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Successful Strategies for Operationalizing Goals-of-Care Documentation
No full textGoals-of-care (GOC) conversations are critically important to ensure that clinical teams and health systems know what matters to their patients, enabling treatment plans to be aligned with patients’ goals. However, because many conversations are ad hoc and clinician dependent, patients with serious medical conditions often do not have GOC conversations documented in their health record, either because these conversations did not occur or because they simply were not entered into the health record. The authors present details of a multiyear, systematic effort that contributed to one health system’s substantial increase in the number of documented conversations that met minimum specification criteria across the 51 hospitals involved in the health system’s initiative. Over the period from January 1, 2024, to December 31, 2024, 8,533 out of 10,063 (84.8%) of patients who were in an ICU for 5 or more days had a documented GOC conversation in the electronic health record at some point between hospital admission and prior to the fifth ICU day. This compares with a preintervention rate of just 555 out of 8,143 (6.8%) of patients who were in an ICU for 5 or more days having a documented GOC conversation in the period from January 1, 2016, to December 31, 2016. Essential strategies included centering efforts within the organization’s mission and vision, partnering with clinical leaders to set strong quality standards and corresponding metrics, easing documentation within the electronic health record, and designing and implementing effective communication skills–building workshops
Impact the Utilization of Evidenced Based Practices has on Post Kidney Transplant Patient Outcomes
No full texthttps://digitalcommons.providence.org/covenant_nurses_week_2025/1018/thumbnail.jp
Got Rib Fractures? PIC This! Producing Improved Patient Outcomes in Trauma Related Rib Fractures, PIC Scores and Use of Intercostal Nerve Blocks
No full texthttps://digitalcommons.providence.org/covenant_nurses_week_2025/1016/thumbnail.jp
Reducing Intracranial Pressure: A Comparison of Hypertonic Saline and Mannitol: An Integrated Research Review
No full texthttps://digitalcommons.providence.org/covenant_nurses_week_2025/1007/thumbnail.jp
Evidence Based Research Review of Remote Independent Chemotherapy/Immunotherapy Verification
No full texthttps://digitalcommons.providence.org/covenant_nurses_week_2025/1003/thumbnail.jp
Limelight: An Open, Web-Based Tool for Visualizing, Sharing, and Analyzing Mass Spectrometry Data from DDA Pipelines.
No full textLiquid chromatography-tandem mass spectrometry employing data-dependent acquisition (DDA) is a mature, widely used proteomics technique routinely applied to proteome profiling, protein-protein interaction studies, biomarker discovery, and protein modification analysis. Numerous tools exist for searching DDA data and myriad file formats are output as results. While some search and post processing tools include data visualization features to aid biological interpretation, they are often limited or tied to specific software pipelines. This restricts the accessibility, sharing and interpretation of data, and hinders comparison of results between different software pipelines. We developed Limelight, an easy-to-use, open-source, freely available tool that provides data sharing, analysis and visualization and is not tied to any specific software pipeline. Limelight is a data visualization tool specifically designed to provide access to the whole data stack , from raw and annotated scan data to peptide-spectrum matches, quality control, peptides, proteins, and modifications. Limelight is designed from the ground up for sharing and collaboration and to support data from any DDA workflow. We provide tools to import data from many widely used open-mass and closed-mass search software workflows. Limelight helps maximize the utility of data by providing an easy-to-use interface for finding and interpreting data, all using the native scores from respective workflows
A Prospective, Multicenter Analysis of Recurrence-Free Survival After Sentinel Lymph Node Biopsy Decisions Influenced by the 31-GEP.
No full textBACKGROUND: Although most patients with cutaneous melanoma (CM) will have a negative sentinel lymph node biopsy (SLNB), up to 20%-30% of these patients will recur. The 31-gene expression profile (31-GEP) test has been prospectively validated to identify patients at low (Class 1A), intermediate (Class 1B/2A), and high (Class 2B) risk of SLN positivity and recurrence.
METHODS: DECIDE is a prospective, multicenter study to assess the effect of 31-GEP testing on SLNB performance rates in patients with T1-T2 tumors considering SLNB and to study long-term outcomes. Here, we assessed outcomes in patients with a Class 1A 31-GEP result (n = 130).
RESULTS: Of Class 1A patients, 63 had an SLNB, with a 3.2% SLN positivity rate (2/63). No Class 1A patients, regardless of SLN status, experienced a recurrence (2-year median follow-up).
CONCLUSIONS: These results are consistent with previous studies that showed the 31-GEP can identify patients at low risk of SLN positivity and recurrence
Effective long-term prophylaxis with lanadelumab in adolescents with hereditary angioedema: EMPOWER/ENABLE.
