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What Adult Medical Care Can Learn from Pediatrics: Creating Comfort, Connection, and Joy in the Hospital
No full textAssociations between body weight, asthma burden, and T2 inflammation among under-resourced children
No full textBACKGROUND: Overweight/obesity is a risk factor for asthma, particularly in under-resourced children, and contributes to higher disease burden. T2 inflammation, a key characteristic of asthma endotypes, has been inconsistently associated with burden of obesity-related asthma, which may be due to limited overlap between different T2 features, including elevated total serum IgE, eosinophilia, and allergen sensitization.
OBJECTIVE: To investigate the effects of different T2 features on association of overweight/obesity with asthma burden in under-resourced children.
METHODS: Among 2,160 children ages 6-20 years from four Inner-City Asthma Consortium cohorts, we investigated the association of overweight/obesity with asthma burden (unscheduled visits, hospitalizations, exacerbations, asthma control, and pulmonary function), and the effect of T2 features (total IgE higher than age-specific cutoffs, total eosinophils \u3e300 cells/ul, or sensitization to ≥2 allergens) on the association.
RESULTS: The odds (OR (95% CI)) of unscheduled visits was higher among those with overweight/obesity (1.35 (1.04-1.75)) and allergen sensitization (1.35 (1.02-1.80)), hospitalizations was higher among those with elevated total IgE (2.17 (1.27-3.69)) and eosinophilia (2.80 (1.56-5.21)), and poor asthma control was higher among those with elevated total IgE (1.27 (1.09-1.41)). Overweight/obesity and all T2 features were associated with lower FEV1/FVC ratio. There was no synergistic or clinically significant mediating influence of any of T2 features on the association of overweight/obesity with asthma burden.
CONCLUSION: Among under-resourced children with asthma, overweight/obesity and T2 inflammation are largely independently associated with unscheduled visits and pulmonary function deficits. T2 inflammation, but not overweight/obesity, is associated with poor control and hospitalizations
Code Sepsis: Educating for Excellence in Sep-1 Compliance
No full texthttps://scholarlycommons.henryford.com/nursresconf2025/1003/thumbnail.jp
Combating Workplace Violence: The Implementation of a Behavioral Emergency Response Team
No full texthttps://scholarlycommons.henryford.com/nursresconf2025/1004/thumbnail.jp
Tele Turnaround: Improving Nursing Telemetry Assessment
No full texthttps://scholarlycommons.henryford.com/nursresconf2025/1031/thumbnail.jp
Under Pressure: Isolating the Data for Prevalence and Severity of Pressure Injuries in Isolation Rooms
No full texthttps://scholarlycommons.henryford.com/nursresconf2025/1033/thumbnail.jp
Association Between the Use of Long-Acting Insulin and Hypoglycemia in Critically Ill Patients with Diabetes
No full textIntroduction: Hypoglycemia in critically ill patients increases morbidity and mortality. Subcutaneous long-acting insulin (LAI) in patients without diabetes is associated with hypoglycemia in the SICU. However, limited evidence exists in patients with diabetes.
Methods: This was a single-center, retrospective cohort study evaluating patients with T2DM who were admitted to the SICU for 24 h and received LAI in combination with sliding scale insulin (LAI + SSI) or sliding scale insulin (SSI) alone. The primary outcome was the incidence of hypoglycemia (BG \u3c 70 mg/dL) in patients who received LAI + SSI or SSI. Secondary outcomes evaluated the number of glucose values across defined categories: hypoglycemia (54-70 mg/dL), severe hypoglycemia (\u3c 54 mg/dL), euglycemia (70-180 mg/dL), hyperglycemia (\u3e180 mg/dL) and glycemic variability.
Results: A total of 228 patients were included in the final analysis. The incidence of hypoglycemia occurred in 17.5% of patients in the LAI + SSI cohort and 18.4% in the SSI cohort (p = .86). After controlling for confounders, no differences were observed with LAI + SSI versus SSI for hypoglycemia (OR 1.09, 95% CI 0.46-2.6, p = .85). Secondary outcomes demonstrated no difference in total hypoglycemia (37 vs 31, p = .80), severe hypoglycemia (15 vs 34, p = .17) and euglycemia (1622 vs 1780, p = .22) in the LAI + SSI cohort compared to SSI alone. Hyperglycemia occurred more frequently with LAI + SSI. However, after adjusting for confounders there was no difference in hyperglycemia (OR 1.8, 95% CI 0.7-4.6, p = .22). No difference was observed in glycemic variability between LAI + SSI and SSI (26.5 vs 24.5, p = .21).
