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Evidence-Based Practice Approach on Protocol Development on Prevention of Hypoglycemia for Patients with Hypertriglyceridemia-Induced Pancreatitis
No full texthttps://scholarlycommons.henryford.com/nursresconf2025/1038/thumbnail.jp
A cross-sectional analysis of doxyPEP use and outcomes in Michigan, United States
No full textBackground: In 2024, national guidance was issued for doxycycline post-exposure prophylaxis (doxy-PEP) to prevent bacterial sexually transmitted infections (STIs). The study purpose was to evaluate doxy-PEP use in patients with increased risk of STI exposure at a large, urban health system.
Methods: IRB-exempt study of adult patients with clinic encounters for increased risk of STI exposure and testing for N. gonorrhoeae, C. trachomatis, and T. pallidum from 01/01/2023-31/10/2024. Patients were identified using ICD-10 code Z20.XX and STI testing. Doxy-PEP prescription utilization was evaluated after a dedicated doxy-PEP order was implemented with appropriate patient counseling instructions. The primary outcome was the proportion of doxy-PEP prescriptions utilized in at-risk patients; secondary outcomes were utilization of the dedicated doxy-PEP order and abnormal STI testing within 3-months of the doxy-PEP prescription.
Results: 4234 high-risk sexual patient encounters were documented; 7.37% of patients received a doxy-PEP prescription. Of these, 29.5% were ordered utilizing a dedicated doxy-PEP order. Most patients who received a doxy-PEP prescription were Black (96.6%), men (92.6%), with a median (IQR) age of 29 (24-37) years, and had private/commercial insurance (42%). One patient had abnormal syphilis testing within 3-months of doxy-PEP prescription.
Conclusions: These findings highlight doxy-PEP underutilization and the need for broader provider engagement and advanced antimicrobial stewardship interventions
Global trends in disability adjusted life years (DALYs) and mortality rates in gastric cancer among elderly (70+ Years) from 1990-2021: A Global Burden of Disease study
No full textBackground: Although the incidence and mortality of gastric cancer have decreased over the past decades due to the progress in diagnostic methods, treatment approaches and preventive measures, it still poses serious global health challenges particularly in the elderly population with significant disparities in the overall Disability-Adjusted Life Years (DALYs) and mortality. This study evaluates gastric cancer related overall DALYs and mortality from 1990-2021 using the Global Burden of Disease (GBD) database. Methods: GBD data for 2021 were studied to evaluate overall DALYs and mortality rate per 100,000 population among 70 and above aged individuals. The Annual Average Percentage Change (AAPC) was calculated to assess trends from 1990 to 2021, and statistical significance assessed through p-values. Results: From 1990 to 2021, the overall DALYs rate for gastric cancer demonstrated a gradual decline. The DALYs rate per 100,000 decreased from 2656.08 in 1990 to 1511.71 in 2021. Similarly, the mortality rate declined from 166.11 per 100,000 in 1990 to 100.06 per 100,000 in 2021. The steepest declines in both DALYs and mortality rates occurred between 2004 and 2007, with annual percentage changes (APC) of -3.81% (95% CI: -4.023 to -3.531; p \u3c 0.000001) and -3.41% (95% CI: -3.632 to -3.155; p = 0.0004), respectively. Across the entire study period (1990-2021), the average annual percentage change (AAPC) for DALYs was -1.80% (95% CI: -1.809 to -1.784; p \u3c 0.000001), while for mortality rates, it was -1.63% (95% CI: -1.655 to -1.605; p \u3c 0.000001). Conclusions: From 1990 to 2021, the burden of gastric cancer among individuals aged 70+ significantly declined, with a 43% reduction in DALYs and a 40% reduction in mortality rates. The sharpest declines occurred from 2004 to 2007. These trends highlight advancements in prevention and treatment but emphasize the need for continued efforts to address the burden in aging populations
Risk Factors Associated with Lower Respiratory Tract Infections in Adult Patients with Respiratory Syncytial Virus Infections
No full textBackground. Respiratory Syncytial Virus (RSV) is known to cause severe disease in elderly individuals and patients with underlying cardiopulmonary or immunocompromised conditions. Little is known about the factors associated with the lower respiratory tract infections (LRTI). Methods. A multicenter historical cohort study was conducted on adult patients hospitalized for laboratory-confirmed RSV-related diseases in Ascension hospitals in Southeast Michigan between January 2017 and December 2021. Hospitalized patients were identified using ICD 10 codes for RSV-related diseases. Medical records were reviewed after IRB approval. LRTI was defined as an acute respiratory disorder meeting at least three out of four criteria: respiratory signs/symptoms (cough/ dyspnea/ tachypnea), fever, oxygen