The Guthrie journal of the Donald Guthrie Foundation for Medical Research最新文献

{"title":"Assessing Knowledge and Attitudes of Nursing Staff Regarding Congestive Heart Failure Medication Regimens and Impact on Patient Understanding Post-Discharge","authors":"Alena Thannikal, Joshua Campbell, Lucy Ellis, Karen S Williams","doi":"10.3138/guthrie.75.1.03","DOIUrl":"https://doi.org/10.3138/guthrie.75.1.03","url":null,"abstract":"A previous study found 68% of readmitted patients did not understand their disease, and 52% did not understand their medications. Patients with heart failure with reduced ejection fraction (HFrEF) are taking complex medications with limited understanding of their role. By educating patients, they may prevent HFrEF progression. The study aimed to assess nursing and patient knowledge, describe differences in perceptions regarding adequacy of medication education provided, while collecting factors driving incomplete patient understanding. Patients admitted with an HFrEF diagnosis and inpatient nurses were included in the study. Patients were prospectively identified and contacted post-discharge for a knowledge and attitudes assessment. Both nurses and patients were anonymously surveyed about HFrEF medication regimens and attitudes towards medication education. The nursing survey yielded a response rate of 7.66% (16/209). One of 16 nurses could correctly identify all medications that improve mortality in HFrEF. Nine nurses (56.3%) felt patients could identify and manage potential side effects after medication education. The patient survey yielded a response rate of 30.3% (10/33). Zero patients after discharge could accurately identify at least 3 of the 6 medications that improve mortality in HFrEF. Only 2 patients (20%) could identify common side effects of HFrEF medications. This study identified gaps in medication education. Nurses struggled to identify mortality-reducing medications for HFrEF and side effects and provide complete medication education. These gaps may be addressed with interdisciplinary solutions that increase pharmacy presence in direct patient care.","PeriodicalId":83043,"journal":{"name":"The Guthrie journal of the Donald Guthrie Foundation for Medical Research","volume":"36 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79369256","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}

{"title":"Evaluation of the Survival Outcomes of Intestinal Adenosquamous Carcinomas Using the SEER 18 Registry: What Do We Know?","authors":"E. Yeung, Ceyda Bertram, Harsha Senapathi, Morgan Perry, A. Morada, David Bertsch, B. Cagir","doi":"10.3138/guthrie.75.1.02","DOIUrl":"https://doi.org/10.3138/guthrie.75.1.02","url":null,"abstract":"Intestinal adenosquamous carcinoma (ASC) is a rare malignancy. This study evaluated overall survival of this malignancy in the small intestine, colon, and rectum. Using the Surveillance, Epidemiology, and End Results (SEER) 18 registry, we analyzed cases from 2000 through 2015 by Cox proportional hazards using univariate and multivariate analysis, adjusting for age, primary tumor site, tumor grade, and type of surgery performed to calculate the hazard ratios for overall survival. All analyses were performed on R version 4.0.5. We identified 332 patients with ASC: small intestine ( n = 20, 6.02%), colon ( n = 200, 60.2%) and rectum ( n = 112, 33.7%). Age of diagnosis was significantly different between the groups: 44.5, 40, and 36, for small intestine, colon, and rectum, respectively ( p < 0.05). The 5-year survival for small intestine, colon, and rectum were 5.0%, 24.9% and 42.5%, respectively ( p < 0.001). Based on grade of cancer at diagnosis, overall 5-year survival was 61% for 1, 39.9% for 2, 25.9% for 3/4 tumors, and 24.1% for tumors of unknown grade with significant difference ( p = 0.006). The overall hazard ratio in poorly differentiated grade 3 tumors was 3.17 times that of well-differentiated tumors (95% CI, 1.01–9.96, p < 0.05). The overall hazard ratio for death in patients without any surgical intervention was 3.33 (95% CI, 2.34–4.72, p < 0.001) compared to patients who had surgery. There was high rate of diagnosis in advanced stages of ASC, which was associated with poor survival outcomes. Patients who underwent surgical intervention had better survival outcomes when adjusted for grade and site of tumor.","PeriodicalId":83043,"journal":{"name":"The Guthrie journal of the Donald Guthrie Foundation for Medical Research","volume":"70 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85107890","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}

