Knee osteoarthritis (KOA) is a highly prevalent and debilitating condition associated with substantial physical, psychological, and socioeconomic burden. For patients in whom conservative therapy has failed and who are unable or unwilling to undergo arthroplasty, treatment options remain limited. Genicular artery embolization (GAE) has emerged as a minimally invasive investigational therapy performed by interventional radiologists and vascular specialists which targets the synovial inflammation and pathological neo-angiogenesis central to KOA pathophysiology. Preclinical studies, imaging analyses, and biomarker data support the mechanistic rationale for GAE, demonstrating reductions in synovitis, hypervascularity, and inflammatory mediators. Existing clinical studies report high technical success rates, reported improvements in pain and function, and low complication rates following GAE. However, current evidence remains limited by the predominance of single-arm studies and the substantial placebo response associated with interventional pain procedures. Notably, three randomized sham-controlled trials have demonstrated mixed results, with one study showing significant benefit and two showing no significant difference compared with sham intervention. Multiple ongoing sham-controlled and investigational device exemption (IDE) trials are expected to better define the true treatment effect, optimal patient selection, and long-term role of GAE within evidence-based KOA management.
BACKGROUND:Nurse leaders are at a higher risk for burnout post-pandemic. Resilience skills training incorporating mind-body awareness and self-compassion practices significantly improved stress, self-compassion, and mindfulness in medical professionals by the end of the training. AIMS:This study aimed to assess if a 6-h resiliency training delivered to nurse leaders would improve measures related to well-being, for example, stress, burnout, life satisfaction, self-compassion, resilience, and mindfulness by the end of the course, and if any improvements would be sustained over time. METHODS:We prospectively examined the effects of a 6-h resiliency training on well-being outcomes in nurse leaders in a longitudinal study during Spring 2022 through Fall 2022. Experienced resiliency teachers trained 46 nurse leaders. Participants took pre-, post-, and 2-months-post online surveys measuring well-being-related variables. Only 48% (n = 22) completed the entire course and surveys at all three times. RESULTS:Nurse leaders were mostly female (n = 38, 83%) and white (n = 27, 59%) with an average age of 44.72 [SD = 9.5] years. Median years of experience were 15.5 [3.5-47]. One-way repeated measures ANOVA demonstrated a significant effect across time on stress (p = 0.02), self-compassion (p = 0.02), mindfulness (p = 0.04), and the exhaustion subscale of burnout (p = 0.008) but the significant changes occurred by the 2-month follow-up. Resilience, life satisfaction, and disengagement scores did not significantly change. LINKING EVIDENCE TO ACTION:Baseline stress and burnout scores were high in 43.5%-63% of the nurse leaders, indicating a need for continued support of nurse leaders to reduce stress and burnout. Post resiliency training, scores in perceived stress and exhaustion decreased significantly over time, demonstrating the efficacy of this 6-h program to improve key variables related to well-being in nurse leaders. While baseline self-compassion scores were already high in nurse leaders, statistically significant improvements in self-compassion and mindfulness, but not resilience, occurred 2 months after this resiliency training program. Significant changes in key variables related to well-being occurred 2 months post training, indicating the need for further exposure and time with practices taught in the course. Nurse leaders need support to break away from work tasks to participate in psychoeducational trainings and interventions to improve well-being. We need further applied research on how to improve well-being in clinicians from a systems and environmental perspective.
e19077 Background: Per the Sepsis-3 guidelines published in 2016, sepsis was defined as a life-threatening organ dysfunction caused by a dysregulated host response to an infection. Patients with Diffuse Large B-Cell Lymphomas (DLBCL) are at increased risks for developing sepsis. In this retrospective cohort study, we sought to identify the in-hospital outcomes of patients with DLBCL admitted for sepsis. Methods: Using the National inpatient sample (NIS) database from 2018-2021, we retrospectively analyzed patients admitted with a primary diagnosis of sepsis using the appropriate ICD10 code. Our primary population included patients ≥ 18 years admitted for sepsis. Patients were divided into 2 groups either having a DLBCL or not. Using a univariate and multivariate analysis, we compared the odds of various in hospital outcomes. The primary outcome was in-hospital mortality. Secondary outcomes considered were need for vasopressors, rate of mechanical ventilation (MV), need for renal replacement therapy (RRT), Disseminated intravascular coagulation (DIC), acute kidney injury (AKI), length of stay (LOS) and total charges (TOTCHG). Results: There were 9,004,557 admissions for Sepsis out of which 33,400 (0.37%) had DLBCL. Compared to non DLBCL group, there was significantly higher odds of in-hospital mortality (adjusted odds ratio (aOR): 1.48, CI: 1.38-1.59, p <0.001). Regarding secondary outcomes, there was increased odds of DIC (aOR: 1.81, CI: 1.48-2.1, p <0.001), need for vasopressor support (aOR: 1.45, CI: 1.32-1.59, p <0.001), LOS (+0.7 days, CI: 0.47-0.92, p <0.001) and additional TOTCHG (+ $17725.61 in additional costs, CI: $12855 - $22595, p <0.001). There was statistically no difference in AKI (aOR: 1.05, CI: 0.972-1.15, p-value 0.192) both groups however, DLBCL patients had significantly lower outcomes of requiring MV (aOR: 0.87, CI: 0.81-0.93, p <0.001) and needing RRT (aOR: 0.65, CI: 0.58-0.74, p <0.001) when compared to non DLBCL cohort. Conclusions: Patients with DLBCL have an overall increased risk of mortality when admitted for sepsis, with notably worse outcomes, increased length of stay and increased healthcare utilization costs. Further research may be needed to explain these outcomes in this patient population.
