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Be good to Eddie Lee
Although Christy considered him a pest, when Eddie Lee, a boy with Down's Syndrome, follows her into the woods, he shares several special discoveries with her.
Book
Resistance of Escherichia coli urinary isolates in emergency department-treated, community-acquired patients over a ten-year period at a community hospital
Urinary tract infections (UTIs) are a commonly treated healthcare condition. When treated in the Emergency Department (ED), empiric antibiotic selection can be challenging due to limited real-time data and the rising prevalence of antimicrobial resistance (AMR), including that of Escherichia coli (E. coli). This study assessed changes in E. coli susceptibility and antimicrobial prescribing for ED-treated community-acquired UTI patients (CA-UTI) over a ten-year period.
We conducted a retrospective study of CA-UTI patients (2011 and 2021 cohorts) treated and discharged from a community hospital ED. Adult patients with a positive urine culture (≥100,000 CFU/mL) but without healthcare-associated risk factors were included. Demographics, pathogens, antibiotic susceptibility, and prescribed antibiotics were collected.
One hundred seventy patients from 2011 and 400 patients from 2021 were included. The 2021 cohort was older and had more male patients. E. coli was the predominant pathogen but decreased in proportion among all isolates from 2011 to 2021. Resistance rates for antibiotics remained largely unchanged. Escherichia. coli resistance to levofloxacin (9.2 vs 9.2 %, p = 0.091587) and sulfamethoxazole-trimethoprim (25.2 vs 26.6 %, p = 0.863859) showed minimal change, while nitrofurantoin resistance decreased significantly (8.4 % vs 2.6 %; p = 0.0233). Prescribing patterns shifted, with a decrease in fluoroquinolone (52.3 % vs. 9 %, p ≤ 0.00001) and an increase in β-lactam prescribing (63.3 % vs. 3.5 %; p < 0.00001).
Resistance rates to commonly prescribed antibiotics remained stable for urinary isolates in ED-treated CA-UTI patients over a decade. A notable shift in prescribing from fluoroquinolones to oral β-lactams was observed. The ongoing importance of local surveillance and antimicrobial stewardship is critical to guiding empiric treatment decisions.
•Two cohorts 10 years apart•Change in prescribing of antibiotic therapy•Unchanged fluoroquinolone resistance•Decreased fluoroquinolone prescribing•Unchanged β-lactam resistance•re
Journal Article
Evaluation of Video-enhanced Case-based Activities Guided by the Pharmacists' Patient Care Process
Objective. To design and develop a series of technology-enhanced, case-based learning activities framed by the Pharmacists' Patient Care Process (PPCP), and to evaluate the impact of these activities on student perceptions and performance. Methods. A mixed methods approach was used to generate both quantitative and qualitative data. Survey and focus group interviews were used to analyze student perceptions. Performance on a pre-and post-assessment was used to measure the impact of PPCP case-based learning activities. Results. Students demonstrated positive attitudes overall towards the case-based learning activities. Themes emerged during focus group interviews regarding awareness of the PPCP, engagement in learning, and a desire for realistic experiences. Significant changes were observed for the pre- and post-assessment within the plan and follow-up parameters, as well as for the total score within each disease state. Conclusion. The use of technology-enhanced, case-based modules framed around a standardized patient care process resulted in positive student perceptions and improved scores on a patient case assessment. The PPCP may be a useful framework for case development to aid students in application of drug therapy knowledge. Keywords: pharmacists' patient care process, case-based learning, video-enhanced cases, student perceptions
Journal Article
Resistance of Escherichia coli urinary isolates in ED-treated patients from a community hospital
The purpose of this study is to provide resistance data for Escherichia coli isolates causing urinary tract infections in emergency department (ED) patients not requiring admission and explore if differences between this subpopulation and the hospital antibiogram exist. Differences between community-acquired urinary tract infection (CA-UTI) and health care–associated (HA-UTI) subgroups were also investigated.
