Providence Regional Medical Center Everett

Novel treatments are needed for the primary and secondary prevention of heart failure in patients with type 2 diabetes, including individuals with and those without a history of heart failure. Conflicting trial evidence exists on whether glucagon-like peptide-1 receptor agonists (GLP-1RAs) reduce the risk of hospitalization for heart failure (HHF) in this broad population and whether this is a class effect or varies by specific agent. Furthermore, their comparative effectiveness against sodium-glucose cotransporter-2 inhibitors (SGLT-2is) is unknown. We emulated 2 target trials using population-based health care data from Stockholm, Sweden (2010-2021). Target trial 1 included adult patients with type 2 diabetes who newly initiated GLP-1RA versus dipeptidyl peptidase-4 inhibitors (DPP-4is), and target trial 2 compared GLP-1RA with SGLT-2i. The primary outcome was HHF. Cox regression was used to estimate intention-to-treat hazard ratios, with inverse probability of treatment weighting used to balance 72 confounders. Major adverse cardiovascular events were used as the positive control outcome. Analyses were conducted for the GLP-1RA class overall and for individual agents, including liraglutide and semaglutide. Target trial 1 included 32 979 patients (42% GLP-1RA and 58% DPP-4i) with a mean age of 64 years and 40% female; and target trial 2 included 30 104 patients (49% GLP-1RA and 51% SGLT-2i) with a mean age of 63 years and 38% female. Starting a GLP-1RA was associated with a lower 3-year absolute risk of HHF than starting a DPP-4i (3.4% versus 4.3%), corresponding to a weighted hazard ratio of 0.77 (95% CI, 0.66-0.91). Absolute 3-year risks for GLP-1RA compared with SGLT-2i on HHF were 3.6% and 3.3% with a weighted hazard ratio of 1.02 (95% CI, 0.85-1.18). The absolute risk difference was largest for patients with higher predicted risk of heart failure at baseline. Results were consistent for single agents, in per-protocol analyses, and in the majority of subgroups. In positive control outcome analyses, GLP-1RA use was associated with a lower rate of major adverse cardiovascular events than DPP-4i use (weighted hazard ratio, 0.85 [95% CI, 0.74-0.99]), consistent with trial findings. GLP-1RA use is associated with a lower risk of HHF compared with DPP-4i and similar risks compared with SGLT-2i in routine clinical care for patients with type 2 diabetes.

Abstract Wabanaki Public Health and Wellness is a Tribally operated public health that serves the four federally recognized Tribes in the state of Maine . Wabanaki Public Health and Wellness is the principal investigator on the Wabanaki Native American Research Center for Health (Wabanaki NARCH), which is supported by the National Institutes of Health. Wabanaki NARCH aims to enhance support systems, promote cultural continuity, and improve the overall well-being of Wabanaki Elders living with dementia. In partnership with two academic institutions, Washington State University and the University of Miami, Wabanaki Public Health and Wellness, through Wabanaki NARCH, is conducting Voices of Our Elders (VOE), an epidemiologic study that seeks to better understand the prevalence of Alzheimer’s disease and Alzheimer’s disease and related dementia (AD/ADRD) and cognitive decline. VOE also seeks to assess health and lifestyle risk factors for AD/ADRD and cognitive decline among Wabanaki Elders. This presentation will offer the perspectives and lessons learned from a Tribal public health district and its academic partners on: 1. The process of developing, adapting, and Indigenizing study designs and research methodologies of an AD/ADRD study that seeks to better serve the needs and perspectives of Wabanaki Elders; 2. Community engagement strategies employed to reach Wabanaki Elders to participate in VOE; and 3. Ethical aspects and strength-based and capacity building approaches for all research partners to consider when conducting research with Tribal communities in addition to the engagement with academic institutional review boards.

