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Steuber TD, Salonia H, Smithgall SE. Evaluation of the creation of podcasts for instructional delivery in a post-graduate training elective course. Curr Pharm Teach Learn 2024; 16:319-326. [PMID: 38575501 DOI: 10.1016/j.cptl.2024.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 02/27/2024] [Accepted: 03/06/2024] [Indexed: 04/06/2024]
Abstract
OBJECTIVES To describe the creation of podcasts for instructional delivery and evaluate strengths and areas for improvement in a post-graduate training (PGT) elective course. METHODS After creating a podcast series, students in the PGT elective from Spring 2021 to Fall 2022 listened to the series then completed a reflection based on five open-ended questions that provoked their thoughts and feelings about use of podcasts as a method of delivering information and teaching. Responses were downloaded and a content analysis was performed. Each investigator analyzed responses from all reflections to identify major themes and subthemes. Letter of intent assignment and overall course grades were compared to assess if podcasts affected student learning. RESULTS Ninety-one students provided reflections about the use of podcasts in the PGT elective course, which revealed three major themes with 13 subthemes, including perception of guests, learner experience, and show and episode production. Students appreciated the various perspectives, authenticity, relatability, and diversity of the guest speakers; the learning environment was described as flexible, relatable, positive, and a safe space; the podcast design was noted to be informative, organized, and easily accessible. Areas for improvement included more interaction with guests and more visuals. Letter of intent assignment and overall course grades were similar before and after podcast implementation. CONCLUSION The use of podcasts as an educational tool in a PGT elective course had a variety of characteristics that students preferred to traditional lecture-style classes.
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Affiliation(s)
- Taylor D Steuber
- University of Missouri-Kansas City School of Pharmacy at MU, Columbia, MO, United States of America.
| | - Holly Salonia
- Central Alabama Veterans Affairs Health Care System, Montgomery, AL, United States of America
| | - Sean E Smithgall
- Auburn University Harrison College of Pharmacy, Mobile, AL, United States of America.
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Steuber TD, Rosandich T, Cadwallader T, Steil L, Belk M, Yendrapalli U, Hassoun A, Edwards J. Dosing and Administration Strategies of Tocilizumab in Patients With COVID-19: A Retrospective Cohort Analysis. Ann Pharmacother 2024; 58:391-397. [PMID: 37522616 DOI: 10.1177/10600280231190401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/01/2023] Open
Abstract
BACKGROUND Tocilizumab may reduce the risk of death, length of stay, and time of mechanical ventilation in patients hospitalized with COVID-19. Limited data are available evaluating low-dose subcutaneous administration of tocilizumab in this setting. OBJECTIVE To compare outcomes of 2 tocilizumab dosing and administration strategies in patients hospitalized with COVID-19. METHODS A retrospective, observational cohort study was conducted to compare clinical outcomes in patients hospitalized with COVID-19 receiving tocilizumab 400 mg intravenously (400 mg IV) or 162 mg subcutaneously (162 mg SC). Hospitalized patients receiving a single dose of tocilizumab were eligible for inclusion and grouped by dosing and administration strategy. The primary endpoint was ventilator-free days at day 28. Secondary endpoints included length of stay (LOS), intensive care unit (ICU) LOS, mechanical ventilation required after dose, 28-day readmission, 28-day mortality, and change in inflammatory markers. RESULTS A total of 303 patients were included, with 147 who received tocilizumab 400 mg IV and 156 who received 162 mg SC. There was no significant difference in average ventilator-free days at day 28 in patients receiving 400 mg IV compared with 162 mg SC (26.4 ± 5.3 vs 25.6 ± 6.8 days, respectively; P = 0.812). There was also no difference in LOS (10.4 ± 12.6 vs 10.5 ± 14.0 days; P = 0.637), ICU LOS (3.9 ± 9.0 vs 3.5 ± 8.3 days; P = 0.679), mechanical ventilation after dose (15.6% vs 19.2%; P = 0.412), 28-day readmission (6.1% vs 9.6%; P = 0.268), or 28-day mortality (23.1% vs 25.6%; P = 0.611). Finally, there was no difference regarding change in inflammatory markers at 48 hours (P > 0.05 for all interactions). CONCLUSION AND RELEVANCE In this retrospective study involving hospitalized patients with COVID-19, there was no difference between tocilizumab 162 mg SC and 400 mg IV in terms of efficacy. The 162 mg SC dose may be a reasonable alternative to traditional doses.
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Affiliation(s)
- Taylor D Steuber
- School of Pharmacy, University of Missouri-Kansas City, Columbia, MO, USA
- Harrison College of Pharmacy, Auburn University, Auburn, AL, USA
| | - Thomas Rosandich
- Harrison College of Pharmacy, Auburn University, Auburn, AL, USA
| | | | - Lauren Steil
- Harrison College of Pharmacy, Auburn University, Auburn, AL, USA
| | - Madeline Belk
- Department of Pharmacy, Huntsville Hospital, Huntsville, AL, USA
| | - Usha Yendrapalli
- Department of Internal Medicine, Huntsville Hospital, Huntsville, AL, USA
| | - Ali Hassoun
- Alabama Infectious Disease Center, Huntsville, AL, USA
| | - Jonathan Edwards
- Department of Pharmacy, Huntsville Hospital, Huntsville, AL, USA
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Steuber TD, Gipson H, Boyett B, Belk M, Thayer B, Edwards J. Head-to-head comparison of multi-dose oritavancin and dalbavancin for complicated infections: A propensity score-matched analysis. Int J Antimicrob Agents 2024; 63:107165. [PMID: 38570019 DOI: 10.1016/j.ijantimicag.2024.107165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 03/20/2024] [Accepted: 03/28/2024] [Indexed: 04/05/2024]
Abstract
BACKGROUND Oritavancin and dalbavancin are long-acting lipoglycopeptide antibiotics approved for the treatment of skin and skin structure infections. Recently, they have been used for outpatient antimicrobial therapy for complicated infections. No head-to-head studies exist for this purpose. OBJECTIVE To compare outcomes of patients treated with multiple doses of oritavancin or dalbavancin for complicated infections. PATIENTS AND METHODS This was a single-centre, retrospective cohort study evaluating adult patients who received two or more doses of lipoglycopeptides for complicated infections from February 2019 through December 2022. Patients receiving oritavancin were compared to dalbavancin after propensity score-matching. The primary endpoint was clinical success at 90 days. Other endpoints included: 30-day re-admission, 30-day mortality, adverse drug reactions (ADRs), and changes in white blood cell count and inflammatory markers after the first dose. RESULTS After exclusions and propensity score-matching, 131 matched pairs (N = 262) were included in the analysis. Most patients were receiving lipoglycopeptide therapy for osteomyelitis. There was no significant difference in clinical success at 90 days in patients who received oritavancin compared to those who received dalbavancin (99 [76%] vs. 103 [79%], respectively; P = 0.556). There was no significant difference in secondary endpoints, however, there was a trend towards higher incidence of ADRs oritavancin compared to dalbavancin (9 [7%] vs. 2 [2%], respectively; P = 0.060) which led to more treatment discontinuation. CONCLUSION There was no significant difference in efficacy between multi-dose oritavancin and dalbavancin for the treatment of complicated infections. Both agents were generally well tolerated; however, dalbavancin may be better tolerated when long-term treatment is warranted.
