Safe and effective anticoagulation use: case studies in anticoagulation stewardship.

Anticoagulant use is prevalent and associated with significant potential for harm. Anticoagulation stewardship practice has emerged to address care gaps and promote safe, effective, and cost-conscious anticoagulation use across health care systems. We present 4 patient cases describing common challenges in anticoagulation management: inappropriate dosing of direct oral anticoagulants, the diagnosis and management of heparin-induced thrombocytopenia, periprocedural anticoagulation management, and heavy menstrual bleeding on anticoagulation.

The dalbavancin dilemma: Establishment of a new formulary restriction workflow to balance access and stewardship.

In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time.

Clinical Classification and Management Outcomes of Anterior Segment-Dominated Persistent Fetal Vasculature: The CCPMOH Report.

Purpose: To describe clinical features, management, and outcomes of anterior segment-dominated persistent fetal vasculature (aPFV).

Design: A secondary analysis of aPFV data from a longitudinal cohort study.

Methods: The age and gender of each participant upon initial presentation, along with biological parameters, best-corrected visual acuity, and biomicroscopic assessments were collected.

Use of Emergency Telemedicine Physicians for Telephone Triage Disposition of Pediatric Patients.

Objectives: Telemedicine is a growing field, with limited data around its utility supporting pediatric emergency care telephone triage. We instituted telemedicine physician support for nurse telephone triage decisions. When the nursing protocols recommended urgent or emergent care, a telemedicine physician reviewed and modified care urgency if appropriate.

Surgical Trends in Chronic Pancreatitis from 2014 Through 2021.

Objectives: We analyzed annual surgical trends for benign chronic pancreatitis (CP), studying specifically mortality, morbidity, and pancreatic fistula rates. We also aimed to identify predictors of pancreatic fistula formation.

Methods: For this analysis, we used data from the American College of Surgeons National Surgical Quality Improvement Program from 2014 through 2021.

Estimation of Whole-Body Bone Mineral Density Through Air Displacement Plethysmography in a Large Sample of Elite Athletes.

Magee, MK, Fields, JB, Jagim, A, Lockard, B, Miller, A, Stroiney, D, and Jones, MT. Estimation of whole-body bone mineral density through air displacement plethysmography in a large sample of elite athletes. J Strength Cond Res XX(X): 000-000, 2024-Dual-energy x-ray absorptiometry (DXA) is used to determine bone mineral density (BMD) and body composition.

Neuro-ophthalmic outcomes after carotid intervention for ocular symptoms.

Background: The long-term neuro-ophthalmic outcomes after carotid intervention in patients presenting with preoperative visual symptoms vary widely based on the underlying etiology of retinal ischemia and are not well understood.

Methods: We performed a retrospective review of consecutive patients presenting with retinal ischemia who subsequently underwent carotid intervention from January 2018 to December 2022. Patients were classified into three groups (group I: amaurosis fugax/vascular transient monocular vision loss, group II: ocular ischemic syndrome [OIS], and group III: central/branch retinal artery occlusion).

Real-time intervention to increase daily chlorhexidine bathing and reduce central line-associated bloodstream infections.

Background: After an increase of central line-associated bloodstream infections (CLABSIs) at our community hospital in 2021, a case-control study suggested that patients with CLABSIs were 3.0 times more likely to have missed daily chlorhexidine gluconate (CHG) bathing than patients without CLABSIs.

Objective: To increase the rate of daily CHG bathing in hospitalized patients with central lines and subsequently reduce the number of CLABSIs.

Clinical Characteristics and Outcomes of Patients With COVID-19 Treated in Mayo Clinic's Advanced Care at Home Program.

Objectives: Mayo Clinic's hospital-at-home program, Advanced Care at Home (ACH), launched in 2020. While hospital-at-home literature reported safe and effective care for the general patient population and those with COVID, comparative outcomes between these two groups were unknown. The aim of this retrospective analysis was to compare the outcomes of COVID and non-COVID patients enrolled in ACH and evaluate if COVID patients can be safely treated in this setting.

Successful management of complete heart block in checkpoint inhibitor induced myocarditis by left bundle branch area pacing: a case report.

Background: Optimal management of checkpoint inhibitor-induced complete heart block is unknown. Previous reports showed relatively high incidence of pacing failure due to the co-existing myocarditis.

