The Impact of Post-Myocardial Infarction (MI) Depression on Cardiovascular-Related Hospitalizations.

Routine depression screening and subsequent treatment in post-myocardial infarction (MI) patients may lead to improved cardiac outcomes. However, screening for depression is not a standard of post-MI care. Though the American Heart Association (AHA) published an advisory recommending routine depression screening in post-MI patients, there is conflicting evidence on the benefit that routine depression screening has on cardiovascular outcomes. The purpose of this study is to compare the occurrence of cardiovascular-related readmissions in post-MI patients diagnosed with depression versus post-MI patients not diagnosed with depression. This retrospective cohort study analyzed the incidence of cardiovascular-related readmissions and mortality in adult post-MI patients diagnosed with depression within 1 year compared to those not diagnosed with depression within a year. Those diagnosed with depression were more likely to experience a subsequent cardiovascular-related hospitalization within 2 years of MI than those not diagnosed with depression (52.6% vs 28.7%; odds ratio [OR], 3.19; 95% CI 2.33-4.38). There was no difference between groups in the incidence of in-hospital mortality.

Perceived Role, Identity and Experiences of Pharmacists and the Potential Impact on COVID-19 Vaccine Uptake per Louisiana Region: A Prospective Cohort Study.

Some of the lowest COVID-19 community vaccination rates in America are found in Louisiana. This study investigated: (1) barriers that Louisiana pharmacists encountered during the pandemic; and (2) the effect of pharmacists' role and identity confidence on willingness to enforce vaccine mandates, and COVID-19 vaccine uptake. Fifty-four community pharmacists from nine regions of Louisiana participated in the study. Pharmacists completed questionnaires about: personal demographics, patient population, vaccination encouragement, COVID-19 concerns, and vaccination administration rates. The importance of feeling like a trusted voice in the community, as well as professional perception and self-assurance, were measured using Likert scale questions. During focus groups, participants discussed experiences with the COVID-19 vaccination rollout and vaccination-related obstacles. As the pandemic progressed, pharmacists reported being overworked, understaffed, and overburdened with new responsibilities. In regions with lower vaccination rates, pharmacists were less likely to feel at ease enforcing vaccine mandates. Independent pharmacists were less comfortable enforcing vaccine mandates than chain pharmacists but had more positive perceptions of their role and identity. This study contributes to further understanding of pharmacy workflow obstacles and pharmacists' perceptions of their professional roles and identities in the community.

Assessing the Impact of COVID-19 Phased Vaccine Eligibility on COVID-19 Vaccine Intent among African Americans in Southeastern Louisiana: A Community-Based, Cohort Study.

The purpose of this study was to explore the impact of eligibility for the coronavirus 2019 (COVID-19) vaccine at the time of the vaccine rollout as a predictor of vaccine intent within the African American community. METHODS: Four hundred eighty-seven African American participants in southeastern Louisiana were surveyed from January-April of 2021, with follow-up surveys occurring in Fall 2021. Survey domains included demographics, vaccine hesitancy, discrimination in the healthcare setting, and knowledge and experiences with COVID-19. Descriptive statistics, Chi-square tests, and binary logistic regression were performed. RESULTS: Participants eligible for the vaccine were 1.61 times as likely to express positive vaccine intent versus ineligible participants. Additional predictors of vaccine intent were age, insurance status and coverage, and female sex at birth. In the multivariable logistic analysis, eligible individuals were 2.07 times as likely to receive the vaccine versus ineligible individuals. CONCLUSIONS: Vaccine eligibility for the COVID-19 vaccine was a significant predictor of intent to vaccinate in the African American community. Younger individuals were less likely to have a positive intent, correlating with the eligibility of ages 16+ occurring 5 months post-vaccine approval.

A Culturally Competent Vaccine Hesitancy Educational Model for Community Pharmacists to Increase Vaccine Uptake, Louisiana, 2021-2022.

In February 2022, an educational model was launched to train Louisiana pharmacists to become positive influencers of vaccination decisions via targeted, culturally competent interventions, with the objective of improving COVID-19 vaccine uptake in communities. A total of 47 pharmacists completed the course, and more than 90% noted that the education would help them optimize vaccine acceptance in their community practice settings. The pharmacists will participate in vaccine surveillance to assess the success of the educational model intervention and predictors of vaccine uptake. (Am J Public Health. 2022;112(S9):S900-S903. https://doi.org/10.2105/AJPH.2022.307070).

Association of Serum Magnesium with Blood Pressure in Patients with Hypertensive Crises: A Retrospective Cross-Sectional Study.

