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2.
Med Clin North Am ; 107(6): 963-977, 2023 Nov.
Article in English | MEDLINE | ID: mdl-37806728

ABSTRACT

Throughout the coronavirus disease 2019 (COVID-19) pandemic, there have been numerous demands on primary care practices and providers affecting work engagement and burnout, which can affect health-care delivery and patient outcomes. We determined potentially modifiable factors associated with work engagement among employees of federally qualified health centers (FQHCs) throughout Louisiana. Resilient coping, spirituality, and social support were associated with being engaged at work. FQHC employees perceiving a more chaotic work environment and those with depressive or anxiety symptoms were less likely to be engaged at work. Being engaged was associated with confidence in COVID-19 vaccine recommendation for adults.


Subject(s)
Burnout, Professional , COVID-19 , Adult , Humans , COVID-19 Vaccines , Health Services Accessibility , Louisiana , Burnout, Professional/epidemiology , Burnout, Professional/prevention & control
3.
Article in English | MEDLINE | ID: mdl-37569001

ABSTRACT

Some of the lowest COVID-19 community vaccination rates in America are found in Louisiana. This study investigated: (1) barriers that Louisiana pharmacists encountered during the pandemic; and (2) the effect of pharmacists' role and identity confidence on willingness to enforce vaccine mandates, and COVID-19 vaccine uptake. Fifty-four community pharmacists from nine regions of Louisiana participated in the study. Pharmacists completed questionnaires about: personal demographics, patient population, vaccination encouragement, COVID-19 concerns, and vaccination administration rates. The importance of feeling like a trusted voice in the community, as well as professional perception and self-assurance, were measured using Likert scale questions. During focus groups, participants discussed experiences with the COVID-19 vaccination rollout and vaccination-related obstacles. As the pandemic progressed, pharmacists reported being overworked, understaffed, and overburdened with new responsibilities. In regions with lower vaccination rates, pharmacists were less likely to feel at ease enforcing vaccine mandates. Independent pharmacists were less comfortable enforcing vaccine mandates than chain pharmacists but had more positive perceptions of their role and identity. This study contributes to further understanding of pharmacy workflow obstacles and pharmacists' perceptions of their professional roles and identities in the community.


Subject(s)
COVID-19 , Community Pharmacy Services , Vaccines , Humans , Pharmacists , COVID-19 Vaccines , Prospective Studies , COVID-19/epidemiology , COVID-19/prevention & control , Professional Role
4.
Am J Med Sci ; 366(4): 254-262, 2023 10.
Article in English | MEDLINE | ID: mdl-37517691

ABSTRACT

BACKGROUND: Diverse, equitable and inclusive participation in clinical research is needed to ensure evidence-based clinical practice and lessen disparities in health outcomes. Yet, clinical trial participation remains critically low in minoritized communities, particularly among Blacks. The Louisiana Community Engagement Alliance against COVID-19 Disparities (LA-CEAL) was launched in response to the disproportionate impact of COVID-19 on Black Louisianans to understand community barriers and preferences and increase inclusive participation in research. This study aims to understand perceptions regarding COVID-19 trial participation among underrepresented Louisianans. METHODS: A rapid assessment integrating cross-sectional, surveys among federally qualified health center (FQHC) patients and community residents, and focus group discussions (FGDs) from community representatives was conducted in 2020-2021. Factors and perceptions underlying trial participation were identified using logistic regression models and thematic analyses, respectively. RESULTS: Quantitative findings (FQHC: N=908, mean age=46.6 years, 66.4% Black; community: N=504, mean age=54.2 years, 93.7% Black) indicated that 0.9% and 3.6%, respectively, ever participated in a COVID-19 trial. Doctors/Healthcare providers were most trusted (FQHC=55.1%; community=59.3%) sources of information about trials. Advancing age was associated with increased odds of being very willing to participate (ORFQHC=1.03, 95% CI 1.02-1.05; ORCommunity=1.02, 95% CI 1.00-1.04). Qualitative data (6 FGDs, 29 attendees) revealed limited awareness, experimentation/exploitation-based fears, and minimal racial/ethnic representation among trialists as barriers to participation. CONCLUSION: COVID-19 trial participation rates were low in our sample. Altruism was a key facilitator to participation; fear, mistrust, and low awareness were predominant barriers. Community-centered approaches, engaging informed providers and trusted community members, may facilitate inclusive trial participation.


