UHSP Collections (University of Health Sciences and Pharmacy)
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Responsible Conduct in Research Policy
No full textUniversity of Health Sciences and Pharmacy in St. Louis is committed to ensuring that all persons conducting research for which it is responsible will maintain the appropriate ethical standards to ensure scientific integrity and meet the expectations of program sponsors and the public.
This policy outlines the responsible conduct in research training requirements applicable to covered persons working on grants or awards sponsored by the NSF, NIFA, and NIH
Evaluation of a guided continuous quality improvement program in community pharmacies
No full textBackground: The importance of creating and sustaining a strong culture of patient safety has been recognized as a critical component of safe medication use. This study aims to assess changes in attitudes toward patient safety culture and frequency of quality-related event (QRE) reporting after guided implementation of a continuous quality improvement (CQI) program in a panel of community pharmacies in the United States (U.S.). Methods: Twenty-one community pharmacies volunteered to participate in the project and were randomly assigned to intervention or control groups. Pharmacy staff in the intervention group received guided training to ensure full implementation of a CQI program while those in the control group partially implemented the program. Pharmacy staff in both groups completed retrospective pre-post safety culture questionnaires and reported medication errors and near misses that occurred in their practices. Rasch analysis was applied to assess questionnaire validity and reliability and to confirm if the ordinal level data approximated interval level measures. Paired t-tests and repeated measure analysis of covariance tests were subsequently used to compare observed changes in the attitudes of subjects and frequency of QREs reporting in intervention and control groups. Results: Sixty-nine employees completed the questionnaire, a 43.9% response rate. Improvement in attitudes toward patient safety was statistically significant in the intervention group in six domains: staff, training, and skill (p=0.017); patient counseling (p=0.043); communication about mistakes (p\u3c0.001); response to mistakes (p\u3c0.001); organizational learning - continuous improvement (p\u3c0.001); and overall patient safety perceptions (p=0.033). No significant differences were observed in QRE reporting rates between intervention and control groups. However, differences were observed in the types of QREs reported (e.g., incorrect safety cap) and the point in the prescription processing workflow where a QRE was detected (e.g., partner check station, and drug utilization review station) in the intervention group (p\u3c0.001). Conclusion: Guided CQI program implementation increased the self-reported patient safety culture attitudes among staff
A Prospective One-Year Microbiologic Survey of Combined Pneumonia and Respiratory Failure
No full textBackground: Pneumonia and respiratory failure are common problems in the intensive care unit (ICU) setting, often occurring together. The relative prevalence of pneumonia types (community acquired, hospital acquired, ventilator associated) and causative pathogens is not well described in patients with respiratory failure. Methods: This was a prospective observational cohort study conducted in the medical ICU (34 beds) of Barnes-Jewish Hospital, an academic referral center of 1,300 beds from January 2016-December 2016. All patients who were prospectively adjudicated to have respiratory failure and pneumonia (RFP) regardless of pneumonia type were classified into one of four microbiologic categories: pathogen negative, antibiotic-susceptible pathogen (according to ceftriaxone susceptibility), antibiotic-resistant pathogen, and viruses. The primary outcomes assessed were the hospital mortality rate and inappropriate initial antibiotic therapy (IIAT) for non-viral pathogens. Results: Among 364 consecutive patients with RFP, 63 (17.3%) had organisms that were antibiotic susceptible, 104 (28.6%) had antibiotic-resistant organisms, 118 (32.4%) were pathogen negative, and 79 (21.7%) had viral infections. For these categories, IIAT occurred in 3.2%, 21.2%, 0.8%, and 0, respectively (p \u3c 0.001). Vasopressor-requiring shock was present in 61.9%, 72.1%, 68.6%, and 67.1%, respectively (p = 0.585), and the hospital mortality rates were 27.0%, 48.1%, 31.4%, and 36.7%, respectively (p = 0.020). Multivariable logistic regression analysis identified IIAT as an independent predictor of in-hospital death (adjusted odds ratio 5.28; 95% confidence interval 2.72-10.22; p = 0.012). Male gender, increasing Acute Physiology and Chronic Health Evaluation (APACHE) II scores, greater age, and the presence of shock also predicted death. Conclusions: Microbiologic categorization of patients with RFP suggests that antibiotic-resistant pathogens and viruses are associated with the highest mortality rates. Vasopressor-requiring shock was common regardless of the microbiologic categorization of RFP. Future development and use of rapid diagnostics and novel therapeutics targeting specific RFP pathogens may allow more timely administration of appropriate antimicrobial therapy and enhance antibiotic stewardship practices
Oxidant production and SOD1 protein expression in single skeletal myofibers from Down syndrome mice
No full textDown syndrome (DS) is a genetic condition caused by the triplication of chromosome 21. Persons with DS exhibit pronounced muscle weakness, which also occurs in the Ts65Dn mouse model of DS. Oxidative stress is thought to be an underlying factor in the development of DS-related pathologies including muscle dysfunction. High-levels of oxidative stress have been attributed to triplication and elevated expression of superoxide dismutase 1 (SOD1); a gene located on chromosome 21. The elevated expression of SOD1 is postulated to increase production of hydrogen peroxide and cause oxidative injury and cell death. However, it is unknown whether SOD1 protein expression is associated with greater oxidant production in skeletal muscle from Ts65Dn mice. Thus, our objective was to assess levels of SOD1 expression and oxidant production in skeletal myofibers from the flexor digitorum brevis obtained from Ts65Dn and control mice. Measurements of oxidant production were obtained from myofibers loaded with 2′,7′-dichlorodihydrofluorescein diacetate (DCFH2-DA) in the basal state and following 15 min of stimulated unloaded contraction. Ts65Dn myofibers exhibited a significant decrease in basal DCF emissions (p \u3c 0.05) that was associated with an approximate 3-fold increase in SOD1 (p \u3c 0.05). DCF emissions were not affected by stimulating contraction of Ts65Dn or wild-type myofibers (p \u3e 0.05). Myofibers from Ts65Dn mice tended to be smaller and myonuclear domain was lower (p \u3c 0.05). In summary, myofibers from Ts65Dn mice exhibited decreased basal DCF emissions that were coupled with elevated protein expression of SOD1. Stimulated contraction in isolated myofibers did not affect DCF emissions in either group. These findings suggest the skeletal muscle dysfunction in the adult Ts65Dn mouse is not associated with skeletal muscle oxidative stress
