JOHN A. KEECH JR., D.O.

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This study examined how effective various screening tools are at identifying harmful substance use in emergency departments (EDs). Out of 2,696 studies, 33 were included, with 21 focused on North American patients. The findings showed that several screening tools, especially those for alcohol use, like AUDIT and RAPS, had high accuracy, detecting alcohol abuse with sensitivities above 83%. This is important because early identification of substance use issues can lead to better patient care and treatment. Who this helps: This helps patients visiting emergency departments.

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This study looked at how using paravertebral blocks (a type of pain relief method) during video-assisted thoracoscopic surgery affects patient outcomes. Researchers found that patients who received paravertebral blocks used significantly less opioid medication in the first 24 hours (78.5 mg compared to 127.0 mg) and had fewer complications (35% vs. 48%) compared to those who did not. While pain scores were similar for both groups, the blocks helped reduce hospital stays and opioid use, making recovery smoother for patients. Who this helps: This benefits patients undergoing video-assisted thoracoscopic surgery by reducing their need for opioids and shortening their hospital stays.

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This study looked at how effective and safe a procedure called peroral endoscopic myotomy (POEM) is for patients with achalasia who have previously had weight-loss surgery. Out of 16 patients, 93.8% experienced a significant improvement in their symptoms after the treatment, with average symptoms scores dropping from 6.1 to 1.7. The findings are important because they show that POEM can successfully treat achalasia in these patients, despite the challenges presented by their prior surgeries. Who this helps: This helps patients with achalasia who have had bariatric surgery.

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In this study, researchers tested a vaccine called seviprotimut-L in patients who had recently undergone surgery for melanoma, a type of skin cancer, and are at high risk for the cancer returning. They found that while the vaccine did not significantly improve the chances of remaining cancer-free for all patients, it worked particularly well for younger patients under 60 and those with a specific type of melanoma (ulcerated), showing a recurrence rate reduction of 68% in the younger group. This is important because it suggests that the vaccine could be a beneficial addition to treatment for certain high-risk patients who need better options after surgery. Who this helps: This helps melanoma patients, especially younger individuals and those with ulcerated melanomas.

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This study looked at how cost-effective the drug crizotinib is for treating advanced non-small cell lung cancer (NSCLC) with a specific genetic change (ROS1+) in Canada, compared to standard chemotherapy. Researchers found that crizotinib could offer patients an additional 0.885 life-years and improve their quality of life, but at a high cost of $238,077 which results in a cost-effectiveness ratio of $273,286 per quality-adjusted life-year (QALY). This means crizotinib is not considered cost-effective when compared to the common value threshold of $100,000 per QALY, although it may provide better results than chemotherapy. Who this helps: This helps patients with ROS1-rearranged advanced lung cancer and their doctors in making informed treatment decisions.

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This study looked at a new treatment called peroral endoscopic myotomy (POEM) for patients with achalasia and spastic esophageal disorders. Of the 125 patients treated, 92% experienced significant improvements, and 88% maintained these improvements a year later. The research shows that POEM is both safe and effective, even for those who have had previous unsuccessful treatments. Who this helps: This benefits patients suffering from achalasia and related esophageal issues.

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This study looked at the costs and benefits of three different treatment plans for patients with primary central nervous system lymphoma (PCNSL). It found that the MATRix treatment, which includes rituximab, methotrexate, cytarabine, and thiotepa, led to better health outcomes, gaining 3.05 quality-adjusted life years (QALYs) at an additional cost of $75,513, which is considered a cost-effective option at $24,758 per QALY. Choosing MATRix stands out as the best choice for treating PCNSL, with a 98% likelihood of being cost-effective compared to the other treatments. Who this helps: This study benefits patients with PCNSL and their doctors by providing insights on the most effective treatment option.

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This study looked at how improving basic prevention practices in hospitals can lower the spread of the bacteria Staphylococcus aureus and reduce surgical site infections among patients undergoing various types of surgery. The research found that when these improved practices were used, the average number of S. aureus transmissions dropped significantly from 1.25 to 0.47, and the rate of infections fell from 7.7% in the control group to just 0.9% in the treatment group. This is important because it shows that better hygiene and care practices during surgery can lead to healthier patient outcomes and lower healthcare costs. Who this helps: This benefits patients undergoing surgery and healthcare providers by minimizing infections.

