Comparing Medication History Capture Rates In-Person Versus Hybrid: A Multisite Pilot Study.

Purpose: Medication history is the method many organizations use to adhere to The Joint Commission's (TJC) National Patient Safety Goal (NPSG) to communicate accurate patient medication information. Literature is sparse comparing the number of medication histories completed in-person versus virtually. Methods: This is a single system, multi-site, retrospective observational study. Patients included were admitted through the Emergency Department during October 2022. The primary aim of this study compared the percent capture rates of medication history between 2 hybrid sites to an in-person site within a health-system. Our secondary objective compared the differences in the 'medication history acuity score' (MHAS), defined as the total number of edits, additions, and deletions made during a medication history. Results: The medication history capture rate at the in-person site was 74% and at the hybrid sites were 91% and 80%. There were no differences in total medications on each medication history between in-person and hybrid (11 [5-16] vs 11 [6-16]; P = .252). There were no differences in changes made on medication histories between in-person and hybrid (4 [1-7] vs 3 [1-7]; P = .595). Conclusions: Our study demonstrates that medication history capture rates and MHAS are comparable in both in-person and hybrid environments. This similarity suggests the feasibility of implementing hybrid models for medication history services in diverse healthcare settings, potentially enhancing the capacity of health systems to meet TJC NPSG. These findings indicate that hybrid models could be an effective strategy for healthcare systems to optimize their medication history services, especially in settings with varied patient volumes and site specialties.

Pharmacy technician development: Insight into training, preparedness, and career-path perceptions.

BACKGROUND: Although opportunities for pharmacy technicians may be expanding, an increasing number of technicians have transitioned out of their roles. It is important to consider what could be done within education and training to promote the retention of pharmacy technicians. OBJECTIVES: The purpose of this study was to survey pharmacy technicians in the state of Ohio to identify key components of professional development. METHODS: A survey was distributed through REDCap to 24,444 pharmacy technicians with active pharmacy technician licenses in the state of Ohio. Inclusion criteria required survey respondents to be at least 18 years old and currently working as a pharmacy technician. RESULTS: A total of 1386 surveys were fully completed (approximately 6% response rate). Professional development opportunities provided by employers varied across most practice sites, but continuing education was the most reported opportunity. Attending conferences, taking specialized training courses, and tuition reimbursement were less common. The top 3 barriers to professional development participation included additional cost, time, and perceived value. Guidance and mentorship from peers, achieving national certification, and formal on-the-job training were the most helpful in job preparation and training. The main reasons to achieve certification included increased pay, development opportunity, or employer requirement. When considering preparation for new roles, 57% of pharmacy technicians felt prepared or very prepared for the job after 90 days. As technicians continued throughout their careers, the training transitioned from formal hands-on training to self-guided training. CONCLUSION: Pharmacy technicians have a desire to remain in their roles, but participation in professional development opportunities was lacking owing to availability of options and barriers. Pharmacy practice sites interested in retaining technicians should invest in offering and encouraging pharmacy technicians to participate in development opportunities. To continue to develop pharmacy technicians, ongoing education and training tied to increased compensation may improve retention and foster an improved learning environment.

Impact of asynchronous virtual learning on student well-being and success.

INTRODUCTION: As the world has rapidly changed during the COVID-19 pandemic, doctor of pharmacy (PharmD) students' overall well-being has been prioritized. This study aimed to evaluate PharmD students' well-being and perceived academic engagement when moved involuntarily to a majority asynchronous and virtual curriculum during the 2020-2021 academic year in response to the COVID-19 pandemic. Additionally, this study aimed to assess demographic predictors relating student well-being and academic engagement. METHODS: A survey administered via Qualtrics (SAP) was sent to three cohorts of professional students (Classes of 2022 to 2024) enrolled in the PharmD program at The Ohio State University College of Pharmacy. These cohorts were engaged in a primarily asynchronous and virtual curriculum due to COVID-19. RESULTS: Although students displayed mixed results on how asynchronous learning affected their well-being, students replied that they would want to continue learning via a hybrid model (53.3%) or completely asynchronous (24%), while 17.3% wanted primarily synchronous and 5.3% did not reply. CONCLUSIONS: Our results indicated that aspects of the majority asynchronous and virtual learning environment were favored by students. Through student responses, our faculty and staff can take into consideration students' opinions when making future changes to the curriculum. We provided this data for others to consider when evaluating well-being and engagement with a virtual and asynchronous curriculum.

