Implementation and evaluation of an interprofessional prescription writing workshop with a simulated electronic prescribing activity for preclerkship medical students

BACKGROUND

Prescription writing skills are essential for physician practice. This study describes the development and implementation of a curricular intervention focused on improving the knowledge and confidence of preclerkship medical students' prescription writing practices utilizing an interprofessional education model, with a focus on electronic prescribing.

METHODS

Medicine and Pharmacy Faculty from a large, urban university collaborated to develop the content of the workshop and a simulation platform was used for the e-prescribing activity. Second-year medical students attended a mandatory in-person workshop facilitated by fourth-year pharmacy students. A pre and post knowledge test and confidence survey were used to assess students' knowledge, confidence, and satisfaction. Outcomes from the knowledge test were evaluated with paired-samples proportions tests, and confidence survey data was evaluated with paired t-tests and Wilcoxon signed-rank tests in a pre-post study design.

RESULTS

Students demonstrated a significant increase in prescription writing knowledge and confidence after completing the workshop. On the pre-test, 7% of students (21/284) completed the electronic prescribing assessment correctly and 51% of students (149/295) completed it correctly on the post-test. All items on the confidence survey showed a significant increase in pre- versus post-survey comparisons (p < 0.001).

CONCLUSIONS

This interprofessional prescription writing workshop facilitated by pharmacy students shows promise for improving the knowledge and confidence of prescription writing and electronic prescribing practices in preclerkship medical students.

Anthracyclines and the risk of arrhythmias: A systematic review and meta-analysis

BACKGROUND

There have been controversial findings from recent studies regarding anthracyclines use and the subsequent risk of arrhythmias. This study aimed to evaluate the existing evidence of the risk of arrhythmias in patients treated with anthracyclines.

METHODS

PubMed, Scopus, and Web of Science databases were searched up to April 2022 using keywords such as "anthracycline" and "arrhythmia." Dichotomous data were presented as relative risk (RR) and confidence interval (CI), while continuous data were presented as mean difference (MD) and CI. Revman software version 5.4 was used for the analysis.

RESULTS

Thirteen studies were included with a total of 26891 subjects. Pooled analysis showed that anthracyclines therapy was significantly associated with a higher risk of arrhythmia (RR: 1.58; 95% CI: 1.41-1.76; P < .00001), ST segment and T wave abnormalities (RR: 1.73, 95% CI: 1.18-2.55, P = .005), conduction abnormalities and AV block (RR = 1.86, 95% CI = 1.06-3.25, P = .03), and tachycardia (RR: 1.736, 95% CI: 1.11-2.69, P = .02). Further analyses of the associations between anthracyclines and atrial flutter (RR = 1.30, 95% CI = 0.29-5.89, P = .74), atrial ectopic beats (RR: 1.27, 95% CI: 0.78-2.05, P = .34), and ventricular ectopic beats (RR: 0.93, 95% CI: 0.53-1.65, P = .81) showed no statistically significant results. Higher doses of anthracycline were associated with a higher risk of arrhythmias (RR: 1.49; 95% CI: 1.08-2.05; P = .02) compared to the lower doses (RR: 1.36; 95% CI: 1.00-1.85; P = .05). Newer generations of Anthracycline maintained the arrhythmogenic properties of previous generations, such as Doxorubicin.

CONCLUSION

Anthracyclines therapy was significantly associated with an increased risk of arrhythmias. Accordingly, Patients treated with anthracyclines should be screened for ECG abnormalities and these drugs should be avoided in patients susceptible to arrhythmia. The potential benefit of the administration of prophylactic anti-fibrotic and anti-arrhythmic drugs should also be explored.

RACE-IT - Rapid Acute Coronary Syndrome Exclusion using the Beckman Coulter Access high-sensitivity cardiac troponin I: A stepped-wedge cluster randomized trial

BACKGROUND

Protocols utilizing high-sensitivity cardiac troponin (hs-cTn) assays for the evaluation of suspected acute coronary syndrome (ACS) in the emergency department (ED) have been gaining popularity across the US and the world. These protocols more rapidly rule-out ACS and more accurately identify the presence of acute myocardial injury. At this time, few randomized trials have evaluated the safety and operational impact of these assays, resulting in limited evidence to guide the use and implementation of hs-cTn in the ED.

OBJECTIVE

The main study objective is to test the effectiveness of a rapid ACS rule-out pathway using hs-cTnI in safely discharging patients from the ED for whom clinical suspicion for ACS exists.

DESIGN

This prospective, implementation trial (n = 11,070) will utilize a stepped wedge cluster randomized trial design. The design will allow for all participating sites to capture benefit from the implementation of the hs-cTnI pathway while providing data evaluating the effectiveness in providing safe and rapid evaluation of patients with clinical suspicion for ACS.

SUMMARY

Demonstrating that clinical pathways using hs-cTnI can be effectively implemented to rapidly rule-out ACS while conserving costly hospital resources has significant implications for the care of patients with possible acute cardiac conditions in EDs across the US.

CLINICALTRIALSGOV IDENTIFIER

NCT04488913.