Subject(s)
COVID-19 , Humans , Middle Aged , Qualitative Research , Cross-Sectional Studies , COVID-19/epidemiology , Focus Groups , Louisiana
5.
Public Health Rep ; 138(3): 422-427, 2023.
Article in English | MEDLINE | ID: mdl-36971286

ABSTRACT

Limited studies are available on how decisions and perceptions on SARS-CoV-2 vaccination have changed since the start of vaccination availability. We performed a qualitative study to identify factors critical to SARS-CoV-2 vaccination decision making and how perspectives evolved among African American/Black, Native American, and Hispanic communities disproportionately affected by COVID-19 and social and economic disadvantage. We conducted 16 virtual meetings, with 232 participants in wave 1 meetings (December 2020) and with 206 returning participants in wave 2 meetings (January and February 2021). Wave 1 vaccine concerns in all communities included information needs, vaccine safety, and speed of vaccine development. Lack of trust in government and the pharmaceutical industry was influential, particularly among African American/Black and Native American participants. Participants showed more willingness to get vaccinated at wave 2 than at wave 1, indicating that many of their information needs had been addressed. Hesitancy remained greater among African American/Black and Native American participants than among Hispanic participants. Participants in all groups indicated that conversations tailored to their community and with those most trustworthy to them would be helpful. To overcome vaccine hesitancy, we propose a model of fully considered SARS-CoV-2 vaccine decision making, whereby public health departments supply information, align with community values and recognize lived experiences, offer support for decision making, and make vaccination easy and convenient.


Subject(s)
COVID-19 Vaccines , COVID-19 , Decision Making , Humans , American Indian or Alaska Native/psychology , Black or African American/psychology , COVID-19/prevention & control , COVID-19 Vaccines/administration & dosage , Hispanic or Latino/psychology , SARS-CoV-2 , Vaccination/psychology
6.
Article in English | MEDLINE | ID: mdl-36554617

ABSTRACT

The purpose of this study was to explore the impact of eligibility for the coronavirus 2019 (COVID-19) vaccine at the time of the vaccine rollout as a predictor of vaccine intent within the African American community. METHODS: Four hundred eighty-seven African American participants in southeastern Louisiana were surveyed from January-April of 2021, with follow-up surveys occurring in Fall 2021. Survey domains included demographics, vaccine hesitancy, discrimination in the healthcare setting, and knowledge and experiences with COVID-19. Descriptive statistics, Chi-square tests, and binary logistic regression were performed. RESULTS: Participants eligible for the vaccine were 1.61 times as likely to express positive vaccine intent versus ineligible participants. Additional predictors of vaccine intent were age, insurance status and coverage, and female sex at birth. In the multivariable logistic analysis, eligible individuals were 2.07 times as likely to receive the vaccine versus ineligible individuals. CONCLUSIONS: Vaccine eligibility for the COVID-19 vaccine was a significant predictor of intent to vaccinate in the African American community. Younger individuals were less likely to have a positive intent, correlating with the eligibility of ages 16+ occurring 5 months post-vaccine approval.


Subject(s)
COVID-19 Vaccines , COVID-19 , Infant, Newborn , Humans , Female , Adolescent , Black or African American , Cohort Studies , COVID-19/epidemiology , COVID-19/prevention & control , Vaccination , Louisiana/epidemiology
7.
Am J Public Health ; 112(S9): S900-S903, 2022 11.
Article in English | MEDLINE | ID: mdl-36446056

ABSTRACT

In February 2022, an educational model was launched to train Louisiana pharmacists to become positive influencers of vaccination decisions via targeted, culturally competent interventions, with the objective of improving COVID-19 vaccine uptake in communities. A total of 47 pharmacists completed the course, and more than 90% noted that the education would help them optimize vaccine acceptance in their community practice settings. The pharmacists will participate in vaccine surveillance to assess the success of the educational model intervention and predictors of vaccine uptake. (Am J Public Health. 2022;112(S9):S900-S903. https://doi.org/10.2105/AJPH.2022.307070).


