The prevalence of gender stereotypes in pharmacy student simulated counseling sessions utilizing standardized patients.

INTRODUCTION: Simulation in healthcare has been a widely adopted modality to gain practical experience prior to working directly with patients. While simulation in academic settings affords many opportunities to enhance learning, it may also present an opportunity to identify cultural stereotypes. The objective of this study was to assess the prevalence of gender stereotypes in pharmacy student simulated counseling sessions. METHODS: Simulated counseling sessions completed across several cohorts of pharmacy students were reviewed. A video database of these counseling sessions was manually reviewed retrospectively to determine if students or trained actors portraying the role of the pharmacist and patient, respectively, assigned providers a gender without prompting. Secondary analysis included time to provider gender assignment and acknowledgement. RESULTS: A total of 73 unique counseling sessions were reviewed. Gender was preferentially assigned in 65 sessions. Assigned provider gender was male for all 65 cases. In most (45 out of 65) cases, gender was assigned by the actors. CONCLUSIONS: Predetermined gender stereotypes exist in simulated counseling sessions. Simulation needs to be continually monitored for promoting cultural stereotypes. Integration of cultural competency into counseling simulation scenarios represents an opportunity to better train healthcare professionals to function within a diverse work environment.

Evaluation of a pharmacist-led antibiotic stewardship program and implementation of prescribing order sets.

BACKGROUND: It is established that pharmacists can play a role in antibiotic stewardship in inpatient settings; however, there remains a paucity of data regarding pharmacist impact on antibiotic stewardship in outpatient care. OBJECTIVES: The purpose of this study was to assess the impact of an outpatient pharmacist antimicrobial stewardship program involving the implementation of prescribing order sets on the rate of compliance with guideline-recommended antibiotic use. METHODS: This was a single-center, retrospective study conducted at a resident-run, adult medicine clinic evaluating the implementation of a pharmacist-led antimicrobial stewardship education program and prescribing order sets. Adult patients were included if they were treated for a diagnosis of urinary tract infection or Helicobacter pylori infection. The primary outcome was a composite of the proportion of antibiotic prescribing that was compliant with guideline-recommended treatment, including indication, antibiotic selection, dose, and duration. The secondary outcomes included an analysis of the individual components of the primary outcome and a subgroup analysis according to infection type. RESULTS: A total of 115 and 43 patients were included in the preintervention and intervention groups, respectively. No statistically significant difference was observed in the proportion of complete guideline-recommended antibiotic regimens after the implementation of the stewardship intervention (P = 0.703) or in any individual component of the composite outcome. However, a subgroup analysis of each infection type demonstrated statistically significant improvements in both complete H pylori regimens and antibiotic selection. CONCLUSIONS: Although the implementation of a pharmacist-led antimicrobial stewardship program at an adult medicine clinic did not lead to an improvement in complete guideline-recommended antibiotic prescribing, notable improvements were observed after subgroup analyses.

The Impact of the Duration of Antibiotic Therapy in Patients With Community-Onset Pneumonia on Readmission Rates: A Retrospective Cohort Study.

BACKGROUND: Recent publications have confirmed that 70% of hospitalized adults with uncomplicated community-acquired pneumonia and health-care-associated pneumonia are prescribed a duration therapy that exceeds current guideline recommendations. OBJECTIVE: The primary objective is to evaluate the relationship between antibiotic duration and all-cause 30-day readmission rates. Secondary outcomes include pneumonia-specific 30-day readmission rate and identification of risk factors for readmission. METHODS: Patients aged ≥18 years with a primary diagnosis of pneumonia from January 1, 2016, to December 31, 2016, were included in this single-center, retrospective cohort study. Patients were categorized by antibiotic therapy duration of ≤7 days (n = 139) or >7 days (n = 286), and outcomes were analyzed in both bivariate and multivariate models. A multivariate logistic regression was used to assess the relationship between all-cause 30-day readmission and antibiotic days. RESULTS: Baseline characteristics were not significantly different between the 2 groups. All-cause 30-day readmission rates were 15.8% and 15.5% for patients who received ≤7 days versus >7 days of antibiotics, respectively (P = .95). Pneumonia-specific 30-day readmission occurred in 3.6% of patients who received antibiotics for ≤7 days compared to 3.5% of patients who received antibiotics for >7 days (P = .95). Multivariate logistic regression showed no statistically significant association between readmission rate and antibiotic duration of >7 days. Statistically significant risk factors for readmission identified by logistic regression include ≥3 hospital admissions within the previous year, a hematocrit <30% at discharge, a history of chronic obstructive pulmonary disorder (COPD), and weight. CONCLUSION: The use of prolonged antibiotic therapy for the treatment of community-onset pneumonia was not associated with a decrease in all-cause or pneumonia-specific 30-day readmission rates.

