Central Baptist Hospital

The feasibility and outcomes of simultaneous atrioventricular node ablation (AVNA) and leadless pacemaker (LLPM) implantation from the internal jugular (IJ) vein are not well studied. We report our single-center case series experience with concomitant implantation of the AVEIR LLPM and AVNA from the IJ venous approach. Patients with persistent atrial fibrillation (AF) with frequent rapid ventricular rate (RVR) episodes refractory to pharmacological therapy and not ideal for AF ablation were selected for LLPM and AVNA. These procedures were performed simultaneously via the IJ vein due to patient preference and anatomical challenges (presence of severe scar tissue from prior procedures, presence of an inferior vena cava [IVC] filter, etc.). All patients were followed for at least 4 weeks post procedure. Ten patients (mean age of 76.1±11.5 years, 60% female) underwent successful simultaneous AVEIR implantation and AVNA via IJ venous access. Median device implantation time was 15.5min, procedure time was 45min, fluoroscopy time was 6.4min, and radiation dose was 82mGy. No device repositioning occurred. Mean pacing capture threshold at implant was 0.65±0.316V and impedance of 848±209Ω. At follow-up, pacing capture threshold was 0.5V at 0.4ms in all patients. Mean radiofrequency (RF) time to successful AVN ablation was 191.6±86s. Hemostasis was obtained within 5min in all cases. There were no procedure-related complications and no adverse interaction from performing these procedures simultaneously. Specifically, there was no interaction with radiofrequency current and LLPM function. Mean time to ambulation post procedure was 82±12min and six out of seven patients scheduled for an elective procedure were able to be discharged home the same day. This early series suggests that simultaneous AVNA and LLPM implantation from the IJ is feasible and safe. This IJ approach provides an alternative access option for the ablate and pace strategy and allows for early ambulation and discharge.

BackgroundVirtually all patients with extensive-stage small cell lung cancer (SCLC) develop resistance to first-line platinum-based chemoimmunotherapy and experience relapse. Second-line therapy is therefore an integral part of the treatment paradigm.MethodsEvidence was reviewed for key second-line regimens recommended in major guidelines for treatment of patients with platinum-sensitive relapse (chemotherapy-free interval ≥90 days), focusing on recent prospective clinical trials and post hoc analyses. Case studies of second-line lurbinectedin are presented as examples of the current management approach to platinum-sensitive relapsed SCLC.ResultsSubject to the limitations of cross-trial comparisons, the evidence review allowed us to draw broad conclusions about the place in therapy of approved options for platinum-sensitive relapse. Platinum rechallenge is more effective and better tolerated than topotecan and is a reasonable second-line choice in suitable patients. Topotecan provides modest clinical benefit and has the potential to cause dose-limiting haematological toxicities. Cyclophosphamide-doxorubicin-vincristine combination therapy offers no clear advantages over topotecan. Efficacy outcomes with second-line lurbinectedin are similar or better than those reported with platinum rechallenge, and lurbinectedin has a more favourable safety profile and simpler administration schedule. Second-line lurbinectedin preserves platinum rechallenge for later use and may resensitize tumour cells to platinum with potential survival advantages. Lurbinectedin safety is not affected by advanced age (≥65 years). Case studies highlight objective and durable responses to second-line lurbinectedin, along with good tolerability and quality of life.ConclusionsAvailable evidence supports second-line lurbinectedin as a useful alternative to platinum rechallenge, topotecan and cyclophosphamide-doxorubicin-vincristine in patients with platinum-sensitive relapsed SCLC.

