20966 research outputs found
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Improving Nurse Confidence Through Unannounced Mock Codes on Inpatient Units
No full texthttps://scholarlycommons.henryford.com/nursresconf2025/1015/thumbnail.jp
Preventing Workplace Violence: Implement a Behavioral Emergency Response Team Leveraging Existing Resources
No full texthttps://scholarlycommons.henryford.com/nursresconf2025/1028/thumbnail.jp
From Code to Conversation: Nursing Leadership\u27s Role in Post-Event Clinical Debriefing
No full texthttps://scholarlycommons.henryford.com/nursresconf2025/1045/thumbnail.jp
Eravacycline use in immunocompromised patients: multicenter evaluation of timely versus late initiation on clinical outcomes
No full textInfections from multidrug-resistant (MDR) bacteria lead to worse outcomes in immunocompromised patients. Eravacycline (ERV) is effective against MDR gram-negative and gram-positive bacteria, but its effects in immunocompromised populations remain unstudied. We aimed to evaluate clinical end points of immunocompromised patients receiving timely versus late ERV therapy. This multicenter, retrospective, observational study (October 2018 to September 2022) included adult immunocompromised patients hospitalized and treated with ERV for ≥ 72 h. The primary outcome was a composite of all-cause 30-day mortality, failure to improve clinically while on ERV, and/or microbial recurrence within 30 days of ERV initiation. Inverse probability of treatment weighting (IPTW) and Kaplan-Meier analyzes were used. Eighty-two patients from 17 US centers were included (median age 62 years; 59% male; intensive care unit admissions 57%). In the unadjusted cohort, timely ERV significantly reduced odds of clinical treatment failure (odds ratio [OR]: 0.321, 95% confidence interval [CI]: 0.129-0.800, P = 0.012) and microbial recurrence (OR: 0.545, 95% CI: 0.326-0.913, P = 0.034) compared to late ERV; in the IPTW-adjusted cohort, these associations remained significant with ORs of 0.675 (95% CI: 0.465-0.979, P = 0.029) for treatment failure and 0.384 (95% CI: 0.142-0.943, P = 0.041) for recurrence. Kaplan-Meier analysis showed a higher cumulative proportion of clinical treatment failure in the late ERV group (57%) compared to the timely ERV group (30%, P = 0.013), with a significantly longer time to clinical treatment failure in the timely ERV group (log-rank P = 0.034). Timely initiation of ERV in immunocompromised patients may improve clinical outcomes by reducing treatment failure and microbial recurrence compared to later initiation.
IMPORTANCE: This multicenter, retrospective study evaluates the impact of timely versus late initiation of eravacycline (ERV) in immunocompromised patients with multidrug-resistant (MDR) bacterial infections. Immunocompromised patients face heightened risks of severe infections due to weakened immune defenses and limited treatment options, yet data on ERV use in this population are scarce. Our findings demonstrate that timely ERV initiation ≤ 72 h from index culture collection) significantly reduces clinical treatment failure and microbial recurrence compared to late initiation, with inverse probability of treatment weighting-adjusted odds ratios of 0.675 (P = 0.029) for treatment failure and 0.384 (P = 0.041) for recurrence. Kaplan-Meier analysis further confirms that delayed ERV therapy is associated with a higher cumulative incidence of clinical failure (57% vs 30%, P = 0.013). These results highlight the importance of early ERV initiation in optimizing outcomes for immunocompromised patients and addressing the growing challenge of MDR infections, emphasizing the need for further prospective studies to confirm these findings
TCT-1233 Three-Dimensional Reconstruction Compared to Two-Dimensional Quantitative Coronary Angiography for Assessment of Coronary Lesions in Guiding Percutaneous Coronary Intervention: A Meta-Analysis
