2026 Southeastern Residency Conference

Evaluation of Postoperative Outcomes and the Impact of an Enhanced Recovery Pathway in Patients Who Have Undergone a Laparotomy Procedure

Mackenzie Winter Waters, Melissa Bagwell, Leborah Cole Lee, Courtney Reliford, Kayla Brown

Abstract
Purpose: Utilization of an enhanced recovery pathway (ERP) perioperatively has shown benefit in reducing postoperative symptoms, complications, length of stay, and readmission rates, but it is not widely utilized at our institution. The purpose of this study was to supplement current literature regarding the clinical impact of an ERP on patient outcomes following surgical procedures by retrospectively assessing patients’ postsurgical outcomes as it relates to ERP utilization compared to those who received standard of care. The hypothesis of this study is that implementation of an ERP would result in a reduction in opioid consumption and a decrease in postoperative complications.

Methods: This single-center, retrospective chart review was approved by the Institutional Review Board at East Alabama Medical Center (EAMC) and evaluated the impact of an ERP after the following elective open laparotomy surgical procedures: gynecologic-oncologic, colorectal, and/or hysterectomy. The primary outcome was total morphine milliequivalents (MME) utilized during inpatient hospitalization stay (IHS). Secondary outcomes included average pain scales, adverse drug events related to narcotics, prescribed narcotic(s) on discharge, incidence of postoperative ileus, incidence of acute kidney injury, adherence to the ERP postoperative analgesic medication regimen (> 75% scheduled doses received), average daily dose of narcotics (in MME) and non-narcotic medications (in mg) used for pain management, length of IHS, 30- and 90-day hospital readmission, and 90-day mortality. Patients were identified using the electronic medical record and assessed for the following inclusion criteria: ≥19 years of age and hospitalized for previously defined elective surgical procedures between May 1, 2024, and May 31, 2025. Exclusion criteria included pregnancy, prisoners, males, length of IHS <24 hours, patients admitted with a bowel obstruction or ileus prior to surgery, and patients who received a patient-controlled analgesia pump for pain management. Criteria were assessed to obtain at least 50 patients in the ERP group and 50 patients in the non-ERP group. Data analysis was conducted using a Chi-square, Fisher’s exact test, Student’s t-test, or Mann-Whitney U test dependent on data type and distribution. All statistical analyses were performed in IBM SPSS Statistics version 30.0.0.0 (IBM Corp., 2024).

Results: There were 1,582 patients screened for inclusion, with 50 patients in each group meeting inclusion criteria. Patients within the ERP group used a lower amount of total MME compared to the non-ERP group (median 766.3 versus 935, P = 0.046). The ERP group had a lower average daily MME utilization (median 242.5 versus 316.7, P = 0.005), lower average pain scales (median 3.4 versus 5.5 (on a 10-point scale), P < 0.001), and a higher average daily utilization of APAP in mg (median 2066.7 versus 1175, P < 0.001). Differences in narcotics prescribed at discharge showed statistical significance (P < 0.001), and post-HOC analysis was performed with the adjusted P value for significance set at < 0.008. Oxycodone was prescribed more frequently in the ERP group (68% versus 28%; P < 0.001) and oxycodone-APAP prescribed more frequently in the non-ERP group (50% versus 10%; P < 0.001). All other secondary outcomes did not show statistical significance.

Conclusion: Utilization of an ERP perioperatively resulted in clinically and statistically significant reductions in narcotic utilization and average pain scales throughout hospitalization. One strength is this study included evaluation of pain outcomes in invasive surgical procedures, which are associated with higher pain scores and longer length of inpatient hospital stay compared to non-invasive surgeries. One limitation of this study was that men were excluded due to the nature of procedures that utilized an ERP. In the future, our organization plans to expand the use of an ERP to other surgical areas, including colorectal surgeries and cesarean deliveries.

Authors: Abigail Murray, Brittany Melville, Micah Corriher, Camille P. Robinette 
 
Background: Metformin remains a cornerstone of type 2 diabetes treatment due to its efficacy and safety, but long-term use can reduce vitamin B12 absorption, potentially causing neuropathy, anemia, cognitive changes, and fatigue. The American Diabetes Association (ADA) Standards of Care 2026 recommend annual vitamin B12 monitoring for patients receiving long-term metformin. However, no standardized monitoring process exists within the Salisbury Veterans Affairs Health Care System (SVAHCS). This project evaluated adherence to ADA-recommended vitamin B12 monitoring among Veterans receiving long-term metformin therapy. 
 
Methodology: Veterans across SVAHCS, including Salisbury, Charlotte, and Kernersville locations aged ≥18 years prescribed metformin or Synjardy® (empagliflozin/metformin) for ≥4 consecutive years were included. Eligible Veterans had an active outpatient prescription filled between November 1, 2020, and October 31, 2021, and at least one additional fill between May 1, 2025, and October 31, 2025. The primary outcome was the percentage of eligible Veterans with a documented vitamin B12 level within the previous 12 months. Secondary outcomes included the percentage of Veterans with vitamin B12 deficiency or borderline deficiency within the past year.  Data were extracted from the VA Corporate Data Warehouse and included demographics and vitamin B12 laboratory results obtained within the previous 12 months. Descriptive statistics were used for analysis. 
Results: A total of 5,037 Veterans met inclusion criteria. The mean age was 70.6 years (range 29–100), and 94.4% were male. Among the cohort, 1,617 Veterans (32.1%) had a documented vitamin B12 level within the past 12 months, while 3,420 (67.9%) did not receive recommended monitoring. Among patients with laboratory testing, 13 Veterans (0.8%) had vitamin B12 deficiency and 244 (15.0%) had borderline vitamin B12 deficiency. 
Conclusions: Adherence to ADA-recommended annual vitamin B12 monitoring among Veterans receiving long-term metformin therapy was low. These findings highlight an opportunity to improve guideline-concordant care through targeted provider education and system-level interventions to increase routine vitamin B12 monitoring and support earlier identification of deficiency. 

Results: A total of 5,037 Veterans met inclusion criteria. The mean age was 70.6 years (range 29–100), and 94.4% were male. Among the cohort, 1,617 Veterans (32.1%) had a documented vitamin B12 level within the past 12 months, while 3,420 (67.9%) did not receive recommended monitoring. Among patients with laboratory testing, 13 Veterans (0.8%) had vitamin B12 deficiency and 244 (15.0%) had borderline vitamin B12 deficiency. 
Conclusions: Adherence to ADA-recommended annual vitamin B12 monitoring among Veterans receiving long-term metformin therapy was low. These findings highlight an opportunity to improve guideline-concordant care through targeted provider education and system-level interventions to increase routine vitamin B12 monitoring and support earlier identification of deficiency. 

Conclusion: Adherence to ADA-recommended annual vitamin B12 monitoring among Veterans receiving long-term metformin therapy was low. These findings highlight an opportunity to improve guideline-concordant care through targeted provider education and system-level interventions to increase routine vitamin B12 monitoring and support earlier identification of deficiency.

