Implementation of Antimicrobial Stewardship Interventions in Primary Care: Acute Bacterial Rhinosinusitis Treatment Strategies.

BACKGROUND: The highest prescribing rates for antibiotics occur in primary care, therefore, ambulatory care pharmacist interventions could play a major role in preventing overuse and misuse of antibiotics. Delegated pharmacists in the SJC primary care setting guided 3 activities with a goal of positively impacting prescribing patterns: monthly webinars provided by Agency for Healthcare Research and Quality (AHRQ), quarterly reporting to physicians of antibiotic prescribing patterns, and development of a clinical decision-making support tool for antibiotic prescribing. METHODS: Retrospective, observational data was collected to evaluate antibiotic prescribing patterns in patients diagnosed with acute sinusitis both before initiatives were implemented (July 1, 2019 through June 30, 2020) and after the initiatives were implemented (April 1, 2022 through June 30, 2022). RESULTS: A total of 675 patients were diagnosed with acute bacterial sinusitis during the specified time frame. Of these, 138 patients were excluded. A total of 279 antibiotics were prescribed in the preintervention group out of 298 patient encounters (93.6%) and 225 antibiotics were prescribed in the post-intervention group out of 244 patient encounters (92.9%) (p = .26). Although the primary outcome was not statistically significant, a significant reduction in patients treated with fluoroquinolones was noted, with 59/298 (20%) of those being prescribed in the pre-intervention group and 20/244 (8%) in the post intervention group (P = .02). CONCLUSIONS: While pharmacist-led antimicrobial stewardship interventions in primary care did not result in a decrease in the overall prescription of antibiotics for acute sinusitis, our study did reveal a notable reduction in the use of fluoroquinolones. This finding highlights a promising avenue for expanding the role of ambulatory care pharmacists.

SARS-CoV-2 Spike Protein Intensifies Cerebrovascular Complications in Diabetic hACE2 Mice through RAAS and TLR Signaling Activation.

Diabetics are more vulnerable to SARS-CoV-2 neurological manifestations. The molecular mechanisms of SARS-CoV-2-induced cerebrovascular dysfunction in diabetes are unclear. We hypothesize that SARS-CoV-2 exacerbates diabetes-induced cerebrovascular oxidative stress and inflammation via activation of the destructive arm of the renin-angiotensin-aldosterone system (RAAS) and Toll-like receptor (TLR) signaling. SARS-CoV-2 spike protein was injected in humanized ACE2 transgenic knock-in mice. Cognitive functions, cerebral blood flow, cerebrovascular architecture, RAAS, and TLR signaling were used to determine the effect of SARS-CoV-2 spike protein in diabetes. Studies were mirrored in vitro using human brain microvascular endothelial cells treated with high glucose-conditioned media to mimic diabetic conditions. Spike protein exacerbated diabetes-induced cerebrovascular oxidative stress, inflammation, and endothelial cell death resulting in an increase in vascular rarefaction and diminished cerebral blood flow. SARS-CoV-2 spike protein worsened cognitive dysfunction in diabetes compared to control mice. Spike protein enhanced the destructive RAAS arm at the expense of the RAAS protective arm. In parallel, spike protein significantly exacerbated TLR signaling in diabetes, aggravating inflammation and cellular apoptosis vicious circle. Our study illustrated that SAR-CoV-2 spike protein intensified RAAS and TLR signaling in diabetes, increasing cerebrovascular damage and cognitive dysfunction.

Impostor Phenomenon and Grit as Predictors of Job Satisfaction in Female Pharmacy Faculty.

