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Introduction: Medical misinformation, which contributes to vaccine hesitancy, poses challenges to health professionals. Health professions students, while capable of addressing and advocating for vaccination, may lack the confidence to engage with vaccine-hesitant individuals influenced by medical misinformation., Methods: An interprofessional in-person simulation activity (90 minutes) using standardized patients was developed and instituted for students in medicine, nursing, pharmacy, and public health programs. Student volunteers were recruited from classes approximately halfway through their respective degree programs (i.e., second or third year of a 4-year program). Online simulation was used as a method to prepare for in-person simulation. Impact on students was assessed primarily through a postprogram student self-assessment., Results: A total of 220 students participated in the program; 206 (94%) had paired data available to analyze. Following program participation, self-assessed abilities increased from pre to post, from 2.8 out of 5 (good) to 3.9 out of 5 (very good; p < .001). Ninety-eight percent of students felt that their ability to address medical misinformation was somewhat/much better after the activity, compared to before, and that their ability to address vaccine hesitancy was somewhat/much better. The overall program was rated highly, with mean scores for each program evaluation item >4 out of 5 (very good)., Discussion: An interprofessional cohort of students demonstrated improvement in self-assessed skills to participate in a conversation with an individual with hesitancy to receive vaccines and/or beliefs informed by misinformation. Students felt that this program was relevant and important to their professional development., (© 2024 Fusco et al.)

Objective: To determine the impact of 2-stage collaborative testing (CT) on academic performance of pharmacy students and to characterize pharmacy student perceptions of CT., Methods: Two-stage CT was piloted in a 2-course patient assessment sequence within a Doctor of Pharmacy program. Students were randomly allocated into 2 groups and further divided into teams of 4 to 5 students. Student teams alternated taking section examinations in a traditional 1-stage (individual) and 2-stage CT (individual then team) format to establish an experimental design. Near the end of each semester, students individually took a post-test to facilitate assessment of CT on academic performance. A 12-item, anonymous survey instrument assessed student perceptions of 2-stage CT. The group differences in academic performance and survey responses were analyzed statistically., Results: There were 128 students enrolled in the course sequence, 123 of whom met the inclusion criteria for assessment of academic performance and 100 of whom completed the survey (response rate = 83%). Generally, students performed better on post-test items initially assessed through 2-stage CT (retention marker) and on post-test items that were answered incorrectly under 2-stage CT conditions (learning marker). Approximately 9 in 10 survey respondents preferred 2-stage CT over traditional 1-stage individual testing, with an equivalent proportion reporting it helped them learn from their mistakes and retain what they learned. There was high-level agreement among respondents that 2-stage CT improved their ability to work as a team and think critically., Conclusion: The implementation of 2-stage CT in a patient assessment course sequence was associated with improved learning and retention and was well-received by students., Competing Interests: Declaration of Competing Interest None declared., (Copyright © 2024 American Association of Colleges of Pharmacy. Published by Elsevier Inc. All rights reserved.)

Micro-credentials (MCs) and digital badges (DBs) have gained popularity in recent years as a means to supplement traditional degrees and certifications. MCs and DBs can play a significant role in supporting student-centered learning by offering personalized and flexible learning pathways, emphasizing real-world relevance and practical skills, and fostering a culture of continuous learning and growth. However, barriers currently exist within health professions education, including pharmacy education, that could limit the full adoption and implementation of MCs and DBs. Research on the use of MCs and DBs in Doctor of Pharmacy degree programs is sparse. In this integrative review, literature on the use of MCs and DBs in health professions education is reviewed, and perspectives on the benefits, issues, and potential future uses within Doctor of Pharmacy degree programs are presented., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 American Association of Colleges of Pharmacy. Published by Elsevier Inc. All rights reserved.)

Study Objective: The standard of care for detecting acute kidney injury (AKI) is change in serum creatinine (SCr) and urine output, which are limited. This study aimed to compare urinary biomarkers neutrophil gelatinase-associated lipocalin (uNGAL) with kidney injury molecule-1 (uKIM-1) in critically ill children exposed to vancomycin who did and did not develop AKI as defined by changes in SCr., Design: Single-center, prospective, clinical, observational cohort study., Setting: Tertiary care children's hospital in an urban setting., Patients: Children aged 0 (corrected gestational age 42 weeks) to 18 years admitted to the intensive care unit who received vancomycin were included., Intervention: None., Measurements: The primary outcome was mean change in uNGAL and uKIM-1 between AKI and no-AKI groups. AKI was defined as a minimum 50% increase in SCr from baseline over a 48 h period, within 7 days of first vancomycin exposure. Three urine samples were collected: baseline (between 0 and 6 h of first vancomycin dose), second (18-24 h after the "baseline"), and third (18-24 h after the second sample). Concentrations of uKIM-1 and uNGAL were measured in each sample., Main Results: Forty-eight children (52% male; median age 6 years) were included. Eight (16.7%) children developed AKI. Mean changes in uNGAL (713.196 ± 1,216,474 vs. 16.101 ± 37.812 pg/mL; p = 0.0004) and uKIM-1 (6060 ± 11.165 vs. 340 ± 542 pg/mL; p = 0.0015) were greater in children with AKI versus no-AKI, respectively., Conclusions: uNGAL and uKIM-1 concentrations increased significantly more in critically ill children with AKI compared with those with no-AKI during the first 48-72 h of vancomycin exposure and may be useful as prospective biomarkers of AKI., (© 2023 Pharmacotherapy Publications, Inc.)

Systems thinking and interprofessional collaborative practice competencies are critical to inculcate in students of health professions programs. The purpose of this study was to evaluate the impact that an interprofessional education (IPE) experience consisting of an educational game, Friday Night at the ER (FNER), and structured debriefing had on students' systems thinking and self-assessed interprofessional socialization and teamwork skills. Systems thinking was evaluated using the Systems Thinking Scale (STS), and interprofessional socialization and teamwork were evaluated using a modified Interprofessional Socialization and Valuing Scale-9 (ISVS-9) and Interprofessional Collaboration Competency Attainment Scale (ICCAS) question #21. This single-center study targeted students in 13 health professions programs. In the cohort (N of 626), Systems thinking increased significantly. Interprofessional socialization increased significantly, with a large effect size, and 485 (78%) students indicated their interprofessional collaborative practice competencies improved. Program evaluation data revealed students highly valued the experience and would recommend it to their peers. Based on our findings, an IPE experience consisting of FNER gameplay and structured debriefing can improve systems thinking and interprofessional socialization and teamwork in a large, diverse group of students of health professions programs.