Patients with a positive urine culture treated and discharged from the ED of a 200-bed community hospital were reviewed. Patients with urinary isolates of more than 100000 colony-forming unit/mL and documented intention to treat were included. Patients who required admission, were pregnant, less than the age of 18 years, or who had a positive culture but without any evidence of intention to treat were excluded. Only the initial visit was included for patients who returned to the ED within 7 days.
Overall, 308 visits were screened, and 217 were included. Of these, 78.3% were CA-UTI, and 21.7% were HA-UTI. Females comprised 88.5% of all patients. E coli was the most common pathogen overall and in both subgroups. E coli resistance to levofloxacin was 13.5% overall, 9.2% for CA-UTI, and 38.5% for HA-UTI compared with 27% on the hospital antibiogram. E coli resistance to sulfamethoxazole/trimethoprim was 26.9% overall, 25.2% for CA-UTI, and 34.6% for HA-UTI vs 26% on the antibiogram.
E coli susceptibility for ED patients not requiring admission may not be accurately represented by hospital antibiograms that contain culture data from various patient types, sites of infection, or patients with varying illness severity. Separation of the ED population into CA-UTI and HA-UTI subgroups may be helpful when selecting empiric antibiotic therapy.
Journal Article
Evaluation of Video-enhanced Case-based Activities Guided by the Pharmacists’ Patient Care Process
To design and develop a series of technology-enhanced, case-based learning activities framed by the Pharmacists’ Patient Care Process (PPCP), and to evaluate the impact of these activities on student perceptions and performance.
A mixed methods approach was used to generate both quantitative and qualitative data. Survey and focus group interviews were used to analyze student perceptions. Performance on a pre- and post-assessment was used to measure the impact of PPCP case-based learning activities.
Students demonstrated positive attitudes overall towards the case-based learning activities. Themes emerged during focus group interviews regarding awareness of the PPCP, engagement in learning, and a desire for realistic experiences. Significant changes were observed for the pre- and post-assessment within the plan and follow-up parameters, as well as for the total score within each disease state.
The use of technology-enhanced, case-based modules framed around a standardized patient care process resulted in positive student perceptions and improved scores on a patient case assessment. The PPCP may be a useful framework for case development to aid students in application of drug therapy knowledge.
Journal Article
Multicenter, Observational Cohort Study Evaluating Third-Generation Cephalosporin Therapy for Bloodstream Infections Secondary to Enterobacter, Serratia, and Citrobacter Species
Objectives: There is debate on whether the use of third-generation cephalosporins (3GC) increases the risk of clinical failure in bloodstream infections (BSIs) caused by chromosomally-mediated AmpC-producing Enterobacterales (CAE). This study evaluates the impact of definitive 3GC therapy versus other antibiotics on clinical outcomes in BSIs due to Enterobacter, Serratia, or Citrobacter species. Methods: This multicenter, retrospective cohort study evaluated adult hospitalized patients with BSIs secondary to Enterobacter, Serratia, or Citrobacter species from 1 January 2006 to 1 September 2014. Definitive 3GC therapy was compared to definitive therapy with other non-3GC antibiotics. Multivariable Cox proportional hazards regression evaluated the impact of definitive 3GC on overall treatment failure (OTF) as a composite of in-hospital mortality, 30-day hospital readmission, or 90-day reinfection. Results: A total of 381 patients from 18 institutions in the southeastern United States were enrolled. Common sources of BSIs were the urinary tract and central venous catheters (78 (20.5%) patients each). Definitive 3GC therapy was utilized in 65 (17.1%) patients. OTF occurred in 22/65 patients (33.9%) in the definitive 3GC group vs. 94/316 (29.8%) in the non-3GC group (p = 0.51). Individual components of OTF were comparable between groups. Risk of OTF was comparable with definitive 3GC therapy vs. definitive non-3GC therapy (aHR 0.93, 95% CI 0.51–1.72) in multivariable Cox proportional hazards regression analysis. Conclusions: These outcomes suggest definitive 3GC therapy does not significantly alter the risk of poor clinical outcomes in the treatment of BSIs secondary to Enterobacter, Serratia, or Citrobacter species compared to other antimicrobial agents.