Subject(s)
COVID-19 , Vaccines , Humans , Models, Educational , Pharmacists , COVID-19 Vaccines , Cultural Competency , Vaccination Hesitancy , COVID-19/prevention & control , Louisiana
8.
BMJ Open ; 12(9): e059566, 2022 09 13.
Article in English | MEDLINE | ID: mdl-36100299

ABSTRACT

OBJECTIVES: In recent years, Iraq has expanded and revised the childhood immunisation schedule, but estimates of the costs of the programme are unavailable. The objective of this study was to estimate the economic costs of delivering childhood vaccines in Iraq from a government perspective. SETTING: Health facilities were sampled using multistage probabilistic sampling and stratifying the country into three regions: Central and South, North/Kurdistan Region, and Retaken Areas. Cost data were collected from 97 health facilities and 44 district and regional vaccine stores. Total national costs were extrapolated using sample weight calibration. PARTICIPANTS: Administrators at each health facility and vaccine store were interviewed using a standardised survey. PRIMARY AND SECONDARY OUTCOME MEASURES: Total costs of vaccine delivery per year, costs per dose delivered and delivery costs per fully vaccinated child. RESULTS: An estimated 15.3 million vaccine doses were delivered in 2018, costing US$99.35 million, excluding costs of vaccines and injection material. Nearly 90% of delivery costs were attributed to personnel salaries. Vaccine record-keeping and management (21%) and facility-based vaccine delivery (19%) were the largest cost contributors. Vaccine transport and storage, programme management, and outreach services represented 13%, 12% and 10%, respectively. All other activities represented less than 10% of the total cost. Average costs per dose delivered was US$6.48, ranging from US$9.13 in Retaken Areas to US$5.84 in the Central and South. Vaccine delivery costs per fully vaccinated child totalled US$149. CONCLUSION: This study provides baseline evidence of the current programme costs and human resource uses which can be used for annual planning, identifying areas for improvement, and targeting strategies to increase programme efficiency.


Subject(s)
Immunization Programs , Vaccines , Child , Cross-Sectional Studies , Health Facilities , Humans , Iraq
9.
J Am Pharm Assoc (2003) ; 62(5): 1675-1679, 2022.
Article in English | MEDLINE | ID: mdl-35738993

ABSTRACT

BACKGROUND: The U.S. Department of Agriculture (USDA) classifies numerous neighborhoods in New Orleans, Louisiana, as food deserts or areas with inadequate access to good quality foods. With approximately 35% of all patients with type 2 diabetes (T2DM) establishing disease control, we hypothesize those living in food deserts will have increased difficulty in controlling T2DM. The purpose of this study is to evaluate the effect of food deserts on glycemic control in patients with T2DM. OBJECTIVE: The purpose of this study is to analyze the effect of food access on T2DM control in patients at a diabetes management clinic compared with the national average of T2DM control. METHODS: Eligible records for review included patients residing in a USDA-determined food desert with a T2DM diagnosis. The primary end point was the proportion of patients with controlled T2DM. T2DM control was defined as glycosylated hemoglobin values less than 7% and less than 7.5% in patients older than 65 years. Records were retrieved for review between the dates of February 2017 and February 2020. RESULTS: A total of 109 patient records were reviewed. Of these, 23 patients (21%) achieved glycemic control. There was a 14% difference (35%-21%) between the food desert patients with T2DM and the general United States population of patients with T2DM (P = 0.030). CONCLUSION: This study underscores the potential implications of limited food access on patients' abilities to manage chronic conditions like T2DM. Clinicians who work in resource-limited settings or with marginalized patient populations have a responsibility to consider food access and other health disparities when creating realistic and feasible treatment goals.


