2025 | ||
Wednesday, May 21st | ||
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(Poster) Courtney Duncan DO, MBA, Pediatric Critical Care Medicine, Advocate Children's Hospital, Advocate Health 11:41 AM - 1:15 PM Background/Significance: Research is increasingly examining how social determinants affect health. The CDC’s Social Vulnerability Index (SVI) and the Child Opportunity Index (COI) assess neighborhood risk and resources, respectively. However, no study has yet explored how SVI and COI relate to asthma outcomes in children treated at two demographically distinct sister hospitals in Chicago. Purpose: The purpose of this study is to determine if children admitted to Advocate Children's Hospital, ACH (Park Ridge or Oak Lawn) with status asthmaticus or acute asthma exacerbation have worse outcomes (longer lengths of stay, higher prism 3 scores, higher rates of mechanical ventilation or ECMO, more use of adjunctive therapies, higher readmission rates, and higher odds of mortality) based on the SVIs and the COIs. Methods: This is a retrospective study utilizing the Virtual Pediatric Systems (VPS) database obtaining subjects admitted from Dec 2020 to Dec 2023 with the diagnosis of status asthmaticus or acute asthma exacerbation <18 years of age admitted to ACH. Research analytics obtained SVIs and COIs.>1,383 subjects were identified with the VPS database that fit the inclusion criteria. A total of 1081 subjects were excluded either due to admission for a different diagnosis, address not within state of Illinois, or non-availability of the data, which left 302 for ongoing analysis. Results: The study included 75 subjects from Oak Lawn and 277 subjects from Park Ridge, with a mean age of 11.94 and 9.12, respectively. The cohort was diverse, with nearly equal sex distribution and a race predominance of black individuals (69%) admitted to Oak Lawn, and white (60%) admitted to Park Ridge. The average hospital stay for Oak Lawn and Park Ridge was 2.5 and 3.63 days, respectively. Social vulnerability was low at both campuses, with most patients scoring 0 on vulnerability indices. Most of the subjects admitted to Park Ridge were from areas with a high child opportunity index (27%). The mean COI score from subjects admitted to Park Ridge Hospital was 55. Whereas, the majority of subjects admitted to Oak Lawn were mostly from areas with a very low child opportunity index (39%) and a mean COI score of 34. Conclusion: The study was limited by a small sample size, which constrained its ability to fully capture the scope of the issue. A larger sample size could have provided more robust results. The study was also conducted within a single hospital system, which may limit its generalizability. Future research should consider including pediatric intensive care units across multiple hospital systems in Chicago to better represent the diverse population. |
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Factors Contributing to Delivery Less Than 32 Weeks in Patients With a History-Indicated Cerclage (Poster) David Esterquest MD, Obstetrics and Gynecology, Advocate Lutheran General Hospital, Advocate Health 11:41 AM - 1:15 PM Background/Significance: History-indicated cerclages are typically placed between 13-14 weeks gestational age with the intention of prolonging pregnancy; however, variations in timing of placement and operative practices may impact fetal and maternal outcomes, requiring further evaluation. Purpose: Evaluation of factors contributing to delivery at less than 32 weeks in patients who underwent a history-indicated cerclage placement. Methods: Retrospective case-control study of singleton pregnancies with history-indicated cerclage placement at multiple hospitals within a large U.S. hospital system between 2020-2023. Subjects were included if they met criteria for history-indicated cerclage placement. They were excluded if maternal and neonatal outcomes were not available. Patients were separated into two groups: those delivering at 32 weeks or greater and those delivering less than 32 weeks. Maternal characteristics, timing of cerclage, and surgical approach were compared between groups. Student’s t-test, chi-squared, and logistic regression were used for statistical analysis, and p-value <0.05 was considered statistically significant. Results: 201 subjects were identified who underwent history-indicated cerclage. Of these, 26 (12.9%) delivered < 32 weeks and 175 (87.1%) ≥ 32 weeks. Patients across both cohorts were similar in terms of age, parity, race, BMI, and type of insurance. Additionally, use of indomethacin, antibiotics, suture type, and vaginal prep used did not vary significantly. Timing of cerclage was later by approximately 3 days in those who delivered <32 weeks; however, this was not statistically significant in the univariable analysis. In the adjusted analysis, controlling for baseline characteristics, timing of cerclage, and surgical approach, those who delivered < 32 weeks were more likely to be single (aOR 4.58, 95% CI 1.34-14.60). Additionally, earlier cerclage placement was associated with lower rates of delivery <32 weeks (aOR 0.62, 95%CI 0.39-0.99). Conclusion: In patients having a history-indicated cerclage placed, earlier gestational age at placement decreased likelihood of delivery at less than 32 weeks. Type of suture and the use of prophylactic antibiotics was not associated with increased rates of delivery > 32 weeks. |
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11:41 AM |
(Poster) Sarah Furqan MD, Neonatology, Advocate Children’s Hospital, Advocate Health 11:41 AM - 1:15 PM Background/Significance: Acute kidney injury (AKI) remains under-recognized in preterm infants. While modified KDIGO criteria guides neonatal AKI diagnosis, the relationship between patent ductus arteriosus (PDA), its management, and AKI development remains unclear. The "ductal steal" phenomenon in PDA may contribute to renal hypoperfusion and AKI. Purpose: To determine AKI frequency using modified neonatal KDIGO criteria in patients <30 weeks gestational age>(GA) with PDA, examine the impact of PDA management on AKI, and explore the association between echocardiographic markers and AKI. Methods: This single-center retrospective study focused on preterm infants born at <30 weeks GA between February 2019 and September 2023. The cohort was categorized by PDA status and AKI stages using the modified KDIGO 2016 criteria. Statistical significance was determined at>p<0.05. Results: Among 166 infants (mean GA 27.1±1.98 weeks, birth weight 1004±315g), the incidence of KDIGO-defined AKI was 80.1%, while clinically coded AKI was only 8.5%, indicating significant under-recognition. In documented PDA cases (n=115), the incidence of AKI was higher with PDA (87% vs 72%, p=0.047). The distribution of AKI severity showed a non-significant trend toward higher stages with PDA (p=0.063). PDA management strategy and severity did not significantly affect AKI occurrence. Echocardiographic findings of reversed diastolic flow showed no significant association with AKI. Conclusion: The significantly higher AKI incidence in infants with PDA underscores its role as a risk factor, though management approach and PDA severity did not impact AKI development. The marked disparity between KDIGO-identified and clinically coded AKI highlights the need for improved recognition and systematic kidney function monitoring in preterm infants with PDA. |
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11:41 AM |
Using Immersive Point of View Simulations to Enhance Provider Patient Experience Scores (Poster) Gagan Singh MSN, RN, Simulation, Good Shepherd Hospital, Advocate Health 11:41 AM - 1:15 PM |
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(Poster) Ryan McKillip MD, Emergency Medicine, Advocate Christ Medical Center, Advocate Health 11:41 AM - 1:15 PM |