e14619 Background: Patients with malignant melanoma (MM) and type 2 diabetes mellitus (T2DM) face treatment challenges due to complex therapy interactions. This study examines whether adding sodium-glucose co-transporter 2 (SGLT2) inhibitors to immunotherapy (pembrolizumab, nivolumab, or ipilimumab) improves survival and reduces mortality. Methods: Using a retrospective cohort design, data from 103 healthcare organizations in the TriNetX Research Network were analyzed. Two matched groups (n=559 each) were compared: immunotherapy alone (IT-only) and immunotherapy plus SGLT2 inhibitors (IT + SGLT2). Propensity score matching ensured comparability. Mortality was the primary outcome, assessed via risk analysis, Kaplan-Meier curves, and hazard ratios. Results: The IT + SGLT2 group had a lower mortality risk (20.4%) than the IT-only group (30.6%; Risk Difference: 10.2%; 95% CI: 5.1%–15.3%; p<0.001). Kaplan-Meier analysis showed higher survival probabilities (58.6% vs. 46.4%; Log-Rank p=0.003). The mortality hazard ratio was 1.427 (95% CI: 1.125–1.810; p=0.241). Conclusions: Adding SGLT2 inhibitors to immunotherapy significantly lowers mortality and improves survival in MM patients with T2DM. These findings highlight their potential to enhance treatment strategies, supported by large-scale data like TriNetX. Further research is needed to validate results and uncover underlying mechanisms for more personalized therapies. Propensity matching of baseline characteristics. Baseline Characteristics Before propensity matching After propensity matching IT only (N=4,021) IT + SGLT2i Group (N=559) P value IT only (N=559) IT + SGLT2i Group (N=559) P value Characteristics: Age, y, mean ± SD 72.7 +/- 11.5 71.2 +/- 10.6 0.002 71.2 +/- 10.5 71.2 +/- 10.6 0.966 Male, n(%) 2,652 (66) 412 (73.7) <0.001 412 (73.7) 412 (73.7) 1.00 Female, n (%) 1,216 (30.2) 128 (22.9) <0.001 131 (23.4) 128 (22.9) 0.83 Race, n (%) White 3,492 (86.8) 497 (88.9) 0.17 501 (89.6) 497 (88.9) 0.70 Black or African American 92 (2.3) 10 (1.8) 0.45 10 (1.8) 10 (1.8) 1.00 Other Race 118 (2.9) 13 (2.3) 0.42 13 (2.3) 13 (2.3) 1.00 Unknown Race 235 (5.8) 33 (5.9) 0.96 272 (18.80%) 302 (20.90%) 0.16 Comorbid Conditions: HTN 3074 (76) 471 (84) <0.01 476 (85.2) 471 (84.3) 0.68 Ischemic heart diseases 1392 (34.6) 242 (43.3) <0.01 239 (42.8) 242 (43.3) 0.86 Malignant neoplasms of ill-defined, other secondary and unspecified sites 2998 (74.6) 411 (73.5) 0.60 416 (74.4) 411 (73.5) 0.73 Benign neoplasms, except benign neuroendocrine tumors 1,785 (44.4) 276 (49.4) 0.03 276 (49.4) 276 (49.4) 1.00 Hemoglobin A1c: 6.9 +/- 1.6; 2135 (53.1) 7.6 +/- 1.7; 378 (67.6) <0.01 7.1 +/- 1.6; 378 (67.8) 7.6 +/- 1.7; 378 (67.6) <0.01 Blood glucose regulation agents 3,031 (75.4) 550 (98.4) <0.001 550 (98.4) 550 (98.4) 1.00 Odds Ratio 1.72 ; 95% CI (1.30 - 2.26) p<0.01 Risk Ratio 1.5; 95% CI ( 1.22 - 1.84 p<0.01

About 25% of patients with acute ischemic stroke (AIS) present within the intravenous thrombolytic (IVT) therapeutic window of <4.5 h. This study is to elucidate the safety and efficacy of IVT in the extended therapeutic window (ETW) in patients with AIS. Using PRISMA guidelines, a systematic review was conducted using PubMed, Embase, and Scopus. A rigorous risk of bias assessment was conducted using the RoB2 tool. Rates of excellent and good functional outcome (mRS 0-1 and mRS 0-2) at 90 days, symptomatic intracranial hemorrhage (sICH), and mortality at 90 days were pooled using generalized linear mixed model and compared with controls. Meta-analyses were conducted employing random-effect models with risk ratio (RR) and 95% confidence intervals (CIs). Subgroup analysis was performed to assess the effect of imaging modalities used for patient selection. Eight randomized controlled trials (n = 2221, 59% male) were included. At 90 days IVT showed higher rates of functional recovery: mRS 0-1: RR 1.21 95% CI 1.1-1.34, p < 0.001, and mRS 0-2: RR 1.11 95% CI 1.03-1.18, p = 0.004. Rate of mortality at 90 day was not different between groups: RR 1.17 95% CI 0.93-1.48, p = 0.17. However, the rate of sICH was higher among IVT group: RR 2.93 95% CI 1.53-5.6, p = 0.001. Subgroup analysis showed higher mRS 0-1 among patients who were selected based on perfusion imaging (p < 0.05). The use of IVT in AIS in ETW is beneficial especially with the use of perfusion imaging for patients' selection.

