Debate as an Active Learning Pedagogy Among Pharmacy Students in a Public Health Course.

OBJECTIVE: To evaluate the impact of a debate activity on pharmacy students' knowledge of public health and health policy topics. METHODS: Forty-six second-year pharmacy students in a required public health and health policy course debated universal healthcare coverage for Americans using the Lincoln-Douglas oral debate format. Demographic data, including age and gender, were collected. Knowledge (before/after) of universal healthcare principles was assessed via a rubric-embedded quiz related to the activity objectives. The students' perceptions of the educational value of the debate were assessed before and after the debate using a 12-item Likert scale (1 = strongly disagree through 5 = strongly agree) and open-ended questions. Descriptive statistics and thematic analysis were conducted using SPSS v25 and Atlas.ti version 9, respectively. Wilcoxon t tests were conducted to compare preknowledge and postknowledge scores. An α level of 0.05 was utilized. RESULTS: Forty-two students completed the perceptions survey, yielding a 96 % response rate. The mean age was 24 ± 4 years and primarily female (63 %). Most students had no previous experience with debates (80.4 %) and there was a statistically significant improvement in knowledge after the debate from 66.5 % ± 13.4 % to 80.7 % ± 12 % , for a total increase of 14.2 %. Open responses indicated that students believed their overall knowledge about other healthcare systems increased and they developed literature review and communications skills. CONCLUSION: The debate activity enhanced the students' knowledge and assessment of controversial public health issues that will be useful during their pharmacy education and careers. The students perceived that the debates enriched their learning.

Impact of Fluoroquinolone Susceptibility Suppression on Discharge Prescribing for Acute Uncomplicated Cystitis.

Background: Fluoroquinolones (FQs) are associated with adverse effects and increasing resistance. However, uncomplicated cystitis remains a frequent reason for FQ use. Selective reporting involves withholding susceptibilities for select antimicrobial agents on microbiology reports, in hopes of dissuading use by providers. The purpose of this study was to investigate the impact of FQ susceptibility suppression on discharge prescribing for hospitalized patients with uncomplicated cystitis. Methods: This retrospective quasi-experimental analysis was conducted among adult patients at a 350-bed academic medical center. Its aim was to compare the incidence of FQ prescribing for cystitis at hospital discharge, one year before and after implementation (1 March 2017-31 March 2019) of a policy to suppress FQ urinary susceptibility results for pansusceptible Klebsiella spp and Escherichia coli. FQ appropriateness and risk factors for FQ use were also examined. Results: There was a relative risk reduction of 39% in discharge FQ prescribing when adjusted for discharge team (adjusted risk ratio, 0.61; 95% CI, .40-.93). Almost all FQ use was inappropriate, largely due to organisms' susceptibility to a guideline-preferred agent (n = 61). In multivariate analysis, odds ratios of discharge FQ prescribing were 0.22 (95% CI, .12-.39) for insured patients, 0.43 (95% CI, .21-.86) for patients with antibiotic allergy, and 57.8 (95% CI, 13.7-244) for those receiving inpatient FQ. Discharge from a medicine team was protective against discharge FQ prescribing. Conclusions: With multidisciplinary inpatient medicine services and avoidance of inpatient FQ use, suppression of FQ susceptibilities on pansusceptible urine isolates for Klebsiella spp and E coli may represent an attractive strategy for antibiotic stewardship at hospital discharge.

Should direct oral anticoagulants be used to treat protein C or S deficiency?

ABSTRACT: Few studies have evaluated the use of direct oral anticoagulants (DOACs) in patients with major thrombophilias, such as protein C or S deficiency. The data related to use of DOACs in treating protein C or S deficiency are heterogeneous, consisting of various DOACs, inconsistent ranges of dosing, dissimilar patient demographics, and inconsistent clinical endpoints. Vitamin K antagonists and low-molecular-weight heparins are preferred until more robust data are available about using DOACs in patients with protein C or S deficiency.

Potential Failure of Vancomycin Dosing Using AUC/MIC in a Patient With Purulent Methicillin-Resistant Staphylococcus aureus Pericarditis.

Objective: The objective of this case report is to describe utilization of area under the curve (AUC)/minimum inhibitory concentration (MIC) vancomycin dosing with variable MIC results in a patient with methicillin-resistant Staphylococcus aureus (MRSA) purulent pericarditis. Case: A 57-year-old Caucasian male presented with cardiac tamponade and pulmonary emboli. Echocardiogram showed moderate-large pericardial effusion with signs of early tamponade physiology. Pericardiocentesis removed serosanguinous, straw yellow fluid. Blood and pericardial cultures revealed MRSA. Patient was then initiated on vancomycin with an initial AUC of 415. MIC of repeat blood cultures were inconsistent. After 8 days of persistent bacteremia, patient was transitioned to daptomycin and ceftaroline with blood culture clearance within 48 hours. Discussion/Conclusion: Guidelines recommend AUC/MIC vancomycin dosing in patients with MRSA bacteremia. Literature regarding treatment of MRSA purulent pericarditis is limited to case reports. Evidence shows variation in MIC results dependent on analysis methods. Further studies on obtaining accurate MIC values and use of AUC/MIC dosing for MRSA purulent pericarditis are prudent to provide appropriate therapy in these patients as mortality is high.

Impact of a Pharmacist-Managed Outpatient Parenteral Antimicrobial Therapy (OPAT) Service on Cost Savings and Clinical Outcomes at an Academic Medical Center.

