Hamamelis virginiana L. Leaf Extracts Inhibit the Growth of Antibiotic-Resistant Gram-Positive and Gram-Negative Bacteria.

Virginian witch hazel (WH; Hamamelis virginiana L.; family: Hamamelidaceae) is a North American plant that is used traditionally to treat a variety of ailments, including bacterial infections. Solvents of varying polarity (water, methanol, ethyl acetate, hexane and chloroform) were used to prepare extracts from this plant. Resuspensions of each extract in an aqueous solution were tested for growth-inhibitory activity against a panel of bacteria (including three antibiotic-resistant strains) using agar disc diffusion and broth microdilution assays. The ethyl acetate, hexane and chloroform extracts were completely ineffective. However, the water and methanolic extracts were good inhibitors of E. coli, ESBL E. coli, S. aureus, MRSA, K. pneumoniae and ESBL K. pneumoniae growth, with the methanolic extract generally displaying substantially greater potency than the other extracts. Combining the active extracts with selected conventional antibiotics potentiated the bacterial growth inhibition of some combinations, whilst other combinations remained non-interactive. No synergistic or antagonistic interactions were observed for any WH extracts/antibiotic combinations. Gas chromatography-mass spectrometry analysis of the extracts identified three molecules of interest that may contribute to the activities observed, including phthalane and two 1,3-dioxolane compounds. Putative modes of action of the active WH extracts and these molecules of interest are discussed herein.

Technology-assisted viva voce exams: A novel approach aimed at addressing student anxiety and assessor burden in oral assessment.

BACKGROUND AND PURPOSE: Viva voce (VIVA) exams are resource intensive, can be prone to inter-rater reliability issues, and induce anxiety in many students. Costs, reliability, validity, and student welfare have been targeted for VIVA re-design. The objective of this study is to design and assess if a less labour-intensive approach to VIVA exams is acceptable to students, reducing student anxiety, whilst maintaining authenticity of the assessment. EDUCATIONAL ACTIVITY AND SETTING: The School of Pharmacy and Medical Sciences (Griffith University) delivers undergraduate and postgraduate pharmacy degrees, which contain multiple VIVAs. We have designed and implemented a modified VIVA called the technology-assisted VIVA exam (TaVIVA) utilising remote recording, retrospective marking, and pre-recorded multimedia delivered questions to test student acceptability, impact on student anxiety, and inform potential delivery as a summative assessment. FINDINGS: Student responses were overwhelmingly positive, reporting satisfaction with the TaVIVA. There was strong agreement that the school should continue to develop the TaVIVA. Students perceived that it was fairer than traditional VIVAs and less anxiety inducing. However, students indicated that the traditional VIVA was more authentic and that they eventually need to conduct a VIVA in the presence of an assessor. SUMMARY: The TaVIVA is an innovative assessment approach with potential benefits over the traditional VIVA, including facilitation of assessment consistency and reductions in student anxiety. We postulate that the TaVIVA is a useful and valid means of scaffolding student performance in VIVA assessment.

An assessment of the growth inhibition profiles of Hamamelis virginiana L. extracts against Streptococcus and Staphylococcus spp.

Staphylococcal and streptococcal species trigger a wide variety of infections involving epithelial tissues. Virginian witch hazel (WH; Hamamelis virginiana L.; family: Hamamelidaceae) is a plant that has been used traditionally by Native Americans to treat a variety of skin conditions. Extracts from the leaves were examined for their inhibitory effects on these bacterial species. Solvents of different polarity (water, methanol, ethyl acetate, hexane and chloroform) were used to prepare extracts from WH leaves, and the aqueous resuspensions were screened for antibacterial activities using disc diffusion and liquid dilution assays. Extract phytochemical profiles and toxicities were also examined, and combinations of extracts with conventional antibiotics were tested against each bacterial strain. The methanolic and aqueous extracts inhibited the growth of S. oralis, S. pyogenes, S. epidermidis and S. aureus, but not S. mutans. The extracts were especially active against staphylococcal species, with MIC values between 200 and 500 µg/ml. Combinations of active extracts with conventional antibiotics failed to yield beneficial interactions, except for two cases where additive interactions were observed (aqueous WH extract combined with chloramphenicol against S. oralis, and methanolic WH extract combined with ciprofloxacin against S. aureus). Phytochemical assays indicated an abundance of tannins, triterpenoids and phenolics in the water and methanol extracts, with trace amounts of these components in the ethyl acetate extract. Phytochemicals were not detected in hexane and chloroform extracts. Thus, phytochemical abundance in extracts was concordant with antibacterial activities. All extracts were found to be non-toxic in Artemia nauplii assays. These findings indicate the potential for WH leaf extracts for clinical use in treating staphylococcal and streptococcal infections, while substantiating their traditional Native American uses.

