Moses Taylor Hospital

Introduction: Peptic ulcer diseases (PUD) remain the most common cause of hospitalized upper GI bleeding patients (30%-60%). Upper endoscopy is needed for diagnosis, stratification, and endoscopic hemostatic therapy of these ulcers depending on the presence of stigmata of increased risk of rebleeding. PUDs with adherent clot (Forrest classification IIb) are at 20-30% risk of rebleeding with a 7% mortality rate. Recent ACG guidelines could not reach a recommendation for or against endoscopic interventions for ulcers with adherent clot resistant to vigorous irrigation. This systematic review and meta-analysis aims to analyze the randomized studies for the treatment of PUD with adherent clot. Methods: The OVID/Medline and Google Scholar databases were screened through June 2021 for randomized studies reporting outcomes (rebleeding and mortality rates) in patients with adherent clot undergoing either endoscopic or medical intervention. Random effects models were used for the meta-analysis. I2 statistics were used to interpret heterogeneity, with I2>75% indicating substantial inter-study variation. A sensitivity analysis was performed using the leave one out method. A p-value < 0.05 was considered statistically significant. Results: Initial database search yielded 1568 articles, of which 8 randomized studies were finally included (Table 1). The total sample size consisted of 713 patients with adherent clot; of which 359 underwent endoscopic intervention while 354 were treated with medical therapy alone (proton pump inhibitors). Meta-analysis of re-bleeding and mortality rates between endoscopic and medical treatment groups revealed a decreased risk of rebleeding with endoscopic intervention (OR 0.247, 95%CI: 0.122-0.498, P=< 0.001) (Figure 1A). Mortality rates (OR 0.573, 95% CI: 0.273-1.204, P=0.151) (Figure 1B), and rates of surgery did not differ significantly between the two cohorts (OR 1.177, 95%CI: 0.598-2.317, P=0.638). However, there was heterogeneity in the type of endoscopic interventions used. Conclusion: The results of our meta-analysis show that endoscopic interventions could benefit patients presenting to the hospital with UGIB due to PUD with adherent clot by decreasing risk of rebleeding. However, there was no effect of endoscopic therapy on mortality. Further, high-quality randomized controlled studies are needed to guide the endoscopists about managing PUD with adherent clot.Table 1.: Mortality in post-bariatric surgery patients that had UGIB (OR).Figure 1.: A. Demographics and mean ago of the study population. B. Group comparisons using a post hoc test.

Abstract Background and AimGastric acid has shown to neutralize many viruses. The working receptor of SARS-CoV-2 is angiotensin-converting enzyme-2 (ACE-2), which has shown to be omnipresent in the gastrointestinal tract. There is a theoretical concern that SARS-CoV-2 can escape the neutralization by gastric acid because of hypochlorhydria caused by the use of proton pump inhibitors (PPI) and can predispose the patients for severe COVID-19.MethodsWe studied the association between prehospitalization PPI use and clinical outcomes among hospitalized COVID-19 patients.ResultsIn our study, 15.6% of hospitalized COVID-19 patients were on PPIs at home. Mortality among PPI-users was 2.3 times higher than non-users, along with 2.5 times higher risk of mechanical ventilation. This relationship existed even after adjusting for confounding variables.ConclusionThese results warrant further investigation in prospective studies to evaluate if PPI-induced hypochlorhydria is associated with worse outcomes, including mortality because of the omnipresence of ACE-2 in the gastrointestinal tract.

To compare categories for activity/severity according to the Disease Activity Score 28-joint count (DAS28), the Clinical Disease Activity Index (CDAI), and the Routine Assessment of Patient Index Data 3 (RAPID3), an index without formal joint counts calculated in 5 versus >100 seconds, as well as the European League Against Rheumatism (EULAR)- DAS28 and the RAPID3 response criteria, in the Rheumatoid Arthritis Prevention of Structural Damage (RAPID 1) clinical trial of certolizumab pegol (CZP). Post hoc analyses were performed using correlations, cross-tabulations, and kappa statistics. Patients (treated with CZP plus methotrexate [MTX] or placebo plus MTX) were classified at baseline and at 52 weeks as high, moderate, low activity/severity or remission, according to the DAS28 (>5.1, >3.2 to ≤5.1, 2.6 to ≤3.2, <2.6 [total range 0-10]), the CDAI (>22, >10 to ≤22, >2.8 to ≤10, ≤2.8 [total range 0-76]), and RAPID3 (>12, >6 to ≤12, >3 to ≤6, ≤3 [total range 0-30]), as well as for good, moderate, and poor EULAR-DAS28 and proposed RAPID3 response criteria. All measures were correlated significantly: RAPID3 with DAS28 and CDAI (rho > 0.7), higher than erythrocyte sedimentation rate with C-reactive protein level (rho = 0.47). At 52 weeks, DAS28, CDAI, and RAPID3 low activity/remission was seen in 30%, 44%, and 42% of CZP-treated patients versus 3%, 7%, and 10% of control patients. Good, moderate, and poor EULAR-DAS28 responses were seen in 30%, 51%, and 19% of CZP-treated patients versus 3%, 28%, and 70% of control patients, and for RAPID3 in 39%, 30%, and 32% of CZP-treated patients versus 8%, 16%, and 76% of control patients. Kappa and weighted kappa values ranged from 0.36-0.53, indicating fair to moderate agreement. RAPID3, DAS28, and CDAI give similar results to distinguish CZP patients from controls in the RAPID 1 clinical trial. DAS28 is specific for clinical trials; RAPID3 appears pragmatically useful for usual care.

A community hospital with nearly 50% of its admitted patients 70 years or older adapted the well-established Hospital Elder Life Program (HELP). The primary adaptation entailed an enhanced participation of trained volunteers in HELP interventions designed to prevent and reduce delirium. Integral program elements include detailed volunteer training, required demonstration of competencies, and regular evaluation and feedback of volunteers provided by program staff. Nurse satisfaction with HELP increased from 64% to 91% in the second year of implementation, and a survey of patients and families indicated that 95% were satisfied with HELP. This innovative volunteer-assisted model of elder care support was positively embraced by patients, their families, and the nursing staff and supported by nursing administration. The use of volunteers is a cost-effective method of enhancing the nursing care of vulnerable elders during hospitalization.

Lalos, Alexander T. MD1; Bansal, Pardeep MD1; Rishikesh, Ranjitha MD1 Author Information

Hospitals and other health care organizations make continuing use of newspaper and magazine advertising as part of their marketing programs. However, many institutions have questioned the effectiveness of advertising because they have not achieved the results they had hoped for. Part of the problem may lie in the fact that many hospital advertisements violate the principles of good copywriting. Well written advertisements will draw larger readership, and should subsequently prove more effective in helping the institution achieve its communications objectives.