Individual and Simultaneous Voltammetric Determination of Ultra-Trace Environmental Contaminant Dihydroxybenzene Isomers Based on a Composite Electrode Sandwich-like Structure

An advanced electroanalytical technique for the simultaneous assessment of environmental contaminant dihydroxybenzene isomers, catechol (CC), hydroquinone (HQ), and resorcinol (RC), has been investigated using palladium nanoparticles (PdNPs) incorporated onto a poly(1,5-diaminonaphthalene) (DAN) matrix over a glassy carbon electrode (GCE). Concurrently, these types of phenols can be assessed by the PdDAN/GCE modified electrode employing square wave voltammetry and cyclic voltammetry (CV) techniques under optimal conditions. This modified electrode has demonstrated linear responses for CC, HQ, and RC from 50.0 to 1000.0 mM; concomitantly, low detection limits of 0.22, 0.22, and 0.47 nM and low quantification limits of 0.740, 0.758, and 1.590 nM, have been, respectively, shown. Successfully, the simultaneous assessment of the three isomers in river stream water, tap water, and underground water has been implemented via the modified electrode under investigation. In comparison to reported studies, the PdDAN catalytic electrode has shown an effective sensitivity, leverage reproducibility, long-term stability, and excellent anti-interference capability for the determination of dihydroxybenzene isomers.

Mucilage-capped silver nanoparticles for glucose electrochemical sensing and fuel cell applications

A simple, cost-effective and green mucilage-capped silver nanoparticles (Mucilage-AgNPs) modified glassy carbon electrode (GC) composite was constructed for efficient and facile electrochemical oxidation of glucose for the first time. Mucilage-AgNPs were synthesized through the direct chemical reduction of Ag⁺ by mucilage extracted from Opuntia ficus-indica. Mucilage-AgNPs were identified and characterized using ultraviolet-visible spectroscopy, transmission electron microscopy and square wave voltammetry. Modification of the GC with AgNPs was carried out via a transfer-sticking technique with an immobilization time of 1 h. The Mucilage-AgNPs/GC composite was studied as a possible anode for glucose oxidation in a biofuel cell. The composite resulted in glucose oxidation with a current density and power density of 85.7 μA cm⁻² and 25.7 μW cm⁻², respectively. Glucose sensing using the Mucilage-AgNPs/GC composite was achieved successfully via two pathways: glucose oxidation and AgNP inhibition. The glucose oxidation-based sensor showed a lower detection limit of 0.01 mM and a linear range of 0.01 to 2.2 mM. The AgNPs inhibition-based sensor provides an indirect determination pathway of glucose with a detection limit of 0.1 mM and a linear range of 0.1 to 1.9 mM. AgNP inhibition is a novel pathway that could be used for determining a large number of organic and inorganic molecules. Overall, the Mucilage-AgNPs/GC is considered a pioneering composite for glucose sensing and fuel cell applications.

A simple, cost-effective and green mucilage-capped silver nanoparticles (Mucilage-AgNPs) modified glassy carbon electrode (GC) composite was constructed for efficient and facile electrochemical oxidation of glucose for the first time.

Isolation and identification of Madurella mycetomatis from two cases of black grain mycetoma in Libya

Two cases of mycetoma of the foot caused by Madurella mycetomatis are reported in which identification of the etiologic agents was confirmed by culture. A Libyan male aged 40 years and a Chadian female aged 30 years, exhibited eumycetoma of the foot 1 and 2 years, respectively, after a local injury. The diagnoses were based on the clinical presentation and confirmed by mycologic analysis of the grains and culture isolation of the etiologic agent. Prior to this report M. mycetomatis has not been recorded in Libya as a cause of eumycetoma.

Yeasts of the genus Candida are the dominant cause of onychomycosis in Libyan women but not men: results of a 2-year surveillance study

BACKGROUND

The reported frequency of recovery of fungi from infected nails varies according to the geographical area.

OBJECTIVES

To establish the nature of the causal agents in a sample of the Libyan population presenting with suspected onychomycosis.

METHODS

Samples were taken from the infected fingernails of 648 patients attending the Tripoli Medical Centre.

RESULTS

Samples from 500 patients proved positive for fungi following culturing, while 476 were potassium hydroxide and culture positive. Of the culture-positive samples, yeasts of the genus Candida (C. albicans, C. parapsilosis, C. glabrata, C. guillermondii and C. tropicalis) were the dominant cause of this condition in women (417 of 434, 96%) but were responsible for only a minority of cases in men (three of 66, 5%). In contrast, dermatophytes (Trichophyton violaceum, T. rubrum, T. mentagrophytes and Microsporum canis) were responsible for this condition in the majority of cases in men (53 of 66, 80%) but only 3% (15 of 434) of cases in women. The mould Aspergillus nidulans was isolated from the nails of 10 (15%) men and two (0.5%) women.

CONCLUSIONS

The data obtained in this study reveal an almost total separation of the aetiological agents responsible for onychomycosis based on gender.

Dermatophytes and other fungi associated with skin mycoses in Tripoli, Libya

This study sought to determine the prevalence of skin infections and their causative agents in the Libyan population. Samples were collected from 2224 patients attending the Dermatology Clinics of the Tripoli Medical Centre (TMC) between August 1997 and December 1999 and were submitted to a mycology laboratory for analysis. Diagnosis was confirmed by microscopic examination in 1180 cases (53.1%) and the causative agent was isolated and cultured in 1160 cases (52.2%). Dermatophytes, Malassezia furfur and Candida albicans were the most common etiological agents isolated. Tinea corporis accounted for 45.9% of cases (85% of cases occurred in children below 15 years of age). The frequency of the other clinical types in descending order was pityriasis versicolor 27.8% (322 cases), candidiosis 13.4% (156 cases), tinea pedis 8.1% (94 cases), tinea manuum 2.6% (30 cases) and tinea barbae 2.2% (26 cases). Trichophyton violaceum was the most common etiological agent, responsible for 44% (300 cases) of dermatophyte infections. Malassezia furfur was ranked the second most frequent causative agent being found in 27.8% of cases, followed by Trichophyton rubrum 13.8% (160 cases) and Candida albicans 10% (116 cases). Other species isolated included Microsporum canis 8.1% (94 cases), Epidermophyton floccosum 6.6% (76 cases) and Trichophyton mentagrophytes 3.1% (36 cases).