Research Spotlight

Posted September 20th 2020

Factors that promote successful endoscopic management of laparoscopic sleeve gastrectomy leaks.

Marc A. Ward M.D.

Marc A. Ward M.D.

Ward, M.A., Ebrahim, A., Clothier, J.S., Prajapati, P.K., Ogola, G.O., Davis, D.G. and Leeds, S.G. (2020). “Factors that promote successful endoscopic management of laparoscopic sleeve gastrectomy leaks.” Surg Endosc Aug 11. [Epub ahead of print.].

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INTRODUCTION: Staple line leaks following laparoscopic sleeve gastrectomy (LSG) are associated with significant morbidity and mortality. Endoluminal techniques, including stent placement and endoluminal vacuum therapy (EVAC), have become viable options to treat these patients without the need for additional surgery. The purpose of this study was to define the conditions where certain endoscopic therapies are most likely to succeed compared to surgery. METHODS: An IRB approved prospectively maintained database was retrospectively reviewed for all patients treated for gastrointestinal leaks from July 2013 to March 2019. All patients who were treated for gastrointestinal leaks following LSG were included. Endpoints include success of leak closure and hospital-related morbidity for the patients treated solely by endoscopic only methods (EP) compared to the additional surgery group (SP). RESULTS: There were 39 patients (33 females; 6 males) with a median age of 45.9 years. The EP group included 23 patients (59%), whereas SP included 16 patients (31%). On average, the SP had longer days from sentinel surgery to our hospital admission (70 vs 41), a higher percentage of previous bariatric surgery prior to sentinel LSG (50% vs 17%), and a higher readmission rates following discharge (50% vs 39%). Total length of stay was also higher in the SP compared to the EP (45.4 vs 11). Using this data, a treatment algorithm was developed to optimally treat future patients who suffer from gastrointestinal leaks following LSG. CONCLUSIONS: Endoscopic therapies, such as EVAC, stent placement, internal drainage, and over-the-scope clips, have a higher chance of success if performed earlier to their sentinel surgery and if patients have had no prior bariatric surgeries. Patients who require additional surgery tend to have longer hospital stays and readmission rates. Using the treatment algorithm provided can help determine when endoscopic therapies are likely to succeed.


Posted September 20th 2020

Cardiovascular ochronosis

William C. Roberts M.D.

William C. Roberts M.D.

Ather, N. and Roberts, W.C. (2020). “Cardiovascular ochronosis.” Cardiovasc Pathol 48: 107219.

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In this review, we summarize previously reported case reports (n=66) in which the presence of ochronotic pigment was found in one or more cardiovascular structures either at necropsy or after operative excision of a cardiac valve or portions of arteries or both. As illustration, we describe black pigment in operatively excised aortic valves and aorta in 2 patients, both probably examples of secondary ochronosis. Ochronosis appears to have fascinated a number of prominent historical figures in medicine, and this review also summarizes their important contributions to this topic.


Posted September 20th 2020

Position Paper on Critical Care Pharmacy Services (Executive Summary): 2020 Update.

Tricia A. Meyer, PharmD

Tricia A. Meyer, PharmD

Lat, I., Paciullo, C., Daley, M.J., MacLaren, R., Bolesta, S., McCann, J., Stollings, J.L., Gross, K., Foos, S.A., Roberts, R.J., Acquisto, N.M., Taylor, S., Bentley, M., Jacobi, J. and Meyer, T.A. (2020). “Position Paper on Critical Care Pharmacy Services (Executive Summary): 2020 Update.” Crit Care Med 48(9): 1375-1382.

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OBJECTIVES: Provide a multiorganizational statement to update the statement from a paper in 2000 about critical care pharmacy practice and makes recommendations for future practice. DESIGN: The Society of Critical Care Medicine, American College of Clinical Pharmacy Critical Care Practice and Research Network, and the American Society of Health-Systems Pharmacists convened a joint task force of 15 pharmacists representing a broad cross-section of critical care pharmacy practice and pharmacy administration, inclusive of geography, critical care practice setting, and roles. The Task Force chairs reviewed and organized primary literature, outlined topic domains, and prepared the methodology for group review and consensus. A modified Delphi method was used until consensus (> 66% agreement) was reached for each practice recommendation. Previous position statement recommendations were reviewed and voted to either retain, revise, or retire. Recommendations were categorized by level of ICU service to be applicable by setting, and grouped into five domains: patient care, quality improvement, research and scholarship, training and education, and professional development. MAIN RESULTS: There are 82 recommendation statements: forty-four original recommendations and 38 new recommendation statements. Thirty-four recommendations were made for patient care, primarily relating to critical care pharmacist duties and pharmacy services. In the quality improvement domain, 21 recommendations address the role of the critical care pharmacist in patient and medication safety, clinical quality programs, and analytics. Nine recommendations were made in the domain of research and scholarship. Ten recommendations are in the domain of training and education and eight recommendations regarding professional development. CONCLUSIONS: The statements recommended by this taskforce delineate the activities of a critical care pharmacist and the scope of pharmacy services within the ICU. Effort should be made from all stakeholders to implement the recommendations provided, with continuous effort toward improving the delivery of care for critically ill patients.