The role of magnesium in blood pressure has been studied among hypertensive patients; however, there is a dearth of studies exploring the role of magnesium in hypertensive crises. The primary objective of this study was to evaluate the relationship between serum magnesium and blood pressure in patients with hypertensive crises. This was a single-center, retrospective, chart review, cross-sectional study of patients with hypertensive crises. Patients were included if they were eighteen years of age or older, with an international classification disease ninth revision (ICD-9) code of 401.9 (hypertensive crises: emergency or urgency) and a documented magnesium level on their electronic medical record. The primary outcome of the study was the correlation between serum magnesium and blood pressure (systolic blood pressure and diastolic blood pressure) in patients with hypertensive crises. Two hundred and ninety-three patients were included in the study. The primary outcome result showed that serum magnesium was positively correlated with systolic blood pressure (r = 0.143, p = 0.014), but not diastolic blood pressure. Conclusion: This study found a significant positive association between magnesium and systolic blood pressure, but not diastolic blood pressure, among patients with hypertensive crises. This positive association of serum magnesium with systolic blood pressure was maintained after adjusting for covariates. This study's findings suggest a potential role of magnesium in blood pressure among patients with hypertensive crises.

Evaluation of Outcomes in Patients Receiving Amantadine to Improve Alertness After Traumatic Brain Injury.

Background: Amantadine has been used off-label to improve alertness after traumatic brain injury (TBI). The goal of this study is to assess the mean change at 72 hours and in course of therapy (COT) Glasgow Coma Scale (GCS) score after amantadine initiation and to correlate the change in GCS score with participation in physical therapy (PT) and occupational therapy (OT) among patients with TBI receiving amantadine during the first hospitalization. Methods: This single-center, retrospective, cohort study included patients ≥18 years old hospitalized for a TBI from August 2012 to February 2018 and received ≥1 dose of amantadine to increase alertness. The primary endpoint is the mean change in 72-hour GCS score after amantadine initiation. The secondary endpoint is the mean change in COT GCS score after amantadine initiation and the correlation between the change in GCS score and percent PT and OT participation at 72 hours and during the COT. Results: Seventy-nine patients were included. The mean age of patients was 41 years, and 79.8% of the patients were men. The mean change in 72-hour GCS score was +0.75 (95% confidence interval [CI] = 0.09-1.42, P = .027), and the mean change in COT GCS score was +2.29 (95% CI = 1.68-2.90, P < .001). There was no significant correlation between the increase in GCS score and percent PT/OT session participation at 72 hours and during the COT, r = -0.15 (P = .24) and r = -0.02 (P = .74), respectively. The percent PT/OT session participation at 72-hour post-amantadine initiation was 61.3% compared with 65.9% during the COT. Conclusion: There were small but statistically significant increases in the mean change at 72 hours and in COT GCS score; however, they were not correlated with percent PT/OT participation. Other studies are needed to determine the appropriate time and GCS score to initiate amantadine along with the optimal dose in the inpatient setting.

Evaluation of serum calcium differences in hypertensive crises and control patients: A randomly matched case-control study.

The role of calcium in blood pressure has been widely studied among hypertensive patients; however, no study has explored the role of calcium in hypertensive crises. The primary objective of this study is to evaluate the differences in serum calcium levels between hypertensive crises patients and a 1:1 random matched controls (age-, sex-, race-, diabetes, and body mass index matched). This study is a single-center, retrospective, chart review, case-control study of patients with hypertensive crises (case group) and patients without hypertensive crises (control group). Patients were included in the case group if they were 18 years of age or older with hypertensive crises and have a documented calcium level. The control group patients were required to be 18 years of age or older, have a documented calcium level, and have no diagnosis of hypertensive crises. The primary outcome of the study was to compare the mean serum calcium in patients with hypertensive crises vs patients without hypertensive crises. Five hundred and sixty-six patients were included in the study: 283 patients in both the case group and control group. The primary outcome results showed that serum calcium concentration was not significantly different between the case group (8.99 ± 0.78 mg/dL) and control group (8.96 ± 0.75 mg/dL) (P = .606). This study found no significant difference in serum calcium levels in patients with hypertensive crises compared to a random matched control group. Larger observational or experimental studies may be useful to evaluate the effect of calcium on blood pressure in hypertensive crises.

Impact of body mass index on 90-day warfarin requirements: a retrospective chart review.

