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  • 1
    In: American Journal of Infection Control, Elsevier BV, Vol. 47, No. 11 ( 2019-11), p. 1284-1289
    Type of Medium: Online Resource
    ISSN: 0196-6553
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2019
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  • 2
    In: Clinical Infectious Diseases, Oxford University Press (OUP), Vol. 69, No. 3 ( 2019-07-18), p. 414-420
    Abstract: There is a paucity of data on the effect of early de-escalation of antimicrobial therapy on rates of Clostridioides difficile infection (CDI). This retrospective cohort study evaluated impact of de-escalation from antipseudomonal β-lactam (APBL) therapy within 48 hours of Enterobacteriaceae bloodstream infections (BSIs) on 90-day risk of CDI. Methods Adult patients hospitalized for 〉 48 hours for treatment of Enterobacteriaceae BSI at Palmetto Health hospitals in Columbia, South Carolina, from 1 January 2011 through 30 June 2015 were identified. Multivariable Cox proportional hazards regression was used to examine time to CDI in patients who received 〉 48 hours or ≤48 hours of APBL for empirical therapy of Enterobacteriaceae BSI after adjustment for the propensity to receive 〉 48 hours of APBL. Results Among 808 patients with Enterobacteriaceae BSI, 414 and 394 received 〉 48 and ≤48 hours of APBL, respectively. Incidence of CDI was higher in patients who received 〉 48 hours than those who received ≤48 hours of APBL (7.0% vs 1.8%; log-rank P = .002). After adjustment for propensity to receive 〉 48 hours of APBL and other variables in the multivariable model, receipt of 〉 48 hours of APBL (hazard ratio [HR], 3.56 [95% confidence interval {CI}, 1.48–9.92] ; P = .004) and end-stage renal disease (HR, 4.27 [95% CI, 1.89–9.11]; P = .001) were independently associated with higher risk of CDI. Conclusions The empirical use of APBL for 〉 48 hours was an independent risk factor for CDI. Early de-escalation of APBL using clinical risk assessment tools or rapid diagnostic testing may reduce the incidence of CDI in hospitalized adults with Enterobacteriaceae BSIs.
    Type of Medium: Online Resource
    ISSN: 1058-4838 , 1537-6591
    RVK:
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2019
    detail.hit.zdb_id: 1099781-7
    detail.hit.zdb_id: 2002229-3
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  • 3
    In: JACCP: JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY, Wiley, Vol. 3, No. 7 ( 2020-11), p. 1269-1279
    Abstract: Patients with a penicillin allergy, most of which are falsely documented, often receive alternative antibiotic therapy leading to negative outcomes. Pharmacy personnel are well‐positioned to provide allergy reconciliation and penicillin skin testing services. Objectives The purpose of this study was to describe the regulatory approval and implementation of a novel, inpatient pharmacist‐ and pharmacy trainee‐administered penicillin allergy assessment and skin testing (PAAST) service. Impact on allergy reconciliation and antibiotic use was assessed. Methods This was a retrospective cohort study describing a pharmacist‐administered PAAST program conducted at a 641‐bed tertiary care medical center in South Carolina. The primary outcome was the proportion of allergies reconciled or resolved pre‐ and post‐PAAST evaluation. The secondary outcomes were the durability of allergy removal and change in antibiotic use post‐PAAST. Results Regulatory approval from the Boards of Pharmacy, Medical Examiners, and Nursing was obtained prior to implementation of the program. There were 161 PAAST evaluations, 119 (74%) allergy assessments alone, and 42 (26%) skin tests. Proportion of patients with reconciled allergies improved from 17 (11%) pre‐PAAST to 120 (75%) post‐PAAST evaluation ( P   〈  .0001). Among 42 skin tests performed, there were no positive results, 36 (86%) negative results, and 6 (14%) indeterminate results. Antibiotic therapy was optimized in 58% (21/36) of patients with a negative skin test. Following a negative skin test, vancomycin use significantly decreased (44% pre‐test vs 17% post‐test, P = .01) while use of penicillins significantly increased (0% vs 39%, P   〈  .0001). Among 35 patients with allergy labels resolved in the electronic health record after a negative test, there were no occurrences of relabeling among a mean of 7.6 patient encounters. Conclusion Implementation of a pharmacist‐administered PAAST service effectively streamlined antimicrobial therapy and resolved penicillin allergy labels, without relabeling. Advocating for pharmacy personnel to perform services such as PAAST should be considered in other institutions and states.
