Impact of Real-Time Clinical Decision Support on Blood Utilization and Outcomes in Hospitalized Patients with Solid Tumor Cancer.

INTRODUCTION: Patients with cancer are frequently hospitalized, and anemia is a common complication of cancer care. Transfusion is often required and commonly occurs above guideline-supported thresholds. It was hypothesized that an educational intervention, combined with real-time clinical decision support (CDS), would reduce blood utilization among hospitalized solid tumor cancer patients without adversely affecting outcomes. METHODS: A retrospective, historical control analysis was conducted comparing transfusion utilization among hospitalized solid tumor cancer patients before and after implementation of the educational intervention and CDS. The primary outcome was receipt of red blood cell (RBC) transfusion. Secondary outcomes included total RBC transfusions per 100 inpatient-days, readmission, outpatient transfusion within seven days of discharge, inpatient mortality, and odds of transfer to the ICU. RESULTS: The odds of receiving a transfusion were significantly reduced in the postintervention cohort (odds ratio [OR] = 0.52, p = 0.005). Among patients receiving transfusion, there was no significant difference between groups in the number of RBC transfusions per 100 inpatient-days (incidence rate ratio = 0.87, p = 0.26). There were also no significant differences in readmission, outpatient transfusion within seven days of discharge, or inpatient mortality, though patients in the postintervention cohort had lower odds of ICU transfer (OR = 0.29, p = 0.04). CONCLUSION: The combined use of an educational intervention and CDS in a hospitalized solid tumor cancer patient population was associated with lower blood utilization, similar patient outcomes, and unchanged short-term outpatient transfusion requirements. Hospitals should consider similar interventions to work toward appropriate resource allocation and mitigation of transfusion-associated risk in this patient population.

Survey of Provider Transfusion Practices for Oncology Patients in an Academic Medical Center.

OBJECTIVES: Hospitalized oncology patients receive care from a variety of professionals, each of whom plays a role in decisions related to blood transfusions. We sought to examine differences in transfusion practices based on professional role, years of experience, and patient clinical scenario. METHODS: We surveyed general medicine residents, hospitalists, and oncologists caring for inpatients at a large academic medical center between August 2013 and June 2014. Respondents reported transfusion practices in three different patient scenarios: a generally healthy patient, a patient with solid tumor malignancy, and a patient with hematologic malignancy. We also assessed rationale for transfusion practices. Bivariate comparisons of respondent characteristics and transfusion threshold were conducted using the Fisher exact test. Multivariate logistic regression was performed to assess the relative relations among professional role, years in practice, clinical scenario, and transfusion threshold <7 g/dL. RESULTS: Of 158 physicians surveyed, 97 responded (61.4%). In bivariate analyses, fewer oncologists than residents or hospitalists used a threshold of <7 g/dL, but the result was significant for only one of three scenarios. The multivariate odds of transfusing at a threshold <7 g/dL were significantly higher among nononcologists (odds ratio [OR] 2.10, 95% confidence interval [CI] 1.03-4.28). Residents and practitioners in practice for <4 years also were more likely to use a threshold <7 g/dL (OR 1.82, 95% CI 0.99-3.33). Providers were less likely to use a restrictive threshold when an underlying malignancy was present (solid tumor OR 0.31, 95% CI 0.15-0.64; hematologic malignancy OR 0.34, 95% CI 0.16-0.70). CONCLUSIONS: Transfusion thresholds differed based on professional role, years in practice, and patient scenario. Further research is needed to determine the optimal transfusion threshold for oncology patients.

Core body temperature is lower in postmenopausal women than premenopausal women: potential implications for energy metabolism and midlife weight gain.

OBJECTIVE: Weight gain during the menopausal transition is common. Although studies have suggested that weight gain is more likely related to aging than menopause, there is a reduction in resting energy expenditure with surgical or natural menopause which is independent of age and changes in body composition. The underlying mechanisms could include a reduction in core body temperature. METHODS: Data were obtained from two related studies. Sample size was 23 men and 25 women (12 premenopausal,13 postmenopausal). In the Clinical Research Unit, core temperature was measured every minute for 24 hours (CorTemp System,HQ Inc.). RESULTS: Mean 24-hour core body temperature was 0.25 ± 0.06 °C lower in postmenopausal than premenopausal women (p=0.001). Mean 24-hour core temperature was 0.34 ± 0.05 °C lower in men than in premenopausal women (p<0.001). CONCLUSIONS: Postmenopausal women, like men, had lower core body temperatures than premenopausal women. This may have implications for midlife weight gain.