Journal Article
Concepts in clinical pharmacokinetics
Understanding the science of pharmacokinetics is a challenge for many pharmacy students and practitioners. Concepts in Clinical Pharmacokinetics, now in its 7th edition, has helped thousands by simplifying this essential, but complex, subject to reflect current practice. The 7th edition has been revised by Robin Southwood, PharmD, BC-ADM, CDE; Virginia H. Fleming, PharmD, BCPS; and Gary Huckaby, PharmD; all experts in clinical pharmacy education. Together, they have updated and expanded the text to include the latest information and insights on concepts through extensive use of correlates, figures, and review questions.
eBook
Resistance ofEscherichia coliurinary isolates in ED-treated patients from a community hospital
Purpose The purpose of this study is to provide resistance data forEscherichia coliisolates causing urinary tract infections in emergency department (ED) patients not requiring admission and explore if differences between this subpopulation and the hospital antibiogram exist. Differences between community-acquired urinary tract infection (CA-UTI) and health care-associated (HA-UTI) subgroups were also investigated. Methods Patients with a positive urine culture treated and discharged from the ED of a 200-bed community hospital were reviewed. Patients with urinary isolates of more than 100000 colony-forming unit/mL and documented intention to treat were included. Patients who required admission, were pregnant, less than the age of 18 years, or who had a positive culture but without any evidence of intention to treat were excluded. Only the initial visit was included for patients who returned to the ED within 7 days. Results Overall, 308 visits were screened, and 217 were included. Of these, 78.3% were CA-UTI, and 21.7% were HA-UTI. Females comprised 88.5% of all patients.E coliwas the most common pathogen overall and in both subgroups.E coliresistance to levofloxacin was 13.5% overall, 9.2% for CA-UTI, and 38.5% for HA-UTI compared with 27% on the hospital antibiogram.E coliresistance to sulfamethoxazole/trimethoprim was 26.9% overall, 25.2% for CA-UTI, and 34.6% for HA-UTI vs 26% on the antibiogram. Conclusions E colisusceptibility for ED patients not requiring admission may not be accurately represented by hospital antibiograms that contain culture data from various patient types, sites of infection, or patients with varying illness severity. Separation of the ED population into CA-UTI and HA-UTI subgroups may be helpful when selecting empiric antibiotic therapy.
Journal Article
“Sung out of the Void”: Yeats's Folkloric Nationalism
Yeats infuses his poetry, prose, and plays with elements of folklore, and the ancient stories are the seeds and roots for much of his work. He assumes his readers' facility with this material, which is credible, considering the wide-spread popularity of Ireland's iconic folklore. It is precisely that familiarity which Yeats exploits in his promotion of an Irish Literary Revival. Discovering a purpose and direction for his work in the late 1880's, Yeats hoped to produce a national and nationalistic literature which would emphasize the uniqueness of Irish culture: one that would pay homage to Ireland's noble past, while serving as a sentinel to its promising future. Yeats's political views changed with time and age and were undoubtedly influenced by his Anglo-Irish heritage and his relationships with revolutionaries. But he was consistently committed to Irish cultural independence, and it is that commitment which drove him to publish three volumes of folklore, numerous articles on the subject, and his own introductions to the tales and their tellers. He wrote hundreds of pages about Ireland's connections to folklore, and he spent much of his life crafting poems and plays born of the legends, tales, and myths. Writing as he did at a pivotal moment of Irish political history, he was attempting to revive the sense of wonder and pride that the Irish, suffocating under British imperialism, seemed to have lost.
Dissertation