IMPORTANCE:Clinical practice guidelines (CPGs) play a critical role in shaping medical care and healthcare policies, yet there is growing concern about the lack of diversity in CPG authorship. This systematic review and meta-analysis aim to assess gender, race, and ethnicity representation among authors of CPGs across different medical specialties. OBJECTIVE:To evaluate the representation of women and individuals from minoritized racial and ethnic groups among authors and contributors of CPGs. DATA SOURCES:A comprehensive literature search was conducted in databases including Ovid MEDLINE, Embase.com, Web of Science, Cochrane CENTRAL, and ClinicalTrials.gov from inception to September 2023. Studies focusing on CPG authorship disparities by gender, race, and ethnicity were selected for review. STUDY SELECTION:Eligible studies included those that reported data on gender, racial, and ethnic composition among CPG authors. Out of 2,436 articles screened, 20 studies met the inclusion criteria for full-text review and meta-analysis. DATA EXTRACTION AND SYNTHESIS:Data extraction was performed independently by two reviewers, with disagreements resolved through consensus, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A meta-analysis was then conducted using a random-effects model. MAIN OUTCOMES AND MEASURES:The primary outcome was the proportion of women and individuals from minoritized racial and ethnic groups among CPG authors. The meta-analysis estimated pooled proportions of women's authorship across the different medical specialties. RESULTS:The 20 included studies covered a total of 36,783 author positions. Women's authorship varied widely across specialties, with an overall pooled proportion of 25.7% (95% Confidence Interval (CI): 21.8%-30.1%). Racial and ethnic data were available in only a few studies, with significant gaps in reporting. The findings indicate persistent gender disparities in CPG authorship, particularly in specialties such as cardiology and gastroenterology. CONCLUSIONS:This analysis demonstrated that substantial disparities in gender, race, and ethnicity remain in CPGs' authorship. More inclusive representation is essential to ensure diverse perspectives in shaping healthcare guidelines.

BACKGROUND:Patients undergoing organ transplantation are often on immunosuppressing medications to prevent rejection of the transplant. The data on use of concomitant immunosuppression for inflammatory bowel disease (IBD) and organ transplant management are limited. This study sought to evaluate the safety of biologic and small molecule therapy for the treatment of IBD among solid organ transplant recipients. METHODS:Medline, Embase, and Web of Science databases were systematically searched for studies reporting on safety outcomes associated with the use of biologic and small molecule therapy (infliximab, adalimumab, certolizumab, golimumab, vedolizumab, ustekinumab, and tofacitinib) in patients with IBD postsolid organ transplant (eg, liver, kidney, heart, lung, pancreas). The primary outcome was infectious complications. Secondary outcomes included serious infections, colectomy, and discontinuation of biologic therapy. RESULTS:Seven hundred ninety-seven articles were identified for screening, yielding 16 articles for the meta-analyses with information on 163 patients. Antitumor necrosis factor α (Anti-TNFs; infliximab and adalimumab) were used in 8 studies, vedolizumab in 6 studies, and a combination of ustekinumab or vedolizumab and anti-TNFs in 2 studies. Two studies reported outcomes after kidney and cardiac transplant respectively, whereas the rest of the studies included patients with liver transplants. The rates of all infections and serious infections were 20.09 per 100 person-years (100-PY; 95% CI, 12.23-32.99 per 100-PY, I2 = 54%) and 17.39 per 100-PY (95% CI, 11.73-25.78 per 100-PY, I2 = 21%), respectively. The rates of colectomy and biologic medication discontinuation were 12.62 per 100-PY (95% CI, 6.34-25.11 per 100-PY, I2 = 34%) and 19.68 per 100-PY (95% CI, 9.97-38.84 per 100-PY, I2 = 74%), respectively. No cases of venous thromboembolism or death attributable to biologic use were reported. CONCLUSION:Biologic therapy is overall well tolerated in patients with solid organ transplant. Long-term studies are needed to better define the role of specific agents in this patient population.

