Antimicrobial Therapy in Long-Term Care: Controversy, Colonization, and Criteria.

OBJECTIVE: To empower pharmacists to improve the outcomes of residents in long-term care facilities with urinary tract (UTIs) and skin and soft-tissue infections (SSTIs). DATA SOURCES: Relevant articles published since 1990 to date were found via PubMed regarding: long-term care, urinary tract infection, skin and soft-tissue infection, antimicrobials, multi-drug-resistant organisms, antimicrobial resistance, and dementia. Two additional Web sites were included for pharmacists' resources. A total of 28 sources were used (studies, Web sites, and review articles). STUDY SELECTION: Sixteen studies were included regarding treatment of suspected infections, antimicrobial resistance of organisms present in long-term care facilities, and interventions previously attempted toward antimicrobial stewardship. DATA EXTRACTION: The types of infection seen in long-term care facilities were narrowed to UTIs and SSTIs. Data were extracted regarding the type/resistance of bacteria and treatment outcomes. DATA ANALYSIS: The review demonstrates growing antimicrobial resistance in long-term care for pathogens causing UTIs and SSTIs. The review outlines guidelines for the treatment of such infections, and the incidence of asymptomatic bacteriuria, and subsequent overtreatment. Also included is a discussion of antimicrobial usage in dementia and resources for antimicrobial stewardship. CONCLUSION: Pharmacists can aid with antimicrobial stewardship in long-term care by educating providers on the need for changes in prescribing habits and the criteria for treating UTIs and SSTIs.

Chronic Obstructive Pulmonary Disease, Part 1: Disease State Review.

In 2018, chronic obstructive pulmonary disease (COPD) was estimated to affect 16.4 million people, or 6.6% of adults in the United States alone. In older people, the estimated prevalence is even higher with reported rates as high as 14.2% in adults older than 65 years of age. COPD is a preventable disease caused by repetitive exposure to noxious particles, especially inhaled toxins from cigarette smoke. It is associated with decreased quality of life, increased hospitalization, increased mortality, and significant financial burden to patients and health care systems. Senior care pharmacists are well-suited to provide assessment, treatment, and patient education related to COPD and smoking cessation. Early and frequent interventions can decrease symptom burden, reduce costs, and improve the lives of those with COPD.

A syndrome-based approach to antimicrobial stewardship in an Arizona skilled nursing facility-Moving the needle through quality improvement.

In 2015, an Arizona skilled nursing facility implemented an antibiotic stewardship protocol targeting unnecessary prescribing for suspect urinary tract infection. The protocol emphasized auditing of culturing and prescribing practices, feedback to prescribers, engagement of clinical staff, and educational in-services. Between Quarter 4 of 2014 (baseline) and Quarter 1 of 2017, urine culturing, days of antibiotic therapy for suspect urinary tract infection, and Clostridiodes difficile infections per 1,000 resident-days decreased by >50% with no urosepsis events.

Integration of mentored self-directed learning (MSDL) through both group and individual presentations in an accelerated modified block program.

BACKGROUND AND PURPOSE: Project aim was to examine the feasibility and logistics of mentored self-directed learning (MSDL) through group and individual presentations in an accelerated modified block curriculum. Perspectives of students and faculty members toward the incorporation of MSDL were also explored. EDUCATIONAL ACTIVITY AND SETTING: During a two-week pharmacotherapy block, students made group presentations requiring two elements: a case presentation on curricular content (Element-1) and an inclusion of "novel" information students did not receive didactically (Element-2). Curricular content for Element-1 stemmed from a pharmacotherapy course on gastroenterology and nutrition, and individual presentations were scheduled during a semester-long skill-based course. Surveys on student perspectives were conducted at baseline, after group presentations, and after individual presentations. Faculty members also provided feedback and evaluations. FINDINGS: Whereas 58% of students considered a case presentation (Element-1) more valuable for their learning than inclusion of Element-2, 78% of faculty's responses indicated the incorporation of both Elements was valuable. For the following individual presentations, 73% of students were willing and able to present a topic not extensively addressed in the didactic curriculum by employing MSDL. Students improved their confidence in preparing and making presentations for peers and faculty/preceptors through the MSDL activities (p < 0.025). At the end of this project, the faculty determined 88% of students were ready to give a presentation considered appropriate for Advanced Pharmacy Practice Experience. DISCUSSION: MSDL through group and individual presentation activities were feasible and provided a valuable learning experience for students in an accelerated modified block curriculum.

Depression in the older adult: What should be considered?

INTRODUCTION: The updated American Geriatrics Society (AGS) 2015 Beers Criteria include the following antidepressant classes as potentially inappropriate medications to be used with caution in older adults: selective serotonin reuptake inhibitors, serotonin norepinephrine reuptake inhibitors, tricyclic antidepressants, and mirtazapine. METHODS: A search of the medical literature using PubMed and references included in the AGS 2015 Beers Criteria. RESULTS: The treatment of depression in the older adult can additionally be complicated by comorbid conditions, as 80% of older adults have at least 1 comorbid condition and 50% have at least 2. These considerations limit the pharmacologic treatment options for depression in older adults. However, the treatment of major depression should not be overlooked, as it is quite common, with estimates of up to 5% of older adults in the community and up to 13.5% in older adults who receive home health care. DISCUSSION: This article reviews treatment considerations of depression in the older adult, including both available screening tools and a discussion balancing the need for treatment of depression in this population with the concerns addressed in the 2015 Beers Criteria.