Risk Factors for Bleeding in Hospitalized Patients with Elevated INR: No Vitamin K Therapy Received Versus Vitamin K Received.

BACKGROUND: Supratherapeutic international normalized ratio (INR) in patients on warfarin is a common side effect. Updated guidelines recommend against using vitamin K to correct INRs 4.5 to 10 in the absence of bleeding. The impact of compliance with updated guidelines during hospitalization has not been fully explored. METHODS: A retrospective, observational study was performed utilizing electronic medical records. The goal was to evaluate management of supratherapeutic INR values for medicine inpatients and identify differences in clinical outcomes among inpatients treated and not treated with vitamin K. Records from adult inpatients with at least one INR value between 4.5 and 9 were reviewed. A total of 51 records were evaluated. Thirty-four patients did not receive vitamin K compared to 17 who did. Bleeding events, readmissions rates, length of stay, and familiarity with new guidelines were studied. RESULTS: Mean age of patients was 73 years, and 71% were female. No statistically significant differences were observed in bleeding events between patients who received vitamin K and those who did not: 2/17 (12%) and 1/34 (3%), respectively (P = .30). No differences in 30-day readmission rates (24% vs 18%; P = .71) or in length of stay (7 vs 4 days; P = .11) were found. All pharmacists (13 of 13) were familiar with CHEST 2012 guidelines on the management of supratherapeutic INR compared to 10 of 21 (48%) hospitalists (P = .001). CONCLUSIONS: With the national focus on reduction of health care costs, health systems are looking at innovative ways to reduce readmission rates and length of stay. This study, which evaluated the use of vitamin K administration, showed no statistical difference between bleeding events, readmission rates, and length of stay in patients who received vitamin K. Education on the updates of guidelines may be beneficial, as many providers were not familiar with the changes in recommendations.

Utilization of an emotional intelligence workshop to enhance student pharmacists' self-awareness.

BACKGROUND AND PURPOSE: This study evaluated the impact of an emotional intelligence (EI) workshop as a tool to improve student pharmacists' self-awareness. The primary objectives were to assess the change in student pharmacists' self-awareness as measured by the Self-Awareness Outcomes Questionnaire (SAOQ) and identify trends in their self-reflection. EDUCATIONAL ACTIVITY AND SETTING: A four-hour EI workshop was delivered in a first-year required student pharmacist leadership course. The components of the workshop included: an EI assessment via the Emotional Quotient Inventory (EQ-i 2.0) administered to student pharmacists outside of class, active learning class time that applied the principles of EI to leadership and group dynamics, and peer-to-peer discussions. Personal results of the EQ-i 2.0 were reviewed individually and in small groups. Student pharmacists completed a self-reflection and EI action plan outside of class. The SAOQ was completed before and after the workshop and the aggregated Likert scales were analyzed by paired t-tests. FINDINGS: After two consecutive course offerings of the workshop (N = 100), there was a significant increase in the total SAOQ score as well as a significant increase for the three positive subscales: reflective self-development, acceptance, and proactivity. There was no change in the negative subscale: emotional costs. Student pharmacists positively perceived the workshop and reported that the activities motivated students to improve their interpersonal skills and increase extracurricular involvement. DISCUSSION: Implementing an EI workshop is an effective curricular method to improve the affective domain of student development, specifically self-awareness.

A Single-Center Retrospective Cohort Analysis of Maternal and Infant Outcomes in HIV-Infected Mothers Treated with Integrase Inhibitors During Pregnancy.

INTRODUCTION: Integrase strand transfer inhibitors (INSTI) are currently being investigated for the treatment of HIV in pregnancy. The purpose of this study is to evaluate the differences in maternal and infant outcomes in HIV-positive mothers treated with INSTI-containing antiretroviral therapy (ART) during pregnancy compared to protease inhibitor (PI)-containing ART. METHODS: A retrospective, cohort study of INSTI- and PI-based ART used in pregnancy between 2007 and 2015 was performed. The primary objective was to evaluate the differences in viral load (VL) suppression prior to delivery. Secondary endpoints included time to and duration of VL suppression and safety parameters in both mothers and infants. For the primary analysis, the two arms were matched 1:2 INSTI to PI based on the presence or absence of viremia at the time of pregnancy determination. Additional analysis was performed on the entire matched and unmatched dataset. RESULTS: Twenty-one patients were matched (7 INSTI and 14 PI). There were no significant differences between groups with respect to the proportion of patients with VL suppression prior to delivery (71.4% INSTI vs. 92.9% PI, p = 0.247), and there were no significant differences in any of the secondary endpoints. Patients with documented adherence issues were statistically more likely to not be virologically suppressed prior to delivery (p = 0.002). CONCLUSION: No differences in efficacy or safety were found between patients treated with INSTIs compared to PIs. This study supports the further investigation of the use of INSTIs during pregnancy to reduce HIV transmission.