Objective: Interprofessional education (IPE) varies across schools/colleges of pharmacy. Long-term impact of IPE on interprofessional collaborative competencies remains uncertain despite available data on singular experiences. This study aimed to evaluate changes in pharmacy students' collaborative abilities over the second and third professional years (PYs)., Methods: Students completed the Interprofessional Collaborative Competency Attainment Scale - Revised (ICCAS-R) after 2 large-scale interprofessional forums that occurred approximately 8 months apart. Four cohorts of students were used to examine the longitudinal change in collaborative abilities: cohort 1 (2019), cohort 2 (2020), cohort 3 (2021) and cohort 4 (2022). The ICCAS-R was used to capture data from 4 timepoints for each student in each cohort: prior to the Spring Forum in PY2 (T1), after the Spring Forum in PY2 (T2), prior to the Fall Forum in PY3 (T3), and after the Fall Forum in PY3 (T4). Using repeated measures analysis of variance, 4 total mean scores (T1 = pre1, T2 = post1, T3 = pre2, T4 = post2) were compared., Results: Four cohorts (N = 414) completed the interprofessional forums and 336 (81%) completed the ICCAS-R instrument and were included. In each cohort, total mean scores increased T1 to T2 and T3 to T4, indicating an increase in self-assessed abilities pre/post-forum. Total mean scores decreased between T2 and T3, indicating that collaborative abilities decreased during the period between interprofessional forums., Conclusion: While students' collaborative abilities increased around the time of the forum experiences, these changes decreased in between experiences. These findings suggest that interprofessional competencies should be reinforced at multiple time points to support enduring effects., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 American Association of Colleges of Pharmacy. Published by Elsevier Inc. All rights reserved.)

Background: Interprofessional (IP) socialization is important to develop early in the training of health professions students., Purpose: This study compared changes in health professions students' IP socialization and readiness to function in IP teams and sought to understand students' participation experiences using a simulation learning game ( Friday Night at the ER [FNER])., Methods: The single-center study targeted students in 13 health professions programs using a mixed-methods design. Student teams engaged in open discussion, played the game, and participated in team debriefing., Results: IP socialization increased from fairly great to great extent among all students. Qualitative analyses revealed 3 overarching themes supporting the development of IP communication and systems-based thinking. Program evaluation data revealed that students highly valued this experience as being effective and important to their professional development., Conclusions: An IP experience consisting of FNER gameplay and structured debriefing can improve IP socialization and lay the foundation for the development of IP skills among early health professions students., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Background: This project investigated the change in nursing, pharmacy, and physical therapy students' interprofessional socialization after participation in a virtual interprofessional escape room and case conference simulation., Interprofessional Education Activity: Interprofessional teams of nursing (n = 93), pharmacy (n = 75) and physical therapy (n = 33) students completed asynchronous, online learning (sepsis recognition and total hip replacement post-operative precautions) followed by a virtual escape room and a virtual simulated patient case conference. During the case conference, interprofessional student teams developed a discharge plan for an individual after a hip replacement complicated by post-operative sepsis. Before and after the experience, students completed a knowledge test and a validated survey instrument that assessed their interprofessional socialization (Interprofessional Socialization and Valuing Scale-21). During the simulated patient case conference, faculty assessed student performance using a standardized rubric. After the experience students completed a program evaluation., Discussion: Interprofessional socialization significantly increased (5.5 ± 0.9 vs. 6.0 ± 0.9) among all students with a medium effect size (Cohen's d = 0.56). Faculty assessment of individual student's team performance during the virtual simulation revealed a moderate rate meeting competency, with good interrater reliability. Students highly valued this learning experience as being both effective and important to their professional development, as indicated on the program evaluation., Implications: A virtual interprofessional experience consisting of asynchronous online learning, a virtual escape room, and a virtual case conference positively influenced students' interprofessional socialization. Students valued the experience and recognized its importance in their development as student health professionals., Competing Interests: Declaration of Competing Interest None., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Objective. Innovation sprints are a novel pedagogy where small groups of students find creative solutions to problems. The purpose of this study was to extend our understanding of innovation sprint pedagogical design by investigating the impact of an innovation sprint on Doctor of Pharmacy (PharmD) students' and Master of Public Health (MPH) students' interprofessional collaboration and problem-solving skills. We hypothesized that the innovation sprint would increase student self-efficacy and that interprofessional collaborative behaviors would be demonstrated by individuals on a team. Methods. MPH and third-year PharmD students were assigned to teams and participated in a required two-hour innovation sprint. Faculty observed student teams and evaluated their interprofessional collaboration skills using a rubric modeled after the Modified McMaster-Ottawa Scale. Students completed a postprogram survey assessing their interprofessional collaborative behaviors and attitudes toward the innovation sprint. Results. Of the 133 students participating in the innovation sprint, 127 completed the postprogram survey (response rate=95%). Faculty determined that 123 students (92%) met the interprofessional collaboration competencies. The mean interprofessional collaborative competencies attainment survey scores increased for both PharmD and MPH students. Qualitative analyses highlighted themes of interprofessional collaboration and problem-solving skills that students valued. Overall, students enjoyed working with each other and engaging in creative problem-solving. Conclusion. An interprofessional innovation sprint involving PharmD and MPH students demonstrated a positive impact on student self-assessed interprofessional collaboration and problem-solving skills. Further, faculty observed a high rate of interprofessional behaviors within student teams. Based on these findings, an innovation sprint may be an effective pedagogical tool to enhance students' skills in these areas., (© 2023 American Association of Colleges of Pharmacy.)