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(Poster) Amjed Zidan DO, Cardiology, Aurora St. Luke’s Medical Center, Advocate Health 11:41 AM - 1:15 PM Background/Significance: Coronary computed tomography angiography (CCTA) has become an essential non-invasive diagnostic tool for evaluating coronary artery disease (CAD). However, the clinical management and testing strategies after CCTA vary based on individual patient findings and institutional practices. Purpose: This study aims to analyze the downstream diagnostic and therapeutic procedures performed following CCTA at Aurora St. Luke Medical Center over a ten-year period. Methods: We performed a retrospective analysis of patients who underwent CCTA at Aurora St. Luke Medical Center between 2012 and 2022. The dataset included a total of 1,803 unique patients, with detailed records of all subsequent diagnostic and interventional procedures. We assessed the frequency and timing of downstream testing, with a focus on the most common procedures such as nuclear myocardial perfusion imaging (NM MPI), stress echocardiography (echo stress), coronary angiography, and percutaneous transluminal coronary angioplasty (PTCA). Results: Among the patients who had CCTA, 30% underwent downstream testing. The most common procedures following CCTA were NM myocardial perfusion imaging (29%) and coronary angiography (24%). Notably, 17% of patients required PTCA, either with or without stenting. Patients underwent additional diagnostic testing at various intervals following the CCTA, with a median time to the next procedure of 518 days (IQR: 87–1,029 days), although some procedures were performed immediately after the CCTA. The data revealed distinct testing pathways, where high-risk patients often received coronary angiograms and interventional procedures soon after CCTA, while others underwent non-invasive follow-up testing, such as NM MPI or echo stress, as part of long-term disease management. Conclusion: This ten-year analysis of downstream testing following CCTA at our institution demonstrates a diverse range of clinical follow-up strategies. The frequent use of nuclear myocardial perfusion imaging and coronary angiography highlights CCTA's role in guiding subsequent diagnostic and therapeutic interventions. The variability in timing suggests that CCTA results inform both urgent interventions and long-term surveillance in CAD management. These findings can inform clinical guidelines and help optimize post-CCTA care to improve patient outcomes. |
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Stress Management Training for Obstetrics and Gynecology Resident Physicians (Poster) Deemantha G. Fernando MD, Obstetrics and Gynecology, Aurora Sinai Medical Center, Advocate Health 11:41 AM - 1:15 PM Background/Significance: Obstetrics and Gynecology (OBGYN) residents face high levels of stress during training. While various strategies have been implemented to help trainees manage stress, studies on the benefits of stress training are limited. Purpose: Our quality improvement study implemented stress management workshops for OBGYN residents to determine if the workshop provided them with tools to navigate work-related stress. Methods: All OBGYN residents (n=13) within one Midwest teaching hospital were asked to voluntarily complete a pre-workshop survey on REDCap to gauge current levels of stress, perceived support, and management strategies. Workshops were held: 11/2023, 3/2024, 5/2024. Post-workshop surveys (n=10) were also completed. Questions were asked on a Likert scale 1-5 (strongly disagree-strongly agree). Basic descriptive statistics were used to describe pre/post-workshop survey responses. Results: Residents reported less stress while operating (2.7 vs. 3.6 pre) and increased strategies for managing stress (3.6 vs. 3.2 pre) but had less recognition of their stress (3.7 vs. 4.2 pre). Residents also expressed increased awareness that stress while operating prevented effective learning and teaching (4.2 vs. 3.0 pre). While co-residents helped to reduce stress (3.9 vs. 3.4 pre), attendings may not (3.1 vs. 3.5 pre). Stress in the evening after operating increased (4.5 to 3.1 pre). Overall, residents expressed they would like stress management training (4.4 vs. 4.3 pre) and felt it was feasible to reduce stress while operating (4.8 vs. 4.2 pre). Conclusion: OBGYN resident stress management workshops may reduce stress and provide tools for effectively managing stress. Addressing work-related stress and providing additional support could further enhance residents' well-being and educational experiences. However, workshops targeting larger groups of OBGYN residents are needed to further identify the overall impact of the workshop. |
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11:41 AM |
The Effect of Calcium Carbonate on Labor Induction: A Pilot Study (Poster) Jarquechia White MD, Obstetrics and Gynecology, Aurora Sinai Medical Center, Advocate Health 11:41 AM - 1:15 PM Background/Significance: Since 1976, U.S. cesarean deliveries (CDs) have increased ~30%. While CDs can be lifesaving, they pose a greater maternal risk than vaginal delivery. Thus, there is great interest in the prevention of CDs. The most common indication for CD is labor dystocia. Calcium carbonate (CaCO3), or Tums, has gained popularity for off-label use to prevent labor dystocia based on anecdotal evidence only. As calcium may improve uterine contractility and carbonate may decrease lactic acid, we sought evidence on the potential of CaCO3 to prevent labor dystocia and decrease CD rates. Purpose: To inform sample size and explore any safety/protocol concerns for future studies, we piloted CaCO3 use during labor induction assessing (1) induction duration with oxytocin, (2) labor dystocia rate, (3) CD rate, and (4) maternal/neonatal safety. Methods: We conducted a quasi-experimental, single-site pilot study among English/Spanish-speaking pregnant adults who presented for labor induction. A prospective treatment group (n=50) was consented June-September 2024, received CaCO3 (500mg every 4 hours) plus standard-dose oxytocin, and completed a side effect survey. A randomly selected retrospective historical control group (n=200) who presented for induction between 2020-2022 and received standard-dose oxytocin alone was also identified. Data was collected from the EMR or survey and stored in REDCap. Frequencies with percentages and medians with interquartile ranges, as appropriate, were computed. Differences were assessed using Pearson chi-squared test of independence or Fisher’s exact, or Wilcoxon’s Rank Sum test, as appropriate. Two tailed p < 0.05 was statistically significant. Results: Gestational age, parity, and starting Bishop score were similar between groups. While induction duration with oxytocin was significantly longer in the prospective CaCO3 group (766 vs 553 mins, p=0.02), the labor dystocia rate was clinically lower, though not statistically significant (4% vs 11%, p=0.18). Similarly, the CD rate was clinically lower in the prospective group but not statistically significant (14% vs 22%, p=0.24). There were no differences in maternal/neonatal safety outcomes. The survey revealed most had no or mild side effects with CaCO3. Conclusion: Despite a longer induction time, clinically relevant differences were found for labor dystocia and CD rates. Our pilot study reveals no safety concerns and informs sample sizes for future studies, as further information is needed to detect meaningful differences regarding CaCO3 use. |
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11:41 AM |
