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Intradetrusor chemodenervation with onabotulinumtoxinA (BOTOX) injections, a common office-based procedure for overactive bladder (OAB), is associated with patient anxiety and discomfort. Aromatherapy and music have been shown to decrease procedure-related anxiety and pain with improved satisfaction. The objectives of this study were to determine whether a relaxing environment consisting of lavender aromatherapy, calming music, and dim lighting compared with a typical office environment decreases patients' anxiety level before undergoing intradetrusor chemodenervation. We hypothesized that a relaxing environment would decrease patients' anxiety level before the procedure as measured by the Visual Analog Scale (VAS). Secondary outcomes included the VAS for pain, satisfaction, and staff energy level. This was a single-center randomized trial of women receiving office intradetrusor chemodenervation for overactive bladder. Participants were randomized to receive their procedures in a relaxing versus typical office environment. Eighty patients were needed to detect a clinically significant 12mm difference on the anxiety VAS. Staff completed a preclinic and postclinic Burnout Battery VAS to measure change in their energy level during the day. Patients in the relaxing environment reported a clinically significant reduction in anxiety (-13.8 ± 18.1 vs -4.7 ± 14.7, P = 0.015). Pain was lower for the relaxing environment group, although it did not reach statistical significance (21.9 vs 28.9, P = 0.261). Satisfaction scores were high in both groups (91.4 vs 89.3, P = 0.599) and not significantly different. The procedure room environment did not affect staff energy levels. A relaxing environment of lavender aromatherapy, calming music, and dim lighting is a noninvasive, easily implemented technique to decrease patients' anxiety before office intradetrusor chemodenervation.

Fibromuscular dysplasia (FMD) is a rare idiopathic, noninflammatory, nonatherosclerotic arteriopathy that leads to wall abnormalities in medium- and small-caliber arteries, typically resulting in alternating areas of stenosis and dilatation, or "beading" at angiography. Stenosis, dissection, and aneurysm can also be seen, and clinical manifestations depend on the vascular territory affected by FMD, with the renal and carotid arteries being most frequently involved. The diagnosis of FMD is made based on imaging features of FMD classified according to the angiographic appearance as focal FMD or multifocal FMD. Early diagnosis is often challenging, as mimics of FMD must first be excluded. The presence of aneurysm, dissection, or tortuosity alone is inadequate to establish the diagnosis, as these are variant manifestations; however, if a patient has focal or multifocal manifestations such as stenosis or stenosis and dilatation in one vascular bed, establishing the diagnosis of FMD, the presence of aneurysm, dissection, or tortuosity in additional vascular beds is considered multivessel involvement of all affected vascular beds. The cerebrovascular system, coronary arteries, renal and mesenteric arteries, and extremities should be evaluated for FMD involvement. The most serious potential complications of FMD are hypoperfusion secondary to aneurysm, dissection, or arterial occlusion, which can lead to hypertension, stroke, or myocardial infarction, as well as subarachnoid hemorrhage. Prompt intervention, blood pressure management, and revascularization are necessary to avoid devastating complications. Radiologists play an important role in timely identification of diverse FMD-associated morbidities and thus may contribute to early diagnosis and treatment of FMD. ©RSNA, 2026 Supplemental material is available for this article.

