University of New Mexico Hospital

Antimicrobial Stewardship (AS) is crucial for delivering high-quality care to patients, minimizing adverse effects and outcomes, mitigating antimicrobial resistance, and generating cost savings for the healthcare system and patients. Successful AS programs are often multi-disciplinary, with infectious diseases and antimicrobial stewardship pharmacists (ID/ASP) playing a key role in the implementation and coordination of care. This study evaluated the documentation of stewardship interventions following the implementation of an ID/ASP-led stewardship program in a large Midwestern academic medical center. This quasi-experimental study evaluated the impact of hiring an ID/ASP with subsequent AS education and feedback and updated documentation methods. It was conducted from January 2023 to September 2023 (pre-intervention) and October 2023 to December 2024 (post-intervention), and compared the impact of an ID/ASP pharmacist on the documentation of key AS interventions by non-ID pharmacists. The number and type of interventions and drugs used in interventions were assessed for adult and pediatric patients before and after the ID/ASP pharmacist was hired. The primary outcome was the average number of interventions documented by non-ID pharmacists per month in the pre-intervention period compared to the post-intervention period. A p-value < 0.05 was considered statistically significant. A total of 5606 non-ID pharmacist interventions occurred throughout the study. There was a statistically significant increase in average monthly documented interventions by non-ID pharmacists after the intervention compared to before (283 ± 102 vs. 152 ± 49, respectively; p = 0.002). Furthermore, the ID/ASP pharmacist contributed an additional average of 104 interventions per month and was able to perform high-impact AS interventions. This study demonstrated a positive impact of an ID/ASP pharmacist-led AS program in a large academic medical center. The number of documented AS interventions significantly increased in the post-intervention period. These data underscore the importance of ID/ASP in advancing the shared goal of antimicrobial stewardship.

1) Analyze National Institutes of Health grant disbursement to female otolaryngologists, 2) compare funding patterns to those of ophthalmology and neurosurgery, and 3) provide strategies to increase female surgeon-scientists. The principal investigators of K, R, and U grants in each specialty were collected from the National Institutes of Health Research Portfolio Online Reporting Tools Expenditures and Results for 2000-2021. To factor in the number of females versus males, the number of female or male grant holders was divided by the respective number of female or male physicians in each field for proportional analysis. Conversion rates of K to R or U grants were calculated. Otolaryngology had a 1.46 times higher rate of female K grant holders (p=0.02), and a trend of 1.27 times higher rate of female R and U grant holders than male grant holders (p=0.13). Neurosurgery had 2.23 times greater rate of female K grant holders (p<0.01), and 2.62 times greater rate of female R and U grant holders than otolaryngology (p<0.01). Ophthalmology trended to have a 0.25 times higher rate of female K grant holders (p=0.24), but a 0.19 times lower rate of R and U grant holders than otolaryngology (p=0.12). Female otolaryngology grant holders tended to convert at a 24.4% lower rate than males (p=0.13). Female otolaryngology surgeon-scientists' success in obtaining funding reflects successful prior initiatives and holds promise for increased female representation in leadership. However, there are fewer female otolaryngology grant holders compared to neurosurgery, illuminating the need for continued efforts.

Many graduating physicians remain inadequately prepared to manage substance use disorders (SUDs) due, in part, to insufficient SUD training during residency, especially in inpatient settings. The aim of the study is to evaluate the impact of a novel addiction medicine consult service (ACS) rotation on residents' knowledge and confidence when serving patients with SUD. The setting is two Oregon teaching hospitals. Twenty-three internal medicine, family medicine, and emergency medicine resident physicians participated. A 2-week rotation on a hospital-based interprofessional ACS was done. Clinical experiences were augmented with self-directed didactics with learning objectives including addiction neurobiology, SUD diagnosis, medications for SUD, and withdrawal management. Twenty-three (74%) participants completed pre- and post-rotation surveys that included 10 multiple-choice knowledge questions and 10 Likert-scale confidence items related to the course's learning objectives. Mean knowledge scores improved from 70.4% pre-rotation to 80.0% post-rotation (p = 0.024, r = -0.332). Self-reported confidence increased in nine of 10 domains (p < 0.001, r -0.505 to -0.603). Participants demonstrated significant improvements in both confidence and objective knowledge. This hospital-based, interprofessional clinical rotation with self-directed didactics may serve as a model for integrating effective addiction medicine training into residency programs and closing gaps in SUD care.

