Using the Theory of Planned Behavior to Evaluate Factors That Influence PharmD Students' Intention to Attend Lectures.

Objective. To use the theory of planned behavior (TPB) to evaluate the contribution of attitude, subjective norm, and perceived behavioral control in predicting students' intention to attend class lectures in a Doctor of Pharmacy (PharmD) curriculum in which lecture recordings were available. Methods. A survey instrument based on the TPB was developed from focus groups with PharmD students. The survey was then distributed to first through third year students at the conclusion of the 2017-2018 academic school year. Respondents were asked to evaluate their beliefs regarding lecture attendance and their intention to attend lectures during the upcoming fall semester. Predictors of intention were evaluated using descriptive statistics and multiple logistic regression analyses. Results. Responses from 198 of 383 students contained usable data (52% effective response rate). The TPB constructs of attitude and subjective norm were predictors of high intention to attend lectures. Students with a positive attitude towards lecture attendance (eg, believed that purposeful active learning is desirable and occurs during class) were nearly 30% more likely to have high intention to attend lectures. Students with a positive subjective norm (ie, perceived social pressure from professors and classmates to attend lectures) were 66% more likely to have high intention to attend lectures. Perceived behavioral control was not associated with high intention to attend lectures. Conclusion. Interventions aimed at improving students' attitudes and subjective norm may be beneficial in improving students' intention to attend class lectures.

A Study of the Relationship Between the PCOA and NAPLEX Using a Multi-institutional Sample.

Objective. To examine the relationship between the Pharmacy Curriculum Outcomes Assessment (PCOA) and the North American Pharmacist Licensure Examination (NAPLEX) using a large, multi-institutional sample of student scores. Methods. A matched dataset was obtained from the National Association of Boards of Pharmacy (NABP) consisting of examination scores for the 1,460 students who completed both the PCOA and the NAPLEX between 2012 and 2015 at six schools/colleges of pharmacy (S/COPs). Bivariate correlations were estimated for total and content area scores on both examinations. Students' total NAPLEX scores were predicted using linear regression models containing total and content area scores on PCOA and dummy variables for S/COP and year. Results. Students' PCOA total score and NAPLEX total score were significantly and moderately correlated (r=0.54). All correlations between PCOA and NAPLEX total and content area scores were significant. and ranged from r=0.22 to 0.56. Regression results showed pharmaceutical and clinical sciences PCOA content scores were significant predictors of NAPLEX total score while basic biomedical sciences and social/behavioral/administrative sciences were not. The PCOA total and content scores accounted for 30%-33% of the variance in total NAPLEX score. Conclusion. Student PCOA and NAPLEX total and content area scores were significantly correlated, which is consistent with the findings of previous research. The somewhat modest proportion of variance in NAPLEX scores accounted for by PCOA scores illustrates the need for use of additional performance measures when evaluating student preparedness for the NAPLEX. This study provides important baseline data that can be used by S/COPs for comparison with their own student data as well as by researchers seeking to conduct additional analyses following recent changes in the PCOA and NAPLEX blueprints.

Point/Counterpoint: Are Outstanding Leaders Born or Made?

The question of whether outstanding leaders are born or made has been debated for years. There are numerous examples of historical figures that came naturally to leadership, while others developed their leadership skills through tenacity and experience. To understand leadership, both nature (the genetic component) and nurture (the environmental influences) must be considered. This article represents the work of two Academic Leadership Fellows Program groups who debated each position at the 2016 American Association of Colleges of Pharmacy (AACP) Interim Meeting in Tampa, Fla., in February 2016.

A Critical Care Hybrid Online Elective Course for Third-Year Pharmacy Students.