Two Years of Primary Care Pop-up Screenings for Milwaukee’s Rohingya Populace (Poster) Alec R. Baca MD, Family Medicine, Aurora St. Luke’s Medical Center, Advocate Health 11:41 AM - 1:15 PM Background/Significance: The Rohingya are a refugee population from Myanmar with over 1000 families settled in Milwaukee over the past decade. Various barriers impede their access to medical care, including language barriers, a low literacy rate, and difficulties navigating the healthcare system. The Burmese Rohingya Community of Wisconsin (BRCW) services Milwaukee's Rohingya through programs that help their integration into American society including healthcare. This study explores a partnership with BRCW to deliver health screenings to Milwaukee’s Rohingya. Purpose: The purpose of this project was to host health screenings at a booth within BRCW's facility. The importance of these screenings is to demonstrate the potential for serving refugee communities’ healthcare needs through community partnerships. Methods: Eight screenings took place throughout 2023-2024. Measurements were taken for participants’ blood pressure, blood glucose, weight, height and BMI, with quick health education being given with an in-person interpreter. Additionally, educational videos in Rohingya on various health topics were available on an iPad on our work stand. At two of our screenings, an additional question was included on if the participant had seen a primary care physician in the past year. Results: Over 170 community members took part in our screenings. Screenings took place coordinating with community events at BRCW including health fairs, a mosque service, community celebrations, and English/citizenship classes. Of the participants, 39 were counseled for having an obese BMI, 27 were counseled for either having or being at a high risk for hypertension, and 7 were counseled for either having or being at a high risk for diabetes. Of the two sessions where it was asked if the participants had seen a primary care provider in the last year, 40 responses showed 95% reporting that they have. Conclusion: Our experience shows the potential for community partnerships in providing health screenings with education for refugee populations with over 57 of the participants receiving counseling for at least one chronic condition. Though interpretation is limited by the data only including two screenings, a higher-than-expected percentage answered affirmatively that they have a primary care physician. Future studies could likely focus more on the quality and reception of our Rohingya-language videos on various health topics, and how to best present them to the community for use. |
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(Poster) Yannis Spiros Lafazanos DO, Internal Medicine, Advocate Lutheran General Hospital, Advocate Health 11:41 AM - 1:15 PM |
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(Poster) Jessy Johnson DC, Aurora Health Center Waukesha, Advocate Health 11:41 AM - 1:15 PM |
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Pediatric Pneumorrhachis: A Systematic Review of Literature (Poster) Divya Abbaraju BS, Rosalind Franklin University 11:41 AM - 1:15 PM Background/Significance: Pneumorrhachis (PR), or air in the spinal canal, is an uncommonly reported radiological finding, especially in pediatrics. Purpose: Evidence for evaluation, management and prognosis of pediatric PR is limited to isolated case reports. We reviewed available case reports to identify causes, management, and outcomes of children with PR and expand current literature. Methods: We searched PubMed, Embase, and CINAHL databases to identify cases of PR in children less than 18 years of age published in English. We excluded duplicates, animal reports, and articles without an illustrative case of spinal air. “Citationchaser” was used to identify additional articles. Results: We identified 110 cases from 1186 articles from the initial search and 6 articles from Citationchaser that met inclusion criteria. Gender was reported in 106, of which 76% (n=81) were males. The median (IQR) age was 12.5 (7-16) years. Lower extremity motor deficits were described in 10 cases (9.09%), including 5 attributed directly to PR, but symptoms in all other cases were related to underlying condition. Etiologies of PR were spontaneous (n=73), traumatic (n=24), iatrogenic (n=11), or other (n=2). Spontaneous PR was most commonly associated with asthma or other respiratory pathology (n=45). Associated air in other locations was noted in 98% (n=72) of patients with spontaneous PR and 17 cases with traumatic PR. PR was identified by computerized tomography (n=103), magnetic resonance imaging (n=3) or radiograph (n=3). Other evaluations included bronchoscopy (n=12), esophagogram (n=17), and echocardiography (n=5). Spontaneous PR resolved with treatment of underlying condition and hyperbaric oxygen therapy was used in one patient. Surgical interventions used in traumatic or iatrogenic PR included chest tube placement (n=4), spinal decompression (n=5), dural tear repair (n=3), and foreign body removal (n=2). The outcome was not reported for 3 patients. Most were discharged home (n=103) without neurologic deficits from PR. Four case subjects, including 3 with neurologic deficits, died from unrelated causes. Conclusion: PR is usually an asymptomatic and self-limited condition that resolves with conservative therapy. It can rarely lead to neurologic deficits and may signify major trauma to the head or spine. Evaluations may be required to identify the source of air leak or air entry into the spinal canal. Associated medical conditions usually determine prognosis. |
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(Poster) Diwante Shuford MD, Emergency Medicine, Advocate Christ Medical Center, Advocate Health 11:41 AM - 1:15 PM Background/Significance: Mechanical chest compression systems, such as the Lund University Cardiopulmonary Assist System (LUCAS), provide consistent high-quality CPR through constant rate and depth. Despite this, there is no difference in clinical outcomes when comparing mechanical to manual CPR. Studies have found that placement of the LUCAS can result in a 32.5 second pause in compressions on average, and it has been shown that longer pauses in chest compressions correlate with decreased survival rates. Purpose: The purpose of this study was to investigate whether pauses in compressions could be shortened with standardized video training on LUCAS application. Methods: First responders from fire departments in the south suburbs of Chicago were recruited in teams of two to participate in a scenario requiring manual chest compressions and LUCAS device application. To control for the effect of practice each team performed three trials of the exercise and was randomly assigned to one of two groups: 1) a group who viewed a LUCAS training video between the first and second trial or 2) a group that viewed the video between the second and third trial. CPR pause times were recorded using a pressure sensor attached to a mannequin and manually by investigators using stopwatches. Times are reported as average in seconds (s) and were compared using tests. Results: Twenty-two pairs of first responders from four fire departments participated, ranging in experience and ALS or BLS training. Group 1 CPR pause times improved after watching the video between Trials 1 and 2, decreasing from 24.9 s (12.8 s) to 17.2 s (4.2 s) (P = 0.07). However, pause times remained relatively unchanged in Trial 3 at 16.5 s (9.2 s), suggesting a plateau in improvement. Group 2 also improved between Trials 1 and 2 (23.5 s [9.9 s] to 16.9 s [6.3 s], P = 0.08), reflecting a practice effect. After watching the video, Group 2 CPR pause times improved further to 12.9 s (3.6 s) in Trial 3 (P = 0.08). Conclusion: While short of statistical significance, the minimal additional improvement between Trials 2 and 3 for Group 1 while Group 2 demonstrated improvement after video exposure suggests that the video had an impact reducing CPR pause times beyond the effect of practice alone. These findings may be confirmed with a larger sample size. Overall, training videos and practice should be adopted by EMS protocols to decrease CPR pause times and improve resuscitation. |
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11:41 AM |
(Poster) Mary Brandt MD, Surgical Oncology, Aurora St. Luke’s Medical Center, Advocate Health 11:41 AM - 1:15 PM Background/Significance: The American College of Surgeons Commission on Cancer implemented standards for synoptic operative reports, based on evidence-based guidelines, that highlight techniques critical to achieving optimal outcomes. Despite this standard, institutions struggle with compliance. Descriptions of successes would be instructional for the community. Our objective was to assess compliance with synoptic reporting across a large multi-state hospital system and describe our process of improvement. Purpose: To describe our experience of increasing compliance for an accepted operative report standard within a large, multi-institutional healthcare system. Methods: We developed a standardized "smart-phrase" to be used system-wide. This phrase populates the synoptic table into an operative report. Training for surgeons was provided at each discipline’s cancer conferences. An iterative approach was employed, with monthly compliance reports sent to core leaders in surgical oncology. Non-compliant surgeons received targeted follow-up and education via email. Results: Initial compliance with synoptic reporting was sentinel lymph node biopsy (SLNBx): 96% (107/112), axillary lymph node dissection (ALND): 75% (9/12), wide excision melanoma (WLE): 54% (7/13) and colon resection: 51% (18/35). Only SLNBx met the >=80% compliance. At nine months, compliance improved in all procedures: SLNBx: 96% (129/135), ALND: 91% (10/11), WLE 86% (12/14), Colon Resection: 81% (22/27). Conclusion: Monthly quality reports and targeted follow-ups improved compliance for three procedures. Challenges persist in refining accurate automatic reports and the diversity and quantity of surgical subspecialty providers within a large multi-institutional healthcare organization. Further interventions are planned for specific service lines to address these barriers. |
