Ceftazidime/Avibactam: A New Antibiotic for Gram-Negative Infections.

OBJECTIVE: To review the chemistry, pharmacology, microbiology, pharmacokinetics, pharmacodynamics, clinical efficacy, safety, dosing, and administration of ceftazidime/avibactam (CAZ/AVI). DATA SOURCES: A search of PubMed using the terms "ceftazidime," "avibactam," "NXL104," and "AVE1330A" was performed. The manufacturer's website was also reviewed to further identify relevant information. STUDY SELECTION: All English-language articles from 2004 to May 2015 appearing in these searches were reviewed for relevance to this paper. In addition, their bibliographies were reviewed to identify any articles not identified in the searches. DATA SYNTHESIS: CAZ/AVI is a new cephalosporin ß-lactamase inhibitor combination with a spectrum of activity targeted against Gram-negative organisms including Enterobacteriaceae and Pseudomonas aeruginosa. The dosing regimen is 2.5 g every eight hours administered via IV infusion over two hours for 5 to 14 days. The dosing regimen should be adjusted based on renal function. A phase II trial has demonstrated that clinical cure rates with CAZ/AVI plus metronidazole are comparable to those with meropenem in the treatment of adults with complicated intra-abdominal infections. Another phase II clinical trial has demonstrated that clinical cure rates with CAZ/AVI are comparable to those with imipenem/cilastatin for the treatment of adults with complicated urinary tract infections (cUTIs). CAZ/AVI has a side effect profile similar to that of cephalosporins and carbapenems. CONCLUSION: CAZ/AVI has a favorable efficacy and safety profile in the treatment of adults with complicated intra-abdominal infections or cUTIs. Further research is needed to refine its role, particularly for the treatment of multi-drug-resistant Gram-negative infections.

Skills laboratory faculty job satisfaction: Effects of high-contact teaching and the COVID-19 pandemic.

INTRODUCTION: The objective of this study is to describe the workload responsibilities and job satisfaction of skills laboratory faculty, both before and during the COVID-19 pandemic. METHODS: School of pharmacy (SOP) skills laboratory faculty were surveyed in fall 2021 to gather information on workload responsibilities and job satisfaction, before and during the COVID-19 pandemic. Quantitative data were reported using descriptive statistics and, when appropriate, student t-tests were used to compare responses from before and during COVID-19. Qualitative data were coded for themes by two investigators with a third investigator used to reach consensus. RESULTS: A total of 45 skills laboratory faculty from 44 of 142 SOP responded to the survey. Faculty reported an average percent effort of 43.9% laboratory teaching, 13.9% non-laboratory teaching, 12.8% service, 6.5% administration, 12.5% patient care, and 10.4% scholarship. Overall job satisfaction decreased from before COVID-19 to during COVID-19, and faculty members' satisfaction specifically with their laboratory role decreased from 7.5 to 6.6 (P = .003). Several themes were identified when respondents described what they loved most about teaching in the laboratory as well as the challenges associated, the majority of which were personnel, resources, and time. CONCLUSIONS: Skills laboratory faculty reported a high number of laboratory courses coordinated each year along with many hours dedicated each week to prepare and conduct skills laboratory activities. While the pandemic is over, the unique aspects of coordinating student-centered courses likely requires more support for skills laboratory faculty members to avoid burnout and improve job satisfaction.

Preparing student-pharmacists to utilize motivational interviewing techniques to address COVID-19 vaccine hesitancy in underrepresented racial/ethnic patient populations.

