scholarly journals Safety of low-volume PEG-asc bowel cleansing preparation for colonoscopy: identifying patients at risk for hypokalemia in a prospective cohort study

2021 ◽  
Vol 09 (08) ◽  
pp. E1198-E1204
Author(s):  
Ankie Reumkens ◽  
Christine Minke Bakker ◽  
Sebastiaan J.W. van Kraaij ◽  
Bjorn Winkens ◽  
Maarten T. Raijmakers ◽  
...  
Keyword(s):  
At Risk ◽  
Bowel Preparation ◽  
Cardiac Risk ◽  
High Risk Population ◽  
Serious Adverse Events ◽  
Safety Standards ◽  
Bowel Cleansing ◽  
Before And After ◽  
Patients At Risk ◽  
Low Volume

Abstract Background and study aims The aim of bowel cleansing preparation should be high-quality results and conformance with safety standards. Previously, we reported that hypokalemia occurred in 23.6 % of patients after bowel preparation in a high-risk population on diuretics or hospitalized and referred for colonoscopy. Here we report on a prospective study in a non-selected colonoscopy cohort to identify patients at risk of developing hypokalemia before and after bowel cleansing with low-volume polyethylene glycol with ascorbic acid (PEG-asc). Patients and methods From January 1 to July 31, 2016, we included all patients undergoing colonoscopy in our institution. Prevalences of hypokalemia before and after PEG-asc bowel cleansing for colonoscopy were calculated and risk factors for developing hypokalemia after PEG-asc bowel cleansing were identified. Results In total, 2011 patients were included in the analysis. Of these, 0.8 % had hypokalemia before bowel cleansing with PEG-asc. After bowel preparation, 5.4 % developed hypokalemia. Of the patients, 281 were considered to have “high cardiac risk.” The combination of “high cardiac risk” and hypokalemia was present in 1 % of the initial colonoscopy population. Female sex, colorectal cancer diagnosis, and thiazide use were found to be significant predictors for hypokalemia after use of PEG-asc. No arrhythmias or serious adverse events due to hypokalemia occurred. Conclusions Physicians referring patients for colonoscopy should be aware that “high cardiac risk” patients and those on thiazide diuretics undergoing bowel cleansing for colonoscopy are a risk of developing post-cleansing hypokalemia but it remains to be determined whether their risk of developing life-threatening arrhythmias is truly increased.

Trastuzumab-Induced Cardiotoxicity: Clinical and Prognostic Implications of Troponin I Evaluation

2010 ◽  
Vol 28 (25) ◽  
pp. 3910-3916 ◽  
Author(s):  
Daniela Cardinale ◽  
Alessandro Colombo ◽  
Rosalba Torrisi ◽  
Maria T. Sandri ◽  
Maurizio Civelli ◽  
...  
Keyword(s):  
At Risk ◽  
Cardiac Dysfunction ◽  
Troponin I ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Trastuzumab Therapy ◽  
Before And After ◽  
Patients At Risk ◽  
Prognostic Implications

Purpose Treatment of breast cancer with trastuzumab is complicated by cardiotoxicity in up to 34% of the patients. In most patients, trastuzumab-induced cardiotoxicity (TIC) is reversible: left ventricular ejection fraction (LVEF) improves after trastuzumab withdrawal and with, or sometimes without, initiation of heart failure (HF) therapy. The reversibility of TIC, however, is not foreseeable, and identification of patients at risk and of those who will not recover from cardiac dysfunction is crucial. The usefulness of troponin I (TNI) in the identification of patients at risk for TIC and in the prediction of LVEF recovery has never been investigated. Patients and Methods In total, 251 women were enrolled. TNI was measured before and after each trastuzumab cycle. LVEF was evaluated at baseline, every 3 months during trastuzumab therapy, and every 6 months afterward. In case of TIC, trastuzumab was discontinued, and HF treatment with enalapril and carvedilol was initiated. TIC was defined as LVEF decrease of > 10 units and below 50%. Recovery from TIC was defined as LVEF increase above 50%. Results TIC occurred in 42 patients (17%) and was more frequent in patients with TNI elevation (TNI+; 62% v 5%; P < .001). Twenty-five patients (60%) recovered from TIC. LVEF recovery occurred less frequently in TNI+ patients (35% v 100%; P < .001). At multivariate analysis, TNI+ was the only independent predictor of TIC (hazard ratio [HR], 22.9; 95% CI, 11.6 to 45.5; P < .001) and of lack of LVEF recovery (HR, 2.88; 95% CI,1.78 to 4.65; P < .001). Conclusion TNI+ identifies trastuzumab-treated patients who are at risk for cardiotoxicity and are unlikely to recover from cardiac dysfunction despite HF therapy.