Introduction: Lower gastrointestinal bleeding (LGIB) is both a common cause of hospitalization and potentially life-threatening condition, but can also be challenging to treat. While there are therapeutic options including epinephrine injection, thermal, and mechanical therapies, Hemospray (TC-325), a sprayable powder, has emerged as a treatment for endoscopic hemostasis. However, studies regarding efficacy of Hemospray specifically in LGIB are limited. We therefore conducted a meta-analysis evaluating the immediate, short, and long term efficacy of hemostasis with Hemospray in adults with LGIB. Methods: A systematic search was performed in PubMed for “hemospray” and “gastrointestinal hemorrhage”. Analyses were performed in R. Studies with LGIB in adult patients using Hemospray were included. Studies with 10 or fewer patients, case reports, letters to the editor, or review articles were excluded. The primary outcomes were immediate hemostasis, early rebleeding (within 7 days) and delayed rebleeding (30 day) after Hemospray application. Results: Five studies were included for analysis with 132 total patients with lower GI bleeding. Primary cause of bleeding was post-procedural. Immediate hemostasis with Hemospray was achieved in 97.54% (95% confidence interval [CI] 94.63%-100%) of all patients. Early rebleeding (within 7 days) was seen in only 8.64% (95% CI 0-20.55%) of patients and delayed rebleeding (30 days) was seen in 13.20% (0-28.75%) of patients (Figure 1, Table 1). Conclusion: Hemospray appears to be effective in the treatment for LGIB achieving both early hemostasis and sustained hemostasis at 30 days. While data is limited, Hemospray should be considered a first line treatment option for LGIB. Further studies are needed for subgroup analyses on the efficacy of Hemospray based on etiology of LGIB.Figure 1.: Immediate hemostasis and rebleeding outcomes with hemospray in lower gastrointestinal bleeding. Table 1. - Location of Lower Gastrointestinal Bleeding Location of Bleed Author Year Number of Patients Number of Bleeding Sites Malignancy Diverticular Post procedural Other Chahal 2020 13 13 1 1 5 Ulcer= 1, IBD= 1, Anastomotic= 3, GVHD= 1 Chen 2015 17 17 2 0 9 Anastomotic ulcer=2, Radiation proctitis=1, Dieulafoy lesion= 1, AVM= 1, IC valve ulceration=1 De Santiago 2019 42 42 2 0 18 Surgical anastomosis= 9, ischemic ulcer= 5, angiodysplasia= 2, other= 6 Hookey 2019 50 52 0 1 40 Radiation proctopathy= 4, Colonic angiodysplasia= 3, visible vessel=1, peri-rectal tissue oozing=1, ischemic ulcer= 1= rectal polyP=1 Ng 2019 10 10 0 10 0 Total 132 134 5 12 72 45

.1%(95%CI:15.8-16.4)vs16.9%for those on AC (95% CI:16.3-17.4), respectively. Conclusion: Our 2020 NIS analysis demonstrated an overall mortality rate of 30.8% for COVID-19 patients who underwent an EGD. Mortality was higher (57.6%) in MV patients vs those who were not (11.5%). AC was not associated with a higher mortality rate. While this analysis revealed a high mortality rate, it is unclear if the mortality was related to UGIB. This highlights the pandemic ’ s impact on admissions from other etiologies and scarcity of inpatient endoscopy procedures in 2020.

Drug allergy to excipients remains underappreciated and frequently leads to inappropriate medication discontinuation. 1 Reker D Blum SM Steiger C et al. “Inactive” ingredients in oral medications. Sci Transl Med. 2019; 11: eaau6753https://doi.org/10.1126/scitranslmed.aau6753 Crossref PubMed Scopus (35) Google Scholar Here, we report a patient with multidrug allergy, which was subsequently determined to be due to hypersensitivity to an excipient common to those medications’ specific formulations.