Wesley Medical Center, located in Wichita, Kansas, is an acute-care center licensed for 760 beds and 102 bassinets. The medical staff of 900 physicians and 3,000 employees provide a full range of diagnostic and treatment services for patients from throughout Kansas and northern Oklahoma. Every year, more than 25,000 adults and children are inpatients and more than 6,000 babies are born at Wesley. The center was founded in 1912 by the Methodist Church, but has been part of HCA Healthcare since 1985.An unrelated organization, Wesley Medical Center in Hattiesburg, Mississippi, has 211 licensed beds and is owned by Triad Hospitals, Inc..
Advancements in laboratory diagnostics are continually occurring and accuracy in interpreting results directly affects optimal patient care. In 2019, Wesley Healthcare surveyed providers on their interpretation of common microbiology results. Feedback led to several updates in how common organisms were reported. The purpose of this study was to evaluate whether these changes in reporting positively impacted clinical decisions made from the updated results.Blood cultures positive for S. aureus Pre-InterventionBlood cultures positive for S. aureus Post-Intervention This quasi-experimental study evaluated the impact of different verbiage on common microbiology results. A survey with six patient cases was sent to providers in 2019 and 2024. Patient cases remained the same in each survey, but utilized the current presentation of microbiology results at the time of the survey. Recipients were asked to make clinical decisions based on the microbiology results presented. The topics included de-escalation of antibiotics based on polymerase chain reaction (PCR) for positive blood cultures (Images 1 and 2), evaluation of C. difficile PCR and enzyme immunoassays, impact of recent immunization on S. pneumoniae urine antigen results, susceptibilities of Group C Streptococcus and H. influenzae (Images 3 and 4), and understanding of minimum inhibitory concentrations (MIC). Chi-squared statistics were used to compare results.H. Influenzae Results (Pre-Intervention)H. Influenzae Results (Post-Intervention) Several trends were seen in both groups. Questions accompanied by lab results that included detailed comments had the highest percentage of correct responses. This included our C. difficile (Pre: 92%, Post: 98%) and S. pneumoniae urine antigen (Pre: 95%, Post: 94%) results. Culture results without any guidance or adjustment between surveys (Group C Streptococcus, Pre:72%, Post: 81%), had sustained lower rates of correct interpretation and resulted in provider reluctance to de-escalate antibiotics. Culture results which had guidance added between the two time periods had a significant increase in percentage of correct responses. This included blood cultures results by PCR (Pre: 58%, Post: 92%, p= < 0.0001) and H. influenzae (Pre: 86%, Post: 98%, p= < 0.02). Addition of detailed interpretative comments to microbiology results may lead to improved de-escalation and promote appropriate antibiotic selection. All Authors: No reported disclosures
OBJECTIVES:Illicit fentanyl exposure among US children has increased in the past 10 years. However, whether rates of prescription fentanyl exposure have changed in this population is unknown. We described prescription fentanyl exposure among young children. METHODS:We studied cases of prescription fentanyl exposure among children aged <6 years that were reported to the National Poison Data System (NPDS) from 2012 through 2024. We described the characteristics of prescription fentanyl exposure and US geographic patterns. We used binomial tests, the Pearson χ2 test, and joinpoint trend analysis with a type I error rate of .05 as the threshold for significance. RESULTS:From 2012 through 2024, a total of 376 cases of prescription fentanyl exposure among children aged <6 years were reported to NPDS. Boys (n = 179; 47.6%) and girls (n = 196; 52.1%) were equally represented (P = .48). Significantly more children aged <2 years than aged 2 to 6 years in our study group had prescription fentanyl exposure (61.5%; P < .001), and the most common formulation was transdermal patch (n = 202; 53.7%). Joinpoint trend analysis showed a slight but not significant increase in prescription fentanyl exposure among children aged <6 years from 2012 through 2015. However, from 2015 through 2024, prescription fentanyl exposure significantly decreased (annual percentage change = -7.9; P < .05). The state with the highest annual exposure rate from prescription fentanyl was Vermont (4.3 per 1 million population). CONCLUSIONS:From 2015 through 2024, during a time of increasing exposure to illicit fentanyl, prescription fentanyl exposure among children aged <6 years decreased. Safe disposal of transdermal patches is important, and caregiver education is needed to prevent serious medical outcomes.