No full textBackground: Accurate assessment of coronary lesions is critical for planning percutaneous coronary intervention (PCI). While two-dimensional quantitative coronary angiography (2D-QCA) is the clinical standard, it is limited by foreshortening, overlap, and projection dependency, which can misrepresent lesion severity. Three-dimensional reconstruction (3D-R) offers a more precise alternative compared to 2D QCA. Methods: We searched PubMed and Embase from inception to July 2025 and identified 239 studies. After removing duplicates and non-relevant records, we included those studies that used validated software to generate 3D-R and compared them with 2D-QCA. Quantitative endpoints included lesion length, reference vessel diameter (RVD), minimal luminal diameter (MLD), and percent stenosis (PS). A random-effects model with a standardized mean difference (SMD) was used. Results: Out of 5 included studies, four studies with 280 coronary segments from 194 patients reported both lesion length and RVD, two studies with 95 segments from 96 patients reported MLD, and four studies with 242 (3D-R) vs. 260 (2D QCA) segments from 216 patients reported PS. Lesion length was longer with 3D-R (SMD: 0.38, CI: 0.20-0.55, p\u3c 0.00001). PS was lower with 3D-R (SMD: -0.61, CI: -1.14 to -0.09, p=0.02). No significant difference in RVD and MLD. [Formula presented] Conclusion: 3D-R showed significantly longer lesion lengths and a lower PS than 2D QCA. These findings suggest that 2D-QCA may underestimate lesion length and overestimate stenosis severity. 3D-R offers a more precise method to evaluate lesions before stent selection, potentially improving PCI outcomes. Categories: CORONARY: Vascular Access: Coronar
The paradoxical impact of depression on mortality, length of stay, and hospitalization charges in patients with prostate and bladder cancer: Using the 2021 NIS database
No full textBackground: Depression is a prevalent comorbidity in patients with cancer, potentially influencing treatment outcomes. This study evaluates the association of depression with mortality, length of stay (LOS), and hospitalisation charges (TOTCHG) among patients with prostate cancer and bladder cancer. Methods: We conducted a retrospective analysis of the NIS 2021 database. Hospitalised patients with prostate cancer, bladder cancer and depression were identified using the appropriate ICD-10 codes. Survey-weighted descriptive statistics were utilized to analyze patient demographics, mortality rates, LOS, and TOTCHG. Multivariable logistic and linear regression models evaluated the impact of depression on outcomes, adjusting for age, sex, race, income quartiles, Charlson comorbidity index, hospital region, teaching status, and bed size. Results: In this study, 182,280 hospitalised prostate cancer patients and 40,855 hospitalised bladder cancer patients were analyzed. Among prostate cancer patients, 9.3% (16,785 patients) were depressed, with depressed individuals slightly younger (adjusted coefficient -0.42 years, p=0.036), predominantly White (76.2%, p,0.001), privately insured (76.1%, p,0.001), with higher comorbidity (85.9%, p,0.001), & in the Midwest region (25.9%, p,0.001). Among bladder cancer patients, 11.4% (4,645 patients) were depressed, with depression more common in younger individuals (adjusted coefficient -1.07 years, p=0.004), women (31.4%, p,0.001), White patients (86.9%, p,0.001), those with higher comorbidity (85.8%, p,0.001), Northeast (29.1%, p=0.019) and privately insured (63.2%). Depressed prostate cancer patients had lower mortality rates (3.75% vs. 4.67%, adjusted OR 0.76, p=0.004), shorter hospital stays (5.33 vs 6.13 days, adjusted - 0.72 days, p,0.001), & lower hospitalization charges (≥73,977 vs. ≥85,966, adjusted reduction -≥11,699, p,0.001). Depressed bladder cancer patients had lower mortality rates (6.45% vs. 9.53%, adjusted OR 0.63, p=0.001), slightly shorter hospital stays (7.25 vs. 7.66 days, adjusted - 0.42 days, p=0.032), and reduced hospitalization charges (≥92,321 vs. ≥104,156, adjusted reduction -≥10,327, p=0.023). Conclusions: This study reveals that depression was more prevalent in younger, White, privately insured patients with higher comorbidities. Interestingly, depressed patients in both cohorts had lower mortality rates, shorter hospital stays, and reduced hospitalisation charges despite their higher comorbidity burdens, suggesting potential differences in healthcare utilisation, disease management, or psychosocial factors. These findings underscore the importance of recognising and addressing depression, as it may not only affect patient quality of life but also play a significant role in shaping clinical and economic outcomes
Quantitative Scoring Of Lung Perfusion Map From Dual Energy CT For Chronic Thromboembolic Pulmonary Hypertension (CTEPH) Evaluation
