Provider and administrator-level perspectives on strategies to reduce fear and improve patient trust in the emergency department in times of heightened immigration enforcement.

Study Objectives: Heightened immigration enforcement may induce fear in undocumented patients when coming to the Emergency Department (ED) for care. Limited literature examining health system policies to reduce immigrant fear exists. In this multi-site qualitative study, we sought to assess provider and system-level policies on caring for undocumented patients in three California EDs.

Extra-Colonic Malignancy in Inflammatory Bowel Disease: a Paucity of Recommendations with Weak Evidence.

Introduction: Little data is available surrounding societal recommendations regarding extra-colonic malignancy in patients with inflammatory bowel disease (IBD). As a result, we systematically analyzed these international guidelines to assess their overall quality as well as their adherence to standards for high-quality practice guidelines.

Methods: A systematic search was performed in multiple databases to identify all guidelines pertaining to extra-colonic malignancy in IBD in April 2020.

ChemoPalRx-A Mobile App That Enhances Chemotherapy Prescription Accuracy: A Cross-Sectional Study.

Purpose: ChemoPalRx is a novel provider order entry mobile application for chemotherapy. This study aims to evaluate the accuracy of prescribing chemotherapy using ChemoPalRx versus handwritten orders at a safety-net hospital in Los Angeles.

Methods: In a cross-sectional study from October 2019 to December 2019, we evaluated all outpatient chemotherapy orders for accuracy.

Ethnic Disparities in Diabetes.

Diabetes disproportionably affects minorities in the United States. Substantial disparities exist in diabetes incidence, glycemic control, complications, mortality, and management. The most important biologic contributors to diabetes disparities are obesity, insulin resistance, and inadequate glycemic control.

Readmission, healthcare consumption, and mortality in Clostridioides difficile infection hospitalizations: a nationwide cohort study.

Objective: Despite being the most common healthcare-related infection in the US, nationwide data on readmission, healthcare consumption, and mortality in Clostridioides difficile infection (CDI) remain limited. We examined these outcomes in a US-based cohort of patients with CDI.

Methods: We queried the 2017 Nationwide Readmission Database using ICD-10-CM codes to identify all adult patients admitted with a principal diagnosis of CDI.

Predictive Modeling of Colonoscopic Findings in a Fecal Immunochemical Test-Based Colorectal Cancer Screening Program.

Background: The fecal immunochemical test (FIT) is the primary modality used by the Los Angeles County Department of Health Services (LADHS) for colorectal cancer (CRC) screening in average-risk patients. Some patients referred for FIT-positive diagnostic colonoscopy have neither adenomas nor more advanced pathology. We aimed to identify predictors of false-positive FIT (FP-FIT) results in our largely disenfranchised, low socioeconomic status population.

Defying the Odds of Sudden Cardiac Death in Hypertrophic Cardiomyopathy.

We report an unusual case of a patient with hypertrophic obstructive cardiomyopathy, anomalous aortic origin of a coronary artery, obesity hypoventilation syndrome, and acquired long QT syndrome who was able to defy the odds of sudden cardiac death in the rarest of circumstances. ().

Feasibility of patient-performed lung ultrasound self-exams (Patient-PLUS) as a potential approach to telemedicine in heart failure.

Aims: Patient-performed lung ultrasound (LUS) in a heart failure (HF) telemedicine model may be used to monitor worsening pulmonary oedema and to titrate therapy, potentially reducing HF admission. The aim of the study was to assess the feasibility of training HF patients to perform a LUS self-exam in a telemedicine model.

Methods And Results: A pilot study was conducted at a public hospital involving subjects with a history of HF.

The Rapid Evaluation of COVID-19 Vaccination in Emergency Departments for Underserved Patients Study.

Study Objective: Emergency departments (EDs) often serve vulnerable populations who may lack primary care and have suffered disproportionate COVID-19 pandemic effects. Comparing patients having and lacking a regular source of medical care and other ED patient characteristics, we assessed COVID-19 vaccine hesitancy, reasons for not wanting the vaccine, perceived access to vaccine sites, and willingness to get the vaccine as part of ED care.

Methods: This was a cross-sectional survey conducted from December 10, 2020, to March 7, 2021, at 15 safety net US EDs.

Changes in epilepsy causes of death: A US population study.

Objectives: Since 2000, medical treatment for epilepsy and cardiovascular risk-reduction strategies have advanced significantly in the United States (US). However, seizure-free rates remain unchanged, and people with epilepsy are at higher risk than the general population for heart disease and stroke. The purpose of this study is to determine how cardiovascular, epilepsy-related, and other causes of death are changing in epilepsy in comparison with the US population.

Impact of the 2016 Election on the Quality of Life of Sexual and Gender Minority Adults: A Difference-in-Differences Analysis.

The 2016 U.S. election significantly changed the political landscape for sexual and gender minority (SGM) individuals.

In patients having transjugular intrahepatic portosystemic shunt, rifaximin prevented overt hepatic encephalopathy.

Bureau C, Thabut D, Jezequel C, et al. Ann Intern Med. 2021;174:633-40.

Global incidence, prevalence and features of primary sclerosing cholangitis: A systematic review and meta-analysis.