BACKGROUND AND PURPOSE: Vaccine hesitancy disproportionally impacts racial/ethnic minority populations. Regarded as trusted, accessible, and knowledgeable, pharmacists are strategically positioned to address this threat using effective communication strategies such as motivational interviewing (MI). Little data exists on programs that prepare student-pharmacists to use MI to combat vaccine hesitancy in underrepresented populations. EDUCATIONAL ACTIVITY AND SETTING: Student pharmacists elected to participate in co-curricular training on addressing COVID-19 vaccine hesitancy in racial/ethnic minority populations. The training included a web-based module on using MI to address COVID-19 vaccine hesitancy and a live group objective structured clinical examination (OSCE) with standardized patient encounters that included prevalent COVID-19 vaccine concerns. Faculty assessed the group's ability to employ core elements of MI to correct vaccine misinformation. After the OSCE, students received feedback from the standardized actors and evaluators. Change in student confidence was assessed. After the training, students volunteered at eight different community events to utilize MI to address vaccine hesitancy in underrepresented patient populations. FINDINGS: A total of 17 students completed the training. Four out of the six groups received a passing score on the OSCE. Students performed satisfactory in the major domains of MI but struggled to answer knowledge-based questions regarding COVID-19 vaccines. As a result of the training, a significant increase in student confidence was seen. All participating students rated the training as either "excellent" or "good." SUMMARY: A novel, co-curricular educational initiative was an effective tool to prepare student-pharmacists to utilize MI to combat vaccine hesitancy in underrepresented racial/ethnic minority populations.

A lot in a little: Assessment of skills laboratory course structures and faculty workloads.

INTRODUCTION: Pharmacy skills development is essential to pharmacy programs to ensure "practice-ready" graduates. The objective was to describe the landscape of skills laboratory (lab) courses and faculty workload across United States schools and colleges of pharmacy (S/COP). METHODS: The American Association of Colleges of Pharmacy Laboratory Instructors Special Interest Group disseminated an anonymous questionnaire to collect faculty demographics, skills lab format, faculty workload, and job satisfaction. Descriptive statistics were generated, and paired t-tests were used to assess changes before and during COVID-19. RESULTS: Faculty from 44 of 142 S/COP responded. Participants (n = 45) were more frequently assistant professors (49%), non-tenure track (80%), and female (98%). A mean of 103 students per class, with a mean of two lab courses in both the first and second years and 1.6 in the third year were reported. Courses had a mean 1.6 lab coordinators each. Many institutions leverage non-lab faculty, pharmacy volunteers, post-graduate trainees, and senior professional students to assist. Faculty reported a mean 28.2 hours per week related to lab activities. The mean assigned percent effort was 44% for teaching in the skills lab, demonstrating consistency with effort calculations. Job satisfaction (scale 1-10) decreased from 7.6 before COVID-19 to 6.4 during COVID-19 (P < .01), with satisfaction specifically with their lab role decreasing from 7.5 to 6.6 (P = .003). CONCLUSIONS: Skills lab faculty reported significant time coordinating labs and identified the need for additional support. S/COP should ensure appropriate personnel resources are available to provide quality clinical skills training.

Early skills laboratory warnings: Laboratory faculty perspectives on student barriers for progression to experiential education.

INTRODUCTION: This study characterized faculty perceptions of student barriers to achieving an Entrustable Professional Activities (EPA) level 2 or higher in the Patient Care Provider domain. METHODS: Pharmacy skills laboratory faculty participated in a nominal group technique (NGT) session. Participants reflected on two questions: "What behaviors would result in a student not achieving a rank of EPA readiness level 2 or higher?" and "What knowledge and skills would result in a student not achieving a rank of EPA readiness level 2 or higher?" Participants developed a ranked list using silent brainstorming, idea generation, clarification, and discussion. RESULTS: Two NGT sessions were conducted. Group 1 reported (lack of) professionalism, (inability to perform) physical skills, (lack of) critical thinking and interpreting data gathered during physical skills, and (inability to achieve) programmatic outcomes and mile makers exams as barriers. Group 2 ranked behaviors as lack of independence, not taking roles and responsibilities seriously, inability to follow instructions, lack of classroom engagement, and disorganized and unable to prioritize. Group 2 ranked knowledge and skills of significant errors when making medication recommendations, inability to identify accurate medication history, inability to perform tasks with time constraints, poor patient communication, and inability to identify resources. CONCLUSIONS: Pharmacy skills laboratory faculty can identify behaviors, knowledge, or skills that may prevent a student from achieving an EPA readiness level 2 or higher such as lack of professionalism and poor critical thinking skills and should be empowered to identify early warning signs for students' success and progression to experiential education.