No full textIntroduction: ECG-gated DECT allows for one-stop evaluation of CTEPH patients, due to its capability to simultaneously map lung perfusion with spectral imaging and characterize RV anatomy and function with high spatiotemporal resolution. Evaluation of its created Pulmonary Blood Volume (PBV) map, however, is still largely based on visual assessment. We have developed and are presenting a novel quantitative scoring methodology. Methods: The method includes the following steps: (1) The DECT analysis application on a Siemens Syngo Via server were used to create lung PBV images and segment the lungs into 5 sub-volumes (3 on right, 2 on left). (2) for any lung sub-volume, the mean value and the standard deviation of HU enhancement from the PBV map are calculated and normalized into percentages with respect to the left atrium HU enhancement scaled by a constant; (3) with a starting value of 0, the score of each sub-volume increases by 1 if either its normalized mean value falls below 80% or its normalized standard deviation exceeds 40%. (4) the overall score is the sum of all sub-volumes. The method was tested on three clinical datasets acquired by dual-source DECT. Results: Scores of the three datasets show correlation with the extent and severity of the perfusion defects as visualized on the PBV images and match clinical imaging reports. Evaluation with more clinical datasets is ongoing. Conclusions: The proposed method shows potential for a simplified semi-automated quantification for clinical use. Quantitative PBV map scoring could enable more objective CTEPH evaluation and more streamlined workflow. [Formula presented] [Formula presented
TCT-742 Risks of Major Bleeding and Hospitalization for Falls After Left Atrial Appendage Occlusion in Patients with Atrial Fibrillation and History of Falls: A Propensity-Matched Analysis
No full textBackground: In patients with atrial fibrillation (AF), falls while on anticoagulation increase bleeding risk. Left atrial appendage occlusion (LAAO) offers an alternative to anticoagulation for stroke prevention in AF, but whether LAAO reduces bleeding and hospitalization for falls is unknown. Methods: In the TriNetX research network, patients with AF and history of falls were identified, and outcomes were compared between those who underwent LAAO (n=2904) vs. those who did not (n=33,956). Propensity score matching yielded 2853 patients per group. Major bleeding, hospitalization for falls, and their composite were assessed at 30 days and 1 year using Kaplan-Meier survival and Cox regression to estimate hazard ratios (HRs) with confidence intervals (CIs). Major bleeding was defined by transfusion, hemoglobin ≤7.5 g/dL, or diagnoses of intracranial, gastrointestinal, retroperitoneal, thoracic, or pericardial bleeding. Results: At 30 days, LAAO was associated with lower risk of major bleeding (HR 0.64; 95%CI 0.56–0.73), hospitalization for falls (HR 0.45; 95 CI 0.39–0.51; p\u3c0.01), and their composite (HR 0.53; 95%CI 0.48–0.58; p\u3c0.01). At 1 year, the LAAO group continued to show lower risks of major bleeding (HR 0.83; 95%CI 0.75–0.91; p\u3c0.01), hospitalization for falls (HR 0.60; 95%CI 0.55–0.66; p\u3c0.01), and their composite (HR 0.68; 95%CI 0.64–0.74; p\u3c0.01; Figure). [Formula presented] Conclusion: In patients with AF and falls, LAAO was associated with lower risks of major bleeding, hospitalization for falls, and their composite at 30 days and 1 year. These findings support LAAO in patients at high risk of anticoagulation-related harm. Categories: STRUCTURAL: Left Atrial Appendage Exclusio
TCT-277 Characteristics and Clinical Outcomes of DanGer Shock-Like and Non–DanGer Shock-Like Patients in AMICS Treated With Impella Support: Insights from RECOVER III and NCSI Registries
No full textBackground: The DanGer Shock trial shifted AMICS management by showing improved outcomes with early pLVAD support, though concerns about its generalizability persist. We assessed outcomes in pLVAD-supported AMICS pts stratified as DanGer Shock-like or non-DanGer Shock-like, using pooled data. Methods: DanGer Shock-like and Non-DanGer Shock-like pts were identified from the National Cardiogenic Shock Initiative (NCT03677180) and RECOVER III (NCT04136392) observational, multicenter, single-arm studies of AMICS pts revascularized with Impella. DanGer Shock-like was defined by absence of: STEMI, out-of-hospital cardiac arrest, IABP prior to Impella, use of Impella RP, and Impella use \u3e24h from