Poster Abstract Title: Pharmacist-Led Calcium Replacement in Trauma Patients
Primary Author: Aileen Jimenez
Contact: [email protected]
Co Authors: Heather Wilson and Madeline Mitchell
Background: Blood product administration has been associated with hypocalcemia in trauma patients receiving massive transfusion protocol (MTP) due to the binding of calcium by citrate. Calcium plays an important role in cardiac contractility and associated cardiac output. It also serves as a cofactor for vitamin K dependent clotting factors in the coagulation cascade; therefore, hypocalcemia is associated with increased mortality in trauma patients given its ability to potentiate coagulopathy, acidosis, and hypothermia. The purpose of this project was to evaluate the impact of standardized, pharmacist-led calcium replacement on hypocalcemia within 36 hours of administration of blood.
Methods: This is an IRB-reviewed, determined exempt, retrospective chart review from July 1, 2024 to February 28, 2026. Adult trauma patients, 18 years or older, who received two or more units of blood within a 24-hour period, and were subsequently admitted to an ICU were included. Data points include volume of blood products received, type and dose of calcium product received, timing of first basic metabolic panel (BMP) or arterial blood gas (ABG) after receipt of blood products, ionized calcium, serum calcium, and/or corrected calcium, and occurrence of hypo-/hypercalcemia. The primary outcome of this study was incidence of hypocalcemia within 36 hours the blood transfusion event. Secondary outcomes included achievement of normocalcemia within 36 hours of the blood transfusion event, continued normocalcemia at 72 hours, time between pRBC administration and calcium replacement, time between pRBC administration and first normalized calcium, percentage of patients with hypocalcemia who received calcium within 36h, and in-hospital mortality.
Results: Overall, 47 patients were included: 30 patients in the pre-group and 17 in the post-group. Baseline characteristics were similar between groups except for volume of fresh frozen plasma (FFP) and cryoprecipitate received (p<0.05). There was a statistically significant difference in the primary outcome of hypocalcemia within 36 hours in the pre-group vs post-group, respectively (90.0% vs 58.8%; Fisher's Exact OR: 0.1587; 95% CI (Corrected): [0.0416, 0.7630]; p=0.0232].. Additionally, there was a statistically significant difference in achievement of normocalcemia within 36 hours (55.6% vs 20.0% ; [OR: 0.2000 95% CI (Corrected): [0.0481, 1.1689] p<0.05) and time between pRBC administration and calcium replacement (9.6 hours v 5.8 hours; [median difference -3.79; 95% CI: [-10.71, -1.23]; p<0.05]). Overall, calcium was replaced more frequently in the pre-group compared to the post-group, but this difference was not statistically significant (56.7% vs 47.1% [OR 0.6797; 95% CI [0.2150, 2.2158]; p=0.5583).
Conclusion: The results suggest that the implementation of a pharmacist-led calcium replacement protocol resulted in less hypocalcemia at 36 hours; however, these results may be influenced by calcium being normal at baseline in the post-group. While pharmacist-led calcium replacement was also associated with a significantly lower time to calcium replacement, this did not result in quicker resolution of hypocalcemia. Limitations of this research include a small sample size, retrospective nature, potential for calcium receipt prior to ICU admission, and lack of differentiation between whole blood and pRBC. Future studies assessing a larger group would be beneficial to more clearly delineate the role of pharmacist-led calcium replacement on calcium levels in trauma patients.

Comparing Tenecteplase and Alteplase for Acute Ischemic Stroke: A Real-World Evaluation of Efficacy and Safety  
Catherine Wise, Katleen Chester, Olivia Morgan, Morgan Daniel; Grady Memorial Hospital, Atlanta, Georgia 
Background: 
Acute ischemic stroke (AIS) is a leading cause of morbidity and mortality worldwide. Intravenous fibrinolytics have been the standard of care for AIS for decades, with alteplase historically being the fibrinolytic of choice, however, there is an expanding body of evidence supporting tenecteplase as a safe and effective alternative fibrinolytic. Tenecteplase is a genetically modified variant of alteplase, with increased fibrinogen binding specificity and extended half-life. Unlikealteplase, which has continuous infusions, tenecteplase is administered as a single intravenous bolus, offering practical advantages such as greater workflow efficiency and rapid treatment initiation, leading to shorter door-to-needle (DTN) times, which may translate to improved reperfusion and patient outcomes. Clinicaltrials, including the EXTEND-IA TNK trial further reported improved reperfusion rates when tenecteplase was administered prior to thrombectomy compared with alteplase. The AcT trial further demonstrated that tenecteplase achieves comparable rates of early recanalization and functional recovery, as assessed by the modified Rankin Scale (mRS). Observational cohort studies suggest real-world benefits, including shorter DTN and door-to-puncture (DPT) times. This study aims to further evaluate tenecteplase and alteplase in real-world practice, with an emphasis on safety and efficacy, to assess potential to enhance stroke care and optimize patient recovery within a high-volume comprehensive stroke center. 
Methods: 
This is a single-center retrospective chart review of patients who presented to Grady Memorial Emergency Care Center who received intravenous fibrinolytics (tenecteplase or alteplase) for AIS treatment between January 2021 to April 2025. Patients under the age of 18, received intravenous fibrinolytics en route to Grady Memorial Hospital via our Mobile Stroke Unit, and in-house stroke patients were excluded from this study. Data was obtained from Institutional Stroke Committeefibrinolytic pharmacy data reports and the Marcus Stroke and Neuroscience Center. The primary outcome of the study was the functional status, defined as mRS, at discharge. Secondary outcomes included average 90-day mRS score, functional independence at 90 days (mRS score of 0-2), Onset-to-Treatment Time (OTT), DNT, DPT for thrombectomy patients, incidence of thrombectomy, successful reperfusion, defined as a TICI score of 2b or 3, incidence of symptomatic intracranial hemorrhage (sICH), defined as neurological deterioration (≥4-point NIHSS increase) attributed to new intracranial hemorrhage on imaging, and overall length of stay (LOS). 
Results:  
A total of 625 patients were included in the analysis; 246 received tenecteplase and 379 received alteplase. Median admission mRS scores were 0 (IQR 0–1) in both groups. Median admission NIHSS scores and functional independence at discharge did not differ between the tenecteplase and alteplase groups. Discharge mRSscores, and hospital length of stay were similar between the two groups. Median OTT time and DTN times were also not found to be significantly different. Inmechanical thrombectomy patients, median DTP time was 83 minutes for tenecteplase and 90.5 minutes for alteplase (p = 0.381). Mechanical thrombectomy was performed in 24.4% of patients treated with tenecteplase and 21.1% of patients treated with alteplase (p = 0.336) with successful reperfusion was achieved in 100% of tenecteplase and 98.8% of alteplase patients (p = 0.728). SICH occurred in 0.4% of patients in the tenecteplase group and 1.3% of patients in the alteplase group (p = 0.41). 
Conclusion:  
Tenecteplase and alteplase are considered similar when it comes to safety and efficacy of the two fibrinolytics with no significant difference to show between the two medications. Similar safety and efficacy features can show that tenecteplase could become a strong medication as reflected in our 2026 acute ischemic stroke guidelines. 
 
