Unity Hospital

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.

Nursing leadership has traditionally focused on developing individual clinician expertise, measuring success through proficiency and autonomy. However, rising patient acuity and increasing health care complexity have exposed the limitations of this model, demonstrating that no single clinician can master the totality of current care. Safety, therefore, depends on collective competence achieved through synchronized cognition. This article defines the concept of collective intelligence, a measurable group capacity for problem-solving that transcends individual expertise, as the critical adaptive engine for high-stakes health care environments. We distinguish collective intelligence from the prerequisite of shared mental models, arguing that, while shared mental models provide a static blueprint for coordination, collective intelligence delivers the dynamic, resilient navigation necessary to manage ambiguous clinical crises. High collective intelligence is driven by 3 key factors: social sensitivity, equal opportunities for participation in conversation, and cognitive diversity. To bridge the gap between theory and practice, we outline 4 evidence-based strategic imperatives for nurse leaders: operationalizing psychological safety, structuring equitable communication, leveraging cognitive diversity, and reframing debriefings to promote metacognition. Ultimately, the mandate for nurse leaders is to transition from managing individuals to architecting interprofessional interaction. The future of patient safety depends on implementing structural and relational interventions that harness the team’s combined cognitive processing capabilities, thereby unlocking the transformative, collaborative brilliance required to secure a high-reliability health care system.

Mechanical circulatory support (MCS) devices, such as the Impella, have become critical tools in managing cardiogenic shock (CS), offering temporary hemodynamic support to improve cardiac output and stabilize patients. This study aimed to evaluate gender-based differences in clinical outcomes following Impella implantation for CS secondary to myocardial infarction (MI). Using real-world data from the TriNetX database, all patients with CS secondary to MI who underwent Impella implantation were identified and then divided into two cohorts based on gender. To minimize selection bias, propensity score matching (PSM) was applied at a 1:1 ratio based on baseline characteristics, including age, race, and comorbidities. Outcomes included in-hospital mortality, acute kidney injury (AKI), cardiac arrest, acute ischemic and hemorrhagic strokes, intraoperative bleeding, acute aortic dissection, critical limb ischemia, acute pulmonary embolism, and readmission rates. Our analysis identified 6,687 individuals who underwent Impella implantation for cardiogenic shock. After PSM, two matched cohorts comprising 1,760 individuals were included. Male gender was associated with a significantly increased incidence of AKI (RR: 1.21, p < 0.001) and readmission (RR: 1.09, p = 0.006). On the other hand, females had a 60% greater chance of developing critical limb ischemia compared to males (RR: 0.40, p < 0.001). Gender did not impact the incidence of cardiac arrest (p = 0.243), acute ischemic strokes (p = 0.953), pulmonary embolism (p = 0.275), or mortality (p = 0.919). The incidences of hemorrhagic stroke, aortic dissection, and intraoperative bleeding were equal in both groups (p = 1). Our study showed that male patients had a higher risk of acute kidney injury and readmissions compared to females, whereas females were more likely to experience critical limb ischemia. These findings highlight the need for gender-specific considerations in the management of CS and the use of MCS.

Introduction: Immune checkpoint inhibitors (ICIs) have improved lung cancer treatment but are associated with an increased risk of cardiotoxicity. We investigated whether statins could mitigate ICI-associated cardiovascular risks in lung cancer patients. Methods: We performed a retrospective, propensity score-matched cohort study utilizing the TriNetX database. We identified lung cancer patients receiving ICIs between April 2013 and June 2023. We created two cohorts: statin users and non-users. The primary efficacy outcome was major adverse cardiovascular events (MACE), defined as a composite of myocardial infarction, ischemic stroke, and heart failure. The secondary efficacy outcomes were myocarditis and cardiac arrest. Safety outcomes were all-cause mortality and serious immune-related adverse events (irAEs). Results: A total of 16,650 lung cancer patients undergoing ICIs were identified, consisting of 6,812 statin users and 9,838 non-users. After propensity score matching, 4,379 patients were well-matched in baseline characteristics. Over a follow-up period of 12 months, statin use was associated with a lower risk of MACE (HR: 0.87, 95% CI: 0.78–0.98), primarily driven by reductions in myocardial infarction (HR: 0.75, 95% CI: 0.58-0.97) and heart failure (HR: 0.85, 95% CI: 0.74–0.98). For safety outcomes, statin use was associated with a reduction in all-cause mortality (HR: 0.83, 95% CI: 0.77–0.90) and did not result in an increased risk of serious irAEs. Conclusion: The use of statins in lung cancer patients with cardiovascular risk factors and without previous cardiovascular events undergoing immunotherapy was associated with a reduction in MACE and all-cause mortality without an increased risk of serious adverse events.