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Affiliation(s)
- Taylor D Steuber
- University of Missouri-Kansas City School of Pharmacy, Columbia, MO.
| | - Hannah Gipson
- Department of Pharmacy, Huntsville Hospital, Huntsville, AL
| | - Brian Boyett
- Department of Pharmacy, Huntsville Hospital, Huntsville, AL
| | - Madeline Belk
- Department of Pharmacy, Huntsville Hospital, Huntsville, AL
| | - Blain Thayer
- Department of Pharmacy, University Hospital, Columbia, MO
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Belk MG, Hammond OD, Seales CC, Edwards JD, Steuber TD. Effect of microbiology comment nudging on antibiotic use in asymptomatic bacteriuria: A before-and-after quasi-experimental study. Infect Control Hosp Epidemiol 2023; 44:1391-1395. [PMID: 36924157 PMCID: PMC10507501 DOI: 10.1017/ice.2022.272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 09/26/2022] [Accepted: 10/10/2022] [Indexed: 03/17/2023]
Abstract
OBJECTIVE To describe the effect of a microbiology comment nudge on antibiotic use for asymptomatic bacteriuria (ASB). DESIGN Single-center, before-and-after, quasi-experimental study. SETTING Community-based, public, not-for-profit teaching hospital in the southeastern United States. PARTICIPANTS Adult inpatients with a positive urine culture and the absence of urinary tract infection signs and symptoms. INTERVENTION Implementation of a microbiology comment nudge on urine cultures. RESULTS In total, 204 patients were included in the study. Antibiotics were less likely to be continued beyond 72 hours in the postimplementation group: 57 (55%) of 104 versus 38 (38%) of 100 (P = .016). They were less likely to have antibiotics continued beyond 48 hours: 60 (58%) of 104 versus 43 (43%) of 100 (P = .036). They were also less likely to have antibiotics prescribed at discharge 35 (34%) of 104 versus 20 (20%) of 100 (P = .028). In addition, they had fewer total antibiotic days of therapy: 4 (IQR, 1-6) versus 1 (IQR, 0-6) (P = .022). CONCLUSION Microbiology comment nudging may contribute to less antibiotic utilization in patients with ASB.
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Affiliation(s)
- Madeline G. Belk
- Huntsville Hospital, Department of Pharmacy, Huntsville, Alabama
| | | | | | | | - Taylor D. Steuber
- Huntsville Hospital, Department of Pharmacy, Huntsville, Alabama
- Auburn University Harrison School of Pharmacy, Pharmacy Practice, Huntsville, Alabama
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Williams B, Muklewicz J, Steuber TD, Williams A, Edwards J. Comparison of Inpatient Standard-of-Care to Outpatient Oritavancin Therapy for Patients With Acute Uncomplicated Cellulitis. J Pharm Pract 2023; 36:27-32. [PMID: 34080450 DOI: 10.1177/08971900211021258] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Shifting inpatient antibiotic treatment to outpatient parenteral antimicrobial therapy may minimize treatment for acute bacterial skin and skin structure infections, including cellulitis. The purpose of this evaluation was to compare 30-day hospital readmission or admission due to cellulitis and economic outcomes of inpatient standard-of-care (SoC) management of acute uncomplicated cellulitis to outpatient oritavancin therapy. METHODS This retrospective, observational cohort study was conducted at a 941-bed community teaching hospital. Adult patients 18 years and older treated for acute uncomplicated cellulitis between February 2015 to December 2018 were eligible for inclusion. Information was obtained from hospital and billing department records. Patients were assigned to either inpatient SoC or outpatient oritavancin cohorts for comparison. RESULTS 1,549 patients were included in the study (1,348 in the inpatient SoC cohort and 201 in the outpatient oritavancin cohort). The average length of stay for patients admitted was 3.6 ± 1.5 days. The primary outcome of 30-day hospital readmission or admission due to cellulitis occurred in 49/1348 (3.6%) patients in the inpatient SoC cohort versus 1/201 (0.5%) in the outpatient oritavancin cohort (p = 0.02). The difference between costs and reimbursement was improved in the outpatient oritavancin group (p < 0.001). CONCLUSION Outpatient oritavancin for acute uncomplicated cellulitis was associated with reduction in 30-day hospital readmissions or admissions compared to inpatient SoC. Beneficial economic outcomes for the outpatient oritavancin cohort were observed. Additional studies are required to confirm these findings.
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Affiliation(s)
- Brandy Williams
- Department of Pharmacy, 532836Huntsville Hospital, Huntsville, AL, USA
| | - Justin Muklewicz
- Department of Pharmacy, 532836Huntsville Hospital, Huntsville, AL, USA
| | - Taylor D Steuber
- Department of Pharmacy, 532836Huntsville Hospital, Huntsville, AL, USA.,Department of Pharmacy Practice, 15460Auburn University Harrison School of Pharmacy, Huntsville, AL, USA
| | - April Williams
- Department of Pharmacy, 532836Huntsville Hospital, Huntsville, AL, USA
| | - Jonathan Edwards
- Department of Pharmacy, 532836Huntsville Hospital, Huntsville, AL, USA
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Isaacs AN, Steuber TD, Howard ML, Dy-Boarman EA, Nisly SA. Evaluating the Impact of Advanced Pharmacy Practice Experiences on Student Pharmacist Metacognition. Am J Pharm Educ 2022; 86:8676. [PMID: 34507955 PMCID: PMC10159483 DOI: 10.5688/ajpe8676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 08/27/2021] [Indexed: 05/06/2023]
Abstract
Objective. To assess factors impacting metacognition during the advanced pharmacy practice experience (APPE) year (final year of the Doctor of Pharmacy program) for student pharmacists at five different institutions.Methods. Student pharmacists completed a pre- and post-APPE year survey that collected data on demographics, curricular and co-curricular experiences, and the 19-item modified metacognition assessment inventory (MAI). Additionally, the post-APPE survey collected data on learning activities completed during the APPE year. Matched survey responses were analyzed to identify associations between change in MAI score and individual experiences.Results. One hundred thirty-nine matched responses were analyzed. A significant improvement in overall student pharmacist metacognition was seen in matched pre- vs post-APPEs surveys. Several significant, moderate to weak correlations were associated with a change in MAI score over the APPE year.Conclusion. The APPE year resulted in a significant change in student pharmacists' metacognition at five institutions. This improvement was multifactorial as individual factors had minimal association with the change in metacognition.