Objective. The purpose of this study was to extend our understanding of escape room pedagogical design by investigating the impact of escape room puzzle content on changes in students' immediate recall knowledge and demonstration of interprofessional skills during a subsequent simulation. Methods. Students from nursing, pharmacy, and physical therapy programs were randomized to complete an escape room themed around acute management of sepsis (intervention group; n=133) or general acute care (control group; n=129) prior to participating in a simulated patient discharge case conference. Students completed a knowledge assessment before the escape room, immediately after the escape room, and immediately after the simulation. Additionally, students completed the Interprofessional Socialization and Valuing Scale (ISVS-21) before and after the experience along with a post-program evaluation. Faculty rated student achievement of interprofessional learning objectives during the simulation using a standardized rubric. Results. Students in the intervention group had higher scores on the knowledge test administered immediately after the escape room. All participants' ISVS-21 scores increased from before to after the activity. Interprofessional learning objectives, as evaluated by faculty, were met by 248 (94.7%) students. Conclusion. Participating in an interprofessional escape room activity with specific puzzle content improved students' immediate recall knowledge. In both groups, self-assessed interprofessional socialization improved, and a high percentage of students achieved the interprofessional learning objectives in a subsequent simulation. Escape rooms can be an innovative pedagogical tool that can positively impact immediate recall knowledge and interprofessional collaborative skills of health professions students., (© 2022 American Association of Colleges of Pharmacy.)

Objective: The Kobayashi score (KS) is the most widely used tool for predicting intravenous immunoglobulin (IVIG) resistance in Kawasaki disease (KD). The KS has shown good sensitivity (86%) and specificity (68%) in Japanese children; however, its use is limited outside of Japan. No models accurately predict IVIG resistance of children with KD in the United States. We sought to develop and test a novel scoring system to predict IVIG resistance in hospitalized children with KD., Methods: A retrospective chart review was conducted of all children diagnosed with KD from January 2000 to December 2015. Subjects were divided into 2 groups: IVIG susceptible or resistant. Variables that differed between the groups were identified and used to create a "new score" to predict resistance to IVIG. The new score was then compared with the KS and performance characteristics were determined., Results: A total of 208 subjects were reviewed. White blood cell count, neutrophil percentage, age, and serum albumin were used in the new score with equal weighting. Overall, the new score achieved improved sensitivity (54% vs 26%) and similar specificity (69% vs 74%) compared with the KS in predicting IVIG resistance in hospitalized children diagnosed with KD., Conclusions: Predicting IVIG resistance in children diagnosed with KD remains challenging. The KS has low sensitivity in predicting IVIG resistance in children with KD in the United States. The new score resulted in improved sensitivity, but many children with true IVIG resistance may be missed. Further research is needed to improve IVIG resistance prediction., Competing Interests: Disclosures. The authors declare no conflicts., (Copyright. Pediatric Pharmacy Association. All rights reserved. For permissions, email: membership@pediatricpharmacy.org 2022.)

Background: Pharmacy students should have the opportunity to practice applying the Pharmacists' Patient Care Process (PPCP) in an interprofessional environment. The purpose of this study was to compare the change in students' confidence in their ability to complete the five steps of the PPCP before and after participation in an interprofessional activity involving physician assistant (PA) students., Interprofessional Education Activity: Second-year pharmacy students and second-year PA students completed an activity in teams of six (four pharmacy and two PA students per team) in which they applied the PPCP to a patient case to create a plan of care. Students completed a pre- and a post-survey regarding their confidence in completing the PPCP and their attitudes toward interprofessional collaboration, as well as a program evaluation after completion of the activity., Discussion: There were 117 pharmacy and 58 PA students divided into 29 interprofessional teams. Of those, 99 (85%) pharmacy and 52 (90%) PA students completed both surveys. There was a statistically significant increase in confidence to perform the PPCP for all students, with a large effect size. There were no changes in attitudes toward interprofessional collaboration. Overall, the program evaluation reflected the activity was rated highly by students., Implications: The interprofessional activity demonstrated a positive effect on students' self-reported confidence in their ability to complete steps of the PPCP. While the interprofessional activity did not affect student attitudes toward interprofessional collaborative practice, the activity was rated highly and most found it to be an important part of their professional development., (Copyright © 2018. Published by Elsevier Inc.)

Graduates of health professions programs are required to work collaboratively as part of interprofessional healthcare teams. The purpose of this study was to create and test the use of an interprofessional escape room, as a method to improve teamwork, prior to interprofessional simulation. The study evaluated performance in simulation with the Observed Interprofessional Collaboration tool and self-reported attitudes toward teamwork using the Interprofessional Socialization and Valuing Scale. A total of 233 students from professional nursing (n of 118) and pharmacy students (n of 115) were split into groups of four (two nursing, two pharmacy students). Groups were randomized to participate in the escape room first followed by simulation, or simulation first followed by the escape room. Results indicated median scores in simulation performance were higher for students who participated in an escape room before simulation compared to an escape room after simulation. There was no difference in the mean change in perceptions of teamwork from pre to post between students who participated in an escape room before simulation. Escape rooms can, in a brief period of time, improve teamwork and consequently performance during simulation. Findings support the use of escape rooms in interprofessional education curriculum as a method to promote teamwork.

Objective: Drug-induced kidney injury contributes to morbidity and mortality in hospitalized children. Antibiotics such as TZP have been implicated in the development of acute kidney injury (AKI) in adults; however, data are limited in children. The purpose of this study was to determine the incidence of AKI in hospitalized children receiving TZP., Methods: This was a retrospective cohort study of hospitalized children between 2 months and 19 years of age who received TZP for at least 48 hours. Acute kidney injury was defined as a 50% increase from the initial serum creatinine (SCr) prior to TZP initiation. Serum creatinine values were adjusted for fluid balance using a validated approach. Severity of AKI was characterized using the Pediatric Risk, Injury, Failure, Loss, End-Stage Renal Disease (pRIFLE) criteria. Descriptive and inferential statistics were used to describe the incidence and risk factors of AKI, with an alpha = 0.05., Results: A total of 65 subjects were included. Twenty-five (38.5%) required PICU admission. The incidence of AKI was 7.7% (n = 5) using adjusted SCr (13.37 cases/1000 patient-days). According to pRIFLE, 6.15% (n = 4) subjects met criteria for Risk (n = 3) or Injury (n = 1), and none developed Failure, Loss, or End-Stage (10.70 cases/1000 patient-days for Risk and Injury categories). No risk factors were identified. Hospital length of stay was longer in subjects who experienced AKI compared with those who did not (p = 0.04)., Conclusions: The incidence of AKI in hospitalized children exposed to TZP was low. In those who did develop AKI, peak SCr occurred approximately 1 week after TZP initiation., Competing Interests: Disclosures. The authors declare no conflicts or financial interest in any product or service mentioned in the manuscript, including grants, equipment, medications, employment, gifts, and honoraria. The authors had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis., (Copyright. Pediatric Pharmacy Association. All rights reserved. For permissions, email: mhelms@pediatricpharmacy.org 2021.)