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11:41 AM |
(Poster) Anna Clennon PharmD, BCOP, Pharmacy, Aurora St. Luke's Medical Center, Advocate Health 11:41 AM - 1:15 PM Background/Significance: Ifosfamide neurotoxicity (IN) is estimated to occur in 10-30% of patients. The effect on incidence of IN when adding neurokinin 1 receptor antagonists (NK1RA) is conflicting in the literature. Fosaprepitant and aprepitant are NK-1RA agents with moderate CYP3A4 inhibition and ifosfamide is a strong CYP3A4 substrate. Theoretically, when combined, this can result in increased ifosfamide concentrations. Clinically, the medical community does not pre-emptively remove NK-1RA in ifosfamide regimens, although alternate antiemetics are available. Other cited risked factors for IN include hypoalbuminemia, poor kidney function, hyponatremia, poor liver function, and preexisting brain metastasis. Purpose: Assessing (fos)aprepitant use and other independent risk factors for IN will help guide the management of modifiable and non-modifiable factors, with the ultimate goal of decreasing IN rates. Methods: A retrospective, single center cohort study included patients between 18-89 years of age who received at least one cycle of an ifosfamide-containing regimen in Wisconsin region without (fos)aprepitant between Jan. 1, 2014-Dec. 1, 2016, or with (fos)aprepitant between Jan. 1, 2022-Dec. 1, 2024. Protected populations and those who had inadequate records were excluded. Risk factors collected included hypoalbuminemia, poor kidney function, hyponatremia, poor liver function, and preexisting brain metastasis. The primary outcome was to identify the incidence of IN with and without (fos)aprepitant use. A secondary outcome was assessed to identify the incidence of risk factors and impact on IN. Baseline characteristics and outcomes utilized descriptive statistics. Results: A total of 104 patients were included (n=52 (fos)aprepitant [A], n=52 in non-(fos)aprepitant [NA]). IN occurred in 25% (n=13) of patients who received fos(aprepitant) versus 9.6% (n=5) in those that did not (p=0.038). Risk factors for IN were more common in the NA group with hypoalbuminemia being the most common (56% A, 52% NA). Patients with 2 or more risk factors experienced the majority of IN within both groups (53.8% A, 80% NA). Conclusion: (Fos)aprepitant may be an independent risk factor for increasing IN. Rates of IN seen across the Advocate Health Midwest Region have risen in a clinically impactful manner, urging clinicians to consider primary prophylactic approaches to reduce incidence such as (fos)aprepitant-free antiemetics, albumin and thiamine supplementation, and methylene blue. |
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Every Patient Needs a PCP - Active Attribution of a Primary Care Provider (Poster) Lindsay Merlotti MD, Advocate Lutheran General Hospital, Advocate Health 11:41 AM - 1:15 PM Background/Significance: Empanelment has been shown to effectively distribute the workload amongst providers in a specific practice resulting in increased patient and provider satisfaction. At the Advocate Lutheran General Hospital Family Medicine (FM) residency, like many residencies, there is not a specific protocol in place to establish a unique panel for each resident and many patients have inaccurate primary care physicians (PCPs) designated. Purpose: Our objective was to have 100% of patients seen at the Nesset Family Medicine office from January 1, 2021, to December 31, 2023, assigned to a specific PCP by January 1, 2024. Methods: A flow sheet was designed to help select which provider should be designated as a patient’s PCP. Patient service representative (PSR) staff and residents utilized this flow sheet to manually re-assign each patient that had an outdated or inaccurate PCP. On our second Plan-Do-Study-Act (PDSA) cycle, we switched to a random assignment protocol. Results: Our main outcome was measured to be the percentage of patients seen at the Nesset Family Medicine Residency Clinic that had a PCP who was a current resident. By the study's end date, we had increased from 61% to 92% of patients who were accurately assigned to a resident panel. As a balancing measure, a survey was distributed to determine the level of stress that this re-assignment process added to the PSR workload: 100% strongly agreed that manual re-assignment added stress. In comparison, 85.71% strongly disagreed with that assignment added stress during routine patient check-in. Conclusions: Patients can effectively be assigned to PCP panels in residency clinics using available tools in Epic EMR. While using a patient’s visit history to re-assign may be most accurate, this is a much more time-intensive and stress-inducing process compared to random assignment. Future plans include optimizing this process as third-year residents graduate from the program each year and possibly incorporating a way to weigh panels by patient complexity. |
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(Poster) Haroon Zubair MD, Structural Interventional Cardiology, Aurora St. Luke's Medical Center, Advocate Health 11:41 AM - 11:41 AM Background/Significance: Real-world outcomes in patients with major post-procedure bleeding after mitral transcatheter edge-to-edge repair (TEER) from a large national database are unknown. Purpose: To study major bleeding outcomes in patients undergoing mitral TEER in order to implement and improve bleeding mitigation strategies. Methods: We used the National Inpatient Sample from 2013 to 2020 in our study. ICD-9 and ICD-10 codes were used to identify our study population. Linear and logistic regression were used to obtain unadjusted and adjusted estimates. Major bleeding was defined by any bleeding requiring blood transfusion after TEER. Results: Of 43,920 patients with mean age (SE) of 77 (0.13) years, 46% were females. Of these, 2156 (4.9%), had major bleeding requiring blood transfusion. Bleeding rates decreased significantly (P-trend < 0.001) from 21% in 2013 to 4% in 2020. Major bleeding was associated with increased in-hospital mortality on both unadjusted (OR 6.3, P < 0.001) and risk-adjusted (AOR 4.12, P < 0.001) analyses. It was also independently associated with an increased length of stay and cost on both unadjusted and risk adjusted analysis. Conclusion: Major bleeding is associated with worse outcomes in patients undergoing mitral TEER. Decreasing trends in these bleeding rates over time shown in our study are encouraging and continued efforts to reduce bleeding rates are needed to further improve these outcomes. |