INTRODUCTION: Impostor phenomenon (IP), grit, and other factors impact job satisfaction for faculty, particularly female faculty. METHODS: The Impostor Phenomenon Research Collaborative (IPRC) evaluated IP, grit, and job satisfaction in pharmacy faculty. A cross-sectional study was conducted with a convenience sample of faculty using a survey, which included demographic questions and validated instruments: Clance Impostor Phenomenon (CIPS), Short GRIT Scale, and Overall Job Satisfaction Questionnaire. Differences between groups, relationships, and prediction were evaluated using independent t-tests, ANOVA, Pearson correlation, and regression analyses. RESULTS: A total of 436 participants completed the survey; 380 self-identified as pharmacy faculty. Two hundred and one (54%) reported intense or frequent feelings of IP. The mean CIPS score was above 60, indicating a risk of negative outcomes related to IP. There were no differences in the prevalence of IP or job satisfaction levels when female and male faculty were compared. Female faculty had higher GRIT-S scores. Faculty reporting more IP had lower grit and lower job satisfaction. Job satisfaction in faculty was predicted by IP and grit; however, grit did not provide a unique prediction when combined with IP for male faculty. CONCLUSION: IP was not more prevalent in female faculty. Female faculty were grittier than male faculty. Higher grit was associated with less IP and higher job satisfaction. IP and grit predicted job satisfaction for female and male pharmacy faculty. Our findings suggest that improving grit may help mitigate IP and impact job satisfaction. Further research on evidence-based IP interventions is needed.

Professional aircrews' attitudes toward infectious diseases and aviation medical issues.

INTRODUCTION: Air carrier and professional corporate aircrews provide a unique and highly distinct population in which to examine potential transport and transmission of infectious diseases (ID). This study sought to assess frequency of flying while acutely ill, identify clinical triggers in self-grounding, determine employer support for self-grounding, examine rates of influenza vaccination, and identify unmet needs for current information on ID issues related to extensive travel required of professional aircrews. METHODS: Anonymous questionnaires were completed by select European mainline, U.S. regional airline, and professional corporate aircrews on ID topics such as flying while ill, flying with ill crewmembers, receipt of influenza vaccination, disinfection, and other aviation medical issues. Data were analyzed and reported as composite and stratified by airline vs. corporate aviation respondents. RESULTS: Aircrews often flew while ill (or with ill crewmembers); 52% flew until fever reached 38 degrees C (100.4 degrees F) and an additional 37% flew up to 38.89 degrees C (102 degrees F). Rate of annual influenza vaccination was quite low for all groups, but especially so for airline crews (21-27%), even given potential occupational exposure risk. Crews also had strongly differing perceptions of employer views on self-grounding, depending upon employment setting. CONCLUSIONS: There were sizable disparities between aircrew flying for U.S. regional, European mainline, and large corporate aviation departments with respect to self-grounding when ill and routinely receiving a seasonal influenza vaccination. All study groups reported a pressing need for enhanced anonymous access to current ID and medical information.

Perceptions of frontline providers on the appropriate qualifications for battalion level care in United States Army ground maneuver forces.

OBJECTIVES: The U.S. Army emplaces physician assistants (PAs) in its maneuver battalions. When contingencies arise, clinic-based physicians join them to augment capability. Because both entities operate similarly, the policy permits a comparison of perceptions of optimal skill sets for the battalion medical mission. METHODS: We conducted a survey to discover associations in opinion regarding the best qualifications for battalion care. We asked deployed PAs and physicians to rate themselves and their counterparts in eight domains. We hypothesized that both entities would rate PAs as superior based on their permanent presence at battalion level and their familiarity with the disease and injury patterns of their population. RESULTS: Among 26 respondents, PAs awarded themselves a score of 8.3 +/- 0.3 out of 10 and a score of 6.5 +/- 0.5 to physicians. Physicians awarded PAs a score of 8.4 +/- 0.3 and themselves a score of 8.3 +/- 0.3. CONCLUSION: Participants support the PA as an appropriate capability for battalion care in prolonged combat environments.

Crossword puzzles as a tool to enhance learning about anti-ulcer agents.

OBJECTIVE: To design, implement, and evaluate the use of crossword puzzles as a low-stakes educational tool for enhancing learning about anti-ulcer agents. DESIGN: Crossword puzzles were created using a free Internet resource and administered to students during 3 consecutive lectures covering the pharmacology and medicinal chemistry of anti-ulcer agents. Student perceptions of the crossword puzzle were examined using an 8-item survey instrument. ASSESSMENT: Over 90% of students indicated that crossword puzzles enhanced their learning, oriented them to the important topics, and served as good reviews of the lecture material. CONCLUSION: Students perceived that crossword puzzles enhanced their learning of anti-ulcer agents. Use of crossword puzzles provides a simple and creative way to incorporate active learning into pharmacy classroom instruction.