Objective: To identify differences among faculty members in various health professional training programs in perceived benefits and challenges of implementing interprofessional education (IPE). Methods: A 19-item survey using a 5-point Likert scale was administered to faculty members across different health disciplines at a west coast, multicollege university with osteopathic medicine, pharmacy, and physician assistant programs. Results: Sixty-two of 103 surveys (60.2%) were included in the study. Faculty members generally agreed that there were benefits of IPE on patient outcomes and that implementing IPE was feasible. However, group differences existed in belief that IPE improves care efficiency (p50.001) and promotes team-based learning (p50.001). Program divergence was also seen in frequency of stressing importance of IPE (p50.009), preference for more IPE opportunities (p50.041), and support (p50.002) within respective college for IPE. Conclusions: Despite consensus among faculty members from 3 disciplines that IPE is invaluable to their curricula and training of health care students, important program level differences existed that would likely need to be addressed in advance IPE initiatives.

No abstract

Patients with severe coccidioidomycosis infections are often treated with either amphotericin B lipid complex (ABLC) or liposomal amphotericin B (L-AmB). Outcome data with these agents in severe coccidioidomycosis cases are currently lacking. The purpose of this study is to evaluate the efficacy and toxicity of ABLC and L-AmB in treating severe coccidioidomycosis. A retrospective pre-post study design was employed. Chart reviews were completed from 1 January 2005 to 31 December 2014 for all patients who received lipid-based amphotericin B. Inclusion criteria included having a follow-up complement fixation (CF) titer or a treatment emergent adverse event (TEAE) prior to follow-up. Patients with meningeal involvement and pregnant patients were excluded. Treatment outcomes were assessed based on documented completion of therapy as well on symptoms, complement fixation titer, and changes to laboratory monitoring parameters. A total of 108 patients were identified, 69 of whom met the inclusion criteria. There were no statistical differences in demographics or disease burden in those that received ABLC and those that received L-AmB, except that those who received L-AmB were more likely to have previously diagnosed chronic kidney disease ( = 4, 12.5% vs = 0, 0.0%; = 0.042) and to have a lower creatinine clearance at the start of therapy (L-AmB = 79.6 mg/dl versus ABLC = 100.4 mg/dl; = 0.008). Successful treatment was achieved in 27 (73.0%) of ABLC patients and 22 (68.8%) of L-AmB patients ( = 0.700). Amphotericin B was discontinued due to documented completion of therapy for 17 (45.9%) ABLC patients and 18 (56.3%) L-AmB patients ( = 0.553). Acute kidney injury (AKI) was the documented reason of treatment cessation for 10 (27.0%) ABLC and 1 (3.1%) L-AmB patient ( = 0.007). ABLC and L-AmB both appear to be equally efficacious in the treatment of severe coccidioidomycosis. L-AmB may have less renal toxicity than ABLC and may be the preferred agent in baseline renal impairment.

This is the first report of a lack of cross-reactivity between itraconazole and voriconazole.

Background: In order to reduce Centers for Medicare and Medicaid Services (CMS)directed readmission penalties and improve patient discharge care, a bedside discharge medication delivery service was developed.Objective: To evaluate the impact of a bedside discharge medication delivery and pharmacist consultation service (Meds-to-Beds; MtB) on 30-day readmission rates at an academic hospital. Methods: The pharmacist-led MtB program was established in September 2016. Unplanned 30-day readmission data and other disease severity indicators were retrospectively collected from September 2015 to January 2017. Readmission data were compared for patients discharged prior to availability of the MtB program vs patients who participated in the program. Results: A total of 174 MtB patients and 170 control patients were included. There were significantly fewer 30-day readmissions in the MtB group (n = 14, 8.0%) compared with the control group (n = 28, 16.5%, P = 0.02). MtB participation was found to decrease the odds of a 30-day readmission (odds ratio = 0.40, 95% confidence interval 0.190, 0.843, P = 0.016). Conclusions: A care transition program in the form of a bedside medication delivery and pharmacist consultation service was associated with a lower likelihood of 30-day hospital readmission. K E Y W O R D S community pharmacy services, medication reconciliation, medication therapy management, patient transfer, pharmacy service, hospital, patient readmission

What is known and objective In vitro studies suggest a CYP2C9‐mediated interaction between milk thistle and warfarin, but there has been no in vivo case report on this interaction. Case description A White Hispanic man in his 30s was well controlled on warfarin therapy for mitral valve replacement. His INR increased from 2.64 to 4.12, and he denied changes to his medications and diet but noted starting a ‘liver cleanse’ supplement which contained milk thistle (200 mg). After stopping the supplement his INR normalized, and he remains on the same warfarin dose. What is new and conclusion This is the first in vivo report of an interaction between milk thistle and warfarin.

Methicillin-resistant Staphylococcus aureus (MRSA) is a common nosocomial infection that has a high burden of morbidity and mortality. Vancomycin is the often-used antibiotic of choice when MRSA is suspected as a causative infectious agent. Recent studies have called into question the reliability of vancomycin as empiric therapy, especially in instances of bacteremia. The isolate's minimum inhibitory concentration (MIC), the source of infection, modality of susceptibility testing, and antibiotic resistance are all issues that should be taken into consideration when formulating a care plan for a patient. We present a case that illustrates some of these issues clinicians are facing.

Background A comprehensive, contemporary evaluation of medication identifiers is necessary to keep up with the fast‐paced mobile and web‐based technology used by health care professionals and patients in order to safely identify and use oral medications. Prior studies evaluating the accuracy of medication identifiers are dated, with the most recent solely examining imprints of oral medications. Objective To compare the accuracy of different medication identifiers, and to identify and quantify ease of use between lay and professional medication identifiers. Methods We conducted a cross‐sectional study of 202 randomly selected oral medications, comparing the results of 14 lay and professional medication identifiers with reference standard‐identified medications. Investigators conducted three different searches for each medication using a standardized search methodology, including each medication's imprint, shape, color, scoring, and dosage form. Results Ident‐A‐Drug, http://drugs.com, Facts & Comparisons, and web‐based Lexicomp were the four most accurate identifiers at 98%, 97.5%, 96.5%, and 96.5%, respectively. Web‐based identifiers correctly identified more medications compared with mobile‐based identifiers (93.2% vs 80.6%, P <0.001). http://drugs.com displayed the medication as the first result most often (96%), followed by Facts & Comparisons (95%). http://drugs.com found the medication on the first search most frequently (97%). Searches without color were more accurate than with color (P <0.001). The most user‐friendly identifiers were Facts & Comparisons, http://drugs.com, Epocrates Mobile, and Lexicomp Mobile. Conclusion http://drugs.com, Facts & Comparisons, and Lexicomp (web and mobile) were determined to be the most accurate and easy‐to‐use medication identifiers. Searching without color was more accurate than searching with color.