Analysis of the impact of secondary prophylaxis on Clostridioides difficile recurrence in critically ill adults.

INTRODUCTION: Clostridioides (formerly Clostridium) difficile infection recurrence in patients re-exposed to antibiotics for treatment of a non-Clostridioides difficile infection is high at approximately 33%. Low-dose per os vancomycin (e.g. 125 mg q12 h) or metronidazole (e.g. 500 mg intravenous/per osq8 h) may help prevent recurrences, but study of secondary prophylaxis in critically ill patients is needed. OBJECTIVES: To determine whether critically ill adults receiving low-dose per os vancomycin for secondary Clostridioides difficile infection prophylaxis have fewer recurrences of Clostridioides difficile infection in 90 days compared with patients receiving metronidazole for secondary Clostridioides difficile infection prophylaxis or control (no secondary prophylaxis). METHODS: This was a retrospective, two-center, observational study in a large academic medical center and affiliated community hospital. Included patients had a history of Clostridioides difficile infection within 1 year of receiving antibiotics for clinical care. We compared patients receiving secondary prophylaxis with vancomycin or metronidazole and control patients; in addition, an unplanned fourth group (vancomycin/metronidazole combination) was identified and analyzed. The primary outcome was Clostridioides difficile infection recurrence within 90 days of a course of broad-spectrum antibiotic therapy. Fisher's exact, analysis of variance, and Kruskal-Wallis tests were used to compare Clostridioides difficile infection recurrence with prophylaxis group and additional contributing factors. RESULTS: Eighty-two patients were included: 38 control (46.3%), 20 metronidazole (24.4%), 17 vancomycin (20.7%), and 7 combination (8.5%). Ten of 82 patients (12.2%) had at least one Clostridioides difficile infection recurrence; 8/38 patients in the control group (21.1%), 1/7 patients in the combination group (14.3%), 1/17 patients in the per os vancomycin group (5.9%), and 0/20 in the metronidazole group (0%; p = 0.073). As a post hoc secondary analysis, the three prophylaxis groups were coalesced into one group and compared with control (4.5% vs 21%; p = 0.039). Additional factors (e.g. age, obesity, immunosuppression, acid suppression) were not significantly associated with Clostridioides difficile infection recurrence or with prophylaxis group. CONCLUSION: There was no difference in Clostridioides difficile infection recurrence between prophylaxis groups, however, given the low recurrence rate, prospective evaluation with a larger sample of critically ill patients is necessary.

Acid-base effects of continuous infusion furosemide in clinically stable surgical ICU patients: an analysis based on the Stewart model.

OBJECTIVES: We sought to test the strength of correlation between predicted and observed systemic acid-base status based on the Stewart model equations during continuous infusion (CI) furosemide therapy. DESIGN, SETTING AND PARTICIPANTS: This was a prospective, single-center, observational study conducted in the Surgical ICU of a large academic medical center. Ten critically ill patients who received CI furosemide were included. MAIN OUTCOMES AND MEASURES: The primary purpose was to characterize the relationship between changes in serum electrolyte and acid-base status and the excretion of electrolytes in the urine during infusion of CI furosemide in critically ill patients. As a secondary endpoint, we sought to evaluate the predictive application of the Stewart model. Over 72-h, intake and output volumes, electrolyte content of fluids administered, plasma and urine electrolytes, urine pH, and venous blood gases were collected. Predicted and observed changes in acid-based status were compared for each day of diuretic therapy using Spearman's correlation coefficient. RESULTS: The mean (SD) strong ion difference (SID) increased from 45.2 (3.2) at baseline to 49.6 (4.0) after 72 h of continuous infusion furosemide. At Day 1, the mean SID (observed) (SD) was 47.5 (3.5) and the predicted SID was 49.5 (5.8). Day 1 observed plasma SID was positively correlated with the predicted SID (rs = 0.80, p = 0.01). By Days 2 and 3, the correlations of observed and predicted SID were no longer statistically significant. CONCLUSIONS AND RELEVANCE: Using the Stewart model, increases in SID as an indicator of metabolic alkalosis due to the chloruretic effects of furosemide were observed. Predicted and observed SID correlated well over the first 24 h of treatment.

