Unity Health System

The COVID-19 pandemic severely disrupted healthcare systems, placing immense physical, emotional, and organizational strain onfront linenursing staff, including registered nurses and nursing assistants. These professionals faced heightened stress due to increased virus exposure, global personal protective equipment (PPE) shortages, and rapidly changing protocols. This study sought to explore the experiences of registered nurses and nursing assistants working in inpatient care during the COVID-19 pandemic, focusing on workplace stressors and available or recommended resources to mitigate these challenges. Despite extensive documentation of elevated stress and burnout among nurses during COVID-19, little is known about how registered nurses and nursing assistants appraised specific workplace stressors and evaluated the adequacy of available organizational resources during the pandemic. Using a qualitative descriptive design, semi-structured interviews were conducted with 14 registered nurses and six nursing assistants from COVID-19 and non COVIDunits at a large academic medical center. Guided by Lazarus and Folkman's Stress and Coping Model, the analysis identified a range of personal, interpersonal, organizational, and societal stressors. Personal stressors included long work hours, loss of loved ones to COVID-19, and feelings of isolation. Interpersonal stressors involved exposure risk, emotional strain from coworkers' stress, and shifts in bedside roles. Organizational stressors encompassed staffing shortages, changes in protocols, and being called off shifts. Societal stressors included inconsistent public health messaging and concerns about protecting vulnerable family members. Participants emphasized the importance of authentic leadership and nursing-centered delivery of resources in addressing these stressors. Six key resource categories emerged: emotional support, staffing, safety, compensation, communication, and stress management. Findings highlight the critical role of nurse managers, effective communication, and staffing policies in mitigating workplace challenges. While rooted in a U.S. context, these insights may inform strategies to support nursing staff globally in future crises, reinforcing the need for tailored, sustainable approaches tofront linecaregiver well-being.

Retatrutide and survodutide exhibit the most favourable efficacy profiles for obesity and T2DM, with acceptable safety. These findings support their potential clinical use and highlight the need for future head-to-head trials.

39 Background: Prostate cancer is a leading cause of cancer-related death among men in the United States (U.S). Despite therapeutic advances, racial disparities persist, with African American men experiencing higher incidence and poorer survival. Data on racial differences in inpatient outcomes, particularly in-hospital mortality, remain limited. This study evaluated racial and ethnic variations in in-hospital mortality among patients hospitalized with malignant prostate cancer (MPC) in the U.S. Methods: The U.S National Inpatient Sample (NIS) from 2016 to 2020 was queried for patients diagnosed with MPC. We used International Classification of Diseases, 10th Revision, Procedure Coding System (ICD-10-PCS) code “C61” to identify patients who were hospitalized for MPC. The study was exempt from institutional review board approval as the NIS database contains deidentified patient information. Multivariable regression analysis was performed to determine the odds of in-hospital mortality among patients with MPC. Multivariable logistic regression followed by marginal effects was used to plot yearly trends in in-hospital mortality. All the outcomes were adjusted for age, gender, Charlson comorbidity index (CCI) and hospital characteristics. All Statistical analyses were conducted using STATA 19 software. Results: The current retrospective study analyzed 98,000 patients hospitalized for MPC between 2016 to 2020. The racial distribution among study patients included: Whites (68,000; 69.4%), African Americans (17,738; 18.1%), Hispanics (7,154; 7.3%), and other minorities (5,098; 5.2%). African Americans were more likely to be hospitalized at a relatively younger age, and with a higher co-morbidity burden (mean age: 69.4 years; mean CCI: 5.5; p<0.01) when compared to Whites (mean age: 73 years; mean CCI: 4.8), Hispanics (mean age: 71.1 years; mean CCI: 5.1) and other minorities (mean age: 71.5 years; mean CCI: 5.0). A total of 3,626 (3.7%) patients died during the study period. On multivariable analysis, a higher absolute in-hospital mortality was observed in African Americans (OR: 1.14, 95% CI: 1.07 – 1.22, p <0.01) and other minorities (OR: 1.19, 95% CI: 1.06 – 1.34, p <0.01), when compared to Whites (OR: reference). Similarly, an increasing trend of in-hospital mortality was observed in African Americans (from 1.6% mortality per annum in 2016 to 2.0% in 2020; trend p <0.01) and Hispanics (from 1.1% mortality per annum in 2016 to 1.6% in 2020; trend p = 0.02). No change in mortality was observed among Whites (trend p = 0.171) and other minorities (trend p = 0.479) during the study period. Conclusions: Racial disparities persist in in-hospital outcomes among patients with MPC in the U.S. African American and Hispanic patients experienced increasing in-hospital mortality over time, highlighting the need for targeted interventions to address inequities in access, comorbidity management, and inpatient care.