Objectives: Antibiotic stewardship at hospital discharge is an area of need. We assessed the rate of optimal antibiotic prescriptions at hospital discharge, on the basis of urine culture and susceptibility data, for children diagnosed with a urinary tract infection (UTI)., Methods: We conducted a retrospective study of patients ≤18 years of age who were admitted to a general pediatrics service at a freestanding children's hospital during 2017 with a diagnosis of UTI and received an antibiotic prescription at discharge. For the primary analysis, optimal antibiotic at hospital discharge was determined by evaluating if the cultured urinary pathogen was susceptible to the prescribed antibiotic and if the antibiotic was the narrowest-spectrum option available. Secondary objectives included assessment of antibiotic dosing accuracy and description of antibiotic treatment duration., Results: A total of 78 cases were included. Sixty-eight (83%) cases were caused by cefazolin-susceptible Escherichia coli and Klebsiella species. Thirty-one (40%) cases had a discharge antibiotic prescription that was determined to be optimal. Of the 47 (60%) cases that were suboptimal, 44 (94%) were considered to be excessively broad spectrum. In 3 (6%) cases, the causative organism was nonsusceptible to the prescribed antibiotic. Ten (13%) discharge antibiotic prescriptions had inaccurate dosing and/or frequency., Conclusions: Missed opportunities for narrow-spectrum antibiotic selection at hospital discharge for pediatric UTIs frequently occurred. In particular, higher-generation cephalosporins and ciprofloxacin were often prescribed for cephalexin-susceptible cases. Antibiotic stewardship attention, specifically at hospital discharge for pediatric UTIs, is likely to have a high impact., Competing Interests: POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose., (Copyright © 2020 by the American Academy of Pediatrics.)

Objective. To produce, implement, and evaluate the effectiveness of a film to develop the foundational knowledge and skills of health professions students and teach them the importance of interprofessional collaboration. Methods. An existing interprofessional case study about a Hispanic man suffering from multiple chronic health conditions and the impact his health had on his family served as the basis for the film. To ensure a high-quality production, faculty members partnered with a local theatre company to produce the film. Upon completion, the film was integrated into an annual interprofessional forum and evaluated by both students and faculty members in 2016, 2017, and 2018. Results. The 22-minute film, entitled Meet Fred Santiago : Improving Care Through Interprofessional Collaboration , was shown to 1921 students and 250 faculty members who participated in the interprofessional forum over the three years. Of these, 1858 students and 174 faculty members completed a program evaluation following the forum. The majority (>86%) of student and faculty respondents agreed or strongly agreed that the film presented a realistic view of the challenges faced by people with multiple chronic health problems. The majority of students (>85%) agreed or strongly agreed that the film helped them appreciate the breadth of issues confronting individuals with multiple chronic health problems. Conclusion. The film, Meet Fred Santiago , is an effective tool for introducing health professions students to the complex interrelationship of medical, psychological, and social issues experienced by individuals with chronic health conditions., (© 2020 American Association of Colleges of Pharmacy.)

Background: Data are limited regarding the preferred antibiotics for treatment of acute pulmonary exacerbations (APEs) of cystic fibrosis (CF), when methicillin-resistant Staphylococcus aureus (MRSA) is suspected. Objective: To compare the rate of return to baseline lung function among individuals with APEs of CF treated with either vancomycin or linezolid. Methods: This retrospective study included individuals hospitalized for APEs of CF from May 1, 2015, to April 30, 2017 who were infected with MRSA and treated with vancomycin or linezolid. The primary outcome was the return to baseline lung function, as measured by forced expiratory volume in 1 s (FEV1). Descriptive and inferential statistics were used. All tests were 2-tailed with α set at 0.05. Results: A total of 122 encounters were included (vancomycin: n = 66; linezolid: n = 66). No difference existed in return to baseline FEV 1 between vancomycin (53 [80.3%]) and linezolid (50 [75.8%]; P = 0.53); nor was there a difference in median percentage change in FEV 1 from admission to follow-up between vancomycin (24.7%) and linezolid (20.7%; P = 0.61). Adverse drug events occurred more frequently in patient encounters treated with vancomycin (10 [15.2%]) compared with linezolid (2 [3%]; P = 0.002). Conclusion and Relevance: Our study observed no difference in the effectiveness of vancomycin compared with linezolid in terms of change in lung function for APEs of CF. The rate of adverse drug events was low. In individuals with CF infected with MRSA who are experiencing an APE, either vancomycin or linezolid appear to be viable treatment options.