Is there a higher prevalence of methicillin-resistant Staphylococcus aureus (MRSA) or vancomycin-resistant Enterococcus (VRE) colonization in patients with antibiotic allergy labels?

BACKGROUND: A penicillin allergy label has been associated with significantly higher rates of methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE) colonization, and correspondingly poorer clinical outcomes. However, there are limited data examining the association between any antibiotic label and colonization rates. We sought to evaluate if there is a relationship between patients with an antibiotic allergy label and prevalence of MRSA or VRE colonization. METHODS: We retrospectively reviewed all patients with an MRSA surveillance culture between December 15, 2014 and January 31, 2015, or a VRE surveillance culture between January 1, 2013 and January 31, 2015, at a tertiary community-based teaching hospital. Our primary objective was to evaluate the prevalence of MRSA or VRE colonization among patients with and without antibiotic allergies. Bivariate analyses included the χ² test and the Student t test to determine statistical significance for categorical and continuous variables, respectively. RESULTS: We included a total of 1,053 unique patients screened for MRSA, and 290 unique patients screened for VRE. The rate of MRSA and VRE colonization was 5.8% (62 of 1,053) and 32.4% (94 of 290), respectively, in our cohort. Antibiotic allergies were documented in approximately 1 out of 3 patients, 337 (32%) for the MRSA group and 94 (32%) for VRE group. There was a significant difference in MRSA colonization between patients with and without an antibiotic allergy, 28 of 337 (8.3%) versus 34 of 716 (4.7%) (P = .025), respectively. In contrast, there was no significant difference in antibiotic allergy rates with and without VRE colonization, 34 of 94 (36.2%) versus 92 of 196 (46.9%) (P = .10), respectively. CONCLUSIONS: An antibiotic allergy label was associated with significantly higher rates of MRSA colonization but no statistical difference with VRE colonization.

Systemic reactions to subcutaneous immunotherapy: Effects of dosing and aeroallergen content.

BACKGROUND: Systemic reactions are a known risk of subcutaneous immunotherapy (SCIT) for aeroallergens. OBJECTIVE: To identify the dose of SCIT that results in the most systemic reactions to SCIT (SCITSRs) and other risk factors for SCITSRs. METHODS: We performed a retrospective review of all SCIT encounters from 2013 to 2017 at a multisite allergy/immunology practice. SCITSRs were identified from the electronic health record through immunotherapy encounters in which epinephrine was administered. Collected data included patient demographics, the dose of immunotherapy at the time of the SCITSR, the presence or absence of asthma, and aeroallergen content. The control group was generated randomly from the same cohort during the same period. RESULTS: There were 86,949 SCIT visits, with 81 SCITSRs (0.9 per 1000 injections). A total of 77.8% of reactions occurred at a dose of 1:1 0.1 mL and above. The presence of cat (81.5% vs 63.0%, P = .01), dog (67.9% vs 37.0%, P < .001), and grass extracts (85.2% vs 67.5%, P = .01) were associated with SCITSRs. Asthma was not significantly associated with SCITSRs. The presence of dust mites, trees, weeds, and molds was not associated with SCITSRs. There were no months or seasons where SCITSRs were more likely to occur. Individuals who experienced SCITSRs had a mean (SD) higher number of included aeroallergenic groups compared with controls (5.86 [1.88] vs 5.00 [1.92], P < .001). CONCLUSION: Risk factors for SCITSRs in a multisite allergy/immunology practice included administration of the highest immunotherapy doses; inclusion of cat, dog, and grass extracts; and the number of aeroallergenic groups included in the extract. This information helps further characterize risk for patients receiving SCIT.

Comparing Direct Challenge to Penicillin Skin Testing for the Outpatient Evaluation of Penicillin Allergy: A Randomized Controlled Trial.