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Assessing Disparity in Early Pediatric Care Receipt Among Multiple Midwest Clinics (Poster) Clare Crosh DO, Pediatrics, Advocate Children’s Hospital, Advocate Health 11:41 AM - 11:41 AM Background/Significance: Disparity in early pediatric care receipt (0-15 months) can have dire consequences to the health of a baby. Routine pediatric check-ups, or well-child visits (WCV), are critical for tracking a child’s growth, development, and overall health. However, significant disparities exist in the attendance of these visits, particularly among racially and ethnically marginalized and lower socioeconomic (SES) families. Purpose: Currently, there is a lack of data to inform the development of strategic priorities for addressing pediatric health disparities and promoting health equity. This gap is partly due to the limited evidence regarding early pediatric-specific health indicators. Therefore, the development of evidence-based, pediatric-focused health equity indicators remains a pressing need. While disparities are recognized, documenting the full extent of the problem is challenging. Institutions must prioritize tracking progress towards health equity, which involves systematically collecting data on health indicators, setting goals, and monitoring progress. Methods: This is a retrospective analysis of two distinct pediatric clinical populations within Advocate Health. Pediatric patients were eligible for inclusion if they were born in 2022 and had at least one WCV within the first 15 months of life. We identified WCVs using electronic medical record data for encounters and billing. Visits were classified as WCV if they had a visit type or SNOMED CT code indicating a WCV. We identified well-child visit timepoints using the AAP Recommendations for Preventive Pediatric Health Care. All analyses were done using Stata MP version 14. Results: Attendance at AAP recommended well child visits ranged from 67.7% to 92.0% across all timepoints. Compared to non-Hispanic white patients, non-Hispanic Black patients had 38% lower odds of having 6 or more well child visits. There were no significant differences in well child visits attendance at 1 week and 1 month. However, these diverged at 2 months with lower SES and predominantly Black sites having significantly lower odds of visit attendance at a majority of the remaining recommended visit timepoints. Patients at sites with lower SES had 43% reduced odds of having at least 6 WCVs in their first 15 months of life compared to higher income and majority White sites. Conclusion: This project compares two distinct pediatric populations within one system to quantify the observation that parents/guardians of non-Hispanic Black children aged 0-1 were less likely to adhere to recommended guidelines. |
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(Poster) Amauchechukwu Ononenyi MD, Undersea and Hyperbaric Medicine, Aurora St. Lukes Medical Center, Advocate Health 11:41 AM - 1:15 PM Background/Significance: Microvascular Fluorescence Angiography (MFA) allows for visualization of blood flow by injecting dye into the bloodstream. It is used in Hyperbaric and Wound Care (HWC) to assess the status of blood flow around a wound and determine the wound’s healing potential. Currently, the use of MFA is not a standardized practice in the field of HWC. Some physicians rely more on their clinical exam, while others feel the need to use MFA. Within the HWC field, it is unclear if MFA is ultimately useful considering the high cost of purchase. MFA is utilized by most HWC physicians at Aurora St. Luke’s Medical Center (ASLMC). There is a need to objectively measure if there are changes to a physician’s assessment and plan for the same wound after they’ve used MFA compared to immediate prior clinical exam. Purpose: To discover whether MFA affects the physician’s decisions on wound status and Hyperbaric Oxygen Therapy (HBOT) plan with the intention of obtaining objective data that would contribute meaningfully to discussion of usefulness of MFA, and thus the practice of MFA usage, both at ASLMC and the larger Advocate health. Methods: Physicians at ASLMC’s HWC department were given pre- and post-MFA surveys with questions regarding the patient’s wound status, whether HBOT duration will be changed, and the provider’s level of confidence (Likert scale) in their decision to modify the HBOT treatment duration. Physicians’ answers between the pre- and post-MFA surveys were compared to determine if their answers changed following MFA. Results: 25 physician surveys were collected and analyzed. Compared to clinical assessment, 32% of physicians changed the wound impression, 36% of physicians changed the planned HBOT duration, and 48% of physicians changed their level of confidence after using MFA. Conclusion: Our results suggest MFA provides clinicians with information about wounds that may not be apparent on clinical exam. One-third of physicians changed their wound impression, as well as planned HBOT duration. Of note, nearly half of physicians shifted their confidence level following MFA. It’s important to realize that using MFA could have provided reassurance and/or altered the confidence for the physicians who made no changes to the impression and plan. In addition, we cannot discount the potential positive impact in the wound healing process because of MFA influencing the extending or shortening of HBOT course, as this plays a role in the discussion of usefulness of MFA. Further studies are ongoing. |
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(Poster) Benjamin Banks MD, Undersea and Hyperbaric Medicine, Aurora St. Luke's Medical Center, Advocate Health 11:41 AM - 1:15 PM Background/Significance: Microvascular Fluorescence Angiography (MFA) allows for assessment of focal tissue perfusion following an amputation. Sequential MFA studies provide visualization of initial microvasculature and evolving angiogenesis at an amputation site, allowing clinicians to assess the impact of Hyperbaric Oxygen Therapy (HBOT) throughout a patient’s recovery. In turn, MFA may then influence the prolongation or completion of HBOT. This study assessed whether MFA impacted the duration of HBOT following lower extremity distal amputation in patients who developed a postoperative ischemic compromised flap (“comp flap”). Purpose: While MFA provides valuable information regarding amputation site health, we must evaluate how this information alters hyperbaric care and patient outcomes. Only by investigating the merits and shortcomings of MFA can we consider this modality’s place amongst numerous other interventions available to our hyperbaric amputee patients. Methods: In this retrospective chart review, lower extremity (LE) amputation patients with clinical findings for comp flap and who also received HBOT were identified. The patients were divided into cohort group (underwent MFA imaging) and control group (no MFA imaging). HBOT duration and clinical outcomes were compared between groups. Results: 267 patients who underwent LE amputation (101 cohorts/166 controls) were identified. Patients received between 1-60 HBOT treatments. Overall, the MFA group received more HBOT treatments than the control group: 46% of MFA patients received 11-20 treatments compared to 34% of controls; 30% of MFA patients received 21-30 treatments compared to 23% of controls; and 12% of MFA patients received 31 or more treatments compared to 9% of controls. Notably, one third (34%) of control patients received 10 or fewer HBOT treatments compared to 13% for the MFA group. Conclusion: MFA’s application in HBOT patient selection and influence on treatment duration has been promoted, however there is little information on direct impact. Interestingly, non-MFA patients status-post LE amputations were more likely to receive ≤10 treatments when compared to the MFA group. MFA patients were more likely to receive 11-20 treatments compared to the non-MFA group. Additionally, MFA appears to influence HBOT by increasing the number of treatments in toe amputation comp flap patients for all hyperbaric treatment course subgroups who received >10 HBOT. Once a patient surpasses 20 HBOT however, the impact of MFA on treatment duration is less robust. Further analyses are needed to understand competing factors as we explore MFA’s role in hyperbaric medicine. |
