Undergraduate dental curricula should include specific competencies relating to antimicrobial use and factors contributing to the development of antimicrobial resistance.
Purpose: The purpose of this study is to assess the impact of a clinic embedded Medication Assistance Program (MAP) specialist on the prescription benefit prior authorization (PA) process and provider satisfaction in an adult pulmonary clinic. Methods: In this mixed methods study, a retrospective cohort analysis was done to determine the turnaround time for the PA process from initial referral to approval or final denial in an adult pulmonary clinic. Additionally, a pre- and post-implementation survey to providers was conducted to assess provider satisfaction and perceptions around the prescription benefit PA process. The first study aim assessed PA efficiency by summarizing PA approval rate and PA turnaround time using descriptive statistics. Any prescriptions written by a clinic provider requiring a PA during the timeframe of June 2018 through August 2018 were included. The second study aim assessed change in provider satisfaction, analyzed via the Mann-Whitney U test. Results: The MAP specialist completed 110 PAs over 3 months for 110 unique patients. Median turnaround time was 3 hours, with 76% of PAs approved in less than 24 hours. Initial approval rate was 82.7%, and overall approval rate following the appeals process was 87.3%. A significant difference between the pre- and post-survey responses were identified in 2 of the 17 questions. Conclusion: Implementation of a clinic embedded MAP specialist to complete PAs demonstrated an efficient process while also improving provider satisfaction.
Bacteria have steadily developed defenses against antibiotics since the world’s first fleet of antibacterial drugs was introduced. One strategy that bacteria can use to become multi‐drug resistant involves the overexpression of large, membrane‐embedded efflux pumps, such as the AcrAB‐TolC pump found in Escherichia coli (E. coli) and other Gram‐negative bacteria. This large efflux pump gives the bacterium the capability of transporting a wide variety of compounds out of the cell, including antibiotics that we use to combat bacterial infections. Overexpression of efflux pumps has been shown to lead to multidrug resistance in clinically important bacterial pathogens. Here, I have sought to identify novel inhibitors of bacterial efflux pumps by screening methanolic plant extracts for efflux pump inhibitory activity using an ethidium bromide‐based fluorescence assay. I have determined that yerba maté extract causes accumulation of ethidium bromide in live E. coli bacterial cells. To determine the ability of yerba maté extract to cause accumulation of clinically relevant antibiotics, I used growth curve analysis of E. coli in the presence of the plant extract with levofloxacin and carbenicillin. I have concluded that the combination of yerba maté and antibiotics enhances the susceptibility of bacteria. This research could open up a new avenue in the treatment of multi‐drug resistant bacterial infections.
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Clare Boothe Luce Research Scholars Program
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