Case Summary: A 71-year-old male with a prior history of stage IV metastatic squamous cell lung cancer presents was admitted for dyspnoea and hypotension 10 days after checkpoint inhibitor treatment using pembrolizumab.

Measuring Research Capacity: Development of the PACER Tool.

Evaluating research activity in research departments and education programs is conventionally accomplished through measurement of research funding or bibliometrics. This limited perspective of research activity restricts a more comprehensive evaluation of a program's actual research capacity, ultimately hindering efforts to enhance and expand it. The objective of this study was to conduct a scoping review of the existing literature pertaining to the measurement of research productivity in research institutions.

Impact of Methicillin-Resistant Nasal Polymerase Chain Reaction Screening Tests on Duration of Vancomycin Therapy for Skin and Soft Tissue Infections.

Recent literature demonstrated a 24-hour reduction in vancomycin duration of therapy (DOT) for skin and soft tissue infections (SSTIs) with a negative methicillin-resistant staphylococcus aureus (MRSA) nasal screening versus a positive nasal screening. Objective of this study was to investigate vancomycin DOT in patients with SSTIs who received MRSA nasal polymerase chain reaction (PCR) screening versus those who did not receive MRSA nasal PCR screening. A retrospective, multi-center, cohort study was completed in admitted adult patients on vancomycin for SSTI from 01/01/2020 to 09/30/2022.

Optimizing influenza vaccine allocation: A predictive analytics approach for informed public health planning.

Disclaimer: In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time.

Pharmacogenomics Concierge Service as an Opportunity for Pharmacist Reimbursement and Practice-based Learning.

Objective: To assess the feasibility of a pilot pharmacogenomics concierge service that incorporates student practice-based learning opportunities and a survey to determine the patients' interest and willingness to pay.

Methods: Participants in the pilot study (n = 34) completed a survey to determine their willingness to pay for concierge services. Six participants indicating the highest level of interest were selected to participate in the program free of charge.

Typical Atrioventricular Nodal Re-Entry Tachycardia Masquerading as Atrial Fibrillation.

We report 3 cases of irregular, narrow complex tachycardia misdiagnosed and treated for atrial fibrillation. The adenosine response, detection of recurring triple cycle length variation patterns, and pseudo-R-wave in lead V during tachycardia made us suspect typical atrioventricular nodal re-entrant tachycardia. The electrophysiology study confirmed atrioventricular nodal re-entrant tachycardia, and symptoms were resolved by slow pathway modification.

Balloon protection of the mesenteric-renal vessels during embolectomy of acute paravisceral aortic occlusion.

Acute thrombosis of the aorta is an uncommon, but potentially devastating, vascular emergency. The absence of pathognomonic signs or symptoms makes the diagnosis challenging and, often, time consuming. No optimal treatment has been established, with greater challenge present when the thrombus involves the mesenteric-renal vessels.

Discrepancy Between Patient vs Provider Assessment of Erection Quality.

Objective: To characterize the discrepancy between patients' and providers' assessments of erection rigidity and its association with patient characteristics and penile ultrasound parameters.

Methods: Patients presenting for penile Doppler ultrasound between July 2022 and October 2023 were reviewed retrospectively. After intracavernosal injection, patients and providers independently rated erection rigidity from 1 to 10 prior to ultrasound.

Incidence of Respiratory Syncytial Virus in Community-Dwelling Adults Aged 18-64 Years Over 2 Seasons, 2022-2024, in a North American Community.

Background: The incidence of respiratory syncytial virus (RSV)-acute respiratory infection (ARI) in community-dwelling adults after the Omicron variant of the COVID-19 pandemic is unknown. Our aim was to assess the incidence of RSV-ARI in adults aged 18 to 64 years over 2 consecutive RSV seasons (October-April 2022-2024) in 4 US states.

Methods: This community-based prospective cohort study comprised 7501 participants in Minnesota, Wisconsin, Florida, and Arizona.

Pulmonary Blastomycosis in Two Immunocompetent Patients: The Role of Obesity and Vitamin D Deficiency.

This case report depicts two patients with morbid obesity who presented to the ED with signs and symptoms of community-acquired pneumonia and were treated accordingly. Despite empiric antibiotic therapy, their symptoms did not subside, prompting further evaluation, which revealed pulmonary blastomycosis. Both patients were also found to have severe vitamin D deficiency.