Cardiovascular diseases (CVD) form a principal consideration in patients with end-stage liver disease (ESLD) undergoing evaluation for liver transplant (LT) with prognostic implications in the peri- and post-transplant periods. As the predominant etiology of ESLD continues to evolve, addressing CVD in these patients has become increasingly relevant. Likewise, as the number of LTs increase by the year, the proportion of older adults on the waiting list with competing comorbidities increase, and the demographics of LT candidates evolve with parallel increases in their CVD risk profiles. The primary goal of cardiac risk assessment is to preemptively reduce the risk of cardiovascular morbidity and mortality that may arise from hemodynamic stress in the peri- and post-transplant periods. The complex hemodynamics shared by ESLD patients in the pre-transplant period with adverse cardiovascular events occurring in only some of these recipients continue to challenge currently available guidelines and their uniform applicability. This review focusses on cardiac assessment of LT candidates in a stepwise manner with special emphasis on preoperative patient optimization. We hope that this will reinforce the importance of cardiovascular optimization prior to LT, prevent futile LT in those with advanced CVD beyond the stage of optimization, and thereby use the finite resources prudently.
Introduction: Colorectal cancer screening via colonoscopy decreased significantly due to the COVID-19 pandemic, with mail-out fecal immunochemical testing (FIT) initiated to maintain screening. Due to concerns surrounding 1FIT follow-up we added FIT navigation (FITNav) via a nurse practitioner who followed 1FIT to colonoscopy in August 2020. After implementation we noted little improvement in colonoscopy , 180 days compliance. This prompted a quality improvement (QI) project which resulted in a centralized database. Here we report a subgroup analysis to answer the question: were there racial disparities in 1FIT follow-up prior to FITNav implementation? Methods: We queried 1FIT from patients 45-85 y/o from 3/1/2019/20-9/3/2019/20, defined as the pre-pandemic and pandemic cohorts respectively. Patients with dementia & .65 y/o, diagnostic/inpatient FIT, or provider-initiated cancellation of colonoscopy due to comorbidities were excluded. Chart review retrieved FIT indications, patient/navigator notification time, GI consult placement time, and colonoscopy. We added Area deprivation index (ADI) to evaluate neighborhood-level disparities. An adjusted and unadjusted cox regression model was used to evaluate colonoscopy , 180 days between pandemic/pre-pandemic, summarizing via hazard ratios (HR) and 95% confidence intervals (CI). (Figure)Results: There were 121 & 103 1FIT meeting criteria in the pandemic & pre-pandemic respectively. Demographics (age, marital status, race, ADI, and sex) between periods showed no statistically significant differences. Proportion receiving colonoscopy , 180 days in the pre-pandemic and pandemic periods was 53.7% and 60.2% (unadjusted HR 1.08, 95% CI 0.76-1.54, p50.676). This remained insignificant when adjusted for race/ethnicity, marital status, priority group, ADI, time to notification, and age (adjusted HR 1.03, 95% CI 0.71-1.50, p50.872). While Black, non-Hispanic individuals had a univariate HR of 2.09 (95% CI 1.33-3.29 p50.001), multivariate HR was 1.59 (95% CI 0.92-2.74, p50.093). ADI did not show a statistically significant difference upon univariate or multivariate analysis. (Table ) Conclusion: No findings were present which suggested new or exacerbated racial disparities. Additionally, neighborhood-level disparities did not modify these findings; however, this evaluation is limited by sample size.
Introduction: Artificial intelligence (AI) with deep learning is revolutionizing patient care across medicine. In Gastroenterology, AI systems are helping endoscopists identify polyps in real-time. Several randomized control trials have tested the efficacy of Computer-Aided Detection (CADe) system in adenoma and polyp detection. We aimed to assess the impact of CADe on adenoma detection rates (ADR) at our institution. Methods: This is a cross-sectional study that took place at a University Hospital between November 2021 and March 2022. We constructed a de-identified database with patients over the age of 45 that underwent screening and surveillance colonoscopies. Incomplete studies secondary to poor bowel preparation were excluded. We compared ADR, Polyp Detection Rate (PDR), total procedure time, withdrawal time, adenoma detected per colonoscopy (APC), and polyp detected per colonoscopy (PPC) between colonoscopies performed with and without CADe. Results: A total of 64 colonoscopies were evaluated, 32 of them were done with CADe, and 32 without it. ADR was 53% with CADe and 43% without (odds ratio 1.45, 95% CI 0.5442-3.9013; p50.4537). Polyp detection rate was 78% with CADe, 62% without CADe (odds ratio 2.1429, 95% CI 0.7118-6.4512; p50.1753). Average total procedure time was 25 minutes 24 seconds (SD 6 7 minutes) with CADe, and 23 minutes 41 seconds without (SD 6 9 minutes) (p50.42), average withdrawal time was 16 minutes 43 seconds (SD 6 6 minutes) for CADe and 14 minutes 49 seconds (SD 6 8 minutes) without CADe (p50.32). APC were 1.48 (SD 6 1.15) with CADe and 0.90 (SD 6 1.3) without CADe (p50.48). PPC were 2 (SD 6 2.38) and 1.90 (SD 6 2.69) respectively (p50.49). Conclusion: Several randomized control trials have proven that the use of CADe increases ADR without increasing withdrawal time. In our study, ADR with CADe was found to be higher compared to an already good ADR without CADe, and procedure, as well as withdrawal time were mildly increased with the use of CADe. However, the results were not significant, likely due to a low sample size. A larger study would be needed in order to show significant differences within the two groups.
Table 1. (continued) Frequency or percent Overall (n559) SRC Q1 (n515) SRC Q21Q31Q4 (n544) p-value Private Ins (median %)
surmised that because SUPREP ingredients contain sodium sulfate, the potential for UC flare is higher. It is pertinent for practitioners to be aware of the possible rare adverse effects of saline-based formulas, especially when treating the IBD population.[2791] Figure 1. (A) Colon (04/19/2022) and (B) Colon (05/09/2022).
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