Evaluation of References Supporting Hospital Pharmacy Policies.

There is a lack of research evaluating the role of references in hospital policies. The goal of this study was to describe the type of literature used as a reference in medication policies and evaluate the agreement of the policy with evidence-based guidelines. One hundred forty-seven pharmacy owned policies met inclusion criteria; 27.2% of the policies contained references, in which tertiary literature was the most frequently cited source (90%), followed by primary (47.5%), and lastly secondary (27.5%). When references were used, all policies agreed with current guidelines. For policies without references, 3.7% disagreed with published guidelines. Disagreement with guidelines may negatively impact patient care, therefore health systems should incorporate librarians into clinical policy development and review to ensure the best available evidence is incorporated into polices.

Risk of bleeding with factor Xa inhibitors versus unfractionated heparin in patients with acute kidney injury.

STUDY OBJECTIVE: To compare bleeding and thromboembolic events in patients receiving therapeutic doses of apixaban or rivaroxaban versus unfractionated heparin (UFH) in patients with acute kidney injury (AKI). DESIGN: Single-center, retrospective, observational study. SETTING: Ascension St. John Hospital in Detroit, Michigan. PATIENTS: Hospitalized adult patients who received therapeutic doses of factor Xa inhibitors (n = 250) or UFH (n = 250) for at least 24 h in the setting of AKI. MEASUREMENTS AND MAIN RESULTS: After adjusting for confounding factors, patients who received a factor Xa inhibitor experienced a lower risk of composite major and clinically relevant nonmajor bleeding (CRNMB) events compared with UFH (OR: 0.57, 95% CI: 0.34-0.94; p = 0.03). There was a significantly decreased risk of CRNMB events in the factor Xa inhibitor group (OR: 0.55, 95% CI: 0.33-0.91, p = 0.02); however, no significant differences in major bleeding or venous thromboembolism (VTE) were noted. CONCLUSIONS: Our results suggest that it may be preferable to continue patients in AKI on factor Xa inhibitors versus transitioning to UFH due to the lower risk of bleeding events.

Podcasts and videos and slides oh my!: Traditional vs. nontraditional teaching methods in remote settings.

INTRODUCTION: Nontraditional teaching methods are student-centered and motivate students to participate in class activities. Some studies have shown benefit in using various teaching activities; however, data are limited regarding students' perspective and performance after implementation of nontraditional learning strategies. The study compared student preference and performance assessment with traditional and nontraditional presentation methods. METHODS: This study included first-year pharmacy students enrolled in a course at a research-intensive, public university. Students in 2020 received traditional lectures while students in 2021 were presented three topics as nontraditional activities, including a podcast, an escape room, a video inspired by Khan Academy, and a traditional asynchronous lecture using slides with voice-over. First-year pharmacy students were surveyed in 2021 regarding their perspective on the nontraditional presentations. Students' performance was compared between 2020 and 2021. RESULTS: Ninety-eight students in 2020 and 89 students in 2021 were enrolled in the course. Sixty-seven students completed the 2021 survey. Most students (71.6%) preferred the traditional lecture; the Khan Academy and escape room activities were the least favored. Most students (86.5%) responded they learned "quite a bit" or a "tremendous amount" with the traditional lecture, and 59.7% of students felt they would perform better on assessments with the traditional lecture compared to nontraditional. Students in 2021 only performed better on all exam questions related to the nontraditional podcast activity. CONCLUSIONS: Students preferred traditional lectures and also seemed to perform better on assessment, with the exception of the nontraditional presentation podcast style. Further studies are needed to confirm these findings.

Clinical Outcomes of Zinc Supplementation Among COVID-19 Patients.

BACKGROUND: Zinc supplementation is frequently prescribed during the treatment of COVID-19. However, the evidence supporting the efficacy of this intervention is mixed. OBJECTIVE: Establish the clinical utility of zinc supplementation to alter disease severity in COVID- 19 illness. METHODS: We performed a multicenter, retrospective, observational chart review of patients admitted to Ascension St. John Hospital or Detroit Medical Center from January 1st, 2020 to May 31st, 2020. All included patients received concomitant hydroxychloroquine due to its zinc ionophore activity. Our primary outcome was a change in Sequential Organ Failure Assessment (SOFA) score with secondary outcomes including all-cause mortality, need for intubation, and QTc prolongation as a safety outcome. RESULTS: We identified 489 patients who received zinc and 587 patients who did not. The primary outcome showed a small difference in the change in SOFA score in patients receiving zinc in univariate analysis (1.08 vs. 1.43, p=0.02), but this difference was not significant after adjustment for confounding factors such as receipt of corticosteroids and ICU admission. Mortality was not different between those that received zinc compared to those that did not (32.7% vs. 35.9%, p=0.268). CONCLUSION: Our retrospective study, including 1064 patients hospitalized in Detroit, demonstrated no differences in mortality or disease severity with zinc combination. Furthermore, prospective studies are needed to establish the utility of zinc in the treatment of COVID-19.