Implementing electronic health records on a medical service trip improves the patient care process.

Background: The efficiency of the patient care process of short-term medical service trips is often not assessed. The Gregory School of Pharmacy has organized annual medical camps in rural Uganda, however, the paper health records used for documentation and communication between stations have shown several limitations that hinder an optimal patient care process. Therefore, our objective was to implement an electronic health record system in these medical camps to improve the workflow and optimize the patient care process. Methods: An electronic health record system that functioned over a battery-operated local area network was developed and implemented. Patient health information was entered and reviewed at the different stations using mobile devices. The impact of electronic health records (used in 2019) on the patient care process was assessed using the number of patients served per physician per hour and the number of prescriptions filled per hour and comparing these to paper records (used in 2017). Results: Electronic health records were successfully implemented and communication across stations was fluid, thus improving transitions. Importantly, 45% more patients were served per physician per hour and 38% more prescriptions were dispensed per hour when using electronic (2019) compared to paper records (2017), despite having a smaller team in 2019. Conclusion: Implementation of electronic health records in rural Uganda improved the patient care process and the efficiency of the medical camp.

The catalyst for change in teaching and assessing virtual laboratory skills.

INTRODUCTION: Historically, pharmacy skills laboratory courses have primarily been delivered utilizing in-person instruction; however, changes in methods of healthcare delivery serve as a catalyst to consider best practices for virtual learning in the skills laboratory setting. PERSPECTIVE: Shifting to a virtual delivery method is valuable for future curriculum and course development. Three specific delivery methods including flipped classroom, virtual formative simulations, and telehealth objective structured clinical examinations, provide examples of the opportunities and challenges instructors may encounter when shifting delivery methods. Furthermore, the examples illuminate the need to deliberately incorporate virtual technology into pharmacy skills laboratory courses to ensure students are practice-ready for the changing methods of delivery in the healthcare environment. IMPLICATIONS: Skills laboratory instructors and students must reimagine how patient care skills can be taught and assessed. It is imperative to reassess priorities and adapt skills-based courses to incorporate the virtual learning environment to prepare student pharmacists for future practice.

Developing a comprehensive APPE-readiness plan with a focus on skills, attitudes, and behaviors.

BACKGROUND AND PURPOSE: Pharmacy schools must have a framework to ensure students have the necessary knowledge, skills, attitudes, and behaviors to be successful during advanced pharmacy practice experiences (APPEs). EDUCATIONAL ACTIVITY AND SETTING: Ten summative assessments, called APPE-readiness assessments (ARAs), were developed based on eight competencies encompassing skills, behaviors, and attitudes that must be demonstrated prior to APPEs. All eight competencies were assessed in the course Case Studies in Pharmacotherapy IV, which is offered in the final semester of the didactic curriculum immediately prior to APPEs. A 15-question pre- and post-survey was conducted to assess student confidence in performing each APPE-readiness competency. Cohort data was evaluated by the curriculum and assessment committee to assess curriculum effectiveness and areas for improvement. FINDINGS: Upon completion of the course, the average first-attempt pass rate across all ARAs was 92.4%. All students who failed on the first attempt passed on the second attempt, thereby demonstrating APPE-readiness. Out of 62 students, 45 and 44 completed the pre- and post-survey, respectively. Prior to the ARAs, the overall average of students who felt (strongly) confident about their ability to perform each competency was 82.2 ± 2.1%. This increased to 92.6 ± 1.6% after the ARAs. SUMMARY: The development of an APPE-readiness assessment plan focusing on skills, attitudes, and behaviors provides insight into student and cohort performance and allows for continuous quality assurance of the pre-APPE curriculum.

First do no 'pharm': Educating medical and pharmacy students on the essentials of medication management.