Assessment of pharmacy technician learning preferences and implications for training.

PURPOSE: To assess pharmacy technician learning preferences using the VARK tool and through self-identification. METHODS: The VARK (visual, aural, read/write, kinesthetic) questionnaire was incorporated into a larger survey, which was distributed during live staff meetings and a continuing education session held by the Ohio Pharmacists Association attended by 204 pharmacy technicians across various practice settings. RESULTS: A 90% response rate was achieved. Most respondents (78.8%) self-identified a single predominant learning preference, with 60.3% indicating a preference for kinesthetic learning methods. In contrast, after assessment with the VARK questionnaire 37.9% of survey participants were categorized as having a quadmodal learning style incorporating all VARK modalities. With regard to the Pharmacy Technician Certification Exam, a large majority of participants (96.2% of those providing a response) indicated that they had taken the exam in the past, with 17 participants (9.3% of those providing a response) indicating more than 1 attempt to pass the exam. Furthermore, experiential (on-the-job) training was identified by a large majority of survey respondents (79.3%) as the preferred way to learn new information. CONCLUSION: Learning preferences of pharmacy technicians vary amongst individuals, with many found to have multiple learning preferences through VARK questionnaire assessment. Incorporating experiential training and establishing learning preferences of pharmacy technicians may aid in development of accredited training programs that cater to the needs of pharmacy technicians.

Small Molecule Interferences in Resazurin and MTT-Based Metabolic Assays in the Absence of Cells.

In vitro assays (such as resazurin and MTT) provide an opportunity to determine the cytotoxicity of novel therapeutics before moving forward with expensive and resource-intensive in vivo studies. A concern with using these assays, however, is the production of false responses in the presence of particular chemical functionalities. To better understand this phenomenon, 19 small molecules at 6 concentrations (1 µM-100 mM) were tested in the presence of resazurin and MTT reagents to highlight potential interfering species. Through the use of absorbance measurements (using well-plate assays and UV-vis spectroscopy) with parallel MS analysis, we have shown that significant conversion of the assay reagents readily occurs in the presence of many tested interfering species without the need for any cellular activity. The most attributable sources of interference seem to arise from the presence of thiol and carboxylic acid moieties. Interestingly, the detectable interferences were more prevalent and larger in the presence of MTT (19 species with some deviations >3000%) compared to resazurin (16 species with largest deviation of ∼150%). Additionally, those deviations in the presence of resazurin were only substantial at high concentrations, while MTT showed deviations across the tested concentrations. This comprehensive study gives insight into chemical functional groups (thiols, amines, amides, carboxylic acids) that may interfere with resazurin and MTT assays in the absence of metabolic activity and indicates that proper control studies must be performed to obtain accurate data from these in vitro assays.

Surface-Anchored Metal-Organic Framework-Cotton Material for Tunable Antibacterial Copper Delivery.

