2024
Impact of large scale, multicomponent intervention to reduce proton pump inhibitor overuse in integrated healthcare system: difference-in-difference study
Kurlander J, Laine L, Kim H, Roberts C, Saffar D, Myers A, Holleman R, Gao Y, Shank M, Nelson R, Forman J, Helfrich C, Krein S, Saini S, Yang Y. Impact of large scale, multicomponent intervention to reduce proton pump inhibitor overuse in integrated healthcare system: difference-in-difference study. The BMJ 2024, 385: e076484. PMID: 38604668, PMCID: PMC11007585, DOI: 10.1136/bmj-2023-076484.Peer-Reviewed Original ResearchMeSH KeywordsAgedDelivery of Health Care, IntegratedGastrointestinal DiseasesGastrointestinal HemorrhageHistamine H2 AntagonistsHumansProton Pump InhibitorsConceptsPrimary care visitsProton pump inhibitors prescriptionUpper gastrointestinal diagnosesMulticomponent interventionCare visitsHealthcare systemHospital admissionUS Veterans Affairs Healthcare SystemVeterans Affairs Healthcare SystemAbsolute reductionGastrointestinal diagnosesIntegrated healthcare systemProton pump inhibitor overuseReducing proton-pump inhibitorDifference-in-differences studyProton pump inhibitorsPercentage of patientsProton pump inhibitor useAcid peptic diseaseElectronic prescribingPrimary careHealthcare utilizationIntervention sitesPPI prescriptionsOlder adults
2023
Management of Bleeding Due to Small-Intestinal Angiodysplasias
Laine L. Management of Bleeding Due to Small-Intestinal Angiodysplasias. New England Journal Of Medicine 2023, 389: 1718-1720. PMID: 37913510, DOI: 10.1056/nejme2310338.Peer-Reviewed Original ResearchTrends in Upper Gastrointestinal Bleeding in Patients on Primary Prevention Aspirin: A Nationwide Emergency Department Sample Analysis, 2016-2020
Li D, Laine L, Shung D. Trends in Upper Gastrointestinal Bleeding in Patients on Primary Prevention Aspirin: A Nationwide Emergency Department Sample Analysis, 2016-2020. The American Journal Of Medicine 2023, 136: 1179-1186.e1. PMID: 37696350, PMCID: PMC10841721, DOI: 10.1016/j.amjmed.2023.08.010.Peer-Reviewed Original ResearchMeSH KeywordsAgedAnti-Inflammatory Agents, Non-SteroidalAspirinCardiovascular DiseasesEmergency Service, HospitalGastrointestinal HemorrhageHumansMedicarePrimary PreventionRisk FactorsUnited StatesConceptsUpper gastrointestinal bleedingGastrointestinal bleedingRed blood cell transfusionNationwide Emergency Department SamplePrimary cardiovascular preventionRecent guideline recommendationsBlood cell transfusionProportion of hospitalizationsEmergency Department SampleMedicare reimbursementInternational Statistical ClassificationRelated Health ProblemsCardiovascular preventionCell transfusionOlder patientsHospital admissionCommon etiologyGuideline recommendationsMajor complicationsUlcer diseaseEndoscopic interventionRevision codesAppropriate indicationsRecent guidelinesCardiovascular disease
2022
Deprescription of aspirin for primary prevention is uncommon at discharge in hospitalised patients with gastrointestinal bleeding
Li D, Ong S, Hughes M, Hung K, Agarwal R, Alexis J, Damianos J, Sharma S, Pires J, Nanna M, Laine L. Deprescription of aspirin for primary prevention is uncommon at discharge in hospitalised patients with gastrointestinal bleeding. Alimentary Pharmacology & Therapeutics 2022, 57: 94-102. PMID: 36394111, DOI: 10.1111/apt.17278.Peer-Reviewed Original ResearchMeSH KeywordsAftercareAgedAged, 80 and overAspirinCardiovascular DiseasesGastrointestinal HemorrhageHumansMiddle AgedPatient DischargePrimary PreventionConceptsMajor adverse cardiovascular eventsGastrointestinal bleedingPrimary preventionCardiovascular eventsRisk of MACEYale-New Haven HospitalPrimary cardiovascular preventionAdverse cardiovascular eventsKaplan-Meier curvesLong-term outcomesRisk-benefit ratioLog-rank testAspirin 81Hospitalised patientsPrimary endpointSecondary endpointsCardiovascular preventionSubsequent hospitalisationMedian ageDeprescriptionHigh riskAspirinHospitalisationPatientsPreventionDisparities in Access to Endoscopy for Patients With Upper Gastrointestinal Bleeding Presenting to Emergency Departments
