Hennepin Healthcare Research Institute

Anemia, highly prevalent among patients receiving maintenance dialysis, may be associated with adverse outcomes. This study describes the patient characteristics, anemia treatment patterns, clinical event rates, and health care resource utilization of patients receiving hemodialysis (HD) in the United States and in a subpopulation of patients hyporesponsive to erythropoietin-stimulating agents (ESAs). Using data from the US Renal Data System, a retrospective, population-based descriptive cohort study of adults with Medicare Parts A and B coverage receiving maintenance HD was conducted. ESA hyporesponsiveness was defined as ESA Resistance Index ≥2 (ESA units/kg/wk/g hemoglobin/L) or ESA dose ≥450 U/kg/wk (within 8 weeks of index (January 1, 2018). Anemia treatments and clinical events were assessed using medical claims during follow-up, until death, loss of Medicare, kidney transplantation, or December 31, 2019. Outcome rates were calculated as number of events divided by follow-up time with 95% confidence intervals based on Poisson distribution. Of the overall prevalent HD population (N = 209,408), 20,223 were ESA hyporesponders. Relative to the overall prevalent HD population, the ESA hyporesponder subpopulation had a higher rate of red blood cell transfusion events (91.1 [95% CI, 90.1-92.2] vs 32.4 [95% CI, 32.2-32.6] per 100 person-years [PY]), thromboembolic events (80.7 [95% CI, 79.3-82.2] vs 71.0 [95% CI, 70.6-71.4] per 100 PY), major adverse cardiovascular events (30.2 [95% CI, 29.6-30.9] vs 20.3 [95% CI, 20.2-20.5] per 100 PY), gastrointestinal erosions (61.8 [95% CI, 60.6-63.0] vs 40.2 [95% CI, 40.0-40.5] per 100 PY), and all-cause mortality (26.2 [95% CI, 25.6-26.8] vs 16.9 [95% CI, 16.8-17.1] per 100 PY). Hospitalizations occurred more frequently in the ESA hyporesponder subpopulation (2.45 vs 1.56 per PY) than in the overall prevalent HD population. This study was not designed to determine causality. The ESA hyporesponder subpopulation had a high burden of red blood cell transfusion use, clinical events, and health care resource utilization.

Abstract Ductal carcinoma in situ (DCIS) of the breast is a heterogeneous, non-invasive condition characterized by the proliferation of malignant epithelial cells within the duct, with variable risk of progression to invasive disease. Current standard treatment involves surgical resection followed by possible adjuvant endocrine therapy and/or adjuvant radiation. However, a substantial proportion of DCIS may never progress to invasive disease and thus may be overtreated with the current standard of care. Consequently, active surveillance (AS) is emerging as a treatment option for patients with DCIS. DCIS is definitely a risk factor for breast cancer, and should be reframed as an opportunity for preventive intervention. RECAST (Re-evaluating Conditions for Active Surveillance Suitability as Treatment) is a Phase II adaptive platform trial studying the efficacy of up front endocrine therapy to identify appropriate candidates for long-term active surveillance versus those who would benefit from standard surgical treatment. Patients with hormone receptor positive DCIS of any grade undergo baseline breast MRI and are randomized to one of four hormonal therapy regimens, including standard endocrine therapy, z-endoxifen, elacestrant or HAV-008 with the potential to offer equivalent or improved benefit with less adverse effects. Serial MRI at 3 and 6 months is then used to evaluate change in background parenchymal enhancement (BPE) and DCIS lesion. Patients deemed low risk based on imaging response have the option to continue AS and avoid surgery and radiation and continue their endocrine therapy for 3 years. The primary endpoint of the trial is to determine whether novel endocrine therapy increases the fraction of patients who will be suitable for long-term AS as measured by the fraction of patients who remain on active surveillance at 7 months compared to control. To date, over 50 patients are enrolled in the trial. Our target accrual of 400 patients. A total of 17 (34%) patients have reported an AE, all grade 1 or 2, with no serious adverse events reported and no safety signals identified. Of the 50 patients currently on treatment, 25 have reached or gone beyond the 6-month mark and 22 (88%) of those patients remain on active surveillance with a median follow up of 351 days. At the 3 month point, one patient progressed on imaging and two chose to come off surveillance due to other reasons. At 6 months, 8% (2/25) progressed on imaging and one additional patient has proceeded to surgery at the 1 year point. One patient who went on to have surgery was found to have invasive disease (pT1bN0). Robust accrual continues at sixteen currently active sites with five more sites anticipated to open in the next few months. The shift to using hormonal therapy in the neoadjuvant setting allows investigators to assess response to endocrine therapy, characterize risk of progression to invasive cancer and helps to better inform treatment-making decisions before continuing AS or proceeding with surgery, and appropriately assesses the value of endocrine risk reduction prior to surgery to avoid it. The trial uses a patient-centered approach and gives all patients a window of opportunity to assess their response as well as medication tolerability to make an informed decision about treatment approach. Citation Format: K. C. Hewitt, C. Yau, R. Mukhtar, C. Thompson, J. Hui, K. Westbrook, J. Jackson, C. Carruthers, C. Farley, S. Bommakanti, K. Brownson, B. Fan, I. Meszoely, T. Balija, M. H. Mcnatt, P. Gilman, J. Marti, T. Li, S. Horton, A. Borowsky, J. Rosenbluth, L. Esserman. Initial results from RECAST DCIS: Multicenter platform trial testing active surveillance and novel endocrine therapy agents for DCIS management [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2025; 2025 Dec 9-12; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2026;32(4 Suppl):Abstract nr PS3-03-08.

