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In February 2022, an educational model was launched to train Louisiana pharmacists to become positive influencers of vaccination decisions via targeted, culturally competent interventions, with the objective of improving COVID-19 vaccine uptake in communities. A total of 47 pharmacists completed the course, and more than 90% noted that the education would help them optimize vaccine acceptance in their community practice settings. The pharmacists will participate in vaccine surveillance to assess the success of the educational model intervention and predictors of vaccine uptake. (Am J Public Health. 2022;112(S9):S900–S903. https://doi.org/10.2105/AJPH.2022.307070 )

Limited studies are available on how decisions and perceptions on SARS-CoV-2 vaccination have changed since the start of vaccination availability. We performed a qualitative study to identify factors critical to SARS-CoV-2 vaccination decision making and how perspectives evolved among African American/Black, Native American, and Hispanic communities disproportionately affected by COVID-19 and social and economic disadvantage. We conducted 16 virtual meetings, with 232 participants in wave 1 meetings (December 2020) and with 206 returning participants in wave 2 meetings (January and February 2021). Wave 1 vaccine concerns in all communities included information needs, vaccine safety, and speed of vaccine development. Lack of trust in government and the pharmaceutical industry was influential, particularly among African American/Black and Native American participants. Participants showed more willingness to get vaccinated at wave 2 than at wave 1, indicating that many of their information needs had been addressed. Hesitancy remained greater among African American/Black and Native American participants than among Hispanic participants. Participants in all groups indicated that conversations tailored to their community and with those most trustworthy to them would be helpful. To overcome vaccine hesitancy, we propose a model of fully considered SARS-CoV-2 vaccine decision making, whereby public health departments supply information, align with community values and recognize lived experiences, offer support for decision making, and make vaccination easy and convenient.

The purpose of this study was to explore the impact of eligibility for the coronavirus 2019 (COVID-19) vaccine at the time of the vaccine rollout as a predictor of vaccine intent within the African American community. Methods: Four hundred eighty-seven African American participants in southeastern Louisiana were surveyed from January–April of 2021, with follow-up surveys occurring in Fall 2021. Survey domains included demographics, vaccine hesitancy, discrimination in the healthcare setting, and knowledge and experiences with COVID-19. Descriptive statistics, Chi-square tests, and binary logistic regression were performed. Results: Participants eligible for the vaccine were 1.61 times as likely to express positive vaccine intent versus ineligible participants. Additional predictors of vaccine intent were age, insurance status and coverage, and female sex at birth. In the multivariable logistic analysis, eligible individuals were 2.07 times as likely to receive the vaccine versus ineligible individuals. Conclusions: Vaccine eligibility for the COVID-19 vaccine was a significant predictor of intent to vaccinate in the African American community. Younger individuals were less likely to have a positive intent, correlating with the eligibility of ages 16+ occurring 5 months post-vaccine approval.

The U.S. Department of Agriculture (USDA) classifies numerous neighborhoods in New Orleans, Louisiana, as food deserts or areas with inadequate access to good quality foods. With approximately 35% of all patients with type 2 diabetes (T2DM) establishing disease control, we hypothesize those living in food deserts will have increased difficulty in controlling T2DM. The purpose of this study is to evaluate the effect of food deserts on glycemic control in patients with T2DM.The purpose of this study is to analyze the effect of food access on T2DM control in patients at a diabetes management clinic compared with the national average of T2DM control.Eligible records for review included patients residing in a USDA-determined food desert with a T2DM diagnosis. The primary end point was the proportion of patients with controlled T2DM. T2DM control was defined as glycosylated hemoglobin values less than 7% and less than 7.5% in patients older than 65 years. Records were retrieved for review between the dates of February 2017 and February 2020.A total of 109 patient records were reviewed. Of these, 23 patients (21%) achieved glycemic control. There was a 14% difference (35%-21%) between the food desert patients with T2DM and the general United States population of patients with T2DM (P = 0.030).This study underscores the potential implications of limited food access on patients' abilities to manage chronic conditions like T2DM. Clinicians who work in resource-limited settings or with marginalized patient populations have a responsibility to consider food access and other health disparities when creating realistic and feasible treatment goals.