The tobacco industry uses package colour to convey product attributes, which can impact consumers' perceptions of products and circumvent policies designed to reduce their appeal. Using artificial intelligence (AI) guided analysis, our goal was to characterise package colour schemes for popular oral nicotine pouch (ONP) brands and examine if colour schemes are associated with ONP characteristics. We used an AI-powered tool to analyse colour schemes of publicly available pack images of US ONP brands. We analysed pack images for the seven most popular ONP brands, and the most popular flavours and nicotine concentrations within brands, identified from US sales data (59 images total). We prompted the AI tool to provide colour scheme analysis and proportions (eg, proportion of colour). All brands used specific colours to indicate specific flavours, such as blue for peppermint, green for wintergreen and other warm colours such as red for cinnamon and yellow for citrus. Some brands used lighter colour schemes representing lower nicotine concentration and darker colour schemes representing higher nicotine concentration. On!, Zeo, Zyn and Rogue used a mix of distinct and subtle colour scheme transitions to signify nicotine concentration. Other brands like Sesh, Velo and Zone maintained uniform designs across all nicotine concentrations. Our results suggest the colour scheme of some ONP packaging was designed to indicate the flavour and nicotine concentration. These characteristics may influence consumers' beliefs about ONPs, and appeal to different populations. AI tools can be valuable in the surveillance of those ONP packaging features.

Background: Primary cardiac lymphoma (PCL) is an extremely rare malignancy, accounting for approximately 1–2% of primary cardiac tumors and about 0.5% of extranodal lymphomas. It primarily affects immunocompetent adults, with a median age of 55–65 years, and male predominance (65–85%). Case Presentation: A 44-year-old male with well-controlled HIV on Rilpivirine presented with a 2-week history of progressive shortness of breath, facial edema, and exertional peripheral cyanosis. His physical exam confirmed facial and upper extremities edema and jugular venous distension suggestive of superior vena cava syndrome. Contrast computed tomography (CT) of the chest identified a large 12 × 6.2 × 7.5 cm lytic rib lesion invading the pleura and chest wall, accompanied by left supraclavicular, axillary, mediastinal, and upper abdominal lymphadenopathy. CT also showed a large (8.3 × 5.8 × 6.0 cm) right atrial mass causing near-complete occlusion of the superior and inferior vena cava (Fig 1A). A transthoracic echocardiogram with contrast-enhanced imaging confirmed a large right atrial mass extending into the IVC (Fig 1B). Cardiac magnetic resonance imaging (MRI) further detailed an 8.3 × 6.5 × 6.4 cm mass nearly filling the right atrium, infiltrating the interatrial septum with mass effect on left atrium and encroaching on the right superior and inferior pulmonary veins (Fig 2A). Biopsy of the rib lesion confirmed high-grade B-cell lymphoma with 11q aberration. The patient was started on Rituximab combined with E-POCH chemotherapy on day 7 of admission. A follow-up PET-CT scan after the first cycle showed significant regression of the intracardiac mass (Fig 2B.) Discussion: PCL is an uncommon extranodal lymphoma, most often presenting as diffuse large B-cell lymphoma (DLBCL). High-grade B-cell lymphoma with 11q aberration (HGBCL-11q) is a distinct entity characterized by a unique 11q gain/loss cytogenetic pattern, typically lacking MYC rearrangement and frequently showing Burkitt-like morphology. Standard treatment for primary cardiac DLBCL involves immunochemotherapy, most commonly R-CHOP unless contraindicated. Curative regimens yield 5-year survival rates of 70–80% in selected cohorts; however, prognosis worsens with advanced or extracardiac disease.

