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No Need to Restrain, Gab a Mitt, and Refrain!
No full texthttps://scholarlycommons.henryford.com/nursresconf2025/1026/thumbnail.jp
A Statewide Standardization of Reporting Rapid Response Activation and Cardiopulmonary Arrest Data
No full texthttps://scholarlycommons.henryford.com/nursresconf2025/1037/thumbnail.jp
Exploring Nursing Generational Attitudes for Greater Engagement - The ENGAGE Study
No full texthttps://scholarlycommons.henryford.com/nursresconf2025/1039/thumbnail.jp
The Combination of Aztreonam-Avibactam in Multidrug-Resistant Gram-Negative Infections
No full textOBJECTIVE: Aztreonam-avibactam (ATM-AVI) is used for difficult-to-treat gram-negative infections. The objective of this review is to analyze the pharmacology, safety, and clinical application of ATM-AVI.
DATA SOURCES: PubMed, Embase, and ClinicalTrials.gov were searched using the terms aztreonam avibactam, PF-06947387, Emblaveo, and ATM-AVI.
STUDY SELECTION AND DATA EXTRACTION: Articles written in English and published from January 1, 1985, to June 10, 2025, that related to pharmacology, safety, clinical trials, and clinical application of ATM-AVI were reviewed.
DATA SYNTHESIS: The ATM-AVI has shown similar efficacy to comparator antibiotics in complicated intra-abdominal infection (cIAI) and hospital/ventilator-acquired pneumonia (HAP/VAP). The REVISIT trial showed cIAI clinical cure rates of 76.4% and 74% for the ATM-AVI and meropenem groups, respectively (treatment difference 2.4% [95% confidence interval, CI = -7.4 to 13.0]). For HAP/VAP, clinical cure rates were 45.9% and 41.7% for the ATM-AVI and meropenem groups, respectively (treatment difference 4.3% [95% CI = -15.1 to 23.1]). The ATM-AVI was generally well tolerated, with hepatic adverse effects being the most commonly reported.Relevance to patient care and clinical practice comparison to existing drugs:The ATM-AVI has demonstrated clinical efficacy for the treatment of cIAI. However, its role needs to be further studied for other infections such as HAP/VAP, urinary tract, and other serious infections. Pharmacoeconomic analysis may be needed to assess the cost-benefit impact in the United States.
CONCLUSION: The ATM-AVI may be an alternative option for the treatment of cIAI and other complicated gram-negative infections. Further studies are needed to delineate the role of ATM-AVI in clinical practice
Inpatient characteristics and outcomes of diffuse large B-cell lymphoma in adolescents and young adults
No full textBackground: Diffuse large B-cell lymphoma (DLBCL) is the most commonly aggressive nonHodgkin’s lymphoma known to also affect adolescents and young adults (AYA). This population faces unique challenges such as financial toxicity, physical and emotional concerns. We examined the inpatient characteristics and outcomes of AYA patients with a diagnosis of DLBCL. Methods: A retrospective cohort analysis using the Nationwide Inpatient Sample database from 2008 to 2021, DLBCL patients with non-elective hospitalizations were identified using ICD-9 and ICD-10 codes. Descriptive analyses were conducted using STATA version 17.0 to compare sociodemographic and clinical characteristics between AYA and older populations. Multivariable logistic and linear regression models were used to examine the association between the age groups and inpatient mortality, prolonged (.5 days) length of stay (LOS), and total hospital charges. Results: There were 346,185 non-elective hospitalizations with DLBCL within the 14-year study period. Of these, 23,163 (6.7%) were in the AYA cohort.The mean age was 30 years in the AYA group and 68.4 years in the older group (P=0.001). There was a higher proportion of males in the AYA group compared to the older group (59.2% vs 56.4%, P = 0.001) but a lower distribution of non-Hispanic Whites (48.6% vs 71.7%, P , 0.001). Regarding clinical characteristics, AYA-DLBCL patients had a higher frequency of febrile neutropenia (19.5 vs 13.6%, P,0.001), bone marrow transplant (4.7 vs 3.8%, P,0.004), HIV (14.5 vs 2.6%, P,0.001), superior vena cava syndrome (3.8 vs 0.9%, P,0.001) and cardiac tamponade (1 vs 0.2%, P,0.001). AYA-DLBCL patients had a lower frequency of severe sepsis (6.3 vs 8.1%, P,0.001), AKI (12.8 vs 23.6%, P,0.001), and acute respiratory failure (6.4 vs 10.5%, P,0.001). On multivariable logistic regression, the AYA group had 50% lower odds of mortality relative to the older adult group (adjusted odds ratio [aOR]: 0.51, 95% confidence interval [CI]: 0.43-0.60, P , 0.001).There was a