Perioperative intravenous contrast administration and the incidence of acute kidney injury after major gastrointestinal surgery: prospective, multicentre cohort study

BACKGROUND

This study aimed to determine the impact of preoperative exposure to intravenous contrast for CT and the risk of developing postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery.

METHODS

This prospective, multicentre cohort study included adults undergoing gastrointestinal resection, stoma reversal or liver resection. Both elective and emergency procedures were included. Preoperative exposure to intravenous contrast was defined as exposure to contrast administered for the purposes of CT up to 7 days before surgery. The primary endpoint was the rate of AKI within 7 days. Propensity score-matched models were adjusted for patient, disease and operative variables. In a sensitivity analysis, a propensity score-matched model explored the association between preoperative exposure to contrast and AKI in the first 48 h after surgery.

RESULTS

A total of 5378 patients were included across 173 centres. Overall, 1249 patients (23·2 per cent) received intravenous contrast. The overall rate of AKI within 7 days of surgery was 13·4 per cent (718 of 5378). In the propensity score-matched model, preoperative exposure to contrast was not associated with AKI within 7 days (odds ratio (OR) 0·95, 95 per cent c.i. 0·73 to 1·21; P = 0·669). The sensitivity analysis showed no association between preoperative contrast administration and AKI within 48 h after operation (OR 1·09, 0·84 to 1·41; P = 0·498).

CONCLUSION

There was no association between preoperative intravenous contrast administered for CT up to 7 days before surgery and postoperative AKI. Risk of contrast-induced nephropathy should not be used as a reason to avoid contrast-enhanced CT.

Impact of pharmacy-led medication reconciliation on medication errors during transition in the hospital setting

Objective:

To assess if the pharmacy department should be more involved in the medication reconciliation process to assist in the reduction of medication errors that occur during transition of care points in the hospital setting.

Methods:

This was an observational prospective cohort study at a 531-bed hospital in Pensacola, FL from June 1, 2014 to August 31, 2014. Patients were included in the study if they had health insurance and were taking five or more medications. Patients with congestive heart failure were excluded from the study. Student pharmacists collected and evaluated medication histories obtained from patients’ community pharmacies, and directed patient interviews. Primary care providers were only contacted on an as needed basis. The information collected was presented to the clinical pharmacist, where interventions were made utilizing clinical judgment.

Results:

During the three month study, 1045 home medications were reviewed by student pharmacist. Of these, 290 discrepancies were discovered (27.8%; p=0.02). The most common medication discrepancy found was dose optimization (45.5%). The remaining discrepancies included: added therapy (27.6%), other (15.2%), and discontinued therapy (11.7%). Pharmacists made 143 interventions based on clinical judgment (49.3%; p=0.04).

Conclusion:

Involvement of pharmacy personnel during the medication reconciliation process can be an essential component in reducing medical errors. With the addition of the pharmacy department during the admission process, accuracy, cost savings, and patient safety across all phases and transition points of care were achieved.

Demographic and clinical profile of patients with juvenile onset open angle glaucoma in southwestern Nigeria

BACKGROUND

This was a non-comparative, retrospective review of patients diagnosed with juvenile open angle glaucoma (JOAG) in the eye clinic of a tertiary hospital in southwestern Nigeria.

OBJECTIVE

To document the demographic characteristics, clinical features and treatment outcome of the patients diagnosed with JOAG.

MATERIALS AND METHODS

Data were extracted from the clinical record of patients diagnosed with JOAG in the eye clinic of the University College Hospital, Ibadan, Nigeria, between January 2001 and December 2005. Such data included the basic demographic data, the clinical characteristic of the patients and the outcome of their treatment.

RESULTS

Twenty-nine patients were reviewed, which represents 3.4% of all newly diagnosed glaucoma patients seen in the out-patient section of the eye clinic of the University College Hospital, Ibadan, over the period reviewed. Eight (27.6%) patients were aged 20 years and below. The mean age was 25.1 ± SD 6.0 years. Eighteen (62.1%) had visual acuity of 6/18 or worse in the better eye at the time of presentation. The mean intraocular pressure (IOP) of the patients at presentation was 32.3 ± SD 15.2 mmHg. Eight (27.6%) patients defaulted within 6 months of presentation. The mean IOP for the 21 patients who were followed up on treatment for a mean period of 9.6 months was 17.0 ± SD 6.0 mmHg.