In the present study, a new copper metal-organic framework (MOF)-cotton material was strategically fabricated to exploit its antibacterial properties for postsynthetic modification (PSM) to introduce a free amine to tune the physicochemical properties of the material. A modified methodology for carboxymethylation of natural cotton was utilized to enhance the number of nucleation sites for the MOF growth. Subsequently, MOF Cu3(NH2BTC)2 was synthesized into a homogenous surface-supported film via a layer-by-layer dip-coating process. The resultant materials contained uniformly distributed 1 µm × 1 µm octahedral MOF crystals around each carboxymethylated fiber. Importantly, the accessible free amine of the MOF ligand allowed for the PSM of the MOF-cotton surface with valeric anhydride, yielding 23.5 ± 2.2% modified. The Cu2+ ion-releasing performance of the materials was probed under biological conditions per submersion in complex media at 37 °C. Indeed, PSM induces a change in the copper flux of the material over the first 6 h. The materials continue to slowly release Cu2+ ions beyond 24 h tested at a flux of 0.22 ± 0.003 µmol·cm-2·h-1 with the unmodified MOF-cotton and at 0.25 ± 0.004 µmol·cm-2·h-1 with the modified MOF-cotton. The antibacterial activity of the material was explored using Escherichia coli by testing the planktonic and attached bacteria under a variety of conditions. MOF-cotton materials elicit antibacterial effects, yielding a 4-log reduction or greater, after 24 h of exposure. Additionally, the MOF-cotton materials inhibit the attachment of bacteria, under both dry and wet conditions. A material of this type would be ideal for clothing, bandages, and other textile applications. As such, this work serves as a precedence toward developing uniform, tunable MOF-composite textile materials that can kill bacteria and prevent the attachment of bacteria to the surface.

Biodegradable crosslinked polyesters derived from thiomalic acid and S-nitrosothiol analogues for nitric oxide release.

Crosslinked polyesters with Young's moduli similar to that of certain soft biological tissues were prepared via bulk polycondensation of thiomalic acid and 1,8-octanediol alone, and with citric or maleic acid. The copolymers were converted to nitric oxide (NO)-releasing S-nitrosothiol (RSNO) analogues by reaction with tert-butyl nitrite. Additional conjugation steps were avoided by inclusion of the thiolated monomer during the polycondensation to permit thiol conversion to RSNOs. NO release at physiological pH and temperature (pH 7.4, 37 °C) was determined by chemiluminescence-based NO detection. The average total NO content for poly(thiomalic-co-maleic acid-co-1,8-octanediol), poly(thiomalic-co-citric acid-co-1,8-octanediol), and poly(thiomalic acid-co-1,8-octanediol) was 130 ± 39 µmol g-1, 200 ± 35 µmol g-1, and 130 ± 11 µmol g-1, respectively. The antibacterial properties of the S-nitrosated analogues were confirmed against Escherichia coli and Staphylococcus aureus. The hydrolytic degradation products were analyzed by time-of-flight mass spectrometry after a 10-week study to investigate their composition. Tensile mechanical tests were performed on the non-nitrosated polymers as well as their S-nitrosated derivatives and suggested that the materials have appropriate Young's moduli and elongation values for biomedical applications.

A naloxone and harm reduction educational program across four years of a doctor of pharmacy program.

BACKGROUND AND PURPOSE: Naloxone distribution is an increasing service provided by pharmacists as more states enact laws enabling pharmacists to dispense naloxone without a prescription or per protocol to individuals in the wake of an opioid overdose epidemic. Education and training programs are necessary to ensure students and practicing pharmacists are able to effectively provide the service. EDUCATIONAL ACTIVITY AND SETTING: All first, second, and third year students in the doctor of pharmacy (PharmD) program at The Ohio State University College of Pharmacy (OSUCOP) participated in a pilot naloxone and harm reduction educational program. The program consisted of a three-part recorded lecture and a hands-on interactive workshop. Fourth-year students had the opportunity to participate. Students completed a ten-question assessment based on the content of the recorded lecture. Following the workshop, self-reflection and feedback were solicited. FINDINGS: Qualitative data indicated students felt the naloxone educational program was beneficial. Inclusion of harm reduction strategies, a mock counseling session, hands-on practice with naloxone delivery devices, and patient case discussions were valued. DISCUSSION AND SUMMARY: OSUCOP was able to develop and deliver a naloxone and harm reduction educational program across all four years of the PharmD curriculum within one year of passage of laws increasing pharmacist dispensing of naloxone.

A structured patient identification model for medication therapy management services in a community pharmacy.