For additional questions: Contact [email protected] 

Impact of Early Methylene Blue on Vasopressor-Free Days in Medical ICU Patients with Septic Shock

Purpose: Septic shock remains a leading cause of intensive care unit (ICU) mortality despite standard therapies such as early antibiotics, fluids, vasopressors, and corticosteroids. Methylene blue has been utilized as an adjunctive agent in the treatment of septic shock by targeting nitric-oxide mediated vasodilation. However, data is lacking. The purpose of this study is to evaluate the impact of early methylene blue administration on vasopressor alive and free days at 28-days in adult patients with septic shock in the medical ICU.

Methods: This single-center, retrospective, cohort study will include adult patients admitted to the medical ICU with septic shock between January 1, 2022 and June 30, 2025 who received norepinephrine, vasopressin, and adjunctive hydrocortisone. The intervention group will consist of patients who additionally received methylene blue within 36 hours of vasopressor initiation and met prespecified inclusion/exclusion criteria. The control group will consist of patients meeting the same inclusion/exclusion criteria but did not receive methylene blue. The primary outcome is vasopressor alive and free days at day 28. Secondary outcomes include daily cumulative vasopressor dose during the first 72 hours after vasopressor initiation, time to vasopressor discontinuation, recurrence of septic shock, ICU and hospital length of stay, and 28-day mortality. Those who receive methylene blue will be assessed for shock liver/liver failure as evidenced by elevated liver function tests three times the upper limit of normal or total bilirubin ≥2 mg/dL, and documentation of serotonin syndrome within 5 days after initiation of vasopressors. Other safety outcomes will include arrhythmias and limb or mesenteric ischemia during the 28-day follow-up period. Data will be collected from the electronic medical record (EMR), recorded using REDCap, and analyzed using appropriate statistical tests.

Results: In progress

Title: Adherence to Venous Thromboembolism Prophylaxis Protocol in High-Risk Bariatric Surgery Patients
Authors: Ashley Bennett, Adele Robbins, Angelita Incer
Emory Saint Joseph's Hospital - PGY1 - Atlanta, Georgia 
Background/Purpose:  Venous thromboembolism (VTE) is a recognized postoperative complication following bariatric surgery, with risk stratification performed using the Cleveland Clinic Risk Score (CRC). Emory Saint Joseph’s Hospital implemented a standardized postoperative enoxaparin protocol for high-risk patients to mitigate this risk. According to the protocol, enoxaparin should be initiated within 14 hours of surgery, with dosing adjusted based on body weight and creatinine clearance. High-risk patients, defined as those with a CRC score >0.4, are recommended to continue enoxaparin upon discharge for ongoing VTE prophylaxis. The purpose of this study was to evaluate the compliance rate with the bariatric surgery postoperative enoxaparin protocol for venous thromboembolism prophylaxis. 
Methodology: Single-center, retrospective chart review of adult patients who underwent bariatric surgery at Emory Saint Joseph’s Hospital between January 1, 2024, and December 31, 2024. Protected/vulnerable patient populations, including pregnant patients and prisoners, were excluded from the study. The primary outcome was compliance rate with the bariatric surgery postoperative enoxaparin protocol for venous thromboembolism (VTE) prophylaxis. Secondary outcomes included incidence of VTE within 30-days of operation, bleeding complications, length of stay, and all-cause mortality within 30 days of operation. Process-related outcomes included time to first dose of enoxaparin postoperatively and dosing adherence. Continuous variables were summarized using medians and interquartile ranges (IQR). Categorical variables were summarized as counts and percentages. 
Results: A total of 118 patients were included in the study, with 86 (72.9%) demonstrating full protocol compliance. Full compliance was achieved if the patient received the correct dose of enoxaparin on the evening of surgery and was appropriately discharged on prophylaxis. Process measure adherence was variable: 96/118 (81.4%) received the first dose within 14 hours postoperatively, and 102/118 (86.4%) were dosed appropriately based on BMI and renal function. Nine patients (5.2%) were classified as high risk (CRC score >0.4). Among these, only 1/9 (11.1%) were appropriately discharged on VTE prophylaxis. Clinical outcomes at 30 days included 3 VTE events (1.7%) and no bleeding or mortality observed. There were no differences in clinical outcomes, such as VTE events or length of stay (LOS), between compliant and non-compliant patients.
Conclusions: Overall, compliance with the bariatric surgery enoxaparin prophylaxis protocol was achieved in 72.9% of patients. Gaps were identified in postoperative administration, timing, dosing, and discharge prescribing for high-risk patients. Despite low compliance, the observed incidence of VTE, bleeding, and mortality was low within 30 days.

Correlation of Methicillin-Resistant Staphylococcus Aureus Polymerase Chain Reaction Nasal Swab in Empyema
Elliott Wilch; Sarah Frye; Martin Gordon; Cragin Currence

Background: Empyema or pyothorax is defined by the presence of purulent exudate in the pleural space and is a life-threatening infectious condition. The most common cause of empyema is bacterial pneumonia and its resulting parapneumonic effusion. Among these patients, 5 to 10% will develop empyema and 30% will require surgical drainage. The American Association of Thoracic Surgery (AATS) Guidelines for the Management of Empyema recommend covering for methicillin-resistant Staphylococcus aureus (MRSA) in patients with hospital acquired empyema as well as those with post-surgical infections. Both the Infectious Disease Society of America (IDSA) and the AATS guidelines do not provide any guidance on de-escalation of antibiotics before the availability of definitive cultures. This contributes to extended durations of anti-MRSA antimicrobials, potentially leading to antimicrobial resistance, Clostridium difficile infections, increased lengths of stay, and increased costs. The clinical utility of MRSA polymerase chain reaction (PCR) nasal swab is well established for antibiotic de-escalation in pneumonia, with multiple studies showing that an MRSA PCR nasal swab has an excellent negative predictive value (NPV) of up to 98%. These studies have demonstrated that the MRSA PCR nasal swab can be a tool used in antimicrobial stewardship to avoid unnecessary anti-MRSA antibiotics as empiric therapies. While the MRSA PCR nasal swab has demonstrated value in pneumonia, very few studies exist assessing its use in infections such as empyema. The following study was conducted to assess the correlation of MRSA PCR nasal swab in patients with empyema.
Methods: This was a single-center, retrospective cohort study assessing the correlation of MRSA PCR nasal swab in empyema. Adult patients with the diagnosis of empyema who had an MRSA PCR obtained during admission were included in the study. Patients were excluded if there were no definitive cultures collected. The primary outcome for the study was the correlation between the MRSA PCR nasal swab and definitive cultures utilizing NPV in patients with empyema. Secondary outcomes included the correlation between the MRSA PCR nasal swab and definitive cultures utilizing specificity, sensitivity, and positive predictive value in patients with empyema. Antimicrobial agent, duration, and time between culture collection and initiation of antibiotics were also analyzed in the study.
Results: Among the 355 patients initially reviewed, 118 did not meet the inclusion criteria, most commonly due to a lack of culture collection. There were 237 patients included in the final analysis. The primary outcome of negative predictive value was 96%. The secondary outcomes of positive predictive value, sensitivity, and specificity were 45%, 55%, and 94.5% respectively.
Conclusion: When examining the utility of the MRSA PCR in empyema, the NPV and specificity were 96% and 94.5% respectively. This study demonstrates that the MRSA PCR nasal swab assay has the potential to be a vital tool in de-escalating antimicrobial therapy in empyema. Utilizing this tool as a means of de-escalation has multiple potential benefits including limiting MRSA antimicrobials and their associated side effects, reducing rates of resistance, and possibly leading to decreased costs for the patient and the healthcare system. While these results are promising, there are several limitations to this study, primarily its retrospective nature and its limited sample size. Future prospective studies are needed to generalize the findings in larger patient populations.