A novel device for intracolonoscopy cleansing of inadequately prepared colonoscopy patients: a feasibility study

Endoscopy ◽  
2018 ◽  
Vol 51 (01) ◽  
pp. 85-92 ◽  
Author(s):  
Kelly van Keulen ◽  
Helmut Neumann ◽  
Jörn Schattenberg ◽  
Aura van Esch ◽  
Wietske Kievit ◽  
...  
Keyword(s):  
Feasibility Study ◽  
Bowel Preparation ◽  
Ease Of Use ◽  
Procedure Time ◽  
Cecal Intubation ◽  
New Device ◽  
Novel Device ◽  
Bowel Cleansing ◽  
Before And After ◽  
Cleaning Device

Abstract Background The importance of high quality preprocedural bowel preparation is widely acknowledged, but suboptimal bowel cleansing still occurs in up to 20 % of all colonoscopy patients. The aim of this study was to evaluate the performance of a novel intraprocedural cleaning device for cleaning poorly prepared colons. Methods This multicenter feasibility study included patients aged 18 – 75 years who were referred for colonoscopy. Intraprocedural cleaning was performed in patients after a limited preprocedural bowel preparation regimen (2 days of dietary restrictions and 2 × 10 mg bisacodyl). The primary outcome was the proportion of adequately prepared patients (Boston Bowel Preparation scale [BBPS] ≥ 2 in each segment) before and after segmental washing with the new device. Secondary outcomes included: cecal intubation rate, procedure time, system usability, patient satisfaction, and safety. Results 47 patients (42.6 % male), with a median age of 61 years (interquartile range [IQR] 46 – 67 years), were included at three clinical sites. Cecal intubation was achieved in 46/47 patients (97.9 %). The cleaning device significantly improved the proportion of patients with adequate bowel cleansing (from 19.1 % to 97.9 %; P < 0.001) and median BBPS score (from 3.0 [IQR 0.0 – 5.0] to 9.0 [IQR 8.0 – 9.0]). Median cecal intubation time and total procedure time were 16.5 minutes (IQR 9.0−28.3) and 34.0 minutes (IQR 25.0 – 42.8), respectively. Physicians were satisfied with the ease of use of the device and it was well tolerated by patients. No severe adverse events occurred during the study period. Conclusions This feasibility study suggests that the intraprocedural cleaning device appears to be safe and effective in cleaning poorly prepared colons to an adequate level, allowing a thorough colorectal examination.

A Pharmacist-Driven Glycemic Control Protocol to Reduce the Rate of Severe Hypoglycemia in High-Risk Patients

2020 ◽  
pp. 001857872097389
Author(s):  
Colleen A. Cook ◽  
Victor Vakayil ◽  
Kyle Pribyl ◽  
Derek Yerxa ◽  
John Kriz ◽  
...  
Keyword(s):  
At Risk ◽  
High Risk ◽  
Glycemic Control ◽  
Risk Reduction ◽  
Severe Hypoglycemia ◽  
Diabetic Patients ◽  
Control Protocol ◽  
Before And After ◽  
Patients At Risk ◽  
Acceptance Rates

Purpose: Hospital pharmacists contribute to patient safety and quality initiatives by overseeing the prescribing of antidiabetic medications. A pharmacist-driven glycemic control protocol was developed to reduce the rate of severe hypoglycemia events (SHE) in high-risk hospitalized patients. Methods: We retrospectively analyzed the rates of SHE (defined as blood glucose ≤40 mg/dL), before and after instituting a pharmacist-driven glycemic control protocol over a 4-year period. A hospital glucose management team that included a lead Certified Diabetes Educator Pharmacist (CDEP), 5 pharmacists trained in diabetes, a lead hospitalist, critical care and hospital providers established a process to first identify patients at risk for severe hypoglycemia and then implement our protocol. Criteria from the American Diabetes Association and the American Association of Clinical Endocrinologists was utilized to identify and treat patients at risk for SHE. We analyzed and compared the rate of SHE and physician acceptance rates before and after protocol initiation. Results: From January 2015 to March 2019, 18 297 patients met criteria for this study; 139 patients experienced a SHE and approximately 80% were considered high risk diabetes patients. Physician acceptance rates for the new protocol ranged from 77% to 81% from the year of initiation (2016) through 2018. The absolute risk reduction of SHE was 9 events per 1000 hospitalized diabetic patients and the relative risk reduction was 74% SHE from the start to the end of the protocol implementation. Linear regression analysis demonstrated that SHE decreased by 1.5 events per 1000 hospitalized diabetic patients (95% confidence interval, −1.54 to −1.48, P < .001) during the 2 years following the introduction of the protocol. This represents a 15% relative reduction of SHE per year. Conclusion: The pharmacist-driven glycemic control protocol was well accepted by our hospitalists and led to a significant reduction in SHE in high-risk diabetes patient groups at our hospital. It was cost effective and strengthened our physician-pharmacist relationship while improving diabetes care.

scholarly journals Development and validation of a scoring system for predicting cancer patients at risk of extended-spectrum b-lactamase-producing Enterobacteriaceae infections.