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This study looked at how rare cancer treatments are assessed and funded in Canada from 2012 to 2017. Researchers found that 16.6% of the cancer drugs reviewed were for rare conditions, and while the approval rate for funding was about the same for both rare (78.6%) and common conditions (75%), rare treatments were less likely to have strong evidence from clinical trials (50% for rare vs. 90% for common). Understanding how rarity impacts treatment funding is crucial because it highlights potential disparities in access to effective treatments for rare cancers. Who this helps: Patients with rare cancers and their caregivers.

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This study looked at how patients' expectations about pain before undergoing video-assisted thoracoscopic surgery (VATS) affected their experience of pain afterward. It found that 59% of the 82 patients experienced moderate to severe acute pain in the first three days after the surgery. Notably, the stronger the patients expected their postoperative pain to be, the more likely they were to report actual high levels of pain afterward, highlighting how important managing expectations is for pain control. Who this helps: This helps patients preparing for surgery by providing insight into how their expectations can influence their pain experience.

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This study looked at the timing of surgery for patients with esophageal cancer who were treated with chemotherapy and radiation before their surgery. Researchers found that patients who had their surgery within 35 days after this treatment had fewer problems known as anastomotic leaks (7.3%) compared to those who waited longer than 35 days (20.0%) or those who did not receive the treatment at all (14.7%). Understanding the best timing for surgery is important because it can help reduce complications after treatment. Who this helps: Patients undergoing esophageal cancer treatment and their doctors.

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This study looked at a new system in Canada designed to help doctors submit requests for funding of cancer drugs when pharmaceutical companies don’t do so. Since its start in 2014, the framework has helped identify 17 areas where patients needed new treatments and led to 6 successful funding requests for drugs, resulting in over 9 new available treatment options as of mid-2018. This matters because it ensures that patients get access to important cancer therapies that are supported by clinical evidence. Who this helps: Patients with cancer who need access to new drug treatments.

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This study looked at a procedure called Peroral Endoscopic Myotomy (POEM) for treating achalasia in patients who have had or are considering gastric bypass surgery. Out of six patients who underwent the procedure, five reported significant improvement in their symptoms, and there were no serious complications, with an average hospital stay of just over a day. This matters because it shows that POEM can be safely performed in obese patients, allowing them to manage achalasia effectively despite their unique surgical history. Who this helps: Patients with achalasia who are also dealing with obesity and have undergone gastric bypass surgery.

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This study looked at a treatment called per oral endoscopic myotomy (POEM) for people with a swallowing disorder called achalasia. Over 31 patients treated in a two-year period, the average hospital stay was just 1.3 days, and their symptoms significantly improved—going from an average score of 6.3 before surgery to just 1.4 one month later. The research shows that using a team of specialists for this procedure is safe, with only one patient experiencing a major complication. Who this helps: This benefits patients with achalasia seeking effective treatment options.

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This study looked at how well patients with esophageal cancer tolerate a specific chemotherapy drug called paclitaxel after their initial treatment. Out of 12 patients, 11 (or 92%) were able to handle at least half of the planned chemotherapy doses, showing that this treatment is generally tolerable. On average, patients lived for 28 months after treatment, and this research suggests that testing patients for their ability to tolerate this therapy can help more patients participate in future treatment trials. Who this helps: This benefits patients with esophageal cancer seeking additional treatment options.

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This study examined the best surgical options for older patients with a type of lung tumor called pulmonary typical carcinoid (TC). Researchers found that 49% of patients had lobar surgery (L-R), while 29% had sub-lobar surgery (SL-R), and 21% had no surgery at all. Those who had surgery (either type) had a nearly 100% survival rate over five years, compared to just 72% for those who did not have surgery, highlighting the importance of surgical intervention. Who this helps: This benefits older patients with pulmonary typical carcinoid tumors who may require surgery for better chances of survival.