BACKGROUND: Rates of obesity continue to rise worldwide as evidenced in the 2017 Centers for Disease Control and Prevention (CDC) report that indicated over 35% of United States (US) citizens are obese, with Louisiana ranked as the fifth most obese state in America. Since large clinical trials tend to exclude obese patients, health care providers are faced with concerns of under- or overdosing these patients on warfarin. METHODS: This retrospective chart review evaluated patients who reported to a community anticoagulation clinic for warfarin management between 1 June 2017 and 30 September 2017. Along with baseline demographics, chronic use of drugs that have clinically significant interactions with warfarin, social activity such as tobacco use and alcohol consumption, were collected. Body mass indexes (BMI) were collected and categorized according to the World Health Organization definitions as follows: Normal (BMI 18-24.9 kg/m2), Overweight (25-29.9 kg/m2), Obesity Class I (30-34.9 kg/m2), Obesity Class II (35-39.9 kg/m2), Obesity Class III (⩾40 kg/m2). The primary outcome was the mean 90-day warfarin dose required to maintain "intermediate control" or "good control" of international normalized ratio (INR), stratified by BMI classifications. The secondary outcome was the time in therapeutic range (TTR) stratified by BMI classifications. RESULTS: A total of 433 patient encounters were included in this study. There was a total of 43 encounters in the Normal BMI category, 111 Overweight encounters, 135 Obesity Class I encounters, 45 Obesity Class II encounters, and 99 Obesity Class III encounters. Approximately 63% of the study population were male, and over 90% the patients were African American. The Obesity Class I and Obesity Class II class required an average of 11.47 mg and 17.10 mg more warfarin, respectively, to maintain a therapeutic INR when compared with the Normal BMI category. These findings were statistically significant with p values of 0.007 and <0.001, respectively. Additionally, upon comparing the Overweight BMI category with the Obesity Class II category, there was a mean warfarin dose difference of 11.22 mg (p = 0.010) more in Obesity Class II encounters to maintain a therapeutic INR. In the secondary analysis of TTR, Overweight category encounters had the highest TTR, whereas encounters in the Normal BMI category had the lowest TTR. CONCLUSION: As BMI increases, there is an increased chronic warfarin requirement to maintain "intermediate control" or "good control" of INR between 2 and 3 in an ambulatory care setting.

Evaluation of serum magnesium differences in hypertensive crises and control patients: A randomly matched case-control study.

Although the role of magnesium in blood pressure has been well studied among hypertensive patients, no study has explored the role of magnesium in hypertensive crises. The primary objective of this study is to evaluate the differences in serum magnesium levels between hypertensive crises patients and matched controls (age-, sex-, race-, and diabetes-matched) in a 1:1 random match. This study is a single-center, retrospective, chart review, case-control study of patients with hypertensive crises (case group) and patients without hypertensive crises (control group). Patients were included in the case group if they were 18 years of age or older with hypertensive crises and have a documented magnesium level. The control group patients were required to be 18 years of age or older, have no diagnosis of hypertensive crises, and have a documented magnesium level. The primary outcome of the study was to compare the mean serum magnesium in patients with hypertensive crises versus patients without hypertensive crises. Three hundred and fifty-eight patients were included in the study: 179 patients in both the case group and control group. The primary outcome results showed that serum magnesium concentration was not significantly different between the case group (1.89 ± 0.29 mg/dl) and control group (1.90 ± 0.31 mg/dl) (p = .787). This study found no significant difference in serum magnesium levels in patients with hypertensive crises compared to a random matched control group. Larger observational or experimental studies may be useful to evaluate the effect of magnesium on blood pressure in hypertensive crises.

Concordance of Vancomycin Population-Predicted Pharmacokinetics with Patient-Specific Pharmacokinetics in Adult Hospitalized Patients: A Case Series.

BACKGROUND: Vancomycin empiric therapy is commonly dosed using clinical algorithms adapted from population-predicted pharmacokinetic parameters. However, precise dosing of vancomycin can be designed using patient-specific pharmacokinetic calculations. OBJECTIVE: The objective of this study is to assess the correlational fit between vancomycin population-predicted and patient-specific pharmacokinetic parameters [elimination rate constant (Ke) and half-life (t1/2)] in a case series of adult hospitalized patients. METHODS: This is a single-center case series of hospitalized adult patients who received vancomycin, had creatinine clearance calculation for derivation of population-predicted pharmacokinetic parameters, and had two vancomycin concentrations for calculation of patient-specific pharmacokinetic parameters. The primary objective of this case series is to evaluate the correlation between population-predicted and patient-specific pharmacokinetic parameters. The secondary objectives of this study are to evaluate the mean bias and precision between the population-predicted and patient-specific pharmacokinetic parameters and to assess the correlation between population-predicted and patient-specific pharmacokinetic parameters in special population subgroups (obese patients with body mass index ≥ 30 kg/m2 and patients with renal dysfunction). All correlation analyses were performed on the population-predicted pharmacokinetics using diverse methods of estimating renal function (Salazar-Corcoran and Cockcroft-Gault methods using either ideal, actual, or adjusted body weights). All significance testing was set at an α of < 0.05. IBM SPSS Statistics version 25 and SAS version 9.4 were used to conduct all statistical analyses. RESULTS: A total of 30 patients were included in the study; 33.3% (10/30) of the patients were obese and 56.7% (17/30) had renal dysfunction. In all patients in the study, the calculated population-predicted Ke and t1/2 using all four creatinine clearance estimation methods were each significantly correlated with patient-specific Ke and t1/2 (all Pearson correlation coefficients [r]: > + 0.7, p < 0.001). The population-predicted Ke and t1/2 calculated using Cockcroft-Gault creatinine clearance using adjusted body weight showed the strongest association with patient-specific Ke and t1/2. In the subgroup analyses, all the population-predicted Ke and t1/2 using four creatinine clearance estimation methods were each significantly correlated with patient-specific Ke and t1/2. The exception was the population-predicted t1/2 derived from Cockcroft-Gault creatinine clearance using actual body weight that did not show a significant correlation with patient-specific t1/2 in obese patients. CONCLUSIONS: In this case series, population-predicted pharmacokinetic parameters were strongly correlated with patient-specific pharmacokinetic parameters. The vancomycin population-predicted pharmacokinetic formula can be used safely to predict a patient's vancomycin pharmacokinetic disposition and can be maintained as an empiric dosing strategy in various hospitalized adult patients.