Objective. To assess the impact of a four-week hybrid online elective course in critical care on student learning attitudes and outcomes compared to that achieved when the same course was taught using a traditional lecture-based approach. Design. A hybrid online elective course was created that featured video-recorded lectures and in-class skills laboratories. Course evaluations were used to assess student perceptions of learning methods, and examination scores were used to assess learning outcomes. Assessment. One hundred five students enrolled in the critical care elective course from 2011-2014. Fifty-four students completed the traditional lecture course, and 51 completed the hybrid online elective course. The examination scores of students who completed the hybrid course were significantly higher than those of students who completed the traditional lecture course. The majority of students enrolled in the hybrid online elective course stated they preferred that format over a traditional course format and would recommend the elective course to a peer. Conclusion. Students preferred the format used for an online hybrid elective course in critical care over a traditional course format, and performed better on examinations than did students who had completed the course when it was offered in a traditional lecture format.

Probable Nonconvulsive Status Epilepticus With the Use of High-Dose Continuous Infusion Ceftazidime.

Multidrug resistant (MDR) bacterial infections are a major concern of health care providers due to their increasing incidence and associated mortality. In some cases, few or no antibiotics have preserved activity. Beta-lactam administration via continuous infusion can optimize time over minimum inhibitory concentration (MIC). In some cases, use of high-dose continuous infusion (HDCI) may be necessary to achieve serum levels in excess of nonsusceptible MIC values. The use of HDCI beta-lactams is not without risk, specifically neurotoxic adverse effects, which appear dose related. We describe a 64-year-old male who experienced myoclonus and nonconvulsive status epilepticus while receiving HDCI ceftazidime for treatment of multidrug resistant Pseudomonas aeruginosa bacteremia. This report serves as a cautionary example of the potential toxicities associated with HDCI beta-lactams and supports the importance of risk-benefit analysis prior to and during treatment. Additionally, the use of serum drug level monitoring may be necessary to better prevent or predict toxicity.

Factors that influence student completion of course and faculty evaluations.

OBJECTIVE: To determine if there is a relationship between students' grades, gender, age, or ethnicity and their completion of course and/or faculty evaluations. METHODS: Data were collected and analyzed for relationships among students' gender, age, ethnicity, and course grade on their completion rates of course and faculty evaluations. RESULTS: The grade a student received in a course was not related to completion rates for course or faculty evaluations. Students born in 1987 or earlier were significantly more likely to complete course or faculty evaluations. Significant differences in completion rates were also found based on the course taken and the gender and ethnicity of the students. CONCLUSIONS: Several demographic characteristics were identified that correlated with the completion of course and/or faculty evaluations. However, no correlation was found with the grade a student receives in a course and completion of either course or faculty evaluations. In order to improve course and faculty evaluation rates, further analysis of the influence of demographics on completion rates is warranted.

Antifungal susceptibility testing: a primer for clinicians.

Antifungal susceptibility testing is not as commonly performed as antibacterial susceptibility testing. The methodology for detecting antifungal resistance is newer and requires different testing supplies that may not be readily available in a clinical laboratory setting. Breakpoints for molds are lacking. Yeast breakpoints are available for most antifungals but are continually updated based on epidemiologic surveillance. Reliable and reproducible antifungal susceptibility testing methods, as well as more research on the role of susceptibility testing in patient care, are necessary in order to provide the clinician with information that can be translated into positive clinical outcomes at the bedside. There are nuances with current testing methods that, if unrecognized, could lead to misinterpretation of results and inappropriate antifungal selection. Clinicians who have an understanding of qualitative and quantitative methods, automated susceptibility testing systems, and other commercial tests can successfully engage this knowledge to improve antifungal use and patient outcomes. This primer describes the common antifungal susceptibility tests used in the clinical microbiology laboratory and reviews literature related to the impact of appropriate drug selection, timing, fungal resistance mechanisms, pharmacokinetics, and pharmacodynamics on clinical outcomes. Both conventional and modern testing methods are discussed.

Symposium on roles of and cooperation between academic- and practice-based pharmacy clinicians.

