Background Among older adults, malnutrition is common, often missed by healthcare providers, and influences recovery from illness or injury. Objective To identify modifiable risk factors associated with malnutrition in older patients. Design Prospective cross-sectional multicenter study Setting 3 EDs in the South, Northeast, and Midwest Participants Non-critically ill, English-speaking adults aged ≥65 years Measurements Random time block sampling was used to enroll patients. The ED interview assessed malnutrition using the Mini Nutritional Assessment Short-Form. Food insecurity and poor oral health were assessed using validated measures. Other risk factors examined included depressive symptoms, limited mobility, lack of transportation, loneliness, and medication side effects, qualified by whether the patient reported the risk factor affected their diet. The population attributable risk proportion (PARP) for malnutrition was estimated for each risk factor. Results In our sample (n=252), the prevalence of malnutrition was 12%. Patient characteristics associated with malnutrition included not having a college degree, being admitted to the hospital, and residence in an assisted living facility. Of the risk factors examined, the PARPs for malnutrition were highest for poor oral health (54%; 95% CI 16%, 78%), food insecurity (14%; 95% CI 3%, 31%), and lack of transportation affecting diet (12%; 95% CI 3%, 28%). Conclusion Results of this observational study identify multiple modifiable factors associated with the problem of malnutrition in older adults.
Background: Immune checkpoint inhibitors have shown efficacy in patients with NSCLC as monotherapy and in combination with chemotherapy. Tislelizumab is a humanized IgG4 monoclonal antibody to PD-1 specifically engineered to minimize F c YR binding on macrophages, possibly minimizing negative interactions with other immune cells. In a phase 1 study, tislelizumab was generally well tolerated and showed antitumor activity; 200mg IV Q3W was established as the recommended dose. Method: This multi-arm phase 2 study, consisting of safety run-in and dose-extension phases, assessed tislelizumab in combination with platinum-based chemotherapy (by tumor histology) as a potential first-line treatment for Chinese patients with lung cancer. All patients received tislelizumab at 200mg Q3W in combination with 4e6 cycles of platinum-doublet until disease progression. Nonsquamous (nsq) NSCLC patients received pemetrexed + platinum Q3W for 4 cycles followed by pemetrexed maintenance, while squamous (sq) NSCLC patients received paclitaxel + platinum (A) or gemcitabine + platinum (B) Q3W, and small-cell lung cancer (SCLC) patients received etoposide + platinum Q3W. Tumor response (RECIST v1.1) and safety/tolerability were evaluated. Result: As of 21 Feb 2018, 48 patients (median age, 62 years [range: 36e75], 71% male, 71% current/former smokers) received tislelizumab treatment (median, 3 cycles [range: 1e7]); 44 patients remain on the study. Across the four cohorts, confirmed and unconfirmed partial responses were observed in 13 and 9 patients, respectively (Table). The most frequent AEs were chemotherapy-related hematologic toxicities. The most commonly reported grade 3 treatment-related AEs were neutropenia (20.8%) and anemia (12.5%); the most common grade 3 immune-related AEs were pyrexia (6.3%) and rash (6.3%). One sq-NSCLC patient experienced a fatal myocarditis/myositis following one cycle of paclitaxel/cisplatin; all other treatmentrelated AEs were managed/resolved by study-drug interruption (n¼15) or discontinuation (n¼4) and appropriate treatment. Conclusion: Tislelizumab, in combination with platinum doublets, demonstrated preliminary antitumor activity and was generally well tolerated in patients with advanced lung cancer.Background: Appropriate staging of non-small cell lung cancer (NSCLC) patients is crucial to provide accurate prognostic information and select appropriate treatment. Several publications have reported an approximate 20% incidence of occult micro-metastasis (MM) in surgically resected lymph nodes (LN) pathologically interpreted as negative by hematoxylin and eosin staining (HandE). Detection of MM was associated with worsened survival. The majority of NSCLC lymph node staging is now conducted using endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA). The purpose of this study is to determine the frequency of detection of occult MM in EBUS-TBNA specimens and to evaluate the impact of the presence of MM on progression-free and overall survival. Method: All patients undergoing EBUS-...
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