Evaluation of a risk assessment model to predict infection with healthcare facility-onset Clostridioides difficile.

Purpose: We evaluated a previously published risk model (Novant model) to identify patients at risk for healthcare facility-onset Clostridioides difficile infection (HCFO-CDI) at 2 hospitals within a large health system and compared its predictive value to that of a new model developed based on local findings.

Methods: We conducted a retrospective case-control study including adult patients admitted from July 1, 2016, to July 1, 2018. Patients with HCFO-CDI who received systemic antibiotics were included as cases and were matched 1 to 1 with controls (who received systemic antibiotics without developing HCFO-CDI).

Optimizing the Treatment of Steroid-Induced Hyperglycemia.

Objective: To review therapeutic strategies for the management of patients with steroid-induced hyperglycemia.

Data Sources: A literature search of MEDLINE/PubMed (1990 to June 2017) was conducted using the search terms steroid, glucocorticoid, corticosteroid, hyperglycemia, and diabetes as well via review of literature citations.

Study Selection And Data Extraction: Relevant clinical trials and case studies focusing on pharmacological interventions in humans were reviewed for inclusion.

Simulated Order Verification and Medication Reconciliation during an Introductory Pharmacy Practice Experience.

Objective. To create, implement, and assess a simulated medication reconciliation and an order verification activity using hospital training software. Design.

Evaluation of a Once/Day Tobramycin Regimen to Achieve Target Concentrations in Adult Patients with Cystic Fibrosis.

Study Objective: To evaluate the success of an initial tobramycin dosing regimen to achieve target peak and trough concentrations in adult patients with pulmonary exacerbations of cystic fibrosis (CF).

Design: Retrospective single-center medical record review.

Setting: Large tertiary care academic medical center.

A patient with HIV and tuberculosis with diminished clopidogrel response.

Patients with HIV are at an increased risk for cardiovascular disease, both as a result of treatment with protease inhibitors and from the disease itself. The medication regimens of patients with HIV and cardiovascular comorbidities are complex and require careful assessment for potentially serious drug-drug interactions. We report a case of clopidogrel non-responsiveness in a patient with HIV, latent tuberculosis and cardiovascular disease with a history of myocardial infarction.

A review of the advances in chronic obstructive pulmonary disease treatment.

Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality across the globe and within the United States. Although several medication classes are used for COPD treatment, none of these medications have been shown to significantly improve long-term lung function or mitigate overall disease progression. This review describes the pharmacologic treatment options for COPD and highlights recent studies evaluating the impact of bronchodilators and combination therapy on lung function, mortality, quality of life, and exacerbations.

Evaluation of pneumococcal vaccination rates after vaccine protocol changes and nurse education in a tertiary care teaching hospital.

Background: Pneumococcal vaccination in eligible patients is recommended by the Infectious Disease Society of America and the Centers for Disease Control (CDC) Advisory Committee on Immunization Practices. Because hospitalization provides an opportunity to vaccinate patients at high risk for developing serious pneumonia complications, eligibility screening and administration of the pneumococcal vaccine prior to discharge in qualified patients are evaluated by the Joint Commission and the Centers for Medicare Medicaid Services (CMS) as part of pneumococcal vaccination core quality measures. Among patients with an inpatient diagnosis of pneumonia in 2008, 56% in our 580-bed tertiary care teaching hospital, compared with 84% nationwide, received pneumococcal vaccination.

Subcutaneous unfractionated heparin for treatment of venous thromboembolism in end-stage renal disease.

Objective: To report 3 cases of venous thromboembolism (VTE) in patients with end-stage renal disease (ESRD) treated with subcutaneous unfractionated heparin (UFH) bridged with warfarin.

Case Summaries: Three patients with ESRD were successfully treated for VTE with unmonitored, fixed-dose subcutaneous UFH every 12 hours and dose-adjusted warfarin. The first patient was initiated on continuous infusion UFH for deep-vein thrombosis, but due to poor vascular access, nurses were unable to consistently measure anti-Xa levels.

Nephrogenic diabetes insipidus induced by two amphotericin B liposomal formulations.

Immunocompromised patients are at risk for invasive molds and resistant fungal infections for which amphotericin B may be the only feasible treatment. Nephrogenic diabetes insipidus (DI) and renal tubular acidosis are known adverse effects of conventional amphotericin B; however, nephrogenic DI has been uncommonly associated with liposomal amphotericin B formulations. We describe an 18-year-old woman with aplastic anemia who developed invasive aspergillosis.

Confirmed beta16 Arg/Arg polymorphism in a patient with uncontrolled asthma.

Objective: To report a case of confirmed beta(16) Arg/Arg polymorphism (Arg/Arg) in a patient with uncontrolled asthma.

Case Summary: A 49-year-old black female presented to the emergency department with acute shortness of breath with subsequent intubation. After extubation, she reported multiple hospitalizations for asthma with one prior intubation, adherence to asthma medications, and very frequent use of her short-acting beta(2)-agonist (SABA).