Subject(s)
Diabetes Mellitus, Type 2 , Blood Glucose , Diabetes Mellitus, Type 2/therapy , Glycated Hemoglobin , Humans , New Orleans , Residence Characteristics , United States
10.
BMJ Glob Health ; 7(Suppl 3)2022 06.
Article in English | MEDLINE | ID: mdl-35750345

ABSTRACT

The purpose of this study is to evaluate Iraq's health facility preparedness for the surge of hospitalised cases associated with the ongoing COVID-19 pandemic. In this article, we review pandemic preparedness at both general and tertiary hospitals throughout all districts of Iraq. COVID-19 pandemic preparedness, for the purpose of this review, is defined as: (1) staff to patient ratio, (2) personal protective equipment (PPE) to staff ratio, (3) infection control measures training and compliance and (4) laboratory and surveillance capacity. Despite the designation of facilities as COVID-19 referral hospitals, we did not find any increased preparedness with regard to staffing and PPE allocation. COVID-19 designated hospital reported an increased mean number of respiratory therapists as well as sufficient intensive care unit staff, but this did not reach significant levels. Non-COVID-19 facilities tended to have higher mean numbers of registered nurses, cleaning staff and laboratory staff, whereas the COVID-19 facilities were allocated additional N-95 masks (554.54 vs 147.76), gowns (226.72 vs 104.14) and boot coverings (170.48 vs 86.8) per 10 staff, but none of these differences were statistically significant. Though COVID-19 facilities were able to make increased requisitions for PPE supplies, all facility types reported unfulfilled requisitions, which is more likely a reflection of global storage rather than Iraq's preparedness for the pandemic. Incorporating future pandemic preparedness into health system strengthening efforts across facilities, including supplies, staffing and training acquisition, retention and training, are critical to Iraq's future success in mitigating the ongoing impact of the ongoing COVID-19 pandemic.


Subject(s)
COVID-19 , Pandemics , Delivery of Health Care , Hospitals , Humans , Iraq
11.
Confl Health ; 15(1): 76, 2021 Oct 18.
Article in English | MEDLINE | ID: mdl-34663395

ABSTRACT

OBJECTIVES: The objective of this study was to assess the resilience of health systems in four governorates affected by conflict from 2014 to 2018, and to convey recommendations. METHODS: Health managers from Al Anbar, Ninawa, Salah al-Din, and Kirkuk governorates discussed resilience factors of Primary Health Care services affected by the 2014-2017 ISIS insurgency in focus groups, and general discussions. Additional information was gathered from key informants and a UNICEF health facility survey. Three specific aspects were examined: (1) meeting health needs in the immediate crisis response, (2) adaptation of services, (3) restructuring and recovery measures. Data from a MoH/UNICEF national health facility survey in 2017 were analyzed for functionality. RESULTS: There were many common themes across the four governorates, with local variations. (1) Absorption The shock to the public sector health services by the ISIS invasion caught health services in the four governorates unprepared, with limited abilities to continue to provide services. Private pharmacies and private clinics in some places withstood the initial shock better than the public sector. (2) Adaptation After the initial shock, many health facilities adapted by focusing on urgent needs for injury and communicable disease care. In most locations, maternal, neonatal, and child health (MNCH) preventive and promotive PHC services stopped. Ill persons would sometimes consult health workers in their houses at night for security reasons. (3) Restructuring or transformative activities In most areas, health services recovery was continuing in 2020. Some heavily damaged facilities are still functioning, but below pre-crisis level. Rebuilding lost community trust in the public sector is proving difficult. CONCLUSION: Health services generally had little preparation for and limited resilience to the ISIS influx. Governorates are still restructuring services after the liberation from ISIS in 2017. Disaster planning was identified by all participants as a missing component, as everyone anticipated future similar emergencies.