Objective. To compare the change in pharmacy students' self-reported competence toward interprofessional collaboration between those that were active participants in or observers of an interprofessional simulation. Methods. Second- and third-year (P2 and P3) pharmacy students and senior nursing students participated in an interprofessional simulation. Third-year pharmacy students and senior nursing students were divided into teams of four (two from each profession) and were active participants. Second-year pharmacy students were observers. All pharmacy students were asked to complete a brief demographic survey and the Interprofessional Collaborative Competency Attainment Survey (ICCAS) after the simulation. Mean retrospective pretest and posttest ICCAS scores for each group of learners were compared using paired sample t tests. To examine the difference in the change in mean total ICCAS score between observers and active participants, repeated measures analysis of variance was completed. Results. One hundred thirty (95%) P2 pharmacy students and 121 (92%) P3 pharmacy students participated in the interprofessional simulation experience as observers and active participants, respectively, and completed the ICCAS for an overall response rate of 94%. The active participants' mean ICCAS scores were significantly higher than those of the observers on both the retrospective pretest (M=4.9, SD=1.0 vs M=5.2, SD=1.0) and the posttest (M=5.9, SD=0.7 vs M=6.2, SD=0.7). The mean change in scores from retrospective pretest to posttest was not significantly different between observer and active participant pharmacy students. Conclusion. Both observation and active participation in an interprofessional simulation experience may increase pharmacy students' self-reported competence in interprofessional collaboration., (© 2020 American Association of Colleges of Pharmacy.)

Objective. To examine pharmacy students' self-assessment and evaluator assessment of the global performance of skills required for effective interprofessional collaborative practice during an objective structured clinical examination (OSCE). Methods. Third-year pharmacy students completed three cases designed to evaluate the skills they would need to engage in effective interprofessional collaborative practice as part of a capstone objective structured clinical examination (OSCE). Students then also completed a brief survey regarding the quality of the cases and the Interprofessional Collaborative Competency Attainment Survey (ICCAS). Student performance on each of the three cases was assessed using the Global Rating Scale (GRS). Paired sample t tests were conducted to compare differences in mean change in ICCAS scores. Correlations between the GRS ratings and ICCAS pre- and post-assessment scores and changes in scores were examined. Results. One hundred twenty-four students participated in the study. The majority of students reported that the OSCE cases were realistic and of high quality. The average total ICCAS score (out of 7) was 5.1 (SD=0.8) at pre-assessment and 5.9 (SD=0.6) at post-assessment; the difference in scores was significant. The mean GRS scores (out of 5 points) for the three cases were 4.2 (SD=0.5), 4.5 (SD=0.6), and 4.6 (SD=0.5); and the mean score for the three cases combined was 4.4 (SD=0.3). A weak relationship was found between the total GRS and ICCAS post-assessment scores. Conclusion. Presenting pharmacy students with OSCE cases that focused on skills important to effective interprofessional collaborative practice was an effective means of assessing their skills and improving their self-assessment of interprofessional collaborative behaviors., (© 2019 American Association of Colleges of Pharmacy.)

Introduction: Faculty and preceptor development have been noted to be areas of need within the expansion of interprofessional education (IPE). The primary objective of this pilot study was to evaluate the impact of a preceptor development program on pharmacy preceptors' self-reported competence toward interprofessional collaboration., Methods: Pharmacy preceptors were invited to participate in a two-hour preceptor development program followed by a brief survey. Preceptor development program objectives were to: define IPE and interprofessional collaborative practice (IPCP); describe the benefits of IPCP for patients/clients, healthcare providers, and health systems; discuss the four Interprofessional Education Collaborative (IPEC) Core Competencies; and describe IPE student experiences aimed at increasing collaborative practice. The Interprofessional Collaborative Competencies Attainment Survey (ICCAS) was administered after the preceptor development program. Descriptive statistics were used to characterize the data and paired t-tests were used to analyze pre-/post-program scores., Results: Thirty (35%) preceptors completed the survey. Mean scores for all twenty items in the ICCAS instrument increased from pre- to post-(p < 0.05). The mean total ICCAS score pre- was 5.28 ± 1.12 and post- was 6.17 ± 1.11 (p < 0.01) out of a possible total score of seven., Conclusions: A preceptor development program targeting IPE and IPCP increased pharmacy preceptors' self-reported competence toward interprofessional collaboration., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Purpose: Common bacterial infections in pediatric patients that the hospital pharmacist may encounter are reviewed, and guidance on the safe and effective use of antibiotics to treat those infections is provided., Summary: Pharmacists play a key role in evaluating and creating antibiotic treatment plans for patients with infections. Bacterial infections are a common reason for hospital admission in pediatric patients, and pharmacists working in hospitals may be consulted to provide treatment and monitoring recommendations. It is important for pharmacists to be aware of similarities and differences in adult and pediatric populations with regard to presenting signs and symptoms of bacterial infections, common causative pathogens, and antibiotic selection, dosing, and monitoring. This article reviews current approaches to treatment of common bacterial infections in pediatric patients and also provides general suggestions for antibiotic use., Conclusion: Pharmacists have an opportunity to positively impact the care of pediatric patients with bacterial infections. Especially at facilities where pediatric patients are not regularly treated, pharmacists can potentially improve care through provision of recommendations for optimal antibiotic selection, dosing, and monitoring., (© American Society of Health-System Pharmacists 2019. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Objective. To evaluate the impact of a large-scale interprofessional forum on pharmacy students' attitudes toward interprofessional collaborative practice. Methods. Pharmacy students were asked to complete the Interprofessional Attitudes Scale (IPAS) prior to and after completing a three-hour interprofessional forum. Scores for the total IPAS and each of the subscales were computed using the mean of students' responses to the items for each. Results. Of the 133 pharmacy students who participated in the forum, there were valid pre- and post-intervention matched IPAS data for 124 (93.2%). In general, prior to the forum, students reported positive attitudes toward interprofessional collaborative practice as demonstrated by mean scores greater than 4.0 (agree) on the total IPAS scale and on all of the IPAS subscales except the Interprofessional Biases subscale). There was a significant increase from pre- to post-intervention scores on all the subscales except Patient-Centeredness. Based on the Cohen d measure of effect size, the greatest changes were in the Teamwork, Roles and Responsibilities and Community-Centeredness subscales, followed by the Interprofessional Biases subscale and Diversity and Ethics subscale. Conclusion. Prior to participating in an interprofessional student forum, pharmacy students generally had positive attitudes toward interprofessional collaborative practice. After participating in the forum, these attitudes become even more positive. Interprofessional education interventions, such as the forum, play an important role in shaping student's attitudes toward interprofessional collaboration.

