PDSA E-News: October 27, 2017



Splenectomy and Rituximab Equally Effective Second-Line Therapies

Rituximab Rituxan bottle

Good news for ITP patients seeking a new therapy after steroids: researchers have discovered that treatment with Rituximab or Splenectomy work equally well. In a retrospective single-center study published in the International Journal of Hematology, response to treatment was observed in 143 ITP patients who did not respond to or were frequently administered corticosteroids. Patients underwent a splenectomy or received intravenous Rituximab for four weeks. Response was measured every three months, and there was no significant difference between the rates without response and response as second-line therapies, meaning Rituximab treatment may be a good alternative to splenectomy for ITP patients.

Nam, James. “Rituximab vs Splenectomy: Response Similar in Immune Thrombocytopenic Purpura” Oncology Nurse Advisor. September 21, 2017. http://bit.ly/2y6IqUL

Switching TPO Agonists Elevates Platelet Counts

Pills in a bottle

Why do some patients receive Romiplostim and then Eltrombopag, and why do some switch from Eltrombopag to Romiplostim? Hematologists in Spain wanted to uncover the reasons for and results of changing between TPO agents for adult ITP patients. Sixty-five percent of patients retrospectively analyzed received Romiplostim first and switched to Eltrombopag. Physicians switched TPO therapies due to “inefficacy, patient preference, side effects, and excessive platelet count fluctuation.” All patients who were first administered Romiplostim and were switched to Eltrombopag due to inefficacy responded to treatment when switched to Eltrombopag; 66% of patients who received Eltrombopag first responded to Romiplostim. All patients responded to the second TPO when switched due to side effects of patient preference. Four of the twenty-six patients included in review achieved remission after switching TPO agonists. Ultimately, switching between Romiplostim and Eltrombopag is an effective treatment plan yielding promising increases in platelet counts.

Lakhwani S et. al. “Thrombopoietin receptor agonist switch in adult primary immune thrombocytopenia patients: A retrospective collaborative survey involving 4 Spanish centres” Eur J Hematology. Oct 2017. http://bit.ly/2hwvakR



Overtreatment and Overdiagnosis Harmful and Common in U.S. Hospitals

Hospital room

Ten percent of people in the U.S. said they were overtreated and had that fact confirmed by another physician, according to a recent study. Overtreatment and overdiagnosis are not only expensive financially and wastes resources, but can cause harm. Dr. Marty Makary, a surgeon at Johns Hopkins Hospital, elaborates “When an industry is delivering between 15 to 30 per cent of all its services unnecessarily, it’s extremely inefficient, very costly, and – in the case of the healthcare sector – it's harmful to people. We are throwing a lot of money into healthcare without getting better outcomes out of it. This is a frustrating issue for patients and businesses that have to pay for healthcare.” Patients and caregivers can play an active role in their healthcare journey by asking the right questions, perhaps getting a second medical opinion, and learning more about their situation so they can participate in shared decision-making.

International Hospitals and Medical Travel. “The Strain of Overtreatment.” International Hospitals and Medical Travel. June 27 2017. http://bit.ly/2g2uyA5




Don’t Stress Out: Rethinking Stress Strategies

Cairn stacked rocks

Stress is a part of daily life, but it doesn’t have to make you sick(er). Just thinking about stress differently can help. Instead of viewing stress as negative, find something positive in the situation.

A study from the University of Wisconsin-Madison examined the perception of stress. Researchers asked participants how much stress they had experienced in the last year, and how much of an effect they felt stress had on the participant’s health. Shockingly, having stress in your life was not linked to premature death, but believing stress is negatively impacting your health increased the risk of death by 43 percent. Rethink the role of stress in your life as a positive motivator, or a sign that your body is physically working harder and stronger. In fact, “the body’s stress response evolved to help us succeed, and the increased arousal symptoms of stress can aid performance during times of stress. The bottom line of the lesson was this: In a tough situation, stress makes you stronger.”

Beyond mentally reframing the role of stress, there are many steps one can take to calm down. These include practicing resiliency, optimism, mindful eating, engaging in both calming and strenuous exercise, and strengthening relationships between family and friends. Next time you begin to feel your heart racing and your mind wandering, turn to one of these alternative forms of stress relief.

Parker-Pope, Tara. “How to be Better at Stress” The New York Times. http://nyti.ms/2vWOKJl






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