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2. Application of 2015 American Gastroenterological Association Guidelines On a Retrospective Cohort of Patients with Asymptomatic Pancreatic Cysts: Can We Truly Forego Endoscopic Ultrasound?

Author

Krishnan Kumar, Omer Anam, Raza Ali, Miller A Ross, and Mody R Dina

Subjects
american gastroenterology association, endoscopic ultrasound-guided fine needle aspiration, guideline, pancreatic cyst, pancreatic neoplasm, Diseases of the digestive system. Gastroenterology, RC799-869
Abstract

Objective: Asymptomatic pancreatic cysts are frequently diagnosed on cross-sectional imaging. Recently, the American Gastroenterological Association (AGA) has put forth guidelines regarding management of these cysts. To date, there is no strong data to indicate whether these guidelines will accurately identify malignancy and mitigate unnecessary endoscopic ultrasound (EUS) procedures. The aim of this investigation was to apply the 2015 AGA guidelines to a retrospective cohort of asymptomatic pancreatic cysts in a large regional referral center. Materials and Methods: This is a retrospective cohort study of patients with asymptomatic pancreatic cysts who underwent EUS with fine-needle aspiration (FNA) over a 3-year period. We applied current AGA guidelines to determine how many EUS procedures would be avoided, and further assessed whether the guidelines adequately identified cases of malignancy. Results: Forty-five patients were identified who underwent EUS FNA for an asymptomatic pancreatic cyst from 2011 to 2014. The mean age was 65 years, and the mean size cyst size was 2.8 cm. According to the 2015 AGA guidelines, EUS was indicated in 13 of the 45 patients and surveillance imaging in the remaining 32 patients. 3 of these 32 patients had atypical cytology on EUS FNA, and final histology showed adenocarcinoma in 2 patients and IMPN with high-grade dysplasia in 1 patient. Conclusion: Applying AGA guidelines in this study cohort would have prevented 32 out of 45 (71%) EUS procedures; however, 3 of these 32 patients had early occult malignancy. This data suggest that additional strategies are needed to identify those patients at high risk.

Published
2018
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7. Comparison of health care resource utilization and costs among patients with GERD on once-daily or twice-daily proton pump inhibitor therapy

Author

Mody R, Eisenberg D, Hou L, Kamat S, Singer J, and Gerson LB

Subjects
Medicine (General), R5-920, Therapeutics. Pharmacology, RM1-950
Abstract

Reema Mody,1 Debra Eisenberg,2 Likun Hou,2 Siddhesh Kamat,2 Joseph Singer,2 Lauren B Gerson3 1Takeda Pharmaceuticals International Inc, Deerfield, IL, 2HealthCore Inc, Wilmington, DE, 3Stanford University School of Medicine, Stanford, CA, USA Background: The purpose of this study was to assess differences in health care resource utilization and costs associated with once-daily and twice-daily proton pump inhibitor (PPI) therapy. Most patients with gastroesophageal reflux disease (GERD) achieve symptom control on once-daily PPI therapy, but approximately 20%–30% require twice-daily dosing. Methods: Patients were ≥18 years of age with at least one medical claim for GERD and at least two PPI claims from HealthCore's Integrated Research Database (HIRDSM) during 2004–2009. Patients were continuously eligible for 12 months before and after the index date (date of first PPI claim). Based on PPI dosing throughout the post-index period (quantity of medication dispensed/number of days supply), patients were classified as once-daily (dose ≤ 1.5 pills per day) or twice-daily (≥1.5) PPI users. Results: The study cohort included 248,386 patients with GERD (mean age 52.8 ± 13.93 years, 56% females) of whom 90% were once-daily and 10% were twice-daily PPI users. The Deyo-Charlson Comorbidity Index for once-daily and twice-daily PPI users was 0.70 ± 1.37 and 0.89 ± 1.54, respectively (P < 0.05). More once-daily patients had claims for Barrett's esophagus (5% versus 2%, P < 0.0001) than twice-daily patients. Post-index, higher proportions of twice-daily patients had at least one GERD-related inpatient visit (7% versus 5%), outpatient visit (60% versus 49%), and office visit (48% versus 38%) versus once-daily patients (P < 0.0001). Mean total GERD-related health care costs were $2065 ± $6636 versus $3749 ± $11,081 for once-daily and twice-daily PPI users, respectively (P < 0.0001). Conclusion: Patients receiving twice-daily PPI therapy were likely to have more comorbid conditions and greater health care utilization and overall costs compared with patients using once-daily PPI therapy. Keywords: gastroesophageal reflux disease, proton pump inhibitors, health care resource utilization, database analysis

