BJC HealthCare is a non-profit health care organization based in St. Louis, Missouri. BJC includes two nationally recognized academic hospitals – Barnes–Jewish Hospital and St. Louis Children's Hospital, which are both affiliated with the Washington University School of Medicine.
We evaluated whether an antibiotic stewardship bundle, which included audit-and-feedback, could reduce antibiotic overuse at hospital discharge. We performed a stepped-wedge cluster randomized trial across participating units at 10 hospitals to evaluate the effect of a discharge-focused stewardship bundle. The trial ran from 12/5/22-11/17/23. After a 24-week baseline period, one hospital crossed into the intervention arm every 2 weeks. The intervention consisted of a) disseminating institutional guidelines for oral antibiotic step-down therapy; and b) prospective audit-and-feedback on inpatients receiving antibiotics who had an anticipated discharge in the next 48 hours. The primary outcome was post-discharge antibiotic use. Secondary outcomes included inpatient antibiotic use, length-of-stay, and readmissions. After the intervention ended, providers and stewardship personnel from each hospital were surveyed and interviewed, respectively, to assess acceptability and feasibility. There were 21,782 patient-admissions included (14,228 baseline period; 7,554 intervention period). Median age was 66 years, with 61% male (Table 1). At the hospital-level, the average number of patients audited per week was 20; one-quarter of audits led to feedback. There were 3,133 (21.9%) patients prescribed post-discharge antibiotics at baseline compared to 1,645 (21.8%) during the intervention (OR 1.02; 95% CI 0.95-1.09). The mean post-discharge duration was 7.1 days (SD 5.2) at baseline compared to 7.6 days (SD 5.6) during the intervention (RR 1.02; 95% CI 0.98-1.07). Inpatient antibiotic duration was shorter during the intervention (RR 0.91; 95% CI 0.86-0.97), but there was no difference in length-of-stay and readmissions (Table 2). One hundred twelve inpatient providers were sent a post-intervention survey; 40 (35.7%) responded; 94% felt that the initiative improved antibiotic-prescribing at discharge (Table 3). However, many stewardship teams reported difficulty in accurately identifying when patients would be discharged (Table 4). An antibiotic stewardship bundle, which included audit-and-feedback, did not reduce antibiotic use at discharge. The bundle was acceptable to providers but difficult for stewardship teams to implement. Yvonne Burnett, PharmD, BCIDP, InflaRx: Honoraria|Melinta Therapeutics: Honoraria
Objective To estimate the association of cleft morphology (palate, alveolar, and lip involvement) and a positive family history with syndromic status in a pooled United States and Guatemalan orofacial cleft population, and to test whether these associations were stable across the two care settings. Design: Cross-sectional secondary analysis of a publicly available registry. Setting: A high-resource US pediatric center (2012–2019) and Guatemalan surgical missions (2017–2020). Patients, Participants: 702 children with an orofacial cleft, recorded syndromic status, and complete predictor data, after exclusion of 115 records for missing outcome (n = 66) or predictors (n = 49). Interventions: None (observational). Main Outcome Measure(s): Syndromic status, modeled by multivariable logistic regression; adjusted odds ratios (aOR) with profile-likelihood 95% CIs and the g-computation marginal prevalence difference for palate involvement. Results Of 702 children, 156 (22.2%) were syndromic. Palate involvement was associated with higher odds of syndromic status (aOR 3.32; 95% CI, 1.21–11.50; P=.02), a marginal syndromic prevalence difference of 14.2 percentage points (95% CI, 2.7–25.3); the E-value was 3.04. Isolated lip involvement was associated with lower odds (aOR 0.22; 95% CI, 0.05–0.90). Family history was not independently associated (aOR 1.55; 95% CI, 0.87–2.73). Estimates were stable under multiple imputation and alternative family-history coding; cohort-stratified and interaction estimates were not estimable in the Guatemalan arm (3 syndromic events). Conclusions Palate involvement was associated with a clinically meaningful increase in the odds of syndromic status, supporting consideration of genetics referral for palate-involved clefts; family history was not an independent flag. Findings are hypothesis-generating given incomplete syndromic ascertainment in the mission setting.
BACKGROUND:The relationship between media portrayal of psychedelic drugs, scientific research and drug policy is an area of debate. AIMS:To apply artificial intelligence technology to measure trends in media sentiment towards the therapeutic potential of psychedelic drugs. METHOD:Up to 300 of the most relevant articles from Google News searches for the term 'psychedelics' were sampled for each year from 2000 to 2025. A large language model, ChatGPT, evaluated subject matter and sentiment. RESULTS:In total, 88.3% of screened URLs (3308 of 3747) were included in the analysis. The proportion of articles focusing on the therapeutic potential of psychedelics increased from 13.3% (26 of 198) from 2000 to 2009 to 85.3% (1254 of 1470) from 2020 to 2025. The average sentiment score from 2000 to 2025 for articles from all publications (N = 2168) was 78.5 ± 9.3 (mean ± s.d.) (possible range: 1-100). 1.3% (29 of 2168) of articles carried negative sentiment (<50) whereas 4.8% (103 of 2168) had extremely positive sentiment (≥90). Average sentiment reached a peak in 2020 (80.8 ± 7.0), and a statistically significant trough in sentiment was observed in 2024 relative to 2020-2023 (2020-2023, 79.2; 2024, 74.3, P < 0.00001, Mann-Whitney U-test). The proportion of negative-neutral articles (≤65) increased annually from a trough of 3.6% (8 of 267) in 2020 to a peak of 20.9% (43 of 253) in 2024. Artificial intelligence sentiment scores were correlated and concordant with average human rater scores (r = 0.88, concordance correlation coefficient 0.84). CONCLUSIONS:Although most 21st-century media coverage of psychedelic drugs has been positively framed, negative and neutral coverage has increased in frequency since 2020. Researchers, clinicians, regulators and policy-makers should be mindful of the complex relationship between media portrayals of psychedelics and the results of scientific research.