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Affiliation(s)
- Alex N Isaacs
- Purdue University, College of Pharmacy, West Lafayette, Indiana
| | - Taylor D Steuber
- Auburn University, Harrison School of Pharmacy, Auburn, Alabama
- University of Auburn Birmingham, School of Medicine, Huntsville, Alabama
| | - Meredith L Howard
- The University of North Texas Health Science Center at Fort Worth, College of Pharmacy, Fort Worth, Texas
| | - Eliza A Dy-Boarman
- Drake University, College of Pharmacy & Health Sciences, Des Moines, Iowa
| | - Sarah A Nisly
- Wingate University, School of Pharmacy, Wingate, North Carolina
- Wake Forest Baptist Medical Center, Winston-Salem, North Carolina
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Thiriveedi M, Steuber TD, Hasan M, Baggett A. Infliximab-Induced Lupus Causing Pericarditis: a Case Report and Review of the Literature. J Gen Intern Med 2021; 36:2134-2138. [PMID: 33855671 PMCID: PMC8298630 DOI: 10.1007/s11606-021-06781-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 03/30/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Mrudula Thiriveedi
- UAB School of Medicine Huntsville Regional Medical Campus, Huntsville, AL, USA
| | - Taylor D Steuber
- Auburn University Harrison School of Pharmacy, Huntsville, AL, USA.
| | - Mohamed Hasan
- UAB School of Medicine Huntsville Regional Medical Campus, Huntsville, AL, USA
| | - Alan Baggett
- UAB School of Medicine Huntsville Regional Medical Campus, Huntsville, AL, USA
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Steuber TD, Andrus MR, Wright BM, Blevins N, Phillippe HM. Effect of Interprofessional Clinical Debates on Attitudes of Interprofessional Teams. PRiMER 2021; 5:14. [PMID: 33860169 DOI: 10.22454/primer.2021.154149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Introduction Current evidence supports the notion of debates as a pedagogical method to teach literature evaluation skills in health care education; however, there are no reports of this method as an interprofessional approach and its potential benefits. The aim of this study was to assess the impact of interprofessional clinical debates on attitudes toward interprofessional teamwork and perceived literature evaluation skills. Methods We invited third-year family medicine residents and fourth-year pharmacy students to complete a survey before and after participating in an interprofessional clinical debate. The anonymous survey was composed of the Students' Perceptions of Interprofessional Clinical Education-Revised (SPICE-R2) instrument to evaluate perceptions of interprofessional teamwork, literature evaluation, and other skills gained through the process. We evaluated matched responses for change in attitudes toward interprofessional teams. Results We evaluated 41 matched responses, which indicated improvement in attitudes toward interprofessional teams and was statistically significant ( P<.001). This finding held true for subscales of roles/responsibilities for collaborative practice and patient outcomes from collaborative practice (P<.001). Participants also perceived improvements in literature evaluation, problem-solving, critical thinking, teamwork, and communication skills. Conclusion The interprofessional clinical debate activity positively impacted medical residents and pharmacy students, and improved attitudes toward interprofessional teams.
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Affiliation(s)
- Taylor D Steuber
- Auburn University Harrison School of Pharmacy, Department of Pharmacy Practice, Huntsville, AL
| | - Miranda R Andrus
- Auburn University Harrison School of Pharmacy, Department of Pharmacy Practice, Huntsville, AL
| | - Bradley M Wright
- Auburn University Harrison School of Pharmacy, Department of Pharmacy Practice, Huntsville, AL
| | - Nancy Blevins
- University of Alabama at Birmingham School of Medicine, Department of Family Medicine, Huntsville, AL
| | - Haley M Phillippe
- Auburn University Harrison School of Pharmacy, Department of Pharmacy Practice, Huntsville, AL
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Steuber TD, Butler L, Sawyer A, Chappell R, Edwards J. Comparison of blood cultures versus T2 Candida Panel in management of candidemia at a large community hospital. Eur J Clin Microbiol Infect Dis 2021; 40:997-1001. [PMID: 33387121 DOI: 10.1007/s10096-020-04144-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 12/27/2020] [Indexed: 11/25/2022]
Abstract
The T2 Candida Panel (T2CP) has high sensitivity and specificity to detect candidemia. Its role in the diagnosis and management of candidemia compared to blood cultures (BC) remains unclear. The purpose of this study was to evaluate the T2CP versus BC in detecting and treating candidemia. A retrospective, observational cohort study was conducted to compare clinical outcomes in patients with candidemia identified by BC versus T2CP. Patients with a positive BC or T2CP for Candida spp. from January 2012 to August 2020 were grouped by initial method of detection (BC vs T2CP). Co-primary endpoints assessed included time to detection of candidemia and time to antifungal therapy. Key secondary endpoints included length of stay (LOS), ICU LOS, and mortality. One hundred sixty-three patients with a positive BC and 89 patients with a positive T2CP were included in the evaluation. The average time to detection of candidemia was significantly shorter in the T2CP group compared to BC group (9 vs 41 h, p < 0.001). The time to antifungal was also significantly shorter in the T2CP group compared to the BC group (4 vs 37 h, p < 0.001). However, LOS was significantly shorter in the BC positive group than the T2CP group with no difference in ICU LOS. There was no difference in in-hospital or 30-day mortality between the two groups. Of patients diagnosed with candidemia at our large community hospital, identification by T2CP led to faster detection and initiation of antifungal compared to blood cultures without improvement in LOS or mortality.
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Affiliation(s)
- Taylor D Steuber
- Department of Pharmacy Practice, Auburn University Harrison School of Pharmacy, 301 Governors Drive SW, Huntsville, AL, 35801, USA.