Jaw fracture management significantly advanced with the introduction of Erich Arch Bars (EABs) during World War II, becoming the gold standard for maxillomandibular fixation (MMF). EABs, however, are time-consuming, pose risks of sharps injuries, and hinder oral hygiene and patient comfort. This study tested the Minne Ties Hybrid Arch Bar System (MTHAB), a novel MMF technology. This cadaveric study used specimens with near-complete dentition to compare MTHAB and EABs. The technologies were applied by trained surgeons to measure occlusal forces, increasing elastic loads, and application and removal times. Surgeons completed structured usability surveys. The results indicated that MTHAB significantly reduced application time (19.8 ± 4.1 min versus 35.2 ± 5.7 min, p = 0.0027) and removal time (1.6 ± 0.4 min versus 5.1 ± 2.1 min, p = 0.0465) compared to EABs, while also being rated higher for ease of use and safety. Both technologies achieved acceptable occlusion forces, although MTHAB needed more elastics to achieve comparable forces to EABs. While MTHAB appears promising, future clinical trials are needed to evaluate long-term outcomes, fixation stability, and patient selection. MTHAB represents a potential advancement in MMF technology, balancing surgical efficiency, safety, and fixation strength.

The American Heart Association (AHA) recently introduced a new clinical entity; the cardiovascular-kidney-metabolic syndrome (CKMS), to promote a multi-disciplinary approach for chronic disease management. This study aims to investigate the relationship between CKMS and major adverse outcomes in older populations in primary care. This study utilized data from 18,367 community-dwelling individuals aged ≥ 65, free from prior cardiovascular disease (CVD). Participants were classified into four CKMS stages (stage 0-no CKMS risk factor to stage 3-high CKMS risk) at baseline based on the AHA definition. The association with 14 health outcomes was analysed using multivariable cause-specific hazard models. Additional stratifications were performed by social disadvantage, inflammation levels, and number of CKMS components within each stage to refine risk staging. Over a median follow-up of 8.6years, the prevalence of CKMS stages 0 to 3 was 2.8%, 8.2%, 52.6%, and 36.0%, respectively. Compared to stage 0, stage 3 associated with all-cause mortality (HR 1.31, 95%CI 1.01-1.69), CVD mortality (3.11, 1.46-6.60), incident total CVD events (2.78, 1.86-4.15), myocardial infarction (2.37, 1.21-4.62), stroke (2.75, 1.50-5.04), heart failure hospitalization (4.56, 1.45-14.37), atrial fibrillation (2.63, 1.61-4.29), cancer (1.31, 1.04-1.64), depression (1.20, 1.04-1.39), and physical disability (1.92, 1.20-3.08). Social disadvantage, high inflammation, and CKMS component count further amplified these associations. No linear trend was observed for cognitive outcomes and non-CVD cause-specific mortality. This study is the first to establish relationships between CKMS and multiple age-related outcomes in older adults, providing critical insights for developing holistic approaches to primary care in the aged.

