Impact of Prematriculation Course Withdrawals on First Year Pharmacy School Success.

OBJECTIVE: Determine the impact of prematriculation course withdrawals on first year pharmacy school (P1) success, defined as on-time progression to the second (P2) year without remediation. METHODS: A retrospective review of students matriculating to a four-year private institution from 2018 to 2021 was conducted. Potential predictors of P1 year success including age, sex, highest degree achieved, prematriculation grade point average (GPA), and course withdrawals were collected. RESULTS: Bivariate analysis indicates that age, cumulative GPA, science GPA, and prematriculation course withdrawals were significantly different between students who were successful vs unsuccessful in the first year of pharmacy school. Out of 220 students analyzed, 40.9% (n = 90) were unsuccessful in the first year. Of those 90 P1 students, 52% did not progress to the P2 year, and 48% progressed but required course remediation. Multivariate analysis demonstrated that independent predictors of P1 success included cumulative GPA and having less than two prematriculation course withdrawals. In addition, the number of prematriculation course withdrawals, cumulative GPA, and having a bachelor's degree or higher were independent predictors of P1 GPA. CONCLUSION: Prematriculation course withdrawal was an independent predictor of both P1 success and P1 GPA. Students with less than two prematriculation course withdrawals were more likely to be successful during the first year of pharmacy school. College of pharmacy admission committees may consider prematriculation course withdrawal frequency when making admission decisions or to identify students that may need additional academic support during the first year of pharmacy school.

Corticosteroids for Blastomycosis-Induced Acute Respiratory Distress Syndrome: A Case Report and Literature Review.

We describe a case report of a patient with Blastomycosis-induced acute respiratory distress syndrome (ARDS) and severe hypoxemia requiring mechanical ventilation, prone positioning, and neuromuscular blockade whose clinical condition rapidly improved with the use of corticosteroids resulting in the patient being discharged home without the need for supplemental oxygen.

Hypertension Statistics for US Adults: An Open-Source Web Application for Analysis and Visualization of National Health and Nutrition Examination Survey Data.

BACKGROUND: Data from the US National Health and Nutrition Examination Survey are freely available and can be analyzed to produce hypertension statistics for the noninstitutionalized US population. The analysis of these data requires statistical programming expertise and knowledge of National Health and Nutrition Examination Survey methodology. METHODS: We developed a web-based application that provides hypertension statistics for US adults using 10 cycles of National Health and Nutrition Examination Survey data, 1999 to 2000 through 2017 to 2020. We validated the application by reproducing results from prior publications. The application's interface allows users to estimate crude and age-adjusted means, quantiles, and proportions. Population counts can also be estimated. To demonstrate the application's capabilities, we estimated hypertension statistics for noninstitutionalized US adults. RESULTS: The estimated mean systolic blood pressure (BP) declined from 123 mm Hg in 1999 to 2000 to 120 mm Hg in 2009 to 2010 and increased to 123 mm Hg in 2017 to 2020. The age-adjusted prevalence of hypertension (ie, systolic BP≥130 mm Hg, diastolic BP≥80 mm Hg or self-reported antihypertensive medication use) was 47.9% in 1999 to 2000, 43.0% in 2009 to 2010, and 44.7% in 2017 to 2020. In 2017 to 2020, an estimated 115.3 million US adults had hypertension. The age-adjusted prevalence of controlled BP, defined by the 2017 American College of Cardiology/American Heart Association BP guideline, among nonpregnant US adults with hypertension was 9.7% in 1999 to 2000, 25.0% in 2013 to 2014, and 21.9% in 2017 to 2020. After age adjustment and among nonpregnant US adults who self-reported taking antihypertensive medication, 27.5%, 48.5%, and 43.0% had controlled BP in 1999 to 2000, 2013 to 2014, and 2017 to 2020, respectively. CONCLUSIONS: The application developed in the current study is publicly available at https://bcjaeger.shinyapps.io/nhanesShinyBP/ and produced valid, transparent and reproducible results.

