Research Spotlight

Watson, J. (2020). “Advocacy and Collaboration: Advancing Cancer Prevention and Screening.” Clin J Oncol Nurs 24(5): 39-44.

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BACKGROUND: Cancer prevention and screening is a significant part of the cancer care continuum. Nurses are trusted professionals who can bring stakeholders together and serve diverse groups. OBJECTIVES: This article describes how nurses can advance cancer prevention and screening initiatives in industry, education, legislative advocacy, research, survivorship, and program development and support. METHODS: An online search and collaborative knowledge revealed examples of nurses leading the way in cancer prevention and screening efforts. FINDINGS: Nurse-driven cancer prevention and screening collaborations advance care farther and faster. By creating maximum impact and mobilizing individual passion for a project, any nurse can find collaborative niche opportunities in clinical practice.

Ward, M.A., Hasan, S.S., Whitfield, E.P., Ogola, G.O. and Leeds, S.G. (2020). “Endoscopic Per-oral Pyloromyotomy for Gastroparesis: Initial Experience and Postoperative Comparison to Predicted Complications Following Laparoscopic Pyloromyotomy as Calculated by the ACS Risk Calculator.” Surg Laparosc Endosc Percutan Tech Sep 15. [Epub ahead of print.].

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INTRODUCTION: Per-oral endoscopic pyloromyotomy (POP) is a promising new therapy in the treatment of gastroparesis, where the pyloric muscle is cut using an endoscopic tunneling technique. This study was designed to report outcomes from our initial experience and compare the rate of complications to the laparoscopic equivalent using the American College of Surgeons (ACS) risk calculator. METHODS: Patients who underwent POP between August 2018 to May 2019 were prospectively followed in a database approved by the institutional review board. Preoperatively, patients were evaluated objectively with a 4-hour gastric emptying study (GES). Following POP, all patients were invited for repeat GES 3 months postoperatively. The same cohort was entered into the ACS risk calculator using laparoscopic pyloromyotomy (LPM) as the selected procedure. Complication risk of LPM was then compared with the actual complication rate of POP. RESULTS: There were 11 patients that met study criteria (median age 52). Sixty-four percent (7/11) of patients agreed to do repeat GES postoperatively. Of those, 6 of 7 (86%) had normal GES (<10% emptying at 4 h) and the mean improvement was 36.4%. All patients were entered into the ACS risk calculator in which LPM (CPT code 43800) was used as a control. The postoperative complication rate was less than the median predicted risk of LPM in all categories including overall complications (0% vs. 10.05%), return to the operating room, (0% vs. 2.68%), and sepsis (0% vs. 1.42%). The rate of readmission (9% vs. 6.29%, P=0.65) was higher in the POP group than LPM predicted. Length of stay for all patients was significantly shorter than predicted (1.8 vs. 4.6 d, P<0.001). CONCLUSIONS: All POP patients had objective improvement in their GES and 86% had normal GES following this procedure. POP had significantly lower morbidity and reduced length of stay compared with that predicted of the laparoscopic equivalent using the ACS risk calculator.

Cheng, X.S., Wall, A. and Teuteberg, J. (2020). “Ethical decision-making in simultaneous heart-liver transplantation.” Curr Opin Organ Transplant 25(5): 519-525.

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PURPOSE OF REVIEW: Simultaneous heart-liver (SHL) transplants are only a small proportion of overall heart and liver transplantation, they have been increasing in frequency and thus challenge the equitable allocation of organs. RECENT FINDINGS: The incidence of SHL transplants is reviewed along with the outcomes of SHL transplants and their impact on the waitlist, particularly in the context of solitary heart and liver transplantation. The ethical implications, most importantly the principles of utility and equity, of SHL transplant are addressed. In the context of utility, the distinction of a transplant being life-saving versus life-enhancing is investigated. The risk of hepatic decompensation for those awaiting both solitary and combined organ transplantation is an important consideration for the principle of equity. Lastly, the lack of standardization of programmatic approaches to SHL transplant candidates, the national approach to allocation, and the criteria by which programs are evaluated are reviewed. SUMMARY: As with all multiorgan transplantation, SHL transplantation raises ethical issues of utility and equity. Given the unique patient population, good outcomes, lack of alternatives, and overall small numbers, we feel there is continued ethical justification for SHL, but a more standardized nationwide approach to the evaluation, listing, and allocation of organs is warranted.