Simulated patient cases using DecisionSim™ improves student performance and satisfaction in pharmacotherapeutics education.

BACKGROUND AND PURPOSE: Pharmacy education is continuously evolving and incorporation of technology is more prevalent. Computer-based patient cases are being utilised to illustrate complex concepts and develop clinical decision-making skills by enabling deliberate practice and continued feedback to scaffold student learning. Simulations are received positively by students but there is limited information on the benefit to student performance. The study aim was to determine the benefits of computer-based cases for oncology therapeutics in terms of student satisfaction and performance. EDUCATIONAL ACTIVITY AND SETTING: Computer based oncology cases were designed using DecisionSim™ technology and introduced to final year pharmacy students. Student satisfaction was measured using a questionnaire with a 5-point Likert scale (1 strongly agree to 5 strongly disagree), and an option for open-ended comments. Performance was measured using results of assessment items in the oncology course compared to a similar course (psychiatric/neurology). FINDINGS: Students found the simulated oncology cases engaged them in learning (median 1.5), had a role in therapeutics education (median 1), and developed decision making skills (median 1). Thematic analysis of open comments suggested it was most beneficial as a self-directed study tool. The students performed significantly higher (p < 0.05) in the oncology end of semester exam (78.6 ±â€¯8.6) compared to psychiatric/neurology (70.7 ±â€¯9.6). SUMMARY: A computer-based simulation for oncology pharmacotherapeutics can engage students and develop decision making skills. DecisionSim™ enhanced both student satisfaction and performance in management of oncology cases, and is a beneficial educational tool for teaching complex therapeutic topics to pharmacy students.

Reducing inappropriate third-generation cephalosporin use for community-acquired pneumonia in a small Australian emergency department.

BACKGROUND: Antimicrobial stewardship is a key component of hospital accreditation in Australia and contributes to the prevention and containment of antimicrobial resistance. The Second Australian Report on Antimicrobial Use and Resistance in Human Health (AURA Report) 2017 calls for greater participation by small hospitals in antimicrobial stewardship activities. Community acquired pneumonia (CAP) and third generation cephalosporin (3GCs) use is a known target for intervention. This paper reports the results of an educational intervention for reducing inappropriate prescribing of 3GCs in the empiric treatment of CAP. METHODS: The intervention was based on a leadership and education campaign in an Emergency Department (ED) in a 96 bed acute rural hospital in New South Wales, Australia. A two-point retrospective audit within (April-June 2010, April-June 2011) was conducted comparing pre-intervention and post-intervention antibiotic prescribing trends for CAP from ED presentations. Data was collected via audit tool and appropriateness was assessed against endorsed guidelines. The main outcome measures were improved prescribing appropriateness and decreased utilisation. RESULTS: Whilst statistically insignificant, a reduction (6.4%) in inappropriate prescribing and a reduction in 3GC utilisation (16.7%) was demonstrated. CONCLUSION: Small hospitals have active contributions to make to prevent and contain antimicrobial resistance via antimicrobial stewardship. The challenge is collecting this data for national data sets whilst instituting local benefits in the context of limited resources. Our results suggest change can occur in antibiotic prescribing, studies such as this model a targeted strategy for resource poor facilities to contribute to national AU data whilst instituting local AMS change.