The effect of prophylactic hemoclips on the risk of delayed post-endoscopic mucosal resection bleed for upper and lower gastrointestinal lesions: a retrospective cohort study.

BACKGROUND: Endoscopic mucosal resection (EMR) is a minimally invasive procedure used for the treatment of lesions in the gastrointestinal (GI) tract. There is increased usage of hemoclips during EMR for the prevention of delayed bleeding. This study aimed to evaluate the effect of hemoclips in the prevention of delayed bleeding after EMR of upper and lower GI tract lesions. METHOD: This is a retrospective cohort study using the Kaiser Permanente Southern California (KPSC) EMR registry. Lesions in upper and lower GI tracts that underwent EMR between January 2012 and December 2015 were analyzed. Rates of delayed bleeding were compared between the hemoclip and no-hemoclip groups. Analysis was stratified by upper GI and lower GI lesions. Lower GI group was further stratified by right and left colon. We examined the relationship between clip use and several clinically-relevant variables among the patients who exhibited delayed bleeding. Furthermore, we explored possible procedure-level and endoscopist-level characteristics that may be associated with clip usage. RESULTS: A total of 18 out of 657 lesions (2.7%) resulted in delayed bleeding: 7 (1.1%) in hemoclip group and 11 (1.7%) in no-hemoclip group (p = 0.204). There was no evidence that clip use moderated the effects of the lesion size (p = 0.954) or lesion location (p = 0.997) on the likelihood of delayed bleed. In the lower GI subgroup, clip application did not alter the effect of polyp location (right versus left colon) on the likelihood of delayed bleed (p = 0.951). Logistic regression analyses showed that the clip use did not modify the likelihood of delayed bleeding as related to the following variables: use of aspirin/NSAIDs/anti-coagulants/anti-platelets, pathologic diagnoses (including different types of colon polypoid lesions), ablation, piecemeal resection. The total number of clips used was 901 at a minimum additional cost of $173,893. CONCLUSION: Prophylactic hemoclip application did not reduce delayed post-EMR bleed for upper and lower GI lesions in this retrospective study performed in a large-scale community practice setting. Routine prophylactic hemoclip application during EMR may lead to significantly higher healthcare cost without a clear clinical benefit.

Predicting community opposition to inclusion in schools: the role of social dominance, contact, intergroup anxiety, and economic conservatism.

This study addresses community members' attitudes toward inclusion, the practice of including students with disabilities in regular education classroom settings. Participants in Study 1 were 271 community adults, completing measures of prior contact with people with disabilities, social dominance orientation (SDO), economic conservatism, intergroup anxiety, prejudice, and opposition to inclusion. Results from structural equation modeling indicated that amount of intergroup anxiety predicted opposition to inclusion via the mediator, prejudice toward people with disabilities, and that amount of prior contact indirectly predicted prejudice toward people with disabilities through intergroup anxiety. SDO positively predicted both intergroup anxiety and prejudice in the model, with prejudice also mediating between SDO and opposition to inclusion. Both SDO and economic conservatism failed to exhibit direct predictive relationships with opposition to inclusion. Participants in Study 2 were 161 community adults. Contact was shown to exert an indirect effect on prejudice via intergroup anxiety, whereas intergroup anxiety impacted inclusive attitudes via prejudice. SDO exerted both direct and indirect (via prejudice) effects on opposition to inclusion.

Are all conservatives alike? A study of the psychological correlates of cultural and economic conservatism.

The author addresses the question of whether cultural and economic conservatism differ among American citizens in their relation to measures of epistemic beliefs and motives, dogmatism, death-related anxiety, and the tendency to exhibit dogmatic aggression against those who hold beliefs and values that diverge from one's own. Data from this study suggest that these types of conservative attitudes exhibit different correlational patterns with the aforementioned measures. Research participants who held more culturally conservative attitudes were more likely to score higher on measures of the belief that knowledge is certain, dogmatism, need to evaluate, and fear of death. They also scored lower on need for cognition than did their less conservative counterparts. Moreover, participants who scored higher on cultural conservatism were more likely to exhibit dogmatic aggression. Economic conservatism was largely unrelated to measures of epistemic beliefs and motives, fear of death, dogmatism, and aggressiveness. Ancillary regression analyses revealed that belief that knowledge is certain and dogmatism were the strongest predictors of cultural conservatism. Cultural conservatism, fear of death, and need for structure were significant predictors of dogmatic aggression.