Conclusion and Relevance: The addition of LAI to SSI in SICU patients with T2DM was not associated with an increased risk of hypoglycemia
101 Parenteral Bridging Practices and Outcomes in Patients on Warfarin for Mechanical Heart Valves and Venous Thromboembolism
No full textIntroduction: Bridging with heparin or low-molecular-weight heparin (LMWH) during warfarin interruption is common. Guidelines against bridging in atrial fibrillation have recently been strengthened, while the evidence against bridging in mechanical heart valves (MHV) and venous thromboembolism (VTE) is less robust. Our objective was to describe the prevalence of bridging in patients on warfarin for MHV or VTE and study post-procedure outcomes. Methods: Patients within the Michigan Anticoagulation Quality Improvement Initiative (MAQI2) registry who were prescribed warfarin solely for MHV or VTE between January 1st, 2020 and July 16th, 2024 with at least one interruption for a surgery or invasive procedure and having at least thirty days of post-procedure follow-up were identified. Interruptions were categorized as bridged or non-bridged. Thirty-day post-procedure bleeding and thrombotic event rates were compared using propensity score matching and then adjusted for unbalanced variables. Patient-level clustering was addressed with a generalized estimating equation approach. Major bleeding defined by International Society on Thrombosis and Haemostasis criteria. Results: 530 patients experienced 775 interruptions, and 427 (55.1%) interruptions were bridged. In 293 matched interruptions, thirty-day post-procedure thrombotic events were comparable between bridged and non-bridged interruptions (1.3 vs 2.7 per 100 interruptions, p=0.40) while major bleeding was also similar (2.7 vs 1.3 per 100 interruptions, p=0.23). Total bleeds of any severity and bleeds requiring ED evaluation/treatment were more common after bridged interruptions (12.8 vs 6.1 per 100 interruptions, p=0.015 and 5.1 vs 1.7 per 100 interruptions, p=0.019, respectively). Conclusion: Bridging was associated with a significant increase in bleeding, without a reduction in thrombotic events during the 30-day post-procedure period
Non-infectious sarcoid-like inflammatory granulomatous conditions (NSIGC) associated with immune checkpoint inhibitors (ICIs) for cancer: Results from the International ICARUS (Immune Checkpoint Associated Rare and Unique Side effects) consortium
No full textBackground: ICIs can be associated with a broad range of toxicities; however, limited data exists on NSIGC secondary to ICIs. Herein, we assembled the first international cohort of patients (pts) with cancer who received ICIs and subsequently developed NSIGC. Methods: We retrospectively collected data from 14 institutions globally on pts with cancer who received ICIs between 2015- 2025 and subsequently developed biopsy-confirmed NSIGC. Pts were eligible if they received anti-programmed cell death protein-1/programmed death-ligand 1 (anti-PD-1/PD-L1) alone or in combination with additional anti-cancer therapies such as chemotherapy, targeted agents or anti-CTLA-4, or if they were treated with other immunotherapies. The chi-squared goodness of fit test was used to analyze the distribution of different ICI regimens and their association with NSIGC, assuming a uniform distribution with an expected frequency of 25 for each of the 5 ICI regimens. Results: The study included 125 pts with biopsy-confirmed NSIGC post-ICI. Of these, 58.4% (n = 73) were male and 83.2% (n = 104) were Caucasians. Median age at cancer diagnosis was 62 years. The top three cancers in the cohort were melanoma (45.6%; n = 57) non-small cell lung cancer (16.8%; n = 21) and renal cell carcinoma (6.4%; n = 8). Out of 125 pts, 48.8% (n = 61) received anti-PD-1/PD-L1 monotherapy, 20% (n = 25) anti-PD-1/PD-L1 + anti-CTLA-4, 17.6% (n = 22) anti-PD-1/PD-L1 + chemotherapy, 8% (n = 10) anti-PD-1/PD-L1 + targeted agents, and 5.6% (n = 7) received other immunotherapies. Our result showed a significant difference between expected and observed