Introduction: New York state requires day/summer camps to keep immunization records for all enrolled campers and strongly recommends requiring vaccination for all campers and staff. The objective of this study was to characterize immunization requirements/recommendations for children/adolescents enrolled in and staff employed at day/summer camps in New York state., Methods: An electronic hyperlink to a 9-question survey instrument was distributed via e-mail to 178 day/summer camps located in New York state cities with a population size greater than 100 000 people. A follow-up telephone survey was offered to nonresponders. The survey instrument included questions pertaining to vaccination documentation policies for campers/staff and the specific vaccines that the camp required/recommended. Fisher's exact and Chi-square tests were used to analyze categorical data., Results: Sixty-five day/summer camps responded to the survey (36.5% response rate): 48 (73.8%) and 23 (41.8%) camps indicated having a policy/procedure for documenting vaccinations for campers and staff, respectively. Camps that had a policy/procedure for campers were more likely to have a policy/procedure for staff ( P = .0007). Age-appropriate vaccinations that were required/recommended for campers by at least 80% of camps included: measles, mumps, and rubella (MMR), diphtheria, tetanus, and pertussis (DTaP), hepatitis B, inactivated/oral poliovirus (IPV/OPV), Haemophilus influenzae type b (Hib), and varicella. Age-appropriate vaccinations that were required/recommended for staff by at least 80% of camps included: DTaP, hepatitis B, IPV/OPV, MMR, meningococcus, varicella, Hib, and tetanus, diphtheria, and pertussis (Tdap)., Conclusion: Vaccination policies at day/summer camps in New York state appear to be suboptimal. Educational outreach may encourage camps to strengthen their immunization policies, which may reduce the transmission of vaccine-preventable diseases.

Background: A correlation between vancomycin (VAN) trough concentrations (VTC) and area under the curve (AUC) to minimum inhibitory concentration (MIC) ratio (AUC/MIC) has not been established in children/adolescents with cystic fibrosis (CF). The primary objective of this study was to determine the correlation between measured VTCs and AUC/MIC using population-based pharmacokinetics., Methods: A retrospective cohort study of children/adolescents diagnosed with CF, 6 to <18 years of age, treated with VAN for methicillin-resistant Staphylococcus aureus infection was conducted. The relationship between final VTCs and calculated AUC/MIC was assessed using Pearson and Spearman correlations. All tests were 2-tailed with alpha set at 0.05., Results: Thirty children/adolescents, 7 to 17 years of age (median age 15 year; interquartile range: 9-17 years), were included. The mean final VAN dose was 58.03 ± 18.58 mg/kg/d, and the median final VTC was 12.6 (11-13.6) mg/L. The mean AUC/MIC was 355.34 ± 138.46 (Le model) versus 426.79 ± 178.92 (Stockmann model; P = 0.089). No correlation existed between VTCs and AUC/MIC using either the model by Le (r = 0.140; P = 0.461) or Stockmann (r = 0.115; P = 0.564). Using the Stockmann model, VAN dose (mg/kg/dose) was found to have a strong positive correlation with AUC (r = 0.8874; P < 0.0001) and AUC/MIC (r = 0.7877; P < 0.0001)., Conclusions: VTCs did not correlate with AUC or AUC/MIC. Further research is needed to determine which estimate of VAN treatment efficacy is most appropriate for children and adolescents with CF infected with methicillin-resistant Staphylococcus aureus.

The purpose of this study was to evaluate the effects of interprofessional high-fidelity simulation-based learning (SBL) on third-year pharmacy and senior nursing students' perceptions of interprofessional care. Students participated in an interprofessional high-fidelity SBL experience consisting of two hospital-based scenarios followed by a debriefing. The "Student Perceptions of Interprofessional Clinical Education-Revised" (SPICE-R) instrument was administered pre- and post-SBL. The "Student Satisfaction and Self-Confidence in Learning" (SSSCL) instrument, which uses a 5-point Likert scale, was administered post-SBL. A total of 104 (78%) pharmacy and 93 (77%) nursing students completed both the pre- and post-survey instruments. Baseline differences between pharmacy and nursing students included number of clinical hours completed [200 (190-240) vs. 210 (209-210); p < 0.001] and previous/current experiencing working directly with other healthcare professionals [71 (53%) vs. 88 (73%); p < 0.001]. Median score increases were observed for all SPICE-R items (p < 0.01) for pharmacy students and nine of ten SPICE-R items (p < 0.01) for nursing students. All students rated both the experience and their confidence highly on the SSSCL; however, nursing scores were higher than pharmacy scores for 7 of 13 items (p < 0.05). An interprofessional high-fidelity SBL experience increased pharmacy and nursing students' perceptions of interprofessional care.