shock onset. Mortality was assessed at discharge, 30 days, and 1 year. Results: Of 804 pts in the pooled database, 539 with complete data were analyzed; 298 (55.3%) met criteria for the DanGer Shock-like group. Patient demographics were similar between groups. Non-DanGer Shock-like pts more often presented in CSWG SCAI stage E (79.3% vs. 44.6%; p\u3c0.0001), with higher baseline lactate, more shock at admission, and greater use of inotropes/vasopressors. Among STEMI pts, door to support time was longer in the non-DanGer Shock-like group. Survival at discharge, 30-day mortality, or 1-year mortality did not differ significantly. (Figure) [Formula presented] Conclusion: Despite greater illness severity and delayed support, non-DanGer Shock-like pts had similar outcomes compared to DanGer Shock-like pts. While encouraging, whether Impella improves outcomes in non-DanGer Shock-like pts remains speculative and warrants confirmation in a randomized trial. Categories: CORONARY: Hemodynamic Support, Cardiogenic Shock and Cardiac Arres
TCT-667 Transcatheter Mechanical Vacuum-Assisted Extraction of Cardiac Mass in Systemic Circulation: A Multi-center Collaboration
No full textSummary: In this multicenter registry, we aim to evaluate the safety and clinical outcomes of transcatheter mechanical vacuum- assisted extraction (TMVE) for intracardiac masses located in the left heart and aortic arch. Specifically, we will assess several factors, including intraprocedural characteristics such as procedural time and hemodynamic effect, procedural success rates, case cancellation and abortion rate, and in-hospital periprocedural and 30-day clinical outcomes in terms of major cardiac structural complications, such as bleeding, vascular complications, hemodynamic instability, stroke, coronary ischemia, and mortality. Additionally, we will evaluate any difference in success rate according to mass type and location and potential damage to left-sided cardiac structures, such as the aortic and mitral valves. We hypothesize that TMVE, as a safe and effective alternative to surgical extraction for high-risk patients unfit for surgical removal of intracardiac masses. Primary aim: To evaluate the procedural safety and success rate of TMVE in the systemic circulation in a multicenter registry Secondary aim: To evaluate the short-to-midterm clinical outcomes of TMVE in the systemic circulation in a multi-center registry. Cardio-embolism caused by large intracardiac and aortic masses is an uncommon yet potentially life-threatening condition. These types of masses can include thrombi, vegetations, atheromas, and cardiac tumors. The consequences of these masses may involve neurologically debilitating or limb-threatening embolic events, obstruction of blood flow leading to hemodynamic compromise and heart failure, and uncontrolled sepsis in cases of infective endocarditis. Indications for mass removal may include an active or recent embolic event, a high risk of embolism, the need for infection control, or the facilitation of concurrent valvular or structural heart procedures, or mechanical circulatory support. While surgical extraction is an effective treatment method, many patients presenting with intracardiac masses may not be suitable candidates for surgery. This may be due to high comorbidity burdens, advanced age or frailty, unfavorable anatomy for open-heart surgery, acute or unstable clinical presentations, or a poor benefit-to-risk ratio for the procedure. Transcatheter mechanical vacuum-assisted extraction (TMVE) using the AngioVAC system (Angiodynamics, New York, USA) has gained popularity for right-sided masses and vegetations both for debulking of mass and for infection control [1, 2]. There has been increasing interest in TMVE of left-sided intracardiac and aortic masses. However, data on left-sided TMVE is scarce. This is a multi-center, retrospective cohort study of all patients who underwent TMVE in the systemic circulation at the participating institutions. The research team from each participating institution will review electronic health records charts to collect relevant data and review pre- and post-procedural images to extract relevant data. The research team will not contact patients who underwent systemic TMVE. A unified data collection spreadsheet including well-defined variables will be used for all participating institutions to ensure the consistency of the data