Inpatient obesity intervention with postdischarge telephone follow-up: A randomized trial.

BACKGROUND: Obesity-related comorbidities frequently contribute to acute illness. Obesity interventions during hospitalization are not often utilized but may be effective. OBJECTIVE: To examine whether inpatient weight loss intervention with postdischarge follow-up results in weight loss at 6 months when compared to control. DESIGN: Prospective, randomized controlled trial. SETTING: Academic medical center in Chicago, Illinois. PATIENTS: Obese adult inpatients. INTERVENTION: Intervention subjects viewed a weight education video, underwent personalized counseling, and set specific weight loss, dietary, and fitness goals prior to discharge. All participants were followed by phone over the subsequent 6 months. The trial was unblinded to participants, physicians, and investigators. MEASUREMENTS: Primary outcome was weight change between groups at 6 months. Weight change from baseline and waist-to-hip ratios (WHR) were also assessed. RESULTS: For 176 participants in the intention-to-treat analysis, mean baseline weight for the intervention group was 107.7 kg (standard deviation [SD]=16.7) and 105.1 kg (SD=17.4) for controls. Mean weight loss at 6 months was 1.08 kg (SD=4.33) for intervention subjects and 1.35 kg (SD=3.65) among controls. There was no significant difference in weight loss between groups at 6 months (P=0.26). As-treated analysis yielded similar results. There were no differences in WHRs between the intervention and control at 6 months (0.04 vs 0.04, P=0.59). CONCLUSIONS: We found no difference in weight loss between the intervention and control groups at 6 months.

24-h core temperature in obese and lean men and women.

Maintenance of core temperature is a major component of 24-h energy expenditure, and its dysregulation could contribute to the pathophysiology of obesity. The relationship among temperature, sex, and BMI, however, has not been fully elucidated in humans. This study investigated core temperature in obese and lean individuals at rest, during 20-min exercise, during sleep, and after food consumption. Twelve lean (18.5-24.9 kg/m(2)) and twelve obese (30.0-39.9 kg/m(2)) healthy participants, ages 25-40 years old, were admitted overnight in a clinical research unit. Females were measured in the follicular menstrual phase. Core temperature was measured every minute for 24 h using the CorTemp system, a pill-sized sensor that measures core temperature while in the gastrointestinal tract and delivers the measurement via a radio signal to an external recorder. Core temperature did not differ significantly between the obese and lean individuals at rest, postmeals, during exercise, or during sleep (P > 0.5), but core temperature averaged over the entire study was significantly higher (0.1-0.2 °C) in the obese (P = 0.023). Each individual's temperature varied considerably during the study, but at all times, and across the entire study, women were ~0.4 °C warmer than men (P < 0.0001). These data indicate that obesity is not associated with a lower core temperature but that women have a higher core temperature than men at rest, during sleep, during exercise, and after meals.

Willingness for weight loss intervention among overweight and obese inpatients.

OBJECTIVES: To determine whether overweight and obese inpatients are receptive to weight-loss interventions while hospitalized and whether interest in weight-loss intervention correlates with accurate self-perception of weight. METHODS: We conducted a cross-sectional survey of overweight and obese patients admitted to the general medicine service at a large urban academic medical center from September 17, 2007 through October 16, 2007. Subjects were identified based on body mass index (BMI) on admission ≥25 and surveyed using a 14-question instrument. The main outcome measure was patient willingness to consider weight-loss intervention. RESULTS: Of 67 eligible patients, 64 (95.5%) agreed to be interviewed. BMI ranged from 25 to 50. Overall, 52.6% (10 of 19) of overweight patients did not believe they were overweight and 46.7% (21 of 45) of those with a BMI over 30 were unaware that they met criteria for obesity. Among all patients surveyed, 56.3% stated they would be interested in weight-loss intervention while hospitalized. In obese patients specifically, 68.9% expressed interest. Interest correlated with BMI (Pearson correlation coefficient (r) = 0.261, P = 0.04), accurate self-perception of weight (P = 0.03), diagnostic delays related to weight (P = 0.01) and a history of past weight-loss attempts (P = 0.04). None of the patients we interviewed received weight-loss intervention of any kind while hospitalized. CONCLUSION: Inpatients who recognize that they are overweight or obese are interested in pursuing weight-loss initiatives. Despite their interest, most do not receive weight-loss interventions while hospitalized.