Background & Aims: Primary sclerosing cholangitis (PSC) is an idiopathic, cholestatic liver disease with a diverse range of clinical manifestations. Inter-regional data on PSC are variable, but its global geoepidemiology has not been well-studied. We aimed to examine the worldwide incidence, prevalence and features of PSC and PSC-inflammatory bowel disease (PSC-IBD).

Pre-procedural Preparation and Sedation for Gastrointestinal Endoscopy in Patients with Advanced Liver Disease.

Gastrointestinal endoscopy in patients with advanced liver disease poses various challenges, a major one being procedural sedation and its associated considerations. While sedation during endoscopy can improve patient comfort, decrease anxiety, and facilitate procedural completion, in patients with advanced liver disease, it is also associated with substantial and unique risks due to alterations in drug metabolism and other factors. As such, the choice of sedative agent(s) and related logistics may require careful inter-disciplinary planning and individualized considerations.

Best practices for prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis.

Acute pancreatitis is of one the most common gastroenterology-related indications for hospital admissions worldwide. With the widespread reliance on endoscopic retrograde cholangiopancreatography (ERCP) for the management of pancreaticobiliary conditions, post-ERCP pancreatitis (PEP) has come to represent an important etiology of acute pancreatitis. Despite many studies aiming to better understand the pathogenesis and prevention of this iatrogenic disorder, findings have been heterogeneous, and considerable variation in clinical practice exists.

Lipid-Lowering Therapy and Hemorrhagic Stroke Risk: Comparative Meta-Analysis of Statins and PCSK9 Inhibitors.

Background And Purpose: Statins were shown to increase hemorrhagic stroke (HS) in patients with a first cerebrovascular event in 2006 (SPARCL), likely due to off-target antithrombotic effects, but continued to sometimes be used in patients with elevated HS risk due to absence of alternative medications. Recently, the PCSK9Is (proprotein convertase subtilisin kexin 9 inhibitors) have become available as a potent lipid-lowering class with potentially less hemorrhagic propensity.

Methods: We performed a systematic comparative meta-analysis assessing HS rates across all completed statin and PCSK9I randomized clinical trials with treatment >3 months, following PRISMA guidelines.

Impact of the COVID-19 Pandemic on Clinical Schedules and Physical and Mental Well-Being of Gastroenterology Nonphysician Healthcare Workers: A Nationwide Survey.

COVID-19 was declared a pandemic in March 2020 by the World Health Organization. To minimize exposure and because of limited personal protective equipment resources, most gastroenterology practices were curtailed/modified during the surge, with slow reopening to a normal/semi-normal schedule. Gastroenterology healthcare workers have been impacted greatly by COVID-19, resulting in job and wage insecurity.

Anti-immigrant Rhetoric and the Experiences of Latino Immigrants in the Emergency Department.

Introduction: Anti-immigrant rhetoric and increased enforcement of immigration laws have induced worry and safety concerns among undocumented Latino immigrants (UDLI) and legal Latino residents/citizens (LLRC), with some delaying the time to care. In this study, we conducted a qualitative analysis of statements made by emergency department (ED) patients - a majority of whom were UDLI and LLRC - participating in a study to better understand their experiences and fears with regard to anti-immigrant rhetoric, immigration enforcement, and ED utilization.

Methods: We conducted a multi-site study, surveying patients in three California safety-net EDs serving large immigrant populations from June 2017-December 2018.

Medical professional liability in gastroenterology: definitions, trends, risk factors, provider behaviors, and implications.

Medical professional liability (MPL) is a notable concern for many clinicians, especially in procedure-intensive specialties such as gastroenterology (GI). Comprehensive understanding of the basis for MPL claims can improve gastroenterologists' practice, lower MPL risk, and improve the overall patient care experience. This is particularly relevant in the setting of the increasing average compensation per paid GI-related MPL claim, and evolving healthcare delivery patterns and regulations.

Severe Hyperphosphatemia in a Patient with Mild Acute Kidney Injury.

Hyperphosphatemia may arise from various conditions including exogenous ingestion, extracellular shifts due to cell death or alterations in acid-base status, increased bone resorption, hormonal dysregulations leading to reduced renal excretion, reduced kidney function, or faulty measurement techniques. We herein present a case of a young pregnant woman who presented with mild acute kidney injury (AKI), invasive mucormycosis receiving liposomal amphotericin, and hyperphosphatemia out of proportion to the degree of kidney injury. While the patient was given routine phosphate-binding agent by her primary care team for presumed AKI-associated hyperphosphatemia, a full investigation by the renal consulting team for contributing factors other than kidney injury revealed that she actually had pseudohyperphosphatemia associated with the use of liposomal amphotericin.

Applications, Limitations, and Expansion of Cholangioscopy in Clinical Practice.

Peroral cholangioscopy (POC) provides minimally invasive, direct endoscopic visualization of the biliary ductal system for both diagnostic and therapeutic purposes. POC has benefited from a number of technologic advances since its first introduction several decades ago. These advances have led to improved utility and expanded functionality, making POC an integral part of managing various bile duct diseases and disorders.