{"title":"Improving Access to Harm Reduction Services in People Who Inject Drugs at a Rural Health System","authors":"A. Kaur, Karen S Williams","doi":"10.3138/guthrie.75.1.06","DOIUrl":"https://doi.org/10.3138/guthrie.75.1.06","url":null,"abstract":"Hospitalists are increasingly responsible for treating infectious complications related to injection-drug use. Despite these complications leading to hospitalizations, harm reduction interventions have not been widely adopted in inpatient settings. Use of naloxone is safe and effective at treating respiratory depression in patients with opioid overdose. The objectives of this study were to assess the need for a multi-modal approach to provide a standard of care in people who inject drugs (PWID), and to create and educate healthcare providers on tools that could improve delivery of harm reduction services. A review of medical records assessed the need for an intervention to increase access of harm reduction services. PWID 18 years or older who presented to the emergency department (ED) or were hospitalized were eligible. After clinician education, investigators utilized prospective audit to assess and re-educate on intervention use. Primary outcome was percentage of naloxone prescription or education provided at discharge. Secondary outcomes included percentage of disease screening, fentanyl test-strips education, safe-injection practice education, vaccination rates, and healthcare provider survey on naloxone. Sixty-five patients were analyzed for the baseline group and 15 patients for the post-intervention group. The median ages were 32 years (IQR, 19–64) and 32 years (IQR, 20–56) in the baseline and post-intervention groups, respectively. Naloxone prescriptions and education had an absolute percentage increase of 2.1% and 6.7%, respectively. Secondary outcomes were not analyzed due to a delay in the intervention implementation. Barriers to implementation of the intervention led to lack of data for analysis of harm reduction services in PWID in a rural hospital system. Future studies could evaluate other methods to increase these services and assess ways to optimize care through transitions.","PeriodicalId":83043,"journal":{"name":"The Guthrie journal of the Donald Guthrie Foundation for Medical Research","volume":"28 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82326832","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}

{"title":"The Guthrie Culture: Dedication to Research and Education","authors":"B. Cagir","doi":"10.3138/guthrie.75.1.01","DOIUrl":"https://doi.org/10.3138/guthrie.75.1.01","url":null,"abstract":"","PeriodicalId":83043,"journal":{"name":"The Guthrie journal of the Donald Guthrie Foundation for Medical Research","volume":"27 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80427787","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}

{"title":"Point-of-Care Naloxone Distribution in the ED Increases Provider Prescription Rate","authors":"Laura Walker, J. Rittenberger","doi":"10.3138/guthrie.75.1.07","DOIUrl":"https://doi.org/10.3138/guthrie.75.1.07","url":null,"abstract":"Distribution of naloxone rescue kits has been found to be safe, reduce death rate from overdose, and be associated with a decrease in high-risk opioid use A rural emergency department (ED) developed an intervention to increase provision of naloxone rescue kits to patients at risk of opioid overdose. Naloxone rescue kits were stocked in the ED Omnicell. An order set was created in the electronic medical record (EMR) consolidating order for rescue kit and referral to substance abuse treatment center. ED providers were given an educational session to demonstrate the effectiveness of naloxone rescue kits and the new care plan. A retrospective review of 12-month periods pre- and post-intervention was completed. Patients at risk of opioid overdose were identified by diagnosis or provider judgement. Primary outcome was order for rescue kit provision at time of discharge. Secondary outcomes included buprenorphine order in ED, referral to substance abuse treatment center, and attendance of 7-day post-discharge follow-up encounter. Analysis performed with chi-square test and a p value of <0.05 was considered significant. Rate of naloxone rescue kit order rose from 1.6% to 10.4% ( p = 0.0025). Rate of buprenorphine ordering rose from 14.2% to 31.3% ( p = 0.0007). Referrals to outpatient treatment did not differ (12.6% versus 19.6%; p = 0.1). Attendance of 7-day follow-up encounter decreased (24.5% versus 46.5%; p = 0.0001). This intervention modestly increased the provision of naloxone rescue kits in one ED. Future work should focus on care coordination with outpatient clinics to improve the follow-up rate.","PeriodicalId":83043,"journal":{"name":"The Guthrie journal of the Donald Guthrie Foundation for Medical Research","volume":"16 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88431657","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}