    Type of Medium: Online Resource
    ISSN: 2574-9870 , 2574-9870
    URL: Issue
    Language: English
    Publisher: Wiley
    Publication Date: 2020
    detail.hit.zdb_id: 2920371-5
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  • 4
    Online Resource
    Online Resource
    Oxford University Press (OUP) ; 2019
    In:  American Journal of Health-System Pharmacy Vol. 76, No. 24 ( 2019-12-02), p. 2041-2047
    In: American Journal of Health-System Pharmacy, Oxford University Press (OUP), Vol. 76, No. 24 ( 2019-12-02), p. 2041-2047
    Abstract: To evaluate residency applicant (RA) and residency program director (RPD) perceptions of Phase II of the Match process since its inception in 2016. Methods An online survey was issued to all Match-registered RAs and RPDs for the 2016, 2017, and 2018 Match periods. Study participant demographics, participant designation (RA or RPD), the year(s) and Phase(s) of the Match participated in were measured using categorical ranges, and overall perceptions of the Match process since Phase II of the Match was implemented were captured with 5-point Likert scales. Results A total of 2,599 individuals (RA and RPD) completed the survey for an overall survey response rate of 12.6%. The majority of RAs were female (73.2%), under the age of 30 (87.4%), Caucasian (67.4%), and recently graduated (90.9% graduated between 2016 and 2018). Most RAs participated in the 2018 Match period (61%), and overall 82% successfully matched to a residency position. RA perceptions relating to process cost-effectiveness and perceived fairness to all applicants differed significantly from RPD perceptions (2.23 versus 3.71 and 2.80 versus 3.67, respectively; p & lt; 0.001 for each). There were no differences between RA and RPD perceptions related to the submission/review process. Conclusion The Phase II of the Match process has demonstrated improved organization and satisfaction from the RPD perspective compared to the previous process. RAs have identified several areas for improvement in the process. It is imperative that efforts are made to continue expanding program and position offerings as much as possible.
    Type of Medium: Online Resource
    ISSN: 1079-2082 , 1535-2900
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2019
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    detail.hit.zdb_id: 2057140-9
    SSG: 15,3
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  • 5
    Online Resource
    Online Resource
    Elsevier BV ; 2017
    In:  American Journal of Pharmaceutical Education Vol. 81, No. 8 ( 2017-10), p. 6702-
    In: American Journal of Pharmaceutical Education, Elsevier BV, Vol. 81, No. 8 ( 2017-10), p. 6702-
    Type of Medium: Online Resource
    ISSN: 0002-9459
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2017
    detail.hit.zdb_id: 603807-4
    SSG: 15,3
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  • 6
    In: Open Forum Infectious Diseases, Oxford University Press (OUP), Vol. 6, No. 11 ( 2019-11-01)
    Abstract: With an increasing number of antimicrobial stewardship–related articles published each year, attempting to stay current is challenging. The Southeastern Research Group Endeavor (SERGE-45) identified antimicrobial stewardship–related peer-reviewed literature that detailed an actionable intervention for 2018. The top 13 publications were selected using a modified Delphi technique. These manuscripts were reviewed to highlight the actionable intervention used by antimicrobial stewardship programs to provide key stewardship literature for teaching and training as well as to identify potential intervention opportunities within one’s institution.
    Type of Medium: Online Resource
    ISSN: 2328-8957
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2019
    detail.hit.zdb_id: 2757767-3
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  • 7
    Online Resource
    Online Resource
    Oxford University Press (OUP) ; 2019
    In:  American Journal of Health-System Pharmacy Vol. 76, No. 21 ( 2019-10-15), p. 1788-1793
    In: American Journal of Health-System Pharmacy, Oxford University Press (OUP), Vol. 76, No. 21 ( 2019-10-15), p. 1788-1793
    Abstract: The attitudes and expectations of residency program directors (RPDs) regarding nontraditional residency applicants (NTAs) were evaluated. Methods This was a cross-sectional, survey-based study targeting RPDs of American Society of Health-System Pharmacists–accredited residency programs. A 14-question survey requesting information related to demographics, perceptions of NTAs compared with traditional applicants, advantages and disadvantages of NTAs, and advice for NTAs was administered electronically to RPDs. The primary outcome of this study was to determine RPDs’ perceptions of NTAs as suitable residency candidates. The secondary outcome evaluated the rate of NTA acceptance into residency programs and a qualitative assessment of RPDs’ advice for NTAs. Results Of the 1,414 RPDs contacted to participate, 328 (23%) completed the survey. RPDs were primarily affiliated with postgraduate year 1 pharmacy practice (52%) or postgraduate year 2 specialty residencies (30%), and 35% reported having an NTA in their program. Most respondents (87%) reported that NTAs are given equal consideration relative to traditional residency applicants. RPDs rated work experience as the most important quality of an NTA, followed closely by the ability to work with others and teachability. Most (277 [85%]) RPDs agreed that NTAs should possess experiences beyond work experience, such as research, leadership, and community service. The biggest concern regarding NTAs was significant time since graduation prior to application. Conclusion The majority of RPDs did not perceive NTAs differently from traditional applicants in the selection process of prospective candidates.