Geochemical properties of blue carbon sediments through an elevation gradient: study of an anthropogenically impacted coastal lagoon.

Global research is showing that coastal blue carbon ecosystems are vulnerable to climate change driven threats including accelerated sea-level rise and prolonged periods of drought. Furthermore, direct anthropogenic impacts present immediate threats through deterioration of coastal water quality, land reclamation, long-term impact to sediment biogeochemical cycling. These threats will invariably alter the future efficacy of carbon (C) sequestration processes and it is imperative that currently existing blue carbon habitats be protected. Knowledge of underlying biogeochemical, physical and hydrological interactions occurring in functioning blue carbon habitats is essential for developing strategies to mitigate threats, and promote conditions to optimise C sequestration/storage. In this current work, we investigated how sediment geochemistry (0-10 cm depth) responds to elevation, an edaphic factor driven by long-term hydrological regimes consequently exerting control over particle sedimentation rates and vegetation succession. This study was performed in an anthropogenically impacted blue carbon habitat along a coastal ecotone encompassing an elevation gradient transect from intertidal sediments (un-vegetated and covered daily by tidal water), through vegetated salt marsh sediments (periodically covered by spring tides and flooding events), on Bull Island, Dublin Bay. We determined the quantity and distributions of bulk geochemical characteristics in sediments through the elevation gradient, including total organic carbon (TOC), total nitrogen (TN), total metals, silt, clay, and also, 16 individual polyaromatic hydrocarbon's (PAH's) as an indication of anthropogenic input. Elevation measurements for sample sites were determined on this gradient using a LiDAR scanner accompanied by an IGI inertial measurement unit (IMU) on board a light aircraft. Considering the gradient from the Tidal mud zone (T), through the low-mid marsh (M) to the most elevated upper marsh (H), there were significant differences between all zones for many measured environmental variables. The results of significance testing using Kruskal-Wallis analysis revealed, that %C, %N, PAH (µg/g), Mn (mg/kg), TOC:NH4 + and pH are significantly different between all zones on the elevation gradient. The highest values for all these variables exists (excluding pH which followed a reverse trend) in zone H, decreasing in zone M and lowest in the un-vegetated zone T. TC content is 16 fold higher overall in vegetated (3.43 -21.84%) than uninhabited (0.21-0.56%) sediments. TN was over 50 times higher (0.24-1.76%), more specifically increasing in % mass on approach to the upper salt marsh with distance from the tidal flats sediments zone T (0.002-0.05%). Clay and silt distributions were greatest in vegetated sediments, increasing in % content towards upper marsh zones The retention of water, metals, PAHs, mud, chloride ions, NH4 +, PO4 3- and SO4 2- increased with elevated C concentrations, concurrently where pH significantly decreased. Sediments were categorized with respect to PAH contamination where all SM samples were placed in the high polluted category. The results highlight the ability of Blue C sediments to immobilise increasing levels of C, N, and metals, and PAH with over time and with both lateral and vertical expansion. This study provides a valuable data set for an anthropogenically impacted blue carbon habitat predicted to suffer from sea-level rise and exponential urban development. Graphical abstract: Summarized results from this study demonstrating the geochemical changes through an elevation gradient, with a transect encompassing intertidal sediments through supratidal salt marsh sediments within Bull Island's blue carbon lagoon zones. Supplementary Information: The online version contains supplementary material available at 10.1007/s10533-022-00974-0.

Biogeochemical properties of blue carbon sediments influence the distribution and monomer composition of bacterial polyhydroxyalkanoates (PHA).