OBJECTIVES: To describe the development and implementation of a structured patient identification model for medication therapy management (MTM) services within traditional dispensing activities of a community pharmacy to facilitate pharmacist-provided completion of MTM services. DESIGN: A daily clinical opportunity report was developed as a structured model to identify MTM opportunities daily for all MTM-eligible patients expecting to pick up a prescription. Pharmacy staff was trained and the standardized model was implemented at study sites. SETTING AND PARTICIPANTS: One hundred nineteen grocery store-based community pharmacies throughout Ohio, West Virginia, and Michigan. OUTCOME MEASURES: A structured patient identification model in a community pharmacy consists of reviewing a clinical opportunity report, identifying interventions for MTM-eligible patients, and possibly collaborating with an interdisciplinary team. This model allows pharmacists to increase MTM cases performed by providing a structured process for identifying MTM-eligible patients and completing MTM services. RESULTS: The development and implementation of a structured patient identification model in the community pharmacy was completed and consists of pharmacists reviewing a clinical opportunity report to identify MTM opportunities and perform clinical interventions for patients. In a 3-month pre- and post-implementation comparison, there was a 49% increase in the number of MTM services provided by pharmacists (P < 0.001). CONCLUSION: A structured patient identification model in the community pharmacy was associated with an increase in the amount of MTM services provided by pharmacists. This method could be a useful tool at a variety of community pharmacies to solve challenges associated with MTM completion.

Two cases of clinical myasthenia gravis associated with pembrolizumab use in responding melanoma patients.

Immune checkpoint inhibitors have changed the landscape of the treatment of multiple solid malignancies, and have been used increasingly in the recent years. Although usually well tolerated, given the relative inexperience of using immune checkpoint inhibitors, we are still learning of new side effects from the treatment. We report on two cases of ocular myasthenia gravis that occurred after treatment with pembrolizumab, an antiprogrammed-death (anti-PD1) monoclonal antibody for advanced melanoma in responding patients. One case is in an 81-year-old man and the second case in an 86-year-old woman, both with BRAF-negative metastatic melanoma receiving pembrolizumab. These two cases of ocular only associated myasthenic syndrome appeared 7 and 11 weeks after the initiation of pembrolizumab. We conclude that the condition is most likely associated with pembrolizumab as symptoms started after treatment with pembrolizumab, neither patient had other evidence of neurological cause for presentation, and symptoms also improved rapidly with administration of steroids. Both patients showed good oncological response to anti-PD1 treatment and one patient successfully continued to receive ongoing treatment with no further complications.

Critical nitric oxide concentration for Pseudomonas aeruginosa biofilm reduction on polyurethane substrates.

Bacterial colonies that reside on a surface, known as biofilms, are intrinsically impenetrable to traditional antibiotics, ultimately driving research toward an alternative therapeutic approach. Nitric oxide (NO) has gained attention for its biologically beneficial properties, particularly centered around its antibacterial capabilities. NO donors that can release the molecule under physiological conditions (such as S-nitrosothiols) can be utilized in clinical settings to combat bacterial biofilm infections. Herein the authors describe determining a critical concentration of NO necessary to cause >90% reduction of a Pseudomonas aeruginosa biofilm grown on medical grade polyurethane films. The biofilm was grown under optimal culture conditions [in nutrient broth media (NBM) at 37 °C] for 24 h before the addition of the NO donor S-nitrosoglutathione (GSNO) in NBM for an additional 24 h. The cellular viability of the biofilm after the challenge period was tested using varying concentrations of NO to determine the critical amount necessary to cause at least a 90% reduction in bacterial biofilm viability. The critical GSNO concentration was found to be 10 mM, which corresponds to 2.73 mM NO. Time kill experiments were performed on the 24 h biofilm using the critical amount of NO at 4, 8, 12, and 16 h and it was determined that the 90% biofilm viability reduction occurred at 12 h and was sustained for the entire 24 h challenge period. This critical concentration was subsequently tested for total NO release via a nitric oxide analyzer. The total amount of NO released over the 12 h challenge period was found to be 5.97 ± 0.66 × 10(-6) mol NO, which corresponds to 1.49 ± 0.17 µmol NO/ml NBM. This is the first identification of the critical NO concentration needed to elicit this biological response on a medically relevant polymer.