Tabletop simulation can be used to support and test system processes for clinical workflows. This paper will describe an innovative approach to testing change in clinical workflows for direct admissions to the operating room and interventional radiology departments in a 700-bed urban hospital in the Pacific Northwest and will highlight the specific benefits to nurse leaders. The simulation exercise involved key stakeholders and subject matter experts from various departments and aimed to evaluate the process workflow, provoke discussion on gaps, uncover improvement opportunities, and formulate recommendations. The simulation experience was broadly acknowledged by those involved as novel, engaging, suitable for complex process changes in health care settings and promoting valuable collaboration.

Background: Perspectives on leadership vary vastly and are based on many factors. Often, there is a disconnect between leadership perceptions and staff perceptions of leadership. Uncovering the disconnect in the leader/follower perception differences can support successful leadership that translates into high-performing teams. In respiratory care, this is especially important, as staffing challenges and high levels of burnout plague the healthcare environment and associates’ careers. We aim to describe how respiratory therapists currently in leadership positions perceive leadership skills and behaviors. Methods: We performed a post-hoc, qualitative, analysis using an inductive approach to identify themes within the unstructured comments provided by the respondents to an IRB approved survey of respiratory therapy leaders sent in July 2023. The research team analyzed the specific comments from the respondents to generate broad generalizations and search for trends. Five researchers (JC, SS, KJR, JJ, and BS) conducted thematic analysis in 2 stages: open coding and axial coding. Results: The original survey yielded 124 survey responses and 54 free-text responses. Two independent analyses were conducted on participants’ responses: comments from questions regarding specific aspects of leadership were analyzed together, while comments from an open-ended response question were analyzed separately. Analysis of the comments related to specific areas of leadership resulted in 6 overarching themes: business competence, relationships, mentoring, strategic thinking, personal development, and clinical competence. Analysis of the unstructured, open-ended comments indicated that leaders were concerned about leadership challenges from both an organizational and personal lens. Conclusions: Themes from this post-hoc analysis identify areas of leadership growth as perceived by respiratory therapy leaders. While clinical competence was identified by the survey respondents as a relevant skill, several other attributes and skills, such as relationship-building and strategic thinking, were identified as important for effective leadership. Further research must be done to compare themes from RT leaders to themes identified by staff RTs and organizational leaders RT leaders report to fully understand opportunities.

IntroductionEmergency departments (ED) are incorporating Peer Support Specialists (PSSs) to help with patient care for substance use disorders (SUDs). Despite rapid growth in this area, little is published regarding workflow, expectations of the peer role, and core components of the PSS intervention. This study describes these elements in a national sample of ED-based peer support intervention programs.MethodsA survey was conducted to assess PSS site characteristics as part of site selection process for a National Institute on Drug Abuse (NIDA) Clinical Trials Network (CTN) evaluating PSS effectiveness, Surveys were distributed to clinical sites affiliated with the 16 CTN nodes. Surveys were completed by a representative(s) of the site and collected data on the PSS role in the ED including details regarding funding and certification, services rendered, role in medications for opioid use disorder (MOUD) and naloxone distribution, and factors impacting implementation and maintenance of ED PSS programs. Quantitative data was summarized with descriptive statistics. Free-text fields were analyzed using qualitative content analysis.ResultsA total of 11 surveys were completed, collected from 9 different states. ED PSS funding was from grants (55%), hospital funds (46%), peer recovery organizations (27%) or other (18%). Funding was anticipated to continue for a mean of 16 months (range 12 to 36 months). The majority of programs provided “general recovery support (81%) Screening, Brief Intervention, and Referral to Treatment (SBIRT) services (55%), and assisted with naloxone distribution to ED patients (64%). A minority assisted with ED-initiated buprenorphine (EDIB) programs (27%). Most (91%) provided services to patients after they were discharged from the ED. Barriers to implementation included lack of outpatient referral sources, barriers to initiating MOUD, stigma at the clinician and system level, and lack of ongoing PSS availability due to short-term grant funding.ConclusionsThe majority of ED-based PSSs were funded through time-limited grants, and short-term grant funding was identified as a barrier for ED PSS programs. There was consistency among sites in the involvement of PSSs in facilitation of transitions of SUD care, coordination of follow-up after ED discharge, and PSS involvement in naloxone distribution.Supplementary InformationThe online version contains supplementary material available at 10.1186/s13722-024-00453-x.