Emily Robert, Michelle Alonso, and Hunter Perrin
James H. Quillen Veteran Affairs Medical Center – Mountain Home, TN
Contact Information: [email protected]
Background/Purpose: Electrolyte deficiencies are common throughout patient care and often require timely replacement to avoid adverse events. Disturbances in electrolytes are particularly important due to the potential to cause life-threatening complications such as cardiac arrhythmias, seizures, neuromuscular dysfunction, and hemodynamic instability. Despite their clinical significance, electrolyte replacement practices are often variable and provider dependent. The Institute for Safe Medication Practices (ISMP) highlights in its 2024-2025 Targeted Medication Safety Best Practices that hospitals should implement layered strategies across the entire medication-use process to improve safety with high-alert medications, including electrolytes. The purpose of this quality improvement project is to align James H. Quillen Veterans Affairs Medical Center (JHQVAMC) medication-use processes with the 2024-2025 ISMP Targeted Medication Safety Best Practice recommendations regarding high-alert medications used for electrolyte replacement therapies.
Methodology: This project aims to evaluate existing electrolyte replacement protocols and order sets, as well as develop new ones as necessary. This project also aims to ensure appropriate electrolyte replacement product utilization and storage. Accomplishing this will require evaluation of the JHQVAMC current electrolyte replacement practices, including revision of current protocols and order sets. Adjustments to current protocols and order sets will include indication, dosing, frequency, duration, and comments regarding appropriate administration and monitoring. The electrolyte protocols and order sets will be submitted for final approval by the Medication Safety Committee and Pharmacy and Therapeutics Committee. Implementation will occur in the emergency department, hematology/oncology clinic, and inpatient wards, including the intensive care unit. Targeted education will be provided by pharmacy services prior to implementation. A retrospective analysis will be conducted comparing data from a pre-implementation period (June 1, 2025 to September 1, 2025) to a post-implementation period (three months; dates to be determined). Data to be collected during pre- and post-implementation time frames will include: patients with potassium < 3.6 mEq/L or phosphorus < 2.3 mg/dL, number of electrolyte replacement order sets available within the electronic health record (EHR), number of electrolyte replacement protocols available within the EHR, potassium and phosphorus supplementation for potassium < 3.6 mEq/L or phosphorus < 2.3 mg/dL, potassium and phosphorus lab values following supplementation, and Omnicell stocking reports to determine presence of concentrated electrolyte vials intended for dilution.
Results: In progress
Conclusions: In progress

Background: Acute ischemic stroke (AIS) is a major cause of disability and death in the United States. Early medical management for AIS is essential for reducing morbidity and mortality. While mechanical thrombectomy (MT) has been shown to improve outcomes in patients with large-vessel occlusions (LVO), complications such as re-occlusion and early neurological deterioration (END) continue to pose significant challenges. Glycoprotein IIb/IIIa inhibitors, such as tirofiban, have demonstrated potential benefit in a subset of patients following thrombolytic and/or MT; however, data supporting their routine use post-thrombectomy is limited. Piedmont Columbus Regional Midtown (PCRM) currently uses tirofiban in select post-thrombectomy patients at high risk of re-occlusion  , determined by the treating physician based on clinical presentation and angiographic findings. This study aims to evaluate the safety and efficacy of PCRM’s targeted post-thrombectomy tirofiban strategy compared to a matched cohort from the pre-tirofiban era, with a focus on functional outcomes and END.  
Methods: A retrospective matched cohort study was conducted on adult patients with LVO stroke who received tirofiban within 3 hours of MT at Piedmont Columbus Regional Medical between January 1, 2024 and December 31, 2025. The primary outcome objective was incidence of END, defined as increase in National Institutes of Stroke Scale (NIHSS) of > 2 within 24 ± 6 hours of mechanical thrombectomy (MT). Secondary objectives included frequency of re-intervention within 48 hours of initial MT, modified Rankin Scale (mRS) at discharge or 90-days post initial intervention, and rate of symptomatic intracranial hemorrhage. A control group was constructed using exact matching on key pre-treatment variables. In total, six patients were included in the treatment group and twelve patients were included in the control group. Data were analyzed using t-tests for continuous variables and Fisher’s exact test for categorical variables.
Results: For the primary objective of END, 50% of patients in the treatment group meet END criteria versus 20% in the control group. For secondary objectives, one patient in the control group required re-intervention while no patients in the treatment group required re-intervention. All treatment group participants had a discharge/90-day mRS of 3-5 compared to 66.7% of control group participants. No patients in either group experienced symptomatic hemorrhagic conversion. None of these outcomes were found to be statistically significant.
Conclusion: There were no statistically significant differences in assessed safety or functional outcomes between groups.
Contact: [email protected]

Does Probiotic Use Protect Against Clostridioides difficile Infections in Patients Taking Antibiotics?