Introduction Intrasaccular flow disruption with WEB device is an effective and safe modality for treatment of wide‐neck bifurcation aneurysms. We describe a case of failed deployment of WEB followed by bailout technique. Materials and methods Pubmed search of case reports and review articles. Results A 55 year old female with history of hypertension and smoking presented with HH‐1/WFNS‐1/MF‐3 subarachnoid hemorrhage. Cerebral angiography showed basilar tip aneurysm measuring 10.4x8.9x11.1 mm, neck of 3.65 mm, with robust R‐PCOM and absent L‐PCOM. After baseline DSA, a 6Fx90 cm guide sheath was parked in the V2 segment of the L‐VA and aneurysm was catheterized using coaxial system of 5F SOFIA‐EX intermediate catheter over VIA‐33 microcatheter and microwire. Measurements were made on orthogonal 2D images and a WEB SL 11x8 mm device was selected and advanced. The device was attempted to be deployed in the dome, however it failed to conform properly. After few attempts to re‐sheathe and re‐deploy, the device failed to flower and took a configuration of a mushroom head inside the aneurysm with an elongated stem extending to mid‐basilar artery. Guide catheter was advanced to distal L‐VA followed by intermediate catheter to distal basilar artery and i we attempt to resheath the device but unable due to small ID of SOFIA. Pulling the device in that configuration was not possible due to concern for basilar artery transection. As a bailout technique, the device was then carefully collapsed into the aneurysm dome by pushing on the microcatheter and delivery wire, and using SOFIA for support while being careful not to breach the dome. Device was then detached. Given significant residual aneurysm, we planned for Y‐stent assisted coiling and gave dual antiplatelet agents enterally. XT‐17 microcatheter was used to catheterize PCAs and we deployed Neuroform Atlas 3x21 mm stents from P1 segments to mid‐basilar artery bilaterally. Stent tines were crossed with a microcatheter and microwire and a total of six Hydrocoils were deposited in the aneurysm.. Final angiogram showed Raymond‐Roy IIIa occlusion with 39% packing density. Patient was extubated and neurologically intact. Conclusion Failed WEB deployment with rigid partial expansion and inability to re‐sheath is a potential complication. Intentional deformation with controlled collapse of the device into the aneurysm dome followed by stent coiling is a possible bailout technique which has not been described before. image

The pressure-flow relationship is fundamental to circulatory hemodynamics of any organ. In the kidney, renal perfusion pressure (RPP), defined as the gradient between mean arterial pressure and renal venous pressure or mean systemic filling pressure, serves as the principal driving pressure for renal blood flow (RBF). This concept recognizes that both arterial hypotension and venous congestion can reduce the pressure gradient for renal perfusion, potentially contributing to renal dysfunction or acute kidney injury (AKI). In health, whenever RPP fluctuates, the kidney autoregulates intrarenal vascular resistance to maintain stable RBF and glomerular filtration rate over a range of RPP. However, in critical illness, autoregulatory capacity may be impaired, and the degree of impairment can vary not only between patients but also within the same patient depending on the disease context or stage of illness. Therefore, during critical illness, inadequate RPP tends to overwhelm renal autoregulation capacity earlier than anticipated, leading to tissue hypoperfusion and increased risk of AKI. Relying on standard blood pressure targets to optimize RPP may not account for such inter- or intra-individual variations in autoregulation. Experimental models have shown that AKI can develop without overt macrocirculatory changes, implicating microcirculatory dysfunction as an important contributor too. Dynamic, multi-modal assessment of renal perfusion may offer a more precise approach to renal protection. Additionally, the focus of research has shifted towards providing new insights into individualized perfusion targets and refining RPP-guided strategies to prevent AKI among high-risk patients in ICU. The objective of this review is to describe the role of RPP, implications of dysregulated renal perfusion, approaches to monitoring renal perfusion, and potential therapies targeting RPP on the horizon for critically ill patients.