Clinical pharmacists are increasingly recognized as vital contributors to acute stroke care, yet their role remains inconsistently defined and underutilized across health care systems. This consensus statement explores the expanding presence of clinical pharmacists within interdisciplinary stroke teams, particularly in the management of both acute ischemic stroke (AIS) and hemorrhagic stroke. This consensus statement panel was composed of clinical pharmacists, emergency medicine physicians, and a vascular neurologist. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach was used to assess the level of certainty and strength of recommendations. We focused on two questions regarding the clinical pharmacist's role in caring for adult patients presenting to the emergency department (ED) with AIS or hemorrhagic stroke. Despite the very low level of evidence, a consensus was reached for the following recommendations: (1) clinical pharmacist involvement in AIS care for adult patients presenting to the ED and (2) clinical pharmacist involvement in hemorrhagic stroke care for adult patients presenting to the ED. Based on the available literature, we believe optimizing the clinical pharmacist role is a critical factor in improving time-sensitive treatment and equity in care delivery.
Furosemide is the most commonly used diuretic in preterm infants despite an incompletely understood relationship between dosing, exposure, and safety within this population. The goals of this study were to characterize furosemide population pharmacokinetics (popPK) in preterm infants and to evaluate safety by relating simulated furosemide exposure to events of ototoxicity, nephrocalcinosis, and nephrolithiasis. A total of 146 plasma furosemide concentrations from 51 preterm (23-28.9 weeks' gestational age) infants across two studies (one randomized, placebo-controlled, dose-escalating safety trial and one opportunistic, observational study) were included in the analysis. Standard nonlinear mixed effects popPK modeling techniques were applied. Exposure was simulated using the final popPK model (area under the curve) and Monte Carlo simulations (maximum concentration [Cmax]). Logistic regression was used to evaluate the relationship between exposure and safety events. The final popPK model was a one-compartment model with the covariates of weight on volume of distribution and both weight and post-natal age on clearance. The model showed accurate predictions, adequate precision, and good model fit. Simulations indicated that furosemide 2 mg/kg administered enterally every 6 h would result in few (approximately 4%) Cmax values exceeding a 50 µg/mL threshold reported to be associated with treatment-associated ototoxicity, and no more than 1% for all other dosing regimens. Events of hearing loss, nephrocalcinosis, or nephrolithiasis were rare and showed no relationship with furosemide exposure in logistic regression analysis. These data contributed to the October 2024 FDA label update to include pediatric popPK data and improve dosing in preterm infants.
BACKGROUND:The role of flow diversion for middle cerebral artery (MCA) aneurysms remains controversial due to frequent involvement of side branches and bifurcations. While outcomes have been reported in cohort studies and case series, the safety and efficacy of this approach remain uncertain. PURPOSE:To evaluate angiographic and clinical outcomes following flow diversion for MCA aneurysms. DATA SOURCES:A systematic literature search was performed across databases in accordance with PRISMA guidelines to identify studies reporting on flow-diverter treatment of MCA aneurysms. STUDY SELECTION:Studies including ≥3 patients treated with flow-diverter devices and reporting angiographic or clinical outcomes were eligible for inclusion. Thirty-three studies encompassing 1,036 MCA aneurysms met criteria, representing the largest cohort to date. DATA ANALYSIS:Data on study design, patient and aneurysm characteristics, treatment details, and angiographic and clinical outcomes were extracted. Pooled estimates with 95% confidence intervals (CIs) were calculated using a random-effects model, with subgroup analyses by aneurysm location and device type. DATA SYNTHESIS:The pooled complete or near-complete occlusion rate was 71% at a mean follow-up of 15 months, with no significant differences across MCA segments (66% proximal, 69% bifurcation, 70% distal) or across device types. The overall complication rate was 13%, predominantly thromboembolic, with a 1% procedural mortality. Functional independence (mRS 0-2) was achieved in 90% of patients. LIMITATIONS:Included studies were predominantly retrospective cohort series and case series with heterogeneity in device type, antiplatelet regimens, follow-up duration, and outcome definitions. Publication bias and underreporting of complications cannot be excluded. CONCLUSIONS:Flow diversion for MCA aneurysms achieves approximately 71% complete or near-complete occlusion with a 13% complication rate. These findings may support its consideration in carefully selected cases, though the retrospective evidence base warrants cautious interpretation.
