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Viruses are prevalent in non-ventilated hospital-acquired pneumonia
No full textBackground Hospital-acquired pneumonia arising in non-ventilated patients (NVHAP) is traditionally thought to be caused by bacteria, and little is known about viral etiologies in this syndrome. We sought to describe the prevalence of viruses causing NVHAP and to determine factors independently associated with the isolation of a virus. Methods We identified patients with NVHAP over one year and reviewed their cultures to determine etiologies. Patients with a viral process were compared to those with either negative cultures or a bacterial infection to determine variables independently associated with the recovery of a virus. Results Among 174 cases, cultures were positive in 46.0%, with viruses identified in 22.4%. Bacterial pathogens arose 23.6% of subjects. The most common viruses included rhinovirus, influenza, and parainfluenza. We noted no seasonality in the isolation of viral organisms, and most cases of viral NVHAP developed after more than a week length of stay (LOS). Outcomes in viral NVHAP were similar to those with bacterial NVHAP. Patients with viral and bacterial NVHAP were generally similar. Two variables were independently associated with isolation of a virus: a history of coronary artery disease (adjusted odds ratio: 5.16, 95% CI: 1.14–22.44) and a LOS of greater than 10 days prior to NVHAP diagnosis (adjusted odds ratio: 2.97, 95% CI: 1.35–6.51). As a screening test for a virus, neither had a good sensitivity or specificity. Conclusions Viruses represent a common cause of NVHAP. Clinicians should consider viral diagnostic testing in NVHAP, as this may represent a means to enhance antimicrobial stewardship
Export Controls Policy
No full textExport control laws govern the transfer of controlled technology and information to foreign countries and to foreign nationals within the U.S. (“deemed exports”). The purpose of export control laws is to provide for the national security of the United States.
University of Health Sciences and Pharmacy in St. Louis (“UHSP” or “the University”) recognizes the importance of maintaining an effective and comprehensive export compliance program. The purpose of the Export Control Policy is to affirm the University’s commitment to compliance with the Export Control Laws; to promote faculty and staff awareness of the Export Control Laws as they relate to the University’s activities; to provide general guidance on the University’s obligations under the Export Control Laws; and to establish procedures to assist faculty and staff in meeting the objectives of this policy statement.
This policy applies to all UHSP investigators, faculty, staff, visiting scientists, postdoctoral fellows, students, scholars, and any other person working at or for UHSP
International Travel Policy
No full textThe University of Health Sciences and Pharmacy in St. Louis International Travel Policy establishes a consistent set of travel standards to be followed by all units of the University. The policy applies to all international travel that is sponsored, funded in any part, or involves the granting of degree credits by University of Health Sciences and Pharmacy in St. Louis. The intent is to provide guidance and oversight of international travel with a view toward managing risk and promoting sustainable educational experiences.
Applies to any faculty members, staff, students, or other individuals whose international travel is sponsored, funded in any part, or involves the granting of degree credits by University of Health Sciences and Pharmacy in St. Louis
Comparison of hospital length of stay in patients treated with non–vitamin K oral anticoagulants or parenteral agents plus warfarin for venous thromboembolism
No full textObjectives: Existing research comparing hospital length of stay for patients treated with non–vitamin K oral anticoagulants or parenteral bridging to warfarin has been conducted primarily with the agent rivaroxaban. The objective of this study was to compare hospital length of stay between patients initiated on the non–vitamin K oral anticoagulants, apixaban or rivaroxaban, and patients initiated on parenteral anticoagulation agents plus warfarin for the treatment of venous thromboembolism. Methods: A retrospective cohort study was conducted at an 859-bed, not-for-profit, teaching hospital. Adult patients admitted for a primary diagnosis of venous thromboembolism between 1 November 2012 and 31 August 2015 and treated with apixaban or rivaroxaban or a parenteral anticoagulant plus warfarin were included in the study. Eligible patients were identified using International Classification of Diseases, Ninth Revision codes for a primary diagnosis of acute thromboses and emboli and medication administration record data. Individuals using anticoagulation therapy prior to admission, released from the emergency department, or treated with thrombectomy or fibrinolytic therapy were excluded. Results: A total of 152 patients were included in this study. Patient characteristics, including renal function, were similar between study arms. Venous thromboembolism treatment with apixaban or rivaroxaban compared to a parenteral anticoagulant plus warfarin was associated with a reduced hospital length of stay (2.63 vs 5.33 days; p \u3c 0.05) and decreased total hospital cost adjusted to 2015 dollars (US38,851; p = 0.013). Conclusion: These results suggest that treatment with a non–vitamin K anticoagulant may significantly reduce hospital length of stay and total hospital cost compared to a parenteral anticoagulant plus warfarin for patients admitted for venous thromboembolism
Controversies and advances in the management of ventilator associated pneumonia
No full textIntroduction: Although national surveillance data suggests that the incidence of ventilator associated pneumonia (VAP) is down-trending, it remains one of the most commonly encountered hospital acquired infections in the United States and worldwide. Its association with increased healthcare costs and worsened patient outcomes warrants continued effort to improve the care of patients with VAP. Areas covered: The increasing prevalence of multi-drug resistant bacteria further drives the need to explore advances in diagnostic and treatment options. In this review, controversies pertaining to the definition and diagnosis of VAP as well as empiric treatment strategies will be discussed along with several developments related to rapid microbiologic testing methods and the use of non-traditional antimicrobial agents. Expert commentary: The application of rapid diagnostic techniques to identify microbial pathogens is perhaps one of the most impactful advancements in the treatment of serious nosocomial infections. This technology has the potential to reduce inappropriate initial antimicrobial therapy, unnecessary antimicrobial exposure, and mortality in patients with VAP. In addition, the anticipated approval of new antimicrobial agents within the next several years will provide a much-needed expansion of available treatment options in an era of growing antimicrobial resistance