Objectives: This study aimed to compare the change in pulmonary function in children and adolescents with cystic fibrosis (CF) who were infected with methicillin-resistant Staphylococcus aureus (MRSA) treated with either vancomycin (VAN) alone or vancomycin plus rifampin (VAN-RIF)., Methods: Included patients were ages 6 to 20 years; hospitalized for an acute pulmonary exacerbation (APE) of CF from May 1, 2012, to April 30, 2014; had a respiratory tract culture positive for MRSA within 1 month of index hospital admission; received at least 48 consecutive hours of VAN or VAN-RIF; and had admission and discharge pulmonary function tests. The primary end point was change in percent predicted forced expiratory volume in 1 second (FEV 1 )., Results: A total of 39 encounters met inclusion criteria: 24 in the VAN group (mean age 15.1 years) and 15 in the VAN-RIF group (mean age 13.7 years). There were no between-group differences in mean percent change in FEV 1 (32.6% ± 28.8% vs. 21.1% ± 12.1%; p = 0.091), mean percent change in forced vital capacity (22.6% ± 25.8% vs. 14% ± 9.4%; p = 0.127), or return to baseline FEV 1 (20 [83.3%] vs. 14 [93.3%] patients; p = 0.631). Median (IQR) length of stay (13 days [11-14 days] vs. 13 days [9-14 days]; p = 0.6) and median (IQR) time to readmission (82 days [43-129 days] vs. 147 days [78-219 days]; p = 0.2) were similar between the VAN and VAN-RIF groups, respectively., Conclusions: Vancomycin monotherapy appears to be adequate when treating APEs of CF in children and adolescents with moderate lung disease and high MRSA VAN minimum inhibitory concentrations. Therefore, the addition of RIF may be unnecessary; however, larger studies are needed to confirm these findings., Competing Interests: Disclosures The authors declare no conflicts or financial interest in any product or service mentioned in the manuscript including grants, equipment, medications, employment, gifts or honoraria. The authors had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Objectives: Compare the rates of acute kidney injury in critically ill children treated with vancomycin and piperacillin-tazobactam versus vancomycin and ceftriaxone., Design: Retrospective cohort study., Setting: A large tertiary care children's hospital in an urban setting., Patients: Children greater than or equal to 2 months old admitted to the PICU who received greater than or equal to 48 consecutive hours of vancomycin and piperacillin-tazobactam or vancomycin and ceftriaxone., Interventions: None., Measurements and Main Results: Acute kidney injury was defined as a minimum 50% increase in serum creatinine, adjusted for total fluid balance, from baseline over a 48-hour period. Bivariate analysis compared treatment groups and acute kidney injury groups. A multivariable logistic regression model was fit for acute kidney injury including covariable analysis. The study included 93 children. There were no differences between treatment groups in terms of age, severity of illness, baseline renal function, vancomycin dosing, or vancomycin trough concentrations. Children who received vancomycin and piperacillin-tazobactam had a higher cumulative frequency of acute kidney injury than those who received vancomycin and ceftriaxone 915/58 [25.9%] vs 3/35 [8.6%]; p = 0.041). After controlling for vancomycin trough concentration, age, concurrent nephrotoxin exposure, and use of vasopressors, exposure to piperacillin-tazobactam significantly increased the risk of acute kidney injury (adjusted odds ratio, 4.55; 95% CI [1.11-18.7]; p = 0.035) compared with ceftriaxone. Use of vasopressors (adjusted odds ratio, 3.73 [95% CI, 1.14-12.3]) and a vancomycin trough greater than or equal to 15 mg/dL (adjusted odds ratio, 4.12 [95% CI, 1.12-15.2)] was also associated with acute kidney injury. Length of stay was longer in children with acute kidney injury (median, 18.0 days; interquartile range, 7.76-29.7) compared with those without acute kidney injury (median, 6.21 days; interquartile range, 2.92-15.6; p = 0.017)., Conclusions: In critically ill children, acute kidney injury occurred more in patients treated with vancomycin and piperacillin-tazobactam versus vancomycin plus ceftriaxone. After controlling for covariates, exposure to piperacillin-tazobactam was associated with an increased odds of acute kidney injury development.

Background: Our goal was to determine the relationship between serum vancomycin trough concentrations (VTCs) and changes in pulmonary function among individuals with an acute pulmonary exacerbation (APE) of cystic fibrosis (CF)., Methods: We included subjects who were ≥6 years of age, were hospitalized for an APE of CF between May 1, 2012, and April 30, 2014, were administered vancomycin for ≥48 hours, and had a history of airway infection with methicillin-resistant Staphylococcus aureus. Pearson correlations were performed to characterize the relationship between VTC and pulmonary function., Results: The mean final VTC (± standard deviation) was 12.6 ± 3.3 µg/mL; 40 (81.6%) of 49 final VTCs were in the range of 10 to <15 µg/mL. The mean change in forced expiratory volume in 1 second (FEV1) between admission and discharge was 24.5% ± 24.4% (P < .001) of predicted values. Forty-two (85.7%) patients returned to their baseline FEV1. No correlation between the change in FEV1 and VTC (Pearson r = -0.10; P = .49) was identified. Similarly, VTC, daily weight-adjusted vancomycin dose, and vancomycin area under the concentration-time curve normalized to the minimum inhibitory concentration (AUC/MIC) were not significant predictors of change in FEV1 or return to baseline FEV1 on multivariate analysis. One (2%) subject experienced acute kidney injury., Conclusions: The majority of patients experienced improvement in pulmonary function and a return to their baseline FEV1 while achieving a VTC in the range of 10 to <15 µg/mL. We were unable to identify a correlation between markers of vancomycin exposure and change in pulmonary function test results. Additional studies are needed to reinforce the efficacy of VTCs of 10 to 15 µg/mL for treating APEs of CF., (© The Author 2017. Published by Oxford University Press on behalf of The Journal of the Pediatric Infectious Diseases Society. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

The diagnostic power of procalcitonin (PCT) in the pediatric intensive care unit (PICU) is uncertain. This study aimed to determine the diagnostic ability of PCT to detect serious bacterial infections (SBI) in a heterogeneous PICU population. This was a retrospective cohort study of patients on whom a PCT level was obtained within 48 hours of admission to a PICU from 2013 to 2015. Discriminatory ability of PCT to predict SBI was examined by test and receiver operating characteristics (AUC [area under the curve]-ROC). Seventy-five patients were included and 28 (37%) had an SBI (median PCT = 6.48 ng/mL) compared with 47 (63%) in the noninfection group (median PCT = 0.23 ng/mL, P < .0001). PCT was able to adequately predict SBI (AUC-ROC = 0.83, 95% CI 0.74-0.93; P < .0001), and a PCT ≥1.28 ng/mL was the optimal threshold to detect SBI with a positive predictive value of 76.7% and negative predictive value of 88.9%. PCT adequately predicted SBI in a heterogeneous PICU population and may be useful for minimizing antibiotic consumption.