NSIGC frequencies across different ICI regimens (X2 = 74.2, df = 4, p \u3c 0.01) indicating a potential association between anti-PD-1/PD-L1 monotherapy and NSIGC. The median time to the diagnosis of NSIGC after ICI initiation was 7.1 months (range: 3.9-26.7 months). Of 125 pts, 55.2% (n = 69) were diagnosed after treatment completion. Among these 69 pts, 56.5% (n = 39) were diagnosed within 6 months, 14.5% (n = 10) between 6 months and 1 year, 10.1% (n = 7) between 1 and 2 years, and 18.8% (n = 13) were diagnosed after 2 years. The remaining 44.8% (n = 56) were diagnosed during treatment, out of which 48.2% (n = 27) required permanent treatment discontinuation due to NSIGC and 3.6% (n = 2) were re-challenged. 19.2% (n = 24) received steroid treatment for NSIGC. Conclusions: To our knowledge, this is the largest dataset to date demonstrating NSIGC as a rare side effect of ICIs. NSIGC frequently occurs after ICI therapy completion but can also result in ICI discontinuation. Biopsy confirmation is critical to prevent misdiagnosis, and further research is required to elucidate the biology, risk factors, and implications for ICI continuation or rechallenge to optimize patient outcomes
Predictors of survival in advanced-stage, high grade primary peritoneal serous cystadenocarcinoma: An NCDB based analysis
No full textBackground: High-grade primary peritoneal cystadenocarcinoma (HPPC) is a rare and aggressive malignancy originating from the peritoneal lining, frequently diagnosed at advanced stages with a poor prognosis. Despite its severity, data on clinical behavior, prognostic factors, and survival outcomes remain limited, particularly in advanced disease. This study utilizes the National Cancer Database (NCDB) to identify key predictors of survival to enhance clinical understanding and inform treatment strategies. Methods: Using the NCDB, we conducted a retrospective analysis of patients diagnosed with HPPC from 2010 to 2017. The primary cohort included AJCC stage III-IV, high grade pathologies. Immunotherapy and chemotherapy were combined into a single variable, systemic therapy (ST) as certain drugs were reclassified in the NCDB during the study period. Treatment modalities included systemic therapy alone (ST), surgery alone (S), and surgery with systemic therapy (S+ST). Kaplan-Meier survival analysis and Accelerated Failure Time (AFT) model were used for estimation of survival outcomes. STROBE guidelines were followed for reporting. Results: A total of 1,539 patients were included. Of these, 935 (60.8%) were aged≥65 years, 1,430 (92.9%) were White, 872 (57%) had Medicare insurance, and 593 (38.57%) received care in Comprehensive Community Cancer Programs. 225 patients (14.6%) received ST, 84 (5.5%) received S, 1,095 (71.1%) received S+ST, and 135 (8.8%) received unspecified regimen combinations. mOS, however, varied by stage and treatment. In stage III,mOSwas 28.02 months with ST, 30.23 months with S, and 51.15 months with S+ST (p, 0.05). In stage IV, mOS was 20.47 months with ST, 4.47 months with S, and 41.17 months with S+ST (p \u3c 0.05). Collectively, covariate adjustment using AFT showed that S+ST significantly improved survival over ST alone (HR 0.63, p \u3c 0.01), while S alone showed no statistically significant benefit (HR 0.93, p = 0.64). Older patients (≥65 years), with Charlson-Deyo Score (CDS) of 1 (vs 0; HR 1.17, p \u3c 0.05), and those with oligometastatic disease M1 (vs M0; HR 1.24, p \u3c 0.01) exhibited worse survival outcomes. Race, gender, insurance, and facility type did not significantly impact mortality, but patients treated in the East South Central (HR 1.82, p \u3c 0.001) and the West South Central (HR 1.42, p = 0.038) had worse survival compared to the Northeast. Conclusions: Older age, burden of comorbidities, presence of metastasis, and treatment in certain geographic regions appear to be associated with worse outcome. Surgery combined with systemic therapy significantly improves survival outcomes, highlighting the importance of a multimodal approach in advanced stage HPPC