Introduction: Telecritical care (TCC) pharmacists may improve medication safety and cost avoidance (CA) through adverse drug event (ADE) prevention, with proactive review often associated with more interventions per patient than alert-based review. This quality improvement (QI) project compared ADE avoidance interventions between first shift, proactive patient review and second shift, alert-based review. Methods: This was a retrospective, multicenter, observational QI project comparing ADE avoidance interventions performed by TCC pharmacists using alert-based review on second shift in 2016 to those performed using proactive patient review on first shift in 2024. The primary outcomes were the quantity and types of interventions performed between time frames. Secondary outcomes included the percentages of interventions per facility, percentage of medications by drug class, frequency of high alert medications and estimated CA. Descriptive statistics were reported. Results: One hundred and seventy-two ADE avoidance interventions were documented with alert-based review (109 major), as compared to 443 (214 major) with proactive review, a 258% increase. In 2016, 41.9% of interventions were associated with high alert medications per the Institute for Safe Medication Practices, similar to rates of 49.4% in 2024. In 2016, the most common drug classes were antimicrobials (19.8%), glycemic control (14.5%), anticoagulants (AC) (13.4%), and pain/agitation/delirium (PAD) (12.2%). In 2024, AC (30.2%), PAD (13.1%), glycemic control (5.9%), antiseizure medications (5.9%), and antimicrobials (4.7%) were most common. Interventions were made at 10 facilities in 2016, with a rural 18-bed ICU accounting for the largest proportion of interventions (25.6%). In 2024, 7 facilities were represented, with the same 18-bed ICU accounting for 36.1% of interventions. Total CA in 2016 was $475,671 and $983,852 in 2024. Assuming 25to 75% of interventions may have been identified without TCC pharmacist presence, adjusted CA for 2016 was $118,918 to $356,753 and $245,963 to $737,889 in 2024. Conclusions: Proactive review resulted in more than 2.5 times the ADE avoidance interventions identified and nearly double CA estimates than alert-based review. This adds to the current literature supporting the TCC pharmacists in ADE prevention.

BackgroundImipenem/relebactam (I/R) demonstrates potent in vitro activity against multidrug-resistant (MDR) Pseudomonas aeruginosa. The objective of this study was to evaluate the effectiveness of I/R for treatment of MDR P. aeruginosa infections across the U.S.Table 1.Detailed inclusion and exclusion criteria for patients receiving I/R1 Pneumonia was defined as the presence of a new or progressive infiltrate with at least one of the following: purulent tracheal secretions, worsening cough or dyspnea, PaO2/FiO2 < 200 with PEEP ≥5 cm H2O, fever (≥38°C) or hypothermia (≤35°C), leukocytosis (≥10,000 white blood cells per µL), or tachypnea (respiratory rate >30 beats per minute).2 MDR was defined as non-susceptibility to at least one agent in three or more antibiotic classes.Table 2.Patient demographics, underlying diseases, severity of illness, and treatment characteristics of patients treated with I/R for pneumonia or bacteremia.*Other immunocompromising conditions included bone-marrow transplant, chronic steroid use, neutropenia, and AIDS.Abbreviations: IQR = interquartile rangeMethodsThis was a retrospective, multicenter, observational study of I/R for MDR P. aeruginosa pneumonia and bacteremia. Patients were included if they received I/R for >48h initiated within 7 days of the index MDR P. aeruginosa culture (Table 1). Clinical success was defined as survival, resolution of signs and symptoms of infection, completion of the intended treatment course, and the absence of a recurrent infection due to MDR P. aeruginosa. I/R susceptibility was determined by site-level microbiology labs; non-susceptibility was defined by the Clinical and Laboratory Standards Institute (CLSI) criteria.Table 3.Real-world characteristics of I/R use in pneumonia and bloodstream infections.1 I/R treatment was discontinued in one patient with acute interstitial nephritisTable 4.Clinical outcomes of patients treated with I/R for MDR P. aeruginosa pneumonia or bacteremia1 Non-susceptibility was defined as a categorical change from susceptible to non-susceptible as defined by CLSI interpretive criteria. Among the 16 cases meeting this criteria, non-susceptibility was identified by gradient strip testing and broth microdilution in 25% and 75%, respectively. The median I/R MICs for isolates categorized as susceptible and non-susceptible were 2 and 8 mg/L, respectively.Results64 patients from 10 centers were included (Table 2); patients from 6 additional centers were screened and did not meet inclusion criteria. The overall cohort was critically-ill; 80%, 75%, and 48% were in the intensive care unit, receiving mechanical ventilation, and on vasopressors, respectively. The median (interquartile range; IQR) SOFA score was 7 (5 – 12). 