BackgroundDiabetic retinopathy is a leading cause of preventable vision loss in adults, and timely retinal screening is essential for early detection and intervention. However, adherence to diabetic eye exam guidelines remains suboptimal, particularly in underserved populations. Geographic Information Systems (GIS) offer a novel approach to visualizing disparities in eye care access and adherence.MethodsWe conducted a retrospective, cross-sectional study of 15,656 patients with diabetes mellitus (aged 18–75) receiving care in a university-based health system in Monroe County, NY, from November 2020 to November 2021. Eye exam adherence was determined using Healthcare Effectiveness Data and Information Set (HEDIS) criteria. Patient-level demographics and ZIP-code-level socioeconomic data were analyzed using ordinary least squares (OLS) regression. GIS choropleth maps were used to visualize regional variations in eye exam adherence and associated demographic and socioeconomic indicators.ResultsOverall, 31.5% of patients were non-adherent to HEDIS eye exam standards. Non-adherence rates varied significantly by ZIP code (range: 13–50%) and were strongly associated with higher poverty (R² = 0.50, p < 0.0001), unemployment (R² = 0.17, p = 0.008), and lower educational attainment (R² = 0.50, p < 0.0001). Non-adherence also increased with higher proportions of Hispanic (R² = 0.24, p = 0.001) and non-Hispanic Black residents (R² = 0.45, p < 0.0001), and decreased with higher proportions of non-Hispanic White residents (R² = 0.45, p < 0.0001). GIS mapping identified an urban cluster of ZIP codes with consistently high non-adherence and socioeconomic risk profiles, as well as a rural outlier with high non-adherence but differing demographic characteristics.ConclusionsOur findings highlight geographic, socioeconomic, and racial disparities in diabetic eye exam adherence. GIS can serve as a powerful tool to identify high-risk populations and inform targeted outreach strategies aimed at reducing vision loss in vulnerable communities.

We report a case of severe hypercalcaemia after a single cycle of a combination therapy of ipilimumab and nivolumab. Initial evaluation ruled out common causes, including bone metastases, parathyroid hormone/parathyroid hormone-related protein elevation and paraproteinaemia. Her serum 1,25-dihydroxyvitamin D (calcitriol) levels were significantly elevated following the first immunotherapy cycle. Hypercalcaemia responded only to glucocorticoid therapy, with normalisation of serum calcium and calcitriol levels. Recurrence of hypercalcaemia after glucocorticoid discontinuation and subsequent resolution with glucocorticoid re-initiation strongly supported a calcitriol-mediated mechanism, most likely as an immune-related effect of ipilimumab and nivolumab.

BackgroundIn 2021, ISDA guidelines recommended fidaxomicin over vancomycin as first line treatment of Clostridioides difficile infection (CDI) based on clinical trials showing reduced recurrence. However, real-world effectiveness studies of fidaxomicin primarily in hospitalized and high-risk populations showed mixed results. Evidence of fidaxomicin effectiveness for community associated (CA) CDI in outpatient settings remains limited. The study aim is to evaluate the real-world effectiveness of fidaxomicin for initial CA-CDI.MethodsWe used data from population-based surveillance of CDI in Monroe County, NY (2020-2024), as part of the CDC Emerging Infections Program. CA CDI was defined as a first episode with no healthcare exposure in the prior 12 weeks. Adults (≥ 18 years) who completed an uninterrupted course of oral therapy were included. Clinical data, inpatient treatment and recurrence at 8 weeks and 90 days were abstracted from medical records. Recurrence rates were compared between fidaxomicin and vancomycin treated groups using bivariate and multivariable log-binomial regression models.ResultsAmong 1193 cases with initial CA-CDI,146 (12.2%) received fidaxomicin and 1047 (87.8%) vancomycin. Groups were similar in sex, comorbidities and prior PPI/H2 blocker use. Cases receiving fidaxomicin were more likely to be aged 40-59 (32% vs. 23.3%). In hospital treatment was comparable (20.5% vs. 18.8%). Recurrence at 8 weeks and 90 days was 8.2% and 8.9% for fidaxomicin, and 14.9% and 17.8% for vancomycin, respectively (p < 0.05). Crude models showed that vancomycin was associated with a higher risk of 8-week recurrence (RR: 1.81; 95% CI: 1.03–3.18) and 90-day recurrence (RR: 2.00; 95% CI: 1.17–3.41). After adjustment, the risk remained elevated for 8-week recurrence (RR: 1.72; 95% CI: 0.98–3.03) and 90-day recurrence (RR: 1.89; 95% CI: 1.10 – 3.23).ConclusionFidaxomicin was associated with a lower recurrence rate than vancomycin in CA-CDI with a statistically significant benefit at 90 days. These findings support the current IDSA guidelines and highlight the real-world advantage of fidaxomicin for initial CA-CDI management.DisclosuresAll Authors: No reported disclosures