Investigators: Brittany Baskett, Kaitlyn Ledet, Melanie Rae Schrack

Practice Site: FMOL Health - Our Lady of the Lake

Email: [email protected]

Purpose: Patients on prolonged antibiotics are at increased risk of contracting a Clostridioides difficile infection (CDI). The 2017 Infectious Disease Society of America and Society for Healthcare Epidemiology of America guideline for management of CDI stated there is insufficient data to recommend administration of probiotics for primary prevention of CDIs outside of clinical trials, while the 2021 American College of Gastroenterology guideline for management of CDI recommends against prophylactic probiotic use. Recently published data in critically ill patients indicate that probiotics used for CDI prevention during antibiotic therapy may increase the risk of probiotic-related bacteremia. Given a recent rise in probiotic prescribing at this site for primary CDI prevention, this study aimed to evaluate whether probiotics reduce CDI risk in patients receiving antibiotics for five or more days without increasing bacteremia risk.
Methods: This study was a single-center, retrospective chart review of patients admitted to any intensive care or progressive care unit at FMOL Health – Our Lady of the Lake from January 2024 to December 2024. Patients were excluded from data analysis if they were less than 18 years of age, received an antibiotic regimen including less than two antibiotics, antibiotic regimen less than five days or greater than 30 days, had infectious diarrhea of other causes, or a history of pre-existing gastrointestinal disorders. Included patients were split into two groups: receipt of antibiotics without probiotics and receipt of antibiotics with three or more days of concurrent probiotic administration.
The primary outcome was the incidence of hospital-acquired CDI. HA-CDI (hospital-acquired CDI) was defined as a positive C. difficile antigen and toxin test after 72 hours of admission to the hospital. Secondary outcomes included incidence of Lactobacillus bacteremia and percent days covered by probiotics.
Results: A total of 441 patients were included in this study with 147 patients in the probiotic group and 294 patients in the control group. In the control group, one patient (0.3%) was diagnosed with HA-CDI, while five patients (3.4%) in the probiotic group were diagnosed with HA-CDI. There were no incidences of Lactobacillus bacteremia. Average percentage of probiotic coverage was 68% of antibiotic days in the probiotic group.
Conclusion: Among critically ill patients requiring at least two antibiotics for at least five days, there was a difference between groups with HA-CDI occurring more often in the probiotic group. This study supports guideline statements that there is not a widely recognized benefit to prescription of probiotics for prevention of CDI; however, there was no demonstrated harm found in this study.

Background: Sepsis is a life-threatening emergency with the potential for high morbidity and mortality. Sepsis often has nonspecific symptoms; however timely recognition of infection-related symptoms is critical. Timing of antibiotic administration is directly linked to improved patient outcomes, whereas delay of subsequent antibiotic doses leads to unfavorable patient outcomes.1 This study aims to identify the presence of significant delays in second dose antibiotics following admission and the associated cause of delay.
Methods: This is an Institutional Review Board exempt, multicenter, retrospective chart review within the Baptist Health system. Patients who presented to an emergency department (ED) within the Baptist Health system were identified through an electronic report. A chart review was performed from August 2024 to January 2025 capturing patients with a sepsis diagnosis. The primary outcome was the rate of subsequent antibiotic doses given outside of a 25% variance of the initial antibiotic dosing interval. Secondary outcomes include degree of delays, cause of delays, and all-cause mortality.   
Results: A total of 295 patients were reviewed with 200 included. Eligible patients were female, of black ethnicity, with a median age of 64 years. The most common admitting diagnosis was community acquired pneumonia. All patients had an attributable source of infection, with 73% meeting at least 2 systemic inflammatory response syndrome (SIRS) criteria consistent with a sepsis diagnosis. Ceftriaxone was the most frequently administered first-dose antibiotic in the ED. Bacterial pneumonia was most likely to have combination empiric therapy with azithromycin while all other indications – including urinary tract infections, skin and soft tissue infections – were often paired with vancomycin. Upon admission, subsequent antibiotic selections included equal quantities of piperacillin-tazobactam and cefepime with a reduction in ceftriaxone continuations. The primary outcome of a greater than 25% variance in antibiotic administration was present in 30.5% of patients. Preemptive doses greater than 25% were present in 26.5% of patients and were most frequently with ceftriaxone. Delays greater than 25% were present in 4% of patients and most frequent with piperacillin-tazobactam dosed at an 8-hour interval. The degree of delay ranged from 26% – 101% and was most commonly due to ordering, followed by administration. Mortality rate present in the preemptive, in-range, and late groups was 28%, 9%, and 12.5%, respectively.
Conclusion: The importance of appropriate timing of subsequent antibiotics in septic patients cannot be overstated. While this study found a moderate incidence of variance in second-dose antibiotics, only 4% had the potential to experience significant harm due to delays greater than 25%. The Baptist Health System may benefit from additional education regarding the once-dose process in the ED to further reduce incidence of ordering delays. Additionally, pharmacy staff may benefit from education on recommended dosing intervals and appropriate timing of common antibiotics utilized in the ED for septic patients.

Impact of Pharmacist Education on Opioid Stewardship Interventions in a Community Hospital 
Authors: Malena Pontrich; Will Stewart
Background:
Opioid stewardship is an important component of patient safety and therapy augmentation. The 2022 CDC Clinical Practice Guidelines for Prescribing Opioids for Pain endorse the use of collaborative efforts among a variety of clinicians, including pharmacists, for integrated pain management. This study is designed to evaluate the impact of pharmacist education on the average number of opioid stewardship clinical interventions per month. Secondary outcomes will include monthly averages of patients discharged with naloxone prescriptions after an opioid stewardship intervention occurred, and average morphine milligram equivalents (MMEs) received per day while inpatient.
Methods:  
This retrospective study was approved by the local Institutional Review Board. Patients admitted to Baptist Health Lexington were included if they were over the age of 18 and had a pharmacist-led opioid stewardship intervention documented during their admission. Subjects were excluded if they were incarcerated patients, pregnant patients, hospice patients, enhanced recovery after surgery (ERAS) patients, or patients with patient-controlled analgesia (PCA). Clinical pharmacists received education on internal opioid stewardship workflow guidelines including possible opioid stewardship intervention types, appropriate use of opioid stewardship interventions, and documentation in the electronic health record. Baseline data on the number of opioid stewardship interventions, naloxone prescriptions at discharge, and average inpatient MMEs was collected from the electronic health record for the six months preceding the intervention, March 2025 through August 2025. The same data was collected for the six months after the education occurred, September 2025 through February 2026. The findings from the pre- and post-intervention stages will then be evaluated.
Results:
Among the 142 interventions included in the final study, 74 were in the pre-intervention group and 68 were in the post-intervention group. Among both groups the breakdown of intervention subtypes in the pre-intervention and post-intervention cohorts, respectively, is as follows: alternative therapy 9 (12.16%) vs 16 (23.53%, discontinuation of opioid 38 (51.35%) vs 31 (45.59%), dose change 13 (17.57%) vs 6 (8.82%), drug information/consultation 7 (9.09%) vs 3 (4.41%), initiation of naloxone 2 (2.70%) vs 6 (8.82%), none selected 5 (6.76%) vs 6 (8.82%). For the primary objective, the pre- and post-intervention average monthly number of opioid stewardship interventions was 12.33 and 11.33 (p = 0.50), respectively. For secondary objectives, the average number of naloxone prescriptions written at discharge per month was 0.7 before pharmacist education and 2.0 after pharmacist education (p = 0.03). The average number of MMEs administered per patient per day while admitted was 57.82 and 51.86 (p = 0.50) pre- and post-intervention, respectively.
Conclusions:
There was no statistically significant difference in the average number of opioid stewardship interventions documented per month in the pre- and post-intervention groups (p = 0.50). There was a statistically significant increase in the average number of naloxone prescriptions written at discharge (p = 0.03). There was no statistically significant difference in the monthly average of inpatient MMEs administered per patient per day (p = 0.50). Pharmacist education did not significantly impact the average number of opioid stewardship interventions or the average number of MMEs administered per patient per day. The average number of naloxone prescriptions written at discharge was significantly increased after pharmacist education on opioid stewardship workflow. Limitations include a small sample size, the exclusion of a large portion of the initial sample population after applying exclusion criteria, staff turnover, and variation in hospital census. Outpatient opioid doses and length of stay were also not accounted for when quantifying administered MMEs for patients which may have impacted results. 