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Assessing Tranexamic Acid Use in Intracranial Hemorrhages Irrespective of Severity (Poster) Patrycja Buch PharmD, Pharmacy, Advocate Lutheran General Hospital, Advocate Health 11:41 AM - 1:15 PM Background/Significance: Tranexamic acid (TXA) is an antifibrinolytic agent commonly used in trauma resuscitation, including in patients with traumatic intracranial hemorrhage (tICH). The CRASH-3 trial demonstrated a mortality benefit when TXA was administered within 3 hours of injury in patients with mild to moderate traumatic brain injury (TBI), measured by a Glasgow Coma Scale (GCS) of 9-15. However, the benefit in patients with severe TBI or those treated beyond the 3-hour window remains unclear. At this institution, TXA may be used outside of CRASH-3 criteria, raising questions about its real-world effectiveness and safety. This study aimed to evaluate TXA utilization and its association with hemostatic effectiveness, mortality, and complications in patients with tICH, regardless of injury severity or timing. Purpose: To evaluate the impact of TXA on clinical outcomes in tICH, regardless of injury severity or timing, and to identify potential benefits or limitations of its routine use. Methods: This was a retrospective, single-center study of patients who presented to the emergency department with a primary diagnosis of TBI between February 2020 and September 2024. In a 2:1 ratio, patients were selected with two control patients for every patient who received TXA. Patients were then stratified by GCS score and timing of TXA administration. The primary outcome was hemostatic effectiveness based on 24-hour CT scan stability. Secondary outcomes included in-hospital mortality and complications (thromboembolism, myocardial infarction, stroke, seizure). Categorical and continuous variables were analyzed using appropriate statistical tests. Results: Ninety-six patients were included (32 TXA, 64 control). Most patients had mild TBI in the TXA and control group (71.9% and 73.4%), and 65.6% of TXA was administered within 3 hours of injury. There was no difference in hemostatic effectiveness between groups, with 24-hour CT showing stability or improvement in 96.7% of TXA patients and 93.5% of the control group, p=0.54. Mortality was higher in the TXA group (15.6% vs. 4.7%, p=0.11). No complications were observed in the TXA group. Conclusion: TXA was well tolerated in this tICH population but did not improve hemostatic effectiveness. Higher mortality in the TXA group warrants further investigation. Findings support the need for larger, prospective studies to better define the role of TXA across all severities of tICH and guide appropriate clinical use. |
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(Poster) Massara Alessa PharmD, Pharmacy, Advocate Lutheran General Hospital, Advocate Health 11:41 AM - 1:15 PM Background/Significance: DOAC (Direct Oral Anticoagulant) use has significantly increased over warfarin, supported by clinical guidelines for conditions like nonvalvular atrial fibrillation and venous thromboembolism. A study by Geller et al. using data from 60 U.S. hospitals and a national prescription database showed DOAC use rose to 83.6% by 2020, while warfarin declined to 41.2%. Rising DOAC use highlights the need for structured monitoring. To address this, Advocate Lutheran General Hospital implemented a pharmacist-run DOAC monitoring service to enhance anticoagulation stewardship. Purpose: To implement a comprehensive DOAC monitoring service and improve safe, effective use of anticoagulation therapy. Methods: This prospective, observational, single-center study included adults discharged on DOACs, excluding patients under 18, in hospice/long-term care, on short-term DOACs post-orthopedic surgery, or with a Watchman device. A collaborative practice agreement allowed pharmacists to order referrals under a physician’s name. Educational tools and pharmacist surveys were developed. Data were collected through chart review in the electronic medical record (EMR). Enrollment began on November 1, 2024, with initial visits starting on November 15. Data collection continued through February 1, 2025. Results: Of the monitored patients, 74% were treated for atrial fibrillation, 19% for venous thromboembolism, and 6% for other reasons. Most (76%) were continuing therapy; 22% were new starts. Apixaban was used in 88% of cases, Rivaroxaban in 12%. Dosing accuracy was 93%, with 1% underdosed and 6% overdosed. Risk-based follow-ups were set at 3 months for high-risk (56%), 6 months for moderate (33%), and 12 months for low-risk (9%). Only 7% had cost issues, and 2% reported adherence concerns. Drug interactions were seen in 7%, primarily with Diltiazem. Antiplatelet/NSAID use occurred in 45%, mostly aspirin. Bleeding occurred in 7%, bruising in 6%; 9% required DOAC interruption. All hospitalizations were unrelated to DOACs. Conclusions: The pharmacist-led DOAC service improved post-discharge anticoagulation management through structured monitoring, early issue detection, and individualized follow-up. Despite outreach and enrollment challenges, it demonstrated strong clinical value. Future steps include extending follow-up, automating enrollment, enabling cost lookups by insurance, and expanding to other Advocate sites. |
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(Poster) Cristina Pecoraro PharmD, Pharmacy, Advocate Lutheran General Hospital, Advocate Health 11:41 AM - 1:15 PM Background/Significance: Four-factor prothrombin complex concentrate (4PCC) is used off-label for factor Xa inhibitor (FXaI)-associated life-threatening hemorrhages. The American Heart Association/American Stroke Association Intracerebral Hemorrhage (ICH) 2022 Guidelines consider 4PCC use in FXaI-associated ICH but do not specify a dose. Several studies have demonstrated similar efficacy and cost savings when dosed at 25 units/kg compared to 50 units/kg, regardless of bleed location. Purpose: Determine whether there is a difference in hemostatic efficacy between 25 units/kg versus 50 units/kg of 4PCC for FXaI reversal in ICH. Methods: This was a single-center review of adult patients who received 4PCC in the Emergency Department for reversal of FXaI-related ICH from February 2020 to January 10, 2025. The primary outcome evaluated the hemostatic effectiveness within 24 hours of 4PCC administration, determined by improvement or worsening of hematoma size based on radiologist impression of computed tomography imaging. Additional outcomes included incidence of thromboembolic events within 30 days, in-hospital mortality, hospital length of stay, and cost per dose administered. Results: A total of 120 patients who received 4PCC for FXaI-associated ICH were included in the analysis. Hemostasis was evaluable in 113 patients with 24-hour post-4PCC imaging available. There was no difference in hemostatic efficacy between groups (92% low dose vs. 86% high dose, p=0.50). Thromboembolic events 30 days post-4PCC occurred in 5.4% versus 7.2% (p=0.64). There was a higher incidence of in-hospital mortality among the high-dose group compared to low-dose (24.1% vs. 8.1%, p=0.04), however patients in the high-dose group were noted to have more severe injuries upon presentation. Conclusion: The findings of this study add to existing literature supporting a 25 units/kg dose as an effective alternative to 50 units/kg 4PCC dosing and provides cost savings for the reversal of FXaI in ICH. |
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Evaluating the Use of Empagliflozin in Pediatric Heart Failure (Poster) Alexis Craven PharmD, Pharmacy, Advocate Christ Medical Center, Advocate Health 11:41 AM - 1:15 PM Background/Significance: Pediatric heart failure (HF) remains a condition with significant morbidity and mortality, presenting a critical challenge in pediatric cardiology. Sodium-glucose cotransporter 2 inhibitors (SGLT2i), initially developed for managing type II diabetes, have demonstrated considerable benefits in adult patients with HF, including reductions in mortality and hospitalization rates. At Advocate Children’s Hospital, empagliflozin is the SGLT2i available on formulary. The paucity of data on empagliflozin in pediatric patients presents a significant gap in the literature. Purpose: This study aims to address this gap by evaluating the safety and efficacy of empagliflozin in children with HF. Methods: This single-center, retrospective observational study of current practice will review the use of empagliflozin in pediatric patients with HF. A report generated from the electronic health record was used to identify potential patients, and patients were included if they were 1 day through 18 years old with HF who were initiated on empagliflozin at Advocate Children’s Hospital Oak Lawn, between January 2022 and December 2024. Patients were excluded if the duration of empagliflozin was less than 7 days and if the indication was not HF. The primary endpoint is a reduction in diuretic use. Secondary endpoints include assessing safety and change in HF class. Data will be collected at initiation and the last recorded follow-up. Key data points will include baseline characteristics, changes in diuretic requirements, adverse events, and other relevant clinical outcomes. Results: Heart failure etiologies included dilated cardiomyopathy (3/25), single ventricle physiology (14/25), diastolic heart failure (6/25), and Marfan syndrome (2/25). Therapy was initiated at 0.1 mg/kg and titrated to 0.2 mg/kg daily. Over the course of treatment, loop and thiazide diuretic requirements decreased by 36% and 20%, respectively. NT-proBNP levels showed a significant reduction, with median values decreasing from 3,916 pg/mL at baseline to 1,532 pg/mL at the latest follow-up (P = 0.008). No adverse events were reported. Conclusion: SGLT2i therapy appeared safe with no reported adverse drug reactions, demonstrating improvements in cardiac biomarkers, stable renal function, and a decreased need for diuretics. These findings help support the potential role of SGLT2i in the management of HF in pediatric patients; however, further studies are warranted to define the safety and efficacy of this therapy in this vulnerable population. |