BACKGROUND: Direct challenge (DC) may be a safe and effective alternative to penicillin skin testing (PST) in low-risk patients. OBJECTIVE: To complete a prospective, randomized, controlled trial comparing PST followed by a challenge to amoxicillin versus a 2-step DC to amoxicillin without preceding skin testing in a predefined low-risk patient population. METHODS: Penicillin allergy histories were reviewed in patients presenting to an outpatient allergy/immunology practice from April 2018 to August 2018. Patients 5 years or older with a cutaneous-only or unknown reaction (>1 year ago for those aged 5-17 years, >10 years ago for those 18 years or older) were randomized 1:1 to PST or 2-step DC. All children younger than 5 years underwent DC, and patients with extracutaneous reaction histories underwent PST. All groups were monitored 30 minutes after administration of amoxicillin. RESULTS: Penicillin allergy was reported in 363 of 2465 (14.7%) patients, of which 185 consented to further evaluation. Thirteen patients younger than 5 years underwent DC; all were negative. Thirteen patients with angioedema and/or extracutaneous symptoms underwent PST; 2 of 13 patients had positive PST result. A total of 159 patients were randomized to DC (49.7%) or PST (50.3%). PST result was negative in 70 of 80 (87.5%) patients. All 70 patients had a negative amoxicillin challenge. DC was negative in 76 of 79 (96.2%) patients; positive DC reactions were minor. Average time for patients undergoing PST was 72.7 ± 5.3 minutes and for patients undergoing DC was 66.7 ± 4.8 minutes. CONCLUSIONS: In low-risk patients, DC provided a safe and effective alternative to PST in delabeling penicillin allergy. Compared with PST, DC may also take less time, cost less money, and lead to fewer penicillin allergy evaluations with false-positive results.

An Exploratory Study of Suboxone (Buprenorphine/Naloxone) Film Splitting: Cutting Methods, Content Uniformity, and Stability.

Suboxone films are U.S. Food and Drug Administration approved to treat opioid dependence. While the package insert states that films should not be cut, physicians often prescribe film fractions for treatment and tapering. There is no data to support this practice, and this study was initiated to evaluate cutting methods, content uniformity, and stability of split films. Suboxone 8-mg buprenorphine/2-mg naloxone films were split using four methods: 1) ruler/razor cut, 2) scissor cut, 3) fold/rip, and 4) fold/scissor cut. United States Pharmacopeia Chapter <905> was used to evaluate the weight variation and content uniformity of split films. The stability of split films stored in polybags was evaluated over 7 days. A stability-indicating high-performance liquid chromatography method was used for content uniformity and stability evaluation. The weight variation results were acceptable for the half films from all four cutting methods, but this was not true for the quarter films. The method of ruler/razor cut was determined most favorable and used for the content uniformity test. Based on the high-performance liquid chromatography results, the half films from the ruler/razor cut method met the passing criteria of United States Pharmacopeia Chapter <905> with acceptance values of 9.8 to 10.4 for buprenorphine and 8.4 to 11.5 for naloxone (=15 is considered passing). The stability results indicated that both actives retained >97.7% of initial strength. Four cutting methods were found to be acceptable for splitting Suboxone films into half but not quarter fractions. The half films from the ruler/razor cut method also passed United States Pharmacopeia Chapter <905> content uniformity test. Both actives remained stable for 7 days when the half films were stored in polybags at room temperature.

The relationship between pharmacy students' beliefs about medications and their academic achievement in a pharmacy practice counseling course.

INTRODUCTION: Pharmacists' beliefs about medications have been identified as a potential factor in how patients are counseled. However, no studies have assessed this relationship. METHODS: Third year pharmacy students were surveyed using previously validated questionnaires about medication beliefs, including the BMQ-General (General-Overuse and General-Harm subscales), Benefit, and Perceived Sensitivity to Medications (Sensitive Soma) scales; each is rated on a five-point Likert scale (higher scores represent stronger feelings). Belief profiles were created using two-step cluster analysis. Students also reported demographics and prior work in a pharmacy. Grades from simulated counseling sessions were collected via school records. Student t-test and multivariate linear regression were used to compare beliefs with grades. RESULTS: Among the 66 responders (84.5% response rate), 54.5% were female, 80.3% white, and 77.3% non-Hispanic; 84.8% reported prior work in a pharmacy. Overall mean (SD) belief scores were General-Overuse 3.12 (0.76), General-Harm 1.83 (0.53), Benefit 3.99 (0.55), and Sensitive Soma 2.37 (0.82). Cluster analyses revealed two beliefs profiles: negative profile (more feelings of overuse, harm, and sensitivity to medications) and positive profile (less feelings of overuse, harm, and sensitivity to medications). Students with positive belief profiles were graded higher by faculty compared to students with negative belief profiles (90.0 vs. 87.2, p = 0.014). Findings remained in a multivariate regression controlling for gender and prior work in a pharmacy. CONCLUSIONS: Findings from this study demonstrate the need for greater understanding about the relationship between pharmacists' beliefs about medications and patient counseling.