Coastal wetlands are highly efficient 'blue carbon' sinks which contribute to mitigating climate change through the long-term removal of atmospheric CO2 and capture of carbon (C). Microorganisms are integral to C sequestration in blue carbon sediments and face a myriad of natural and anthropogenic pressures yet their adaptive responses are poorly understood. One such response in bacteria is the alteration of biomass lipids, specifically through the accumulation of polyhydroxyalkanoates (PHAs) and alteration of membrane phospholipid fatty acids (PLFA). PHAs are highly reduced bacterial storage polymers that increase bacterial fitness in changing environments. In this study, we investigated the distribution of microbial PHA, PLFA profiles, community structure and response to changes in sediment geochemistry along an elevation gradient from intertidal to vegetated supratidal sediments. We found highest PHA accumulation, monomer diversity and expression of lipid stress indices in elevated and vegetated sediments where C, nitrogen (N), PAH and heavy metals increased, and pH was significantly lower. This was accompanied by a reduction in bacterial diversity and a shift to higher abundances of microbial community members favouring complex C degradation. Results presented here describe a connection between bacterial PHA accumulation, membrane lipid adaptation, microbial community composition and polluted C rich sediments. Graphical Abstract: Geochemical, microbiological and polyhydroxyalkanoate (PHA) gradient in a blue carbon zone. Supplementary Information: The online version contains supplementary material available at 10.1007/s10533-022-01008-5.

Frequency of Course Remediation and the Effect on North American Pharmacist Licensure Examination Pass Rates.

Objective. Remediation is a tool that allows students to correct an academic deficiency after earning an unsatisfactory grade. There is a lack of data on remediation processes and their impact on future academic performance. This study aimed to evaluate the impact of remediation frequency on North American Pharmacist Licensure Examination (NAPLEX) performance.Methods. The primary analysis was the relationship between the NAPLEX first-time pass rate and the frequency of course remediations (no remediations, one remediation, and two or more remediations). Additional analyses included the correlation between the NAPLEX scaled score and the number of course remediations and characteristics of the course remediated.Results. A total of 116 students with NAPLEX data were included for analysis. Compared to students who never remediated, NAPLEX first-time pass rates were similar among those who remediated only one course; however, students who remediated two or more courses had significantly lower NAPLEX pass rates. Remediation in courses mapped to Pharmacy Curriculum Outcomes Assessment (PCOA) area 4.0 (clinical sciences), and courses with mixed PCOA content areas were negatively correlated with NAPLEX scaled scores. A significant negative correlation existed between remediation in students' second or third years in pharmacy school and the NAPLEX scaled score, but this correlation was not significant for students in their first year.Conclusion. Multiple course remediations are negatively correlated with NAPLEX scaled scores and a reduced first-time NAPLEX pass rate, but a single course remediation has no effect. Institutions should aim to evaluate their current remediation practices and assess whether additional support should be provided to students with multiple course remediations.

Chronic Heart Failure: A Pharmacologic Review.

Chronic heart failure affects over 6 million Americans and is the main reason that people older than 65 years get admitted to the hospital (Centers for Disease Control and Prevention, 2020). Management of heart failure requires interdisciplinary efforts involving primary care physicians, cardiologists, nurses, and pharmacists among other providers. Nurses can play a key role in identifying patients at risk for heart failure exacerbation and are often at the front lines providing education regarding medication adherence. This article summarizes the medications used in chronic heart failure and describes common side effects, dosing considerations, and counseling points that are essential for appropriate management.

Acute Decompensated Heart Failure: A Pharmacologic Review.

Chronic heart failure (CHF) is a growing disease in the United States. Exacerbations of CHF can lead to acute decompensated heart failure (ADHF) and hospitalizations. Nurses play a key role in the treatment of ADHF as they administer medications, monitor patients' response to therapy, and can prompt providers to alter therapy if therapeutic outcomes are not being achieved. Nurses also play a vital role in discharge education for patients who are hospitalized for ADHF, as they can counsel patients on ways to reduce further hospitalizations. It is important for nurses to understand and recognize symptoms of ADHF, pharmacologic treatments for ADHF, and common etiologies of ADHF to help improve patient outcomes.