Objective. The primary objective of this study was to determine if the exposure to sterile compounding in the pharmacy curriculum produces pharmacy graduates who are both competent and confident in the area of sterile compounding. Our secondary objective was to identify additional variables that may predict student performance. Methods. Participants were recruited from the fourth-year College of Pharmacy class of 2018. The students were asked to complete a questionnaire assessing the following domains: demographics, compounding performance confidence, prior experience and theoretical knowledge. A written assessment was followed by a faculty-evaluated practicum in which the students were required to prepare two sterile products using a standardized rubric. Results were analyzed with a student t-test and linear regression to determine differences in performance based upon prior experience, confidence and theoretical knowledge. Results. Overall the 158 students performed well on the knowledge and skill examination, with an average total score of 89.8%. Of the 158 total participants, the 122 survey respondents had an overall mean confidence score of 2.9 on a four point Likert scale, with 40.2% of students scoring in the confident (3) or very confident (4) range of the survey. In our analysis, we found that neither prior compounding experience or self-rated confidence were predictive of students’ total score. Conclusion. Our results indicate that the inclusion of sterile compounding education and training in all four years of the pharmacy curriculum produces graduates who are competent with varying levels of confidence in the area of sterile compounding.

Objectives The objective of this study was to assess the resilience of health systems in four governorates affected by conflict from 2014 to 2018, and to convey recommendations. Methods Health managers from Al Anbar, Ninawa, Salah al-Din, and Kirkuk governorates discussed resilience factors of Primary Health Care services affected by the 2014–2017 ISIS insurgency in focus groups, and general discussions. Additional information was gathered from key informants and a UNICEF health facility survey. Three specific aspects were examined: (1) meeting health needs in the immediate crisis response, (2) adaptation of services, (3) restructuring and recovery measures. Data from a MoH/UNICEF national health facility survey in 2017 were analyzed for functionality. Results There were many common themes across the four governorates, with local variations. (1) Absorption The shock to the public sector health services by the ISIS invasion caught health services in the four governorates unprepared, with limited abilities to continue to provide services. Private pharmacies and private clinics in some places withstood the initial shock better than the public sector. (2) Adaptation After the initial shock, many health facilities adapted by focusing on urgent needs for injury and communicable disease care. In most locations, maternal, neonatal, and child health (MNCH) preventive and promotive PHC services stopped. Ill persons would sometimes consult health workers in their houses at night for security reasons. (3) Restructuring or transformative activities In most areas, health services recovery was continuing in 2020. Some heavily damaged facilities are still functioning, but below pre-crisis level. Rebuilding lost community trust in the public sector is proving difficult. Conclusion Health services generally had little preparation for and limited resilience to the ISIS influx. Governorates are still restructuring services after the liberation from ISIS in 2017. Disaster planning was identified by all participants as a missing component, as everyone anticipated future similar emergencies.

