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Background It is unknown whether ChatGPT provides quality responses to infectious diseases (ID) pharmacotherapy questions. This study surveyed ID pharmacist subject matter experts (SMEs) to assess the quality of ChatGPT version 3.5 (GPT-3.5) responses. Methods The primary outcome was the percentage of GPT-3.5 responses considered useful by SME rating. Secondary outcomes were SMEs' ratings of correctness, completeness, and safety. Rating definitions were based on literature review. One hundred ID pharmacotherapy questions were entered into GPT-3.5 without custom instructions or additional prompts, and responses were recorded. A 0–10 rating scale for correctness, completeness, and safety was developed and validated for interrater reliability. Continuous and categorical variables were assessed for interrater reliability via average measures intraclass correlation coefficient and Fleiss multirater kappa, respectively. SMEs' responses were compared by the Kruskal-Wallis test and chi-square test for continuous and categorical variables. Results SMEs considered 41.8% of responses useful. Median (IQR) ratings for correctness, completeness, and safety were 7 (4–9), 5 (3–8), and 8 (4–10), respectively. The Fleiss multirater kappa for usefulness was 0.379 (95% CI,.317–.441) indicating fair agreement, and intraclass correlation coefficients were 0.820 (95% CI,.758–.870), 0.745 (95% CI,.656–.816), and 0.833 (95% CI,.775–.880) for correctness, completeness, and safety, indicating at least substantial agreement. No significant difference was observed among SME responses for percentage of responses considered useful. Conclusions Fewer than 50% of GPT-3.5 responses were considered useful by SMEs. Responses were mostly considered correct and safe but were often incomplete, suggesting that GPT-3.5 responses may not replace an ID pharmacist's responses. [ABSTRACT FROM AUTHOR]

There are many pharmacologic therapies that are being used or considered for treatment of coronavirus disease 2019 (COVID-19), with rapidly changing efficacy and safety evidence from trials. The objective was to develop evidence-based, rapid, living guidelines intended to support patients, clinicians, and other healthcare professionals in their decisions about treatment and management of patients with COVID-19. In March 2020, the Infectious Diseases Society of America (IDSA) formed a multidisciplinary guideline panel of infectious disease clinicians, pharmacists, and methodologists with varied areas of expertise to regularly review the evidence and make recommendations about the treatment and management of persons with COVID-19. The process used a living guideline approach and followed a rapid recommendation development checklist. The panel prioritized questions and outcomes. A systematic review of the peer-reviewed and grey literature was conducted at regular intervals. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach was used to assess the certainty of evidence and make recommendations. Based on the most recent search conducted on 31 May 2022, the IDSA guideline panel has made 32 recommendations for the treatment and management of the following groups/populations: pre- and postexposure prophylaxis, ambulatory with mild-to-moderate disease, and hospitalized with mild-to-moderate, severe but not critical, and critical disease. As these are living guidelines, the most recent recommendations can be found online at: https://idsociety.org/COVID19guidelines. At the inception of its work, the panel has expressed the overarching goal that patients be recruited into ongoing trials. Since then, many trials were conducted that provided much-needed evidence for COVID-19 therapies. There still remain many unanswered questions as the pandemic evolved, which we hope future trials can answer. [ABSTRACT FROM AUTHOR]

Background Carbapenem-resistant Klebsiella pneumoniae (CR Kp) is the most prevalent carbapenem-resistant Enterobacterales in the United States. We evaluated CR Kp clustering in patients in US hospitals. Methods From April 2016 to August 2017, 350 patients with clonal group 258 CR Kp were enrolled in the Consortium on Resistance Against Carbapenems in Klebsiella and other Enterobacteriaceae , a prospective, multicenter, cohort study. A maximum likelihood tree was constructed using RAxML. Static clusters shared ≤21 single-nucleotide polymorphisms (SNP) and a most recent common ancestor. Dynamic clusters incorporated SNP distance, culture timing, and rates of SNP accumulation and transmission using the R program TransCluster. Results Most patients were admitted from home (n = 150, 43%) or long-term care facilities (n = 115, 33%). Urine (n = 149, 43%) was the most common isolation site. Overall, 55 static and 47 dynamics clusters were identified involving 210 of 350 (60%) and 194 of 350 (55%) patients, respectively. Approximately half of static clusters were identical to dynamic clusters. Static clusters consisted of 33 (60%) intrasystem and 22 (40%) intersystem clusters. Dynamic clusters consisted of 32 (68%) intrasystem and 15 (32%) intersystem clusters and had fewer SNP differences than static clusters (8 vs 9; P =.045; 95% confidence interval [CI]: −4 to 0). Dynamic intersystem clusters contained more patients than dynamic intrasystem clusters (median [interquartile range], 4 [2, 7] vs 2 [2, 2]; P =.007; 95% CI: −3 to 0). Conclusions Widespread intrasystem and intersystem transmission of CR Kp was identified in hospitalized US patients. Use of different methods for assessing genetic similarity resulted in only minor differences in interpretation. [ABSTRACT FROM AUTHOR]