Impact of faculty interviewers on student matriculation following pharmacy school offer of admission.

INTRODUCTION: Acceptance to pharmacy school relies on data such as grade point average (GPA) and Pharmacy College Admission Test (PCAT) scores in addition to holistic review. The interview is the final step in finding successful applicants. This study sought to identify if faculty interviewers had an impact on prospective students' decisions to accept an offer of admission to our college of pharmacy. METHODS: A seven-year retrospective review of applicants granted an offer of admission was conducted. Analyses determined if interviewer assignment impacted yield of students matriculating into the program. RESULTS: Fifty-two different faculty interviewed 1634 applicants who were subsequently offered admission during the seven-years of review; of these applicants, 482 matriculated (yield 29.5%). Ten faculty interviewers provided 1020 (62.4%) of these interviews, with 302 applicants matriculating (yield 29.6%). Univariate analysis of these 10 interviewers did not find a significant difference in yield. Matriculation between the highest and lowest yielding faculty members trended toward a difference but was not statistically significant. Lower cumulative GPA, lower quantitative PCAT, lack of a bachelor's degree or higher, and interviewing later in the admissions cycle correlated with a higher matriculation yield (P < 0.05). CONCLUSIONS: Faculty interviewers did not impact an applicant's decision to accept an offer of admission to pharmacy school. Interviewing late in the admissions cycle, not having a bachelor's degree, lower cumulative GPA, and lower quantitative PCAT score correlated with increased matriculation yield.

Outpatient Parotidectomy: A Retrospective Series.

OBJECTIVES: Recent literature suggests that outpatient head and neck surgery is safe and may decrease costs. This study assesses whether outpatient parotidectomy differs in complication type and rate from inpatient surgery. METHODS: Patients who underwent parotidectomy at our institution from 2011 to 2019 were retrospectively reviewed and divided by inpatient or outpatient status. Complications including infection, seroma, salivary fistula, hematoma, and flap necrosis, as well as readmission rates were tabulated. Drain placement, related to tumor size, was also analyzed using a receiver operating curve. RESULTS: 144 patients had available data for analysis. Nine of the 144 patients had complications. Seven of 98 outpatients and two of 46 inpatients had complications. There was no statistically significant difference in complication rate between the two groups (P = .518). Tumor size ≥4.62 cm3 was associated with drain placement (P = .044). CONCLUSION: Outpatient parotidectomy is a safe and viable alternative for carefully selected patients.

Novel Vasopressors in the Treatment of Vasodilatory Shock: A Systematic Review of Angiotensin II, Selepressin, and Terlipressin.

STUDY OBJECTIVE: Vasodilatory shock is the most common type of shock. Catecholamine vasopressors are the cornerstone of hemodynamic therapy but carry risks. Angiotensin II (AT2) was recently approved, and other novel agents (selepressin and terlipressin) are under investigation and used outside the United States (terlipressin). We performed a systematic review to summarize the efficacy and safety of these novel vasopressors and to offer guidance on their appropriate use. DESIGN: Systematic review of controlled trials. METHODS: Numerous databases were searched using terms related to angiotensin II, selepressin, terlipressin, vasopressor, and shock. Twenty-one citations, including 16 prospective comparative trials and 5 post hoc analyses reporting effects of AT2, selepressin, and terlipressin, were reviewed for data on outcomes related to hemodynamic measures, mortality, severity and duration of illness, concomitant vasopressor utilization, and adverse effects. Findings from eligible literature are described qualitatively using Cochrane methods. RESULTS: Fourteen controlled trials were assessed after exclusion of 2 dated trials of a distinct AT2 formulation. Trials are limited for AT2 (n = 2) and selepressin (n = 1), while terlipressin was investigated in 11 small trials. Overall, the trials have an unclear risk of bias. Most report mean arterial pressure (MAP) as primary end point, and all indicate novel vasopressors increase MAP compared to placebo and to a similar degree as with catecholamine vasopressors. Mortality findings are preliminary, as they have been limited to specific subgroups in trials of terlipressin and post hoc analyses of one trial of AT2. Trials reported safety concerns for each agent including thromboembolism with AT2 and ischemia with terlipressin/selepressin. CONCLUSION: In this systematic review, controlled trials of novel vasopressors in treatment of vasodilatory shock were limited and of low quality. Angiotensin II, selepressin, and terlipressin appear to significantly increase MAP, but further study is required, particularly for selepressin, to determine their safety, efficacy, and role in treatment of vasodilatory shock.