Observations of resistance through minimum inhibitory concentrations trends for respiratory specimens of commonly isolated organisms.

OBJECTIVE: The objective of this study was to determine minimum inhibitory concentration (MIC) trends among common bacterial organisms found in respiratory isolates in the trauma intensive care unit setting. METHODS: In this retrospective observational study, MIC data was reviewed over a three year period from January 2009 to December 2011 for the three most frequently identified organisms isolated from respiratory specimens in a trauma intensive care unit along with corresponding hospital data. RESULTS: The most frequently isolated bacterial species identified were Staphylococcus aureus (229 isolates), Pseudomonas aeruginosa (129 isolates), and Acinetobacter species (87 isolates) in the analysis within our institution from 2009-2011. There was considerable variability among the MIC trends for the analyzed organisms. For Pseudomonas isolates, observed sensitivities were as high as 100% for antibiotics ciprofloxacin and imipenem in 2009, but decreased over the next two years in 2010 and 2011. There was considerable variability among the MIC trends for Acinetobacter over the three year period for the antibiotics tested. The MIC data for most Staphylococcus aureus isolates over the three years were sensitive to vancomycin with little change in the observed MIC data. CONCLUSION: The data reported is observational and indicates the need for future studies to establish a valid relationship of the MIC data over time in our institution particularly among our gram negative organisms, to monitor patterns of antimicrobial resistance.

Antimicrobial susceptibilities of respiratory pathogens in the surgical/trauma intensive care unit compared with the hospital-wide respiratory antibiogram in a level I trauma center.

BACKGROUND: Unit-specific antibiograms have developed to guide clinicians to appropriate antibiotic choices for subsets of patients. The additional level of a unit- and respiratory-specific antibiogram for surgical and trauma patients defines key differences in susceptibility information for treating hospital-acquired pneumonia. METHODS: This was a three-year, retrospective single-center study. A total of 729 positive respiratory specimens from 612 patients were analyzed using Quality Compass Pathfinder(®), the antibiotic-reporting software. Culture and susceptibility reports were compared for the surgical/trauma intensive care unit (S/TICU) and the general hospital (excluding the S/TICU but including the medical ICU [MICU]). Data were filtered to include those genera and organisms with a high association with hospital-acquired pneumonia: Acinetobacter, Citrobacter, Enterobacter, Escherichia coli, Haemophilus, Klebsiella, Neisseria, Pseudomonas, Staphylococcus, Stenotrophomonas, Streptococcus, and Serratia. RESULTS: For gram-negative organisms, susceptibility differences were noted for Acinetobacter and Pseudomonas between the S/TICU and the rest of the hospital. In particular, Acinetobacter was significantly more susceptible to ciprofloxacin (86% vs. 43%; p<0.001), gentamicin (86% vs. 54%; p=0.001), imipenem-cilastatin (93% vs. 55%; p<0.001), trimethoprim-sulfamethoxazole (88% vs. 54%; p=0.001), and tobramycin (50% vs. 0; p=0.012). Pseudomonas isolates from the S/TICU were significantly more susceptible to aztreonam (83% vs. 68%; p=0.037), ciprofloxacin (86% vs. 69%; p=0.019), and imipenem-cilastatin (94% vs. 79%; p=0.01). For gram-positive organisms, Staphylococcus isolates from the S/TICU were significantly more susceptible to erythromycin (81% vs. 57%; p=0.007) and trimethoprim-sulfamethoxazole (98% vs. 91%; p=0.034) than were the hospital isolates. CONCLUSIONS: For key respiratory pathogens, such as Pseudomonas, Acinetobacter, and Staphylococcus, surgical and trauma patients present greater susceptibility to several antibiotics. Although this information cannot be extrapolated to other institutions, it does provide a basis for comparable institutions to consider developing unit- and collection-site-specific antibiograms for infections that affect surgical/trauma patients commonly.