2020 ◽  
Author(s):  
Alvaro Jose Martinez-Valencia ◽  
Brian J Gómez Martínez ◽  
Anita M Montañez Ayala ◽  
Katherin Garcia ◽  
Ricardo Sánchez Pedraza ◽  
...  
Keyword(s):  
At Risk ◽  
Cancer Patients ◽  
Scoring System ◽  
Conditional Logistic Regression ◽  
Characteristic Curve ◽  
High Risk Population ◽  
Eligibility Criteria ◽  
Extended Spectrum Beta Lactamase ◽  
Extended Spectrum ◽  
Patients At Risk

Abstract Background: Extended-spectrum beta-lactamase producing Enterobacteriaceae (ESBL-PE) infections are frequent and highly impact cancer patients. We developed and validated a scoring system to identify cancer patients harboring ESBL-PE at the National Institute of Cancer of Colombia. Methods: We retrospectively analyzed medical records of 1695 cancer patients. Derivation phase included 710 patients admitted between 2013 to 2015, ESBL-PE positive culture (n = 265) paired by month and hospitalization room with Non-ESBL-PE (n = 445). A crude and weighted score was developed by conditional logistic regression. The model was evaluated in a Validation cohort (n = 985) with the same eligibility criteria between 2016 to 2017. Results: The score was based on eight variables (reported with Odds Ratio and 95% confidence interval): Hospitalization ≥7 days (5.39 [2.46 - 11.80]), Hospitalization during the previous year (4 , 87 [2.99 - 7.93]), immunosuppressive therapy during the previous 3 months (2.97 [1.44-6.08]), Neutropenia (1.90 [1.12 - 3.24]), Exposure to Betalactams during previous month (1.61 [1.06 - 2.42]), Invasive devices (1.51 [1.012 - 2.25]), Neoplasia in remission (2.78 [1.25 - 1.17]), No chemotherapy during the previous 3 months (1.90 [1.22 - 2.97]). The model demonstrated an acceptable discriminatory capacity in the Derivation phase, but poor in the Validation phase (Recipient Operating Characteristic Curve: 0.68 and 0.55 respectively). Conclusions: Cancer patients have a high prevalence of risk factors for ESBL-PE infection. The scoring system did not adequately discriminate patients with ESBL-PE. In a high-risk population, other strategies should be sought to identify patients at risk of resistant ESBL-PE infection.

New Ultra Low Volume Bowel Preparation and Overview of Existing Bowel Preparations

2020 ◽  
Vol 21 (11) ◽  
pp. 844-849 ◽  
Author(s):  
Hein Htet ◽  
Jonathan Segal
Keyword(s):  
Clinical Trials ◽  
Side Effects ◽  
Bowel Preparation ◽  
High Volume ◽  
Extensive Literature ◽  
Electrolyte Disturbances ◽  
Bowel Cleansing ◽  
Bowel Prep ◽  
Low Volume ◽  
Bowel Preparations

Background: Adequate bowel cleansing is essential in achieving a good quality colonoscopy. However, one of the barriers to achieving high-quality bowel cleansing is the patient's tolerability. Different bowel preparations have been developed to improve tolerability while maintaining adequate bowel cleansing. Objectives: We aim to explore the pros and cons of commonly used bowel preparations, particularly highlighting the new ultra-low volume bowel preparation. Methods:: Extensive literature search was carried out on various databases to evaluate the effectiveness and side effects of different bowel cleansing agents, including findings of recent clinical trials on ultra-low bowel preparation. Results:: Polyethylene glycol (PEG) has been commonly used as a bowel prep. Due to its high volume required to ingest to achieve an adequate effect, it has been combined with various adjuncts to reduce the volume to make it more tolerable. Magnesium and phosphate-based preps can achieve low volume, but they can be associated with multiple side effects, mainly electrolyte disturbances. Ultra low volume prep (NER1006) was achieved by combing PEG with ascorbic acid, and its efficacy and side effects were demonstrated in three noninferiority studies. Conclusion: It is important to consider patient preferences, co-morbidities and tolerability, and efficacy and side effect profiles when choosing bowel prep for patients undergoing colonoscopy. New ultra-low bowel prep showed promising results in initial clinical trials, but further real-world post-marketing data will inform its value in clinical practice.

scholarly journals Antibody Responses in HIV-Infected Patients With Advanced Immunosuppression and Asymptomatic Cryptococcal Antigenemia