AimTo determine work conditions and reactions related to nurse burnout while exploring characteristics of favorable work environments among nurses without burnout.Design/MethodsThe Coping with Covid survey, administered between April 14, 2020, and March 2021, was fashioned after the Mini Z, with 15 questions related to work conditions (fear/safety, work overload, anxiety/depression from work, feeling valued, and sense of purpose) and healthcare worker (HCW) reactions, including burnout, stress, and intention to leave (ITL) the job. Work conditions and reactions such as burnout were measured on 5‐point scales and then dichotomized as present/high or absent/low. Multilevel regressions assessed burnout‐related work conditions, adjusting for gender, race, and years in practice. Thematic analysis of comments from nurses without burnout identified protective factors.ResultsOf 58,408 HCW respondents at over 200 organizations (median response rate 34%), 11,040 were nurses, with 10,873 at 43 organizations with over 10 nurses. More than half the nurses (56%) reported burnout, 42% intended to leave, and only 40% felt valued. Nurse burnout was significantly related to workload (adjusted odds ratio (aOR) 3.71 (95% CIs 3.26, 4.22), p < 0.001); anxiety/depression symptoms from work (aOR 2.96 (2.59, 3.39), p < 0.001), and fear of exposure to SARS‐CoV‐2 (aOR 1.38 (1.20, 1.59), p < 0.001). Those feeling valued had less than half the odds of burning out (aOR 0.40 (0.35, 0.46), p < 0.001). These variables explained 42 percent of burnout variance. Nurses without burnout identified additional positive influences, including teamwork, leader support, and timely communication.ConclusionsNurse burnout may be prevented by addressing workload, mental health symptoms, and relationships with team members and leaders. Feeling valued is a strong mitigator of burnout. These strategies may be useful to nurse leaders in building sustainable workplaces.ImplicationsAlmost half of nurse burnout may be addressed by a brief list of remediable variables.

Despite numerous calls to action, palliative care remains inadequately integrated into pulmonary-critical care medicine (PCCM) practice and is de-emphasized in PCCM education. Barriers to specialty palliative care demonstrate a clear need for efficient and effective primary palliative care delivered by PCCM clinicians with advanced training. This American Thoracic Society Workshop Report builds on our policy statement on the proactive integration of palliative care in serious respiratory illness with 2 goals: (1) Develop a scalable "PalliPulm" framework to improve palliative care education and practice in PCCM and (2) inform palliative care-focused education and training programs in PCCM to guide future initiatives. We convened an interdisciplinary and interprofessional group of experts between May 2024 and February 2025 over 4 phases: (1) hybrid workshop; (2) virtual breakout groups; (3) nominal group technique and rapid qualitative analysis; and (4) workshop report development. We identified core primary palliative care skills that PCCM trainees and clinicians should obtain and prioritized the most essential skills-that is, symptom management, serious illness communication, and caregiver support in ambulatory settings and serious illness communication, symptom management, palliative care fundamentals, and end of life care in inpatient settings. We describe pragmatic ways to integrate palliative care into PCCM education and offer advanced educational resources. We provide recommendations for framing palliative care to patients and caregivers, illustrate ways to deliver culturally appropriate palliative care, and offer a path for the future of PalliPulm. This report guides PCCM leaders, trainees, and clinicians to establish scalable PalliPulm educational and practice initiatives and improve its integration into practice.