No full textBACKGROUND: Symptoms of hereditary angioedema (HAE) typically first present during childhood, but the frequency/severity of attacks often increases at puberty. Real-world data on long-term HAE prophylaxis in adolescents are limited. We report pooled data from adolescent patients enrolled in two Phase 4 studies (EMPOWER, ENABLE) evaluating the effectiveness/safety of lanadelumab (monoclonal antibody directed against plasma kallikrein) for the prevention of HAE attacks.
METHODS: Adolescent patients (aged 12 to \u3c 18 years) with HAE-C1INH enrolled in EMPOWER and ENABLE received open-label lanadelumab 300 mg once every 2 weeks. Effectiveness outcomes were based on patient-reported assessments of on-treatment HAE attacks. Safety was assessed through the recording of treatment-emergent adverse events (TEAEs) and serious adverse events. This analysis categorized patients as new or established lanadelumab patients.
RESULTS: Thirteen new and seven established patients on lanadelumab were included. The observed monthly attack rate in new patients fell from 3.8 (mean) and 2.8 (median) during the pre-enrollment period to 0.65 (mean) and 0.21 (median) during the cumulative study period after lanadelumab initiation (84.2% and 92.9% reductions, respectively). In established patients, mean (SD) HAE attack rate (as treated) during the overall study period was 0.04 (0.03) attacks/month. Most HAE attacks were of mild/moderate severity. Nine new patients reported 42 TEAEs, mostly mild/moderate in severity, with 3 TEAEs reported as serious. Seven established patients reported 12 TEAEs (all mild/moderate and non-serious). No TEAEs were related to lanadelumab.
CONCLUSION: These data support lanadelumab\u27s effectiveness/safety in adolescents with HAE, consistent with results from Phase 3 lanadelumab studies in mixed adult/adolescent populations.
CLINICAL TRIAL IDENTIFIERS: NCT03845400 (EMPOWER) and NCT04130191 (ENABLE)
Sharing data from the Human Tumor Atlas Network through standards, infrastructure and community engagement.
No full textData from the first phase of the Human Tumor Atlas Network (HTAN) are now available, comprising 8,425 biospecimens from 2,042 research participants profiled with more than 20 molecular assays. The data were generated to study the evolution from precancerous to advanced disease. The HTAN Data Coordinating Center (DCC) has enabled their dissemination and effective reuse. We describe the diverse datasets, how to access them, data standards, underlying infrastructure and governance approaches, and our methods to sustain community engagement. HTAN data can be accessed through the HTAN Portal, explored in visualization tools-including CellxGene, Minerva and cBioPortal-and analyzed in the cloud through the NCI Cancer Research Data Commons. Infrastructure was developed to enable data ingestion and dissemination through the Synapse platform. The HTAN DCC\u27s flexible and modular approach to sharing complex cancer research data offers valuable insights to other data-coordination efforts and researchers looking to leverage HTAN data
Sensorimotor Physiological Mapping During Asleep Deep Brain Stimulation Lead Placement With Multichannel Intraoperative Neuromonitoring.
No full textBACKGROUND AND OBJECTIVES: Lead placement during asleep deep brain stimulation (DBS) surgery has relied primarily on intraoperative imaging, forgoing traditional awake neurophysiological testing. We aimed to describe our experience of asleep macrostimulation mapping of implanted DBS leads using intraoperative neuromonitoring (IONM) techniques, which were used to guide electrode placement-in addition to intraoperative computed tomography imaging and in place of awake neurophysiological testing.
METHODS: This was a single institution retrospective study of asleep DBS surgery with IONM mapping for Parkinson\u27s disease, ET, and dystonia targeting the ventral intermediate nucleus, subthalamic nucleus, and globus pallidus interna.
RESULTS: A series of 88 consecutive patients from a single surgeon were included. 67 patients received DBS for Parkinson\u27s disease, 14 for essential tremor, and 7 for dystonia. The DBS target was globus pallidus interna for 60 patients, subthalamic nucleus for 14, and ventral intermediate nucleus for 14, with 95.5% undergoing bilateral lead placement. The mean single stage surgery time was 170 minutes. No patients required surgical lead revision, and no unanticipated sensorimotor side effects were noted during DBS programming. Compared with patients undergoing awake DBS surgery, there was no significant difference in patient-reported outcomes.
CONCLUSION: Asleep IONM mapping offers valuable physiological data to guide electrode asleep DBS placement and complement intraoperative imaging techniques