20966 research outputs found
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The importance of Breaks in the Emergency Department. A pilot.
No full texthttps://scholarlycommons.henryford.com/nursresconf2025/1032/thumbnail.jp
Using the Modified Minnesota Detoxification Scale to Evaluate Alcohol Withdrawal Syndrome: An Integrative Review
No full texthttps://scholarlycommons.henryford.com/nursresconf2025/1034/thumbnail.jp
Vitals & Vigilance: Nurse-Driven Innovation in Pediatric Sepsis Detection
No full texthttps://scholarlycommons.henryford.com/nursresconf2025/1036/thumbnail.jp
Bridging Gaps in Suicide Prevention: A CNS Led Strategy Gounded in Community Education and Social Determinants of Health
No full texthttps://scholarlycommons.henryford.com/nursresconf2025/1042/thumbnail.jp
TCT-688 Utility of Intravascular Ultrasound in Optimizing Outcomes Following Coronary Covered Stent Deployment
No full textBackground: Intravascular ultrasound (IVUS) has been shown to enhance outcomes in percutaneous coronary interventions (PCI), particularly through improved stent sizing and expansion. In this study, we investigated the role of IVUS in patients who required covered stents for the treatment of coronary artery perforation (CAP). Methods: We conducted a retrospective analysis of 131 patients treated with either Papyrus or GraftMaster covered stents for CAP between December 2014 and January 2024. Patients were divided into two cohorts: those who received IVUS-guided PCI and those who did not. The primary outcomes assessed included procedural success, stent thrombosis, in-stent restenosis, and the requirement for additional covered stents. Statistical comparisons were performed using chi-square tests, with significance defined as p \u3c 0.05. Results: Of the 131 patients, 34 (26.0%) underwent IVUS-guided stent implantation. Procedural success was significantly higher with IVUS (88.2% vs. 65.8%, p = 0.000047), and stent thrombosis was lower (0.0% vs. 7.9%, p = 0.0079). In-stent restenosis rates were similar (12.9% vs. 16.1%, p = 1.00). The need for a second covered stent was markedly reduced with IVUS (5.9% vs. 34.2%, p = 0.000008). [Formula presented] Conclusion: Use of IVUS in the management of CAP requiring covered stents was associated with improved procedural success and lower rates of both stent thrombosis and need for additional stents. These findings suggest that IVUS may play an important role in optimizing outcomes when deploying covered stents in emergent PCI settings. Categories: IMAGING AND PHYSIOLOGY: Imaging: Intracoronar
AML-1276: CRISPR-Cas9 Therapies in Hematologic Malignancies: A Meta-Analysis of Clinical Outcomes, Safety, and Translational Implications
No full textCRISPR-based gene editing has introduced transformative possibilities in hematologic oncology, offering precise and durable immunologic interventions. With increasing adoption in early-phase trials, an integrated understanding of its efficacy and safety is essential. Objective: To evaluate the efficacy, safety, and translational potential of CRISPR-Cas9-based therapies in hematologic malignancies through a structured meta-analysis of early-phase clinical trials. Design: Systematic review and meta-analysis of CRISPR-based hematologic cancer trials published between 2019 and 2024. Random-effects modeling was used due to inter-trial heterogeneity. Setting: Academic hospitals and early-phase clinical centers conducting gene-modified cellular therapy trials. Patients or Other Participants: Nine clinical trials encompassing 80 patients with relapsed or refractory hematologic malignancies, including Tcell acute lymphoblastic leukemia (T-ALL), aggressive B-cell lymphomas, and multiple myeloma. Inclusion criteria varied by trial; most patients had exhausted standard therapies. Interventions: All studies employed ex vivo CRISPR editing of immune cells. Interventions included TRAC- and PD-1-knockout chimeric antigen receptor (CAR) T cells, universal CD7-targeted base-edited T cells, and suicide-gene modified donor lymphocytes. Products were administered as single infusions following lymphodepletion. Main Outcome Measures: Overall response rate (ORR), complete response (CR) rate, incidence of cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS), and detection of off-target edits. Results: The pooled ORR was 62.3% (95% CI, 50.1%–73.2%), with a CR rate of 34.6%. Base-edited CAR7 T cells achieved CR in five of nine pediatric T-ALL patients. CRS occurred in 48% of patients (mostly grade 1–2) and ICANS in ∼17%, with no grade ≥3 events. No treatment-related deaths or clinically significant off-target events were reported. Deep sequencing confirmed primarily on-target edits with rare, non-propagating chromosomal changes. Follow-up ranged from 6 to 12 months. Conclusions: CRISPR-Cas9-based therapies exhibit promising antitumor activity and a manageable safety profile in hematologic cancers. These findings support the clinical viability of gene-edited cellular therapy, especially in relapsed settings. However, larger trials and long-term data are essential to validate the durability, genomic stability, and scalability of these platforms