{"title":"The Internal COVID-19 Database Registry: A Rural, Community Hospital’s Experience with the Pandemic","authors":"M. Assaad, A. Karki","doi":"10.3138/guthrie.75.1.04","DOIUrl":"https://doi.org/10.3138/guthrie.75.1.04","url":null,"abstract":"The COVID-19 pandemic has brought to light several long-term complications that may be challenging for clinicians to manage. Therefore, it is imperative for physicians to be able to identify patients at risk for infection and to understand the deleterious physiologic and clinical effects the virus can have on long-term lung function. The authors utilized the internal COVID-19 database registry at a rural, community hospital to identify the presence of pulmonary-specific conditions that may have predisposed the patient population to infection. Data were collected from 1,329 patients admitted to the hospital between March 2020 and November 2021. Data regarding patient demographics, vaccination status, baseline pulmonary conditions, and pulmonary function tests were collected. All statistical analysis was carried out in R statistical programming language (R Core Team, 2021). The pulmonary condition that had the highest mortality rate (42.86%) was obesity hypoventilation syndrome; however, the total number of patients with this diagnosis was only 7. With regards to change in pulmonary function parameters following admission, the only variable that was found to be statistically significant was a decrease in DLCO (diffusing capacity) for patients who survived. Interestingly, there was no statistically significant difference in mortality among vaccinated patients. Although some confounding variables may exist, the registry database may prove clinically useful to help guide physicians in establishing disease patterns and better managing long-term complications from COVID-19. Additional variables of interest to measure may include new imaging findings of pulmonary fibrosis, development of pulmonary hypertension, and new oxygen requirements.","PeriodicalId":83043,"journal":{"name":"The Guthrie journal of the Donald Guthrie Foundation for Medical Research","volume":"68 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72644978","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}

{"title":"Emergency Department Utilization within a Rural Health System during Early COVID-19 Pandemic","authors":"L. Walker, Clinton Hobson, Morgan Perry, J. Rittenberger","doi":"10.3138/guthrie.75.1.05","DOIUrl":"https://doi.org/10.3138/guthrie.75.1.05","url":null,"abstract":"Stay-at-home orders were issued during March 2020 to contain the spread of COVID-19. We sought to understand the impact of COVID-19 on emergency care utilization within one rural health system. This studied a retrospective cohort of patients presenting to system emergency departments (EDs). Primary outcome was ED volume. Secondary outcomes were admission rate for stroke, acute coronary syndrome (ACS), and critical illness states. A report was generated for all ED visits during study period March 19–May 31, 2020, and reference period: March 19–May 31, 2019. For the primary outcome, a regression model was used. Mixed-effects logistic and linear models were used for evaluating differences in rates for secondary outcomes. There was a decrease in weekly volume (−609 ±57, p < 0.001). There was an increase in admission rate for sepsis (OR 1.43 [95% CI 1.18–1.72]), stroke (OR 1.54 [95% CI 1.11–2.12]), and overall critical illness presentation (OR 1.59 [95% CI 1.41–1.8]). There were higher rates of vasopressor use (OR 1.91 [95% CI 1.56–2.33]) and inpatient mortality (OR 1.49 [95% CI 1.09–2.05]). There were 37 cases of COVID-19. ED volume decreased by 40% with evidence of greater severity of illness in the setting of low COVID-19 disease burden. Efforts should be developed to reassure the public of the importance and safety of timely hospital care during future pandemics. Hospital staffing models should anticipate greater severity of illness despite lower patient volume.","PeriodicalId":83043,"journal":{"name":"The Guthrie journal of the Donald Guthrie Foundation for Medical Research","volume":"51 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81916969","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}

{"title":"Bronchogenic Cyst Diagnosed by Bronchoscopy with Endobronchial Ultrasound (EBUS) and Transbronchial Needle Aspiration (TBNA)—A Case Report and Review of the Literature","authors":"M. Assaad, R. Meenakshisundaram, M. Swalih, J. Lantry, Jonathan Burgei, Katie M Alsheimer, Anam Aqeel, Louis Dubois, B. Hehn","doi":"10.53481/001c.57698","DOIUrl":"https://doi.org/10.53481/001c.57698","url":null,"abstract":"Lower respiratory tract anomalies are not commonly encountered in clinical practice, specifically with regards to adult medicine. Bronchogenic cysts, in particular, are rare anomalies that may present as a diagnostic challenge for most clinicians, especially if the patient is asymptomatic. Furthermore, presenting symptoms are often non-specific, and imaging may be misleading. Historically, gold standard for diagnosis requires surgical resection and pathological evaluation. However, there may be a role for bronchoscopy and endobronchial ultrasound (EBUS) with transbronchial needle aspiration (TBNA) in the diagnosis and, potentially, treatment of bronchogenic cysts. The patient was referred to pulmonary for abnormal imaging. A computed tomography scan of the chest revealed a mediastinal mass that was initially concerning for malignancy. After undergoing bronchoscopy with EBUS, it was determined based on ultrasound that the lesion in question was in fact cystic in nature. Furthermore, TBNA of the lesion yielded serous fluid and resulted in shrinkage of the lesion. There are several peer-reviewed, published case reports detailing the use of bronchoscopy with EBUS-TBNA to aid in diagnosis of bronchogenic cysts. The obvious advantage of this method is potentially avoiding unnecessary surgery. However, there are also case reports detailing potentially fatal adverse events from performing needle aspiration of bronchogenic cysts, the most devastating being mediastinitis. Further data is needed regarding the utility and safety of bronchoscopy with EBUS-TBNA in diagnosing and managing bronchogenic cysts.","PeriodicalId":83043,"journal":{"name":"The Guthrie journal of the Donald Guthrie Foundation for Medical Research","volume":"70 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84566840","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}