The Relationship Between Prior Experiences in Mathematics and Pharmacy School Success.

Objective. To assess students' pre-pharmacy math experiences, confidence in math ability, and relationship between experiences, confidence, and grades in math-based pharmacy courses. Methods. A cross-sectional survey of first year to third year pharmacy students was conducted. Students reported type of pre-pharmacy math courses taken, when they were taken [high school (HS) vs. college] and year of HS and college graduation. Students rated their confidence in math ability using the previously validated 11-item Fogerty Math Confidence Scale (Cronbach alpha=0.92). Math grade point average (GPA), Pharmacy College Admission Test quantitative (PCAT quant) scores, and grades (calculations and kinetics) were obtained from transcripts and school records. Spearman correlation and multivariate linear regression were used to compare math experiences, confidence, and grades. Results. There were 198 students who reported taking math courses 7.1 years since HS graduation and 2.9 years since their last schooling prior to pharmacy school. Students who took math courses with more time since HS/last schooling had lower calculations and kinetics grades. Students reporting having taken more HS math courses had better calculations grades. Students with higher math GPA, and PCAT quant scores also had higher calculations and kinetics grades. Greater confidence in math ability was associated with higher calculations grades. In multivariate regressions, PCAT quant scores and years since HS independently predicted calculations grades, and PCAT quant scores independently predicted kinetics grades. Conclusion. The number of pre-pharmacy math courses and time elapsed since they were taken are important factors to consider when predicting a pharmacy student's success in math-based pharmacy school courses.

Signal detection for bleeding associated with the use of direct oral anticoagulants.

PURPOSE: The potential link between serious or life-threatening bleeding and the use of direct oral anticoagulants (DOACs) was evaluated. METHODS: Qualitative and quantitative reviews of case reports of bleeding events involving dabigatran, rivaroxaban, apixaban, edoxaban, and warfarin through March 31, 2017, were performed. A disproportionality analysis was conducted for each DOAC using an empirical Bayesian approach based on the relative reporting rate. Subanalyses were performed to assess (1) bleeding events (including mortality and life-threatening events) associated with DOACs among all adverse-event reports and (2) warfarin-related bleeding events. These analyses were conducted based on clinical definitions from the Medical Dictionary for Regulatory Activities. RESULTS: During the Food and Drug Administration Adverse Event Reporting System (FAERS) review period, 35 adverse-event terms (in any system organ class) with a disproportionality score (EB05) of >7.5 for DOACs were identified; this accounted for 40,109 adverse-event reports. Adverse events with the highest disproportionality scores included atrial thrombosis, increased factor X level, dysfunctional uterine bleeding, high-frequency ablation, pericardial hemorrhage, and internal hemorrhage. Adverse events with the highest EB05 (>5) included internal hemorrhage, hemorrhage, and exsanguination; events with the greatest number of patient experiences included hemorrhage (6,881 events), internal hemorrhage (2,569 events), and hematoma (1,995 events). Warfarin-related events (including death or life-threatening events) were also assessed. A total of 8,729 adverse events were associated with warfarin use. The most common of these included hemorrhage (6,225 events), hematoma (2,199 events), and internal hemorrhage (270 events). CONCLUSION: The disproportionality analysis of the FAERS database suggests a quantitative signal between DOAC use and life-threatening or serious bleeding.

The Use of Telemedicine for Penicillin Allergy Skin Testing.

