RESUMO
Purpose: Pharmacist-led penicillin skin testing (PST) was incorporated into antimicrobial stewardship at a community hospital to increase use of optimal antimicrobial therapy, reduce use of broad-spectrum agents, and reduce antimicrobial therapy-related costs. Methods: A clinical decision support software alert identified qualifying patients with penicillin allergies. Patients receiving a nonoptimal antimicrobial agent were prioritized for PST. Patients were excluded if they reported a history of extreme hypersensitivity to a penicillin agent, such as Stevens-Johnson syndrome, toxic epidermal necrolysis, or mucocutaneous eruption with epidermal detachment. Pediatric patients less than 18 years old and pregnant patients were excluded. Data collected for each patient included the medication that precipitated the reaction; reaction type; age when the reaction occurred; current antibiotic therapy; indication for therapy; preferred antimicrobial agent; days of therapy on each agent used; positive, negative, or ambiguous PST result; recent antihistamine use; and any adverse events that occurred. Outcomes of the PST results, pharmacist interventions made after PST, and resulting cost savings to patients were all reported. Results: Among 31 patients tested, 27 were negative for penicillin allergy, 1 was positive for penicillin allergy, and 3 yielded an indeterminate test. Pharmacist recommendation to change therapy based on PST results was accepted in 13 of 15 patients where recommendations were made. Cost savings in antimicrobial therapy alone for patients who received PST was US $74.75 per day. Conclusion: Pharmacist-driven PST provided opportunities to clarify allergies, optimize antimicrobial therapy, and save antimicrobial therapy-related costs to patients.
RESUMO
BACKGROUND: Cognitive control deficits, as captured by inhibitory control measures, are indicative of increased impulsivity and are considered a marker for substance use disorder vulnerability. While individuals with alcohol use disorder (AUD) typically exhibit inhibitory control dysfunction, evidence of impaired inhibitory control among harmful drinkers, who are at increased risk of developing an AUD, is mixed. This study examined the response inhibition of binge drinkers using a task that employed neutral, as well as both immediate and delayed reward contingencies, to determine whether reward induced heightened impulsivity in this population. METHODS: Binge alcohol users (n = 42) and controls (n = 42) were administered a Monetary Incentive Control Task that required participants to successfully inhibit a prepotent motor response to both neutral and immediately rewarding stimuli in order to secure a large delayed reward. RESULTS: Binge drinkers had significantly worse response inhibition than controls irrespective of trial condition and even after controlling for differences in weekly intake. Although both binge and control participants exhibited significantly worse inhibitory control in the presence of immediate reward, the control group showed a greater reduction in inhibition accuracy compared to the binge group in reward relative to neutral conditions. Both groups demonstrated significantly enhanced control when forewarned there was an increased chance response inhibition would be required. Control participants secured the delayed reward more often than binge participants. CONCLUSIONS: Despite the variability in the literature, this study demonstrated consistent generalized impulse control deficits among binge-drinking individuals that were unrelated to reward manipulations. These findings point to mechanisms that may confer vulnerability for transition from binge drinking to AUD.
