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Healthcare utilization and costs associated with gastroparesis

World Journal of Gastroenterology 2017年第24期23卷 4428-4436页

作者： Vaibhav Wadhwa Dhruv Mehta Yash Jobanputra Rocio Lopez Prashanthi N Thota Madhusudhan R Sanaka Department of internal medicine Fairview HospitalCleveland Clinic Department of internal medicine Westchester Medical Center Department of Gastroenterology and Hepatology Digestive Disease InstituteCleveland Clinic Center for Advanced Endoscopy Digestive Disease InstituteCleveland Clinic

To use a national database of United States hospitals to evaluate the incidence and costs of hospital admissions associated with gastroparesis. METHODSWe analyzed the National Inpatient Sample Database (NIS) for all patients in whom gastroparesis (ICD-9 code: 536.3) was the principal discharge diagnosis during the period, 1997-2013. The NIS is the largest publicly available all-payer inpatient care database in the United States. It contains data from approximately eight million hospital stays each year. The statistical significance of the difference in the number of hospital discharges, length of stay and hospital costs over the study period was determined by regression analysis. RESULTSIn 1997, there were 3978 admissions with a principal discharge diagnosis of gastroparesis as compared to 16460 in 2013 (P < 0.01). The mean length of stay for gastroparesis decreased by 20 % between 1997 and 2013 from 6.4 d to 5.1 d (P < 0.001). However, during this period the mean hospital charges increased significantly by 159 % from $13350 (after inflation adjustment) per patient in 1997 to $34585 per patient in 2013 (P < 0.001). The aggregate charges (i.e., “national bill”) for gastroparesis increased exponentially by 1026 % from $50456642 ± 4662620 in 1997 to $568417666 ± 22374060 in 2013 (P < 0.001). The percentage of national bill for gastroparesis discharges (national bill for gastroparesis/total national bill) has also increased over the last 16 years (0.0013% in 1997 vs 0.004% in 2013). During the study period, women had a higher frequency of gastroparesis discharges when compared to men (1.39/10000 vs 0.9/10000 in 1997 and 5.8/10000 vs 3/10000 in 2013). There was a 6-fold increase in the discharge diagnosis of gastroparesis amongst type 1 DM and 3.7-fold increase amongst type 2 DM patients over the study period (P < 0.001). CONCLUSIONThe number of inpatient admissions for gastroparesis and associated costs have increased significantly over the last 16 years. Inpatient cost

关键词： Inpatient admission rates Gastroparesis Cancer epidemiology National inpatient database

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Patient Feedback for Acupuncture Practice Improvement:A Survey from Mayo clinic

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Chinese Journal of Integrative medicine 2017年第11期23卷 816-821页

作者： Barbara S Thomley Saswati Mahapatra Brent A Bauer Molly J Mallory LI Guang-xi Alexander Do Tony Y Chon Division of Operations Mayo Clinic HospitalAZ(85054)United States Integrative medicine and Health Division of General Internal MedicineMayo ClinicMN(55902)United States

Objective： To understand patient satisfaction with acupuncture appointment duration for the first and subsequent appointments in the plan of care, time spent with the acupuncture provider, willingness to pay for longer duration appointments, and lack of insurance coverage. Methods： Patients who were referred for an acupuncture consult to the Center for Integrative medicine at Mayo clinic were asked to participate in the survey in August 2014. Patients were given paper survey at time of appointment check-in and entered into Research Electronic Data Capture Survey database tool to reveal patient-reported outcomes. Results： In total, 104 of 329 patients receiving acupuncture treatment responded to the survey with a 32% response rate. Insight and recommended changes to the duration of the initial and subsequent appointments were obtained. Most patients reported that time spent with the provider（76 cases, 74%） and appointment length（74 cases, 68%） were ＂just right＂. Seventy cases（70%） of respondents indicated that they wanted longer treatment. Patients reported return appointments with duration of 30 min was not enough. Fifty-three patients（62%） were willing to pay for additional costs not covered by insurance. Conclusions： We used patient feedback to assess the acupuncture practice in a complementary and integrative medicine program. Most patients referred for the acupuncture consult appeared to be satisfied with the current level of practice. These findings were used to establish a quality improvement plan that may be implemented to improve patient satisfaction with the acupuncture practice.