- Department of Pharmacy, Huntsville Hospital, 101 Sivley Road, Huntsville, AL, 35801, USA.
| | - Lauren Butler
- Department of Pharmacy, Huntsville Hospital, 101 Sivley Road, Huntsville, AL, 35801, USA
| | - Adam Sawyer
- Department of Pharmacy, Huntsville Hospital, 101 Sivley Road, Huntsville, AL, 35801, USA
| | - Rachel Chappell
- Department of Pharmacy, DCH Regional Medical Center, 809 University Boulevard East, Tuscaloosa, AL, 35401, USA
| | - Jonathan Edwards
- Department of Pharmacy, Huntsville Hospital, 101 Sivley Road, Huntsville, AL, 35801, USA
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Steuber TD, Janzen KM, Howard ML. A Systematic Review and Meta-Analysis of Metolazone Compared to Chlorothiazide for Treatment of Acute Decompensated Heart Failure. Pharmacotherapy 2020; 40:924-935. [PMID: 32639593 DOI: 10.1002/phar.2440] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Treatment of volume overload in the setting of acute decompensated heart failure (ADHF) is typically achieved through the use of loop diuretics. While they are highly effective, some patients may develop loop diuretic resistance. One strategy to overcome this scenario includes sequential nephron blockade with a thiazide-type diuretic; however, it is unknown which thiazide-type diuretic used in this setting is most effective. A systematic review and meta-analysis were performed to compare the efficacy and safety of chlorothiazide with metolazone as add-on therapy in the setting of loop diuretic resistance for the treatment of ADHF. Literature searches were conducted through PubMed, Google Scholar, and Science Direct from inception through February 2020 using the following search terms alone or in combination: metolazone, chlorothiazide, acute decompensated heart failure, loop diuretic, and urine output. All English-language prospective and retrospective trials and abstracts comparing metolazone to chlorothiazide for the treatment of ADHF were evaluated. Studies were included if they analyzed urine output for at least 24 hours in patients with ADHF. Meta-analysis was conducted to evaluate pooled effect size by using a random-effect model. Primary outcomes included net and total urine output. Secondary outcomes included commonly reported safety outcomes. Four studies comparing the use of metolazone to chlorothiazide as an adjunct to loop diuretics to treat ADHF were included in the evaluation. Metolazone was as effective as chlorothiazide to augment loop diuretic therapy in ADHF in most studies with no pooled difference in net or total urine output. However, there were notable differences in baseline loop diuretic dosing, ejection fraction, renal function, race, and endpoint timing across studies. Adverse effects were commonly observed and included electrolyte abnormalities, change in renal function, and hypotension but were comparable between groups. Metolazone is as effective as chlorothiazide as add-on to loop diuretics in treating ADHF without an increase in safety concerns.
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Affiliation(s)
- Taylor D Steuber
- Department of Pharmacy Practice, Auburn University Harrison School of Pharmacy, Huntsville, Alabama, USA.,Department of Pharmacy, Huntsville Hospital, Huntsville, Alabama, USA
| | - Kristin M Janzen
- Division of Pharmacy Practice, The University of Texas at Austin College of Pharmacy, Austin, Texas, USA.,Department of Pharmacy, Dell Seton Medical Center at the University of Texas, Austin, Texas, USA
| | - Meredith L Howard
- Department of Pharmacotherapy, University of North Texas System College of Pharmacy, Fort Worth, Texas, USA
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Steuber TD, Tucker-Heard G, Edwards J, Sawyer A, Thottacherry E, Hassoun A. Utilization and impact of a rapid Candida panel on antifungal stewardship program within a large community hospital. Diagn Microbiol Infect Dis 2020; 97:115086. [PMID: 32535413 DOI: 10.1016/j.diagmicrobio.2020.115086] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 05/07/2020] [Accepted: 05/11/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND The T2 Candida Panel (T2CP) bodes high sensitivity and specificity to detect candidemia, enabling providers to make quick therapy decisions and possibly decrease mortality. However, utilization in practice and clinical application remains to be evaluated. OBJECTIVES To evaluate the overall provider-utilization of the T2CP at a large community hospital. METHODS This single center, retrospective, observational study compared antifungal management in all patients with positive or negative T2CP. Additional endpoints included patient-specific variables influencing antifungal management decisions. RESULTS Six hundred twenty-eight T2CP results were evaluated. Antifungal optimization occurred in 54% of patients who had antifungal orders at the time of T2CP test. Antifungal therapy was avoided in 60.4% of negative cases. Patients with negative T2CP had significantly fewer days of therapy compared to positive tests. CONCLUSIONS Although the T2CP led to fewer days of antifungal therapy with negative tests, many opportunities for improvement in antifungal stewardship were identified, specifically, with negative tests.
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Affiliation(s)
- Taylor D Steuber
- Auburn University Harrison School of Pharmacy, Department of Pharmacy Practice, 301 Governors Drive SW, Huntsville, AL 35801; Huntsville Hospital, Department of Pharmacy, 101 Sivley Road, Huntsville, AL 35801.