Evaluation of Atrial Fibrillation Post-Left Ventricular Assist Device Authors: Glennessa Hodge, Anna Crider, Brian Tran, Kiara Patino, Eleanor Schoen, Mahmoud H. Abdou Background  
Atrial fibrillation is a common postoperative complication following ventricular assist device (VAD) placement contributing to significant morbidity. Beta-blockers are considered first-line agents for the prevention of postoperative atrial fibrillation (POAF); however, many VAD patients are not on beta-blockers preoperatively due to relying on inotropes. Amiodarone is commonly used to reduce the incidence of POAF; however, its role and optimal duration in VAD recipients remains unclear. Current guidelines offer varying recommendations on dosing and therapy duration, ranging from 4 to 12 weeks. This study aims to identify the incidence of POAF, assess the use of amiodarone in management, and explore the impact on patient outcomes.    
Methods  
This study was a retrospective chart review of patients who received a left ventricular assist device (LVAD) at Emory University Hospital (EUH) or Emory Saint Joseph’s Hospital (ESJH) from October 1st, 2022, to March 31st, 2025. 
The primary outcome of this study was to identify the incidence of atrial fibrillation from LVAD implant to post-operative day 90. Secondary objectives included 90-day rehospitalization, postoperative total length of stay, thromboembolic or stroke incidence, and death. Amiodarone dosing was up to provider discretion as there were no protocols in place during this study time frame. Descriptive statistics include mean, median, or mode as appropriate to assess the primary and secondary outcomes. A multivariate regression analysis was conducted to compare POAF and non-POAF patients to identify associated risk factors.   
Results
POAF was seen in 71 out of 119 (37.5%) participants. 90-day all cause and arrhythmia related rehospitalization were 69 (36%) and 12 (6%) out of 190 respectively. The median postoperative length of stay was 22 in the total population, 24 (IQR 19-38.5) amongst POAF patients, and 20 (IQR 16-25.5) for non-POAF patients. 90-Day mortality was 18 (9%) out of 190, 6 from the POAF group and 12 from the non-POAF group. Antiarrhythmics used to treat POAF were amiodarone (35.3%), digoxin (4.2%), and dofetilide (0.5%). Majority of POAF patients were treated with intravenous amiodarone and then transitioned to oral amiodarone 200 mg daily at discharge. 43% of patients discharged on amiodarone did not have their amiodarone plan readdressed within 90 days post discharge. Of the 73 out of patients who received amiodarone prophylaxis for a median of 14 days, 44 (60.2%) did not experience POAF (OR = 1.77, 95% CI = 0.64 - 2.14).  
Conclusion
The POAF incidence is consistent with the 15-50% reported from previous studies. The patient population had common risk factors for POAF, including older age (≥ 60, 42.8%), male sex (77%), hypertension (76%), diabetes (46%), and non-ischemic cardiomyopathy (75%). Amongst patients that experienced POAF, approximately 89.5% were managed with amiodarone at a variety of doses. 56% of patients were on amiodarone prior to admission and 7% were intentionally placed or continued amiodarone for prophylaxis per documentation. 
Analysis of all patients that received amiodarone within the 72 hours immediately prior to LVAD implantation, revealed a greater percentage of patients who got prophylaxis did not experience POAF, however this study was not adequately powered to detect significant difference in outcomes. 90-day outcomes between patients that did and did not experience POAF were similar, however, the POAF group had a longer length of stay at 24 days and a higher percentage of cardiac related readmission compared to the non-POAF group.  
This study suggests a possible benefit in amiodarone prophylaxis in patients with high risk features or history of atrial fibrillation prior to LVAD. The exact dosing regimen and duration is still to be explored, but our study found that higher cumulative amounts of amiodarone did not show better outcomes.

Title: Efficacy and Safety of Sugammadex Versus Neostigmine for Neuromuscular Blocker Reversal Following Minimally Invasive Direct Coronary Artery Bypass 
Authors: Micah Wilson and Jeannie Watson

Introduction: Neuromuscular blocking agents given for anesthesia are reversed with neostigmine or sugammadex to facilitate extubation. Due to neostigmine's shorter half-life and indirect mechanism of action1, patients may require additional doses in order to achieve extubation, leading to longer recovery times, increased risk of complications and costs2. Sugammadex however, has a longer half life, less adverse effects, and has a direct mechanism of action3. The purpose of this study was to evaluate the safety, effectiveness, and cost associated with each agent.  
Methods: This is a single-center, retrospective, cohort study utilizing electronic medical records of adult patients undergoing minimally invasive direct coronary artery bypass (MIDCAB) procedure and receiving either sugammadex or neostigmine/glycopyrrolate at Ascension Saint Thomas Hospital West from January 2021 to September 2025. Patients were included if they were 18 years of age or older and received either sugammadex or neostigmine/glycopyrrolate post-MIDCAB. Patients were excluded if they originally failed reversal with neostigmine, returned to the operating room for complications, were on mechanical circulatory support, pregnant or incarcerated. The primary outcome was to determine whether there was a difference in the time to extubation between both cohorts. Secondary outcomes included total hospital length of stay, total time spent in the ICU (Intensive Care Unit) post-op, reintubation rates, occurrence rate of safety objectives, and cost per dose.
Results: A total of 156 patients were included in the study, with 78 patients receiving sugammadex and 78 patients receiving neostigmine. The primary outcome was found to be statistically significant, with patients receiving sugammadex spending significantly shorter time intubated when compared to neostigmine. (3.9 hours vs.7.9 hours ; p = <0.0001). There was also a statistically significant difference between the groups in total hospital length of stay as well as ICU length of stay. Additionally, both groups were similar in adverse events and reintubation rates.
Conclusion: In this study, we observed that patients reversed with sugammadex had shorter time to extubation when compared to neostigmine. These patients were also more likely to be extubated in the OR (operating room) rather than the ICU and had shorter lengths of stay in the ICU and hospital overall. Despite positive outcomes, the limiting factor to increasing the use of sugammadex for all patients, is the cost compared to neostigmine. Therefore, further studies that include more patients are warranted to fully determine the benefit of sugammadex and to justify the additional cost associated with it.