{"title":"Parathyroid Carcinoma: A Diagnostic Challenge – A Case Report","authors":"F. Manas, Shobha Mandal, B. Mols-Kowalczewski","doi":"10.53481/001c.37960","DOIUrl":"https://doi.org/10.53481/001c.37960","url":null,"abstract":"Parathyroid carcinoma is a rare endocrine carcinoma, presenting as hypercalcemia with elevated parathyroid hormone (PTH) levels, and with renal and bone involvement. It is often misdiagnosed as parathyroid adenoma, resulting in conservative resection of the parathyroid gland and recurrence or metastasis after a few years. A 52-year-old, morbidly obese woman presented with asymptomatic hypercalcemia and elevated PTH. Ultrasound of the neck showed a cystic lesion adjacent to the right thyroid lobe. Sestamibi (MIBI) parathyroid scintigraphy showed increased radiopharmaceutical uptake by the right superior parathyroid gland without any enlarged or suspicious lymph nodes. She was diagnosed with primary hyperparathyroidism. She underwent right superior parathyroidectomy and en bloc right thyroid lobectomy due to suspicion of parathyroid carcinoma. The histological examination was consistent with parathyroid carcinoma. Parathyroid carcinoma is a rare disease with no clear diagnostic criteria. The curative treatment for parathyroid carcinoma is the initial en bloc resection. Therefore, early diagnosis is important and high clinical suspicion is warranted in patients with severe hypercalcemia and markedly elevated PTH, with or without palpable neck mass, and renal or bone involvement.","PeriodicalId":83043,"journal":{"name":"The Guthrie journal of the Donald Guthrie Foundation for Medical Research","volume":"100 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74960825","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}

{"title":"Regional differences in buprenorphine distribution in Pennsylvania from 2010-2020","authors":"Alden J. Mileto, Robert J. Rinaldi, Steven J. Grampp, K. McCall, B. Piper","doi":"10.1101/2022.07.01.22277139","DOIUrl":"https://doi.org/10.1101/2022.07.01.22277139","url":null,"abstract":"Background Buprenorphine is a synthetic opioid frequently used in combination with naloxone for the treatment of opioid use disorder (OUD). Overall buprenorphine distribution has increased nationally; however, pronounced regional differences in this distribution have also been identified. The objective of this study was to analyze buprenorphine distribution by three-digit zip codes in Pennsylvania from 2010-2020. Methods Data was extracted from the Drug Enforcement Administrations Automated Reports and Consolidated Orders System (ARCOS) yearly to gather buprenorphine distribution, in grams per 3-digit zip code, from 2010-2020. After compiling this data, a percent change for each 3-digit zip code was calculated to analyze the change in distribution from 2010-2020. The total weight of buprenorphine distributed for the state of Pennsylvania over the last decade was calculated. The amount of buprenorphine distributed in grams per each 3-digit zip code was compared to their population densities to analyze if there was any association between population and buprenorphine distribution. Zip codes that were outside of a 95% confidence interval were considered significant (p < .05). Results Pennsylvania pharmacies and hospitals dispensed 116.3 kg of buprenorphine in 2010. That number increased 217.3% to 369.0 kg in 2020. The 155-zip code (Somerset) experienced the largest increase (885%). In contrast the 190-zip (Philadelphia) experienced the smallest increase (79%). The 155 (Somerset), 169 (Wellsboro), and 177 (Williamsport) zip codes experienced significantly greater elevations relative to the state average. Conclusion Our analysis uncovered that buprenorphine distribution in Pennsylvania from 2010-2020 rose 217%. With the increasing awareness of opioid addiction, and the large number of opioid prescriptions in the US, this increase was expected. The zip codes of 155, 169, 177 showed a statistically significant increase in buprenorphine distribution relative to the overall state average. No zip codes displayed a statistically significant decrease in buprenorphine distribution. Interestingly, some of the more densely populated areas in Pennsylvania were at or below the average state increase of 217% (Pittsburgh 150-152: 228%; Philadelphia 190-191: 79%; Harrisburg 170-171: 202%). Furthermore, the statistically significant zip codes of 155, 169, and 177 were among the least densely populated areas of Pennsylvania. Further pharmacoepidemiological research is needed to continue to characterize, and ideally remediate, the pronounced regional variation in buprenorphine distribution.","PeriodicalId":83043,"journal":{"name":"The Guthrie journal of the Donald Guthrie Foundation for Medical Research","volume":"43 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90428563","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}