Plasma-modified nitric oxide-releasing polymer films exhibit time-delayed 8-log reduction in growth of bacteria.

Tygon(®) and other poly(vinyl chloride)-derived polymers are frequently used for tubing in blood transfusions, hemodialysis, and other extracorporeal circuit applications. These materials, however, tend to promote bacterial proliferation which contributes to the high risk of infection associated with device use. Antibacterial agents, such as nitric oxide donors, can be incorporated into these materials to eliminate bacteria before they can proliferate. The release of the antimicrobial agent from the device, however, is challenging to control and sustain on timescales relevant to blood transport procedures. Surface modification techniques can be employed to address challenges with controlled drug release. Here, surface modification using H2O (v) plasma is explored as a potential method to improve the biocompatibility of biomedical polymers, namely, to tune the nitric oxide-releasing capabilities from Tygon films. Film properties are evaluated pre- and post-treatment by contact angle goniometry, x-ray photoelectron spectroscopy, and optical profilometry. H2O (v) plasma treatment significantly enhances the wettability of the nitric-oxide releasing films, doubles film oxygen content, and maintains surface roughness. Using the kill rate method, the authors determine both treated and untreated films cause an 8 log reduction in the population of both Gram-negative Escherichia coli and Gram-positive Staphylococcus aureus. Notably, however, H2O (v) plasma treatment delays the kill rate of treated films by 24 h, yet antibacterial efficacy is not diminished. Results of nitric oxide release, measured via chemiluminescent detection, are also reported and correlated to the observed kill rate behavior. Overall, the observed delay in biocidal agent release caused by our treatment indicates that plasma surface modification is an important route toward achieving controlled drug release from polymeric biomedical devices.

Facial aesthetic outcome analysis in unilateral cleft lip and palate surgery using web-based extended panel assessment.

BACKGROUND AND AIM: The reproducible measurement of aesthetic outcomes after cleft lip and palate (CLP) surgery remains elusive, and there is no internationally recognised system. The aim of this pilot study was to better understand how humans rate post-operative aesthetic outcome after unilateral cleft lip and palate (UCLP) repair using a novel web-based rating platform with an extended panel of surgeon raters. METHODS: Cropped images of 5-year-old UCLP patients were arranged in a randomly generated sequence within a web-based aesthetic scoring tool as part of an agreement/reliability study. Assessors rated the appearances of patients using a five-point Likert-type scale on two occasions. A mixed-effect statistical model was adopted to analyse the effects of rater, image and timing. RESULTS: Images of 76 patients were scored by 29 UK-based cleft surgeons. Intra-rater variability was found, and the linear weighted kappa was 0.56. This allowed identification of the most and least consistent raters. The random image effect (p < 0.001) suggested that a broad range of aesthetic outcomes were included in the current study. Surgeon raters in this study were likely to score the images more preferably at the second assessment. CONCLUSIONS: A web-based scoring system provides extended data capture, and mixed-effect statistical modelling reveals the effect that time, image and rater have on the scorings. The selection and training of raters, in combination with an exemplary yardstick, might improve inter- and intra-rater agreement. The development of objective measures based upon digital facial recognition can replace the highly variable subjective human influence on rating the aesthetic outcome.

Nitric oxide release from a biodegradable cysteine-based polyphosphazene.

