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EBP Competency, Beliefs, and Organizational Readiness: A Quantitative Descriptive Study
No full texthttps://digitalcommons.providence.org/swedish_fish_2025/1008/thumbnail.jp
Efficiency Rx: EMR Training for Resident Wellness
No full text*Winner of the top award in the wellness divisio
Five-Year Survival Outcomes With Atezolizumab After Chemotherapy in Resected Stage IB-IIIA Non-Small Cell Lung Cancer (IMpower010): An Open-Label, Randomized, Phase III Trial.
No full textIMpower010 (ClinicalTrials.gov identifier: NCT02486718) previously showed that atezolizumab improved disease-free survival (DFS) versus best supportive care (BSC) after adjuvant chemotherapy in patients with resected non-small cell lung cancer (NSCLC). We report DFS final analysis, second overall survival (OS) interim analysis, and safety with a ≥5-year follow-up. Patients with completely resected stage IB-IIIA NSCLC were randomly assigned to atezolizumab (1,200 mg once every 3 weeks, 16 cycles) or BSC after platinum-based chemotherapy. At clinical cutoff (January 26, 2024), stratified hazard ratios (HRs; 95% CI) for DFS were 0.85 (95% CI, 0.71 to 1.01; P = .07) in the intention-to-treat (n = 1,005), 0.83 (95% CI, 0.69 to 1.00) in the all-randomized stage II-IIIA (n = 882), and 0.70 (95% CI, 0.55 to 0.91) in stage II-IIIA PD-L1 tumor cell (TC) ≥1% (n = 476) populations. Stratified HRs (95% CI) for OS were 0.97 (95% CI, 0.78 to 1.22), 0.94 (95% CI, 0.75 to 1.19), and 0.77 (95% CI, 0.56 to 1.06), respectively. The unstratified HRs (95% CI) in the stage II-IIIA PD-L1 TC ≥50% population (n = 229) were 0.48 (95% CI, 0.32 to 0.72) for DFS and 0.47 (95% CI, 0.28 to 0.77) for OS, and the unstratified HRs in the stage II-IIIA PD-L1 TC ≥50% without EGFR/ALK alterations (n = 209) population were 0.49 (95% CI, 0.32 to 0.75) and 0.44 (95% CI, 0.26 to 0.74). No new safety signals were reported. IMpower010 is the first study to report survival outcomes with a ≥5-year follow-up and continued to show benefit with atezolizumab versus BSC after adjuvant chemotherapy in patients with resected stage II-IIIA PD-L1-selected NSCLC
Metabolomics biomarkers of frailty: a longitudinal study of aging female and male mice.
No full textFrailty is an age-related geriatric syndrome. We performed a longitudinal study of aging female (n = 40) and male (n = 47) C57BL/6NIA mice, measured frailty index and derived metabolomics data from plasma. We identify age-related differentially abundant metabolites, determine frailty-related metabolites, and generate frailty features, both in the whole cohort and sex-stratified subgroups. Using the features, we perform an association study and build a metabolomics-based frailty clock. We find that frailty-related metabolites are enriched for amino acid metabolism and metabolism of cofactors and vitamins, include ergothioneine, tryptophan and alpha-ketoglutarate, and present sex dimorphism. We identify B vitamin metabolism related flavin-adenine dinucleotide and pyridoxate as female-specific frailty biomarkers, and lipid metabolism related sphingomyelins, glycerophosphoethanolamine and glycerophosphocholine as male-specific frailty biomarkers. These associations are confirmed in a validation cohort, with ergothioneine and perfluorooctanesulfonate identified as robust frailty biomarkers. Our results identify sex-specific metabolite frailty biomarkers, and shed light on potential mechanisms
ALSUntangled #79: alpha-lipoic acid.
No full textAlpha-lipoic acid (ALA) is a naturally occurring fatty acid. It serves as an essential cofactor for enzymatic reactions in mitochondrial energy production, is a potent antioxidant and has anti-inflammatory effects, which are plausible mechanisms in slowing ALS progression. In ALS preclinical studies, ALA slowed motor function decline and improved survival. There were self-reported cases of improved muscle strength in ALS patients when ALA was taken with numerous additional supplements, making it difficult to discern its efficacy. One small, 6-month open-label study showed improved quality of life, fatigue, and mood after participants took it with B vitamins and amino acids for the first 3 months. So far, no clinical trials have been published in people living with amyotrophic lateral sclerosis (PALS). Given the insufficient clinical data, we cannot endorse ALA and will support more research on its efficacy in slowing ALS progression
Surgical management of severe refractory gastroparesis: outcomes of jejunostomy tube placement.
No full textBACKGROUND: Surgical referrals for refractory gastroparesis (GP) are becoming more common as medical options are limited. Supplemental intestinal alimentation via feeding jejunostomy tubes (JT) is required to treat underlying malnutrition in only the most severe cases. The aim of this study was to determine predictive factors associated with successful restoration of oral nutrition after insertion of a JT for patients with severe malnutrition associated with GP.
METHODS: Retrospective review of all patients who had JT inserted between November 2007 and October 2023 at The Oregon Clinic for severe gastroparesis. Baseline demographics, comorbidities, objective studies, symptom scores and operative details were recorded. The primary outcome was successful return to independent oral intake defined as removal of the feeding tube without additional supplementation (TPN) at one year after the last procedure.
RESULTS: One hundred and eleven of 905 patients (12%) had JTs inserted during the study period. There was a total of 164 gastroparesis procedures including pyloric intervention (81), gastric neurostimulator (GNS) implantation (29), RNY gastrectomy (19), and fundoplication (35). Multiple procedures were performed in 48% during the disease course. Twenty-six (23.4%) patients achieved adequate return of oral intake and successful JT removal by 12 months, while (62%) required ongoing feeding access and/or TPN. Only pyloric intervention was independently associated with successful JT removal at one year (p = 0.011, OR 5.032, p = 0.045). Patients undergoing two procedures had the highest rate of JT removal within one year (36.6%, p = 0.036, OR 12.00, p = 0.022).
CONCLUSION: Malnutrition requiring feeding jejunostomy tubes is a rare complication of gastroparesis. When the disease has progressed to this stage, most patients remain j-tube dependent long-term despite surgical interventions. Pyloric intervention (laparoscopic pyloroplasty or endoscopic pyloromyotomy) substantially increases the likelihood of successful resumption of oral alimentation and subsequent liberation from feeding tubes. Pyloric intervention should be performed concurrently for any patient requiring a feeding jejunostomy for severe gastroparesis