PSHP 2026 Residency Conference

Purpose: The purpose of this retrospective study is to evaluate the appropriateness and effectiveness of low-intensity pravastatin 20 mg daily in statin-naïve, kidney transplant recipients, according to the estimated baseline ASCVD risks.
Methods: The study includes a chart review of 296 subjects who underwent kidney transplants between September 1, 2023, and September 1, 2024, with at least 12 months of post-transplant follow-up. Baseline demographics that are pertinent to estimate ASCVD risk are included. Transplant data was collected, including transplant indication, lipid profiles, and incidence of delayed graft function. Goal statin intensity was extrapolated based on age, history of diabetes mellitus, chronic kidney disease, tobacco use, coronary calcium scores (when available), and calculated ASCVD scores. ASCVD risk scores were assessed using the American College of Cardiology online calculator. Pravastatin initiation and monthly continuation were recorded. If pravastatin discontinuation occurred within 12 months, timing, reason for discontinuation, and intensity changes were further assessed. Information on immunosuppressive therapy was also collected.
Results: A total of 296 patients were evaluated, and 60 patients were included for analysis. The 10-year ASCVD risk was estimated for 24 (40%) patients. Low-intensity pravastatin was appropriate in 35 (58%) patients. The median changes in LDL, HDL, and total cholesterol levels from day 30 to 365 post-transplant were 7.5 mg/dL, 1.5 mg/dL, and 10 mg/dL, respectively (all p-value>0.05). Approximately 51 (85%) patients continued pravastatin throughout one year post transplant. Four (6.7%) discontinued pravastatin due to reported intolerance or self-discontinuation; no patients met clinical criteria for hepatoxicity and rhabdomyolysis. One (1.7%) experienced non-fatal myocardial infarction (MI); however, no patients experienced ischemic stroke. 
Conclusion: We estimated that more than a third of patients might be considered for a higher intensity statin based on baseline characteristics, estimated risk assessment, and ASCVD risk enhancers. Most patients remained on low-intensity pravastatin for up to one-year post-transplant. Changes in lipid profile from 30 days to 365 days were not significant. No major safety issues were observed, except for non-fatal MI. 

Purpose
To evaluate the impact of a pharmacist-led intervention on inappropriate beta-blocker prescribing in adults with essential hypertension (HTN) without compelling indications
Methods
A prospective cohort study of adults with essential HTN who were prescribed a beta-blocker without a compelling indication was conducted across eight family medicine practices at our institution. A randomized convenience sample (N≈120) was identified from a prior medication use evaluation. After chart review, recommendations were sent to the primary care practitioner (PCP) to deprescribe the beta-blocker or switch to a guideline-preferred agent. Patients were excluded for resistant HTN, documented ASCVD, heart failure, recent myocardial infraction, arrhythmias, migraine, hyperthyroidism, intolerance to first-line agents, or cardiology-managed HTN. The primary endpoint was the recommendation acceptance rate. Secondary outcomes were absolute change in inappropriate beta-blocker use, time to implementation, predictors of acceptance, and documented adverse drug events. Descriptive statistics were used.
Results
A total of 25 patients met inclusion criteria. Eleven (44%) recommendations to deprescribe were accepted. Among accepted recommendations with follow-up (n = 6), 3 were implemented. Twelve (48%) recommendations were refused, and 2 (8%) received no response. The most common reason for refusal was that the beta-blocker had been initiated by a specialist (n = 11). Reported adverse drug reactions potentially related to beta-blockers (N = 26) consisted of fatigue (n = 14), bradycardia (n = 4), and sleep disturbances (n = 8). Male sex was associated with lower odds of recommendation acceptance (OR, 0.14; 95% CI, 0.02–0.84; P = 0.032).
Conclusion: to be presented at the conference

Purpose: 
This retrospective cohort study characterized approaches for resuming semaglutide or tirzepatide after at least two consecutive missed doses and evaluated tolerability in outpatient clinics at Penn Presbyterian Medical Center (PPMC).


Methods: 
This study included adults who missed at least two consecutive doses of semaglutide or tirzepatide between October 2024 and November 2025 and reinitiated therapy at a non-starting dose. Exclusion criteria included patients who resumed at the lowest dose, those switching medications (except brand substitutions), or without follow-up data. Chart review captured demographics, indication, therapy duration before lapse, prior and resumed doses, and number of missed doses. The primary outcome was the tolerability associated with the dose step changes related to missed doses. Tolerability was defined as no patient-reported adverse drug reactions (ADRs), a dose increase or continuation. Intolerance was defined as any patient-reported ADR, a dose reduction, or discontinuation. Secondary outcomes included reasons for lapse and months saved by avoiding restart at the initial dose. Descriptive statistics were used.


