Highlights Castleman disease is an overgrowth of lymphatic cells, usually in the chest or abdomen. Multicentric Castleman disease affects lymphatic cells throughout the body. HHV-8 and HIV have been associated with multicentric Castleman disease. Unicentric Castleman disease affects a single group of lymph nodes. Centricity is considered the most important indicator of patient outcomes.
Purpose: Hospital pharmacists contribute to patient safety and quality initiatives by overseeing the prescribing of antidiabetic medications. A pharmacist-driven glycemic control protocol was developed to reduce the rate of severe hypoglycemia events (SHE) in high-risk hospitalized patients. Methods: We retrospectively analyzed the rates of SHE (defined as blood glucose ≤40 mg/dL), before and after instituting a pharmacist-driven glycemic control protocol over a 4-year period. A hospital glucose management team that included a lead Certified Diabetes Educator Pharmacist (CDEP), 5 pharmacists trained in diabetes, a lead hospitalist, critical care and hospital providers established a process to first identify patients at risk for severe hypoglycemia and then implement our protocol. Criteria from the American Diabetes Association and the American Association of Clinical Endocrinologists was utilized to identify and treat patients at risk for SHE. We analyzed and compared the rate of SHE and physician acceptance rates before and after protocol initiation. Results: From January 2015 to March 2019, 18 297 patients met criteria for this study; 139 patients experienced a SHE and approximately 80% were considered high risk diabetes patients. Physician acceptance rates for the new protocol ranged from 77% to 81% from the year of initiation (2016) through 2018. The absolute risk reduction of SHE was 9 events per 1000 hospitalized diabetic patients and the relative risk reduction was 74% SHE from the start to the end of the protocol implementation. Linear regression analysis demonstrated that SHE decreased by 1.5 events per 1000 hospitalized diabetic patients (95% confidence interval, −1.54 to −1.48, P < .001) during the 2 years following the introduction of the protocol. This represents a 15% relative reduction of SHE per year. Conclusion: The pharmacist-driven glycemic control protocol was well accepted by our hospitalists and led to a significant reduction in SHE in high-risk diabetes patient groups at our hospital. It was cost effective and strengthened our physician-pharmacist relationship while improving diabetes care.
We aimed to demonstrate that surgery can be tailored to address a patient's unique medical and surgical issues. Our patient presented with severe symptomatic cholelithiasis and massive splenomegaly; she had additionally planned for pregnancy shortly after surgery. A combined laparoscopic cholecystectomy and splenectomy was proposed to avoid large abdominal incisions immediately prior to the planned pregnancy. No procedural complications were observed, and the patient successfully carried a healthy pregnancy to term within 1 year of surgery. We have provided supplemental data from the National Surgical Quality Improvement Program (NSQIP) database that compares the complication rates between laparoscopic splenectomy (LS) and open splenectomy (OS) for thrombocytopenia. These data support the safety and efficacy of LS.We discovered two related studies on splenectomy for thrombocytopenia from the literature. A NSQIP study published in 2013 compared patients who had undergone LS and OS and were cared for prior to 2010. A metaanalysis published in 2021 summarized the data from smaller reported series. 1,2 This case report and NSQIP study compared the expected complications and patient outcomes for LS and OS in this era, where LS is the standard approach. This study demonstrates the value of a tailored surgical approach. In addition, our supplemental NSQIP data reinforce the safety of LS. The patient's excellent clinical outcome demonstrates that combined laparoscopic cholecystectomy and splenectomy is safe, even in patients planning for pregnancy shortly after surgery. This case report has been reported in line with the SCARE Criteria. 3 | Case historyWe report the 5-year follow-up of a 28-year-old Caucasian woman who underwent combined laparoscopic cholecystectomy and splenectomy for severe symptomatic
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