Nitric oxide (NO) is a unique bioactive molecule that performs multiple physiological functions and has been found to exhibit antithrombotic, antimicrobial, and wound-healing effects as an exogenous therapeutic agent. NO release from polymeric materials intended for use in biomedical applications has been established to reduce their thrombogenicity and decrease the likelihood of infection and inflammation that frequently produce medical complications. As a result, numerous NO-releasing polymers have been developed in an effort to utilize the beneficial properties of NO to improve the performance of implantable materials. The majority of synthetic NO-releasing biodegradable polymers that have been reported to date are polyesters, and there is significant interest in the development of new NO-releasing materials with improved or distinctive physicochemical characteristics. Polyphosphazenes are polymers with inorganic phosphorus-nitrogen backbones, and hydrolytically-sensitive derivatives with organic substituents have been prepared that degrade under physiological conditions. For this reason, biodegradable poly(organophosphazenes) are interesting candidate materials for applications such as tissue engineering, where the addition of NO release capability may be therapeutically useful. Herein, we report the first development and characterization of an NO-releasing poly(organophosphazene) from poly(ethyl S-methylthiocysteinyl-co-ethyl cysteinyl phosphazene) (POP-EtCys-SH). The thiolated polymer was synthesized from the reaction of poly(dichlorophosphazene) with ethyl S-methylthiocysteinate, followed by partial cleavage of the disulfide linkages to form free thiol groups. The conversion of thiol to the NO-releasing S-nitrosothiol functional group with tert-butyl nitrite resulted in a polymer (POP-EtCys-NO) with an average NO content of 0.55 ± 0.04 mmol g-1 that was found to release a total of 0.35 ± 0.02 mmol NO g-1 over 24 h under physiological conditions (37 °C, pH 7.4 phosphate buffered saline). Extracts obtained from both the thiolated and S-nitrosated polymers were not found to significantly impair the viability of human dermal fibroblasts or induce morphological changes, indicating that this cysteine-based polyphosphazene may possess potential utility as an NO-releasing biomaterial.

Reprint of: Nitric oxide-releasing polysaccharide derivative exhibits 8-log reduction against Escherichia coli, Acinetobacter baumannii and Staphylococcus aureus.

Health-care associated infections (HAIs) and the increasing number of antibiotic-resistant bacteria strains remain significant public health threats worldwide. Although the number of HAIs has decreased by using improved sterilization protocols, the cost related to HAIs is still quantified in billions of dollars. Furthermore, the development of multi-drug resistant strains is increasing exponentially, demonstrating that current treatments are inefficient. Thus, the quest for new methods to eradicate bacterial infection is increasingly important in antimicrobial, drug delivery and biomaterials research. Herein, the bactericidal activity of a water-soluble NO-releasing polysaccharide derivative was evaluated in nutrient broth media against three bacteria strains that are commonly responsible for HAIs. Data confirmed that this NO-releasing polysaccharide derivative induced an 8-log reduction in bacterial growth after 24h for Escherichia coli, Acinetobacter baumannii and Staphylococcus aureus. Additionally, the absence of bacteria after 72 h of exposure to NO illustrates the inability of the bacteria to recover and the prevention of biofilm formation. The presented 8-log reduction in bacterial survival after 24h is among the highest reduction reported for NO delivery systems to date, and reaches the desired standard for industrially-relevant reduction. More specifically, this system represents the only water-soluble antimicrobial to reach such a significant bacterial reduction in nutrient rich media, wherein experimental conditions more closely mimic the in vivo environment than those in previous reports. Furthermore, the absence of bacterial activity after 72 h and the versatility of using a water-soluble compound suggest that this NO-releasing polysaccharide derivative is a promising route for treating HAIs.

Structural outcomes in the Cleft Care UK study. Part 2: dento-facial outcomes.

OBJECTIVES: To compare facial appearance and dento-alveolar relationship outcomes from the CSAG (1998) and CCUK (2013) studies. SETTING AND SAMPLE POPULATION: Five-year-olds born with non-syndromic unilateral cleft lip and palate. Those in the original CSAG were treated in a dispersed model of care with low-volume operators. Those in CCUK were treated in a more centralized, high-volume operator model. MATERIALS AND METHODS: We compared facial appearance using frontal view photographs (252 CCUK, 239 CSAG) and dental relationships using study models (198 CCUK, 223 CSAG). Facial appearance was scored by a panel of six assessors using a standardized and validated outcome tool. Dento-alveolar relationships were scored by two assessors using the 5-Year-Olds' Index. Ordinal regression was used to compare results between surveys. RESULTS: Excellent or good facial appearance was seen in 36.2% of CCUK compared with 31.9% in CSAG. In CCUK, 21.6% were rated as having poor or very poor facial appearance compared with 27.6% in CSAG. The percentage rated as having excellent or good dento-alveolar relationships was 53.0% in CCUK compared with 29.6% in CSAG. In CCUK, 19.2% were rated as having poor or very poor dento-alveolar relationships compared to 36.3% in CSAG. The odds ratios for improved outcome in CCUK compared to CSAG were 1.43 (95% CI 1.03, 1.97) for facial appearance and 2.29 (95% CI 1.47, 3.55) for dento-alveolar relationships. CONCLUSIONS: Facial and dento-alveolar outcomes were better in CCUK children compared to those in CSAG.