Results:
Among 65 patients, the mean age was 46 years and 76.9% were female. Most were prescribed tirzepatide (46.2%) or semaglutide (38.5%) for weight loss. The median number of missed doses was 3 (IQR, 2 to 4), with a median dose step change of -1 (IQR, -2 to 0). A dose reduction occurred in 37 patients (57%), 24 patients (36.9%) had no change, and 4 patients (6.2%) had a dose increase. Overall, 95.4% of patients tolerated reinitiation. Access-related issues accounted for 87.7% of lapses. The median months saved by avoiding restart at the initial dose was 2 (IQR, 1 to 3). Additionally, tolerability remained high across missed-dose subgroups.


Conclusion: 
Resuming semaglutide or tirzepatide at a non-starting dose after at least two missed doses was well-tolerated in most patients. Dose reductions were common with high rates of tolerability. This approach prevented titration delays typically caused by missed doses. Further studies should prospectively evaluate optimal reinitiation strategies, including the impact on long-term weight loss and glycemic control.

Purpose:
The purpose of this study was to compare the number of patients who had appropriate lipid panel follow-up/monitoring at TUHS divided by management type: managed by pharmacy (Rx-managed) and not managed by pharmacy (Non-Rx-managed).


Methods:
This study was conducted at the Temple Internal Medicine Associates (TIMA) clinic at TUHS from 07/01/2024 to 06/30/2025. Inclusion criteria were age ≥18 years, TIMA patients, ≥2 in-person visits (≥3 months apart), and ≥1 lipid panel during the study period. Exclusion criteria included ESRD, palliative care, pregnancy, TSH >4.5 mIU/L, or TG >400 mg/dL. Patients were categorized as Rx-managed (≥2 pharmacist visits) or Non-Rx-managed (managed exclusively by non-pharmacist clinicians). The primary endpoint was the number of lipid panels. Secondary endpoints included mean LDL-C, number of patients achieving LDL-C <100 mg/dL and <70 mg/dL, and number of patients receiving lipid-lowering therapy. Due to group size differences, 1:4 propensity score matching was performed using age, sex, race, T2DM, and ASCVD. Continuous variables were analyzed using the Wilcoxon rank-sum test, and categorical variables using Fisher’s exact or Chi-square tests.


Results:
Baseline characteristics were similar between groups after 1:4 matching. A greater proportion of patients in the Rx-managed group had more than one lipid panel compared with the Non-Rx-managed group (39.7% vs 27.1%, p=0.006). Mean LDL-C was numerically lower in the Rx-managed group (86.6 vs 88.4 mg/dL), though not statistically significant. The proportion of patients achieving LDL-C goals was similar between Non-Rx-managed and Rx-managed groups (<100 mg/dL: 67.1% vs 70.2%; <70 mg/dL: 34.3% vs 38.8%). Use of lipid-lowering therapy was comparable between groups. This study used real-world data and propensity matching to improve comparability; however, it was limited by its retrospective, single-center design and lack of baseline lipid values.


Conclusion: 
Patients in the Rx-managed group were more likely to receive additional lipid monitoring than those in the non-Rx- managed group. Although not statistically significant, the Rx-managed group showed trends toward lower LDL-C and greater goal attainment. Future studies with longer follow-up and baseline lipid values are needed to better evaluate longitudinal lipid outcomes and the clinical impact of pharmacist-led management in lipid management.