AML-608: Acute Myeloid Leukemia-Associated Pneumonia Mortality Trends (1999–2023) and ARIMA-Based Projections Through 2050 in Geriatric US Adults
No full textPneumonia is a prevalent and serious complication in acute myeloid leukemia (AML), affecting more than 25% of treated patients and substantially contributing to adverse clinical outcomes. The hypothesis posits that AML-associated pneumonia mortality demonstrates significant socioeconomic and regional disparities across the US population. Objective: To examine mortality trends in AML-associated pneumonia among US adults aged ≥65 years from 1999–2023 and project rates through 2050, focusing on socioeconomic disparities. Methods: Mortality data from the CDC WONDER Multiple Cause of Mortality dataset (1999–2023) were analyzed using ICD-10 codes for pneumonia (18) and AML (C92). Age-adjusted mortality rates (AAMR) per million were standardized to the 2000 US population. Joinpoint regression estimated annual percent change (APC) with 95% CI, using a significance threshold of P \u3c 0.05. Trends were forecasted using an autoregressive integrated moving average (ARIMA) model after augmented Dickey–Fuller (ADF)-based stationarity testing. Results: A total of 12,447 AML-associated pneumonia deaths were recorded. AAMR rose to 13.7 per million (95% CI, 12.7–14.7) in 2020. The ARIMA model, with Akaike information criterion (AIC) of 33.41 and root mean square deviation (RMSE) of 1.05, projected AAMR of 11.6 in 2030 (95% CI, 8.73–14.47), 2040 (95% CI, 7.13–16.07), and 2050 (95% CI, 5.97–17.23). Males consistently exhibited higher AAMR, reaching 16.15 in 2050 (95% CI, 14.87–17.43), compared with females at 7.9 (95% CI, −0.69–16.49). Historically, males exhibited higher AAMR (19.9; 95% CI, 18.1–21.7) than did females (9.6; 95% CI, 8.5–10.7). A significant increase was noted among non-Hispanic Whites (APC = 0.57%; 95% CI, 0.27–0.91; P \u3c 0.001). The Western region reported the highest AAMR, maintaining 12.9 per million from 1999 to 2023. Large central metro areas peaked at 14.9 per million (95% CI, 12.9–17.0) in 2020. California had the highest state-level AAMR at 14.5 (95% CI, 13.7–15.2). Conclusion: Mortality from AML-associated pneumonia increased from 1999 to 2023, peaking post-COVID. Significant disparities were observed among males, non-Hispanic Whites, residents of the West, large metropolitan areas, and California, indicating the necessity for targeted interventions in response to projected rising trends. Grant/Funding Acknowledgements: None
Obesity paradox in non-small cell lung cancer (NSCLC) patients on immune checkpoint inhibitors: Real-world evidence using the global collaborative network database
No full textBackground: Non-small cell lung cancer (NSCLC) is the most common type of lung cancer, accounting for about 85% of all cases. Immune checkpoint inhibitors (ICIs) have recently transformed the landscape of cancer management. Recent studies suggest that obesity may improve survival outcomes in some cancer types; however, there remains a dearth of data on the effect of obesity in cancer patients on ICIs. We aim to analyse and evaluate this relationship. Methods: This retrospective cohort population-based real-world study was obtained by querying the TriNetX Global Collaborative Network database. We identified patients with NSCLC who received ICI. The ICIs included pembrolizumab, nivolumab, cemiplimab, iplimumab, atezolizumab, durvalumab and avelumab. The patient population was divided into two cohorts: patients with a BMI between 18.5-29.9kg/m2 and 30.0-39.9kg/m2. Racial and demographic information was obtained. Propensity score matching was carried out to remove confounders. Patients were matched for medical comorbidities, including tobacco use, emphysema, asthma, Type 2 diabetes mellitus and bronchiectasis. Survival analysis was conducted using Kaplan-Meier and log-rank test. The primary outcome was survival (OS) for 1 and 5 years. The secondary outcomes were complications of NSCLC, which included hemoptysis, malignant pleural effusion, SVC syndrome, dysphagia, and complications of ICI therapy, including hepatitis, colitis, thyroiditis, pneumonitis and rash. Results: Before propensity score matching (PSM), significant demographic and comorbid disparities existed between the obesity BMI group (N = 6,854) and the normal BMI group (N = 1,546). After PSM, both cohorts exhibited strong similarities, with 1,545 patients in both cohorts. Mean age (69 years vs 64.7 years), male (56.6% vs 58.04%), white (55.75% vs 52.34%). The obesity BMI was associated with an improved OS at 1 year (hazard ratio [HR] 0.753 [95% CI, 0.671-0.844], p = 0.0295) and at 5 years (HR 0.687 [95% CI, 0.625-0.754], p = 0.0233) in patients treated with ICIs. Obesity BMI was also associated with a reduction in NSCLC complications, including dysphagia (odds ratio [OR] 0.711 [95% CI, 0.543-0.931], p = 0.013), SVC syndrome (OR 0.457 [95% CI, 0.230-0.909], p = 0.002). However, the differences in rates of other complications, including hemolysis and malignant pleural effusion, were insignificant. There was also no difference in the rates of immune-related adverse events (IRAEs) between both patient populations. Conclusions: Our retrospective population-based study found that obesity was associated with improved 1-year and 5-year OS compared to normal BMI. In addition, obesity was associated with reduced rates of complications such as dysphagia and SVC syndrome. It is pertinent to research these findings further to provide more holistic care for patients