关键词： care survey health integrative medicine acupuncture practice

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Diffuse large B-cell lymphoma successfully treated with amplified natural killer therapy alone: A case report

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World Journal of clinical Cases 2023年第30期11卷 7432-7439页

作者： Kenjiro Nagai Syo Nagai Yuji Okubo Keisuke Teshigawara Department of internal medicine Medical Corporation Ebino Centro ClinicEbino 889-4304Japan Department of internal medicine Higashinotoin ClinicKyoto 604-8175Japan

BACKGROUND The prognosis of patients with advanced diffuse large B-cell lymphoma(DLBCL)is poor,with a 5-year survival rate of approximately 50%.The mainstay of treatment is multidrug combination chemotherapy,which has been associated with serious side *** natural killer(ANK)cell therapy amplifies and activates natural killer(NK)cells to attack only malignant *** ANK cells attack programmed death ligand 1(PD-L1)-positive tumor cells,ANK therapy is considered effective against adult T-cell lymphoma and malignant *** SUMMARY Herein,we report a case of an older patient with advanced DLBCL who was successfully treated with ANK immunotherapy.A 91-year-old female visited our hospital with sudden swelling of the right axillary lymph node in April *** patient was diagnosed with stage II disease,given the absence of splenic involvement or contralateral *** therapy was *** rounds of lymphocyte sampling were performed on July 28,*** reduce the occurrence of side effects,the six samples were diluted by half to obtain 12 *** NK cells were administered twice *** treatment efficacy was evaluated by performing computed tomography and serological tests every 1 or 2 *** treatment suppressed lesion growth,and the antitumor effect persisted for several *** patient experienced mild side ***-L1 immunostaining was positive,indicating that the treatment was highly *** ANK therapy can be used as a first-line treatment for malignant lymphoma;the PD-L1 positivity rate can predict treatment efficacy.

关键词： Diffuse large B-cell lymphoma Natural killer cells Immunostaining Hodgkin's lymphoma Older adult Case report

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Management of gastrointestinal bleed in the intensive care setting,an updated literature review

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World Journal of Critical Care medicine 2025年第1期14卷 20-41页

作者： Vignesh K Nagesh Sai Priyanka Pulipaka Ruchi Bhuju Emelyn Martinez Shruthi Badam Gomathy Aarthy Nageswaran Hadrian Hoang-Vu Tran Daniel Elias Charlene Mansour Jaber Musalli Sanket Bhattarai Lokeash Subramani Shobana Tannishtha Sethi Ritvik Sethi Namrata Nikum Chinmay Trivedi Amer Jarri Colin Westman Nazir Ahmed Shawn Philip Simcha Weissman Jonathan Weinberger Ayrton I Bangolo Department of internal medicine Palisades Medical CenterNorth BergenNJ 07047United States Department of internal medicine University of Arkansas for Medical SciencesLittle RockAR 72205United States Department of internal medicine Hackensack Palisades Medical CenterNorth BergenNJ 07047United States Department of Gastroenterology Hackensack University Medical CenterHackensackNJ 07061United States Department of Pulmonology and Critical Care HCA Florida Bayonet Point HospitalHudsonFL 34667United States Department of Hematology&Oncology John Theurer Cancer Center at Hackensack University Medical CenterHackensackNJ 07601United States

Gastrointestinal(GI)bleeding is a critical and potentially life-threatening condition frequently observed in the intensive care unit(ICU).This literature review consolidates current insights on the epidemiology,etiology,management,and outcomes of GI bleeding in critically ill *** bleeding remains a significant concern,especially among patients with underlying risk factors such as coagulopathy,mechanical ventilation,and renal *** GI bleeding in the ICU requires a multidisciplinary approach,including resuscitation,endoscopic intervention,pharmacologic therapy,and sometimes surgical *** with enhanced management strategies,GI bleeding in the ICU is associated with considerable morbidity and mortality,particularly when complicated by multi-organ *** review reiterates the need for adequate resuscitation and interventions in managing GI bleeding in critically ill patients,aiming to enhance survival rates and improve the quality of care within the ICU setting.

关键词： Gastrointestinal bleed Varices Variceal bleeding Diverticular bleed Angiodysplasia Ulcer Hemorrhoids Endoscopy Enteroscopy Embolization

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A case-based approach to integrative medicine for cardiovascular disease prevention

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Journal of Integrative medicine 2020年第2期18卷 159-162页

作者： Brody Slostad Tejinder Khalsa Kathleen Young Hildalicia Guerra Anjali Bhagra Department of internal medicine Mayo ClinicRochesterMinnesota 55904USA Department of Cardiovascular medicine Mayo ClinicRochesterMinnesota 55904USA Department of Neurology Mayo ClinicRochesterMinnesota 55904USA

Cardiovascular disease is commonly encountered in the adult population and has large impacts on morbidity and mortality. The ever-expanding evidence base for the use of integrative medicine in cardiology necessitates providers caring for patients with cardiovascular disease to be familiar with these ***, providers may find it difficult to adequately discuss these therapies in an average office *** a case-based, question-and-answer approach, the authors review some clinically relevant and helpful research that addresses the incorporation of integrative medicine in cardiovascular disease prevention.