Since the early 2000s, an influx of novel glucose-lowering agents has changed the therapeutic landscape for treatment of diabetes and diabetes-related complications. Glucagon-like peptide-1 (GLP-1) receptor agonists represent an important therapeutic class for the management of type 2 diabetes (T2D), demonstrating benefits beyond glycemic control, including lowering of blood pressure and body weight, and importantly, decreased risk of development of new or worsening chronic kidney disease (CKD) and reduced rates of atherosclerotic cardiovascular events. Plausible non-glycemic mechanisms that benefit the heart and kidneys with GLP-1 receptor agonists include anti-inflammatory and antioxidant effects. Further supporting their use in CKD, the glycemic benefits of GLP-1 receptor agonists are preserved in moderate-to-severe CKD. Considering current evidence, major guideline-forming organizations recommend the use of GLP-1 receptor agonists in cases of T2D and CKD, especially in those with obesity and/or in those with high cardiovascular risk or established heart disease. Evidence continues to build that supports benefits to the heart and kidneys of the dual GLP-1/glucose-dependent insulinotropic polypeptide (GIP) receptor agonist tirzepatide. Ongoing outcome and mechanistic studies will continue to inform our understanding of the role of GLP-1 and dual GLP-1/GIP receptor agonists in diverse patient populations with kidney disease.

Abstract Background A growing body of evidence suggests potential sex differences in the clinical outcomes of COVID-19. In this study we evaluated whether sex and baseline clinical variables were associated with treatment effect after receipt of immunomodulators vs placebo in a study population derived from ACTIV-1 IM clinical trial. Methods ACTIV-1 IM is a master protocol that evaluated infliximab, abatacept and cenicriviroc in addition to standard of care in adult patients hospitalized with moderate or severe SARS-CoV-2 infection through randomized, double-blind comparisons to shared placebo. We performed a subgroup analysis of the modified intention-to-treat cohort. Primary outcome was association of sex with time-to-recovery at day 28, key secondary outcomes were 28-day mortality and clinical status at day 14. Results A total of 1381 participants were included. There was no difference in treatment effect for primary endpoint of time-to-recovery based on sex for infliximab (RRR 1.14, 95% CI 0.95-1.37 for males and RRR 1.09, 95% CI 0.90-1.34 for females with interaction p=0.77), abatacept (RRR 1.14, 95% CI 0.95–1.37 for males and RRR 1.13, 95% CI 0.91-1.40 for females with interaction p=0.93) or cenicriviroc (RRR 0.99, 95% CI 0.79–1.24 for males, RRR 0.98, 95% CI 0.77-1.24 for females, interaction p=0.93) substudies. There was no difference in treatment effect by sex for secondary outcomes for infliximab and abatacept substudies. The cenicriviroc substudy was terminated early for futility and found no difference in treatment effects based on sex for secondary outcomes either. Conclusion There was no difference in treatment effect for infliximab, abatacept or cenicriviroc among males vs females. This suggests a more complex interplay of pathogen and host factors deserving further research to identify therapeutic targets for COVID-19. Disclosures Radica Alicic, MD, MSc, Boehringer Ingelheim Pharmaceuticals, Inc.: Advisor/Consultant Caryn Morse, MD, Gilead Sciences Inc.: Grant/Research Support|Janssen: Grant/Research Support|Laurent Pharma: Grant/Research Support|Moderna: Grant/Research Support|Ridgeback Bio: Grant/Research Support William G. Powderly, MD, Merck: Advisor/Consultant