UF Health Shands Hospital is a teaching hospital of the University of Florida in Gainesville, Florida. It is one of seven hospitals in the University of Florida Health system, and one of two campuses for UF's Health Science Center, the other being UF Health at Jacksonville.
Abstract Background and aims Mobile Stroke Units (MSUs) may accelerate enrollment and early trial processes in intracerebral hemorrhage (ICH), but their impact on enrollment efficiency, feasibility, and safety in randomized trials remains incompletely defined. Methods FASTEST was a multicenter randomized trial enrolling patients with spontaneous ICH. In this secondary analysis, patients were categorized as direct MSU enrollment (enrolled entirely on MSU), MSU-facilitated enrollment (identification and initial management on MSU but enrollment in the ED), or non-MSU enrollment. Enrollment efficiency was assessed by time from symptom onset to randomization and by site-level enrollment rates during MSU-available versus MSU-unavailable periods. Issues with MSU enrollment and adverse events were evaluated. Comparisons were conducted using nonparametric tests for continuous variables and χ2 or Fisher's exact tests for categorical variables. Results Among 100 patients enrolled across 13 MSU sites, 38 were enrolled via MSU pathways (17 direct MSU; 21 MSU-facilitated). Median onset-to-randomization time was shorter for MSU-associated enrollments compared with non-MSU enrollments (93 [IQR 26] vs 111.5 [IQR 19] minutes; p<0.001), with a higher proportion enrolled within 90 minutes (36.8% vs 17.7%; p=0.032). Among MSU-associated enrollments, issues were infrequent, with isolated cases of weight estimation error and study kit issues (each 2.6%), with 94.7% having no identified issues. Rates of thromboembolic events did not differ between the two groups. At the site level, enrollment rates during MSU-available periods were higher than during MSU-unavailable periods (0.188 (SD=0.20) vs 0.057 (SD=0.04) enrollments per 10 days), representing a 0.131 relative increase. Conclusions MSUs were associated with faster enrollment, higher enrollment efficiency, and acceptable safety. Conflict of interest
A single dose of ceftriaxone is associated with reduced incidence of early ventilator-associated pneumonia (VAP) and decreased antibiotic exposure in patients with isolated head injury, but the impact in patients with multisystem trauma is unknown. This was a single-center, retrospective cohort study conducted in mechanically ventilated, multisystem trauma patients who were admitted to the intensive care unit (ICU) between September 2020 and September 2024. Patients who received one dose of ceftriaxone within 12 h of intubation were included in the early ceftriaxone group. Early VAP occurred in 3 (10%) patients in the early ceftriaxone group and 15 (25%) patients in the deferred or no antibiotics group ( P = .10). No differences in secondary outcomes were identified. In patients who received early ceftriaxone in this cohort, there was no difference in early VAP incidence compared to those who had no or deferred antibiotics past 12 h of intubation; however, the study may have lacked sufficient power to detect a difference. Future, larger studies in multisystem trauma patients are needed to better delineate the impact of prophylactic antibiotics on VAP outcomes.
In this retrospective study, fungal blood cultures rarely detected fungal pathogens not found in paired standard blood cultures, with added findings in only 0.4% of cases. Given the low diagnostic yield and high cost, results support reserving fungal blood cultures for select high-risk patients to improve diagnostic stewardship.
BACKGROUND:Phenytoin is a highly protein-bound medication and monitored due to its narrow therapeutic range. Free phenytoin serum concentratinos (fPHTm) are not readily available in many institutions. OBJECTIVE:To evaluate whether population-specific correction factors (CFs) improve estimated free phenytoin serum concentrations (fPHTe) compared with traditional Winter-Tozer CF. METHODS:This retrospective review included adults with same-day measured total phenytoin serum concentrations (mPHT), fPHTm, albumin, and blood urea nitrogen (BUN) values. Patients were stratified by active/breakthrough seizures, intermittent hemodialysis (IHD), or adults younger than 65. Patient-specific fPHTm percentages were used in the estimation of fPHTe. RESULTS:Of 126 phenytoin levels reviewed, 66 met inclusion criteria. Population-specific CFs demonstrated lower bias and greater precision. In patients with active/breakthrough seizures and BUN <50 mg/dL, CF 0.29 improved accuracy compared with CF 0.2 (reduced mean percentage error [MPE] -59.59 vs -111.99 - indicating overprediction, root mean square error [RMSE] 1.79 vs 2.91), with similar trends when BUN exceeded 50 g/dL. A preliminary finding among adult patients younger than 65 showed better performance with a CF 0.275 than CF 0.2, with lower MPE (-40.43 vs -78.98) and RMSE (1.32 vs 2.16). In the IHD cohort, CF 0.201 outperformed CF 0.1 (MPE -74.40 vs -197.53 and RMSE 2.07 vs 5.32). CONCLUSION AND RELEVANCE:Population-specific CF estimated fPHTe more accurately and precisely than traditional CF. Findings remain preliminary due to limited representation, and further research is needed to improve CF selection across various subgroups.