Rodriguez NJ, Zheng N, Mezzacappa C, Canavan M, Laine L, Shung D. Disparities in Access to Endoscopy for Patients With Upper Gastrointestinal Bleeding Presenting to Emergency Departments. Gastroenterology 2022, 164: 1044-1046.e4. PMID: 36228735, PMCID: PMC10083188, DOI: 10.1053/j.gastro.2022.10.001.Peer-Reviewed Original ResearchMeSH KeywordsEmergency Service, HospitalEndoscopy, GastrointestinalGastrointestinal HemorrhageHumansTrends in characteristics, management, and outcomes of patients presenting with gastrointestinal bleeding to emergency departments in the United States from 2006 to 2019
Zheng NS, Tsay C, Laine L, Shung DL. Trends in characteristics, management, and outcomes of patients presenting with gastrointestinal bleeding to emergency departments in the United States from 2006 to 2019. Alimentary Pharmacology & Therapeutics 2022, 56: 1543-1555. PMID: 36173090, PMCID: PMC9669230, DOI: 10.1111/apt.17238.Peer-Reviewed Original ResearchMeSH KeywordsEmergency Service, HospitalGastrointestinal HemorrhageHumansIncidenceOdds RatioPatient DischargeRetrospective StudiesUnited StatesConceptsGastrointestinal bleedingLength of stayEmergency departmentMultivariable analysisIncidence of GIBRed blood cell transfusionNationwide Emergency Department SampleBlood cell transfusionIncidence of patientsOutcomes of patientsSex-adjusted incidenceEmergency Department SampleCase fatality rateRecent epidemiologic studiesProportion of casesED dischargeMore comorbiditiesCell transfusionRBC transfusionMore patientsComorbid populationEpidemiological evaluationInpatient costsPrimary diagnosisEpidemiologic studiesAssociation of Antisecretory Drugs with Upper Gastrointestinal Bleeding in Patients Using Oral Anticoagulants: A Systematic Review and Meta-Analysis
Kurlander JE, Barnes GD, Fisher A, Gonzalez JJ, Helminski D, Saini SD, Sengupta N, Yang YX, Scheiman J, Laine L. Association of Antisecretory Drugs with Upper Gastrointestinal Bleeding in Patients Using Oral Anticoagulants: A Systematic Review and Meta-Analysis. The American Journal Of Medicine 2022, 135: 1231-1243.e8. PMID: 35679879, PMCID: PMC10031639, DOI: 10.1016/j.amjmed.2022.05.031.Peer-Reviewed Original ResearchConceptsUpper gastrointestinal bleedingProton pump inhibitorsGastrointestinal bleedingH2-receptor antagonistsObservational studyOral anticoagulantsAntisecretory drugsRelative riskLower riskNonsteroidal anti-inflammatory drug useSystematic reviewAnti-inflammatory drug useOvert upper gastrointestinal bleedingLow statistical heterogeneitySingle observational studyGreater treatment effectRandom-effects modelWeb of ScienceConcomitant aspirinRandomized trialsCochrane LibraryPump inhibitorsBias assessmentStatistical heterogeneityBleedingAmerican College of Gastroenterology-Canadian Association of Gastroenterology Clinical Practice Guideline: Management of Anticoagulants and Antiplatelets During Acute Gastrointestinal Bleeding and the Periendoscopic Period
Abraham NS, Barkun AN, Sauer BG, Douketis J, Laine L, Noseworthy PA, Telford JJ, Leontiadis GI. American College of Gastroenterology-Canadian Association of Gastroenterology Clinical Practice Guideline: Management of Anticoagulants and Antiplatelets During Acute Gastrointestinal Bleeding and the Periendoscopic Period. The American Journal Of Gastroenterology 2022, 117: 542-558. PMID: 35297395, PMCID: PMC8966740, DOI: 10.14309/ajg.0000000000001627.Peer-Reviewed Reviews, Practice Guidelines, Standards, and Consensus StatementsMeSH KeywordsAdministration, OralAnticoagulantsCanadaGastroenterologyGastrointestinal HemorrhageHumansSocieties, MedicalConceptsDirect oral anticoagulantsP2Y12 receptor inhibitorsAcute gastrointestinal