| | - Glady's Tucker-Heard
- Auburn University Harrison School of Pharmacy, Department of Pharmacy Practice, 301 Governors Drive SW, Huntsville, AL 35801; Auburn University Harrison School of Pharmacy, Department of Pharmacy Practice, 350 Clinic Drive, Mobile, AL 36688
| | - Jonathan Edwards
- Huntsville Hospital, Department of Pharmacy, 101 Sivley Road, Huntsville, AL 35801
| | - Adam Sawyer
- Huntsville Hospital, Department of Pharmacy, 101 Sivley Road, Huntsville, AL 35801
| | - Elizabeth Thottacherry
- UAB Huntsville Regional Medical Campus, Department of Internal Medicine, 301 Governors Drive SW, Huntsville, AL 35801
| | - Ali Hassoun
- Alabama Infectious Diseases Center, 420 Lowell Dr SE #301, Huntsville, AL
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Thottacherry E, Heard GT, Steuber TD, Hassoun A, Sawyer AJ, Edwards J. 256. Optimizing the Clinical Utilization of T2 Rapid Candida Panel at a Large Community Hospital. Open Forum Infect Dis 2019. [PMCID: PMC6809570 DOI: 10.1093/ofid/ofz360.331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background Candidemia is the fourth leading hospital-acquired bloodstream infection with an estimated mortality rate of 35%. Fungal blood cultures result in at least five days and fail to identify 40% of Candida infections. The T2 Candida Panel is a diagnostic test which utilizes whole blood to provide rapid detection of five Candida varieties. It has a 91% sensitivity and 99% specificity rate and enables physicians to initiate or de-escalate therapy rapidly, possibly decreasing mortality. However, practical utilization clinically has not been studied. Our aim is to evaluate the appropriate utilization of the T2 Candida Panel in a large community hospital. Methods A retrospective chart review of hospitalized with a T2 Candida Panel result from December 2015 to June 2018 was performed. The panel was restricted and could only be ordered by two specialties, Infectious Disease and Oncology. Baseline demographics and patient characteristics were collected. Endpoints assessed included patient outcomes, antifungal medication use, T2 Candida panel results, corresponding blood culture results, time to appropriate therapy and duration of therapy. Results A total of 628 T2 Candida panels resulted during the study period with 56.6% involving the intensive care setting. The average age was 59.5 years with 52.5% of the population being male. Of the total, 8.1% (n = 60) were positive. Only three patients had a positive fungal blood culture result with a negative T2 panel collected at the same time (sensitivity 94.3%, 95% CI 80.8–99.3; specificity 94.2%, 95% CI 91.4–96.3). 264 (42%) were ordered with concomitant antifungal therapy and 48.1% underwent de-escalation of therapy based on T2 result. The average time to de-escalation was 137 hours. Of the positive results, 40 (66.7%) had an antifungal ordered when the T2 panel was ordered and 30 (50%) were switched to appropriate therapy after T2 resulted in an average time of 11 hours. Conclusion Our data shows that while the T2 Candida Panel demonstrated faster and more sensitive results, there was still a considerable delay in achieving appropriate therapy. The variation in utilization of the T2 Candida Panel indicates that further intervention regarding appropriate use of the panel is required. ![]()
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Disclosures All authors: No reported disclosures.
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Affiliation(s)
| | | | - Taylor D Steuber
- Auburn University Harrison School of Pharmacy, Huntsville, Alabama
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Thottacherry E, Whitfield PL, Steuber TD, Li C, Sawyer AJ, Edwards J, Hassoun A. 2425. Correlating Use of High-Risk Antimicrobials and the Incidence of Hospital-Onset Clostridium difficile Infection: Targeting Prescribing Trends for Antimicrobial Stewardship. Open Forum Infect Dis 2019. [PMCID: PMC6810352 DOI: 10.1093/ofid/ofz360.2103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Background Hospital-onset Clostridium difficile infection (HO-CDI) has a significant morbidity and mortality risk. It also poses increasing financial strain on the healthcare system. Certain antibiotics have been associated with increased HO-CDI incidence and novel strategies are needed to determine what modifiable risk factors exist. Choices of antibiotic have changed overtime time to overcome potential side effects, leading to a possibility that changed prescribing trends could be linked to significant differences in the rate of HO-CDI. Methods This study took place at a 971-bed community hospital from January 2016 to January 2018. Monthly utilization (grams) of 11 antimicrobials considered high risk of HO-CDI was collected, along with monthly HO-CDI rate. Antimicrobials included cephalosporins, carbapenems, fluoroquinolones and clindamycin. Correlational (Pearson’s) and logistic regression analyses were completed to identify association with HO-CDI. A P-value of < 0.05 was considered statistically significant. Results 215 cases of HO-CDI were identified during the study period with 30 being classified as severe. The average HO-CDI rate was 4.3 cases/1000 patient-days. There were no significant correlations identified for any antimicrobials and HO-CDI rate (p> 0.05 for all interactions). Pearson’s correlation coefficients were not significant for any antimicrobial. The multivariable logistic regression model including all antimicrobials, indicated that only ceftazidime had a statistically significant positive effect on the HO-CDI rate. Bearing in mind that only a small number of ceftazidime was prescribed, additional univariate analysis was performed indicating that there was no significant linear association between the HO-CDI rate and ceftazidime utilization (P = 0.3527). Conclusion Our study shows that there is no significant correlation between specific antimicrobial use and HO-CDI rates, even though there has been a general increase in HO-CDI rates. Additional analysis involving control groups of antibiotic use in patients without HO-CDI as well as incidence of HO-CDI in patients without antibiotic use at all is required to further assess possible modifiable risk factors in the inpatient population. ![]()
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Disclosures All authors: No reported disclosures.
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Affiliation(s)
| | | | - Taylor D Steuber
- Auburn University Harrison School of Pharmacy, Huntsville, Alabama
| | - Chao Li
- Auburn University Harrison School of Pharmacy, Huntsville, Alabama
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Steuber TD, Nisly SA, M Gillette C. Grit in pharmacy faculty: A pilot analysis focused on productivity measures. Curr Pharm Teach Learn 2019; 11:1029-1034. [PMID: 31685172 DOI: 10.1016/j.cptl.2019.06.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 03/28/2019] [Accepted: 06/21/2019] [Indexed: 05/12/2023]
Abstract
INTRODUCTION Grit, a "perseverance and passion for long-term goals," is an important characteristic that has been linked to success in academics and career endeavors. In pharmacy education, there have been mixed results on grit as a predictor of academic performance in pharmacy students. Furthermore, there have been no studies on the implications of grit in pharmacy faculty. The purpose of this study was to determine pharmacy faculty Short Grit Scale (Grit-S) scores at two universities and whether those scores correlate with faculty productivity. METHODS A 36-item electronic survey was administered to pharmacy faculty members at two institutions. Baseline demographics and self-reported Grit-S scores were obtained. Metrics of productivity in the areas of teaching, scholarship, and service were defined using quantitative measures. Non-parametric analyses were conducted to test if higher Grit-S scores correlated with other variables. RESULTS Faculty reported an average Grit-S score of 3.68. There was no significant correlation between Grit-S scores and components of faculty productivity in teaching and service for the previous academic year or career. Higher Grit-S scores had a moderately positive correlation with the number of peer-reviewed publications in 2017. CONCLUSION Grit-S scores are high among pharmacy faculty and were not correlated with higher productivity in most components of faculty workload.
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Affiliation(s)
- Taylor D Steuber
- Auburn University Harrison School of Pharmacy, 301 Governors Drive SW, Suite 357, Huntsville, AL 35801, United States.
| | - Sarah A Nisly
- Wingate University School of Pharmacy, 220 N Camden St., Wingate, NC 28174, United States.
| | - Chris M Gillette
- Wake Forest School of Medicine, 475 Vine Street, Winston-Salem, NC 27101, United States.
