Identification of Antibiotic Administration as a Potentially Novel Factor Associated With Tacrolimus Trough Variability in Kidney Transplant Recipients: A Preliminary Study.

Tacrolimus trough variability is an important risk factor for kidney allograft outcomes. Recent evidence suggests that the gut microbiota is associated with tacrolimus dosing requirements and direct metabolism of tacrolimus. We hypothesize that administration of antibiotics, which are known to alter the gut microbiota, is associated with tacrolimus trough variability. METHODS: We conducted a retrospective chart review of subjects who received kidney transplants at our institution from 2012 to 2013 and evaluated subjects who received antibiotics during the first month of transplantation (Abx Group, N = 60) and subjects who did not (No Abx Group, N = 200). We evaluated whether antibiotic administration in the Abx Group had increased tacrolimus trough concentrations and concentration over tacrolimus dosage (C/D) after antibiotic administration. We also evaluated tacrolimus variability as measured by standard deviation (SD) and coefficient of variation between the Abx Group and No Abx Group. RESULTS: In the Abx Group, tacrolimus trough concentration over tacrolimus dosage (C/D) increased 7 and 15 days after antibiotic administration (P = 0.001, P = 0.07, respectively, Wilcoxon signed-rank test). From postoperative day 31-45, the variability in tacrolimus trough levels in the Abx Group as measured by SD and coefficient of variation was significantly higher than the variability in the No Abx Group (P = 0.03, P = 0.02, Wilcoxon rank sum test, respectively). CONCLUSIONS: Our identification of antibiotic administration as a potentially new risk factor for tacrolimus trough variability suggests the need to carefully follow tacrolimus trough levels after antibiotic administration.

Evaluation of medical student experience using medical student created StudentPACS flash based PACS simulator tutorials for learning radiological topics.

RATIONALE AND OBJECTIVES: With studies regularly containing hundreds of images, the authors believe that the ability to efficiently review numerous images and identify findings is an important skill to teach medical students. Using the StudentPACS Adobe Flash extension, created within their department, the authors created StudentPACS modules that provide users with a virtual picture archiving and communication system environment, in which findings can be selected by mouse, triggering questions with referenced answers. The aim was to assess medical students' impressions of how learning from these modules compared to their personal experiences learning radiology from textbooks or static images. MATERIALS AND METHODS: StudentPACS modules were created by medical students on elective under the supervision of resident and attending radiologists. MS I to IV students were then asked to complete StudentPACS modules that tied in with their current coursework, followed by an anonymous survey. Approximately 293 students participated. RESULTS: The majority of students reported that StudentPACS modules were either equivalent to or better than learning from static images or textbooks (90 +/- 3% [257 of 285], P < .00002), were not difficult to use (85 +/- 4% [248 of 293], P < .00002), presented them with clinical content that tied in well with the depicted imaging (90 +/- 3% [263 of 293], P < .00002), and taught them new information (69 +/- 5% [202 of 293], P < .00002). Most respondents felt the StudentPACS modules presented information they would find useful in clinical practice (91 +/- 3% [266 of 293], P < .00002), reported satisfactory experiences using StudentPACS modules as a source of self-directed learning material (79 +/- 5% [232 of 293], P < .00002), and stated that they would use StudentPACS modules for learning different topics in the future (85.6 +/- 4% [244 of 285], P < .00002). CONCLUSION: Medical students found using StudentPACS modules at least equivalent to, if not better than, using static books or annotated images.