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Should Non-Autologous Bypass Graft Conduits be Abandoned in the Current Endovascular Era? (Poster) Ahmad Asha MD, Surgery, Advocate Lutheran General Hospital, Advocate Health 11:41 AM - 1:15 PM Background/Significance: As only a minority of patients undergoing infrainguinal bypass grafting will have adequate autogenous vein, alternative non-autogenous conduits are frequently employed. Unfortunately, their clinical performance has historically been so poor that they are often characterized as “last-ditch” efforts. As more and more patients are now successfully treated endovascularly, only the worst candidates may be revascularized using suboptimal conduits. Purpose: The purpose of this retrospective clinical study was to assess the contemporary results of lower extremity bypass surgery using commercially-available non-autogenous grafts. Methods: Consecutive prosthetic bypasses for peripheral arterial occlusive disease performed at a single institution were included. Patient demographic characteristics, perioperative complications, and limb-specific outcomes were reviewed. Results: Between the years 2015 and 2023, a total of 82 consecutive patients underwent infrainguinal bypass grafting using prosthetic conduits (55 cryopreserved veins and 27 PTFE grafts). Most patients were male (62%), white (74%), diabetic (55%) and presenting with chronic limb-threatening ischemia (CLTI; 90%). Comorbidities such as coronary artery disease (76%) and heart failure (44%) were prevalent. The majority of patients presenting with tissue loss exhibited advanced limb threat with 75% having Wound, Ischemia, foot Infection (WIfI) class 3 and 4. Distal bypass targets included the above-knee popliteal artery (n=31), the below-knee popliteal artery (n=18) or the tibio-pedal arteries (n=33). Perioperative complications occurred in 35% of operations including surgical site infections in 21%. After a median follow-up duration of 19 months (IQR=24 months), limb salvage was achieved in 60 patients with CLTI (81%). Reintervention was commonplace (43%) as was the need for multiple reinterventions (12%). Primary bypass patency was maintained in only 52.8±2.3% of patients at 1-year (46.5±3.1% for cryopreserved vein and 70±7.8% for PTFE). 14 patients (19%) who presented with CLTI eventually required major amputation; only one of them had a patent bypass graft before limb loss. Of the 23 patients with tissue loss who achieved wound healing after prosthetic conduit bypass, 13 eventually lost patency. Conclusions: If adequate autologous vein is not available for infrainguinal bypass, both the graft and the patient are likely to do poorly. In this contemporary series using either cryopreserved vein or PTFE, the 1-year primary patency was only 52.8±2.3%, and 19% of patients presenting with CLTI required amputation. Given these dismal results, continued development and liberalization of endovascular techniques appears warranted. |
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(Poster) Kanella Eliadis PharmD, Pharmacy, Advocate Christ Medical Center, Advocate Health 11:41 AM - 1:15 PM Background/Significance: According to the National Center for Drug Abuse Statistics, in 2023 at least 6.7% of people with alcohol use disorder will go on to develop alcohol withdrawal syndrome (AWS). Benzodiazepines, the mainstay rescue treatment for AWS, are associated with detrimental side effects such as decreased consciousness and respiratory depression. Gabapentin has been studied as an alternative agent to benzodiazepines. Purpose: This study evaluated the difference in lorazepam requirements in patients admitted to the neurocritical care unit (NCCU) who received high dose gabapentin load and taper compared to patients on lorazepam symptom-triggered protocol for or at risk for developing AWS. Methods: In this retrospective study, patient data was collected from 11/1/2020, through 8/31/2024, in NCCU patients treated for or suspected to develop AWS at Advocate Christ Medical Center (ACMC), Advocate Lutheran General Hospital (LGH), and Aurora St. Luke’s Medical Center (ASLMC). Inclusion criteria included patients over the age of 18 years old, documentation of treatment of AWS, documentation of receiving gabapentin load and taper at ACMC (1200mg enteral for 1 dose followed by 900mg every 8 hours for 2 days) and received at least one dose of lorazepam for symptom-triggered CIWA-Ar protocol at LGH and ASLMC. Patients were excluded if prior to admission medications included gabapentin, benzodiazepines, or phenobarbital as well as a past medical history of epilepsy, seizures not attributable to AWS and known gabapentin intolerance. The primary endpoint was the difference in lorazepam requirements (in milligrams). Secondary endpoints included length of stay, use of lorazepam and phenobarbital as rescue medication(s), and complications of AWS, such as intubation rate. Results: After applying inclusion and exclusion criteria there were a total of 57 patients, 24 patients in the gabapentin group and 33 patients in the lorazepam group. Patients in the gabapentin group required an average of 1.42mg of lorazepam compared to an average of 7mg of lorazepam in the lorazepam group (p=0.001). The rate of intubation was similar between both groups with no patients in the gabapentin group requiring intubation due to over sedation. Conclusion: High dose gabapentin load and taper significantly decreased the lorazepam requirements of neurocritical care patients who are at risk for developing alcohol withdrawal syndrome without increasing the rates of intubation due to over sedation. |
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Order-to-Needle: Coordinating Intrathecal Chemotherapy Administration (Poster) Hafsah Nawaz PharmD, Pharmacy, Advocate Lutheran General Hospital, Advocate Health 11:41 AM - 1:15 PM Background/Significance: Intrathecal (IT) chemotherapy is a complex, high-risk procedure involving administration of chemotherapy into cerebrospinal fluid. Errors in administration can result in significant morbidity or mortality. Since 1968, more than 69 documented cases of IT chemotherapy administration errors have been reported. However, the true incidence of errors is likely much higher due to under-reporting. To reduce risks, multiple healthcare professionals must be well-trained, adhere to protocol, and remain vigilant. Purpose: The objective of this project is to develop and implement a streamlined workflow for scheduling, preparation, and administration of IT chemotherapy. This workflow aims to establish effective communication to facilitate timely medication preparation, promote thorough documentation, and safe administration of IT chemotherapy. Methods: A retrospective chart review of adult IT chemotherapy administrations at Advocate Lutheran General Hospital was conducted from January 2024 through March 2025. Data focused on workflow and safety metrics, including dual authentication, barcode scanning compliance, and documentation in the medication administration record. Based on preliminary data, a standardized workflow was created to coordinate scheduling, preparation, and administration of IT chemotherapy. The workflow included secure interdepartmental communication, reinforcement of barcode scanning prior to administration, and real-time dual authentication. Primary outcomes included barcode scanning and dual authentication compliance; secondary outcomes included team satisfaction, documentation accuracy, and charge capture. Results: We retrospectively reviewed 118 patients–62 in the preliminary group and 56 in the post-implementation group. Barcode scanning compliance improved from 6.5% to 30%. Dual authentication compliance rose from 66% to 88%, reflecting improved real-time verification. Documentation and charge capture accuracy improved from 95% to 100% post-implementation. Conclusion: Implementation of a standardized workflow for intrathecal chemotherapy administration led to measurable improvements in safety and documentation practices. Barcode scanning and dual authentication increased notably, and documentation and charge capture accuracy reached 100% post-implementation. These findings support the effectiveness of a structured workflow enhancing patient safety and operational efficiency in intrathecal chemotherapy administration. |
