Using computerized provider order entry to enforce documentation of tests with pending results at hospital discharge

BACKGROUND

Small numbers of tests with pending results are documented in hospital discharge summaries leading to breakdown in communication and medical errors due to inadequate followup.

OBJECTIVE

Evaluate effect of using a computerized provider order entry (CPOE) system to enforce documentation of tests with pending results into hospital discharge summaries.

METHODS

We assessed the percent of all tests with pending results and those with actionable results that were documented before (n = 182 discharges) and after (n = 203 discharges) implementing the CPOE-enforcement tool. We also surveyed providers (n = 52) about the enforcement functionality.

RESULTS

Documentation of all tests with pending results improved from 12% (87/701 tests) before to 22% (178/812 tests) (p = 0.02) after implementation. Documentation of tests with eventual actionable results increased from 0% (0/24) to 50% (14/28)(p<0.001). Survey respondents felt the intervention improved quality of summaries, provider communication, and was not time-consuming.

CONCLUSIONS

A CPOE tool enforcing documentation of tests with pending results into discharge summaries significantly increased documentation rates, especially of actionable tests. However, gaps in documentation still exist.

Prognostic factors in stages II/III/IV and stages III/IV endometrioid and serous adenocarcinoma of the endometrium

AIMS

To explore and to compare the outcome of patients diagnosed with stage II/III/IV and stage III/IV endometrioid adenocarcinoma (EAC) with their serous carcinoma (USC) counterparts.

MATERIALS AND METHODS

A total of 107 patients (73 EAC and 34 USC) were evaluated. For statistical analysis, the following baseline variables were considered for their prognostic value: the patient's age at presentation, the tumor size, the depth of myometrial invasion (MI), the lympho-vascular involvement (LVI) and the USC and the EAC subtypes (considered as binary variables). Disease free survival (DFS), death of disease (DOD) and overall survival (OS) were assessed using univariate and multiple Cox proportional hazards models.

RESULTS

In univariate analysis, USC tends to recur more frequently than EAC (p = 0.004), a finding that disappeared in multivariate analysis. Furthermore, tumor histology had no significance in predicting the tumor outcomes. Among all of the prognostic factors and after adjusting for the aforementioned variables, MI ≥50% was the only independent factor in predicting DOD in stages II/III/IV (p = 0.009) and in stages III/IV (p = 0.004). MI was also an independent predictive factor for OS (p = 0.02) and early recurrences in stages III/IV. LVI was the only independent factor in predicting recurrences (p = 0.004) in stages II/III/IV but not in stages III/IV.

CONCLUSION

Based on our study, tumor histology was not a significant factor in predicting disease outcome in stages II/III/IV and II/IV. Despite our limited sample size, we believe that our findings provide meaningful insights into the clinical study of endometrial cancer patients which in turn warrants further investigation.

Modulation of microRNA associated with ovarian cancer cells by genistein

PURPOSE

Role of microRNAs in malignancies is well established due their regulatory role in cellular differentiation, proliferation and cell cycle control. Our purpose was to determine miRNA profiles of serially established ovarian cancer cell lines and the effect of genistein treatment.

METHODS

Cell lines (UL-3A, UL-3B) were established from one patient during progression of disease. miRNA profiling was performed in untreated and genistein-treated cells. Estrogen receptors (ER) were studied with real-time polymerase chain reaction (RT-PCR) and Western immunoblotting. In vitro migration and invasion assays were utilized.

RESULTS

While 108 miRNAs were expressed equally in both cell lines and their genistein-treated counterparts, an additional 53 miRNAs were differentially expressed. Genistein resulted in induction of ERalpha and ERbeta in ovarian cancer cells. A significant reduction in migration and invasion of UL-3A and UL-3B was demonstrated in genistein-treated cells.

CONCLUSION

Common and unique miRNA profiles were demonstrated between the two cell lines, some of which were altered by genistein.

Effect of Zileuton (A-64077) on the 5-lipoxygenase activity of human whole blood ex vivo

The potency and reversibility of a new orally active 5-lipoxygenase (5-LO) inhibitor were evaluated in human volunteers. Zileuton (A-64077) 600 mg q.i.d. was administered to volunteers for 14 days in a phase I study, and blood samples were withdrawn, stimulated with ionophore A23187 and LTB4 levels were determined using both reverse phase high performance liquid chromatography (RP-HPLC) and radioimmunoassay (RIA). The drug significantly inhibited (above 70%) LTB4 biosynthesis in whole blood stimulated with A-23187 throughout the 14 days. The activity of 5-LO was also measured one week after stopping the medication and was returned to control levels. Measurement of LTB4 levels using either RP-HPLC or RIA gave similar percentage of inhibition although RIA appeared to underestimate by half the absolute amounts of LTB4 in the blood samples. These results show that Zileuton is a highly active and reversible 5-LO inhibitor in human.

Effect of a 5-lipoxygenase inhibitor on leukotriene generation and airway responses after allergen challenge in asthmatic patients

The effect of a single oral dose (800 mg) of zileuton (A-64077), a specific 5-lipoxygenase inhibitor, on the early and late airway responses to inhaled allergen was studied in a randomised, double blind, placebo controlled, and crossover trial in nine subjects with atopic asthma. Leukotriene generation was also assessed in vivo by measuring urinary leukotriene (LT) E4 excretion, and ex vivo by measuring calcium ionophore stimulated whole blood LTB4 production. Zileuton almost completely inhibited ex vivo LTB4 production but reduced urinary excretion of LTE4 by only about half. There was a trend for the early asthmatic response to be less on the day of zileuton treatment, but this did not reach statistical significance (p = 0.08). The zileuton induced reduction in maximum fall in FEV1 in the early asthmatic response was, however, significantly related to the reduction in urinary LTE4 excretion (r = 0.8), but not to the reduction in LTB4 generation ex vivo. There was no significant change in the allergen induced late asthmatic response, or in the increase in airway responsiveness to methacholine following antigen. The results provide some support for the hypothesis that the cysteinyl leukotrienes have a role in the allergen induced early asthmatic response. More complete in vivo inhibition of 5-lipoxygenase may be needed to produce a significant reduction in airway response to allergen challenge.

Metabolic rate, respiratory exchange ratio, and apneas during meditation

We tested the hypothesis that a drop in metabolic rate (MR) causes the apneas observed in some subjects during transcendental meditation (TM). We measured O2 consumption (VO2) and CO2 production (VCO2) in three groups of experienced meditators and one group of nonmeditating controls. Measurements were made before, during, and after TM for the meditators and before, during, and after eyes-closed relaxation for the nonmeditating controls. The three groups of meditators consisted of 1) those showing little change in the frequency of ventilation (f) with meditation, 2) those showing a marked decline in f, and 3) those showing numerous apneas and a marked fall in f. There were significant trial effects but no group or interaction effects for the decline in VO2. Thus we concluded that a drop in MR is not the cause of the apneas. However, there were significant trial and interaction effects for the changes in VCO2 and the respiratory exchange ratio (R), with a significant drop in R for the meditators but not for the controls. We report additional evidence and speculate that the drop in R is a consequence of mild hypoventilation.