lower odd of prolonged hospital stay in the AYA group (aOR: 0.88, 95% CI: 0.82-0.93, P , .001).TheAYA cohort had higher odds of increased hospital expenditure (b-Coefficient: 11,260, 95% CI: 3,794–18,728, P = 0.003). Conclusions: This represents the largest epidemiological study to date on DLBCL hospitalizations in AYA. The AYA cohort had lower inpatient mortality, increased hospital costs, and higher rates of febrile neutropenia and HIV. Higher hospital charges may be due to more febrile neutropenia rates, bone marrow transplants and other aggressive interventions performed in younger patients. Additional studies are needed to understand and improve long-term treatment-related toxicities in this population
Management of Rapidly Reaccumulating Pleural Effusion Secondary to Pancreaticopleural Fistula in a Nonsurgical Candidate
No full textINTRODUCTION: Pancreaticopleural fistula (PPF) is a rare complication of chronic pancreatitis. Current treatment options include medical management with thoracentesis and octreotide, endoscopic retrograde cholangiopancreatography (ERCP) with stenting to close off the fistula tract, and pancreatic salvage surgery for fistula repair. We present a complicated case of PPF with rapidly re-accumulating pleural effusion and failed pancreatic stenting in non-surgical candidate. CASE: A 33-year-old man with past medical history of chronic alcoholic pancreatitis and severe malnutrition (body mass index 15.86) presented with dyspnea on exertion and pleuritic chest pain. Computed tomography (CT) showed large left-sided pleural effusion, complete collapse of the lung, and chronic pancreatitis. Thoracentesis revealed exudative fluid. Chest x-ray showed a small pneumothorax ex-vacuo and re-accumulation of pleural effusion. Magnetic resonance cholangiopancreatography (MRCP) showed a defect in the left diaphragmatic crura and a fistula from the pancreatic tail to the retro-crural region. Pleural effusion was initially managed with interval thoracentesis until chest tube placement. This was complicated by enlargement of the pneumothorax with lung collapse. ERCP demonstrated large ductal stones that precluded deep cannulation of the dorsal pancreatic duct, so the ventral pancreatic duct was accessed for stent placement. The large pneumothorax self-resolved, but the chest tube continued to have high output. Octreotide was started at 50 mcg every 8 hours for 1 day, then increased to 100 mcg every 8 hours, which resulted in decreased chest tube output over several days. He was discharged with the chest tube. Octreotide was discontinued on discharge, and he required several additional collection devices. Extracorporeal shockwave lithotripsy and ERCP with dorsal pancreatic duct stenting were planned outpatient for definitive management of the PPF. DISCUSSION: This case highlights multiple complexities of PPF treatment. Rapid re-accumulation of large-volume pleural effusions indicated a large fistula tract that required diversional stenting. Despite multiple ERCP attempts, large ductal stones in the pancreatic head prevented deep cannulation. Surgical intervention was considered, however severe malnutrition made him not a surgical candidate. Additionally, large volume drainage of exudative pleural effusion was complicated by a large pneumothorax ex-vacuo due to trapped lung pathology. Thoracic intervention was considered, however, the pneumothorax self-resolved. Due to high volume output from chest tube, octreotide was initiated for splanchnic vasoconstriction and resulted in reduced output. In patients who are not surgical candidates and fail endoscopic management, octreotide can be helpful in managing recurrent pleural effusion secondary to PPF, and further evaluation of efficacy is warranted
Updated trends in second primary malignancy in patients with renal cell carcinoma: A retrospective population-based analysis
