Impact of education and clinic site champion on extragenital testing for sexually transmitted infections.

BACKGROUND: Sexually transmitted infections (STIs) are on the rise in the United States. Infections at extragenital (EG) sites (throat or rectum) may serve as an overlooked reservoir for STIs. The aims of this project were to determine the proportion of patients receiving EG testing and to observe the impact of an educational intervention. METHODS: Phase I included four urgent care clinics and baseline data for adults receiving STI testing (Chlamydia trachomatis and Neisseria gonorrhoeae). Clinics received access to an educational presentation regarding the importance of EG testing. Two of these clinics served as pilot sites for the implementation of self-collection kits. Phase II involved further expansion and utilization of clinic site champions. RESULTS: Phase I baseline data indicated that less than 1% of samples from patients receiving STI testing were from EG sites. There was an increase in EG testing after the educational intervention and implementation of self-collection kits. A larger increase in EG testing was seen after utilization of a site champion in Phase II. CONCLUSION: EG infections serve as a potential source for STI transmission which makes multi-site testing necessary. Our interventions to improve EG testing were most effective in Phase II after implementing a clinic site champion.

Serum sickness-like reaction associated with efalizumab.

OBJECTIVE: To report a case of serum sickness-like reaction (SSLR) possibly induced by efalizumab, a recombinant humanized immunoglobulin G1 kappa isotype monoclonal antibody approved for treatment of moderate-to-severe plaque psoriasis. CASE SUMMARY: A 37-year-old woman with plaque psoriasis who had been treated with efalizumab for 2 months developed a fever, erythematous rash, and progressive joint swelling and pain that required hospitalization. An exhaustive workup for infectious and rheumatologic causes of the patient's symptoms was negative. Given the relative temporal relationship between efalizumab therapy and the patient's signs and symptoms, a diagnosis of serum sickness was made. Systemic corticosteroids were initiated, which resulted in rapid resolution of the patient's signs and symptoms. Use of an objective causality assessment suggests that the patient's SSLR was possibly related to efalizumab. DISCUSSION: Like many therapeutic monoclonal antibodies, efalizumab is associated with several adverse events, including allergic reactions. SSLR, a nonimmediate hypersensitivity syndrome, can occur with a variety of drugs including monoclonal antibodies. However, a MEDLINE search (1964-July 2008) identified only one other possible case of SSLR related to efalizumab. CONCLUSIONS: Clinicians using efalizumab should be aware of this possible adverse reaction.

A collaborative program to increase adult pneumococcal vaccination rates among a high-risk patient population receiving care at urgent care clinics.

OBJECTIVE: We report a project that utilized pharmacy students to increase pneumococcal vaccination rates in patients aged 19-64 years with high-risk medical conditions within urgent care clinics. The study also sought to better identify the number of patients previously vaccinated for pneumococcal disease. A total of 1,178 patients were considered eligible for pneumococcal vaccination during the study period, 287 (24.4%) of whom were determined to be previously vaccinated through chart assessment or patient interview. Of the remaining 891 patients, chart documentation of pneumococcal vaccination administered at the time of the urgent care visit was present for 96 patients (10.7%) in the intervention clinics compared with 6 patients in 2 control clinics who received the usual standard of care (P < .0001).