Wall, A., Lee, G.H., Maldonado, J. and Magnus, D. (2020). “Genetic disease and intellectual disability as contraindications to transplant listing in the United States: A survey of heart, kidney, liver, and lung transplant programs.” Pediatr Transplant Sep 30;e13837. [Epub ahead of print.]. e13837.

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Discrimination based on disability is prohibited in organ transplantation, yet studies suggest it continues in listing practices for intellectual disability and genetic diseases. It is not known if this differs between adult and pediatric programs, or by organ type. We performed an online, forced-choice survey of psychosocial listing criteria for adult and pediatric heart, kidney, liver, and lung transplant programs in the United States. Of 650 programs contacted, 343 (52.8%) submitted complete. A minority of programs had formal listing guidelines for any condition considered (Down Syndrome, Duchenne Muscular Dystrophy, Becker Muscular Dystrophy, DiGeorge Syndrome, and Wolf Hirschhorn Syndrome; and mild [IQ < 70] and severe [IQ < 35] intellectual disability), although a majority had encountered most. Pediatric programs were significantly (P < .02) more lenient in the level of contraindication to listing for all genetic conditions considered except Duchenne Muscular Dystrophy, and for mild and severe intellectual disability. Level of contraindication differed significantly by organ type (heart, lung, liver, and kidney) for Duchenne Muscular dystrophy (P = <.001), Becker Muscular Dystrophy (P < .001), DiGeorge Syndrome (P < .001), Wolf-Hirschhorn syndrome (P = .0012), and severe intellectual disability (P < .001). There is significant variation among transplant programs in availability of guidelines for as well as listing practices regarding genetic diseases and intellectual disability, differing by both adult vs pediatric program, and organ type. Programs with absolute contraindications to listing for specific genetic diseases or intellectual disability should reframe their approach, ensuring individualized assessments and avoiding elimination of patients based on membership in a particular group.

Kelly, C.R., Yen, E.F., Grinspan, A.M., Kahn, S.A., Atreja, A., Lewis, J.D., Moore, T.A., Rubin, D.T., Kim, A.M., Serra, S., Nersesova, Y., Fredell, L., Hunsicker, D., McDonald, D., Knight, R., Allegretti, J.R., Pekow, J., Absah, I., Hsu, R., Vincent, J., Khanna, S., Tangen, L., Crawford, C.V., Mattar, M.C., Chen, L.A., Fischer, M., Arsenescu, R.I., Feuerstadt, P., Goldstein, J., Kerman, D., Ehrlich, A.C., Wu, G.D. and Laine, L. (2020). “Fecal Microbiota Transplant is Highly Effective in Real-World Practice: Initial Results from the FMT National Registry.” Gastroenterology Sep 30;S0016-5085(20)35221-5. [Epub ahead of print.].

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INTRODUCTION: Fecal microbiota transplantation (FMT) is commonly used for treatment of C. difficile infections (CDI), although prospective safety data are limited and real-world FMT practice and outcomes are not well described. The FMT National Registry was designed to assess FMT methods and both safety and effectiveness outcomes from North American FMT providers. METHODS: Patients undergoing FMT in clinical practices across North America are eligible. Participating investigators enter de-identified data into an online platform including FMT protocol, baseline patient characteristics, CDI cure and recurrence, and short and long-term safety outcomes. RESULTS: Of the first 259 participants enrolled at 20 sites, 222 have completed short-term follow-up at 1 month, and 123 have follow-up to 6 months; 171 (66%) are female. All FMTs were done for CDI, and 249 (96%) used an unknown donor (e.g., stool bank). One-month cure occurred in 200 (90%); of these, 197 (98%) received only a single FMT. Among 112 with initial cure who were followed to 6 months, 4 (4%) had CDI recurrence. Severe symptoms reported within 1-month of FMT included diarrhea (5 (2%)) and abdominal pain (4 (2%)); 3 (1%) had hospitalizations possibly related to FMT. At 6 months, new diagnoses of irritable bowel syndrome were made in 2 (1%) and inflammatory bowel disease in 2 (1%). CONCLUSIONS: This prospective real-world study demonstrated high effectiveness of FMT for CDI with a good safety profile. Assessment of new conditions at long-term follow-up is planned as this registry grows and will be important for determining the full safety profile of FMT.