e16435 Background: Pancreatic cancer is the 10th most common cancer among males and the 8th most common cancer for females in the United state. Obesity is a major risk factor for pancreatic cancer. However, the role of obesity in inpatient mortality among pancreatic cancer patients has not been extensively examined. This study explores the mortality rates of hospitalized pancreatic cancer patients with obesity and without obesity. Methods: Using the National Inpatient Sample (2018–2022), we identified adult patients hospitalized with a primary diagnosis of pancreatic cancer. Patients were stratified by metastatic versus non-metastatic disease and by obesity status (obese versus non-obese). The primary outcome was mortality. Secondary outcomes included length of stay (LOS), total hospital charges, and palliative care encounters. Multivariate logistic regression analysis was used to adjust for confounders. Results: A total of 131,685 patients were hospitalized with a primary diagnosis of pancreatic cancer, of whom 62,794.98 had non-metastatic disease and 68,889.99 had metastatic cancer. Among these patients, 11% were obese, while 89% were non-obese. Additionally, 54.17% of females were obese compared to 45.83% of males (p < 0.0001). The mean age of non-obese patients was 69.38 years (95% CI: 69.22-69.55), while obese patients were younger, with a mean age of 66.95 years (95% CI: 66.56-67.35, p < 0.0001 ). There were approximately 8,290 deaths (95% CI: 7,863.28–8,716.73) among these patients, of which 71% had metastatic cancer and 29% had non-metastatic cancer. After adjusting for confounders, obesity was associated with significantly lower odds of death among hospitalized pancreatic cancer patients (OR = 0.61, 95% CI: 0.51–0.72, p < 0.001). Female patients had significantly lower odds of mortality compared to male (OR = 0.87, 95% CI: 0.77-0.98, p < 0.032), while African American patients had increased mortality compared to White patients (OR = 1.19, 95% CI: 1.01-1.40, p > 0.032). Obesity was not significantly associated with increased LOS (p= 0.451), although it was associated with higher total hospital charges in hospitalized pancreatic cancer patients (β = 5,091.917, p < 0.001) after adjusting for confounders. Additionally, obese patients were less likely to have palliative care encounters compared to non-obese patients (OR = 0.57, 95% CI: 0.52-0.62, p < 0.001). Conclusions: Obesity in hospitalized pancreatic cancer patients was associated with lower odds of mortality, increased hospital charges, and decreased palliative care utilization. These findings suggest that obesity may have a complex, protective effect on survival in hospitalized patients, warranting further investigation to understand the underlying mechanisms and its clinical implications. Association between obesity and pancreatic cancer. Odds Ratio P Value 95% Confidence Interval Primary Outcome Mortality 0.6094746 p <0.001 .5111609 - .7266974 Secondary Outcome Length of Stay (LOS) 0.0983923 P=0.451 .3541148 - .1573303 Total Charges 5091.917 p <0.001 2349.202 - 7834.632 Palliative Care Encounters 0.5795194 p <0.001 0.5229095 - .6422579
e15671 Background: Early-onset colorectal cancer (EOCRC), defined as colorectal cancer (CRC) diagnosed in individuals under the age of 50, has been increasing in incidence worldwide. Colorectal cancer is now the leading cause of cancer death in men younger than 50 years and the second leading cause in women younger than 50 years in the United States. [1] Understanding the risk factors associated with EOCRC is crucial for early detection and prevention. This retrospective study aims to identify and evaluate the demographic, lifestyle, and modifiable risk factors associated with EOCRC. Methods: We conducted a retrospective analysis of 3,369 patients diagnosed with colorectal cancer between 2005 and 2024. Data was collected from a single institution’s cancer registry and electronic health records. Inclusion criteria included individuals diagnosed with CRC via colonoscopy, imaging, and/or pathologic confirmation. Risk factors evaluated included family history of CRC, smoking, alcohol consumption, signs of metabolic syndrome (diabetes, obesity, and/or hypertension), insurance status, and race. Statistical analysis was performed using multivariable logistic regression to assess the associations between these risk factors and the likelihood of early onset CRC. Results: Of the 3,369 patients, 395 (11.7%) were diagnosed with EOCRC (mean age = 41.71) and 2974 (88.3%) had late onset CRC (mean age = 69.23). EOCRC predominantly affected the sigmoid, rectosigmoid, and rectum (53.4%). Among the identified risk factors, both EOCRC and late-onset CRC patients shared a similar probability (53.6% v 50.2%) of having a family history of cancer. Of patients with EOCRC, 43.0% were current or former smokers, versus late onset CRC, in which 49.2% were current or former smokers. There was no statistically significant difference in alcohol consumption between EOCRC and late-onset CRC. Among patients diagnosed with EOCRC, 16/395 (4.0%) were also diagnosed with diabetes, 37/395 (9.4%) were either obese or morbidly obese, and 61/395 (15.4%) had hypertension. Conclusions: Our study highlights several key risk factors for early-onset colorectal cancer, including family history of CRC, smoking, and metabolic syndrome. Modifiable factors such as smoking and obesity may offer potential for prevention in high-risk populations, particularly the Hispanic population.