Introduction The Janssen Ad26.COV2.S vaccine was developed to prevent SARS-CoV-2 illness. Phase 3 trials were initiated in 2020, including sites at the University of Kentucky, Norton Healthcare Louisville, and Baptist Health Lexington. This study followed non-immunosuppressed adult subjects through July 2022 to evaluate vaccine efficacy and safety, with a total of 1,094 participants. Methods Subjects aged 18 years or older, in good health, and without major immunological conditions were included. Three trials (ENSEMBLE-1, ENSEMBLE-2, and AMPLIFY) were conducted. Participants were evaluated for vaccine efficacy if they were nucleocapsid antibody-negative and had no prior COVID-19 infection at the time of their first booster. Vaccine regimens included a prime and single boost with Ad26.COV2.S or other combinations of prime and boost vaccinations, including mRNA vaccines. Results A total of 1,094 subjects were enrolled, with 903 subjects evaluated for vaccine efficacy. Among these, 431 received only a prime and single boost with Ad26.COV2.S, and 472 received other combinations of vaccines. During the study period, 174 COVID-19 infections occurred, with 95 (55%) being asymptomatic. The incidence of infections was similar between those who received only Ad26.COV2.S (94 infections) and those with other vaccination regimens (80 infections), with no significant difference (P &gt; .05). There were no serious vaccine-related safety concerns, and only one hospitalization occurred, involving a 75-year-old diabetic who recovered without intubation. Conclusion The Ad26.COV2.S vaccine, as a prime and single boost, demonstrated similar efficacy to other vaccination regimens in preventing COVID-19 infections. Both regimens provided protection against severe disease and hospitalization, with no significant safety concerns identified. This study supports the effectiveness and safety of the Ad26.COV2.S vaccine in the adult population during a period of high COVID-19 incidence.

Fieldwork supervision is the "signature pedagogy" for training genetic counseling students, ensuring that students have the experience necessary to become minimally competent genetic counselors. According to the National Society of Genetic Counselors 2022 Professional Status Survey, roughly 40% of genetic counselors serve as supervisors for genetic counseling graduate students. Despite fieldwork supervision being essential for training, there are currently no validated supervision skill assessment tools for genetic counseling fieldwork supervisors to use for professional development. While a self-efficacy scale for genetic counselors currently exists, a comprehensive self-efficacy scale for genetic counseling supervision skills does not. The purpose of the study was to develop and validate a genetic counseling supervisory self-efficacy scale (GCSSES). This study was comparative, quantitative, and cross-sectional, with data collected via an online questionnaire which assessed supervision self-efficacy (95 items), derived from 154 published GC supervision competencies, demographics (5), experience (9), and supervisory development (18), using the Psychotherapy Supervisory Development Scale (PSDS). A total of 119 board-certified genetic counselors completed the survey. Factor analysis eliminated 40 items due to insufficient factor loading, and item-item correlation eliminated one item with elevated inter-item correlation, leaving 54 items on the finalized GCSSES. Exploratory factor analysis derived four GCSSES factors, which accounted for 65% of the variance in the scale: (a) Goal Setting, Feedback, and Evaluation; (b) Complex Aspects of Supervision; (c) Conflict Resolution; and (d) Working Alliance. Preliminary analyses show the GCSSES has high reliability and internal consistency (Cronbach's alpha = 0.99). Positive correlations between experience variables and supervisory self-efficacy were identified. A 54 item GCSSES was developed by this study. The GCSSES may serve as a tool for genetic counseling supervisors and graduate programs to assess skills, monitor professional development, and target training. A genetic counseling supervisory self-efficacy scale can also be used in future studies regarding training of genetic counseling supervisors.