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Clinical advancements in total neoadjuvant therapy for locally advanced rectal cancer: a narrative review
No full textTucatinib and trastuzumab emtansine for patients with previously treated HER2-positive locally advanced and metastatic breast cancer: primary analysis of the randomized phase III trial HER2CLIMB-02.
No full textBACKGROUND: Trastuzumab emtansine (T-DM1) is a standard treatment option in patients with previously treated human epidermal growth factor receptor 2 (HER2)-positive locally advanced or metastatic breast cancer (LA/MBC). Here, we report the efficacy and safety of tucatinib in combination with T-DM1 compared with T-DM1 alone from the phase III HER2CLIMB-02 study (NCT03975647).
PATIENTS AND METHODS: Eligible patients had HER2-positive LA/MBC that had been previously treated with trastuzumab and a taxane in any setting; these included patients with brain metastases (BMs). Patients were randomly assigned 1 : 1 to receive T-DM1 (3.6 mg/kg intravenously every 21 days) combined with either tucatinib (300 mg orally twice daily) in the tucatinib arm or placebo (orally twice daily) in the control arm.
RESULTS: In total, 463 patients were randomly assigned. After a median follow-up duration of 24.4 months, the median progression-free survival (PFS) was 9.5 months in the tucatinib arm and 7.4 months in the control arm [hazard ratio (HR) 0.76, 95% confidence interval (CI) 0.61-0.95, P = 0.0163]. A PFS benefit was observed across all prespecified subgroups, including in patients with BMs. Interim overall survival analysis results were immature. The median OS was not reached in the tucatinib arm and was 38.0 months in the control arm (HR 1.23, 95% CI 0.87-1.74). The incidences of treatment-emergent adverse events (TEAEs) associated with any treatment discontinuation and of grade ≥3 TEAEs were higher in the tucatinib arm than in the control arm (22.1% versus 11.6% and 68.8% versus 41.2%, respectively). The most common grade ≥3 TEAEs in the tucatinib arm were elevated alanine aminotransferase (16.5%) and aspartate aminotransferase levels (16.5%) (versus 2.6% for both in the control arm).
CONCLUSION: The addition of tucatinib to T-DM1 improved PFS in patients with previously treated HER2-positive LA/MBC, including patients with BMs, and exhibited a manageable safety profile
Improving Compliance Via Barcode Scanning with ROVER App
No full textPurpose: The purpose of the project was to increase compliance with interoperability workflows through implementation of barcode scanning using the Rover app. The goal was to streamline electronic medical record (EMR) programming and overcome workflow challenges.
Background: Infusion interoperability links EMR systems with smart infusion pumps to streamline programming and monitoring. Orders are sent directly from the EMR to the pump, nurses verify settings, and infusion data is relayed back for documentation, reducing manual input and enhancing patient safety by minimizing errors. Current interoperability workflow includes the use of handheld scanners located on computers.
Hospital benchmark for interoperability compliance was set to 95% or higher. Monthly pharmacy safety medication reports revealed that hospital wide infusion interoperability compliance was 82.9%, indicating the need for an intervention. Evidence indicates that implementing portable handheld devices improved scanning compliance and minimized workaround practices. Workarounds identified included confined room configurations, frequent transitions between infusion pumps and workstations on wheels, and the accessibility of medication bar code scanners and workstations. Incorporating handheld devices enabled nurses to directly view programming alerts and warnings on application screens, thereby empowering them to manage infusions more safely and effectively.
Methods/Approach: This quality improvement project sought to improve nursing compliance rates with interoperability workflows on two Medical-Surgical units through implementation of barcode scanning using the Rover app between December 2024 through June 2025. While scanning is required for interoperability, use of the Rover app was recommended. The Alaris Interoperability Mobile (AIM) Project collaborated with shared governance, Nursing Professional Development, local IT, and regional informatics to ensure seamless integration of the Rover app with existing systems. Pre-intervention efforts involved training superusers, distributing informational process videos, updating mobile devices, and collaborating with department leadership to schedule superusers for both day and night shifts. Real-time training on use of the Rover app was facilitated by easily identifiable super-users wearing distinctive AIM project t-shirts. Superusers were stationed on the units to assist staff and to address challenges. Project progress was communicated monthly through flyers and emails, along with individual interoperability scanning compliance reports. Recognition of high-performing users assisted with sustaining staff engagement. Analyzing data from the medication safety dashboard helped the project identify recurring issues and key areas to focus on. In the final project month, staff were surveyed on app usage, barriers, and support received.
Results/Outcomes: Monthly compliance rates for the medical unit ranged between 81% to 90% with a nine-month average of 85%. The TeleOncology unit ranged between 83% to 93% with an eight-month average of 88%. Feedback from the post-project survey indicated that nurses frequently utilized the Rover app in scenarios where workstations and scanners were inaccessible or when room configurations hindered the use of workstations on wheels. Many nurses supported extending implementation of the AIM project across the hospital.
Conclusion & Implications:
The introduction of the Rover app increased scanning compliance, which decreased risk for medication errors, and increased patient safety
PERIOPERATIVE SKIN INTEGRITY: A Quality Improvement Initiative to Prevent Skin Injuries in Surgical Patients
No full textEvaluating the impact of a Nurse-Driven Oxygen Titration & Weaning Guidelines on Length of Stay and Costs of Care: QI
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The Prognostic Value of Cardiac Troponin in Acute Ischemic Stroke Patients With Heart Failure: A Comparative Study Across Age Groups.
No full textHence, this research aims to establish the correlation between cardiac troponin and results in acute ischemic stroke (AIS) patients with heart failure. It examines 367 AIS patients stratified into 2 age groups: 65-74 years and ≥75 years. According to the findings, independent ambulation at admission or discharge signifies less severe strokes National Institutes of Health Stroke Scale. That is, the characteristics that are important for the stroke severity in patients of different ages are different: while the patients aged 75 and older, the important predictors are peripheral vascular disease and increased heart rate, the stroke severity in the younger age is predicted by smoking history and increased serum creatinine. Further, the article examines the value of troponin in a consecutive series of 1145 AIS patients and demonstrates that increased troponin is an independent predictor of in-hospital mortality. Mortality of the troponin-positive patients is significantly high with an odds ratio of 4.28. Moreover, the second trial on 200 AIS patients demonstrated that the cardiac troponin isoforms size is an independent predictor of major adverse cardiac events, odds ratio of 9.76. A study of 151,972 reaffirms the relationship between high troponin levels, increased stroke severity, and worse clinical prognosis. In conclusion, the current work fosters the significance of evaluating cardiac troponin in AIS patients with heart failure for enhanced mortality and adverse cardiovascular events\u27 risk estimation