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This study looked at how patients with thymic carcinoma, a rare type of cancer in the thymus gland, were treated using a combination of surgery, chemotherapy, and radiation from 2007 to 2014. Out of nine patients, 67% were alive two years after treatment, and those who underwent surgery followed by other therapies had good outcomes, with only one patient experiencing disease progression about 10 months after treatment. This research highlights that a comprehensive treatment approach can be effective for advanced thymic carcinoma, and different strategies may help those whose tumors cannot be surgically removed. Who this helps: This helps patients with thymic carcinoma and their doctors in planning effective treatment options.

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This study looked at what factors might predict chronic pain in patients six months after undergoing thoracic surgery. The researchers found that about 33% of patients who had a larger incision surgery (thoracotomy) and 25% of those who had a smaller, camera-assisted surgery (thoracoscopy) experienced chronic pain, and the level of pain was similar for both groups. They concluded that the main factor related to chronic pain was the severity of pain experienced right after surgery, while mental or social factors did not seem to play a role. Who this helps: This helps patients recovering from thoracic surgery by highlighting important pain factors to discuss with their doctors.

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This study looked at how high doses of vitamin C (pharmacological ascorbate) affect two types of cancer cells: non-small-cell lung cancer (NSCLC) and glioblastoma (GBM). Researchers found that these cancer cells become more vulnerable to the effects of vitamin C because of changes in how they handle iron, which is disrupted by the vitamin C treatment. This matters because it suggests a new way to make certain cancer treatments more effective. Who this helps: This helps patients with non-small-cell lung cancer and glioblastoma.

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This paper studies a specific case of a patient with a rare type of breast cancer who experienced a strong and lasting positive response to a medication called everolimus. The patient had been treated for 14 months and displayed near-complete remission despite being heavily treated before. This finding highlights the importance of understanding genetic mutations in tumors, as it suggests that some patients may have unique responses to targeted therapies based on their specific cancer genetics. Who this helps: This information helps doctors and researchers in identifying potential new treatments for patients with advanced breast cancer.

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This paper looks at how to successfully start and maintain a lung transplant program, which is crucial for treating people with severe lung diseases. The authors found that more than 40% of new lung transplant programs fail, but the program they initiated at the University of Iowa has been successful, performing 101 transplants with a 91% survival rate after one year, ranking them among the best in the country. This research highlights the importance of assessing program resources, recipient and donor availability, and ongoing quality measures to ensure long-term success in lung transplantation. Who this helps: Patients needing lung transplants and the medical teams that support them.

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This study focused on a technique for improving access to the left part of the lungs during a complex lung transplant procedure, especially for patients with idiopathic pulmonary fibrosis. Researchers developed a cost-effective method to move the heart out of the way during surgery, enabling doctors to implant the new lung without using heart-lung machines. This approach can make the surgery safer and more efficient. Who this helps: This benefits patients undergoing bilateral lung transplants, particularly those with lung conditions like idiopathic pulmonary fibrosis.

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This study looked at how well mixed venous oxygen saturation (SVO2) reflects the oxygen extraction ratio (O2ER) in critically ill patients. Researchers analyzed data from 8,324 patient records and found that changes in the amount of oxygen a patient receives (FiO2) do not significantly alter the SVO2 readings, which means that these readings can be trusted even when patients are on higher levels of oxygen. This is important because it allows doctors to reliably use SVO2 measurements to assess how well patients are using oxygen, without worrying about the effects of oxygen delivery. Who this helps: This helps doctors and healthcare professionals caring for critically ill patients.

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This study looked at how two important protein structures, microtubules and actin filaments, interact in frog egg extracts to influence cell movement and division. Researchers found that when microtubules are present, they cause actin filaments to move in two ways: quickly jerking at about 250-300 nanometers per second and slowly gliding at about 50 nanometers per second. Understanding these interactions helps us clarify how cells move and divide, which is essential for many biological processes, including development and healing. Who this helps: This benefits researchers studying cell biology, as well as doctors dealing with diseases related to cellular movement and division.

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This study looked at how granulocyte colony stimulating factor (G-CSF) affects neutropenia, a drop in white blood cells, in patients with serious cancers undergoing chemotherapy with melphalan. Researchers found that G-CSF helped increase white blood cell counts significantly, reaching levels as high as 80 billion cells per liter, and reduced the duration of neutropenia. This is important because shorter periods of low white blood cell count can lead to fewer health complications and a better chance of surviving chemotherapy. Who this helps: Patients undergoing chemotherapy for cancer.