Objective. To evaluate the relationship between assessment item formats (case-based versus noncasebased) and item performance characteristics. Methods. Assessment items (1,575) were collected from examinations administered in several therapeutics courses over 4 academic years. Items were categorized as either ''case-based'' or ''noncase-based'' and item performance characteristics (discrimination index and level of difficulty) were evaluated. Results. Noncase-based items represented approximately three-fourths of all items that were evaluated, and demonstrated a higher discrimination index than case-based items. Case-based items were generally lengthier and included more detailed information than noncase-based items; however, they were not more difficult and exhibited a lower discrimination index. Secondary analyses revealed that 5-foil multiple-choice items are more difficult and have a higher discrimination index compared to 4-foil items. Conclusion. The format used for an examination/test item (case-based or noncase-based) has an impact on item performance characteristics.

Purpose. To determine if the use of a novel vancomycin nomogram predicts dosing regimens that achieve target trough concentrations equal to or more accurate than dosing regimens calculated using traditional pharmacokinetic calculations, evaluate the incidence of subtherapeutic and supratherapeutic troughs, and assess pharmacist's impressions of the nomogram. Methods. Prospective, open-label study in 473 patients who had a new order for vancomycin and were >18 years of age and ≤120 kg. Patients were randomized to the active group, dosed using the nomogram, or to the control group, dosed using traditional pharmacokinetic calculations already in place at our institution. Results. Patients dosed via nomogram were within the appropriate trough range in 44% of cases compared to 33% in the control group (P = 0.014). Vancomycin troughs less than 10 mcg/mL were significantly decreased with the use of nomogram (P = 0.032). Incidence of supratherapeutic troughs, greater than 20 mcg/mL, was not significantly different between groups (P = 0.706), and pharmacists agreed that the nomogram was easy to use and saved their time. Conclusions. A novel vancomycin nomogram was prospectively validated and found to be more effective than traditional pharmacokinetic dosing. The nomogram is being implemented as the standard dosing protocol at our institution.

Pharmacists' participation in obtaining patients' medication histories through chart review and patient interview increased the effectiveness of the medication reconciliation process in an inpatient BHU.

No abstract

Background Perioperative outcome data related to metabolic syndrome in coronary artery bypass graft (CABG) patients are lacking. Objective To determine the incidence of metabolic syndrome in CABG patients and whether its presence or the patient’s sex affects postoperative lengths of stay in the intensive care unit and hospital. Methods A retrospective observational study in CABG patients. Risk factors from the Society of Thoracic Surgeons’ Adult Cardiac Surgery Database were used to categorize patients as having metabolic syndrome. Perioperative outcomes were compared between patients with and without metabolic syndrome and between sexes. Outcomes were based on the operational definitions of the Society of Thoracic Surgeons. Results Among 657 patients, 333 had metabolic syndrome; 63.8% (n = 215) of women and 36.9% (n = 118) of men (P ≤ .001). Mean postoperative stays were significantly longer in patients who had metabolic syndrome. Women had longer postoperative stays than did men. Mean postoperative stay for women was 2.7 (SD, 3.4) days in the intensive care unit and 8.2 (SD, 7.1) days in the hospital, compared with 2.0 (SD, 3.8) days in the intensive care unit (P = .01) and 6.6 (SD, 6.8) days in the hospital for men (P = .003). Women with metabolic syndrome also had higher rates of in-hospital death (P = .03). Conclusion Both female patients and patients with metabolic syndrome undergoing CABG surgery are at higher risk for longer postoperative stays. Women with metabolic syndrome are the CABG patients at highest risk for in-hospital death.