12.
Am J Pharm Educ ; 85(3): 8345, 2021 03.
Article in English | MEDLINE | ID: mdl-34283771

ABSTRACT

Objective. To determine whether the exposure to sterile compounding in the pharmacy curriculum produces Doctor of Pharmacy graduates who are both competent and confident in the area of sterile compounding, and to identify additional variables that may predict student performance.Methods. Participants were recruited from the fourth-year pharmacy class of 2018 at one university. The students were asked to complete a questionnaire assessing the following domains: demographics, confidence in compounding performance, prior experience, and theoretical knowledge. A written assessment was followed by a faculty-evaluated practicum in which the students were required to prepare two sterile products using a standardized rubric. Results were analyzed with a Student t test and linear regression to determine differences in performance based upon prior experience, confidence, and theoretical knowledge.Results. Overall, the 158 students performed well on the knowledge and skill examination, achieving an average total score of 89.8%. Of the 158 total participants, the 122 survey respondents had an overall mean confidence score of 2.9 on a four-point Likert scale, with 40.2% of students scoring in the confident or very confident range of the survey. In our analysis, we found that neither prior compounding experience or self-rated confidence were predictive of students' total score.Conclusion. The results of this study suggest that the inclusion of sterile compounding education and training in all four years of the pharmacy curriculum produces PharmD graduates who are competent, with varying levels of confidence in the area of sterile compounding.


Subject(s)
Education, Pharmacy , Pharmacy , Students, Pharmacy , Curriculum , Drug Compounding , Humans
13.
World J Emerg Surg ; 12: 34, 2017.
Article in English | MEDLINE | ID: mdl-28775763

ABSTRACT

BACKGROUND: Antimicrobial Stewardship Programs (ASPs) have been promoted to optimize antimicrobial usage and patient outcomes, and to reduce the emergence of antimicrobial-resistant organisms. However, the best strategies for an ASP are not definitively established and are likely to vary based on local culture, policy, and routine clinical practice, and probably limited resources in middle-income countries. The aim of this study is to evaluate structures and resources of antimicrobial stewardship teams (ASTs) in surgical departments from different regions of the world. METHODS: A cross-sectional web-based survey was conducted in 2016 on 173 physicians who participated in the AGORA (Antimicrobials: A Global Alliance for Optimizing their Rational Use in Intra-Abdominal Infections) project and on 658 international experts in the fields of ASPs, infection control, and infections in surgery. RESULTS: The response rate was 19.4%. One hundred fifty-six (98.7%) participants stated their hospital had a multidisciplinary AST. The median number of physicians working inside the team was five [interquartile range 4-6]. An infectious disease specialist, a microbiologist and an infection control specialist were, respectively, present in 80.1, 76.3, and 67.9% of the ASTs. A surgeon was a component in 59.0% of cases and was significantly more likely to be present in university hospitals (89.5%, p < 0.05) compared to community teaching (83.3%) and community hospitals (66.7%). Protocols for pre-operative prophylaxis and for antimicrobial treatment of surgical infections were respectively implemented in 96.2 and 82.3% of the hospitals. The majority of the surgical departments implemented both persuasive and restrictive interventions (72.8%). The most common types of interventions in surgical departments were dissemination of educational materials (62.5%), expert approval (61.0%), audit and feedback (55.1%), educational outreach (53.7%), and compulsory order forms (51.5%). CONCLUSION: The survey showed a heterogeneous organization of ASPs worldwide, demonstrating the necessity of a multidisciplinary and collaborative approach in the battle against antimicrobial resistance in surgical infections, and the importance of educational efforts towards this goal.


Subject(s)
Anti-Infective Agents/therapeutic use , Antimicrobial Stewardship/methods , Intraabdominal Infections/drug therapy , Postoperative Complications/drug therapy , Cross-Sectional Studies , Global Health/trends , Humans , Surveys and Questionnaires
14.
Am J Pharm Educ ; 81(9): 6004, 2017 Nov.
Article in English | MEDLINE | ID: mdl-29302084

ABSTRACT

Objective: To provide specific considerations for hosting non-U.S. pharmacy students at U.S.-based colleges/schools of pharmacy (C/SOP) for experiential clerkships and training. Findings: A literature review (2000-2016) in PubMed, Google Scholar and IPA databases was conducted using specific keywords. Recommendations and future directions for development of experiential rotations for non-U.S. students in U.S. experiential rotations are presented for both the home and host country. Summary articles and best practices across the disciplines, as well as expert opinion, were found across U.S. models for hosting non-U.S. students in advanced practice rotations in the medical disciplines. Consistent themes regarding legal agreements, acculturation, standardized calendars and social and safety considerations were considered for inclusion in the final document. Conclusion: Development of a successful experiential rotation/training for non-U.S. students requires consideration for well-developed objectives, qualified preceptors, multitude of legal and cultural considerations and recommendations for longevity and sustainability.