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Improving Resident Physician Empathic Communication Skills QI Project (Poster) Maxwell J. Nanes DO, Hospice and Palliative Medicine, Aurora St. Luke’s Medical Center, Advocate Health 11:41 AM - 1:15 PM Background/Significance: Effective empathic communication is crucial in clinical practice, particularly in end-of-life discussions. Research highlights the importance of recognizing and responding to patient emotional cues, yet gaps remain in training resident physicians to develop these skills. Prior studies suggest that empathy can be enhanced through structured educational interventions, such as role play and simulation. Given the high prevalence of audio-based medical education, this quality improvement (QI) project seeks to improve Aurora Health Care resident physician empathic communication skills via a podcast-based instructional approach. Purpose: This project aims to enhance resident physicians’ confidence and ability to engage in empathic communication during difficult conversations, particularly in end-of-life (EOL) scenarios. This project incorporates evidence-based communications training principles into an accessible audio podcast format to be trialed within the Auora Health Care System residency programs. Methods: The QI project consists of two main components: (1) the development of a short (20 minute) educational podcast featuring a simulated patient-clinician dialogue interspersed with instructional commentary, and (2) post-podcast surveys assessing listener engagement and perceived impact. The project population included internal medicine and family medicine resident physicians at Aurora Health Care hospitals in Wisconsin. Survey responses were evaluated using a Likert scale, focusing on agreement ratings of 4 (agree) and 5 (strongly agree). Results: Thirty-one residents took the survey after a listening session of the podcast: 42% were from family medicine (FM) and 58% from internal medicine (IM). Overall, most respondents (55% - 71%) agreed with statements asking whether they felt the podcast improved their ability to recognize and respond to emotional cues during EOL discussions. FM residents were more likely than IM residents to agree or strongly agree with these statements. The podcast was received well overall with 77% of respondents agreeing that they can apply what they learned to their practice. With regard to the primary objective of self-rated perception of ability to recognize and respond to emotional cues, FM residents were more likely than IM residents to rate their post-listening self-perceptions favorably overall. Of the responses to questions tailored to the primary objective, the lowest scoring question was with regard to whether the podcast made residents feel more confident in their ability to convey empathy in discussions with patients, but there was parity among the resident groups with 54% of FM residents and 56% of IM residents self-rating at 4 or 5. The secondary objective assessed the effectiveness of using a podcast as a medium for this QI project. Here the highest ratings of the entire survey were returned for the question regarding whether residents felt they could apply skills from the podcast to their practice, with 85% of FM residents and 72% of IM residents rating 4 or 5 to this question. In all responses, a trend was observed in the PGY-2 classes. They on average had the lowest % of answers at the 4 or 5 level when compared with all other resident levels in response to all questions. Conclusion: There were overall favorable perceptions of the podcast from all survey respondents. The findings from this QI project indicate a podcast can be used as a practical tool to teach residents empathic communication skills. While the residents found it valuable, survey results suggest further steps like a role play session or discussion may improve confidence in these discussions. |
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Use of Methylene Blue in Refractory Shock and its Impact on Vasopressor Requirements (Poster) Sarah Kelly PharmD, Pharmacy, Advocate Christ Medical Center, Advocate Health 11:41 AM - 1:15 PM Background/Significance: Refractory shock has been defined as the requirement of high-dose vasopressors to attain hemodynamic targets and is associated with a high rate of mortality. Methylene blue is used by some providers as an adjunct to vasopressors for the treatment of refractory shock. Lack of established guidance and variability of use between providers has created a need to determine if there is a benefit to adding this drug to standard vasopressor therapy. Purpose: The objective of this project is to determine if treatment with methylene blue decreases vasopressor requirements in patients experiencing refractory shock. Methods: This single-center, retrospective review of current practice assessed patients admitted to the Advocate Christ Medical Center medical intensive care unit (ICU) for the management of shock between August 1, 2022, and December 31, 2024. A report generated from the electronic health record was used to identify potential patients, and patients were evaluated for inclusion in this study if they were at least 18 years of age and received at least 2 concomitant vasopressors. Peri- or post-operative patients were excluded. A search of medication orders for methylene blue was used to identify patients in the intervention group, and all patients that met eligibility criteria were included. An equal number of control patients were enrolled to match the intervention group. The primary endpoint was vasopressor-free days at 28 days. Secondary endpoints included ICU length-of-stay, hospital length-of-stay, mortality at 28 days, and mortality within 4 hours. Additional data points collected included demographic information, dose of methylene blue, time hospitalized prior to methylene blue administration, change in vasopressor requirements following methylene blue administration, dose of vasopressors in norepinephrine equivalents, administration of adjunctive therapies, administration of fluid resuscitation within 24 hours, and positive microbiological cultures. Results: A total of 77 patients were included, with 38 patients in the methylene blue group and 39 patients in the control group. Median vasopressor-free days at 28 days were decreased for methylene blue at 0.10 days versus 0.21 days for control (p=0.328). Length-of-stay was shorter in the methylene group than the control group at 7.33 days versus 9.98 days for hospital (p=0.474) and 2.78 days versus 3.52 days for ICU (p=0.276). Mortality at 28 days was similar between groups at 76.32% for methylene blue and 76.92% for control (p>0.99). 2 patients died within 4 hours of vasopressor initiation in the methylene blue group, compared to 0 patients in the control group (p=0.157). Conclusion: Administration of methylene blue was not associated with a change in vasopressor-free days compared to standard shock management. Further research regarding appropriate dosing and timing of initiation is necessary to determine the role in therapy of methylene blue for refractory shock. |
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Evaluating the Utility of Daily Blood Cultures in Persistently Febrile Pediatric Oncology Patients (Poster) Kalyn Jarrett PharmD, Pharmacy, Advocate Lutheran General Hospital, Advocate Health 11:41 AM - 1:15 PM |