Relationship between vancomycin trough concentrations and nephrotoxicity: a prospective multicenter trial.

Several single-center studies have suggested that higher doses of vancomycin, aimed at producing trough concentrations of >15 mg/liter, are associated with increased risk of nephrotoxicity. We prospectively assessed the relative incidence of nephrotoxicity in relation to trough concentration in patients with documented methicillin-resistant Staphylococcus aureus (MRSA) infections at seven hospitals throughout South Carolina. Adult patients receiving vancomycin for at least 72 h with at least one vancomycin trough concentration determined under steady-state conditions were prospectively studied. The relationship between vancomycin trough concentrations of >15 mg/ml and the occurrence of nephrotoxicity was assessed using univariate and multivariate analyses, controlling for age, gender, race, dose, length of therapy, use of other nephrotoxins (including contrast media), intensive care unit (ICU) residence, episodes of hypotension, and comorbidities. Nephrotoxicity was defined as an increase in serum creatinine of 0.5 mg/dl or a ≥ 50% increase from the baseline for two consecutive measurements. MICs of vancomycin for the MRSA isolates were also determined. A total of 288 patients were studied between February 2008 and June 2010, with approximately one-half having initial trough concentrations of ≥ 15 mg/ml. Nephrotoxicity was observed for 42 patients (29.6%) with trough concentrations >15 mg/ml and for 13 (8.9%) with trough concentrations of ≤ 15 mg/ml. Multivariate analysis revealed vancomycin trough concentrations of >15 mg/ml and race (black) as risk factors for nephrotoxicity in this population. Vancomycin trough concentrations of >15 mg/ml appear to be associated with a 3-fold increased risk of nephrotoxicity.

A peer review process for classroom teaching.

OBJECTIVE: Describe the planning, implementation, and faculty perceptions of a classroom peer-review process, including an evaluation tool. DESIGN: A process for peer evaluation of classroom teaching and its evaluation tool were developed and implemented by a volunteer faculty committee within our department. At the end of the year, all faculty members were asked to complete an online anonymous survey to evaluate the experience. ASSESSMENT: The majority of faculty members either agreed or strongly agreed that the overall evaluation process was beneficial for both evaluators and for those being evaluated. Some areas of improvement related to the process and its evaluation tool also were identified. SUMMARY: The process of developing and implementing a peer-evaluation process for classroom teaching was found to be beneficial for faculty members, and the survey results affirmed the need and continuation of such a process.

Rhabdomyolysis associated with the nutritional supplement Hydroxycut.

PURPOSE: A case of rhabdomyolysis associated with the use of Hydroxycut is reported. SUMMARY: An 18-year-old Caucasian man arrived at an urgent care center complaining of bilateral leg pain and weakness. His creatine kinase (CK) concentration was 13,220 IU/L. He was diagnosed with rhabdomyolysis and instructed to go to the emergency room. He admitted to decreased urine output for four to five days before hospital admission. He had no significant past medical history, and his medications before symptom onset included Hydroxycut four caplets by mouth daily, naproxen sodium 220 mg by mouth as needed for pain, dextroamphetamine saccharate-amphetamine salts (Adderall) 15 mg by mouth once five days prior for a school examination, and hydrocodone-acetaminophen and cyclobenzaprine for pain. His social history revealed a recent increase in his exercise regimen, and his last alcoholic beverage was consumed five days prior. Upon admission, laboratory tests revealed elevated concentrations of CK, serum creatinine (SCr), aspartate transaminase, alanine transaminase (ALT), and alkaline phosphatase. The patient was diagnosed with rhabdomyolysis and treated with intravenous hydration. The patient's leg tenderness was reduced, and he was discharged with instructions to stop Hydroxycut, increase fluid intake, avoid alcohol consumption, and limit physical activity for the next week. Two weeks after hospital discharge, the patient's CK and liver enzyme values returned to normal, excluding ALT and SCr, which remained slightly elevated, and his lower-extremity tenderness fully resolved. CONCLUSION: An 18-year-old Caucasian man with no significant medical history developed rhabdomyolysis possibly associated with the ingestion of Hydroxycut in addition to his increased exercise regimen.

First-year residency candidates' experience in various areas of pharmacy practice.

OBJECTIVE: To determine the extent of experience or exposure pharmacy residency candidates had in various areas of hospital pharmacy practice and to identify any candidate-specific variables that correlated with a larger extent of experience. METHODS: Over a 3-year period, a self-assessment survey instrument was administered to 116 postgraduate first-year (PGY1) pharmacy practice residency candidates to evaluate their extent of experience within various areas of hospital pharmacy practice such as patient care activities, drug information, and drug distribution/control. RESULTS: The residency candidates reported the greatest amount of experience in patient counseling, working with pharmacy databases, taking medication histories, pharmacokinetics, and outpatient dispensing procedures. They had less experience with medical emergencies, parenteral nutrition, and intravenous admixture techniques. Overall, there was no correlation between class rank, advanced pharmacy practice experiences, geographic region, or year of interview and the extent of candidates' experience in any specific area of pharmacy. CONCLUSION: PGY1 residency candidates in this sample reported minimal experience in areas necessary for hospital pharmacy practice and this suggests possible deficiencies in the PharmD curriculum. PGY1 residency programs in acute care settings should recognize these educational deficits and assure that residents have exposure to and develop proficiency in critical areas such as medical emergencies, parenteral nutrition, and intravenous admixture techniques.