Subject(s)
Clinical Clerkship , Education, Pharmacy/methods , International Educational Exchange , Problem-Based Learning/methods , Schools, Pharmacy , Students, Pharmacy , Teaching , Cooperative Behavior , Curriculum , Humans , United States
15.
World J Emerg Surg ; 11: 33, 2016.
Article in English | MEDLINE | ID: mdl-27429642

ABSTRACT

Intra-abdominal infections (IAI) are an important cause of morbidity and are frequently associated with poor prognosis, particularly in high-risk patients. The cornerstones in the management of complicated IAIs are timely effective source control with appropriate antimicrobial therapy. Empiric antimicrobial therapy is important in the management of intra-abdominal infections and must be broad enough to cover all likely organisms because inappropriate initial antimicrobial therapy is associated with poor patient outcomes and the development of bacterial resistance. The overuse of antimicrobials is widely accepted as a major driver of some emerging infections (such as C. difficile), the selection of resistant pathogens in individual patients, and for the continued development of antimicrobial resistance globally. The growing emergence of multi-drug resistant organisms and the limited development of new agents available to counteract them have caused an impending crisis with alarming implications, especially with regards to Gram-negative bacteria. An international task force from 79 different countries has joined this project by sharing a document on the rational use of antimicrobials for patients with IAIs. The project has been termed AGORA (Antimicrobials: A Global Alliance for Optimizing their Rational Use in Intra-Abdominal Infections). The authors hope that AGORA, involving many of the world's leading experts, can actively raise awareness in health workers and can improve prescribing behavior in treating IAIs.


Subject(s)
Anti-Infective Agents/pharmacology , International Cooperation , Intraabdominal Infections , Drug Resistance, Microbial , Humans , Intraabdominal Infections/diagnosis , Intraabdominal Infections/drug therapy , Intraabdominal Infections/microbiology , Microbial Sensitivity Tests , Prognosis
16.
Am J Pharm Educ ; 80(3): 38, 2016 Apr 25.
Article in English | MEDLINE | ID: mdl-27170809

ABSTRACT

International outreach by schools and colleges of pharmacy is increasing. In this paper, we provide current practice guidelines to establish and maintain successful global/international advanced pharmacy practice experiences (G/I APPEs) with specific recommendations for home/host country and host site/institution. The paper is based on a literature review (2000-2014) in databases and Internet searches with specific keywords or terms. Educational documents such as syllabi and memoranda of understanding (MoUs) from pharmacy programs were also examined. In addition, a preliminary draft was developed and the findings and recommendations were reviewed in a 90-minute roundtable discussion at the 2014 American Association of Colleges of Pharmacy Annual Meeting. Recommendations for the host country include travel considerations (eg, passport, visa, air travel), safety, housing, transportation, travel alerts and warnings, health issues, and financial considerations. For the home country, considerations for establishment of G/I APPE site (eg, vetting process, MoU, site expectations) are described. The paper is a resource for development of new G/I APPEs and provides guidance for continuous quality improvement of partnerships focusing on G/I pharmacy education.