bleedingProthrombin complex concentrateSecondary preventionAcetylsalicylic acidGastrointestinal bleedingPCC administrationReceptor inhibitorsTemporary interruptionEndoscopy settingTarget patientsGastroenterology Clinical Practice GuidelineFresh frozen plasma administrationAdministration of idarucizumabManagement of anticoagulantsDual antiplatelet therapyAcute GI bleedingGrading of RecommendationsClinical practice guidelinesFresh frozen plasmaAcute GIASA monotherapyPeriendoscopic managementAntiplatelet therapyManagement of Patients on Anticoagulants and Antiplatelets During Acute Gastrointestinal Bleeding and the Peri-Endoscopic Period: A Clinical Practice Guideline Dissemination Tool
Barkun AN, Douketis J, Noseworthy PA, Laine L, Telford JJ, Abraham NS. Management of Patients on Anticoagulants and Antiplatelets During Acute Gastrointestinal Bleeding and the Peri-Endoscopic Period: A Clinical Practice Guideline Dissemination Tool. The American Journal Of Gastroenterology 2022, 117: 513-519. PMID: 35354773, DOI: 10.14309/ajg.0000000000001688.Peer-Reviewed Reviews, Practice Guidelines, Standards, and Consensus Statements
2021
Acute gastrointestinal bleeding: proposed study outcomes for new randomised controlled trials
Jensen DM, Barkun A, Cave D, Gralnek IM, Jutabha R, Laine L, Lau JYW, Saltzman JR, Soetikno R, Sung JJY. Acute gastrointestinal bleeding: proposed study outcomes for new randomised controlled trials. Alimentary Pharmacology & Therapeutics 2021, 54: 616-626. PMID: 34288017, PMCID: PMC9385213, DOI: 10.1111/apt.16483.Peer-Reviewed Reviews, Practice Guidelines, Standards, and Consensus StatementsMeSH KeywordsAcute DiseaseGastrointestinal HemorrhageHospitalizationHumansRandomized Controlled Trials as TopicConceptsAcute gastrointestinal bleedingGastrointestinal bleedingPrimary endpointRed blood cell transfusionRelevant outcomesHealth care resource utilisationLength of hospitalisationSerious adverse eventsTrial of patientsBlood cell transfusionPeer-reviewed fundingMeaningful primary endpointCell transfusionAcute bleedingAdverse eventsComposite outcomeSecondary outcomesFuture RCTsNew RCTsPrimary outcomeHemostatic outcomesClinical trialsCommon causeOutcome measuresGI sourceFresh frozen plasma transfusion in acute variceal haemorrhage: Results from a multicentre cohort study
Mohanty A, Kapuria D, Canakis A, Lin H, Amat MJ, Paniz G, Placone NT, Thomasson R, Roy H, Chak E, Baffy G, Curry MP, Laine L, Rustagi T. Fresh frozen plasma transfusion in acute variceal haemorrhage: Results from a multicentre cohort study. Liver International 2021, 41: 1901-1908. PMID: 33969607, DOI: 10.1111/liv.14936.Peer-Reviewed Original ResearchMeSH KeywordsBlood Component TransfusionCohort StudiesEnd Stage Liver DiseaseEsophageal and Gastric VaricesGastrointestinal HemorrhageHumansPlasmaRetrospective StudiesSeverity of Illness IndexConceptsAcute variceal hemorrhageFresh frozen plasma transfusionFrozen plasma transfusionFFP transfusionLength of stayPlasma transfusionVariceal hemorrhageCohort studyClinical outcomesEnd-stage liver disease (MELD) scoreStage liver disease scoreTertiary health care centerSevere variceal bleedingLiver Disease scoreMulticentre cohort studyRetrospective cohort studyHigh-risk patientsOdds of mortalityPoor clinical outcomeHealth care centersMultivariable regression analysisEligible patientsActive bleedingVariceal bleedingMultivariable analysisNeural network predicts need for red blood cell transfusion for patients with acute gastrointestinal bleeding admitted to the intensive care unit
