Conectar
by Yuxuan Gao, Shiyao Jiang, Yu Cui, Yumeng Wang, Lili Yu
With the extensive clinical application of immune checkpoint inhibitors (ICIs), immune-related adverse events (irAEs) associated with these agents have increasingly garnered significant attention. Unlike other irAEs, endocrine irAEs are mostly irreversible, with variable and nonspecific symptoms, which poses challenges for clinicians in diagnosis. As a result, this study leveraged the U.S. Food and Drug Administration Adverse Event Reporting System (FAERS) and the Japanese Adverse Drug Event Report (JADER) pharmacovigilance databases to conduct an in-depth investigation into adverse events induced by PD-1/PD-L1 inhibitors, with a focus on irAEs induced by PD-1/PD-L1 inhibitors. This study pioneers the systematic cross-database validation of endocrine irAEs induced by PD-1/PD-L1 inhibitors. The integration of data from the JADER offers unique safety insights for Asian populations, bolsters global pharmacovigilance efforts, and uncovers regional variations in irAEs reporting. Notably, this study revealed a higher prevalence of endocrine irAEs among men aged over 50 years receiving PD-1/PD-L1 inhibitors. Both PD-1 and PD-L1 inhibitors are strongly associated with thyroid dysfunction, adrenal insufficiency, and pituitary inflammation. Additionally, it identifies several previously undocumented endocrine irAEs. This result unearthed safety signals hitherto unreported in drug inserts, underscoring the imperative for updating the safety labeling of PD-1/PD-L1 inhibitors with respect to endocrine irAEs. The emergence of off-label uses further underscores the need for additional clinical trials to assess their efficacy and safety.To explore the association of the Geriatric Nutritional Risk Index (GNRI) with in-hospital mortality and costs in older inpatients and to compare these associations between cancer and non-cancer patients to inform clinical practice.
Retrospective observational study.
A hospital-based study was conducted in Southwest China between January 2018 and December 2020. Demographic, clinical, laboratory and anthropometric data of inpatients aged 65 and over, along with hospitalisation deaths and costs, were collected through the Hospital Information System of a general hospital and its affiliates. GNRI was calculated at admission to assess nutritional risk. Marginal structural models and stratified analyses estimated hospitalisation outcomes for older inpatients with and without various types of cancer across different nutritional risk grades.
Among 37,267 participants, in-hospital mortality and costs increased with higher nutritional risk. Older inpatients with major nutritional risk had significantly higher mortality and costs than those with no nutritional risk. Older cancer inpatients with major nutritional risk had the highest mortality and costs, significantly exceeding those of non-cancer inpatients. For each cancer type, increased nutritional risk was associated with higher in-hospital mortality and costs. Respiratory cancer inpatients with major nutritional risk had the highest mortality, while digestive cancer inpatients had the highest costs.
Higher GNRI-assessed nutritional risk was associated with increased in-hospital mortality and costs in older inpatients, with stronger associations observed in cancer patients compared to non-cancer patients. Integrating GNRI into routine nursing practice could have significant clinical and economic benefits by promoting early nutritional screening in patient care and targeted interventions to reduce mortality and healthcare costs in high-risk populations.
Integrating GNRI assessment into routine patient care can effectively identify patients at high risk for in-hospital mortality and costs, allowing for timely nutritional support to enhance patient outcomes. GNRI, as a simple and globally applicable tool, can be integrated into diverse healthcare settings, providing an effective method for nutritional risk screening in older patients. When applying GNRI in clinical nursing and medical practice, special consideration should be given to the presence and type of cancer, as cancer patients with severe nutritional risk may benefit the most from targeted interventions.
What problem did the study address? This study investigated the association between GNRI-assessed nutritional risk and in-hospital mortality and costs in older inpatients. It further examined whether these associations differ between cancer and non-cancer patients and among different cancer types to improve clinical application.
What were the main findings? The study found that higher nutritional risk assessed by GNRI was associated with increased in-hospital mortality and costs in older inpatients. These associations were stronger in older cancer patients compared to non-cancer patients, with respiratory cancers showing the highest mortality and digestive cancers incurring the highest costs. These findings emphasise the important role of nutritional screening using GNRI in patient care with varying clinical profiles and informing nursing and medical strategies globally, particularly in resource-limited settings.
Where and on whom will the research have an impact? The findings are relevant to older inpatients in hospital settings worldwide, particularly those with cancer, as well as to nurses and healthcare professionals. GNRI provides a practical and easily implementable tool for them to assess nutritional risks upon admission and guide timely nutritional support strategies based on clinical profiles including cancer presence and type in older inpatients. Incorporating GNRI into routine nursing care, nurses and healthcare professionals will be better equipped to address nutritional risks, ultimately improving patient care and optimising clinical and economic outcomes for older patients.
We have adhered to relevant EQUATOR guidelines, specifically following the STROBE (strengthening the reporting of observational studies in epidemiology) guidelines for reporting this observational study.
No public contribution was required in the design or conduct of this research. Patients contributed through data collected from the Hospital Information System, which was used for analysis.
Developing a severity assessment scale for critically ill patients' thirst and conducting reliability and validity tests, aiming to provide healthcare professionals with a scientific and objective tool for assessing the level of thirst.
Based on literature review and qualitative interviews, a pool of items was generated, and a preliminary scale was formed through two rounds of Delphi expert consultation. Convenience sampling was employed to select 178 ICU patients in a top-three hospital from May 2023 to October 2023 as the study subjects to examine the reliability and validity of the severity assessment scale for critically ill patients' thirst.
The developed severity assessment scale for critically ill patients' thirst consists of 8 evaluation items and 26 evaluation indicators. The agreement coefficients for two rounds of expert consultation were 100% and 92.6% for the positive coefficient, and the authority coefficients were .900 and .906. Kendall's concordance coefficients were .101 and .120 (all p < .001). The overall Cronbach's α coefficient for the scale was .827. The inter-rater reliability coefficient was .910. The Item-Content Validity Index (I-CVI) ranged from .800 to 1.000, and the Scale-Content Validity Index/Average (S-CVI/Ave) was .950.
The critically ill patients' thirst assessment scale is reliable and valid and can be widely used in clinical practice.
The AiMi Academic Services (www.aimieditor.com) for English language editing and review services.
The scale developed in this study is a simple and ICU-specific scale that can be used to assess the severity of thirst in critically ill patients. As such, the severity of thirst in critically ill patients can be evaluated quickly so that targeted interventions can be implemented according to the patient's specific disease and treatment conditions. Therefore, patient comfort can be improved, and thirst-related health problems can be prevented.
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