PURPOSE: The findings of an academic symposium as they relate to the history and role of the academic pharmacy clinician, the strengths and limitations of the academic pharmacy clinician model, and the framework for future synergistic work relations among clinical pharmacy practitioners are summarized. SUMMARY: On April 23, 2008, a symposium was convened to bring key thought leaders together to discuss the relationship of the academic-based pharmacy clinician and the practice-based pharmacy clinician. Participants included clinical faculty and administrators from two colleges of pharmacy, practice-based clinical pharmacists and pharmacy managers from seven health care institutions, and representatives from the American Association of Colleges of Pharmacy, the American College of Clinical Pharmacy, and the American Society of Health-System Pharmacists. Symposium participants discussed the roles and expectations of clinical pharmacists based on primary affiliation within the contemporary practice model for academic- and practice-based pharmacy clinicians and identified sources of conflict for academic- and practice-based pharmacy clinicians. Symposium participants agreed that in order to succeed, the academic-based and the practice-based pharmacy clinicians must function in a true partnership as each individual has strengths, resources, and benefits to bring to the relationship. Furthermore, knowledge, consideration, and an understanding of the potentially different goals and objectives of each institution are critical. CONCLUSION: A symposium attended by clinical faculty members and administrators from two colleges of pharmacy, practice-based clinical pharmacists and pharmacy managers from seven health care institutions, and representatives from three national pharmacy organizations was conducted to discuss the roles of and cooperation between academic- and practice-based pharmacy clinicians.

Invasive candidiasis and the utility of antifungal susceptibility testing in the ICU.

Invasive fungal infections are a major cause of health care-associated morbidity and mortality in the ICU. In particular, Candida spp. are among one of the leading causes of bloodstream infections and sepsis. Advances in antifungal therapy in the last decade have led to many more options in the treatment of fungal infections, yet increasing resistance and clinical failures are common, especially in the management of invasive candidiasis in the ICU. Prompt diagnosis of these infections and appropriate antifungal treatment are imperative for improving survival. Although reliable antifungal susceptibility testing is available to aid in the therapy of fungal infections, testing is not always recommended. This review addresses the epidemiology of Candida infections in the ICU, antifungal resistance, therapy, and the usefulness of antifungal susceptibility testing in the ICU setting.

Significant publications on infectious diseases pharmacotherapy in 2007.

PURPOSE: Significant publications on infectious diseases (ID) pharmacotherapy in 2007 were compiled and summarized. SUMMARY: On January 2, 2008, the 21 members of the Houston Infectious Disease Network (HIDN) were asked to select an article that was published in a peer-reviewed journal between January 1 and December 31, 2007, and write a summary highlighting why the article was significant to the diagnosis or treatment of ID. Articles were selected based on prior "top 10" presentations at major ID and pharmacy meetings or were listed as major articles in prominent ID journals. Priority was given to peer-reviewed publications and nationally recognized clinical treatment guidelines. Nineteen articles and summaries were submitted by HIDN members. The publication listing was distributed to Society of Infectious Diseases Pharmacists members via an Internet survey in early February 2008. Members were asked to select the 10 most significant articles relating to ID pharmacotherapy from the list of 19 and were allowed to add an additional article that was not already listed. A total of 102 individuals participated in the survey. A listing of the top 10 articles published in 2007 and one honorable mention was compiled, and the significance of each article was summarized. CONCLUSION: The increased number of articles in the peer-reviewed medical literature related to the diagnosis and treatment of ID has made it challenging to maintain a contemporary knowledge base of key publications. This summary of significant ID articles published in 2007 can help to alleviate the burden of knowledge management.

Comparative pharmacodynamics of gentamicin against Staphylococcus aureus and Pseudomonas aeruginosa.