saturation below 94%, and abnormal chest x-ray at the time of hospital admission. Data were analyzed using Student\u27s t-test, the chi-Squared test, the Mann-Whitney U test and logistic regression using SPSS v. 29.0. Results. Of 360 patients, 143 (39.7%) had LRTI. The mean (sd) age of patients with LRTI was 69.1 + 15.3 years, and 76 (53.1%) were female. The mean Charlson Weighted Index of Comorbidity score was 2.5 + 2.1. Factors associated with LRTI in univariable analysis were age, sex, asthma, time period (TP) (pre-COVID (2017-2019) and COVID (2020-2021), maximum temperature within 24 hours of admission (Tmax), lowest diastolic blood pressure, oxygen requirement and neutrophil count at admission, infectious disease (ID) consultation, and antibiotics given for \u3e1 day. Predictors for LRTI in multivariable logistic regression were COVID TP (odds ratios [OR], 2.0; 95% CI 1.2-3.4), Tmax ([OR], 1.2; 95% CI 1.0-1.5), oxygen requirement at presentation (OR, 2.1; 95% CI 1.2-3.4), ID consultation ([OR], 2.7; 95% CI 1.6-4.4), antibiotics given for \u3e1 day (OR, 3.7; 95% CI 2.2-6.2) while female sex was inversely related to LRTI episodes ([OR], 0.4; 95% CI 0.3-0.7) . Conclusion. Our study finds that COVID time period, maximum temperature within 24 hours of admission, oxygen requirement at admission, ID consultation, and antibiotics given \u3e1 day were significantly associated with LRTI among adult patients with RSV infection. Female sex was less likely to have LRTI. Further studies needed to confirm these findings
Safety of Endoscopic Retrograde Cholangiopancreatography (ERCP) in Liver Transplant Patients: A Population-Based Propensity-Matched Study
No full textPurpose: Liver transplant (LT) recipients undergoing Endoscopic retrograde cholangiopancreatography (ERCP) represent a unique patient group that faces distinct challenges during ERCP. This study aims to assess the risk of post-ERCP complications in LT patients. Methods: A retrospective cohort study using the TriNetX US Collaborative Network identified LT patients who underwent ERCP and compared them to a matched non-LT group. The primary outcome was post-ERCP pancreatitis. Secondary outcomes included bleeding, cholangitis, sepsis, transfusion need, and mortality. Results: A total of 3,032 patients were identified in the LT group (group 1), and 126,056 in the no LT group (group 2). The mean age in group 1 was 56.7 +/- 12.1, and 57.7+/- 17.9 in group 2. Females were 982 in group 1, and 66,482 in group 2. Propensity score matching was performed on all baseline characteristics that can be potential confounders, including age, sex, race, and co-morbidities. (Table 1) The outcome analysis after matching showed the incidence of acute pancreatitis post-ERCP was 1.3% in LT group compared to 1.7% in the non-LT group, however it was not statistically significant (RR = 0.770; CI = 0.480 - 1.235, p = 0.277). There was no statistically significant difference in rates of cholangitis (5.5% in LT vs. 4.3% in no LT, RR=1.293, CI=0.980-1.707, p=0.068), sepsis (2.8% vs. 1.8%, RR=1.550, CI=0.996-2.412, p=0.050), gastrointestinal bleeding (1.1% vs. 1%, RR=1.105; CI=0.605-2.019, p=0.745) or mortality (0.4% vs. 0.4%, RR=0.999, CI=0.416-2.396, p=0.998). (Table 2) Conclusions: Liver transplant patients undergoing ERCP exhibited a short-term safety profile similar to that of the general population, particularly in the risk of acute pancreatitis. These findings highlight the safety of ERCP in post liver transplant patients despite being on chronic immunosuppression. [Formula presented] CITATION INFORMATION: Abusuliman M., Ismail A., Elfert K., Abusuliman A., Eldesouki M., Cox T., Amreia M., Elsaka H., Ali M., Estrada P., Elhanafi S. Safety of Endoscopic Retrograde Cholangiopancreatography (ERCP) in Liver Transplant Patients: A Population-Based Propensity-Matched Study AJT, Volume 25, Issue 8 Supplement 1 DISCLOSURES: M. Abusuliman: None
TCT-788 Aspirin Alone Vs P2Y12 Inhibitor Alone vs Dual Antiplatelet Therapy Post Myocardial Infarction with Non-Obstructive Coronary Arteries (MINOCA): A Meta- Analysis
No full textBackground: Myocardial Infarction with non-obstructive coronary arteries (MINOCA) accounts for 2-6% of all myocardial infarctions. We conducted a meta-analysis to determine the efficacy of aspirin alone (ASA) vs P2Y12 inhibitor alone vs Dual Antiplatelet therapy (DAPT) post MINOCA. Methods: A systematic literature search was conducted across multiple databases to find studies that reported outcomes for ASA, P2Y12 inhibitor alone vs DAPT post MINOCA. We performed statistical pooling for incidence estimates using the generic inverse variance method employing a random effects model. Results: A total of six studies [n=13635} were included in the meta-analysis. ASA was not associated with a reduced incidence of Major adverse cardiovascular events (MACE) [pooled HR=1.06; 95% CI=0.41-2.72, p\u3e0.05] or Repeat MI [summary HR=1.12; 0.47-2.65]. P2Y12 inhibitor therapy alone was not associated with a reduced incidence of MACE or reduced mortality (p\u3e0.05). DAPT therapy post MINOCA was found to be associated with reduced mortality [Summary HR=0.73; 95% CI=0.55-0.97, p\u3c0.05] but did not with a reduced risk of MACE (p\u3e0.05). The outcome of Repeat MI for DAPT could not be pooled due to only one study reporting this outcome. [Formula presented] Conclusion: After MINOCA, Dual Antiplatelet therapy is associated with reduced mortality and favourable outcomes. However, mono-platelet therapy does not have a mortality or MACE benefit. Large scale randomized prospective data is needed to establish conclusive evidence. Categories: CORONARY: Acute Myocardial Infarctio