Purpose 
This study evaluates the implementation of an ED agitation protocol on the reduction of repeat sedative doses within 1 hr in agitated adults, leading to safer, more effective agent selection and evidence-based pharmacologic management.
Methods 
This multi-center retrospective chart review evaluated electronic medical records of adult ED patients across all LVHN sites who were treated with at least one dose of sedative medication for agitation. Patients treated from 7/1/2022–7/1/2023 and 10/1/2023–10/1/2024 were identified, stratified by study period, and randomly selected to be included for analysis. Patients who were not treated for acute agitation, had alternative indications for benzodiazepines, (Ex. CIWA benzodiazepines), or had a pre-administration SPO₂<92% or SBP< 90 were excluded from analysis. Variables collected included medication selection, times of medication administration, ED LOS, patient disposition, and safety data. A sample size of 169 patients per group was calculated to detect 15% differences in repeat sedative use (49% vs 34%) using a two-tailed chi-square test (α=0.05, power=80%).
Results 
Baseline characteristics were similar amongst groups. Agent treatment selection was similar pre- and post-protocol implementation. The proportion of patients requiring an additional sedative within 1 hour significantly decreased post-protocol implementation (8.9% vs 17%, p=0.025). ED length of stay was significantly reduced (20 h vs 25 h, p=0.00006). The proportion of patients requiring 1:1 monitoring before and after implementation was (31% vs 39%, p=0.096), a reduction in 8%. Restraint use decreased by 13% post-implementation (31% vs 43%). ICU admission rates did not differ between groups (p=0.769). Adverse events were infrequent, limiting conclusions. Diphenhydramine use was not associated with ED LOS. 
Conclusion 
Adoption of a standardized ED agitation protocol was associated with fewer repeat sedative doses within one hour and a reduction in emergency department length of stay. These improvements occurred without increases in ICU admission, monitoring needs, or adverse events. Protocol-driven, evidence-based medication selection enhances initial agitation control, reduces restraint use, improves patient safety, and promotes more efficient care delivery. 

Purpose: 
Harm reduction minimizes negative outcomes associated with substance use. Fentanyl test strips are distributed as a strategy due to its presence in local supply. The primary goal is to assess impact of test strips on high-risk behaviors.
 
Methods:
Retrospective chart reviews were conducted using the Veterans Health Administration (VHA) Computerized Patient Record System (CPRS) to collect data on 129 veterans who received fentanyl test strips from behavioral health teams between 10/02/2024 to 09/08/2025. Veterans receiving outpatient care aged 18 and older with active opioid and/or stimulant use disorder were included in our review. Veterans with significant cognitive impairments or acute psychiatric instability that prevent informed consent were excluded. A prospective component was planned but will not be reported due to insufficient enrollment.  
 
Results:
Among veterans offered fentanyl test strips, the majority accepted, with only a small percentage declining. A subset of veterans accepted additional fentanyl test strip kits when re-offered.  Additionally, many veterans who accepted the fentanyl test strips already had naloxone on hand, or received it concurrently. 
 
Conclusion:
Fentanyl test strip acceptance, including repeated offer acceptances, suggest potential utilization and perceived benefits by veterans. However, further evaluation is warranted to determine whether use leads to reduction in high-risk behaviors. Additionally, ensuring naloxone access alongside fentanyl test strip distribution further supports harm-reduction efforts to protect veterans who are at risk for opioid overdose. 
 

Purpose: The primary objective was to compare administration times of intravenous push (IVP) compared to piggyback (IVPB) antibiotics in the emergency department (ED) in patients with sepsis and septic shock. 


Methods: This retrospective, single-center, IRB-exempt, chart review conducted at Jefferson Einstein Philadelphia Hospital (JEPH) included ED patients with sepsis or septic shock who received either IVP or IVPB ceftriaxone or daptomycin. Patients with sepsis were identified by ICD-10 code and sepsis alert, and septic shock patients had vasopressor requirements. Patients were excluded if transferred from outside hospital. To account for institution-wide process changes due to drug shortages, IVPB antibiotics were evaluated from January 1, 2024 to September 30, 2024, and IVP antibiotics were evaluated from November 1, 2024 to July 31, 2025.


Results: Patients assessed for eligibility included 76 patients in the IVP group and 51 patients in the IVPB group. No patients who were administered daptomycin met inclusion criteria. There was no difference in median time to administration between the two groups (IVPB 40.8 min vs IVP 39.2 min. p=0.99). In patients with sepsis, 34/46 patients (73.9%) and 51/72 patients (70.8%) in the IVPB and IVP group received antibiotics within 3 hours, respectively. In patients with septic shock, 1/5 patients (20%) and 2/4 patients (50%) in the IVPB and IVP group received doses within one hour, respectively. Similar rates of in-hospital mortality were seen in septic shock patients, and no patients experienced a type-1 hypersensitivity reaction.



Conclusion:  Results showed no difference in administration times between IVP and IVPB ceftriaxone. Post-intervention IVP times to administration in prior studies were comparable to pre-intervention IVPB times to administration at JEPH. Future research should aim to evaluate potential factors that may contribute to delays in time to administration of antibiotics in sepsis and septic shock.