Shung D, Huang J, Castro E, Tay JK, Simonov M, Laine L, Batra R, Krishnaswamy S. Neural network predicts need for red blood cell transfusion for patients with acute gastrointestinal bleeding admitted to the intensive care unit. Scientific Reports 2021, 11: 8827. PMID: 33893364, PMCID: PMC8065139, DOI: 10.1038/s41598-021-88226-3.Peer-Reviewed Original ResearchConceptsAcute gastrointestinal bleedingRed blood cell transfusionBlood cell transfusionGastrointestinal bleedingHigh-risk patientsCell transfusionRed blood cellsPatient cohortIntensive Care III (MIMIC-III) critical care databaseIntensive care unit staySevere acute gastrointestinal bleedingPacked red blood cellsBlood cellsCommon gastrointestinal causesLaboratory test featuresTime-updated dataIntensive care unitValidation patient cohortCritical care databaseLarge urban hospitalMedical Information MartInternal validation setGastrointestinal causesUnit stayCare unitTowards personalised management for non-variceal upper gastrointestinal bleeding
Sung JJY, Laine L, Kuipers EJ, Barkun AN. Towards personalised management for non-variceal upper gastrointestinal bleeding. Gut 2021, 70: 818-824. PMID: 33649044, DOI: 10.1136/gutjnl-2020-323846.Peer-Reviewed Reviews, Practice Guidelines, Standards, and Consensus StatementsMeSH KeywordsEndoscopy, GastrointestinalGastrointestinal HemorrhageHemostasis, EndoscopicHumansPractice Guidelines as TopicPrecision MedicineUpper Gastrointestinal TractConceptsIndividual patientsNon-variceal upper gastrointestinal bleedingPre-endoscopic assessmentUpper gastrointestinal bleedingImportant clinical issuePostendoscopic managementGastrointestinal bleedingPatient characteristicsEndoscopic evaluationPoint of careOptimal treatmentInternational guidelinesClinical issuesInternational professional societiesClinical settingSpecific management strategiesStages of managementPatientsTreatmentProfessional societiesManagement strategiesGuidelinesBleedingHaemostasisLesionsEarly identification of patients with acute gastrointestinal bleeding using natural language processing and decision rules
Shung D, Tsay C, Laine L, Chang D, Li F, Thomas P, Partridge C, Simonov M, Hsiao A, Tay JK, Taylor A. Early identification of patients with acute gastrointestinal bleeding using natural language processing and decision rules. Journal Of Gastroenterology And Hepatology 2021, 36: 1590-1597. PMID: 33105045, DOI: 10.1111/jgh.15313.Peer-Reviewed Original ResearchConceptsNatural language processingElectronic health recordsLanguage processingNLP algorithmSystematized NomenclatureReal timeAcute gastrointestinal bleedingBidirectional Encoder RepresentationsDecision rulesEHR-based phenotyping algorithmsGastrointestinal bleedingRisk stratification scoresEncoder RepresentationsData elementsPhenotyping algorithmStratification scoresHealth recordsAlgorithmPhenotyping of patientsEmergency department patientsTime of presentationRisk stratification modelED reviewDeploymentExternal validation
2020
ABC score: a new risk score that accurately predicts mortality in acute upper and lower gastrointestinal bleeding: an international multicentre study
Laursen SB, Oakland K, Laine L, Bieber V, Marmo R, Redondo-Cerezo E, Dalton HR, Ngu J, Schultz M, Soncini M, Gralnek I, Jairath V, Murray IA, Stanley AJ. ABC score: a new risk score that accurately predicts mortality in acute upper and lower gastrointestinal bleeding: an international multicentre study. Gut 2020, 70: 707-716. PMID: 32723845, DOI: 10.1136/gutjnl-2019-320002.Peer-Reviewed Original ResearchMeSH KeywordsAge FactorsAgedComorbidityFemaleGastrointestinal HemorrhageHematologic TestsHumansMalePredictive Value of TestsProspective StudiesRisk AssessmentRisk FactorsSensitivity and SpecificityConceptsLower gastrointestinal bleedingABC scoreLower riskHigher ABC scoresGastrointestinal bleedingRisk scoreMortality rateHospital mortality rateInternational cohort studyManagement of patientsNew risk scoreInternational multicentre studyLower ABC scoreLGIB patientsUGIB patientsComorbidity scoreCohort studyMulticentre studyBlood testsValidation cohortDevelopment cohortLGIBUGIBHigh riskPatientsMachine Learning Prognostic Models for Gastrointestinal Bleeding Using Electronic Health Record Data.
