Novant Health Forsyth Medical Center, doing business as Forsyth Medical Center, is a 921-bed, not-for-profit, regional medical center in Winston-Salem, North Carolina, that offers a full range of medical, surgical, rehabilitative and behavioral health services. Coupled with the nearby 22-bed Novant Health Medical Park Hospital, Forsyth Medical Center gives Winston-Salem one of the largest, best-equipped hospital facilities in the state. Forsyth Medical Center is accredited by The Joint Commission and is a member of the American Hospital Association.Novant Health Forsyth Medical Center and Novant Health Medical Park Hospital perform close to 40,000 surgical procedures each year, including more than 6,500 general surgery procedures, 7,000 orthopaedic and neurological procedures and 700 open-heart surgeries. Forsyth Medical Center is also active in a number of different clinical areas, including cancer diagnoses, stroke treatments and the delivery of babies.
IntroductionSacituzumab govitecan is approved for the treatment of triple-negative advanced/metastatic breast cancer and hormone-receptor positive, HER2-negative advanced/metastatic breast cancer. Clinical trials show favorable improvements in progression-free survival (PFS) and overall survival (OS). However, they report a large percentage of patients experiencing hypersensitivity reactions. It has been observed that use of sacituzumab govitecan at [redacted institution] may have a lower rate of hypersensitivity reactions than seen in clinical trials.MethodsThis study aimed to determine the real-world data of PFS and OS of sacituzumab govitecan while evaluating the incidence and severity of hypersensitivity reactions. It was a retrospective, single-center, multi-site study conducted across [redacted], which included adult patients who received at least one dose of sacituzumab govitecan from April 1, 2020 to July 31, 2024 for an FDA-approved breast cancer indication.ResultsA total of 75 patients met the inclusion criteria for assessment. The median PFS was 2.8 months (95% CI, 0.0-14.4) and the median OS was 7.2 months (95% CI, 0.0-19.3). No hypersensitivity reactions were reported, hence reaction severity was not assessed nor associated with treatment discontinuation.Conclusion and RelevanceThis study demonstrated that PFS and OS may be shorter than estimated in clinical trials. However, baseline performance status and previous lines of therapy were not evaluated and thus may have impacted the results. Additionally, no hypersensitivity reactions were observed. From review of this data, the low risk of reactions helps justify future research to assess the necessity of certain premedications and/or elimination of observation times.
Staphylococcus aureus continues to be a main cause of bloodstream infections (BSI) with an annual incidence rate of fifty cases per 100,000 person-years and mortality rates up to 30%. Methicillin-susceptible strains are frequently considered less complicated, however, pose just as high mortality rates and therapeutic challenges as methicillin-resistant cases. First-line treatment continues to be anti-staphylococcal penicillins, like nafcillin or oxacillin, and first generation cephalosporins, such as cefazolin. In cases of persistent bacteremia, newer in vitro studies and small case series have shown possible synergistic activity when cefazolin and ertapenem are combined. The purpose of this study is to describe the use of combination cefazolin and ertapenem in the treatment of persistent BSIs due to methicillin-susceptible Staphylococcus aureus (MSSA).Table 1.Baseline DemographicsTable 2.Results This case series was conducted through an electronic medical record report identifying patients ≥18 years old with MSSA BSI who received concomitantly at least one dose of both cefazolin and ertapenem at Novant Health acute care facilities from January 1, 2021, through July 31, 2024. Twenty-three patients were included. The most common sources of BSI included pulmonary, skin and skin structure with abscess, bone and joint, and implanted device-related infections. The median blood culture clearance was seen after 2 days of combination cefazolin and ertapenem. The average days of monotherapy was 3.5 days and the median days from the initial positive blood culture to combination therapy initiation was 6 days. 30-day all-cause mortality occurred in 5 patients (21.7%), which was consistent with mortality rates previously reported for persistent Staphylococcus aureus BSI. In the data-lacking clinical challenge of persistent MSSA BSI, combination cefazolin and ertapenem may serve as a safe and effective way to improve the time to clearance of blood cultures. This is the largest study to date summarizing the clinical success of this novel combination strategy. Additional data is needed to compare this regimen to standard of therapy; however, clinicians can consider utilizing this combination strategy in patients with persistent MSSA BSI. All Authors: No reported disclosures
INTRODUCTION:There has been a surge in attention to ethical controversies associated with organ donation in the USA. The Neurocritical Care Society (NCS) Ethics Committee sought to understand member experiences and attitudes related to organ donation in the USA. METHODS:We designed a survey of members who practice in the USA and have interacted with an organ procurement organization (OPO)/potential donor. The survey was disseminated by NCS from 1 June 2025 to 1 September 2025. Free-text responses were reviewed to identify themes. RESULTS:Of 2204 NCS members in the USA, there were 71 respondents who completed the survey and 37 respondents who provided free-text comments. Experiences and attitudes varied, but 59% of respondents indicated that they generally think that communication between the OPO and patient surrogates about donation after brain death/death by neurologic criteria seems appropriate, and 34% indicated that they generally think that communication between the OPO and patient surrogates regarding donation after cardiac death/death by circulatory-respiratory criteria (DCD) seems appropriate. Themes included (1) the need to improve education for the treatment team about organ donation; (2) blurred boundaries between patient care and care directed toward organ donation; (3) misalignment between OPOs and treatment team priorities; (4) loss of trust between patient surrogates and the treatment team based on interactions with OPOs; (5) suboptimal timing of communication between OPOs and patient surrogates; (6) concerns regarding a potential lack of transparency, empathy, and cultural sensitivity in communication between OPOs and patient surrogates; (7) opportunities for improvement in preoperative care before donation and palliation after extubation for DCD; and (8) changes in willingness to donate organs based on interactions with OPOs. CONCLUSIONS:Although the results from this survey reflect the experience and attitudes of a small percentage of NCS members in the USA, they indicate that there are opportunities for improvement in organ donation processes. Survey results will guide the NCS Ethics Committee in supporting members navigating ethical controversies related to organ donation.