Aminoglycosides are often used to treat severe infections with gram-positive organisms. Previous studies have shown concentration-dependent killing by aminoglycosides of gram-negative bacteria, but limited data are available for gram-positive bacteria. We compared the in vitro pharmacodynamics of gentamicin against Staphylococcus aureus and Pseudomonas aeruginosa. Five S. aureus strains were examined (ATCC 29213 and four clinical isolates). Time-kill studies (TKS) in duplicate (baseline inocula of 10(7) CFU/ml) were conducted to evaluate bacterial killing in relation to increasing gentamicin concentrations (0 to 16 times the MIC). Serial samples were obtained over 24 h to quantify bacterial burden. Similar TKS with P. aeruginosa ATCC 27853 were conducted, and the time courses of the all bacterial strains were mathematically modeled for quantitative comparison. A dose fractionation study (using identical daily doses of gentamicin) in an in vitro hollow-fiber infection model (HFIM) over 5 days was subsequently used for data validation for the two ATCC strains. Model fits to the data were satisfactory; r(2) values for the S. aureus and P. aeruginosa ATCC strains were 0.915 and 0.956, respectively. Gentamicin was found to have a partially concentration-dependent killing effect against S. aureus; concentrations beyond four to 8 times the MIC did not result in significantly faster bacterial killing. In contrast, a concentration-dependent profile was demonstrated in suppressing P. aeruginosa regrowth after initial decline in bacterial burden. In HFIM, thrice-daily gentamicin dosing appeared to be superior to once-daily dosing for S. aureus, but they were similar for P. aeruginosa. Different killing profiles of gentamicin were demonstrated against S. aureus and P. aeruginosa. These results may guide optimal dosing strategies of gentamicin in S. aureus infections and warrant further investigations.

Optimization of meropenem minimum concentration/MIC ratio to suppress in vitro resistance of Pseudomonas aeruginosa.

Suppression of resistance in a dense Pseudomonas aeruginosa population has previously been shown with optimized quinolone exposures. However, the relevance to beta-lactams is unknown. We investigated the bactericidal activity of meropenem and its propensity to suppress P. aeruginosa resistance in an in vitro hollow-fiber infection model (HFIM). Two isogenic strains of P. aeruginosa (wild type and an AmpC stably derepressed mutant [MIC = 1 mg/liter]) were used. An HFIM inoculated with approximately 1 x 10(8) CFU/ml of bacteria was subjected to various meropenem exposures. Maintenance doses were given every 8 h to simulate the maximum concentration achieved after a 1-g dose in all regimens, but escalating unbound minimum concentrations (C(min)s) were simulated with different clearances. Serial samples were obtained over 5 days to quantify the meropenem concentrations, the total bacterial population, and subpopulations with reduced susceptibilities to meropenem (>3x the MIC). For both strains, a significant bacterial burden reduction was seen with all regimens at 24 h. Regrowth was apparent after 3 days, with the C(min)/MIC ratio being < or = 1.7 (time above the MIC, 100%). Selective amplification of subpopulations with reduced susceptibilities to meropenem was suppressed with a C(min)/MIC of > or = 6.2 or by adding tobramycin to meropenem (C(min)/MIC = 1.7). Investigations that were longer than 24 h and that used high inocula may be necessary to fully evaluate the relationship between drug exposures and the likelihood of resistance suppression. These results suggest that the C(min)/MIC of meropenem can be optimized to suppress the emergence of non-plasmid-mediated P. aeruginosa resistance. Our in vitro data support the use of an extended duration of meropenem infusion for the treatment of severe nosocomial infections in combination with an aminoglycoside.

Comparison of beta-lactams in counter-selecting resistance of Pseudomonas aeruginosa.

Suppression of resistance in a dense population of Pseudomonas aeruginosa has been shown with optimized quinolone exposures. However, relevance to the beta-lactams is questionable because of the unknown impact of the inoculum effect. We explored the bactericidal activity of various beta-lactams and their propensity to suppress spontaneous resistance. Minimal killing and resistance selection was seen with piperacillin, most likely due to the inoculum effect. Moderate and significant killing was seen at 24 h with ceftazidime and meropenem, respectively; however, regrowth and selective resistance amplification was apparent at 48 h. Our results suggest that different beta-lactam subclasses have a distinct killing profile and propensity to suppress resistance against a dense population of P. aeruginosa. The pharmacodynamics of each subclass of agent should be examined individually, and investigations longer than 24 h may be necessary to fully evaluate the relationship between drug exposures and the likelihood of resistance suppression.