Measuring Citation Impact in Non-Indexed Repository-Based Journals: An Investigation of Repository Tools and Proposed Alternatives
No full textScholarly journals hosted on library-sponsored institutional repositories (IR) expand publishing alternatives for institutional and external authors. As with other repository content, journal impact is often associated with download counts. In many scholarly areas, however, citation remains the primary metric for which many promotion and tenure requirements include. In addition to providing download usage, Digital Commons, one repository platform owned by Elsevier, also utilizes a metric source provided by another Elsevier company, PlumX. PlumX provides download counts, social media mentions, and citations counts. The citation count in PlumX is a valuable tool for journals that are not indexed in a database, such as Scopus, which measures citation rates. During the process of application for indexing to Scopus for one IR’s longest published journals, we discovered that identifying citations for non-indexed journals in Scopus was possible and searches revealed that the journal had received over 30 citations. However, the PlumX dashboard in Digital Commons showed zero citations. PlumX utilizes CrossRef data from registered DOIs to inform citation rates of journals; however, an article’s references are not a required field. Upon initial inspection, there appeared to be variations in reference data, though presumably complete CrossRef records did not populate citation data in PlumX. Currently, an investigation of this variance is underway with PlumX and CrossRef. In this presentation, I will discuss available findings and provide alternative resources for citation counts that non-indexed journals can incorporate into their impact reporting
Colon adjuvant chemotherapy based on evaluation of residual disease (CIRCULATENORTH AMERICA): NRG-GI008
No full textBackground: Currently, there are no biomarkers validated prospectively in randomized studies for resected colon cancer (CC) to determine need for adjuvant chemotherapy (AC). However, circulating tumor DNA (ctDNA) represents a highly specific and sensitive approach (especially with serial monitoring) for identifying minimal/molecular residual disease (MRD) postsurgery in CC patients (pts), and may outperform traditional clinical and pathological features in prognosticating risk for recurrence. CC pts who do not have detectable ctDNA (ctDNA-) are at a much lower risk of recurrence and may be spared the toxicities associated with AC. Furthermore, for CC pts with detectable ctDNA (ctDNA+) who are at a very high risk of recurrence, the optimal AC regimen has not been established. We hypothesize that for pts whose CC has been resected, ctDNA status may be used to risk-stratify for making decisions about AC. Methods: In this prospective phase II/III trial, up to 1,912 pts with resected stage IIB, IIC, and III CC will be enrolled. Based on the post-operative ctDNA status using personalized and tumor-informed assay (Signatera™, bespoke assay), those who are ctDNA- (Cohort A) will be randomized to immediate AC with fluoropyrimidine (FP)+oxaliplatin (Ox) for 3-6 mos per established guidelines v serial ctDNA monitoring. Patients who are ctDNA+ post-operatively, or with serial monitoring (Cohort B), will be randomized to FP+Ox v more intensive AC with addition of irinotecan (I) for 6 mos. One cycle of chemotherapy is allowed while awaiting ctDNA testing results for cohort assignment. The primary endpoints for Cohort A are time to ctDNA+ status (phase II) and disease-free survival (DFS) (phase III) in the immediate v delayed AC arms. The primary endpoint for Cohort B is DFS in the FP+Ox v FP+Ox+I arms for both phase II and phase III portions of the trial. Secondary endpoints include prevalence of detectable ctDNA post-operatively, time-to-event outcomes (overall survival and time to recurrence) by ctDNA status, and the assessment of compliance to adjuvant therapy. Biospecimens including archival tumor tissue, as well as post-operative plus serial matched/normal blood samples, will be collected for exploratory correlative research. Active enrollment across the NCTN started in June 2022 with CCTG sites joining in August 2023. Current accrual (as of 1-27-2025): 647/1,912. NCT: 05174169. Support: U10 CA180868, -180822; -180888; UG1 CA189867; Natera, Inc