Published
2013

13. Internal evaluation of risk stratification tool using serial procalcitonin and clinical risk factors in pediatric febrile neutropenia: The non-interventional, single institution experience prior to clinical implementation.

Author

Nessle, C. N., Braun, T., Choi, S. W., and Mody, R.

Subjects
FEBRILE neutropenia, CALCITONIN, RISK assessment, EVALUATION methodology, CRITICAL care medicine, DESCRIPTIVE statistics
Abstract

Risk stratification of pediatric febrile neutropenia (FN) is an established concept, yet clinical risk tools misclassify nearly 5% of clinical standard-risk episodes with severe outcomes. The internal evaluation of a clinical risk tool before implementation has not been well-described. In this noninterventional cohort study, we evaluated a study decision rules (SDR) tool; a clinical risk tool with serial procalcitonin. The study standard-risk (SSR) group met clinical standard-risk criteria with two serial procalcitonin <0.4 ng/mL. The study high-risk (SHR) group met clinical high-risk criteria or clinical standard-risk with a procalcitonin ≥0.4 ng/mL. Descriptive and bivariate statistics compared the groups and outcomes. Clinical criteria alone identified 39.1% (238/608) standard-risk episodes; 5.9% (14/238) had severe events. Prospectively using the SDR, the SHR group encompassed 76.6% (92/120) of episodes; severe events occurred in 20% (3/15) of standard-risk episodes included due to elevated procalcitonin ≥0.4 ng/mL. The SHR group had more blood stream infections [21.7% (20/92) vs. 0% (0/28); P = 0.007] and intensive care admissions [13% (12/92) vs. 3.6% (1/28); P = 0.158]. In conclusion, the SDR with serial procalcitonin aided in identifying severe events in clinical standard-risk episodes, but analysis was limited. Institutions may consider similar internal evaluation methodology before FN episode risk stratification. [ABSTRACT FROM AUTHOR]

Published
2023
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39. Clinical Characteristics and Outcomes of Cardiac Findings in Young Persons Following SARS-CoV-2 Infection