Subject(s)
Congresses as Topic , Education, Pharmacy/methods , Internationality , Pharmacy Residencies/methods , Problem-Based Learning/methods , Travel , Congresses as Topic/trends , Education, Pharmacy/trends , Humans , Pharmacy Residencies/trends , Preceptorship/methods , Preceptorship/trends , Problem-Based Learning/trends , Schools, Pharmacy/trends , Students, Pharmacy , Travel/trends
17.
Am J Health Syst Pharm ; 73(5 Suppl 1): S42-8, 2016 Mar 01.
Article in English | MEDLINE | ID: mdl-26896525

ABSTRACT

OBJECTIVE: The objective of this study was to determine minimum inhibitory concentration (MIC) trends among common bacterial organisms found in respiratory isolates in the trauma intensive care unit setting. METHODS: In this retrospective observational study, MIC data was reviewed over a three year period from January 2009 to December 2011 for the three most frequently identified organisms isolated from respiratory specimens in a trauma intensive care unit along with corresponding hospital data. RESULTS: The most frequently isolated bacterial species identified were Staphylococcus aureus (229 isolates), Pseudomonas aeruginosa (129 isolates), and Acinetobacter species (87 isolates) in the analysis within our institution from 2009-2011. There was considerable variability among the MIC trends for the analyzed organisms. For Pseudomonas isolates, observed sensitivities were as high as 100% for antibiotics ciprofloxacin and imipenem in 2009, but decreased over the next two years in 2010 and 2011. There was considerable variability among the MIC trends for Acinetobacter over the three year period for the antibiotics tested. The MIC data for most Staphylococcus aureus isolates over the three years were sensitive to vancomycin with little change in the observed MIC data. CONCLUSION: The data reported is observational and indicates the need for future studies to establish a valid relationship of the MIC data over time in our institution particularly among our gram negative organisms, to monitor patterns of antimicrobial resistance.


Subject(s)
Acinetobacter/drug effects , Anti-Bacterial Agents/pharmacology , Drug Resistance, Bacterial/drug effects , Pseudomonas aeruginosa/drug effects , Respiratory Tract Infections/microbiology , Staphylococcus aureus/drug effects , Acinetobacter/isolation & purification , Acinetobacter/physiology , Anti-Bacterial Agents/therapeutic use , Ciprofloxacin/pharmacology , Ciprofloxacin/therapeutic use , Drug Resistance, Bacterial/physiology , Humans , Imipenem/pharmacology , Imipenem/therapeutic use , Intensive Care Units/trends , Microbial Sensitivity Tests/methods , Microbial Sensitivity Tests/trends , Pseudomonas aeruginosa/isolation & purification , Pseudomonas aeruginosa/physiology , Respiratory Tract Infections/drug therapy , Retrospective Studies , Staphylococcus aureus/isolation & purification , Staphylococcus aureus/physiology , Vancomycin/pharmacology , Vancomycin/therapeutic use
18.
Surg Infect (Larchmt) ; 16(1): 62-7, 2015 Feb.
Article in English | MEDLINE | ID: mdl-25761081

ABSTRACT

BACKGROUND: Unit-specific antibiograms have developed to guide clinicians to appropriate antibiotic choices for subsets of patients. The additional level of a unit- and respiratory-specific antibiogram for surgical and trauma patients defines key differences in susceptibility information for treating hospital-acquired pneumonia. METHODS: This was a three-year, retrospective single-center study. A total of 729 positive respiratory specimens from 612 patients were analyzed using Quality Compass Pathfinder(®), the antibiotic-reporting software. Culture and susceptibility reports were compared for the surgical/trauma intensive care unit (S/TICU) and the general hospital (excluding the S/TICU but including the medical ICU [MICU]). Data were filtered to include those genera and organisms with a high association with hospital-acquired pneumonia: Acinetobacter, Citrobacter, Enterobacter, Escherichia coli, Haemophilus, Klebsiella, Neisseria, Pseudomonas, Staphylococcus, Stenotrophomonas, Streptococcus, and Serratia. RESULTS: For gram-negative organisms, susceptibility differences were noted for Acinetobacter and Pseudomonas between the S/TICU and the rest of the hospital. In particular, Acinetobacter was significantly more susceptible to ciprofloxacin (86% vs. 43%; p<0.001), gentamicin (86% vs. 54%; p=0.001), imipenem-cilastatin (93% vs. 55%; p<0.001), trimethoprim-sulfamethoxazole (88% vs. 54%; p=0.001), and tobramycin (50% vs. 0; p=0.012). Pseudomonas isolates from the S/TICU were significantly more susceptible to aztreonam (83% vs. 68%; p=0.037), ciprofloxacin (86% vs. 69%; p=0.019), and imipenem-cilastatin (94% vs. 79%; p=0.01). For gram-positive organisms, Staphylococcus isolates from the S/TICU were significantly more susceptible to erythromycin (81% vs. 57%; p=0.007) and trimethoprim-sulfamethoxazole (98% vs. 91%; p=0.034) than were the hospital isolates. CONCLUSIONS: For key respiratory pathogens, such as Pseudomonas, Acinetobacter, and Staphylococcus, surgical and trauma patients present greater susceptibility to several antibiotics. Although this information cannot be extrapolated to other institutions, it does provide a basis for comparable institutions to consider developing unit- and collection-site-specific antibiograms for infections that affect surgical/trauma patients commonly.