HPV-11 variability, persistence and progression to genital warts in men: The HIM study
No full textHPV-11 and HPV-6 are the etiological agents of about 90% of genital warts (GWs). The intra-typic variability of HPV-11 and its association with infection persistence and GW development remains undetermined. Here, HPV infection in men (HIM) participants who had an HPV-11 genital swab and/or GW, preceded or not by a normal skin genital swab were analysed. Genomic variants were characterized by PCR-sequencing and classified within lineages (A, B) and sublineages (A1, A2, A3, A4). HPV-11 A2 variants were the most frequently detected in the genital swab samples from controls and in both genital swabs and GW samples from cases. The same HPV-11 variant was detected in the GW sample and its preceding genital swab. There was a lack of association between any particular HPV-11 variant and the increased risk for GW development
Actions of the Biceps Brachii at the Shoulder: A Review
No full textBi-articular muscles cross more than one joint and contribute to motion at both joints, and the extremities of the human body contain several such muscles. Actions produced by all muscles are determined, to a large extent, by joint moment arms and muscle length. These are transient factors which change as joint angles are altered. Measuring muscle moments while manipulating both joints will produce a better understanding of the actions of bi-articular muscles. This review summarizes investigations which have explored the actions of the biceps brachii as shoulder and elbow joints are moved into various angle combinations. Clinical implications of the findings are discussed
Thrombolytic therapy in wake-up stroke patients
No full textObjective: The aim of the study is to review existing and ongoing trial data on wake-up stroke (WUS) patients for thrombolytic therapy. Methods: A literature search was conducted in PubMed (conception- October 2016) using the terms wake-up stroke, acute ischemic stroke, wake-up thrombolysis, computed tomography imaging in wake-up stroke, and magnetic resonance imaging in wake-up stroke. Ongoing trials were found using the ClinicalTrials.gov website. Results: The search yielded 61 articles in PubMed and 7 ongoing trials. After removing duplicate/irrelevant articles, 33 articles and relevant referenceswere reviewed; of these, 6 articles and 3 ongoing trialswere included. Two retrospective studies evaluating the characteristics between WUS and known-onset stroke were identified; the only significant difference between groups was the ability to receive treatment with tissue plasminogen activator (tPA). One study suggested that perfusion brain imaging may be useful to identify patients that may benefit from tPA. In addition, 3 studies have evaluated WUS treatment; all used different methods to identify potential patients. Two of 3 studies showed that treatment with tPA is associated with better outcomes when controlling for baseline National Institutes of Health Stroke Scale. No difference in safety outcomes was seen between groups for all 3 studies. Conclusions: Available data suggest promising strategies to identify WUS patients who may benefit from thrombolysis. Once on-going trials are complete, theremay be sufficient information to redefine tPA eligibility for previously excluded patients
Depression Treatment among Adults with Multiple Sclerosis and Depression in Ambulatory Care Settings in the United States
No full text. There is little information regarding depression treatment patterns among adults with MS and depression in ambulatory settings at national level in the United States (US). . The objectives of this study were to identify patterns and predictors of depression treatment in ambulatory settings in US among adults with MS and depression. . A cross-sectional study was conducted by pooling multiple years (2005-2011) of National Ambulatory Medical Care Survey and the outpatient department of the National Hospital Ambulatory Medical Care Survey data. The final study sample was comprised of ambulatory visits among adults with MS and depression. Dependent variable of this study was pharmacological treatment for depression with or without psychotherapy. Predictors of depression treatment were determined by conducting multivariable logistic regression. . Out of all ambulatory visits involving MS diagnosis, 20.59% also involved a depression diagnosis. Depression treatment was observed in 57.25% of the study population. Fluoxetine was the most prescribed individual antidepressant. Age and total number of chronic diseases were significant predictors of depression treatment. . Approximately six out of ten ambulatory visits involving MS and depression recorded some form of depression treatment. Future longitudinal studies should examine health outcomes associated with depression treatment in this population
Establishing the validity and reliability evidence of preceptor assessment of student tool
No full textObjective. To evaluate the validity and reliability evidence of the preceptor assessment of student tool (PAST) which was designed to assess doctor of pharmacy (PharmD) student rotation performance. Methods. Evaluation data were loaded into WINSTEPS software to conduct a Rasch rating scale analysis. Validity evidence was examined from construct and content validity perspectives, and reliability was assessed via student and item separation index and reliability coefficient. Data from 435 observations were included in the analysis. Results. All 19 items measured the same construct of interest and the five-point rating scale functioned appropriately and differentiated students’ ability. However, the item/person map indicated an absence of items at the end of the measurement continuum. Conclusion. Although adding items at the end of the measurement continuum may be beneficial, PAST showed good validity and reliability evidence when used to evaluate PharmD student rotations and is suitable to assess mastery learning