Effects of steroid stewardship on glycemic control in acute exacerbations of chronic obstructive pulmonary disease patients.

Introduction: The adverse effects of corticosteroids are dose-dependent, and guidance is to use the lowest effective dose in most disease states. The study facility recently reported a steroid stewardship program that reduced steroid dosing in acute exacerbations of chronic obstructive pulmonary disease (AECOPD) patients by 50%. The purpose of this post-hoc analysis was to evaluate the effect of this intervention on glycemic control in hospitalized AECOPD before and after cohorts.

Implementation of a novel learning experience in scientific writing, publishing, and peer review into a first year pharmacy practice residency.

Background: Pharmacists with competency in writing, publishing, and peer review are essential to continue advancing the pharmacy profession, but structured training of these skills may vary.

Objective: The authors set out to implement and assess the impact of a structured learning experience into a postgraduate year 1 pharmacy residency training program that provides tangible experience in the processes of scientific writing, publishing, and peer reviewing.

Methods: A quarterly pharmacy newsletter process was augmented to include an editorial board that consisted of residency trained pharmacists with varying levels of experience in scientific writing, publishing, and peer reviewing.

A multifaceted stewardship intervention helps curb steroid overprescribing in hospitalized patients with acute exacerbations of COPD.

Purpose: Corticosteroid overprescribing is well documented in real-world practice. There is currently no evidence to guide best practices for steroid stewardship. The aim of this study was to assess the effects of a 3-part stewardship intervention strategy on inpatient steroid prescribing in patients with acute exacerbations of COPD (AECOPD).

Impact of Glucagon-Like Peptide-1 Receptor Agonists (GLP-1RA) on Food Content During Esophagogastroduodenoscopy (EGD).

Background: Glucagon-like peptide-1 receptor agonists (GLP-1RA) have delayed gastric emptying properties; however, the impact on esophagogastroduodenoscopy (EGD) visualization is unknown.

Objective: This study examines the impact of GLP-1RA use on EGD visualization and gastric content retention.

Methods: This was a retrospective cohort study with matched controls.

Transitioning From Consult-Based to Automatic Pharmacy-Driven Vancomycin Management: Results From a Single, Primary Care Center.

Objective: The transition to area under the curve (AUC) vancomycin monitoring requires substantial updates in pharmacy policies and procedures. The study facility was tasked with transitioning from a consult-based collaborative agreement to an automatic pharmacist management policy on all intravenous (IV) vancomycin orders. The purpose of this quality assessment (QA) study was to evaluate the effectiveness of this transition.

Efficacy and Safety of Vancomycin Therapy After the Transition to AUC/MIC Monitoring in a Primary Facility.

Background: New guidance recommends area under the curve/minimum inhibitory concentration (AUC/MIC) instead of trough-based monitoring for vancomycin therapy. While this transition has demonstrated improved safety and efficacy in large, tertiary centers, this has not been assessed in the primary hospital setting.

Objective: The primary objectives were to evaluate the efficacy and safety of AUC/MIC monitoring in inpatient veterans treated with intravenous vancomycin for ≥72 hours compared to a historical cohort of trough-based monitoring.

Deinduction of P-glycoprotein resulting in delayed viral response during hepatitis C treatment.

What Is Known And Objective: Drug-drug interactions can involve inhibition or induction of cell membrane transporters. Deinduction occurs after an inducing agent is stopped.

Case Summary: This case describes suspected P-glycoprotein (P-gp) deinduction by carbamazepine resulting in a slow viral response during treatment of chronic hepatitis C virus (HCV) infection.

Provider perceptions on steroid dosing in AECOPD: Laying the groundwork for steroid stewardship.

Introduction: Steroid overprescribing is well documented in acute exacerbations of COPD (AECOPD). Given the myriad of unwanted side effects of corticosteroids, facilities should implement steroid stewardship efforts. The objective of this project was to evaluate the prescribing habits of steroids in AECOPD for needs assessment and to tailor interventions in a single centre.

Gap Analysis for the Conversion to Area Under the Curve Vancomycin Monitoring in a Small Rural Hospital.

Objective: Consensus guidelines for vancomycin monitoring now recommend area under the curve (AUC) calculations for optimal vancomycin efficacy and safety. This will be a major practice change for many facilities. Implementation guidance is available but has not been reported in smaller, primary care hospitals.

Steroid-Induced Sleep Disturbance and Delirium: A Focused Review for Critically Ill Patients.

Objective: Insomnia and delirium have gained much attention since the publication of recent guidelines for the management in critically ill adults. Neurologic effects such as sleep disturbance, psychosis, and delirium are commonly cited adverse effects (AEs) of corticosteroids. Steroid use is considered a modifiable risk factor in intensive care unit patients; however, reported mechanisms are often lacking.

