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Patient-reported outcomes among patients with mantle cell lymphoma or chronic lymphocytic leukemia receiving pirtobrutinib in the BRUIN phase 1/2 study: final analysis.
No full textBACKGROUND: This study presents patient-reported outcomes (PROs) from the phase 1/2 BRUIN (NCT03740529) trial of pirtobrutinib monotherapy for the treatment of B-cell malignancies, including chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) and mantle cell lymphoma (MCL).
METHODS: PROs were collected at each cycle using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire and item library (IL) sets for CLL/SLL- and MCL-related symptoms and an Expanded Fatigue measure. Prespecified analyses included descriptive change from baseline, time to worsening (TTW) using Kaplan-Meier method, and longitudinal analyses using a mixed model for repeated measures.
RESULTS: A total of 263 patients with CLL/SLL and 124 with non-blastoid MCL who received pirtobrutinib monotherapy after prior BTKi were included in the final PRO analysis. The proportion of patients with CLL/SLL who improved or remained stable from baseline through Cycle 31 remained above 80% for physical function (PF), CLL/SLL-related symptoms, fatigue, and global health status/quality of life (GHS/QoL). The proportion of patients with MCL who improved or remained stable through Cycle 20 remained above 70% for PF, MCL-related symptoms, fatigue, and GHS/QoL. Median TTW was not reached in either CLL or MCL. Longitudinal analyses for PF, CLL/SLL-related symptoms, fatigue, and GHS/QoL consistently met statistically significant and clinically-meaningful improvement from baseline for CLL. PRO assessments remained stable over time for MCL.
CONCLUSIONS: The final analysis from the BRUIN trial demonstrates stability in PROs throughout the duration of treatment with pirtobrutinib. Most patients with CLL/SLL and MCL reported stable or improved outcomes throughout the study
Primary ovarian insufficiency diagnosis, treatment, and sequelae: current evidence.
No full textPurpose of review: Primary ovarian insufficiency (POI) is a disease that significantly affects the fertility, mental health, and physical health of up to 3.5% of women. Current evidence suggests a succinct diagnostic criteria, but there is limited information on who is at risk of this diagnosis as well as the optimal treatment options to prevent sequelae. The goal of this review is to synthesize the most recent available evidence on POI and provide the best recommendations for its management.
Recent findings/highlighted research: General consensus guidelines were recently updated and published, being affirmed by multiple specialties. This is the first update since 2015. Data continues to advance in terms of unique health risks, specifically in bone and cardiometabolic risks for these patients. Genetic advances have suggested that more complex testing may be of interest; however, this research is still developing.
Summary: Additional research is needed to determine which patients are most at risk for developing POI, the ideal treatment for its related health consequences, genetic testing to determine individual risk, and implications for long-term health
Life Cycle Assessments Enhance a Health System\u27s Environmental Stewardship Initiative.
No full textHealthcare is one of the world\u27s largest polluters. Hospitals face a paradox: while healing patients, they can be simultaneously harming the environment that sustains human health. Over the past century, health metrics have shown significant improvement with life expectancy rising and infant mortality falling, yet carbon emissions, water and energy use, ocean acidification, and deforestation have increased. Left unchecked, this level of consumption and resource use could lead to increased mortality, loss of biodiversity, water shortages, and nutritional disparities. Life cycle assessments have been suggested to examine the broader environmental impact and inform healthcare product decisions. This article describes what a life cycle assessment is, how it can be used for informed product decision-making, and provides recommendations for use in healthcare
The Murdock Daily Reilly (M.D.R.) Scale: A Pressure Injury Risk Assessment Scale for Critical Care
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Dissecting Aneurysm in Cervical Artery Dissection: Insights from the STOP-CAD Study.
No full textBackground: Cervical artery dissection (CeAD) may result in dissecting aneurysm (DA) formation. We aimed to characterize risk factors and clinical outcomes associated with DA in a large, international CeAD cohort. Methods: We performed a secondary analysis of the Antithrombotic Treatment for Stroke Prevention in Cervical Artery Dissection (STOP-CAD), an international, multicenter, retrospective cohort. Patients with spontaneous CeAD were assessed for DA at baseline and de novo DA formation. Significant covariables in univariable analysis were included in multivariable regression models aiming to identify factors associated with DA formation. Logistic regression and Cox proportional hazards models evaluated the association of DA with ischemic and hemorrhagic outcomes. Results: Among 4,008 patients with CeAD, 546 (13.6%) had a DA at baseline, and 221/2938 (7.5%) patients developed a de novo DA during follow up, of which 172/221 (78.2%) were detected in the first 180 days. Patient with DA had a mean age of 47 years and 383 (49.9%) were women. Baseline or de novo DA was associated with history of connective tissue disorder (adjusted odds ratio [aOR] 2.02; 95% CI, 1.22-3.36), fibromuscular dysplasia (aOR 1.69; 95% CI, 1.28-2.25) and multiple vessel dissection (aOR 1.53, 95% CI 1.19-1.98). Lower odds of DA was seen in Hispanic ethnicity (aOR 0.64, 95% CI 0.43-0.97) and ischemic stroke presentation (aOR 0.41, 95% CI 0.34-0.49). Fibromuscular dysplasia was associated with de novo DA formation (aOR 2.30; 95% CI, 1.52-3.49). DA was not associated with ischemic stroke (Hazard ratio [HR], 0.71; 95% CI, 0.44-1.16; p=0.173) or intracranial hemorrhage (ICH) (HR 1.09; 95% CI, 0.42-2.84; P=0.86) by day 180. Conclusions: DAs are relatively common manifestations of CeAD, typically occurring within six months of CeAD diagnosis. DA was not associated with an increased risk of subsequent ischemic stroke or ICH