BACKGROUND: Polypharmacy is a dilemma in modern medical practice and presents an opportunity for interprofessional collaboration. Our pilot project evaluated whether implementing an interprofessional education (IPE) session would influence awareness of interprofessional values/ethics, roles/responsibilities, communication, and teams/teamwork. INTERPROFESSIONAL EDUCATION ACTIVITY: A dual-institution, multi-part IPE session on medication management was implemented with medicine and pharmacy students. Part 1 consisted of a pillbox exercise whereby students simulated the patient experience of taking medications. Part 2 was an interprofessional medication reconciliation exercise with a standardized patient. After completing the session, students were asked to reflect on their experience in response to a prompt. Reflections were analyzed qualitatively for overarching themes. DISCUSSION: This pilot uniquely captured the interaction between medical and pharmacy students from neighboring institutions. After completing the IPE session, both groups of students felt they were better equipped to take a medication history, perform medication reconciliation, and understand the value of a community pharmacist. Major themes elicited from reflections included: (1) increased awareness of barriers to medication adherence, (2) increased empathy towards adults with polypharmacy, (3) appreciation for the interprofessional team, and (4) realization of the importance of medication reconciliation and patient understanding of their medications. IMPLICATIONS: The collaboration between institutions, located at a distance from one another, demonstrates a novel approach that can be used by others to facilitate IPE. All students gained experience interacting in an interprofessional setting simulating their future practice(s). Future studies are needed to evaluate the extent of those interactions and potential outcomes.

Engaging Pharmacy Students, Residents, and Fellows in Antimicrobial Stewardship.

Antimicrobial stewardship programs are mainly established by infectious diseases physicians and infectious diseases-trained clinical pharmacists with the goal of optimizing patients' outcomes while halting antimicrobial resistance, decreasing adverse events, and controlling health care cost. The role of the infectious diseases-trained clinical pharmacist in antimicrobial stewardship is well established; however, there are not enough formally trained pharmacists to assume the challenging responsibilities of the steward coordinator. The purpose of this article was to review the available literature and resources and propose a model to engage introductory pharmacy practice experience students, advanced pharmacy practice experience students, postgraduate year (PGY) 1 pharmacy residents, PGY2 infectious diseases pharmacy residents, and PGY2 or PGY3 infectious diseases pharmacy fellows in antimicrobial stewardship. Further studies are needed to assess and document the impact of pharmacy students and postgraduate trainees on antimicrobial stewardship programs.

Comparative effects of in vitro ischemia on contractile responses of mouse and rat bladders to various forms of stimulation.

OBJECTIVES: To compare in an in vitro study the sensitivity of rat and mouse bladders to ischemia and reperfusion. Urinary bladder dysfunction is related to ischemia and reperfusion. Several studies have been conducted in which one animal model was used in the urinary bladder dysfunction experiments, but very few studies have compared the consequences of urinary bladder dysfunction in different species. METHODS: Male rats and mice were anesthetized and their bladders removed. Bladder strips were placed in 15-mL baths containing oxygenated Tyrode's solution with glucose. Strips were stimulated by field stimulation, carbachol, and KCl, and the responses were recorded. Individual strips were switched for 1 hour to Tyrode's with no glucose equilibrated with nitrogen. During this hour, one half of the strips received repetitive stimulation. After the 1 hour of ischemia, the strips were returned to Tyrode's solution with glucose and oxygen for 1 hour without repetitive stimulation. The strips were restimulated as described above. RESULTS: The rat bladder generated significantly greater tension than the mouse bladder. The responses of the mouse, but not the rat, bladder strips were suppressed after repetitive field stimulation in normal solution. In both species, the responses were suppressed under ischemic conditions with or without repetitive stimulation. The responses of the mouse bladders were more sensitive to ischemia and repetitive stimulation than rat bladders. CONCLUSIONS: These results have demonstrated that the mouse bladder is more sensitive to ischemic stress than the rat bladder. This information would be important when choosing species for the study of ischemia and reperfusion.