The incidence of multi-drug resistant (MDR) gram-negative (GN) organisms including Pseudomonas and Acinetobacter spp has increased in the last decade, prompting re-evaluation of colistin for the ...management of these infections. Aerosolized colistin as an adjunct to intravenous therapy is a current option for the management of MDR-GN pneumonia, although data supporting this practice is limited. This study evaluates the efficacy of adjunctive aerosolized colistin in combination with intravenous colistin in critically ill patients with MDR-GN pneumonia.
A retrospective multi-center cohort analysis comparing critically ill patients with MDR-GN pneumonia who received intravenous colistin (IV) alone or in combination with adjunctive aerosolized colistin (IV/AER) with a primary endpoint of clinical cure at the end of colistin therapy. Secondary endpoints included microbiologic cure, duration of mechanical ventilation, length of stay, and hospital mortality. A post-hoc subgroup analysis was performed for patients with high quality cultures used for diagnosis of MDR-GN pneumonia. Dichotomous data were compared using Fisher's exact test while the student's t-test or Mann-Whitney U test were used for continuous variables.
Ninety-five patients met criteria for evaluation with 51 patients receiving IV and 44 receiving IV/AER. Baseline characteristics were similar between the two groups. Twenty patients (39.2%) receiving IV and 24 (54.5%) receiving IV/AER achieved clinical cure (p = 0.135). There was no difference in microbiologic cure rates between the IV and IV/AER colistin groups (40.7vs. 44.4%, p = 0.805). The IV group demonstrated a trend towards higher pneumonia attributable mortality (70.4 vs. 40%, p = 0.055). In the subgroup analysis of patients with high quality respiratory cultures, there was a significantly lower clinical cure rate for those in the IV group as compared to the IV/AER group (31.3 vs. 57.1%, p = 0.033).
Addition of aerosolized colistin to IV colistin may improve clinical cure and mortality for patients with MDR-GN pneumonia. Larger, prospective trials are warranted to confirm the benefit of adjunctive aerosolized colistin in critically ill patients with MDR-GN pneumonia.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
The American Society of Health-System Pharmacists residency accreditation standards require all postgraduate residency training programs to teach and evaluate a resident’s ability to advance practice ...through project development and presentation, underscoring the importance of conducting research in today’s professional climate. Although many residents express strong interest in research participation and contributing to the medical literature, many obstacles to publication have been identified. We aim to illustrate a deliberate approach to teaching this material and structuring the longitudinal experience in a way that maximizes resources to overcome these barriers. Such efforts should aid residents, advisors, and program directors in establishing curriculum which leads to successful completion and publication of pharmacy resident’s research projects.
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NUK, OILJ, SAZU, UKNU, UL, UM, UPUK, VSZLJ
PURPOSE.The implementation of an interprofessional clinical pharmacology selective (CPS) learning experience for pharmacy residents and medical students is described.
SUMMARY.The opportunity for ...pharmacy residents to provide didactic lectures at a college of pharmacy and to develop teaching and preceptor skills with experiential pharmacy students may be limited by institution-specific affiliations and geographic location. In order to overcome these barriers, the Mayo Clinic Hospital postgraduate year 1 (PGY1) pharmacy residency program implemented an interprofessional learning experience in which pharmacy residents serve the role of preceptors for first- and second-year medical students on a CPS. Medical students at the Mayo Medical School (MMS) work alongside the PGY1 resident to develop patient-specific, medication problem lists and gain an appreciation for pharmacy-focused interventions. Medical students teach pharmacy residents diagnostic, pathophysiologic, and patient-assessment considerations related to the medical schoolʼs curriculum. The clinical rounds component of the CPS allows for resident achievement of ASHP competency area R4, which focuses on the design of an effective educational activity; selection of a preceptor role; employment of instruction, modeling, coaching, and facilitation; use of effective presentation skills; generation of objective-based learner assessment questions; and identification of areas for continuous improvement.