IntroductionDespite recent advances in the care of critically ill patients with cancer, studies show that lung cancer is associated with higher Intensive Care Unit (ICU) mortality than other types of cancer. This systematic review and meta-analysis aim to investigate the ICU outcomes and predictors of mortality in critically ill patients with lung cancer.MethodsPubMed, OVID MEDLINE, Cochrane and Embase were searched to identify relevant studies. The primary outcome was ICU mortality. The secondary outcomes were hospital mortality and predictors of mortality. Abstracts, case reports and case series were excluded.ResultsThirty-three studies met inclusion criteria, including 28 cohort studies (n = 4123) and five population-based studies (n = 82,475). The pooled ICU mortality was 46.4% (95% CI 41.0-51.8; n = 16,772). The pooled hospital mortality was 51.9% (95% CI 46.9-56.9; n = 72,215). The pooled long-term mortality (6-12 months) was 73.5%, (95% CI 68.2- 78.2; n = 84,008). Predictors of mortality included the presence of metastatic disease (RR 1.30, 95% CI 1.06-1.59), poor performance status (RR 1.33, 95% CI 1.12-1.57), requirement for mechanical ventilation (RR 2.25, 95% CI 1.58-3.21), requirement for vasopressors (RR 1.95, 95% CI 1.54-2.46), higher APACHE or SAPS score (standardized mean difference 0.63, 95% CI 0.45-0.80), and higher SOFA score (mean difference 1.95, 95% CI 1.21-2.70).ConclusionCritically ill patients with lung cancer have reasonable short term but poor long-term outcome. Focused and early goals of care discussions are crucial part of ICU care in this patient population.

BackgroundHybrid atrial fibrillation (AF) ablation has been used to achieve rhythm control in AF management. It requires both epicardial and endocardial ablation. There is limited evidence regarding the safety of this procedure.ObjectiveThe study aimed to compare in-hospital complication rates between hybrid AF ablation and endocardial catheter ablation (ECA) using a nationally representative dataset.MethodsUsing the National Inpatient Sample, we identified patients who underwent AF ablation between 2017 and 2022. The cohort was divided into 2 groups; those who underwent ECA and those who underwent hybrid AF ablation. The primary outcome was major adverse cardiovascular events (MACEs).ResultsAfter propensity score weighting, hybrid ablation was associated with a significantly lower MACE rate (3.1% vs 5.6%, P = .0036). Rates of cardiac complications (8.8% vs 7.5%, P = .594), infections (2.7% vs 3.7%, P = .595), and length of stay (2.96 ± 0.30 vs 3.19 ± 2.45 days, P = .285) were comparable between groups. Hybrid ablation was associated with higher rates of hemorrhagic complications (12.7% vs 4.0%, P < .001), with a comparable rate of blood transfusion, whereas pulmonary complications showed a trend toward an increase (3.8% vs 1.5%, P = .099).ConclusionHybrid AF ablation was associated with a significantly lower MACE rate compared with ECA, contrasting with earlier studies that suggested higher risk. This shift likely reflects improvements in technique and more refined patient selection. While rates of pulmonary and hemorrhagic complications were higher with hybrid ablation, transfusion needs remained similar between groups.

Mitral Valve Transcatheter Edge-to-Edge Repair (M-TEER) is a minimally invasive procedure for patients with symptomatic mitral regurgitation. Its outcomes in patients with a history of coronary artery bypass grafting (CABG) remain unclear. We analyzed data from the Nationwide Inpatient Sample, using ICD-10-CM codes for M-TEER and CABG. Primary outcomes included in-hospital all-cause mortality and periprocedural cardiac complications. Inverse probability of treatment weighting was employed to compare M-TEER patients with or without prior CABG. From January 2016 to December 2020, we identified 48,835 M-TEER cases in the U.S. with 9,655 patients (19.78%) having a prior CABG. These patients were older and had more comorbidities. M-TEER procedures increased over the study period, including those with prior CABG (2,145 in 2016 vs. 2,682 in 2020). Adjusted analysis showed no significant difference in in-hospital mortality between patients with and without prior CABG [adjusted odds ratio (aOR) 0.85, 95% confidence interval (CI) 0.85-1.32, p = 0.47]. However, patients with prior CABG had lower odds of periprocedural cardiac complications [aOR 0.72, 95% CI 0.59-0.87, p = 0.001]. M-TEER appears safe for patients with prior CABG, showing no adverse peri-procedural outcomes compared to those without CABG. Despite more comorbidities, M-TEER remains a safe option for these patients.