MM-423: Secondary Hematologic Malignancies in Patients With Multiple Myeloma: A Retrospective Analysis of Risk Factors and Incidence in a Large Urban Health System
No full textMultiple myeloma (MM) is a common hematologic malignancy. While overall survival has improved due to advances in therapy, there is concern regarding the risk of secondary hematologic malignancies (SHM). Objective: To identify patients treated for MM who subsequently developed SHM and estimate the incidence and timing of SHM. Design: Retrospective, observational study. Setting: Henry Ford Health, a large urban, tertiary care network in Detroit, MI. Patients: Patients age 18 years or more with a confirmed diagnosis of MM between January 2005 and December 2022 and a subsequent SHM diagnosis were identified through electronic medical records review. Results: Of 3122 patients with MM, 297 were identified by automatic data pull as having a diagnosis of SHM. After manual review, nine patients met the inclusion criteria. Six patients (66.7%) were male. Median age at MM diagnosis was 62 (range: 53–73) years. About 44.4% were African American, 33.3% were Caucasian, 11.1% were Asian, and 11.1% identified as other. At a median follow-up of 58 (range: 35–144) months, most patients (66.6%) had received only one line of therapy, some had two lines (22.25%), and one patient had received 12 lines of therapy. Five patients (55.6%) underwent autologous stem cell transplantation. Most patients (77.8%) received maintenance therapy, most commonly with lenalidomide (66.7%), for a median duration of 11 (range: 0–29) months. SHM were diagnosed at a median of 4 years after MM diagnosis, being primarily myeloid in origin (77.8%). Median time from MM diagnosis to death was 64 (range: 49–78) months, and median time from SHM diagnosis to death was 5 (range: 0–9) months. Conclusion: Despite the sample size and retrospective nature, our study has some key findings. First, the incidence of SHM was 0.2%, which is significantly less than the 8–18% in previous studies. Second, most patients were not heavily pretreated, often receiving only 1–2 lines of therapy and shorter duration of lenalidomide maintenance prior to the development of SHM. Accordingly, further work needs to be done to evaluate the impact of both patient- and disease-dependent factors, as well as MM therapy, on the development of SHM
Combination casdatifan plus cabozantinib expansion cohort of phase 1 ARC-20 study in previously treated patients with clear cell renal cell carcinoma
No full textBackground: Hypoxia-inducible factor 2-alpha (HIF-2a) is highly dysregulated in clear cell renal cell carcinoma (ccRCC), resulting in increased expression of proteins involved with angiogenesis, proliferation, and cancer cell survival. Casdatifan is an orally bioavailable small-molecule HIF-2a inhibitor. We investigated the safety and efficacy of casdatifan in combination with the anti-vascular endothelial growth factor receptor tyrosine kinase inhibitor (VEGFR-TKI) cabozantinib in previously treated patients with ccRCC in an expansion cohort (casdatifan + cabozantinib) of the phase 1, open-label ARC-20 (NCT05536141) trial. Methods: Patients enrolled in the casdatifan + cabozantinib expansion cohort were previously treated with immunotherapy (IO) alone or with anti-VEGF therapies. Casdatifan 100 mg and cabozantinib 60 mg were given orally once daily. Endpoints included the incidence of treatment-emergent adverse events (AEs) and objective response rate (ORR) by RECIST v1.1. This study is ongoing; data as of January 3, 2025, are reported. Results: Overall, 27 patients with a median (range) follow-up of 2.9 (0.1-6.8) months were enrolled. At data cut off, prior treatment settings included adjuvant only (n = 5/26) and metastatic (1L n = 17/26; 2L n = 4/26). Prior therapies included IO only (n = 15/26) or IO plus VEGFR-TKI (n = 11/26). All grade AEs occurred in 89% of patients with the most common being anemia (n = 16 [59%]) and fatigue (n = 15 [56%]). Most common (.10%) grade≥3 AEs were anemia (n = 7 [26%]) and hypoxia (n = 3 [11%]). No cardiac events were reported. AEs leading to casdatifan-only, cabozantinib-only, or both casdatifan + cabozantinib dose reductions occurred in 3 (11%), 7 (26%), and 2 (7%) patients, respectively. Only one (4%) pt discontinued due to an AE, hypoxia related to casdatifan. Responses continue to be observed among the efficacy evaluable population (n = 22; as of January 27, 2025) with ORR of 41% (n = 1 complete response; n = 8 partial response). Activity was seen across all IMDC risk groups. Conclusions: In previously treated patients with ccRCC, casdatifan 100 mg in combination with cabozantinib 60 mg had a manageable AE profile with promising clinical activity. These data support continued evaluation of this combination in the phase 3 PEAK-1 clinical trial