Shung D, Laine L. Machine Learning Prognostic Models for Gastrointestinal Bleeding Using Electronic Health Record Data. The American Journal Of Gastroenterology 2020, 115: 1199-1200. PMID: 32530828, PMCID: PMC7415736, DOI: 10.14309/ajg.0000000000000720.Commentaries, Editorials and LettersMeSH KeywordsElectronic Health RecordsGastrointestinal HemorrhageHumansIntensive Care UnitsMachine LearningPrognosisRetrospective StudiesConceptsRisk assessment toolGastrointestinal bleedingIntensive care unit patientsClinical risk assessment toolCare unit patientsElectronic health record dataHealth record dataLevel of careAssessment toolElectronic health recordsAPACHE IVaHospital mortalityHospital courseUnit patientsPrognostic toolClinical practicePrognostic modelHealth recordsRecord dataBleedingExternal validationPatientsLack of generalizabilityMortalityCareManagement of Nonvariceal Upper Gastrointestinal Bleeding.
Barkun AN, Laine L, Leontiadis GI, Bardou M. Management of Nonvariceal Upper Gastrointestinal Bleeding. Annals Of Internal Medicine 2020, 172: 573. PMID: 32311706, DOI: 10.7326/l20-0014.Commentaries, Editorials and LettersTiming of Endoscopy in Patients Hospitalized with Upper Gastrointestinal Bleeding
Laine L. Timing of Endoscopy in Patients Hospitalized with Upper Gastrointestinal Bleeding. New England Journal Of Medicine 2020, 382: 1361-1363. PMID: 32242363, DOI: 10.1056/nejme2002121.Commentaries, Editorials and LettersPhysicians' Perceptions of Proton Pump Inhibitor Risks and Recommendations to Discontinue: A National Survey.
Kurlander JE, Rubenstein JH, Richardson CR, Krein SL, De Vries R, Zikmund-Fisher BJ, Yang YX, Laine L, Weissman A, Saini SD. Physicians' Perceptions of Proton Pump Inhibitor Risks and Recommendations to Discontinue: A National Survey. The American Journal Of Gastroenterology 2020, 115: 689-696. PMID: 32091419, PMCID: PMC7196016, DOI: 10.14309/ajg.0000000000000558.Peer-Reviewed Original ResearchMeSH KeywordsFemaleGastroesophageal RefluxGastrointestinal HemorrhageHumansMaleMiddle AgedPerceptionPhysiciansPractice Patterns, Physicians'Proton Pump InhibitorsSelf ReportSurveys and QuestionnairesConceptsProton pump inhibitorsPPI adverse effectsAdverse effectsHigh riskLong-term PPI useGastroesophageal reflux diseaseMultiple adverse effectsPPI useReflux diseasePPI discontinuationInhibitor riskMost internistsPump inhibitorsPhysicians' perceptionsInternists' perceptionsSignificant associationGeneral medicineDiscontinuationLogistic regressionClinical usePatientsFuture interventionsIndividual riskPreventionUGIBUse of Fecal Occult Blood Testing as a Diagnostic Tool for Clinical Indications: A Systematic Review and Meta-Analysis.
Lee MW, Pourmorady JS, Laine L. Use of Fecal Occult Blood Testing as a Diagnostic Tool for Clinical Indications: A Systematic Review and Meta-Analysis. The American Journal Of Gastroenterology 2020, 115: 662-670. PMID: 31972617, DOI: 10.14309/ajg.0000000000000495.Peer-Reviewed Original ResearchConceptsFecal occult blood testIron deficiency anemiaSensitivity of FOBTAcute diarrheaClinical indicationsSystematic reviewFecal occult blood testingDiagnostic testsSpecific gastrointestinal symptomsOccult blood testingPrimary end pointOccult blood testColorectal cancer screeningPositive stool cultureRisk of biasQUADAS-2 toolGastrointestinal symptomsAdult patientsEndoscopic evaluationUlcerative colitisEndoscopic activityBlood testsIdentifiable causeStool culturesBlood testing