Posted September 20th 2020

Position Paper on Critical Care Pharmacy Services: 2020 Update.

Tricia A. Meyer, PharmD

Tricia A. Meyer, PharmD

Lat, I., Paciullo, C., Daley, M.J., MacLaren, R., Bolesta, S., McCann, J., Stollings, J.L., Gross, K., Foos, S.A., Roberts, R.J., Acquisto, N.M., Taylor, S., Bentley, M., Jacobi, J. and Meyer, T.A. (2020). “Position Paper on Critical Care Pharmacy Services: 2020 Update.” Crit Care Med 48(9): e813-e834.

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OBJECTIVES: To provide a multiorganizational statement to update recommendations for critical care pharmacy practice and make recommendations for future practice. A position paper outlining critical care pharmacist activities was last published in 2000. Since that time, significant changes in healthcare and critical care have occurred. DESIGN: The Society of Critical Care Medicine, American College of Clinical Pharmacy Critical Care Practice and Research Network, and the American Society of Health-Systems Pharmacists convened a joint task force of 15 pharmacists representing a broad cross-section of critical care pharmacy practice and pharmacy administration, inclusive of geography, critical care practice setting, and roles. The Task Force chairs reviewed and organized primary literature, outlined topic domains, and prepared the methodology for group review and consensus. A modified Delphi method was used until consensus (> 66% agreement) was reached for each practice recommendation. Previous position statement recommendations were reviewed and voted to either retain, revise, or retire. Recommendations were categorized by level of ICU service to be applicable by setting and grouped into five domains: patient care, quality improvement, research and scholarship, training and education, and professional development. MAIN RESULTS: There are 82 recommendation statements: 44 original recommendations and 38 new recommendation statements. Thirty-four recommendations represent the domain of patient care, primarily relating to critical care pharmacist duties and pharmacy services. In the quality improvement domain, 21 recommendations address the role of the critical care pharmacist in patient and medication safety, clinical quality programs, and analytics. Nine recommendations were made in the domain of research and scholarship. Ten recommendations were made in the domain of training and education and eight recommendations regarding professional development. CONCLUSIONS: Critical care pharmacists are essential members of the multiprofessional critical care team. The statements recommended by this taskforce delineate the activities of a critical care pharmacist and the scope of pharmacy services within the ICU. Effort should be made from all stakeholders to implement the recommendations provided, with continuous effort toward improving the delivery of care for critically ill patients.


Posted September 20th 2020

Position Paper on Critical Care Pharmacy Services (Executive Summary): 2020 Update.

Tricia A. Meyer, PharmD

Tricia A. Meyer, PharmD

Lat, I., Paciullo, C., Daley, M.J., MacLaren, R., Bolesta, S., McCann, J., Stollings, J.L., Gross, K., Foos, S.A., Roberts, R.J., Acquisto, N.M., Taylor, S., Bentley, M., Jacobi, J. and Meyer, T.A. (2020). “Position Paper on Critical Care Pharmacy Services (Executive Summary): 2020 Update.” Am J Health Syst Pharm Aug 20;zxaa217. [Epub ahead of print].

Full text of this article.

OBJECTIVES: Provide a multiorganizational statement to update the statement from a paper in 2000 about critical care pharmacy practice and makes recommendations for future practice. DESIGN: The Society of Critical Care Medicine, American College of Clinical Pharmacy Critical Care Practice and Research Network, and the American Society of Health-System Pharmacists convened a joint task force of 15 pharmacists representing a broad cross-section of critical care pharmacy practice and pharmacy administration, inclusive of geography, critical care practice setting, and roles. The Task Force chairs reviewed and organized primary literature, outlined topic domains, and prepared the methodology for group review and consensus. A modified Delphi method was used until consensus (>66% agreement) was reached for each practice recommendation. Previous position statement recommendations were reviewed and voted to either retain, revise, or retire. Recommendations were categorized by level of ICU service to be applicable by setting, and grouped into five domains: patient care, quality improvement, research and scholarship, training and education, and professional development. MAIN RESULTS: There are 82 recommendation statements: forty-four original recommendations and 38 new recommendation statements. Thirty-four recommendations were made for patient care, primarily relating to critical care pharmacist duties and pharmacy services. In the quality improvement domain, 21 recommendations address the role of the critical care pharmacist in patient and medication safety, clinical quality programs, and analytics. Nine recommendations were made in the domain of research and scholarship. Ten recommendations are in the domain of training and education and eight recommendations regarding professional development. CONCLUSIONS: The statements recommended by this taskforce delineate the activities of a critical care pharmacist and the scope of pharmacy services within the ICU. Effort should be made from all stakeholders to implement the recommendations provided, with continuous effort toward improving the delivery of care for critically ill patients.