Subject(s)
Bacteria/drug effects , Bacteria/isolation & purification , Bacterial Infections/microbiology , Intensive Care Units , Microbial Sensitivity Tests , Respiratory Tract Infections/microbiology , Trauma Centers , Bacteria/classification , Humans , Retrospective Studies
19.
Am J Pharm Educ ; 78(4): 76, 2014 May 15.
Article in English | MEDLINE | ID: mdl-24850938

ABSTRACT

OBJECTIVE: To evaluate the efficacy of faculty-led problem-based learning (PBL) vs online simulated-patient case in fourth-year (P4) pharmacy students. DESIGN: Fourth-year pharmacy students were randomly assigned to participate in either online branched-case learning using a virtual simulation platform or a small-group discussion. Preexperience and postexperience student assessments and a survey instrument were completed. EVALUATION: While there were no significant differences in the preexperience test scores between the groups, there was a significant increase in scores in both the virtual-patient group and the PBL group between the preexperience and postexperience tests. The PBL group had higher postexperience test scores (74.8±11.7) than did the virtual-patient group (66.5±13.6) (p=0.001). CONCLUSION: The PBL method demonstrated significantly greater improvement in postexperience test scores than did the virtual-patient method. Both were successful learning methods, suggesting that a diverse approach to simulated patient cases may reach more student learning styles.


Subject(s)
Computer Simulation , Computer-Assisted Instruction , Education, Pharmacy/methods , Patient Simulation , Problem-Based Learning , Teaching/methods , Adult , Curriculum , Educational Measurement , Humans , Internet , Male , Students, Pharmacy , Surveys and Questionnaires , Young Adult
20.
J Health Care Poor Underserved ; 24(1 Suppl): 47-63, 2013 Feb.
Article in English | MEDLINE | ID: mdl-23395944

ABSTRACT

PURPOSE: This study was conducted to investigate the relationship between acculturation and diabetes risk among Arab Americans in Southeastern Louisiana. The secondary objective was to identify the prevalence of diabetes, hypertension, hyperlipidemia, and cardiovascular disease in the same population. BACKGROUND: Research suggests that Arab Americans report disproportionate rates of diabetes and other chronic diseases. METHODS: A cross-sectional study of 181 Arab Americans was conducted in Louisiana. Interviewers recruited participants to answer a 37-item survey with a five-dimension acculturation assessment and abridged National Institute of Health Survey and American Diabetes Association (2010) diabetes tool. Results were analyzed using factor analysis and Spearman's correlation. RESULTS: A negative correlation was found between Arab acculturation variables and diabetes risk among males (r=-.216, p=.044) and American acculturation variables among females (r=-.222, p=.032). Twelve percent reported being diagnosed with Type II diabetes by a primary care physician.


Subject(s)
Acculturation , Arabs/statistics & numerical data , Diabetes Mellitus, Type 2/ethnology , Adolescent , Adult , Cross-Sectional Studies , Female , Humans , Louisiana/epidemiology , Male , Middle Aged , Prevalence , Risk Factors , Time Factors , Young Adult
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