53% received treatment with another new β-lactam for MDR P. aeruginosa infections prior to I/R. The median time to I/R initiation was 67 hours. I/R treatment was primarily prescribed based on susceptibility results in 75% of patients, including resistance to other novel β-lactam agents (Table 3). 63% of patients completed the intended I/R treatment course as planned. At day 7 and 30, 80% and 55% met criteria for clinical success, respectively (Table 4). The overall 30- and 90-day mortality rates were 17% and 30%, respectively. Recurrent infections were documented in 38% of patients within 90 days.ConclusionIn this critically-ill patient population we found that I/R was often used following treatment with other novel β-lactams. Clinical outcomes were generally comparable to those previously reported in similar real-world studies for other novel β-lactam agents suggesting that I/R plays a role in treatment of MDR P. aeruginosa infections, particularly when other agents are not available or test resistant.Disclosuresjason M. Pogue, PharmD, Entasis: Advisor/Consultant|Entasis: Grant/Research Support|GlaxoSmithKline: Advisor/Consultant|Melinta: Grant/Research Support|Merck: Advisor/Consultant|Merck: Grant/Research Support|Shionogi: Advisor/Consultant|Shionogi: Grant/Research Support Alexander J. Lepak, MD, FIDSA, BioMerieux: Grant/Research Support William R. Miller, M.D., Merck: Grant/Research Support|UpToDate: Royalties, topic author Jeffrey C. Pearson, PharmD, InflaRx Pharmaceuticals, Inc.: Advisor/Consultant Emre Yucel, PhD, Merck & Co., Ltd: Stocks/Bonds (Public Company)

BackgroundCatheter-related or central line-associated bloodstream infection (CRBSI/CLABSI) causes substantial morbidity and mortality. Managing CRBSI/CLABSI often involves removing the infected central venous catheter (CVC) and inserting a new one at a different vascular site. Currently, no adjunct antimicrobial lock therapy (in combination with systemic antibiotics) has been FDA-approved and is urgently needed. Our study evaluated a novel triple combination antimicrobial therapy (Mino Lok (MLT)) containing minocycline, EDTA, and ethanol. MLT has shown broad-spectrum in-vitro activity and positive results in a Phase 2 trial.MethodsThis international, multicenter, superiority trial was conducted at 34 sites. Cancer, hemodialysis (HD), or other patients requiring a long-term CVC (LTCVC), aged ≥ 12 years, with CLABSI/CRBSI, were enrolled and randomized in a 1:1 ratio to receive either MLT or site-specific standard of care (SOC) antimicrobial lock for 2 hours/day for 7 days. The primary endpoint was median time to catheter failure (defined as mortality, catheter removal due to inability to administer lock or infectious-related reasons, worsening signs/symptoms, persistent or recurrent bloodstream infection, or deep-seated infection).ResultsFrom February 2018 to February 2024, 241 subjects were enrolled and randomized with 228 receiving study drug. A significant difference in median time to catheter failure in intent-to-treat (ITT) and modified ITT (MITT) populations (p≤ 0.0006) was observed (Figures 1 & 2). The CVC was successfully retained in 57% of patients in MLT vs 38% in SOC (p=0.0025). Clinical and microbiological failure related to the catheter or CLABSI were significantly higher in SOC (p=0.0058 and p=0.012, respectively) (Table 1). Adverse events (AEs), serious AEs (SAEs) and all-cause mortality were comparable for the two groups. There were no drug-related SAEs.ConclusionThis phase 3 pivotal study demonstrated MLT to be highly effective and superior to SOC antimicrobial locks in salvaging LTCVCs associated with CRBSI/CLABSI in cancer, HD and other patients requiring LTCVC. MLT has broad-spectrum activity, was well-tolerated, and was not associated with drug-related SAEs. MLT may satisfy an urgent unmet need in the management of CRBSIs/CLABSI.DisclosuresAnne-Marie Chaftari, MD, Citius Pharmaceuticals, Inc., Cranford, New Jersey, USA: Grant/Research Support Vinay Rathore, MD, Citius Pharmaceuticals, Inc. 11 Commerce Drive, First Floor Cranford: Grant/Research Support Paul P. Cook, MD, Gilead: Grant/Research Support|Janssen: Grant/Research Support|Pfizer: Grant/Research Support Onix Cantres-Fonseca, MD, Citius Pharmaceuticals, Inc.: