Iron Supplementation is Underutilized after Hospitalization for Gastrointestinal Bleeding
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Introduction: Iron deficiency anemia (IDA) is common in the hospital setting and is frequently caused by gastrointestinal bleeding (GIB).While treatment is aimed at the underlying cause of IDA, it is also targeted at replenishing iron stores to reduce anemia progression and decrease the risk of end organ damage. Objective:The primary aim of this study was to assess whether patients hospitalized with IDA secondary to GIB received iron supplementation upon discharge.Methods: Retrospective analysis evaluating 992 patients admitted to our tertiary care hospital from 1/1/17 -12/1/17 who underwent endoscopy for GIB.IDA was defined as ferritin ≤ 30, iron saturation ≤ 10% or a ≥ 2gram drop from the patient's baseline hemoglobin.A secondary endpoint assessed readmission rates within a 180-day follow up period after discharge and associated morbidity and mortality.Results: A total of 228 patients met inclusion criteria for analysis.There were 115 males (50.4%) with an overall mean age of 62.6± 2.1y.Overall, 106 (46.5%) patients eligible by our criteria to receive iron therapy were discharged on this therapy.In regression analysis, receiving iron (OR = 13.6;95% CI, 7.0-26.6)or a blood transfusion (2.72; 1.1-6.9)during hospitalization were independently associated with discharge on iron.Discharge on iron was not associated with readmission but there was a non-significant trend toward anemia improvement for those supplemented with iron.Conclusions: At our institution, physicians failed to provide iron supplementation on discharge to over 50% of eligible patients.Patients diagnosed with IDA secondary to GIB are more likely to be discharged with iron supplementation if it was started during hospitalization or they received a blood transfusion.We believe the medication reconciliation performed automatically by the electronic medical record (EMR) at the time of discharge had a significant impact on this finding.Keywords:
Gastrointestinal bleeding
Iron supplementation
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Introduction: Iron deficiency anemia (IDA) is common in the hospital setting and is frequently caused by gastrointestinal bleeding (GIB).While treatment is aimed at the underlying cause of IDA, it is also targeted at replenishing iron stores to reduce anemia progression and decrease the risk of end organ damage. Objective:The primary aim of this study was to assess whether patients hospitalized with IDA secondary to GIB received iron supplementation upon discharge.Methods: Retrospective analysis evaluating 992 patients admitted to our tertiary care hospital from 1/1/17 -12/1/17 who underwent endoscopy for GIB.IDA was defined as ferritin ≤ 30, iron saturation ≤ 10% or a ≥ 2gram drop from the patient's baseline hemoglobin.A secondary endpoint assessed readmission rates within a 180-day follow up period after discharge and associated morbidity and mortality.Results: A total of 228 patients met inclusion criteria for analysis.There were 115 males (50.4%) with an overall mean age of 62.6± 2.1y.Overall, 106 (46.5%) patients eligible by our criteria to receive iron therapy were discharged on this therapy.In regression analysis, receiving iron (OR = 13.6;95% CI, 7.0-26.6)or a blood transfusion (2.72; 1.1-6.9)during hospitalization were independently associated with discharge on iron.Discharge on iron was not associated with readmission but there was a non-significant trend toward anemia improvement for those supplemented with iron.Conclusions: At our institution, physicians failed to provide iron supplementation on discharge to over 50% of eligible patients.Patients diagnosed with IDA secondary to GIB are more likely to be discharged with iron supplementation if it was started during hospitalization or they received a blood transfusion.We believe the medication reconciliation performed automatically by the electronic medical record (EMR) at the time of discharge had a significant impact on this finding.
Gastrointestinal bleeding
Iron supplementation
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Genentech is partnering with the German cancer company Affimed to develop immunotherapies for multiple kinds of solid and blood cancers. Affimed is developing therapies that engage natural killer cells of the innate immune system to help direct them to attack cancer cells. Genentech will pay Affimed $96 million up front and up to $5 billion more in potential payments.
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Бұл зерттеужұмысындaКaно моделітурaлы жәнеоғaн қaтыстытолықмәліметберілгенжәнеуниверситетстуденттерінебaғыттaлғaн қолдaнбaлы (кейстік)зерттеужүргізілген.АхметЯссaуи университетініңстуденттеріүшін Кaно моделіқолдaнылғaн, олaрдың жоғaры білімберусaпaсынa қоятынмaңыздытaлaптaры, яғнисaпaлық қaжеттіліктері,олaрдың мaңыздылығытурaлы жәнесaпaлық қaжеттіліктерінеқaтыстыөз университетінқaлaй бaғaлaйтындығытурaлы сұрaқтaр қойылғaн. Осы зерттеудіңмaқсaты АхметЯсaуи университетіндетуризмменеджментіжәнеқaржы бaкaлaвриaт бaғдaрлaмaлaрыныңсaпaсынa қaтыстыстуденттердіңқaжеттіліктерінaнықтaу, студенттердіңқaнaғaттaну, қaнaғaттaнбaу дәрежелерінбелгілеу,білімберусaпaсын aнықтaу мен жетілдіружолдaрын тaлдaу болыптaбылaды. Осы мaқсaтқaжетуүшін, ең aлдыменКaно сaуaлнaмaсы түзіліп,116 студенткеқолдaнылдыжәнебілімберугежәнеоның сaпaсынa қaтыстыстуденттердіңтaлaптaры мен қaжеттіліктерітоптықжұмыстaрaрқылыaнықтaлды. Екіншіден,бұл aнықтaлғaн тaлaптaр мен қaжеттіліктерКaно бaғaлaу кестесіменжіктелді.Осылaйшa, сaпa тaлaптaры төрт сaнaтқa бөлінді:болуытиіс, бір өлшемді,тaртымдыжәнебейтaрaп.Соңындa,қaнaғaттaну мен қaнaғaттaнбaудың мәндеріесептелдіжәнестуденттердіңқaнaғaттaну мен қaнaғaттaнбaу деңгейлерінжоғaрылaту мен төмендетудеосытaлaптaр мен қaжеттіліктердіңрөліaйқын aнықтaлды.Түйінсөздер:сaпa, сaпaлық қaжеттіліктер,білімберусaпaсы, Кaно моделі.
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The nationally-recognized Susquehanna
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