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Steuber TD, Lee J, Holloway A, Andrus MR. Nondihydropyridine Calcium Channel Blockers for the Treatment of Proteinuria: A Review of the Literature. Ann Pharmacother 2019; 53:1050-1059. [PMID: 30966785 DOI: 10.1177/1060028019843644] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective: To review the use of nondihydropyridine calcium channel blockers (non-DHP CCBs) for the treatment of proteinuria in diabetic and nondiabetic kidney disease. Data Sources: A search using PubMed and MEDLINE, Scopus, and Google Scholar was performed from 1964 through February 2019 using the following search terms alone or in combination: verapamil, diltiazem, non-dihydropyridine calcium channel blocker, proteinuria, albuminuria, microalbuminuria, kidney disease, renal disease. Study Selection and Data Extraction: All prospective English-language trials examining one or more non-DHP CCB for the treatment of proteinuria were evaluated. Data Synthesis: A total of 13 clinical trials examining the use of non-DHP CCBs to treat proteinuria alone or in combination with angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) were included in the evaluation. Most studies evaluated patients with macroalbuminuria secondary to diabetes and hypertension. Verapamil was the most common agent studied. Non-DHP CCBs were effective in reducing proteinuria in diabetic kidney disease but did not reduce renal or cardiovascular outcomes in the one trial that evaluated clinical end points. They were generally well tolerated, with the most common adverse effect reported being constipation. Relevance to Patient Care and Clinical Practice: This review evaluates and summarizes the available evidence on non-DHP CCBs for treatment of proteinuria in patients with existing kidney disease. Conclusion: Non-DHP CCBs may be a reasonable therapeutic option for patients with diabetic kidney disease and persistent proteinuria despite maximum doses of ACE inhibitors or ARBs. Additionally, they may be reasonable alternatives to ACE inhibitors or ARBs if a contraindication or intolerance exists.
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Affiliation(s)
- Taylor D Steuber
- 1 Auburn University Harrison School of Pharmacy, Huntsville, AL, USA.,2 Huntsville Hospital, Huntsville, AL, USA
| | - Jenna Lee
- 3 Yale-New Haven Hospital, New Haven, CT, USA
| | | | - Miranda R Andrus
- 1 Auburn University Harrison School of Pharmacy, Huntsville, AL, USA
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Abstract
Objective: To review the use of direct oral anticoagulants (DOACs) in patients with chronic liver disease (CLD). Data Sources: A MEDLINE literature search was performed from 1964 through February 2019 using the following search terms: cirrhosis, chronic liver disease, direct oral anticoagulant, and the individual DOACs. Study Selection and Data Extraction: All English-language human trials and reports that examined DOACs for treatment or prevention of venous thromboembolic (VTE) events in patients with CLD were included. Data Synthesis: A total of 6 clinical trials examining the use of DOACs in patients with CLD were identified. All DOACs have been utilized in patients with CLD, with the exception of betrixaban, for prevention of stroke in atrial fibrillation or treatment of VTE (except for treatment of pulmonary embolism). The studies primarily evaluated patients with mild to moderate liver disease (Child-Turcotte-Pugh class A and B). The DOACs had similar rates of bleeding compared with traditional anticoagulants. Relevance to Patient Care and Clinical Practice: This review evaluates and summarizes the available evidence on DOACs in the setting of CLD. These agents may be more appealing in this population because monitoring or administration may be difficult with traditional anticoagulants (warfarin or low-molecular-weight heparins). Conclusion: Early data suggest that DOACs may be safe in patients with mild to moderate CLD. Should a DOAC be selected as an alternative to traditional anticoagulants, more frequent monitoring should be used because hepatotoxicity may be a concern. Larger clinical trials are needed to address efficacy outcomes as well as differences among individual DOACs in this population.
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Affiliation(s)
- Taylor D Steuber
- 1 Auburn University Harrison School of Pharmacy, Huntsville, AL, USA
| | - Meredith L Howard
- 2 University of North Texas System College of Pharmacy, Fort Worth, TX, USA
| | - Sarah A Nisly
- 3 Wingate University School of Pharmacy, Wingate, NC, USA
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Steuber TD, Janzen KM, Sprunger TL, Nisly SA. Hybrid Online Delivery of a Pharmacy Residency and Fellowship Elective Course. Innov Pharm 2018; 9:1-5. [DOI: 10.24926/iip.v9i2.1147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Objective: To describe and evaluate the transition of a pharmacy residency and fellowship (PRF) elective course to a hybrid online platform.
Innovation: In 2016, the 1-credit hour PRF elective was transitioned from a live, synchronous course to a hybrid online platform. Over the course of the semester, students completed eight modules along with assignments that pertained to a different component of PRF. Course grades and evaluations, as well as PRF placement rates, were compared between 2015 (live, synchronous course) and 2016 (hybrid online course). There were no differences in overall course grades or student evaluations of individual relevant course objectives between the two course formats. However, more students rated the course as excellent during the 2015 live, synchronous course. Placement rates were similar between students who took the course in 2015 and 2016.
Critical Analysis: Following the transition of a PRF elective to a hybrid online platform, course grades, evaluation of individual relevant course objectives, and PRF placement rates remained similar to previous years. Creative educational venues can help meet the student demand while simultaneously allowing faculty to manage their time. However, instructors should balance this with desire of students to have more face-to-face in class time.
Type: Note
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Affiliation(s)
- Meredith L. Howard
- Department of Pharmacotherapy; University of North Texas System College of Pharmacy; Fort Worth Texas
| | - Taylor D. Steuber
- Department of Pharmacy Practice; Auburn University Harrison School of Pharmacy; Huntsville Alabama
| | - Sarah A. Nisly
- Wingate University School of Pharmacy; Wingate North Carolina
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Steuber TD, Janzen KM, Walton AM, Nisly SA. Assessment of Learner Metacognition in a Professional Pharmacy Elective Course. Am J Pharm Educ 2017; 81:6034. [PMID: 29367769 PMCID: PMC5774189 DOI: 10.5688/ajpe6034] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Accepted: 01/25/2017] [Indexed: 05/20/2023]
Abstract
Objective. To investigate the effect of strategic feedback and metacognitive processes on learners' ability to predict performance and improve self-awareness. Methods. Strategic faculty and peer feedback, as well as self-assessments, were implemented in a professional pharmacy elective course throughout the semester, focused on three case-based oral presentations. After each presentation, students utilized an objective rubric to determine self-predicted and peer-predicted scores. Actual scores from faculty were compared to students' predicted scores. Results. Students' ability to predict presentation scores did not improve over time; however, students were able to accurately estimate performance in certain rubric sections on individual presentations (depth of problem, presentation). Students were generally overconfident in predicting their performance. When broken down into tertiles, top performing students were more accurate in their self-assessments compared to bottom performing students. Bottom performing students were highly overconfident in their assessment. Conclusion. Self-awareness is essential for professionals, though difficult to cultivate and improve in one semester. Incorporating longitudinal, continuous feedback and metacognitive skills may help learners become more aware of their own performance and devise a plan for enhancement.