Characteristics of Drug-Related Podcasts and This Medium's Potential as a Pharmacy Education Tool.

Objective. To analyze the publication frequency and characteristics of drug-related podcasts and describe the role of pharmacists in creating content for this audio-based educational medium. Methods. Podcasts that potentially included drug-related educational information were identified based on four podcast categories that were publicly available as of June 2016. Podcasts were screened by two reviewers to determine whether they contained at least five episodes with drug-related content and a minimum of 10 audio episodes. Metrics related to the podcast, audio episodes, and names of the content authors were collected and a descriptive analysis was conducted. Results. Of the 960 podcasts screened, 125 met the study criteria and were included in the descriptive analysis. These drug-related podcasts produced a median of two episodes per month and each episode lasted an average of 27 minutes. The most common professions represented by podcast hosts and guests were physicians (83.2%), followed by nurses and nurse practitioners (11.2%) and pharmacists (10.4%). Podcast content varied widely, with critical care and emergency medicine being the most common (18.4%), followed by general medicine (14.4%) and complementary and alternative medicine (13.6%). Conclusion. Drug-related podcasts are numerous and easily accessible; however, the quality and accuracy of their content cannot be easily determined as episodes do not consistently cite references. Pharmacists appear to be underrepresented in developing this particular genre of educational content, pharmacy educators should consider producing and disseminating educational material through podcasts for students and practitioners.

Live-feed use in the classroom as an engagement tool.

BACKGROUND AND PURPOSE: Recent studies suggest that social media use in the classroom leads to improved engagement and participation. However, student attitudes regarding classroom engagement, academic performance, and overall teaching effectiveness toward this tool have been mixed. The aim of this study was to determine the effectiveness of live-feed on students' classroom engagement. EDUCATIONAL ACTIVITY AND SETTING: This study included the use of live-feed in a research and statistics course for first-year pharmacy students. At the end of the course, students were invited to participate in a post-survey to assess impressions on classroom engagement after the usage of live-feed in the classroom. FINDINGS: Fifty out of 62 students (81%) responded to the survey. Seventy percent reported that live-feed application promoted collaborative learning and discussion, and 68% stated that it increased their understanding of the topic. Sixty-six percent reported that live-feed application created a supportive anonymous environment, and 64% felt it encouraged them to ask questions. Sixty percent of the students reported that live-feed did not increase their engagement in the classroom but agreed that it lowered their anxiety toward class participation. Sixty-four percent of the students were positive about live-feed boosting their willingness to participate in topic discussions and 72% believed that live-feed made learning a fun activity. SUMMARY: Live-feed can be a useful tool in academic settings to provide a supportive environment and promote students' willingness to participate in classroom discussions.

Nonlinear protein binding of phenytoin in clinical practice: Development and validation of a mechanistic prediction model.