Perceived motivating factors and barriers for the completion of postgraduate training among American pharmacy students prior to beginning advanced pharmacy practice experiences
No full textObjective. To examine perceived motivating factors and barriers (MFB) to postgraduate training (PGT) pursuit among pharmacy students. Methods. Third-year pharmacy students at 13 schools of pharmacy provided demographics and their plan and perceived MFBs for pursuing PGT. Responses were characterized using descriptive statistics. Kruskal-Wallis equality-of-proportions rank tests determined if differences in perceived MFBs existed between students based on plan to pursue PGT. Results. Among 1218 (69.5%) respondents, 37.1% planned to pursue PGT (32.9% did not, 30% were undecided). Students introduced to PGT prior to beginning pharmacy school more frequently planned to pursue PGT. More students who planned to pursue PGT had hospital work experience. The primary PGT rationale was, “I desire to gain more knowledge and experience.” Student debt was the most commonly cited barrier. Conclusion. Introducing pharmacy students early to PGT options and establishing work experiences in the hospital setting may increase students’ desire to pursue PGT
Using environmental engineering to increase hand hygiene compliance: A cross-over study protocol
No full textIntroduction Compliance with hand hygiene recommendations in hospital is typically less than 50%. Such low compliance inevitably contributes to hospital-acquired infections that negatively affect patients\u27 well-being and hospitals\u27 finances. The design of the present study is predicated on the assumption that most people who fail to clean their hands are not doing so intentionally, they just forget. The present study will test whether psychological priming can be used to increase the number of people who clean their hands on entering a ward. Here, we present the protocol for this study. Methods and analysis The study will use a randomised cross-over design. During the study, each of four wards will be observed during four conditions: olfactory prime, visual prime, both primes and neither prime. Each condition will be experienced for 42 days followed by a 7-day washout period (total duration of trial=189 days). We will record the number of people who enter each ward and whether they clean their hands during observation sessions, the amount of cleaning material used from the dispensers each week and the number of hospital-acquired infections that occur in each period. The outcomes will be compared using a regression analysis. Following the initial trail, the most effective priming condition will be rolled out for 3 months in all the wards. Ethics and dissemination Research ethics approval was obtained from the South Central-Oxford C Research Ethics Committee (16/SC/0554), the Health Regulatory Authority and the sponsor. Trial registration number ISRCTN (15397624); Edge ID 86357
Positive medication changes resulting from comprehensive and noncomprehensive medication reviews in a medicare part D population
No full textBACKGROUND: Health care organizations face the challenge of reducing costs while improving health outcomes. Currently, more than 39 million seniors are enrolled in a Medicare Part D prescription benefit plan, many of whom also qualify for medication therapy management (MTM) services. MTM programs provide valuable services designed to prevent or resolve medication-related problems (MRPs). Two core components of all MTM programs include comprehensive medication reviews (CMRs) with followup interventions and focused non-CMR interventions. Currently, there is limited research comparing the rate of MRPs resolved by CMR and non- CMR interventions. OBJECTIVE: To determine whether CMRs versus non-CMR interventions resulted in more pharmacist-initiated intervention recommendations and positive medication changes. METHODS: This retrospective, cross-sectional quality improvement project evaluated outcomes for individuals who received interventions following a CMR compared with those who received non-CMR interventions as part of a comprehensive MTM program. For this project, eligible individuals qualified for an MTM program. A positive medication change was defined as the addition of an appropriate medication or the removal of an inappropriate medication within 120 days of a pharmacist recommendation. Differences between the groups were calculated using the Wilcoxon rank sum test. RESULTS: During the 2-year period (2012 and 2013), 788,756 beneficiaries were enrolled in the MTM program and evaluated for potential MRPs. In both years, pharmacists recommended more medication changes per member for those receiving a CMR (0.81 in 2012 and 0.82 in 2013) compared with the non-CMR group (0.68 in 2012 and 0.61 in 2013; P value \u3c 0.001 for both years). However, recommendations made via non-CMR interventions (representing the vast majority of all medication reviews) were more likely to result in a positive medication change (OR = 1.24, 95% CI = 1.21-1.28 for 2012; OR = 1.26, 95% CI = 1.22-1.30 for 2013). CONCLUSIONS: These quality improvement project results suggest that Medicare Part D beneficiaries participating in a university-based MTM program who received non-CMR interventions had a higher likelihood of having positive medication changes than those receiving CMRs. These results are enlightening and may provide initial evidence to support inclusion of a non- CMR performance metric for the Centers for Medicare & Medicaid Service\u27s star ratings for MTM programs
Respiratory Protection Program Policies and Procedures
No full textIt is the policy of the University of Health Sciences and Pharmacy in St. Louis to provide its employees with a safe and healthful work environment. The guidelines in the respiratory protection program are designed to help reduce employee exposure against occupational dusts, fumes, mists, biological, radionuclides, gases and vapors. The primary objective is to prevent excessive exposure to these contaminants. This is accomplished as far as feasible by accepted engineering and work practice control measures. When effective engineering controls are not feasible, or while they are being implemented or evaluated, respiratory protection may be required to achieve this goal. In these situations, respiratory protection, training and medical evaluations are provided at no cost to the employees
Hearing Conservation Program
No full textUniversity of Health Sciences and Pharmacy in St. Louis Hearing Conservation Program has been established to meet the requirements of The Occupational Safety and Health Administration (OSHA) General Industry Standard “Occupational Exposure to Noise” Part 1910.95. Evidence is well established that worker exposure to noise of sufficient intensity and duration can result in hearing damage.
The primary goal of the Hearing Conservation Program is to reduce, and eventually eliminate to the extent possible, hearing loss due to workplace noise exposures