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Affiliation(s)
- Taylor D Steuber
- Auburn University Harrison School of Pharmacy, Huntsville, Alabama
| | - Kristin M Janzen
- Butler University College of Pharmacy and Health Sciences, Indianapolis, Indiana
| | - Alison M Walton
- Butler University College of Pharmacy and Health Sciences, Indianapolis, Indiana
| | - Sarah A Nisly
- Wingate University School of Pharmacy, Wingate, North Carolina
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Howard ML, Steuber TD, Nisly SA, Wilhoite J, Saum L. Pharmacy resident-led student mentoring program: A focus on developing mentoring skills. Curr Pharm Teach Learn 2017; 9:1123-1128. [PMID: 29233381 DOI: 10.1016/j.cptl.2017.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2016] [Revised: 04/21/2017] [Accepted: 07/27/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND AND PURPOSE Formalized mentoring programs are often credited for influencing professional development of mentees. Unfortunately, little information exists regarding advancement of mentoring skills. We report the development and evaluation of a program to cultivate mentoring skills in pharmacy residents. EDUCATIONAL ACTIVITY AND SETTING Advanced pharmacy practice experience students and pharmacy residents were contacted for program participation. Resident mentors were paired with a student mentee for the program. Mentors were provided resources and support throughout the program. Sessions were held to facilitate mentoring relationships and to discuss professional development topics. Pre- and post-perception surveys were administered to mentors to measure changes in mentoring comfort and ability. Only matched pre- and post-surveys were included for analysis. The program was held and evaluated over two separate academic years FINDINGS: Fifty-three residents mentored 54 students over two cycles of the program. Mentors' matched perception surveys (n = 26) reported increased comfort in mentoring (p < 0.001), increased confidence in delivery of subjective content (p < 0.001), increased comfort in providing written and oral feedback (p = 0.013), and increased effectiveness in provision of written and oral feedback (p = 0.004 and p = 0.013 respectively). Mentors also reported heightened belief that serving as a student mentor will be beneficial to their long-term career goals (p = 0.034). DISCUSSION AND SUMMARY Overall, this formal resident-led student mentoring program improved resident comfort serving in a mentoring role.
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Affiliation(s)
- Meredith L Howard
- University of North Texas System College of Pharmacy, 3500 Camp Bowie Blvd., RES 435D, Fort Worth, TX 76107, United States.
| | - Taylor D Steuber
- Auburn University Harrison School of Pharmacy, 301 Governors Drive SW, Suite 357, Huntsville, AL 35801, United States.
| | - Sarah A Nisly
- Wingate University School of Pharmacy, 220N Camden Rd, Wingate, NC 28174, United States.
| | - Jessica Wilhoite
- Butler University College of Pharmacy and Health Sciences, 4600 Sunset Ave, Indianapolis, IN 46208, United States.
| | - Lindsay Saum
- Butler University College of Pharmacy and Health Sciences, 4600 Sunset Ave, Indianapolis, IN 46208, United States.
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Howard ML, Steuber TD, Walton AM, Nisly SA. Pharmacy residents as primary educators within a professional pharmacy elective. Curr Pharm Teach Learn 2017; 9:862-868. [PMID: 29233316 DOI: 10.1016/j.cptl.2017.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Revised: 12/29/2016] [Accepted: 05/20/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND AND PURPOSE The purpose of this study was to evaluate the impact of a course change from a faculty-led professional pharmacy elective to a primarily pharmacy resident-led course on student satisfaction and learning. EDUCATIONAL ACTIVITY AND SETTING In 2014, pharmacy residents were transitioned into primary teaching roles in a drug-induced diseases elective to increase student exposure to residents and different teaching styles. Student learning roles did not change. Course evaluations and grades were compared between the resident-led year and prior year. FINDINGS There was no significant difference between overall course grades during the resident-led year (94.2 ± 36.6 in 2014 vs. 94.1 ± 2.7 in 2013; p=0.975). Course evaluations were similar to the previous year and students provided favorable feedback. DISCUSSION AND SUMMARY This pharmacy resident-led elective allowed for resident integration in to an interactive professional elective. Student satisfaction with the course remained similar to the previous year and overall course grades did not differ.
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Affiliation(s)
- Meredith L Howard
- University of North Texas System College of Pharmacy, 3500 Camp Bowie Blvd., RES 435D, Fort Worth, TX 76107, United States.
| | - Taylor D Steuber
- Auburn University Harrison School of Pharmacy, 301 Governors Drive SW, Suite 357, Huntsville, AL 35801, United States.
| | - Alison M Walton
- Butler University College of Pharmacy and Health Sciences, 4600 Sunset Ave., Indianapolis, IN 46208, United States.
| | - Sarah A Nisly
- Wingate University School of Pharmacy, 220 N Camden Rd, Wingate, NC 28174, United States.
