay, patients with preoperative DOAC assays had odds 1.44× higher for major bleeding, 2.98× higher for in-hospital mortality and 16.3× higher for receiving anticoagulant reversal.</p><p><strong>Conclusion: </strong>A preoperative DOAC assay order was associated with worse outcomes despite increased reversal administration. However, the DOAC assay titer can reflect the patient's likelihood of bleeding.</p>","PeriodicalId":35045,"journal":{"name":"Hospital practice (1995)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9844682","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-08-01DOI: 10.1080/21548331.2023.2221132
Nguyen Thi Cam Huong, Nguyen Van Luu, Nguyen Hai Nam, Suhaib Ghula, Ahmad Taysir Atieh Qarawi, Pham Thi Mai Truc, Dang Nguyen Trung An, Nguyen Tien Huy, Pham Thi Le Hoa
Objectives: Vietnam is one of the countries in highly endemic areas of hepatitis B virus (HBV) infection in the world. Our study aims to determine the prevalence of HBV infection among different age groups of workers who had been included for annual general health checkups.
Methods: This cross-sectional study was conducted at the Health Screening Department, University Medical Center at Ho Chi Minh City, Vietnam, using anonymous data from employees who had health checkups from June 2017 to June 2018.
Results: A total of 5727 subjects were included, with an overall HBV prevalence of 9.0%. The prevalence of HBV infection was significantly higher in men and lowest in the age groups of 18-30. In multivariable analysis, the variables that were independently associated with HBV infection were male gender (Odd ratio (OR), 2.03; 95% confidence interval (CI), 1.58-2.60; p < 0.001), older than 30 years old (age group of 31-40: OR 1.7; 95% CI, 1.33-2.18; p < 0.001; of 41-50, OR 1.82; 95% CI, 1.37-2.43; p < 0.001); high total cholesterol (OR, 0.77; 95% CI, 0.64-0.94; p = 0.011), high triglyceride (OR, 0.53; 95% CI, 0.42-0.65; p < 0.001), and having significant fibrosis (OR, 2.7; 95% CI 1.85-3,95; p < 0.001).
Conclusions: The prevalence of HBV infection among employees on health assessments is still high (9%), even in the age group under 30 (7%). Male, age group older than 30, and significant liver fibrosis were the factors related to HBV infection. High cholesterol and level triglyceride were protective factors against HBV infection.
目的:越南是世界上乙型肝炎病毒(HBV)感染高发地区之一。我们的研究旨在确定每年进行一般健康检查的不同年龄组工人中HBV感染的流行情况。方法:本横断面研究在越南胡志明市大学医学中心健康筛查部进行,使用了2017年6月至2018年6月进行健康检查的员工的匿名数据。结果:共纳入5727例受试者,HBV总患病率为9.0%。乙型肝炎病毒感染率在男性中明显较高,在18-30岁年龄组中最低。在多变量分析中,与HBV感染独立相关的变量为男性(奇数比(OR), 2.03;95%置信区间(CI), 1.58-2.60;p p p p = 0.011),高甘油三酯(OR, 0.53;95% ci, 0.42-0.65;结论:健康评估的员工中HBV感染率仍然很高(9%),甚至在30岁以下的年龄组中(7%)也是如此。男性、年龄大于30岁、肝纤维化明显是HBV感染的相关因素。高胆固醇和高甘油三酯水平是预防HBV感染的保护因素。
{"title":"Prevalence of hepatitis B virus infection in health checkup participants: a cross-sectional study at University Medical Center, Ho Chi Minh City, Vietnam.","authors":"Nguyen Thi Cam Huong, Nguyen Van Luu, Nguyen Hai Nam, Suhaib Ghula, Ahmad Taysir Atieh Qarawi, Pham Thi Mai Truc, Dang Nguyen Trung An, Nguyen Tien Huy, Pham Thi Le Hoa","doi":"10.1080/21548331.2023.2221132","DOIUrl":"https://doi.org/10.1080/21548331.2023.2221132","url":null,"abstract":"<p><strong>Objectives: </strong>Vietnam is one of the countries in highly endemic areas of hepatitis B virus (HBV) infection in the world. Our study aims to determine the prevalence of HBV infection among different age groups of workers who had been included for annual general health checkups.</p><p><strong>Methods: </strong>This cross-sectional study was conducted at the Health Screening Department, University Medical Center at Ho Chi Minh City, Vietnam, using anonymous data from employees who had health checkups from June 2017 to June 2018.</p><p><strong>Results: </strong>A total of 5727 subjects were included, with an overall HBV prevalence of 9.0%. The prevalence of HBV infection was significantly higher in men and lowest in the age groups of 18-30. In multivariable analysis, the variables that were independently associated with HBV infection were male gender (Odd ratio (OR), 2.03; 95% confidence interval (CI), 1.58-2.60; <i>p</i> < 0.001), older than 30 years old (age group of 31-40: OR 1.7; 95% CI, 1.33-2.18; <i>p</i> < 0.001; of 41-50, OR 1.82; 95% CI, 1.37-2.43; <i>p</i> < 0.001); high total cholesterol (OR, 0.77; 95% CI, 0.64-0.94; <i>p</i> = 0.011), high triglyceride (OR, 0.53; 95% CI, 0.42-0.65; <i>p</i> < 0.001), and having significant fibrosis (OR, 2.7; 95% CI 1.85-3,95; <i>p</i> < 0.001).</p><p><strong>Conclusions: </strong>The prevalence of HBV infection among employees on health assessments is still high (9%), even in the age group under 30 (7%). Male, age group older than 30, and significant liver fibrosis were the factors related to HBV infection. High cholesterol and level triglyceride were protective factors against HBV infection.</p>","PeriodicalId":35045,"journal":{"name":"Hospital practice (1995)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9845237","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}