Enzymatic deinduction phenomenon and clinical implications with a focus on direct-acting oral anticoagulants.

: The aim of the study was to describe the deinduction process and clinically relevant cases reported in the medical literature. Performed PubMed database search for key words 'enzymatic deinduction'. Findings are summarized.

Acetazolamide Causes Worsening Acidosis in Uncompensated COPD Exacerbations: Increased Awareness Needed for Patient Safety.

Background: Acetazolamide has been studied extensively in post-hypercapnic alkalosis as a tool to facilitate ventilator weaning in chronic obstructive pulmonary disease (COPD). It has also been utilized to facilitate respiratory drive in nonmechanically ventilated patients with COPD. Although this is generally a forgiving intervention, providers must carefully select patients for this medication, as it can cause severe acidosis and deterioration of clinical status in severe COPD cases.

An obscure case of using apixaban anti-Xa levels in a morbidly obese patient who was nil per os with enterocutaneous fistula.

: Apixaban anti-Xa levels have been introduced to monitor apixaban activity. Presented is a fundamental use of anti-Xa monitoring in questionable absorption in enterocutaneous fistula. A 57-year-old morbidly obese male (150 kg, BMI 42.

Implementation of the Procalcitonin Assay in a Rural Hospital.

Most positive studies in procalcitonin (PCT) utilization were done in large, tertiary medical centers. Furthermore, there is a paucity of data describing the implementation process. This article is the first to describe in detail the implementation process and initial outcomes after 6 months of PCT testing in a rural, 65-bed, primary hospital.

Administration of four-factor prothrombin complex concentrate for a life-threatening bleed in a Jehovah's Witness patient.

: Life-threatening bleeds are medical emergencies that require time-sensitive decision making. Patients of the Jehovah's Witness faith can present a challenging conundrum when their beliefs conflict with modern treatment options for haemorrhage. Providers may not be aware of the grades of acceptance of the newer products outside of packed red blood cells.

Unlinked memory helper responses promote long-lasting humoral alloimmunity.

Essential help for long-lived alloantibody responses is theoretically provided only by CD4 T cells that recognize target alloantigen, processed and presented by the allospecific B cell. We demonstrate that in an alloresponse to multiple MHC disparities, cognate help for class-switched alloantibody may also be provided by CD4 T cells specific for a second "helper" alloantigen. This response was much shorter-lived than when help was provided conventionally, by Th cell recognition of target alloantigen.

Psychiatric outcomes in operatively compared with non-operatively managed patients with facial trauma: Is there a difference?

Patients who sustain facial injury and who require an operation may be at greater risk for developing psychological distress and maladaptive coping. The purpose of this study was to examine psychological responses in adult victims of facial trauma after operation. A consecutive group of adult patients attending specialist outpatient clinics after facial trauma were evaluated for psychological distress.

Germinal center alloantibody responses are mediated exclusively by indirect-pathway CD4 T follicular helper cells.

The durable alloantibody responses that develop in organ transplant patients indicate long-lived plasma cell output from T-dependent germinal centers (GCs), but which of the two pathways of CD4 T cell allorecognition is responsible for generating allospecific T follicular helper cells remains unclear. This was addressed by reconstituting T cell-deficient mice with monoclonal populations of TCR-transgenic CD4 T cells that recognized alloantigen only as conformationally intact protein (direct pathway) or only as self-restricted allopeptide (indirect pathway) and then assessing the alloantibody response to a heart graft. Recipients reconstituted with indirect-pathway CD4 T cells developed long-lasting IgG alloantibody responses, with splenic GCs and allospecific bone marrow plasma cells readily detectable 50 d after heart transplantation.

Doctors recognized by the British honours systems: a retrospective analysis of the last decade.

Objectives: The British honours system is one of the oldest in the world rewarding individuals, including those of the medical profession. The authors were interested to see if any particular specialty was honoured to a greater extent. We aimed to establish the number of those honoured, the duration of clinical practice involved, as well as additional factors.

Does attribution of blame influence psychological outcomes in facial trauma victims?

Purpose: The relative importance of different variables and specific post-traumatic psychological reactions after facial injuries is poorly understood. The aim of the present study was to assess the association between the subjective attribution of blame and anxiety and depression in facial trauma victims.

Materials And Methods: We undertook a comparative cross-sectional study of psychological outcomes in a cohort of adult patients who have sustained a facial injury.

The HfaB and HfaD adhesion proteins of Caulobacter crescentus are localized in the stalk.

The differentiating bacterium Caulobacter crescentus produces two different cell types at each cell division, a motile swarmer cell and an adhesive stalked cell. The stalked cell harbours a stalk, a thin cylindrical extension of the cell surface. The tip of the stalk is decorated with a holdfast, an adhesive organelle composed at least in part of polysaccharides.