Antibacterial activity of linezolid and vancomycin in an in vitro pharmacodynamic model of gram-positive catheter-related bacteraemia.

OBJECTIVES: The aim of this study was to compare the activity of linezolid and vancomycin in an in vitro pharmacodynamic model to assess potential differences in activity against biofilm-embedded organisms. METHODS: Single-lumen central venous catheters colonized with biofilm-embedded Staphylococcus aureus, Staphylococcus epidermidis or vancomycin-resistant Enterococcus faecium (VRE) were treated with simulated clinical dosing regimens of linezolid 600 mg every 12 h or vancomycin 1 g every 12 h in a one-compartment in vitro pharmacodynamic model. Quantitative cultures were sampled through the catheter and peripheral ports over 48 h to dynamically assess changes in the burden of catheter colonization and organism seeding, respectively. At 24 and 48 h catheters were removed, sonicated and cultured for adherent organisms. RESULTS: Both linezolid and vancomycin suppressed bacterial growth on the catheter and release of S. aureus and S. epidermidis into the model compared with controls (P < 0.05), while linezolid also suppressed counts compared with control and vancomycin versus VRE. Neither agent completely eradicated bacterial colonization of the catheters. MICs for the isolates recovered from the model did not increase over time with linezolid or vancomycin exposure. CONCLUSIONS: Lack of activity against biofilm-embedded organisms appeared to be the primary reason for microbiological failure of both drugs in the model.

Relationship between fluoroquinolone use and changes in susceptibility to fluoroquinolones of selected pathogens in 10 United States teaching hospitals, 1991-2000.

We retrospectively examined the relationship between fluoroquinolone use and the susceptibilities of 11 bacterial pathogens to fluoroquinolones in 10 US teaching hospitals from 1991 through 2000. Statistical significance was determined by 2-way analysis of variance, with the number of isolates tested each year as a weighting factor. The analysis of baseline-to-end point change in the percentage of susceptibility and the slope of the regression line (trend line) for logit percentage of susceptibility showed that the overall percentage of susceptibility to fluoroquinolones decreased significantly during the study period (P<.05) and that change in percentage of susceptibility was significantly related to change in fluoroquinolone use (P<.05). Particularly notable were the decreases in the susceptibilities of Pseudomonas aeruginosa, Proteus mirabilis, and Escherichia coli (decreases of 25.1%, 11.9%, and 6.8%, respectively).

Targeting bacterial virulence: the role of protein synthesis inhibitors in severe infections. Insights from the Society of Infectious Diseases Pharmacists.

Morbidity and mortality due to certain bacterial pathogens have not declined despite the availability of effective antimicrobial treatments. Staphylococcus aureus and Streptococcus pyogenes cause a number of serious infections, such as necrotizing fasciitis and toxic shock syndrome, which are associated with the release of bacterial toxins. Animal studies have demonstrated clindamycin, a protein synthesis inhibitor, to be more effective in treating these severe infections than other more susceptible antimicrobial treatments. Linezolid, another protein synthesis inhibitor, also has shown efficacy in in vitro studies. Human trials to validate the effects of antibiotic therapies on bacterial virulence have not been performed. Future animal and human studies are needed to help elucidate the immunomodulatory mechanisms of protein synthesis inhibitors in order to optimize antimicrobial treatment and decrease the morbidity and mortality associated with severe bacterial infections.

Influences of linezolid, penicillin, and clindamycin, alone and in combination, on streptococcal pyrogenic exotoxin a release.

An in vitro model was used to compare the effects of linezolid, clindamycin, and penicillin, alone and in combination, on streptococcal pyrogenic exotoxin A (SPE A) release against virulent group A streptococci (GAS). All regimens exhibited lower (P < 0.05) SPE A release at 1 h than those with penicillin alone. Linezolid and clindamycin, alone or in combination with penicillin, may optimize the treatment of GAS infections by reducing bacterial burden and exotoxin release.