Clancy J. Clark

Background: ViSi Mobile has the capability of monitoring a patient’s posture continuously during hospitalization. Analysis of ViSi telemetry data enables researchers and health care providers to quantify an individual patient’s movement and investigate collective patterns of many patients. However, erroneous values can exist in routinely collected ViSi telemetry data. Data must be scrutinized to remove erroneous records before statistical analysis. Objective: The objectives of this study were to (1) develop a data cleaning procedure for a 1-year inpatient ViSi posture dataset, (2) consolidate posture codes into categories, (3) derive concise summary statistics from the continuous monitoring data, and (4) study types of patient posture habits using summary statistics of posture duration and transition frequency. Methods: This study examined the 2019 inpatient ViSi posture records from Atrium Health Wake Forest Baptist Medical Center. First, 2 types of errors, record overlap and time inconsistency, were identified. An automated procedure was designed to search all records for these errors. A data cleaning procedure removed erroneous records. Second, data preprocessing was conducted. Each patient’s categorical time series was simplified by consolidating the 185 ViSi codes into 5 categories (Lying, Reclined, Upright, Unknown, User-defined). A majority vote process was applied to remove bursts of short duration. Third, statistical analysis was conducted. For each patient, summary statistics were generated to measure average time duration of each posture and rate of posture transitions during the whole day and separately during daytime and nighttime. A k-means clustering analysis was performed to divide the patients into subgroups objectively. Results: The analysis used a sample of 690 patients, with a median of 3 days of extensive ViSi monitoring per patient. The median of posture durations was 10.2 hours/day for Lying, 8.0 hours/day for Reclined, and 2.5 hours/day for Upright. Lying had similar percentages of patients in low and high durations. Reclined showed a decrease in patients for higher durations. Upright had its peak at 0‐2 hours, with a decrease for higher durations. Scatter plots showed that patients could be divided into several subgroups with different posture habits. This was reinforced by the k-means analysis, which identified an active subgroup and two sedentary ones with different resting styles. Conclusions: Using a 1-year ViSi dataset from routine inpatient monitoring, we derived summary statistics of posture duration and posture transitions for each patient and analyzed the summary statistics to identify patterns in the patient population. This analysis revealed several types of patient posture habits. Before analysis, we also developed methodology to clean and preprocess routinely collected inpatient ViSi monitoring data, which is a major contribution of this study. The procedure developed for data cleaning and preprocessing can have broad application to other monitoring systems used in hospitals.

Introduction: Pancreatic surgery often has a lengthy recovery in the elderly. Minimally invasive surgery (MIS) can decrease length of stay (LOS), but it is unknown if this benefit applies to octogenarians (Age > 79).Methods: The NSQIP database was used to determine if MIS approaches were associated with reduced LOS among octogenarians undergoing pancreaticoduodenectomy (Whipple) or distal pancreatectomy (Distal). Operative approaches were classified as “Open” or “MIS” and propensity score (PS) matching was performed.Results: For the Whipple, 1665 Open and 101 MIS procedures occurred (median LOS 9, 8 days, p = 0.584). For Distal, 472 Open and 223 MIS procedures occurred (median LOS 6, 5 days, p < 0.01). After PS matching, there were 202 Whipple (101 per group) and 446 Distal (223 per group) patients. There was no difference in LOS by approach in the Whipple group (p = 0.546). The median LOS was 9 (IQR 7–15), Open and 8 (IQR 6–13), MIS. For Distal, there was a difference in LOS in the Open versus MIS approach (p < 0.01) and the median LOS was 6 (IQR 5–8) and 5 (IQR 4–6).Conclusions: Among octogenarians the MIS approach was associated with decreased LOS in distal pancreatectomies, but not in pancreaticoduodenectomies.

Myeloid sarcoma (MS) is an extramedullary manifestation of acute myeloid leukemia (AML) and commonly occurs in sites such as the lymph nodes, skin, soft tissues, and bone. It more rarely manifests in the pancreas, with less than 20 cases reported in the literature since 1987. Despite its rarity, MS should be considered in the differential diagnosis of a soft tissue mass causing obstructive jaundice, especially if the patient has a known hematologic disease. Isolated cases of pancreatic MS have been known to progress to AML; therefore, it is crucial to differentiate MS from more common diagnoses, such as pancreatic cancer or pancreatitis. This is a case of a 70-year-old male with symptomatic obstructive jaundice secondary to pancreatic MS, ultimately requiring endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP) for diagnosis and management. Also included is a comprehensive review of previous case reports with similar clinical presentations, management, and treatment of pancreatic MS.

Introduction: Treatment of advanced pancreatic adenocarcinoma remains suboptimal. Therapeutic agents with a novel mechanism of action are desperately needed; one such novel agent is CPI‐613 targets. We here analyze the outcomes of 20 metastatic pancreatic cancer patients treated with CPI‐613 and FOLFIRINOX in our institution and evaluate their outcomes to borderline‐resectable patients treated with curative surgery.Methods: A post hoc analysis was performed of the phase I CPI‐613 trial data (NCT03504423) comparing survival outcomes to borderline‐resectable cases treated with curative resection at the same institution. Survival was measured by overall survival (OS) for all study cases and disease‐free survival (DFS) for resected cases with progression‐free survival for CPI‐613 cases.Results: There were 20 patients in the CPI‐613 cohort and 60 patients in the surgical cohort. Median follow‐up times were 441 and 517 days for CPI‐613 and resected cases, respectively. There was no difference in survival times between CPI‐613 and resected cases with a mean OS of 1.8 versus 1.9 year (p = 0.779) and mean PFS/DFS of 1.4 versus 1.7 years (p = 0.512). There was also no difference in 3‐year survival rates for OS (hazard ratio [HR] = 1.063, 95% confidence interval [CI] 0.302–3.744, p = 0.925) or DFS/PFS (HR = 1.462, 95% CI 0.285–7.505, p = 0.648).Conclusion: The first study to evaluate the survival between metastatic patients treated with CPI‐613 versus borderline‐resectable cases undergoing curative resection. Analysis revealed no significant differences in survival outcomes between the cohorts. Study results are suggestive that there may be potential utility with the addition of CPI‐613 to potentially resectable pancreatic adenocarcinoma, although additional research with more comparable study groups are required.