Grant/Research Support Mayur Ramesh, MD, Citius Pharmaceuticals, Inc.: Grant/Research Support Mark E. Rupp, MD, Armata: Advisor/Consultant|Citius Pharmaceuticals, Inc.: Advisor/Consultant|Magnolia: Grant/Research Support|Teleflex: Advisor/Consultant Leonard Mermel, DO, Citius Pharma: Advisor/Consultant|CorMedix Pharma: Advisor/Consultant|Destiny Pharma: Board Member|Lightline Medical: Advisor/Consultant|Pristine Access Technology: Advisor/Consultant|Pristine Access Technology: Stocks/Bonds (Private Company) Alan Lader, PhD, Citius Pharmaceuticals, Inc.: Senior Vice-President/employee Issam I. Raad, Distinguished Professor, Citius Pharmaceuticals, Inc. (Grant/Research Support): Advisor/Consultant|Citius Pharmaceuticals, Inc. (Grant/Research Support): Grant/Research Support|Citius Pharmaceuticals, Inc. (Grant/Research Support): Patent|Citius Pharmaceuticals, Inc. (Grant/Research Support): Ownership Interest|Citius Pharmaceuticals, Inc. (Grant/Research Support): Stocks/Bonds (Public Company)|Spectrum Vascular: Patent|Spectrum Vascular: Ownership Interest

Imipenem-relebactam demonstrates in vitro activity against multidrug-resistant (MDR) Pseudomonas aeruginosa, but real-world effectiveness data are limited. MIRAGE was a multicenter, retrospective, observational study of imipenem-relebactam for MDR P. aeruginosa pneumonia and bacteremia. Patients were included if they received imipenem-relebactam for >48 h within 7 days of index P. aeruginosa culture. The primary outcome was clinical success at day 30, defined as survival, resolution of signs and symptoms of infection, completion of intended treatment course, and absence of recurrent infection. Secondary outcomes included 30- and 90-day mortality, infection recurrence, and development of non-susceptibility. Sixty-three patients were included. Median (IQR) age was 61 (51-70) years, and the median Charlson Comorbidity Index was 5 (3-6). Forty-six percent of patients had an immunocompromising condition, 79% were in the intensive care unit, 76% were receiving mechanical ventilation, and 48% required vasopressors. Median SOFA score was 7 (5-12). Forty percent of index isolates that were tested displayed non-susceptibility to both ceftolozane-tazobactam and ceftazidime-avibactam. Fifty-six percent of patients achieved clinical success at day 30. All-cause 30- and 90-day mortality rates were 18% and 29%, respectively. Recurrent infections were documented in 37% of patients within 90 days, and resistance developed in 39% (16/41) of evaluable patients. Clinical outcomes following imipenem-relebactam for treatment of MDR P. aeruginosa were comparable to those reported in real-world studies for other novel β-lactam agents. Our data suggests that imipenem-relebactam has a role in the treatment of patients infected with MDR P. aeruginosa.

Abstract Background: Patients on long-term anticoagulation face increased bleeding risk when antiplatelets are co-prescribed, especially upper gastrointestinal (GI) bleeding. Guidelines recommend limiting antiplatelet use to highly select patients on background anticoagulants and promoting GI prophylaxis with proton pump inhibitors (PPIs) for those requiring dual antithrombotic therapy. Objectives: To assess the impact of an anticoagulation management service (AMS)-led intervention on reducing excess antiplatelet use and increasing PPI prescribing in patients who require continued antiplatelet therapy. Methods: This study of retrospective chart review included adults (≥18 years) on long-term direct oral anticoagulant (DOAC) therapy from October 2023 to September 2024. The intervention group included AMS-enrolled patients who received structured annual anticoagulation review. The control group consisted of DOAC patients receiving usual care outside AMS. The AMS annual review aims to optimize antithrombotic therapy by deprescribing unnecessary antiplatelets and initiating PPIs when clinically indicated. Results: Of 8,462 eligible patients, 3,125 were in the AMS group and 5,337 in the non-AMS group. Antiplatelet use was significantly lower in AMS patients at baseline (9% vs. 15%) and study end (7% vs. 16%) (p&lt;0.0001). PPI use was significantly higher in AMS patients at both time points (50% vs. 30% for baseline, 67% vs. 38% at the end of study) (p&lt;0.0001). Acceptance rates for AMS recommendations were 18.8% for antiplatelet discontinuation and 33% for PPI initiation. Conclusion: AMS-led interventions effectively reduced concurrent antiplatelet use in patients on background DOAC and increased PPI prescribing in those on dual therapy, demonstrating the value of centralized anticoagulation services in primary care.