Background: Outpatient antimicrobial therapy (OPAT) is managed by a variety of teams, but primarily through an infectious disease clinic. At our medical center, OPAT monitoring is performed telephonically by pharmacists through a collaborative practice agreement under the supervision of an infectious disease physician. The effect of telephonic monitoring of OPAT by pharmacists on patient outcomes is unknown. Methods: This retrospective cohort study was conducted between July 2017 and July 2018 at a 350-bed academic medical center and included adult patients discharged home on IV antibiotics or oral linezolid. The experimental group comprised patients discharged with a consultation for the OPAT management program, whereas the control group comprised patients discharged home without a consultation. The primary outcome was 30-day readmission. Results: In total, 399 patients were included: 243 patients in the OPAT management program group and 156 patients in the control group. The 30-day readmission rates were similar in each cohort (20% vs 19%; P = .8193); however, the 30-day readmission rates were lower in the OPAT management program for patients discharged on vancomycin (19.4% vs 39.1%; P = .004). Conclusions: We did not find a difference in 30-day readmissions between patients receiving pharmacy-driven OPAT management services and those who did not. Patients receiving vancomycin via OPAT had lower 30-day readmissions when included in the pharmacist-driven OPAT management program. Institutions with limited resources may consider reserving OPAT management services for patients receiving antimicrobials that require pharmacokinetic dosing and/or close monitoring.

Evaluation of Naloxone Co-Prescribing Rates for Older Adults Receiving Opioids via a Meds-to-Beds Program.

Over 10,000 older adults died from opioid overdose in 2019. Naloxone is an underutilized antidote that could prevent many opioid overdose-related deaths. There is a paucity of literature evaluating naloxone prescribing through meds-to-beds programs and in older adults. This single-center, retrospective, observational cohort study aimed to assess prescribing patterns of naloxone in patients 65 years and older who were prescribed opioids via a meds-to-beds program between December 2020 and November 2021. All patients 65 years and older dispensed an opioid via meds-to-beds were included. Patients receiving hospice or comfort care or those with unavailable records were excluded. The primary outcome was to assess the frequency of naloxone co-prescribing with opioid prescriptions via meds-to-beds. The 144 patients included were primarily females with a median age of 69 years old and opioid prescriptions for 45 morphine milligram equivalents daily. Two patients were prescribed naloxone (1.4%), one of whom was ultimately dispensed naloxone (0.7%). Of the 65 prescribers included in our study, the incidence of naloxone co-prescribing (2/65, 3.1%) was no different from a previously-reported rate among prescribers (3/179, 1.7%), p = 0.61. Naloxone co-prescribing for older adults receiving opioid prescriptions through a meds-to-beds program was low and opportunities for program enhancement exist.

Publication rates of pharmacy residents involved in a team-based research program.

PURPOSE: The University of Oklahoma College of Pharmacy (OUCOP) implemented an individualized residency research committee and skill development program to facilitate completion and publication of research projects. The purpose of this study was to evaluate the outcomes the program had on project publication rates and subsequent publications after graduation for postgraduate year 1 (PGY1) and postgraduate year 2 (PGY2) residents. METHODS: This study included OUCOP PGY1 and PGY2 residents from classes graduating from 2011 through 2019. Literature searches for all resident projects and subsequent publications were performed. Data collection included residency type (PGY1 vs PGY2), initial position after residency, and project type. The primary objective was to identify the publication rate of research projects. Secondary objectives included a comparison of the number of publications after residency graduation between residents who did and did not publish their residency project and analysis of factors associated with subsequent publications. Zero-inflated Poisson regression was utilized to analyze subsequent publication status controlling for other factors. Statistical analyses were performed using SAS/STAT with an a priori P value of <0.05. RESULTS: Eighty-two projects were completed by 73 residents. Forty-three of 82 projects were published (52.4%) by 39 of 73 residents (52.1%). After residency graduation, 54 residents (74.0%) had a subsequent publication. Factors associated with subsequent publications were initial position in an academic role and completion of additional training after residency. CONCLUSION: After implementation of the program, the majority of residents published their projects and had subsequent publications. Future efforts should be taken to identify opportunities to foster independence in research and scholarship for residents.

Review of Ceftazidime-Avibactam, Meropenem-Vaborbactam, and Imipenem/Cilastatin-Relebactam to Target Klebsiella pneumoniae Carbapenemase-Producing Enterobacterales.

Objective: To provide a review of 3 novel antimicrobial agents-ceftazidime-avibactam, meropenem-vaborbactam, and imipenem/cilastatin-relebactam-regarding treatment of Klebsiella pneumoniae carbapenemase-producing Enterobacterales (KPC). Data Sources: A literature search of PubMed and OVID (MEDLINE) was performed up to March 2020 using the following search terms: Vabomere, meropenem-vaborbactam, vaborbactam, RPX7009, Klebsiella pneumoniae carbapenemase, KPC, carbapenem-resistant Enterobacteriaceae, CRE, relebactam, imipenem-relebactam, MK-7655, ceftazidime-avibactam. Abstracts from conferences, article bibliographies, and product information were also reviewed. Study Selection and Data Extraction: Articles were first screened by English language, then title, then abstract, and finally by review of the full article. Fifty-five clinical and preclinical studies were included. Data Synthesis: These 3 novel ß-lactam/ß-lactamase inhibitor combinations have shown considerable improvement in safety and efficacy as compared with traditional polymyxin-based combination therapy for the treatment of KPC infections. While meropenem-vaborbactam has not shown improved activity against Pseudomonas aeruginosa, it has shown decreased rates of resistance to KPC versus ceftazidime-avibactam. Conclusions: With increasing incidence of KPC infections on a global scale, pharmacists should be aware of the notable similarities and differences between these 3 agents, and the current data supporting their use. Pharmacists may want to consider meropenem-vaborbactam over ceftazidime-avibactam for KPC infections due to decreased likelihood of resistance.