Background/Purpose: Early-onset sepsis (EOS) is a systemic infection occurring within the first week of life and remains a major contributor to neonatal morbidity and mortality. Clinical manifestations of EOS are often nonspecific. Empiric broad‑spectrum antibiotics are frequently initiated in suspected infection based on maternal or neonatal risk factors. Literature supports discontinuation of empiric antibiotic therapy if blood cultures remain negative at 36 – 48 hours. Despite support for discontinuation, providers often continue antibiotics due to concerns of missed infection or presumed clinical improvement due to initiation of therapy. Prolonged antibiotic exposure in neonates is associated with adverse outcomes including disruption of gut microbiome, necrotizing enterocolitis, and development of antimicrobial resistance. This study aimed to evaluate the prevalence of prolonged empiric antibiotic therapy for culture‑negative EOS.

Methodology: This was a multi-centered, retrospective chart review which evaluate neonates delivered within the Northeast Georgia Health System and admitted to the NICU between January 1, 2023, and December 31, 2024. Patients were included if blood cultures were obtained within the first 72 hours of life, and at least one dose of ampicillin plus gentamicin was administered. Patients with positive blood cultures within the first 72 hours were excluded, as well as any patient that was discharged and readmitted within the first 72 hours of life. The primary objective was to evaluate the prevalence of prolonged empiric antibiotic therapy (> 48 hours) despite negative cultures. The secondary objective was to evaluate the prevalence of treatment failure, defined as discontinuation and reinitiation of any antibiotic within the first 14 days of life.

Results: A total of 125 neonates met inclusion criteria. Of these, 94 neonates (75%) received standard empiric therapy, and 31 neonates (25%) received prolonged empiric therapy despite negative blood cultures. Baseline characteristics were similar between groups, with no statistically significant differences observed for gestational age, birth weight, gender, or mode of delivery. The mean total days antibiotic exposure was 3 days in the standard group compared to 7 days in the prolonged group (P < 0.001). Treatment failure occurred in 9 of 94 neonates (10%) in the standard group and 3 of 31 neonates (10%) in the prolonged group, with no significant difference between groups (P = 0.613).

Conclusions: Of the 125 neonates included in this retrospective chart review, (25%) received empiric antibiotics beyond the consensus recommended 36 to 48 hour rule‑out period despite negative cultures. Prolonged empiric therapy did not reduce treatment failure when compared to the standard group. There was a clinically significant increase in antibiotic exposure in the prolonged group. Further studies are needed to evaluate the long-term effects of empiric treatment for early onset sepsis. These findings also highlight opportunities for antimicrobial stewardship initiatives aimed at reinforcing evidence-based, consensus recommended use of empiric antibiotics.

Purpose/Background: Atrial fibrillation (AF) is the most common cardiac rhythm disorder. Sixty to seventy percent of patients with AF who present to the emergency department (ED) have rapid ventricular response (RVR), a heart rate (HR) greater than 120 beats per minute (bpm) in response to inappropriate ventricular rate control. The 2023 Guideline for the Diagnosis and Management of Atrial Fibrillation recommends that patients with acute AF with RVR without decompensated heart failure receive an intravenous (IV) bolus dose of diltiazem 0.25 mg/kg actual body weight. However, this is not always applied in practice with some prescribers utilizing lower, non-weight-based doses. 

Methodology: A retrospective chart review and analysis was conducted to evaluate the efficacy of utilizing the full, guideline and package insert recommended bolus of diltiazem as compared to a low dose bolus for AF with RVR. All patients included in this study were adults admitted to any CaroMont Health ED. Patients were identified by generating a report of those who have been admitted for AF with RVR and received an IV bolus of diltiazem between January 1, 2022 and January 1, 2025. The primary endpoint was the incidence of achieving a HR of less than 100 bpm within 30 minutes of diltiazem bolus administration. Secondary endpoints included incidence of bradycardia, incidence of hypotension, administration of additional rate-controlling medications, length of stay, mortality and readmission after 30 days. Additional information collected included past medical history of AF, heart failure, hypertension, and hyperthyroidism; home antiarrhythmic prescription(s); and primary diagnosis of admission. All categorical endpoints and demographics were evaluated using a chi-square test. Parametric continuous variables utilized t-tests, while nonparametric continuous variables were analyzed using Mann-Whitney U tests. The reliability of data abstracted was validated through a 10 percent medical record review by a co-investigator. An interrater agreement coefficient was reported using a kappa statistic. 

Results: In progress 

Conclusions: In progress 

Impact of Systemic Corticosteroids on Antibiotic Days of Therapy in Hospital-Acquired Pneumonia and Ventilator-Associated Pneumonia 
Samantha Saraceno, Zoanne Harlas, Joseph Crosby, Ryan Sarvestani, John Carr 
St. Joseph/Candler Health System
Background/Purpose: Clinical outcomes related to the use of systemic corticosteroids are not well defined in hospital-acquired pneumonia and ventilator-associated pneumonia (HAP/VAP) patients. Much of the available evidence is extrapolated from research and guidelines on community-acquired pneumonia (CAP). However, HAP and VAP are fundamentally different from CAP and are associated with significantly higher morbidity and mortality. Studies have suggested long-term use of corticosteroids prior to developing HAP/VAP can increase mortality, antibiotic days of therapy and days of mechanical ventilation. The purpose of this study was to determine whether the use of corticosteroids is associated with prolonged need for antimicrobial therapy in patients with HAP/VAP.

Methodology: This was a retrospective, cohort study. We looked at two groups, those who received systemic corticosteroids during treatment and those who did not. Adult patients diagnosed with HAP/VAP based on ICD10 codes were included. Exclusion criteria included pregnancy, multiple sources of infection, viral or fungal pneumonia, those who were immunocompromised, neutropenia and long-term steroid use at baseline. The primary outcome was the number of days free from antibiotics. Secondary outcomes included number of days free from mechanical ventilation, incidence of multi-drug resistant infection, hospital length of stay and in-hospital mortality. Continuous measures were analyzed by mean and standard deviation, and a t-test was used to determine p-value. For intermittent measures, percentages were calculated, and chi-square tests were used to analyze data. Statistical significance was determined as a p-value < 0.05.

Results: 116 patients were screened, with 81 being excluded and 35 meeting inclusion criteria. There were 15 patients included in the corticosteroid group and 20 patients included in the no corticosteroid group. The primary outcome was not statistically significant with number of days free from antibiotics being 15.98 days in the steroid group and 11.2 days in the without steroids group, resulting in a p-value of 0.087. The secondary outcome of number of days free from mechanical ventilation showed statistical significance with the steroid treatment group having a mean of 7.65 days on mechanical ventilation compared to the without steroids group having a mean of 15.92 days, resulting in a p-value of 0.035. All other outcomes showed no statistical significance with no p-values > 0.05.

Conclusion: For patients diagnosed with HAP/VAP, treatment involving corticosteroids had no impact on duration of antibiotic therapy compared to those who did not receive corticosteroids. Thus, systemic corticosteroids may have little to no impact on duration of antibiotic therapy in this patient population. Patients diagnosed with HAP/VAP who are mechanically ventilation may have a shorter duration of ventilation if systemic corticosteroids are used as part of therapy. Further research is needed to confirm these preliminary findings.