CONCLUSION

Most patients with JOAG in this review presented with advanced form of the disease. Early detection through parent-driven school eye health program and community-based case detection could help in reducing the scourge arising from JOAG among our population.

Does the Additional Prognostic Benefit of Screen Detection in Early Breast Cancer Apply to All Patients?

IntroductionScreen detection may confer prognostic benefit independent of disease stage in EBC leading to suggestions that mode of presentation should be considered when deciding adjuvant therapy. We aim to determine if this additional prognostic benefit is seen in all patients.MethodsData from 3 centres in Glasgow of consecutive women aged between 50-65yrs with EBC diagnosed between 1995 and 2001 were examined. Patients were grouped by mode of presentation into screen detection and symptomatic. Breast cancer specific survival was the endpoint. Multivariate analysis including interaction between mode of presentation and pathology was performed with further subgroup analysis if the interaction was significant.Results1534 women were included with a median follow up of 5.5yrs. Mode of presentation was screening in 1007 (65.6%) women. After adjustment for pathology screen detection had no significant survival benefit: HR 0.73 (0.50-1.08, p = 0.116). Mode of presentation had an independently significant interaction with both nodal status and ER status (p = 0.003 and p = 0.01 respectively). Further analysis demonstrated that screening was an independent predictor of survival in the 1-3 node positive group (HR 0.33 (0.15-0.73), p = 0.006); the ER positive group (HR 0.53 (0.31-0.89), p = 0.017) and in the moderate NPI group only (HR 0.54 (0.31-0.94), p = 0.030).ConclusionsThese results provide evidence of a significant interaction between mode of presentation and pathology. Further research is needed before incorporating mode of presentation into decisions regarding adjuvant therapy.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 4007.

Epidemiology of dementia in Nigeria: results from the Indianapolis-Ibadan study

We determined the prevalence of dementia in a cohort of 2494 elderly Nigerians residents in Idikan Community, Ibadan, Nigeria. We utilized the Community Screening Instrument for Dementia to select subjects for clinical assessment in the second stage. The findings were compared with those of 2212 African Americans living in Indianapolis, studied simultaneously using similar methodology. The overall age-adjusted prevalence rates of dementia and Alzheimer's disease in Ibadan were 2.29% and 1.41%, respectively. These rates were much lower than the respective values of 8.24% and 6.24% obtained for African Americans. In Ibadan, Alzheimer's disease accounted for 64.3% of the cases, with old age and female gender being the significant risk factors, whilst 'living with others' appeared to be protective (P < 0.05). Amongst African Americans, on the other hand, old age, rural living below the age of 19 years, low educational attainment and family history of dementia were the risk factors. There was a lack of association between Alzheimer's disease and possession of the apolipoprotein E epsilon4 allele in the Nigerian sample, unlike the finding in African Americans, where significant association was shown. In addition, the frequencies of the vascular risk factors investigated were lower in Nigerians. Our results showed lower prevalence of dementia and Alzheimer's disease in Nigerians, compared with African Americans. There was no association between Alzheimer's disease and apolipoprotein E (epsilon4 allele) in the former. The differences in the frequencies of vascular risk factors between Nigerian subjects and African Americans would suggest involvement of environmental factors in disease process.

Lack of an association between apolipoprotein E epsilon 4 and Alzheimer's disease in elderly Nigerians

As part of a community-based study of Alzheimer's Disease (AD) in a Nigerian population aged 65 years and over, we have determined apolipoprotein E (APOE) genotypes on 56 subjects (39 controls and 17 subjects with dementia, including 12 with AD). The epsilon 4 allele of APOE was not associated with AD or dementia in this community-based sample. The epsilon 4 allele frequency was 17.6% in demented patients and 16.7% in AD patients compared with 20.5% in the control subjects. These findings are in marked contrast to the strong association between the epsilon 4 allele and AD in our previously reported study with African Americans.