No full textBackground: Survival outcomes for patients with renal cell carcinoma (RCC) have improved in recent years. However, the risk of developing second primary malignancy (SPM) in RCC survivors remains underexplored. SPM pose significant challenges in cancer survivors, impacting long-term morbidity and mortality. Therefore, we aim to evaluate and discuss incidence and risk of SPM in RCC patients using a large population-based dataset. Methods: We analyzed the Surveillance, Epidemiology, and End Results (SEER) database, comparing secondary cancer rates among RCC cases diagnosed from 2000 to 2021. The histologic code for RCC in the SEER database is 8312/3. A second primary malignancy was defined as a malignancy developing at least six months after the initial RCC diagnosis. We used the SEER Multiple Primary Standardized Incidence Ratios (MP-SIR) session to obtain the p-value, observed/expected (O/E) ratios, absolute excess risk (AER) per 10,000. Results: 43,477 Renal Cell Carcinoma cases from 2000- 2021 met our inclusion criteria and were included in our study. Of these cases, 5,931 (13.6%) developed second primary malignancies. The mean age of SPM was 70.45 years. The risk of developing SPM was significantly higher than the general population, with an O/E ratio of 1.27 (CI 1.23-1.30, AER 42.67, p \u3c 0.05). Most common SPM included Brain (O/E ratio 1.33 CI 1.02- 1.72, p \u3c 0.05), Pancreas (O/E ratio 1.18 CI 1.01-1.36, p \u3c 0.05), Liver (O/E ratio 1.67 CI 1.4-1.97, p \u3c 0.05), Lung (O/E ratio 1.27 CI 1.18-1.36, p \u3c 0.05), Prostate (O/E ratio 1.16 CI 1.09-1.23, p \u3c 0.05, Thyroid (O/E ratio 2.7 CI 2.29-3.17, p,0.05), Multiple Myeloma (O/E ratio 1.42 CI 1.17-1.71, p \u3c 0.05), AML (O/E ratio 1.6 CI 1.23-2.03, p \u3c 0.05), CML (O/E ratio 1.77 CI 1.2-2.51, p \u3c 0.05). Conclusions: Compared to the general population, there is a statistically significant increased risk of secondary primary malignancies in RCC patients. These findings highlight the importance of ongoing surveillance, risk stratification, and tailored follow-up strategies to improve early detection and intervention for SPM in RCC survivors
Comparative survival outcomes among histological subtypes of pulmonary adenocarcinoma: A nationwide study
No full textBackground: Adenocarcinoma of the lung is a heterogeneous malignancy with multiple histological subtypes. In the US, population survival outcomes across these subtypes remain underexplored. Methods: A retrospective analysis of patients with various Lung Adenocarcinomas (Acinar, Lepidic, Papillary, Solid & solid type, Invasive mucinous, Mixed mucinous/non-mucinous, Colloid, Fetal, and Enteric type), diagnosed between 2010 and 2017, was conducted using the National Cancer Database in accordance with STROBE guidelines. Unadjusted median overall survival (mOS) was estimated using Kaplan-Meier survival analysis. Multivariate regression analysis was performed using accelerated failure time model to estimate covariate-adjusted hazard ratios (HR). Covariates included age, sex, race, tumor grade, TNM stage, Charlson Comorbidity Index, insurance status, year of diagnosis, facility type, and treatment modality. Lepidic carcinoma served as the reference arm for HR calculations. Results: A total of 46,218 patients were included in this large cohort study. 39,865 patients (86.3%) were white, 27,094 (58.6%) were female, 31,827 (69%) were aged $65 years, 29,843 (64.57%) had Medicare insurance, and 18,788 (40.65%) were treated in academic or research institutions. For unadjusted mOS, Acinar adenocarcinoma (n=15,877; 34.35%) demonstrated the best outcomes (mOS: 97.84 months, p,0.05). After covariate adjustment, Solid adenocarcinoma (n=1,736; 3.76%) had the most favorable prognosis (HR = 0.85, p,0.01). In contrast, Enteric type adenocarcinoma (n=33; 0.07%) exhibited the poorest survival, with an mOS of only 27.24 months (HR = 1.63, p,0.05). Lepidic adenocarcinoma (n=8,923; 19.31%), the reference group, demonstrated an mOS of 73.03 months with HR of 1. Other subtypes, such as Mixed/non mucinous adenocarcinoma (n=195; 0.42%; mOS: 85.22 months, HR = 0.91, p = 0.377) and Papillary adenocarcinoma (n=6,094; 13.19%; mOS: 64.79 months, HR = 0.97, p = 0.236), showed intermediate survival, with no statistically significant differences. On the other hand, significant differences were observed for Fetal adenocarcinoma (n=46; 0.10%; mOS: 39.82 months, HR = 1.17, p = 0.467), Invasive mucinous adenocarcinoma (n=1,254; 2.71%; mOS: 51.81 months, HR = 1.17, p,0.01), and Colloid adenocarcinoma (n=12,060; 26.09%; mOS: 44.09 months, HR = 1.29, p,0.01). Conclusions: This study highlights marked differences in survival across lung adenocarcinoma subtypes. These results stress the importance of further research to develop therapies tailored to specific histological variants
102 Impact of Home Testing on INR Control and Adverse Events in Black Patients on Warfarin for Atrial Fibrillation or Venous Thromboembolsim
