Clostridioides (Formerly Clostridium) difficile Infection During Hospitalization Increases the Likelihood of Nonhome Patient Discharge.

BACKGROUND: Clostridioides (formerly Clostridium) difficile infection (CDI) is associated with significant morbidity and mortality, including frequent hospitalizations. However, the impact of CDI after hospital discharge is poorly understood. The purpose of this study was to assess patient discharge disposition and understand CDI-related risk factors for nonhome discharge. METHODS: Using a nationally representative database of Veterans Health Administration (VHA) patients (2003-2014) and a validation database from hospitalized non-VHA patients in Houston, Texas, admission and discharge disposition was obtained for patients with CDI and matched controls. Incidence of and clinical/microbiologic risk factors for nonhome discharge were assessed using these databases. RESULTS: A total of 15173 VHA patients with CDI and 48599 non-CDI control patients originally admitted from the community were included. Significantly more patients with CDI were discharged to a nonhome location compared with controls (18% vs 8%; P < .0001), most commonly hospice/death (12%) or nursing home/long-term care facility (6%). Results were confirmed using a propensity-matched analysis and a validation cohort of 1941 hospitalized patients with CDI in Houston, Texas. Age, comorbidities, severe CDI, and ribotypes F027, F001, and F053-163 were associated with a nonhome discharge (P < .05 for all). CONCLUSIONS: Hospitalized patients with CDI frequently required a higher level of medical care residence at discharge compared with non-CDI patients. Risk factors for discharge to a higher level of care included CDI disease severity and variables associated with recurrent CDI.

Assessment of the validity of peer scores and peer feedback in an online peer assessment platform (Kritik).

BACKGROUND AND PURPOSE: Online peer assessment platforms aim to improve the accuracy of peer scores (numerical scores based on a rubric) and hold students accountable for peer feedback (written comments). We evaluated the validity of peer scores and peer feedback using the online platform, Kritik. EDUCATIONAL ACTIVITY AND SETTING: The course was a two-credit hour online infectious diseases pharmacotherapy elective consisting of twelve third-year students enrolled in a four-year doctor of pharmacy program. Students analyzed patient cases and created video presentations of their therapeutic care plan weekly. Each student scored three peers' presentations using a rubric and provided peer feedback in Kritik. The instructor independently scored the presentations. The students' presentation scores, which was the weighted average of three peers' scores, was compared to the instructor's score. Students also rated the peer feedback they received using two Likert-type scales (feedback-on-feedback [FoF] ratings). Two faculty rated 97 randomly selected peer feedback (written comments) and recorded their FoF ratings separately. Students completed an anonymous course evaluation and exit survey. FINDINGS: The Pearson correlation coefficient between weighted peer scores and instructor scores for 91 presentations was r = 0.880. There was fair agreement in FoF ratings between students and faculty based on weighted kappa. All students would recommend the course and had a positive experience with peer assessment and the platform. SUMMARY: Weighted peer scores strongly correlated with instructor scores, and students held each other accountable for peer feedback in Kritik. Our findings should be confirmed in different contexts and settings.

Development of a communication-based virtual patient counseling objective structured clinical examination (OSCE) for first year student pharmacists.

Objective: This text seeks to describe a framework for delivering and executing a virtual patient counseling OSCE and compare student performance to the in-person alternative. Methods: A communication-based virtual patient counseling objective structured clinical examination (OSCE) was created to fulfill the educational outcomes of a previously held in-person OSCE in response to the COVID-19 pandemic. The virtual nature of this OSCE simulated a telehealth encounter, which has increased in utilization since the beginning of the COVID-19 pandemic. This OSCE was offered twice in one semester - once as a formative assessment and once as a summative assessment. Student performance was mapped to learning outcomes and compared the previous year's in person performance. Results: The described virtual framework for executing the OSCE successfully decreased the time required and saw <1% change in overall performance from students when compared to the previous year in person which was not statistically significant. Conclusion: This framework for a virtual communication-based OSCE reduces time with a negligible impact on student performance compared to the in person alternative. Innovation: This work describes a telehealth virtual patient counseling model to replace the traditional patient counseling OSCE in pharmacy education with comparable outcomes.

Improving pharmacy students' empathy and attitudes regarding opioid overdose and substance use disorder in a skills-based learning environment.

INTRODUCTION: Using a skills-based learning environment as a launch pad for developing empathy for patients with substance use disorder or at high risk for opioid overdose allows for learning continuity and early intervention. Empathy for this patient population may reduce bias and stigma associated with negative health outcomes. Previous studies have assessed empathy in pharmacy students, but not in the context of substance use disorder and opioid overdose harm reduction among first professional year pharmacy students in skills-based education. This cohort study aimed to measure the change in empathy and opioid overdose-related attitudes before and after a two-part skills-based learning activity that focused on drug diversion and opioid overdose treatment. METHODS: First professional year pharmacy students were given a pre- and post-survey consisting of empathy and attitudes sections. The Kiersma-Chen Empathy Scale (KCES) and the Opioid Overdose Attitudes Scale (OOAS) were used. The intervention was a skills-based learning activity with two segments, one that focused on naloxone counseling and the other focused on drug diversion. RESULTS: The aggregate mean change in KCES and OOAS scores of the cohort increased by 1.837 (P = .014) and 2.349 (P = .008), respectively. Of note, students with lower baseline empathy and attitudes scores showed more improvement in both KCES and OOAS scores. CONCLUSIONS: Students showed improvement in empathy and attitudes regarding opioid overdose and substance use disorder. A larger magnitude of improvement was noted with lower baseline scores.