BACKGROUND: Penicillin skin testing (PST) is increasingly used as a tool to evaluate penicillin allergy in patients with a reported history. The limited availability of allergists, however, may be an impeding factor. OBJECTIVE: We sought to assess the clinical utility of telemedicine to facilitate PST. METHODS: Penicillin-allergic inpatients receiving systemic antibiotics were prospectively identified between April and August 2017. Qualifying patients underwent PST performed by a trained allergy/immunology physician assistant (PA). On completion of PST, a telemedicine consultation, through the use of real-time interactive video conferencing (Microsoft Lync 2013, Redmond, Wash), was performed remotely by an allergist. Patients were surveyed regarding their satisfaction with the telemedicine experience. RESULTS: Fifty patients consented to PST through a telemedicine consultation. The average total time to complete a consultation was 128 minutes (standard deviation [SD] ± 33). Of this, the average PA travel time was 46 minutes (36%) with the remaining time spent on clinical services (82 minutes, 64%). The average physician telemedicine time per patient was 5 minutes (SD ± 2). Patients rated their experience as an average of 4.5 on a scale of 1 (highly unsatisfied) to 5 (highly satisfied). Of the 46 PST-negative patients, 33 were transitioned to a ß-lactam antibiotic that reduced the use of vancomycin, metronidazole, aztreonam, aminoglycosides, and clindamycin (P < .05). More than $30,000 was saved throughout the study period. CONCLUSIONS: Telemedicine is an effective and novel approach to facilitate PST in the inpatient setting and carries a high degree of patient satisfaction. This method has the potential to optimize and improve access to allergy/immunology resources.

Evaluation of Over-the-Counter Medication Knowledge and Literacy in Adolescent Students.

OBJECTIVE: To 1) assess and compare knowledge and literacy of over-the-counter (OTC) medications among middle school (MS) and high school (HS) students, and 2) to assess student self-identified lack of knowledge regarding OTC medications. METHODS: A convenience sample of suburban adolescent students completed a 2-part survey about OTC medications: part 1 included demographics and baseline knowledge of OTCs, and part 2 included medication label interpretation (literacy). Descriptive statistics and chi-square test were used to summarize and compare responses among MS and HS students. RESULTS: Students (n = 309) were in MS (46.2%) and HS (53.8%), with a mean age of 14 ± 1.8 years, 61.4% male, 81.2% white, and 84.3% non-Hispanic. A majority of students (68.5%) agreed that they always speak with an adult before taking medication. Students responded correctly to 19% of brand versus generic knowledge questions; conversely, 65% selected "I don't know." Similar trends were seen for questions about medication indications (26% correct, 59% didn't know), side-effects (8% correct, 67% didn't know), and combining medications (21% correct, 63% didn't know). When students referenced a medication label, 55% answered label interpretation questions correctly and 30% reported "I don't know." HS students answered more questions correctly and were less likely to report "I don't know" to questions about common OTC medications (eg, ibuprofen, Tylenol, etc) compared with MS students (P < .05). DISCUSSION: Overall, baseline knowledge of OTC medications was low; however, students were better at interpretation of drug labels. MS students self-reported less knowledge about common OTC medications compared with HS students. This study provides an important foundation for future OTC medication educational programs for adolescents.

Enhanced Adherence in Patients Using an Automated Home Medication Dispenser.

BACKGROUND: Many factors contribute to medication nonadherence including psychological and memory disorders, aging, and pill burden. The Automated Home Medication Dispenser (AHMD) is a medication management system intended to help solve unintentional medication nonadherence. OBJECTIVE: The purpose of this study was to determine if use of the AHMD improved medication adherence. METHODS: We conducted a 6-month prospective, feasibility study assessing use of the AHMD in 21 patient-caregiver dyads. Patients were referred by their physician because of poor medication adherence and included if they resided in Rochester, NY and on at least two medications in pill form. Pill counts were performed at baseline to assess previous adherence. Prospective medication adherence was assessed using AHMD recorded dosing information. A paired t-test was used to compare previous and prospective adherence. RESULTS: The mean age of patients was 75.1 years. Fifteen patients (71.4%) and eight caregivers (38.1%) were women; half (47.6%) of caregivers lived with the patient. The most common patient comorbidities were hypertension (76.2%) and memory disorder (61.9%). Mean adherence increased from 49.0% at baseline to 96.8% after 6 months of AHMD use (p < .001). CONCLUSION: In a cohort of unintentionally nonadherent patients, use of the AHMD for 6 months significantly improved medication adherence.

A survey of inpatient practitioner knowledge of penicillin allergy at 2 community teaching hospitals.