2018 ◽  
Vol 6 (1) ◽  
Author(s):  
Admire Hlupeni ◽  
Antonio Nakouzi ◽  
Tao Wang ◽  
Kathryn F Boyd ◽  
Tariro A Makadzange ◽  
...  
Keyword(s):  
At Risk ◽  
T Cell ◽  
Characteristic Curve ◽  
Information Criteria ◽  
Immunoglobulin M ◽  
Cd4 T Cell ◽  
Enzyme Linked Immunosorbent Assay ◽  
Before And After ◽  
Plasma Antibody ◽  
Patients At Risk

Abstract Background There are no host biomarkers of risk for HIV-associated cryptococcal meningitis (CM) except CD4+ T-cell deficiency. At present, serum cryptococcal antigen (CrAg) screening of those with CD4 &lt;100 cells/µL is used to identify persons at risk for HIV-associated CM. We determined if plasma antibody profiles could discriminate CrAg+ from CrAg- patients. Methods We performed serological analyses of 237 HIV-infected asymptomatic Zimbabwean patients with CD4 &lt;100 cells/µL; 125 CrAg- and CrAg+ but cerebrospinal fluid CrAg- by CrAg lateral flow assay. We measured plasma immunoglobulin M (IgM), immunoglobulin G (IgG) 1, and IgG2 concentrations by Luminex, and titers of Cryptococcus neoformans (Cn) glucuronoxylomannan (GXM) polysaccharide and naturally occurring Laminarin (natural Lam, a β-(1–3)-glucan linked polysaccharide)-binding IgM and IgG by enzyme-linked immunosorbent assay. Results GXM-IgG, -IgM, and -IgG2 levels were significantly higher in CrAg+ patients, whereas natural Lam-IgM and Lam-IgG were higher in CrAg- patients before and after adjustment for age, sex, and CD4 T-cell count, despite overlap of values. To address this variability and better discriminate the groups, we used Akaike Information Criteria to select variables that independently predicted CrAg+ status and included them in a receiver operating characteristic curve to predict CrAg status. By inclusion of CD4, GXM-IgG, GXM-IgM, and Lam-IgG, -IgG2, and -IgM, this model had an 80.4% probability (95% confidence interval, 0.75–0.86) of predicting CrAg+ status. Conclusions Statistical models that include multiple serological variables may improve the identification of patients at risk for CM and inform new directions in research on the complex role that antibodies may play in resistance and susceptibility to CM.

The Effect of Rapid Screening for Methicillin-ResistantStaphylococcus aureus(MRSA) on the Identification and Earlier Isolation of MRSA-Positive Patients

2010 ◽  
Vol 31 (4) ◽  
pp. 374-381 ◽  
Author(s):  
Eilish Creamer ◽  
Anthony Dolan ◽  
Orla Sherlock ◽  
Toney Thomas ◽  
John Walsh ◽  
...  
Keyword(s):  
At Risk ◽  
Predictive Value ◽  
Tertiary Care ◽  
Turnaround Time ◽  
Rapid Screening ◽  
Pcr Assay ◽  
Period 2 ◽  
Before And After ◽  
Patients At Risk ◽  
Risk Patients

Objectives.(1) To determine whether rapid screening with polymerase chain reaction (PCR) assays leads to the earlier isolation of patients at risk for methicillin-resistantStaphylococcus aureus(MRSA) colonization, (2) to assess compliance with routine MRSA screening protocols, (3) to confirm the diagnostic accuracy of the Xpert MRSA real-time PCR assay (Cepheid) by comparison with culture, and (4) to compare turnaround times for PCR assay results with those for culture results.Design.Before-and-after study conducted in a 700-bed acute tertiary care referral hospital. Study periods were (1) a 5-week period before PCR testing began, (2) a 10-week period when the PCR assay was used, and (3) a 5-week period after PCR testing was discontinued.Results.Among 489 at-risk patients, MRSA was isolated from 20 (33%) of 60 patients during period 1, 77 (22%) of 349 patients during period 2, and 18 (23%) of 80 patients during period 3. Twenty-two (27%) of 82 at-risk patients were not screened during period 1, compared with 40 (10%) of 389 at-risk patients not screened during period 2 (P< .001). More MRSA-positive patients were preemptively isolated during periods 1 and 3 compared with period 2 (34 [24%] of 140 vs 28 [8%] of 389;P< .001); however, more MRSA-positive patients were isolated after notification of MRSA-positive results during period 2 (47 [13%] of 349) compared with periods 1 and 3 (2 [1%] of 140;P< .001). The sensitivity, specificity, positive predictive value, and negative predictive value of the PCR assay were 95%, 97%, 82%, and 99%, respectively. The mean turnaround time from receipt of specimens in the laboratory to PCR assay result was 2.6 hours.Conclusions.Rapid screening with the Xpert MRSA PCR assay facilitated compliance with screening policies and the earlier isolation of MRSA-positive Patients. Discrepant results confirm that PCR testing should be used as a screening tool rather than as a diagnostic tool.

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