    Type of Medium: Online Resource
    ISSN: 1079-2082 , 1535-2900
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2019
    detail.hit.zdb_id: 1224627-X
    detail.hit.zdb_id: 2057140-9
    SSG: 15,3
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  • 8
    Online Resource
    Online Resource
    Oxford University Press (OUP) ; 2019
    In:  Open Forum Infectious Diseases Vol. 6, No. Supplement_2 ( 2019-10-23), p. S377-S377
    In: Open Forum Infectious Diseases, Oxford University Press (OUP), Vol. 6, No. Supplement_2 ( 2019-10-23), p. S377-S377
    Abstract: A multidisciplinary approach using pre-authorization and/or prospective audit and feedback combined with institutional guidelines, personnel education, and intervention monitoring is essential for successful antimicrobial stewardship programs (ASP). Assessing the impact of ASPs can be process-based and/or outcome-based. Electronic medical record-based clinical decision support (CDS) tools can be used to prioritize stewardship interventions. Methods The Medical University of South Carolina (MUSC) transitioned from Theradoc® to Epic® for ASP surveillance and data collection in 2018. The ASP team developed a scoring algorithm with integral rules to identify and analyze inpatients who might require ASP interventions. The dynamic list captures and scores patients based on key infection-related data and prioritizes interventions. Additionally, we created a smart form flowsheet to streamline stewardship efforts for use by physicians and pharmacists. Accuracy of event capture was assessed during the buildout and via daily comparisons between Theradoc® and Epic®. Our goals are to optimize the treatment of potentially fatal infections (e.g., bacteremia) and delay emerging resistance. Results Our ASP module utilizes a scoring algorithm to identify and prioritize patients with positive blood or central nervous system cultures, other positive critical diagnostic tests, and high-risk antimicrobial use. Additional rules identify “bug-drug” mismatches, multiple positive cultures, and de-escalation opportunities. For example, the rules assign a high priority to patients with positive blood cultures and no prescribed antibiotics, but a lower priority score to restricted antimicrobial orders. We created a smart form flowsheet to document microorganism, presumed source, anti-infective use, ASP intervention, and acceptance of recommendations, allowing for multidisciplinary documentation outside of Epic® I-vents. Finally, we created a Reporting Workbench report which allows for monthly compilation and analysis of ASP interventions. Conclusion The MUSC Epic® ASP platform build showcases a CDS system that allows for streamlined, multidisciplinary communication, documentation, and analysis of outcomes. Disclosures All authors: No reported disclosures.
    Type of Medium: Online Resource
    ISSN: 2328-8957
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2019
    detail.hit.zdb_id: 2757767-3
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  • 9
    Online Resource
    Online Resource
    Elsevier BV ; 2022
    In:  American Journal of Infection Control Vol. 50, No. 8 ( 2022-08), p. 941-946
    In: American Journal of Infection Control, Elsevier BV, Vol. 50, No. 8 ( 2022-08), p. 941-946
    Type of Medium: Online Resource
    ISSN: 0196-6553
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2022
    detail.hit.zdb_id: 392362-9
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  • 10
    In: American Journal of Health-System Pharmacy, Oxford University Press (OUP), ( 2022-05-08)
    Abstract: In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Purpose To describe the perceptions of residency candidates, residency practitioners (current residents and preceptors), and residency program directors (RPDs) regarding a virtual interview process for pharmacy residency programs across multiple institutions. Methods In May 2021, an anonymous web-based questionnaire characterizing perceptions of the virtual interview process used during the coronavirus disease 2019 (COVID-19) pandemic was distributed to residency candidates, residency practitioners, and RPDs across 13 institutions. Quantitative responses measured on a 5-point Likert scale were summarized with descriptive statistics, and open-ended questions were analyzed using thematic qualitative methods. Results 236 residency candidates and 253 residency practitioners/RPDs completed the questionnaire, yielding response rates of 27.8% (236 of 848), and 38.1% (253 of 663), respectively. Overall, both groups perceived the virtual interview format positively. When asked whether virtual interviews should replace in-person interviews moving forward, 60.0% (18 of 30) of RPDs indicated they agreed or strongly agreed, whereas only 30.5% (61 of 200) of current preceptors/residents and 28.7% (66 of 230) of residency candidates agreed or strongly agreed. Thematic analysis of qualitative responses revealed that while virtual interviews were easier logistically, the lack of in-person interactions was a common concern for many stakeholders. Lastly, the majority (65.0%) of residency candidates reported greater than $1,000 in savings with virtual interviews. Conclusion Virtual interviews offered logistical and financial benefits. The majority of RPDs were in favor of offering virtual interviews to replace in-person interviews, whereas the majority of residency candidates and practitioners preferred on-site interviews. As restrictions persist with the ongoing pandemic, our results provide insight into best practices for virtual pharmacy residency interviews.
    Type of Medium: Online Resource
    ISSN: 1079-2082 , 1535-2900
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2022
    detail.hit.zdb_id: 1224627-X
    detail.hit.zdb_id: 2057140-9
    SSG: 15,3
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