BACKGROUND: The negative effect of the penicillin allergy label on antibiotic use and patient outcomes has brought to light the need for thorough penicillin allergy assessments and heightened practitioner education. OBJECTIVE: To evaluate practitioner knowledge of penicillin allergy and the clinical approach to the patients with penicillin allergy. METHODS: An electronic survey was distributed to attending physicians, residents, pharmacists, nurse practitioners, and physician assistants practicing adult inpatient medicine at 2 community-based teaching hospitals from February to April 2016. RESULTS: A total of 276 (39%) of 716 practitioners completed surveys were analyzed. Most respondents were attending physicians (45%) with more than 10 years of experience (53%). Approximately half of the respondents indicated that they were unfamiliar with the rate of cross-reactivity between penicillin and cephalosporin (46%), carbapenem (42%), and monobactam (48%) antibiotics. When evaluating the role of penicillin skin testing and temporary induction of drug tolerance in the case vignettes, only 41% and 19% of respondents appropriately considered these options as the leading antibiotic management plan, respectively. Despite acknowledging the need for allergy/immunology consultation in clinical scenarios, 86% of respondents indicated that they never consult an allergist or immunologist or do so only once per year. Overall, pharmacists had a better understanding of the natural history of penicillin allergy and antibiotic cross-reactivity (P < .05). CONCLUSION: There is an overall limited understanding of the management of patients with a history of penicillin allergy in the hospital setting, where collaborative efforts between allergy and nonallergy health care practitioners are sparse. The expansion of a multidisciplinary approach may optimize antimicrobial prescribing in this subset of patients.

Medication adherence in patients with myotonic dystrophy and facioscapulohumeral muscular dystrophy.

Myotonic dystrophy (DM) and facioscapulohumeral muscular dystrophy (FSHD) are the two most common adult muscular dystrophies and have progressive and often disabling manifestations. Higher levels of medication adherence lead to better health outcomes, especially important to patients with DM and FSHD because of their multisystem manifestations and complexity of care. However, medication adherence has not previously been studied in a large cohort of DM type 1 (DM1), DM type 2 (DM2), and FSHD patients. The purpose of our study was to survey medication adherence and disease manifestations in patients enrolled in the NIH-supported National DM and FSHD Registry. The study was completed by 110 DM1, 49 DM2, and 193 FSHD patients. Notable comorbidities were hypertension in FSHD (44 %) and DM2 (37 %), gastroesophageal reflux disease in DM1 (24 %) and DM2 (31 %) and arrhythmias (29 %) and thyroid disease (20 %) in DM1. Each group reported high levels of adherence based on regimen complexity, medication costs, health literacy, side effect profile, and their beliefs about treatment. Only dysphagia in DM1 was reported to significantly impact medication adherence. Approximately 35 % of study patients reported polypharmacy (taking 6 or more medications). Of the patients with polypharmacy, the DM1 cohort was significantly younger (mean 55.0 years) compared to DM2 (59.0 years) and FSHD (63.2 years), and had shorter disease duration (mean 26 years) compared to FSHD (26.8 years) and DM2 (34.8 years). Future research is needed to assess techniques to ease pill swallowing in DM1 and to monitor polypharmacy and potential drug interactions in DM and FSHD.

Parent and Child Independent Report of Emotional Responses to Asthma-Specific Vignettes: The Relationship Between Emotional States, Self-Management Behaviors, and Symptoms.

UNLABELLED: Little is known about the emotional intelligence (EI) of parents and their children with asthma. Objectives of this study were to assess: 1) parent's and children's report of emotions in response to an asthma vignette (proxy for EI) and 2) the relationship between emotions, self-management behaviors, and symptoms. DESIGN AND METHODS: We conducted a descriptive, mixed methods study of children 7-12 years old with asthma. Parent-Child dyads (n=104) responded to an asthma vignette to gain insight into emotions, symptoms, and self-management behaviors. Additional questions assessed confidence and worry using a 5-point Likert scale. Thematic analyses and descriptive statistics were used to assess qualitative and quantitative outcomes. RESULTS: Children were predominantly male (58%), 7-9 (58%), and White (46%). The most common negative emotions reported by children were scared and sad. Children who sought help from an adult were less likely to report using medications compared to children who did not seek help (39.5% vs. 62.3%, p=.029). Children with low worry and high confidence had fewer symptoms compared to children reporting high worry and low confidence (symptoms: days 3.24 vs. 6.77, p=.012, nights 2.71 vs. 5.36, p=.004). CONCLUSIONS: Children provided appropriate emotional responses to the asthma vignette; emotions were related to self-management behaviors and symptoms. More studies are needed to specifically assess EI in this population. PRACTICE IMPLICATIONS: Parents and children with greater EI may be better able to understand their needs, engage in self-management behaviors, and communicate with their nurses, to improve their support network and ability to access services.