Despite the challenges of the pandemic, there has been substantial progress with coronavirus disease 2019 (COVID-19) therapies. Pivotal COVID-19 trials like SOLIDARITY, RECOVERY, and ACCT-1 were rapidly conducted and data disseminated to support effective therapies. However, critical shortcomings remain on trial conduct, dissemination and interpretation of study results, and regulatory guidance in pandemic settings. The lessons that we learned have implications for both the current pandemic and future emerging infectious diseases. There is a need for establishing and standardizing clinical meaningful outcomes in therapeutic trials and for targeting defined populations and phenotypes that will most benefit from specific therapies. Standardized processes should be established for rapid and critical data review and dissemination to ensure scientific integrity. Clarity around the evidence standards needed for issuance of both emergency use authorization (EUA) and biologic license application (BLA) should be established and an infrastructure for executing rapid trials in epidemic settings maintained. [ABSTRACT FROM AUTHOR]

Given the urgent need for treatments during the coronavirus disease 2019 pandemic, the US Food and Drug Administration issued emergency use authorizations (EUAs) for multiple therapies. In several instances, however, these EUAs were issued before sufficient evidence of a given therapy's efficacy and safety were available, potentially promoting ineffective or even harmful therapies and undermining the generation of definitive evidence. We describe the strengths and weaknesses of the different therapeutic EUAs issued during this pandemic. We also contrast them to the vaccine EUAs and suggest a framework and criteria for an evidence-based, trustworthy, and publicly transparent therapeutic EUA process for future pandemics. [ABSTRACT FROM AUTHOR]

Background: The integration of Electronic Health Records (EHRs) in healthcare has changed how healthcare is performed, necessitating a comprehensive understanding of these systems among pharmacists. The ability to navigate EHRs is crucial for pharmacy students' success in introductory and advanced pharmacy practice experiences (IPPEs and APPEs). This manuscript describes the development and use of an EHR training environment in an APPE-readiness course., Educational Activity: We developed an APPE-readiness course integrating a comprehensive longitudinal patient case within the Epic EHR training environment. The course was designed for third-year pharmacy students in their final didactic semester, focusing on practical skills and the Pharmacists' Patient Care Process (PPCP). Using a fictitious patient with multiple chronic conditions, students engaged in a variety of activities, including data collection, problem assessment, care plan creation, literature and guideline application, and communication using the SBAR technique. The course aimed to transition classroom knowledge into practical skills, assessed individually through application-based exams and quizzes., Critical Analysis of the Educational Activity: The course required significant initial resource investment but demonstrated benefits in student perceptions of preparedness. Student feedback indicated a desire for more group work and advanced learning options for quicker learners. Adjustments were made in the second course year, including modifications to the patient case and incorporation of resident instructors to help with the EHR training environment. Survey results showed improvements in students' self-assessed skills and confidence in their APPE readiness in both class years., Conclusions: The EHR-based capstone course effectively increased students' confidence and preparedness for APPEs, highlighting the value of practical, longitudinal case-based learning. Our work supports the integration of EHR training in pharmacy curricula to enhance APPE-readiness. Other institutions can use similar EHR training environment tools in their curricula., Competing Interests: Declaration of competing interest Each of the authors has contributed significantly to this work and has reviewed the manuscript. The authors have no relevant conflicts of interest or competing interests to disclose. IRB review was waived., (Copyright © 2024 Elsevier Inc. All rights reserved.)

We surveyed acute-care hospitals on strategies to reduce inappropriate C. difficile testing and treatment of colonized patients. Decision support during C. difficile test ordering was common, but "hard stops" to prevent placement of inappropriate orders and active intervention of antimicrobial stewardship programs on positive C. difficile test reports were infrequent.