Nitric oxide-releasing polysaccharide derivative exhibits 8-log reduction against Escherichia coli, Acinetobacter baumannii and Staphylococcus aureus.

Health-care associated infections (HAIs) and the increasing number of antibiotic-resistant bacteria strains remain significant public health threats worldwide. Although the number of HAIs has decreased by using improved sterilization protocols, the cost related to HAIs is still quantified in billions of dollars. Furthermore, the development of multi-drug resistant strains is increasing exponentially, demonstrating that current treatments are inefficient. Thus, the quest for new methods to eradicate bacterial infection is increasingly important in antimicrobial, drug delivery and biomaterials research. Herein, the bactericidal activity of a water-soluble NO-releasing polysaccharide derivative was evaluated in nutrient broth media against three bacteria strains that are commonly responsible for HAIs. Data confirmed that this NO-releasing polysaccharide derivative induced an 8-log reduction in bacterial growth after 24h for Escherichia coli, Acinetobacter baumannii and Staphylococcus aureus. Additionally, the absence of bacteria after 72h of exposure to NO illustrates the inability of the bacteria to recover and the prevention of biofilm formation. The presented 8-log reduction in bacterial survival after 24h is among the highest reduction reported for NO delivery systems to date, and reaches the desired standard for industrially-relevant reduction. More specifically, this system represents the only water-soluble antimicrobial to reach such a significant bacterial reduction in nutrient rich media, wherein experimental conditions more closely mimic the in vivo environment than those in previous reports. Furthermore, the absence of bacterial activity after 72h and the versatility of using a water-soluble compound suggest that this NO-releasing polysaccharide derivative is a promising route for treating HAIs.

Pharmacy residents' pursuit of academic positions.

OBJECTIVE: To describe pharmacy residents' interest in and pursuit of academic positions. METHODS: An electronic presurvey and postsurvey were sent to pharmacy residents during the 2011-2012 residency year. The initial survey evaluated residents' job preferences and interest in academia at the beginning of residency, and the follow-up survey focused on job selection and reasons for pursuing or not pursuing positions in academia. RESULTS: Nine hundred thirty-six residents responded to the initial survey and 630 participated in both the initial and follow-up survey. Forty-eight percent of those responding to both surveys strongly considered a career in academia in the initial survey, 28% applied for an academic position, and 7% accepted a position. Second-year postgraduate residents were more likely than first-year postgraduate residents to apply for and be offered a faculty position. CONCLUSION: Pharmacy residents are interested in academia. While increasing interest among residents is encouraging for faculty recruitment, the academy should also encourage and develop adequate training experiences to prepare residents to succeed in these positions.

Practical management of anticoagulation in patients with atrial fibrillation.

Anticoagulation for atrial fibrillation has become more complex due to the introduction of new anticoagulant agents, the number and kinds of patients requiring therapy, and the interactions of those patients in the matrix of care. The management of anticoagulation has become a "team sport" involving multiple specialties in multiple sites of care. The American College of Cardiology, through the College's Anticoagulation Initiative, convened a roundtable of experts from multiple specialties to discuss topics important to the management of patients requiring anticoagulation and to make expert recommendations on issues such as the initiation and interruption of anticoagulation, quality of anticoagulation care, management of major and minor bleeding, and treatment of special populations. The attendees continued to work toward consensus on these topics, and present the key findings of this roundtable in a state-of- the-art review focusing on the practical aspects of anticoagulation care for the patient with atrial fibrillation.