Epidemiology, Clinical Features and Outcomes of COVID 19 Patients Post Evusheld Therapy Among Immunosuppressed Patients
No full textBackground. Evusheld® is a combination of two monoclonal antibodies, Tixagevimab and Cilgavimab. It was developed for the pre-exposure prophylaxis (PrEP) and treatment of COVID-19 illness for those who are immunocompromised. There is paucity of long-term real-world data on the use of Evusheld among the immunosuppressed patients against the SARS-CoV-2 Omicron variants. Methods. A retrospective cohort chart review of patients 18 years and older who received the two dose Evusheld regimen from December 1, 2021 to January 31, 2023 at a community teaching institution was performed to evaluate the effectiveness of Evusheld as PrEP of COVID-19 patients. Evusheld as PrEP was indicated for patients with active solid tumor and hematologic malignancies or those receiving immunosuppressive treatment including CART therapy, biologic agents and high-dose corticosteroids (i.e., ≥ 20 mg prednisone or equivalent per day when administered for ≥ 2 weeks). The following data was collected: patient demographic, development of COVID19 after receiving Evusheld®, intensive care unit (ICU) length of stay (LOS), hospital LOS, ventilation requirement, duration of ventilation, and mortality among these patients within six months of receiving Evusheld therapy. Results. Of the 663 patients screened, 459 were excluded primarily for duplicate patients. The mean age of the 204 included patients was 68.3 years and 97 (47.5%) were female. Eighteen (8.8%) patients had a positive COVID-19 test within 180 days of receiving Evusheld. None of the COVID positive patients were admitted to the hospital or required mechanical ventilation. All COVID positive patients survived. Conclusion. Our study shows that Evusheld was effective in preventing COVID-19 among the immunocompromised patients during the six-month followup period. This study also showed that patients who developed COVID-19 after Evusheld did not develop severe disease or require hospitalization
TCT-961 Outcomes of Percutaneous Coronary Intervention in Nonagenarians in the United States
No full textBackground: Although Percutaneous Coronary Intervention (PCI) is the cornerstone treatment acute myocardial infarction (AMI), its use in the elderly, specifically nonagenarians patients, is not well studied. This study sought to compare the outcomes and complications of nonagenarian patients who experienced AMI between those who underwent PCI and those who underwent medical treatment only. Methods: We evaluated 301,440 nonagenarian (ages 90−99) patients who presented to the hospital with AMI who were listed in the National Inpatient Sample from 2016 to 2021. AMI was defined according to the ICD-10 Diagnostic Codes. Multivariable logistic regression analysis was used to examine the association of PCI with primary outcomes of mortality and secondary outcomes. The temporal trend of both the incidence of PCI in nonagenarian patients as well as the mortality rate between 2016 and 2021 were expressed as percentages over time. Results: Of the total (n = 301,440) nonagenarian patients with AMI, 33,035 patients underwent PCI while 268,406 did not undergo PCI and rather, just utilized optimized medical therapy (OMT). Of these, 3290 (9.96%) died in the PCI group, and 43580 (16.24%) died in the OMT group. All of the secondary outcomes were significantly different between the PCI and OMT groups. Comparing the two groups, the PCI group was associated with decreased mortality (OR 0.63 [95% CI, 0.58−0.69]; p \u3c 0.001), acute heart failure (OR 0.88 [95% CI, 0.82−0.95] p \u3c 0.001), and AKI (OR 0.75 [95% CI, 0.70−0.79]; p \u3c 0.001), and increased cardiogenic shock (OR 3.06 [95% CI, 2.77−3.38]. The temporal of PCI in nonagenarian patients showed an increase in frequency from about 8.3 in 2016 to about 13.7% in 2021. Furthermore, comparing the mortality between the PCI and OMT groups showed a significant difference with a decreased mortality in the PCI group. Conclusion: Nonagenarian patients experiencing AMI who underwent PCI were associated with a significant mortality decrease compared to those who underwent OMT only. The PCI group was also associated with a significant decrease in multiple secondary complications including acute heart failure, AKI, acute stroke, and an increase in cardiogenic shock. Temporally, we have seen an increase in PCI being used in nonagenarian patients over the interval. Categories: CORONARY: Acute Coronary Syndrome