关键词： Integrative medicine Coronary artery disease Atrial fibrillation Preventive medicine Cerebrovascular disease

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Pembrolizumab-induced Guillain-Barrésyndrome in triple-negative breast cancer:A case report

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World Journal of clinical Oncology 2025年第2期16卷 144-151页

作者： Phani Bhavana Cherukuri Muhammad Tayyeb Sai Rakshith Gaddameedi Doantrang Du Trishala Meghal Department of internal medicine Monmouth Medical CenterLong BranchNJ 07740United States Department of Hematology Oncology Monmouth Medical CenterLong BranchNJ 07740United States

BACKGROUND The programmed cell death protein 1 inhibitor pembrolizumab has become a key treatment for various cancers,including triple-negative breast ***,it is associated with immune-related adverse events,including rare but serious neurological complications such as Guillain-Barrésyndrome(GBS).GBS is a potentially life-threatening autoimmune disorder characterized by muscle weakness and *** present a unique case of pembrolizumab-induced GBS to highlight the importance of recognizing this complication and managing it promptly in patients receiving immune checkpoint *** SUMMARY A 69-year-old woman with a medical history of hypertension,anxiety,depression,and stage IIIB triple-negative breast cancer treated with pembrolizumab,carboplatin,and paclitaxel,presented to the emergency department with a 1-month history of tingling,lower extremity weakness,and shooting *** progressed to global weakness,ascending paralysis,and double *** examination revealed significant lower extremity weakness and sensory *** resonance imaging of the lumbar spine and cerebrospinal fluid analysis confirmed *** treatment with intravenous immunoglobulin led to relapse,requiring additional intravenous immunoglobulin and high-dose *** patient’s condition improved,pembrolizumab therapy was permanently discontinued,and she was discharged to a rehabilitation *** Pembrolizumab can induce GBS,necessitating early recognition,prompt diagnosis,and multidisciplinary management to prevent serious complications.

关键词： Pembrolizumab Guillain-Barrésyndrome Triple-negative breast cancer Immune-related adverse events Intravenous immunoglobulin therapy High-dose steroids Case report

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Fractional excretion of sodium in hepatorenal syndrome:clinical and pathological correlation

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World Journal of Hepatology 2016年第34期8卷 1497-1501页

作者： Ali A Alsaad Hani M Wadei Department of internal medicine Mayo Clinic Department of Transplant Mayo Clinic

AIMTo determine the accuracy of fractional excretion of sodium (FeNa) in the diagnosis of hepatorenal syndrome (HRS). METHODSEighty-eight liver transplantation candidates with renal dysfunction and/or proteinuria were included in the study sample. The baseline characteristics of the patients were obtained. All the 88 patients underwent iothalamate glomerular filtration rate testing, 24-h urine collection for urinary sodium and protein excretions, random urine for sodium and creatinine testing, and percutaneous kidney biopsy. FeNa was calculated using the equation [(urine sodium × serum creatinine)/(serum sodium × urine creatinine)] × 100%. Diuretic use was recorded among the participants. Patients on renal replacement therapy were not included in the original sample. RESULTSSeventy-seven (87%) of the 88 patients had FeNa P = 0.4). FeNa P = 0.47). Calculated positive predictive value and negative predictive value for FeNa P = 0.41). CONCLUSIONFeNa 1%.

关键词： Fractional excretion of sodium Hepatorenal syndrome Renal dysfunction Liver transplantation Urinary sodium excretion Accuracy

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Echocardiography in centenarians： characteristics, utility and follow-up

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Journal of Geriatric Cardiology 2018年第5期15卷 328-333页

作者： Jorge A Brenes-Salazar Jaime de la Fuente Punnaiah Marella Hari Chaliki Christopher Scott Heidi M Connolly Roger L Click Department of Cardiovascular Diseases Mayo Clinic Rochester USA Department of internal medicine Mayo Clinic Rochester USA Department of Cardiovascular Diseases Mayo Clinic Arizona USA Division of Biostatistics Mayo Clinic Rochester USA