Objective: To review the treatment of methicillin-resistant Staphylococcus aureus (MRSA)-associated acute pulmonary exacerbations (APEs) in cystic fibrosis (CF)., Data Sources: A search of PubMed, MEDLINE, Cochrane Library and Clinicaltrials.gov databases through November 2014 was conducted using the search terms Staphylococcus aureus, methicillin-resistant Staphylococcus aureus, pulmonary exacerbations, and cystic fibrosis., Study Selection and Data Extraction: All English-language research articles, case reports, and case series were evaluated. A total of 185 articles were identified related to MRSA and CF; 30 articles that studied treatments of MRSA APE in CF were included., Data Synthesis: The persistent presence of MRSA in the respiratory tract of patients with CF has been associated with higher morbidity and an increased risk of death. Limited clinical data exist supporting the efficacy of any specific antimicrobial currently available for the treatment of APE secondary to MRSA., Conclusions: Data extrapolated from other populations suggest that vancomycin and linezolid are appropriate first-line treatment options for the treatment of APE secondary to MRSA. Second-line options include doxycycline or minocycline and trimethoprim/sulfamethoxazole, each of which may be useful in patients coinfected with other respiratory pathogens, for which they may provide overlapping coverage. Ceftaroline and ceftobiprole are newer antibiotics that appear to have a potential role in the treatment of APE in CF, but the latter is not currently available to the US market. Although potentially useful, clindamycin is limited by high rates of resistance, telavancin is limited by its toxicity profile, and tigecycline is limited by a lack of demonstrated efficacy for infections that are similar to that seen in the CF population. Studies investigating the clinical utility of the above-cited antibiotics for APE in CF secondary to MRSA are desperately needed to broaden the treatment armamentarium for this medical condition., (© The Author(s) 2015.)

Objectives: Delay of antimicrobial administration in adult patients with severe sepsis and septic shock has been associated with a decrease in survival to hospital discharge. The primary objective of this investigation was to determine the time to first antimicrobial administration after the onset of sepsis in critically ill children. Secondary objectives included appropriateness of empiric antimicrobials and microbiological testing, fluid resuscitation during the first 24 hours after onset of sepsis, intensive care unit and hospital length of stay, and mortality., Methods: Retrospective, chart review of all subjects less than or equal to 18 years of age admitted to the pediatric intensive care unit (PICU) with a diagnosis of sepsis between January 1, 2011, and December 31, 2012., Results: A total of 72 subjects met the inclusion criteria during the study period. Median time to first antimicrobial administration by a nurse after the onset of sepsis was 2.7 (0.5-5.1) hours. Cultures were drawn prior to administration of antimicrobials in 91.7% of subjects and were repeated within 48 hours in 72.2% of subjects. Empiric antimicrobial regimens were appropriate in 91.7% of cases. The most common empiric antimicrobial regimens included piperacillin/tazobactam plus vancomycin in 19 subjects (26.4%) and ceftriaxone plus vancomycin in 15 subjects (20.8%). Median PICU length of stay was 129 (64.6-370.9) hours, approximately 5 days, and median hospital length of stay was 289 (162.5-597.1) hours, approximately 12 days. There were 4 deaths during the study period., Conclusions: Time to first antimicrobial administration after onset of sepsis was not optimal and exceeded the recommendations set forth in international guidelines. At our institution, the process for treating pediatric patients with severe sepsis and septic shock should be modified to increase compliance with national guidelines.

Objective: To compare withdrawal symptoms among pediatric intensive care patients receiving clonidine to those not receiving clonidine while being weaned from long-term dexmedetomidine., Methods: This retrospective analysis evaluated Withdrawal Assessment Tool-1 (WAT-1) scores and hemodynamic parameters in pediatric patients on dexmedetomidine for 5 days or longer between January 1, 2009, and December 31, 2012. The primary objective was to compare withdrawal symptoms based on the number of elevated WAT-1 scores among patients on clonidine to those not on clonidine, while being weaned from long-term dexmedetomidine. The secondary objective was to describe withdrawal symptoms associated with long-term dexmedetomidine use., Results: Nineteen patients (median age, 1.5 years; interquartile range [IQR], 0.67-3.3) received 20 treatment courses of dexmedetomidine for at least 5 days. Clonidine was received by patients during 12 of the treatment courses. The patients in the clonidine group had an average of 0.8 (range, 0-6) elevated WAT-1 scores 24 hours post wean compared to an average of 3.2 (0-8) elevated WAT-1 scores in the no clonidine group (p = 0.49). There were no significant difierences between prewean and postwean systolic or diastolic blood pressures among the 2 groups. The average heart rate during the postwean period was 112 beats per minute (bpm) (range, 88.5-151.5) in the clonidine group compared to 138.4 bpm (range, 117.8-168.3) in the no clonidine group (p = 0.003). In the clonidine group, the mean change in heart rate postwean compared to prewean was an increase of 3.6 bpm (range, -39.6 to 47.5), compared to a mean increase of 29.9 bpm (range, 5.5-74.7) in the no clonidine group (p = 0.042)., Conclusions: There was no difierence in WAT-1 scores between groups, with the clonidine group displaying a trend towards fewer elevated WAT-1 scores during the 24 hours post dexmedetomidine wean. Patients who received clonidine had significantly lower heart rates than the no clonidine group.

Objectives: The objectives of this evaluation of medication use were to characterize the use of intravenous acetaminophen at our institution and to determine if acetaminophen was prescribed at age-appropriate dosages per institutional guidelines, as well as to evaluate compliance with restrictions for use. Total acquisition costs associated with intravenous acetaminophen usage is described as well., Methods: This retrospective study evaluated the use of acetaminophen in pediatric patients younger than 18 years of age, admitted to a tertiary care hospital, who received at least 1 dose of intravenous acet-aminophen between August 1, 2011, and January 31, 2012., Results: A total of 52 doses of intravenous acetaminophen were administered to 31 patients during the 6-month study period. Most patients were admitted to the otorhinolaryngology service (55%), and the majority of doses were administered either in the operating room (46%) or in the intensive care unit (46%). Nineteen doses (37%) of intravenous acetaminophen were administered to patients who did not meet institutional guidelines' eligibility criteria. Three patients received single doses of intravenous acetaminophen that were greater than the dose recommended for their age. One patient during the study period received more than the recommended 24-hour maximum cumulative dose for acetaminophen. Total acquisition cost of intravenous acetaminophen therapy over the 6-month study period was $530.40., Conclusions: Intravenous acetaminophen was used most frequently among pediatric patients admitted to the otorhinolaryngology service during the perioperative period. Nineteen doses (37%) were administered to patients who did not meet the institutional guidelines' eligibility criteria. Our data support reinforcing the availability of institutional guidelines to promote cost-effective use of intravenous acetaminophen while minimizing the prescription of inappropriate doses.