No full textIntroduction: Black patients on warfarin have higher rates of stroke, major bleeding, and death compared to White patients. Suboptimal warfarin control, reflected by lower time in therapeutic range (TTR), may contribute to these disparities. Home INR testing has shown mixed results in improving TTR and reducing adverse events (AEs), with limited evidence on its impact in Black patients. Our objective was to compare INR control and AEs between Black home-testers and non-home testers on warfarin for atrial fibrillation (AF) or venous thromboembolism (VTE). Methods: From the Michigan Anticoagulation Quality Improvement Initiative (MAQI2) registry, Black patients on warfarin for AF or VTE between April 2012 and July 2024 were identified. Patients without at least 3 months of follow-up were excluded. Patients without documented home-testing were classified as non-home-testers while patients with ≥3 months of consecutive home testing were classified as home-testers. Home-tester outcome rates were calculated for the home-testing period only. Outcome rates were adjusted by inverse probability weighting, and comparisons were made using negative-binomial model. Major bleeding was based on International Society on Thrombosis and Haemostasis criteria. Results: 122 home-testers and 1086 non-home-testers were compared. Home-testers had a higher TTR (58.8% vs 55.4%, p \u3c 0.01) and fewer non-major bleeds (23.1 vs. 33.1 per 100 pt-yr, p=0.024). Major bleeding and thrombotic event rates were similar between the groups. Conclusion: Home INR testing was associated with better INR control and less non-major bleeding in Black patients. Enhanced support for Black patients may further improve outcomes and bridge the gap in anticoagulation care quality
First-line immunotherapy with or without chemotherapy versus BRAF plus MEK inhibitors for patients with BRAFV600E-mutated metastatic non-small cell lung cancer: The FRONT-BRAF study
No full textBackground: Patients (pts) with BRAFV600E mutated non-small cell lung cancer (NSCLC) can be effectively treated with BRAF and MEK inhibitors (BRAFi+MEKi) or with immune checkpoint inhibitors ± chemotherapy (ICI±CT). Which one should be prioritized as initial systemic treatment in this population remains unclear. Methods: Clinicopathologic data were collected from pts with metastatic BRAFV600E mutated NSCLC treated with 1st line ICI6CT or BRAFi+MEKi between 2015 and 2024 at 17 centers across the United States, Europe, and Brazil. Results: Of 284 patients, 88 received ICI6CT and 196 received BRAFi+MEKi. Compared to pts treated with BRAFi+MEKi, pts receiving ICI6CT were more likely to have a history of smoking (83% vs. 61%, P\u3c0.001) and a higher median PD-L1 tumor proportion score (TPS) (68% vs 30%, P\u3c0.001). ICI6CT, compared to BRAFi+MEKi, was associated with a lower objective response rate (ORR, 49% vs 63%, P=0.03), similar median progression-free survival [mPFS, 9.6 vs.12.2 months (mo.), HR 1.13, P=0.43], but significantly improved median overall survival (mOS, 40.9 vs 25.1 mo., HR 0.69, P=0.039), even after adjusting in a multivariable model (HR 0.66, P=0.02). Consistent results were observed in a propensity score-matched cohort (1:1 ratio, N=75 pts per treatment group), where ICI6CT, compared to BRAFi+MEKi, was associated with improved mOS (40.9 vs 22.7 mo., HR 0.63, P=0.04), but similar ORR and mPFS. In key subgroup analyses, ICI6CT, compared to BRAFi+MEKi, was associated with longer mOS in pts with a history of tobacco smoking (HR 0.60, P=0.01), PD-L1 TPS ≥1% (HR 0.66, P=0.039), and without brain metastases (HR 0.66, P=0.045). A shorter mPFS was noted in pts without tobacco smoking history (HR 1.94, P=0.03). In evaluating genomic correlates of treatment efficacy, pts with TP53 co-mutations (N=107) had worse outcomes compared to pts with wild-type TP53 (N=121) when treated with BRAFi+MEKi, including shorter mPFS (HR 1.67, P=0.01) andmOS(HR 1.77, P=0.01), but not with ICI6CT. Notably, pts with TP53 co-mutations had longer mOS with ICI6CT compared to BRAFi+MEKi (48.4 vs 18.8 mo., HR 0.46, P=0.005). In contrast, pts with IDH1 co-mutations (N=9) had worse outcomes compared to pts with wild-type IDH1(N=188) when treated with ICI6CT, including shorter mPFS (HR 4.04, P=0.03) and mOS (HR 6.12, P=0.007), as well as shorter mPFS with BRAFi+MEKi (HR 2.73, P=0.03). Safety of BRAFi+MEKi was comparable whether administered as 1st line or as 2nd line therapy following ICI±CT, with similar rates of adverse events of any grade (71% vs 76%, P=0.58) and grade ≥3 (22% vs 23%, P=0.92). Conclusions: Initial therapy with ICI±CT, compared to BRAFi+MEKi, showed a lower ORR, similar PFS, but superior OS, particularly among specific subgroups of pts. A prospective evaluation of the optimal 1st-line therapy for this population is warranted