Objective: Determine if prophylactic tocilizumab reduces the incidence of vasoplegic syndrome (VS) in patients undergoing left ventricular assist device (LVAD) implantation.
Background: Vasoplegic syndrome is a life-threatening complication that occurs in 5% to 25% of patients undergoing cardiothoracic surgery with a mortality rate as high as 25%. Vasoplegic syndrome is characterized by profound systemic hypotension with normal to high cardiac output, requiring treatments such as vasopressors, nitric oxide modulators, (e.g. methylene blue and hydroxocobalamin) and other rescue medications such as angiotensin II. Recent case studies have suggested that tocilizumab may prevent vasodilatory syndromes, including VS. Tocilizumab’s antagonism of interleukin-6 may prevent the vasodilatory response by reducing the body’s cytokine production and inflammatory response. This mechanism may be able to reduce the sterile inflammatory response that is thought to cause VS.   
Methodology: This was a retrospective chart review study of adult patients who underwent LVAD implantation at Piedmont Atlanta Hospital between January 2020 and December 2025. Patients were excluded from the study if they had received tocilizumab for alternative indications or had a SARS-CoV-2 infection within 10 days of surgery. The primary outcome of the study was to compare the incidence of VS between those who did and did not receive tocilizumab. Secondary outcomes included adverse drug events attributed to tocilizumab, vasoactive-inotropic score (VIS) at 6 and 24 hours, mortality at 48 hours and 28 days, the need for rescue medications use, infection within 28 days of surgery, the duration of mechanical ventilation, intensive care unit (ICU) length of stay, and mechanical circulatory support post-surgery. Statistical analysis was completed using chi-squared test or Fischer’s exact test. A p-value of < 0.05 was considered statistically significant.
Results: The assessed cohort included 82 patients in the control group and 41 patients in the experimental group. All patients were included in the statistical analysis. When comparing prophylactic tocilizumab to the control group, there was found to be no difference in incidence of VS (26.8% vs 15.9%; p=0.1476. No statistical significance was found between rate of infection (26.8% vs 21.9%; p=0.548), mortality at 48 hours (0% vs 0%; p=0), mortality at 28 days (10% vs 9.8%; p=0.2509), and the use of rescue medications (14.6% vs 9.8%; p=0.1661). There was a significant difference when comparing VIS scores at 6 hours (15; 95% CI 11-21.48 vs 11.96; CI 8.5-17.12, p=0.0098) and at 24 hours (12.33; CI 9.5-15.29 vs 9.25; CI 7.5-15.75). 
Conclusions: There was no statistically significant difference seen in the primary outcome of incidence of VS when using prophylactic tocilizumab. There were no statistically significant differences noted in any secondary endpoints, except that tocilizumab may worsen the VIS score at 6 and 24-hours post-surgery and prolong times on the ventilator. Study limitations included the retrospective and small patient population. Prospective trials with a larger sample size are warranted in this population.

Title: Decreasing hypoglycemic events after administration of anti-diabetic agents
Presenter: Lillian James
Authors: Lillian James, Amanda Guffey, Jean Goette, Erik Turgeon at Lexington Medical Center
Background: Inpatient hypoglycemia remains a significant and preventable complication in hospitalized patients, particularly those receiving insulin or other anti-diabetic medications. Numerous studies have shown that inpatient hypoglycemia is associated with increased morbidity, mortality, length of hospital stay, and healthcare costs. Importantly, many episodes of inpatient hypoglycemia are preventable. The ADA Standards of Care in Diabetes 2025 guidelines emphasize that preventing hypoglycemia is just as important as avoiding hyperglycemia and call for hospital wide protocols to guide insulin dosing and glucose monitoring. The purpose of this study was to implement targeted strategies aimed at reducing the incidence of severe hypoglycemic events, defined as a blood glucose level less than or equal to 40 mg/dL, in hospitalized patients.
Methodology: This study was a pre- and post-intervention chart review of severe inpatient hypoglycemic events conducted at a single-center, 607-bed community teaching hospital. The interventions involved implementation of modified insulin orders, which included adjustments to the frequencies and thresholds for sliding scale insulin, instructions to contact the provider regarding basal insulin administration when the patient is NPO, and the introduction of a sliding scale insulin calculator. The purpose of this review was to evaluate the impact of these interventions on the incidence of severe hypoglycemic events in hospitalized patients. A severe hypoglycemic event is defined as a blood glucose level less than or equal to 40 mg/dL occurring within 24 hours of receiving an anti-diabetic medication. The pre-intervention group consisted of patients who experienced a severe hypoglycemic event between January 1, 2025, and June 30, 2025. The post-intervention group included patients who experienced a severe hypoglycemic event between October 15, 2025, and March 31, 2026. Outcomes were manually analyzed by the investigator through EHR- generated data and manual chart review.
Results: A total of 4,294 patients were included in the pre-intervention group, and 4,188 patients were included in the post-intervention group. Severe hypoglycemic events occurred in 83 patients in the pre-intervention group and 69 patients in the post-intervention group. The incidence of severe hypoglycemia decreased from 1.9% to 1.6%; however, this reduction was not statistically significant (p = 0.33).
Conclusions: Implementation of an insulin calculator and revised insulin order sets resulted in a numerical, but not statistically significant reduction in severe hypoglycemic events. Continued data collection will be essential to better assess the impact of these interventions and determine alignment with national performance standards.

Background: Traumatic brain injury (TBI) is associated with increased risk of post-traumatic seizures (PTS), and seizure prophylaxis may reduce seizure prevalence, brain injury, and mortality.1,2 Currently, guidelines from the American College of Surgeons Trauma Quality Programs (ACS-TQIP), Brain Trauma Foundation (BTF), and Neurocritical Care Society (NCS) recommend the use of levetiracetam or phenytoin for early PTS prevention in patients with TBIs.1,3,4 However, adverse effects associated with levetiracetam, including somnolence and behavioral disturbances (i.e. agitation, hallucinations, emotional lability), have prompted interest in lacosamide as a potential alternative. 5 Levetiracetam is the standard antiepileptic medication prescribed for PTS prophylaxis at Prisma Health Richland. This study will evaluate the efficacy and safety of lacosamide compared with levetiracetam for seizure prophylaxis in patients with TBI.
Methods: Adults diagnosed with TBI and, within 24 hours of admission, received seizure prophylaxis with either lacosamide or levetiracetam between February 27th, 2021, and August 31st, 2025, were included in the study. Patients were excluded if they had a history of seizures or epilepsy prior to admission or if they had a seizure prior to initiating antiepileptic medication. The primary objective, seizure incidence within the first 7 days following TBI, will be analyzed using multivariable logistic regression adjusting for clinically relevant covariates and incorporating propensity score methods as appropriate. Secondary objectives include time to seizure following prophylaxis initiation, analyzed using Cox proportional hazards regression, and adverse effects occurring within 7 days of prophylaxis initiation, which will be summarized descriptively and compared using appropriate statistical tests.
Results: In Progress
Conclusions: In Progress