CONCLUSION.The Mayo Clinic Hospital PGY1 pharmacy residency program and MMS successfully implemented an innovative learning experience to promote interprofessional education between pharmacy residents and medical students. The program establishes collaborative relationships early in students’ professional careers and allows for attainment of the ASHP-required competency area R4 through delivery of a CPS to medical students.
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DOBA, IZUM, KILJ, NUK, OILJ, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK, VSZLJ
Abstract Purpose The purpose of the study is to determine if a modified 4T (m4T) scoring system, which omits clinical evaluation of other thrombocytopenic etiologies, is different from the 4T scoring ...system's probability to predict a positive heparin-induced thrombocytopenia (HIT) laboratory test in the intensive care unit. Materials and methods This is a single-centered retrospective analysis of critically ill adults who had an enzyme-linked immunosorbent assay antiplatelet factor 4 antibody (ELISA anti-PF4 Ab) ordered. Patients were identified as HIT positive (optical density, ≥ 0.40) or HIT negative (optical density, < 0.40) based on the ELISA anti-PF4 Ab. Both 4T and m4T scores were calculated, and the diagnostic accuracy was compared using paired receiver operating characteristic curves. Results A total of 1487 adult intensive care unit patients with an ELISA anti-PF4 Ab ordered between January 2007 and December 2009 were eligible for study enrollment. Application of exclusion criteria and random selection yielded a total of 232 patients included for analysis (58 HIT-positive and 174 HIT-negative patients). The area under the curve for the 4T and m4T scores were 0.683 (95% confidence interval, 0.604-0.762) and 0.680 (95% confidence interval, 0.600-0.759), respectively ( P = .065). Conclusion This study does not show a difference in the probability of the m4T and 4T scoring systems to predict a positive ELISA anti-PF4 Ab test in the critically ill patient population. Further prospective studies are needed to validate the m4T scoring system.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
Abstract Background: Evidence exploring the use of corticosteroids for acute respiratory distress syndrome (ARDS) has targeted various stages of disease progression, from preventing ARDS in high-risk ...patients to halting disease evolution once ARDS has developed. Objective: The aim of this review was to evaluate randomized, controlled trials describing the role of corticosteroids in preventing and treating ARDS. Methods: English-language randomized, controlled trials were identified using MEDLINE via PubMed and EMBASE searches (key terms: acute respiratory distress syndrome, acute lung injury , and corticosteroids ; years: 1968-January 2008). Results: A total of 10 trials were found and included in this analysis. Trials describing the role of high-dose corticosteroids compared with controls in preventing ARDS found no benefit, with the range of occurrence of ARDS in at-risk populations from 14% to 64% and absolute increases in mortality from 4% to 31%. Conflicting evidence was found for treating late-phase ARDS with corticosteroids, with 13% hospital mortality among patients receiving corticosteroids versus 63% with controls ( P = 0.03) in one small study, but no significant difference was found when evaluating 60-day mortality (corticosteroid group, 29.2% vs control, 28.6%) in another investigation. The use of highdose corticosteroids for the treatment of early phase ARDS was not associated with significant differences in 45-day mortality (methylprednisolone, 60% vs control, 63%).However,onetrialfoundthatmethylprednisolone taper for early ARDS was associated with significant improvement in lung function or extubation (69.8% vs 35.7%; P = 0.002), fewer days on mechanical ventilation (median, 5.0 vs 9.5; P = 0.002), higher intensive care unit survival (79.4% vs 57.4%; P = 0.03), but similar rates of hospital survival (methylprednisolone, 76.2% vs control, 57.1%; P = NS). Conclusions: Data from clinical trials did not support the use of short-course, high-dose corticosteroids for preventing ARDS or for the treatment of early ARDS. Longer-course corticosteroids have not conclusively been associated with improved survival in the treatment of late-phase ARDS but have provided some benefits in other markers of disease severity in this setting and in early phase ARDS. Published trials support the administration of low- to moderate-dose corticosteroids in the treatment of early (<7 days) and late-phase (days 7\2-14) ARDS, but this evidence is controversial.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
Factors capable of impacting hospital mortality in patients with septic shock remain uncertain. Our objective was to identify predictors of hospital mortality among patients who received appropriate ...antimicrobial therapy for bacteremic septic shock after accounting for severity of illness, resuscitation status, and processes of care.