Background Echocardiography has been shown to be a valuable resource in the diagnosis of many cardiac conditions, and can be used in all age groups, from the fetus to the oldest old. In the context of an increasingly aging population, the impact and utility of echocar- diography in centenarians is largely unknown. This study is to determine whether echocardiography in centenarians aids in making clinical patient management decisions. Methods A retrospective review of echocardiograms from 1986 to 2014, at two affiliated tertiary centers, in individuals who were 100 years or older at the time of the examination. Patient and echocardiogram characteristics, management decisions based on echocardiography, and mortality were documented. Results 114 centenarians had echocardiograms, with ages ranging from 100 to 107 years （101 - 1.4 years）. In 82 of the centenarians evaluated （72%）, no changes in management occurred as a consequence of the echocardiogram. From all management changes directly related to the echocardiogram, 81% （n = 26） of these corresponded to medication adjustments; interventional or surgical procedures followed the echocardiogram only in 4% （n = 5） of the total number of centenarians. Echocardiogram-based changes in management were only significant in patients that were referred for congestive heart failure （P = 0.02）. After the echocardiogram was performed, 1-month and 1-year mortality were 15% and 47%, respectively. The median survival after the echocardiogram was obtained was 13 months （range 0.03 to 145 months）, with no difference if there was a change or no change in manage- ment （P = 0.21）. Conclusions Among centenarians undergoing echocardiography, despite additional diagnostic information, echocardio- grams in centenarians influence management in a minority of cases, most commonly in the form of medication changes for treatment of heart failure. A significant proportion of centenarians are deceased within a year of undergoing echocardiographic ass

关键词： Centenarian Echocardiography Geriatric

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An uncommon source of upper gastrointestinal bleeding:epiphrenic esophageal diverticulum

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Gastroenterology Report 2017年第4期5卷 313-315,I0003页

作者： Chung Sang Tse Neil D.Parikh Department of internal medicine Mayo ClinicRochesterMNUSA Division of Gastroenterology Department of Internal MedicineYale School of MedicineNew HavenCTUSA

Esophageal diverticula are rare findings that have an estimated incidence of 1 per 500000 people per year,even though acute upper gastrointestinal bleeding is a relatively common medical emergency with an incidence of up to 150 per 100000 people per year and a mortality rate of 7-14%.An 83-year-old man presented with hematemesis and *** upper endoscopy revealed an esophageal diverticulum,within which was an adherent *** of the clot identified a bleeding vessel within the diverticulum;this was successfully clipped and hemostasis was *** the best of our knowledge,this is the first case report of a bleeding epiphrenic esophageal diverticulum that was successfully managed endoscopically with hemostatic clips *** rare,our case serves as a reminder that bleeding epiphrenic esophageal diverticula can present as massive upper gastrointestinal bleeding and urgent endoscopic therapy can be life-saving.

关键词： upper gastrointestinal bleed epiphrenic esophageal diverticulum esophago-gastroduodenoscopy

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Gastric cancer mortality related to direct radiographic and endoscopic screening:A retrospective study

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World Journal of Gastroenterology 2021年第33期27卷 5595-5609页

作者： Hiroaki Hagiwara Fumitaka Moki Yukiko Yamashita Kazuki Saji Keigo Iesaki Hiromitsu Suda Department of internal medicine Hagiwara ClinicMaebashi 379-2106GunmaJapan Maebashi Medical Association Maebashi 371-0035GunmaJapan Gunma Health Foundation Maebashi 371-0005GunmaJapan Department of internal medicine and Surgery Yamashita ClinicMaebashi 371-0016GunmaJapan Department of internal medicine Saji ClinicMaebashi 371-0133GunmaJapan Department of internal medicine Iesaki ClinicMaebashi 371-0805GunmaJapan Department of Pediatrics Suda Kids ClinicMaebashi 371-0813GunmaJapan

BACKGROUND Despite its decreased incidence in Japan,gastric cancer continues among the leading causes of cancer-related deaths in both men and ***,efforts are still required to lower the mortality rate of gastric cancer in *** City introduced endoscopic gastric cancer screening in 2004,and participants are able to choose between direct radiography and ***,we expected to see a decrease in mortality rate from gastric cancer after introducing endoscopic screening and a difference in mortality rate reduction between screening *** To evaluate the impact on gastric cancer mortality rate of two types of gastric cancer screening in Maebashi City,*** Participants aged 40 to 79 years of the Maebashi City gastric cancer screening program in 2006 who were screened by direct radiography(n=11155)or endoscopy(n=10747)were *** were followed until March 31,2012,by cross-referencing their data against the Gunma Prefecture cancer registry *** compared the detection rate of gastric ***,we compared the mortality rate between the two *** Cox proportional hazards model was used to estimate the hazard ratio(HR)of gastric cancer ***,the reduction in gastric cancer mortality rate associated with each screening method was *** Gastric cancer was detected in 22 participants undergoing direct radiography(detection rate,0.20%)and in 52 participants undergoing endoscopy(detection rate,0.48%).However,most gastric cancers detected by endoscopic screening were early cancers that may not have resulted in *** found no significant difference in gastric cancer mortality rate between participants receiving annual screening and those who do *** the number of gastric cancer deaths in the direct radiography group was set as 1 in the Cox proportional hazard analysis,the HR of gastric cancer death was 1.368(95%CI:0.7308-2.562)in the overall group of *** results showed no s

关键词： Gastric cancer Radiography Endoscopy Population-based cancer screening Mortality reduction

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