Author

Jones, Milissa U., Richard, Stephanie A., Malloy, Allison M. W., Colombo, Rhonda E., May, Joseph, Saunders, David, Lindholm, David A., Ganesan, Anuradha, Sablak, Ceyda, Hickey, Patrick W., Dobson, Craig P., Pollett, Simon D., Flanagan, Ryan, Cowden, J., Darling, M., DeLeon, S., Lindholm, D., Markelz, A., Mende, K., Merritt, S., Merritt, T., Turner, N., Wellington, T., Bazan, S., Love, P.K, Dimascio-Johnson, N., Elnahas, N., Ewers, E., Gallagher, K., Glinn, C., Jarral, U., Jennings, D., Larson, D., Reterstoff, K., Rutt, A., Silva, A., West, C., Al-Eid, H., Blair, P., Chenoweth, J., Clark, D., Bowman, J., Chambers, S., Colombo, C., Colombo, R., Conlon, C., Everson, K., Faestel, P., Ferguson, T., Gordon, L., Grogan, S., Lis, S., Martin, M., Mount, C., Musfeldt, D., Odineal, D., Perreault, M., Robb-McGrath, W., Sainato, R., Schofield, C., Skinner, C., Stein, M., Switzer, M., Timlin, M., Wood, S., Banks, S., Carpenter, R., Kim, L., Kronmann, K., Lalani, T., Lee, T., Smith, A., Smith, R., Tant, R., Warkentien, T., Berjohn, C., Cammarata, S., Kirkland, N., Libraty, D., Maves, R., Utz, G., Bradley, C., Chi, S., Flanagan, R., Fuentes, A., Jones, M., Leslie, N., Lucas, C., Madar, C., Miyasato, K., Uyehara, C., Adams, H., Agan, B., Andronescu, L., Austin, A., Barton, B., Becher, D., Broder, C., Burgess, T., Byrne, C., Chung, K, Davies, J., English, C., Epsi, N., Fox, C., Fritschlanski, M., Hadley, A., Hickey, P., Laing, E., Lanteri, C., Livezey, J., Malloy, A., Michel, A., Mohammed, R., Morales, C., Nwachukwu, P., Olsen, C., Parmelee, E., Pollett, S., Richard, S., Rothenberg, J., Rozman, J., Rusiecki, J., Saunders, D., Samuels, E., Sanchez, M., Scher, A., Simons, M., Snow, A., Telu, K., Tribble, D., Tso, M., Ulomi, L., Wayman, M., Hockenbury, N., Chao, T., Chapleau, R., Christian, M., Fries, A., Harrington, C., Hogan, V., Huntsberger, S., Lanter, K., Macias, E., Meyer, J., Purves, S., Reynolds, K., Rodriguez, J., Starr, C., Iskander, J., Kamara, I., Barton, B., Hostler, D., Hostler, J., Lago, K., Maldonado, C., Mehrer, J., Hunter, T., Mejia, J., Mody, R., Montes, J., Resendez, R., Sandoval, P., Barahona, I., Baya, A., Ganesan, A., Huprikar, N., Johnson, B., and Peel, S.

Abstract

We studied cardiac complications in young persons with severe acute respiratory syndrome coronavirus 2. In a prospective cohort of 127 Military Health System beneficiaries 0–22 years old, 3.1% had cardiac abnormalities, all resolved within 6 months. Our findings support guidelines against routine cardiac screening in mild COVID-19 cases without cardiac symptoms.

Published
2024
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40. Multistate outbreak of Salmonella infections associated with frozen pot pies--United States, 2007

Author

Meyer, S., Smith, K., Azzam, I., Sowadsky, R., Williams, I.T., Henao, O., Nguyen, T., Austin, J., Van Duyne, S., and Mody, R.

Subjects
Statistics, Distribution, Prevention, Contamination, Methods, Health aspects, Causes of, Company distribution practices, Salmonella food poisoning -- Distribution -- Statistics -- Causes of -- Prevention, Salmonella -- Health aspects -- Methods -- Statistics, Food preparation -- Methods -- Health aspects -- Statistics, Food safety -- Methods -- Statistics -- Health aspects, Pies -- Contamination -- Distribution -- Statistics, Food -- Safety and security measures
Abstract

On June 6, 2007, a cluster of four human Salmonella serotype I 4,5,12:i:- * infections sharing a pulsed-field gel electrophoresis (PFGE) pattern was identified by the Pennsylvania Department of Health [...]

Published
2008

44. Peptidolytic monoclonal antibodies elicited by a neuropeptide

Author

PAUL S, SUN M, MODY R, TEWARY H. K, STEMMER P, MASSEY R. J, MEHROTRA S, DREYER T, MELDAL M, TRAMONTANO A., GIANFERRARA, TERESA, Paul, S, Sun, M, Mody, R, TEWARY H., K, Stemmer, P, MASSEY R., J, Gianferrara, Teresa, Mehrotra, S, Dreyer, T, Meldal, M, and Tramontano, A.

Published
1992

46. Multiple-Aetiology Enteric Infections Involving Non-O157 Shiga Toxin-ProducingEscherichia coli- FoodNet, 2001-2010

Author

Luna-Gierke, R. E., primary, Wymore, K., additional, Sadlowski, J., additional, Clogher, P., additional, Gierke, R. W., additional, Tobin-D'Angelo, M., additional, Palmer, A., additional, Medus, C., additional, Nicholson, C., additional, McGuire, S., additional, Martin, H., additional, Garman, K., additional, Griffin, P. M., additional, and Mody, R. K., additional

Published
2014
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