We conducted a secondary subgroup analysis of a prospective severe sepsis cohort study. Patients with septic shock and positive blood cultures who received appropriate antimicrobial therapy were included. Univariable analyses were used to identify differences between hospital survivors and non-survivors, and a multivariable logistic regression model revealed independent determinants of hospital mortality.
From January 2008 to December 2010, 58 of 224 included patients died in the hospital. Multivariable logistic regression analysis demonstrated 2 independent predictors of hospital mortality. These included continuous renal replacement therapy utilization within 48 hours of septic shock recognition (adjusted odds ratio OR, 5.52; 95% confidence interval CI, 1.94-16.34) and intra-abdominal infection (adjusted OR, 3.92; 95% CI, 1.47-10.79). Escherichia coli was independently associated with a lower risk of hospital mortality (adjusted OR, 0.34; 95% CI, 0.11-0.90).
Intra-abdominal infection and continuous renal replacement therapy were associated with increased hospital mortality in patients with septic shock who received appropriate antimicrobial therapy. Our findings may be explained by suboptimal intra-abdominal infection management or inadequate antimicrobial concentration in these patients.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
Pharmacy Calculations Rewald, Matthew A; Lorang, Bradley A; Schramm, Garrett E
2021, 20210101
eBook
Pharmacy technicians serve critical roles on the healthcare team, and dependency on accurate calculations is paramount to ensure medication safety and effectiveness and optimal patient outcomes. The ...second edition has been restructured to focus on the most important pharmacy calculation concepts -- covering the fundamentals related to the accuracy and basic math operations, units of measurement and conversions, critical thinking in problem solving, dosing calculations, percentages, concentration calculations, compounding formulas, intravenous infusion calculations, and business math.
The incidence of community-associated, healthcare-associated, and hospital-acquired sterile-site infections due to methicillin-resistant Staphylococcus aureus (MRSA) isolates and the susceptibility ...of the isolates to non- beta -lactam antibiotics were evaluated for 549 hospitalized patients during a 3-year period. The incidence of community-associated MRSA infection increased significantly. The annual percentage of MRSA isolates from cases of healthcare-associated and hospital-acquired infection that were susceptible to 3 or more non- beta -lactam antibiotics increased significantly.
The pharmacy residency program guide to Twitter Webb, Andrew J.; Margetak, Danielle; Schramm, Garrett E. ...
JAACP : Journal of the American College of Clinical Pharmacy,
April 2021, 2021-04-00, Volume:
4, Issue:
4
Journal Article
Peer reviewed
Background
Twitter has emerged as a powerful networking and educational tool within the health care community. The instantaneous and casual nature of Twitter allows for easy access to a near ...limitless pool of medical professionals and the opportunity to share intra‐ and interprofessional knowledge. Beyond individual development, Twitter has the potential to positively impact pharmacy residency programs in a multitude of ways.
Objective
This article serves as a practical guide for pharmacy residency programs to implement and maintain a successful Twitter account.
Recommendations
At the program level, a Twitter account creates an official voice and brand while simultaneously providing detail and perspective beyond what a residency website may offer. Additionally, it allows for dynamic ground‐level engagement with prospective residency candidates, current residents, and preceptors which is mutually beneficial to the program audience. In the age of virtual recruitment, successfully utilizing digital tools to meet candidates where they are is essential for attracting the right candidate for the program. Implementation of a successful social media strategy has potential barriers that include garnering buy‐in from departmental leadership, operationalizing a social media team, and maintaining engagement momentum.
Conclusion
Pharmacy residency programs should consider starting an official Twitter account.
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FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
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