AIMS: To individualize treatment, phenytoin doses are adjusted based on free concentrations, either measured or calculated from total concentrations. As a mechanistic protein binding model may more accurately reflect the protein binding of phenytoin than the empirical Winter-Tozer equation that is routinely used for calculation of free concentrations, we aimed to develop and validate a mechanistic phenytoin protein binding model. METHODS: Data were extracted from routine clinical practice. A mechanistic drug protein binding model was developed using nonlinear mixed effects modelling in a development dataset. The predictive performance of the mechanistic model was then compared with the performance of the Winter-Tozer equation in 5 external datasets. RESULTS: We found that in the clinically relevant concentration range, phenytoin protein binding is not only affected by serum albumin concentrations and presence of severe renal dysfunction, but is also concentration dependent. Furthermore, the developed mechanistic model outperformed the Winter-Tozer equation in 4 out of 5 datasets in predicting free concentrations in various populations. CONCLUSIONS: Clinicians should be aware that the free fraction changes when phenytoin exposure changes. A mechanistic binding model may facilitate prediction of free phenytoin concentrations from total concentrations, for example for dose individualization in the clinic.

Life-threatening idiopathic reaction to hydrochlorothiazide treated with veno-venous extracorporeal membrane oxygenation.

Hydrochlorothiazide has been shown to cause rare, but serious non-cardiogenic pulmonary edema. We present a case report of a patient with apparent septic shock and acute respiratory distress syndrome (ARDS) requiring life-sustaining veno-venous extracorporeal membrane oxygenation (VV-ECMO). Upon further review of the literature and the chronology of the patient's presentation, her condition was most likely due to an immune-mediated reaction to hydrochlorothiazide. This represents the first case, to our knowledge, of such a severe reaction to hydrochlorothiazide supported with ECMO therapy.

Characterization of Free Phenytoin Concentrations in End-Stage Renal Disease Using the Winter-Tozer Equation.

BACKGROUND: The Winter-Tozer (WT) equation has been shown to reliably predict free phenytoin levels in healthy patients. In patients with end-stage renal disease (ESRD), phenytoin-albumin binding is altered and, thus, affects interpretation of total serum levels. Although an ESRD WT equation was historically proposed for this population, there is a lack of data evaluating its accuracy. OBJECTIVE: The objective of this study was to determine the accuracy of the ESRD WT equation in predicting free serum phenytoin concentration in patients with ESRD on hemodialysis (HD). METHODS: A retrospective analysis of adult patients with ESRD on HD and concurrent free and total phenytoin concentrations was conducted. Each patient's true free phenytoin concentration was compared with a calculated value using the ESRD WT equation and a revised version of the ESRD WT equation. RESULTS: A total of 21 patients were included for analysis. The ESRD WT equation produced a percentage error of 75% and a root mean square error of 1.76 µg/mL. Additionally, 67% of the samples had an error >50% when using the ESRD WT equation. A revised equation was found to have high predictive accuracy, with only 5% of the samples demonstrating >50% error. CONCLUSION: The ESRD WT equation was not accurate in predicting free phenytoin concentration in patients with ESRD on HD. A revised ESRD WT equation was found to be significantly more accurate. Given the small study sample, further studies are required to fully evaluate the clinical utility of the revised ESRD WT equation.

Unexplained increases in serum vancomycin concentration in a morbidly obese patient.

INTRODUCTION: To report a case of increases in vancomycin concentrations without additional vancomycin doses being given. CASE STUDY: A 64 year-old morbidly obese female received three total doses of vancomycin for surgical prophylaxis and for ventilator-associated pneumonia. Subsequent vancomycin concentrations from the patient's central venous catheter (CVC) demonstrated increasing drug levels from 27.1 to 45.9mcg/mL despite no additional vancomycin being given and proper line flushing prior to sample collection. There is no clear explanation for the increase in the patient's vancomycin concentration. Drug leaching from the CVC, enterohepatic recycling, drug redistribution from adipose or other tissues, and assay cross-reactivity with other medications are all potential explanations for the increased vancomycin concentrations. CONCLUSION: This case report describes an unexplained increase in vancomycin concentrations and reinforces both the fallibility of laboratory testing and that unusual circumstances do occur. Several potential causes are hypothesised with CVC drug leaching being the most likely. Nurses and other healthcare providers with similar scenarios should consider a peripheral blood sample to rule out the potential for CVC drug leaching as a possible explanation.