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Steuber TD, Shiltz DL, Cairns AC, Ding Q, Binger KJ, Courtney JR. A Multicenter Analysis of Factors Associated With Apixaban-Related Bleeding in Hospitalized Patients With End-Stage Renal Disease on Hemodialysis. Ann Pharmacother 2017. [PMID: 28643524 DOI: 10.1177/1060028017717282] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND In 2014, the United States Food and Drug Administration approved a labeling change for apixaban to include recommendations for patients with severe renal impairment and patients with end-stage renal disease (ESRD) on hemodialysis (HD), though these recommendations are largely based on pharmacokinetic and pharmacodynamic data. OBJECTIVE Identify variables associated with bleeding events in hospitalized patients with ESRD on HD receiving apixaban. METHODS This retrospective, multicenter cohort study evaluated hospitalized patients with ESRD on HD receiving apixaban from January 1, 2013, through March 31, 2016. Correlational analysis and logistic regression were completed to identify factors associated with bleeding. RESULTS A total of 114 adults were included in the analysis. The median length of stay (LOS) was 6.2 (interquartile range = 3.8-11.9) days and bleeding events occurred in a total of 17 patients (15%). A weak correlation was identified for higher cumulative apixaban exposure, increased number of HD sessions while receiving apixaban, and increased hospital LOS ( P < 0.05; correlation coefficient < 0.40). When controlling for confounders, logistic regression revealed that composite bleeding events were independently increased by continuation of outpatient apixaban (odds ratio = 13.07; 95% CI = 1.54-110.54; P = 0.018), increased total daily dose of apixaban (odds ratio = 1.72; 95% CI = 1.20 to 2.48; P = 0.003), and total HD sessions while receiving apixaban (odds ratio = 2.04; 95% CI = 1.06-3.92; P = 0.033). CONCLUSION The association between these factors and increased bleeding should prompt concern for long-term anticoagulation with apixaban in patients with ESRD receiving chronic HD.
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Affiliation(s)
- Taylor D Steuber
- 1 Auburn University Harrison School of Pharmacy, Huntsville, AL, USA.,2 Huntsville Hospital, Huntsville, AL, USA
| | - Dane L Shiltz
- 3 Ferris State University College of Pharmacy, Big Rapids, MI, USA.,4 Spectrum Health, Grand Rapids, MI, USA
| | - Alex C Cairns
- 5 Butler University College of Pharmacy and Health Sciences, Indianapolis, IN, USA.,6 Indiana University Health, Indianapolis, IN, USA
| | - Qian Ding
- 3 Ferris State University College of Pharmacy, Big Rapids, MI, USA
| | - Katie J Binger
- 5 Butler University College of Pharmacy and Health Sciences, Indianapolis, IN, USA.,6 Indiana University Health, Indianapolis, IN, USA
| | - Julia R Courtney
- 5 Butler University College of Pharmacy and Health Sciences, Indianapolis, IN, USA.,6 Indiana University Health, Indianapolis, IN, USA
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Nisly SA, Janzen KM, Steuber TD, Trujillo TN. Alumni survey as a quality-improvement tool for defining residency success. Am J Health Syst Pharm 2016; 73:1722-1725. [DOI: 10.2146/ajhp160125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
| | - Kristin M. Janzen
- College of Pharmacy and Health Sciences Butler University Indianapolis, IN
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Abstract
OBJECTIVE To review the use of GLP-1 agonists in patients with type 1 diabetes mellitus (T1DM). DATA SOURCES A search using the MEDLINE database, EMBASE, and Cochrane Database was performed through March 2016 using the search terms glucagon-like peptide 1 (GLP-1) agonists, incretin, liraglutide, exenatide, albiglutide, dulaglutide, type 1 diabetes mellitus STUDY SELECTION AND DATA EXTRACTION All English-language trials that examined glycemic end points using GLP-1 agonists in humans with T1DM were included. DATA SYNTHESIS A total of 9 clinical trials examining the use of GLP-1 agonists in T1DM were identified. On average, hemoglobin A1C (A1C) was lower than baseline, with a maximal lowering of 0.6%. This effect was not significant when tested against a control group, with a relative decrease in A1C of 0.1% to 0.2%. In all trials examined, reported hypoglycemia was low, demonstrating no difference when compared with insulin monotherapy. Weight loss was seen in all trials, with a maximum weight loss of 6.4 kg over 24 weeks. Gastrointestinal adverse effects are potentially limiting, with a significant number of patients in trials reporting nausea. CONCLUSION The use of GLP-1 agonists should be considered in T1DM patients who are overweight or obese and not at glycemic goals despite aggressive insulin therapy; however, tolerability of these agents is a potential concern. Liraglutide has the strongest evidence for use and would be the agent of choice for use in overweight or obese adult patients with uncontrolled T1DM.
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Affiliation(s)
- Kristin M Janzen
- Butler University College of Pharmacy and Health Sciences, Indianapolis, IN, USA Indiana University Health, Indianapolis, IN, USA
| | - Taylor D Steuber
- Butler University College of Pharmacy and Health Sciences, Indianapolis, IN, USA Indiana University Health, Indianapolis, IN, USA
| | - Sarah A Nisly
- Butler University College of Pharmacy and Health Sciences, Indianapolis, IN, USA Indiana University Health, Indianapolis, IN, USA
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Abstract
Objective: To assess the use of oral iron, intravenous (IV) iron, and erythropoiesis-stimulating agents (ESAs) for the prevention and management of perioperative anemia in elective orthopedic surgery patients, and to provide a clinical algorithm for use. Data Sources: A PubMed and MEDLINE search was conducted from 1964 through March 2016 using the following search terms alone or in combination: orthopedic, surgery, elective, anemia, blood transfusion, iron, erythropoiesis-stimulating agents, and erythropoietin.Study Selection and Data Extraction: All English-language prospective and retrospective human studies and meta-analyses evaluating oral iron, IV iron, or ESA alone or in combination in elective orthopedic surgery patients were evaluated, provided they reported blood transfusion outcomes. Data Synthesis: A total of 9 prospective and retrospective studies and 1 meta-analysis were identified and included. In the preoperative setting, administration of oral iron, IV iron, or ESA alone or in combination to correct underlying anemia led to significantly reduced transfusion rates. Transfusion requirements were generally less with combination therapy (ESA + oral or IV iron). In the short-term perioperative or postoperative period, use of oral or IV iron led to conflicting results, with some reporting a statistically significant reduction in blood transfusions, whereas others reported none. Conclusions: In elective orthopedic surgery, IV or oral iron with or without an ESA may provide benefit in prevention of postoperative anemia and results in blood transfusion reduction without significantly increasing the risk of adverse events. These agents should be considered at the lowest effective dose with emphasis on administration prior to planned surgery.
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Affiliation(s)
- Taylor D. Steuber
- Butler University College of Pharmacy and Health Sciences, Indianapolis, IN, USA
- Indiana University Health, Methodist Hospital, Indianapolis, IN, USA
| | - Meredith L. Howard
- University of North Texas System College of Pharmacy, Fort Worth, TX, USA
| | - Sarah A. Nisly
- Butler University College of Pharmacy and Health Sciences, Indianapolis, IN, USA
- Indiana University Health, Methodist Hospital, Indianapolis, IN, USA
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