Background: Iraq has experienced decades of devastating wars and conflicts, which profoundly affected health including higher child mortality during 1990s. We examined the recent trends for child mortality and maternal, neonatal, child health and family planning (MNCH-FP) services since early 2000s during which Iraq also experienced war, invasions and conflicts. Methods: We conducted in-depth secondary data analyses using Multiple Indicator Cluster Surveys from 2006, 2011, and 2018. We examined national and subnational rates and trends for neonatal and under-five child mortality and 27 MNCH-FP indicators at national, regional and governorate levels. We used Lives Saved Tool (LiST) to model the impact of expanding coverage for child mortality reduction. Findings: From 2006 to 2018, under-five child mortality (U5MR) dropped from 40.9 to 27.1 deaths per 1,000 livebirths; neonatal mortality (NMR) declined from 21.6 to 13.3 deaths per 1,000 livebirths, with overall annual rate reductions (ARR) of 3.4% and 4.1%, respectively. ARRs were greater in Kurdistan (U5MR: 8.3%; NMR: 10.6%) compared to South/Central region (U5MR: 2.7%; NMR: 3.2%). Child mortality increased during post-2003 war and ISIS invasion periods. Analysis of governorates shows heterogeneity with limited progress in several governorates. LiST modeling suggests that universal scale up of MNCH interventions by 2030 could reduce 39% of child deaths in Iraq. Interpretation: Despite wars, conflicts, and invasions, Iraq demonstrated significant resilience and is poised to reach SDG-3.1 goals in upcoming years. However, significant inequity persists by regions, governorates, and socioeconomic variables. Addressing this is critical to strategically accelerate child mortality reduction in Iraq. Funding: UNICEF Iraq Office through contributions from the Government of Canada and Czech Republic. Declaration of Interest: All authors declare no competing interests.

Objective The objective of this study was to determine minimum inhibitory concentration (MIC) trends among common bacterial organisms found in respiratory isolates in the trauma intensive care unit setting. Methods In this retrospective observational study, MIC data was reviewed over a three year period from January 2009 to December 2011 for the three most frequently identified organisms isolated from respiratory specimens in a trauma intensive care unit along with corresponding hospital data. Results The most frequently isolated bacterial species identified were Staphylococcus aureus (229 isolates), Pseudomonas aeruginosa (129 isolates), and Acinetobacter species (87 isolates) in the analysis within our institution from 2009–2011. There was considerable variability among the MIC trends for the analyzed organisms. For Pseudomonas isolates, observed sensitivities were as high as 100% for antibiotics ciprofloxacin and imipenem in 2009, but decreased over the next two years in 2010 and 2011. There was considerable variability among the MIC trends for Acinetobacter over the three year period for the antibiotics tested. The MIC data for most Staphylococcus aureus isolates over the three years were sensitive to vancomycin with little change in the observed MIC data. Conclusion The data reported is observational and indicates the need for future studies to establish a valid relationship of the MIC data over time in our institution particularly among our gram negative organisms, to monitor patterns of antimicrobial resistance.

Unit-specific antibiograms have developed to guide clinicians to appropriate antibiotic choices for subsets of patients. The additional level of a unit- and respiratory-specific antibiogram for surgical and trauma patients defines key differences in susceptibility information for treating hospital-acquired pneumonia.This was a three-year, retrospective single-center study. A total of 729 positive respiratory specimens from 612 patients were analyzed using Quality Compass Pathfinder(®), the antibiotic-reporting software. Culture and susceptibility reports were compared for the surgical/trauma intensive care unit (S/TICU) and the general hospital (excluding the S/TICU but including the medical ICU [MICU]). Data were filtered to include those genera and organisms with a high association with hospital-acquired pneumonia: Acinetobacter, Citrobacter, Enterobacter, Escherichia coli, Haemophilus, Klebsiella, Neisseria, Pseudomonas, Staphylococcus, Stenotrophomonas, Streptococcus, and Serratia.For gram-negative organisms, susceptibility differences were noted for Acinetobacter and Pseudomonas between the S/TICU and the rest of the hospital. In particular, Acinetobacter was significantly more susceptible to ciprofloxacin (86% vs. 43%; p0.001), gentamicin (86% vs. 54%; p=0.001), imipenem-cilastatin (93% vs. 55%; p0.001), trimethoprim-sulfamethoxazole (88% vs. 54%; p=0.001), and tobramycin (50% vs. 0; p=0.012). Pseudomonas isolates from the S/TICU were significantly more susceptible to aztreonam (83% vs. 68%; p=0.037), ciprofloxacin (86% vs. 69%; p=0.019), and imipenem-cilastatin (94% vs. 79%; p=0.01). For gram-positive organisms, Staphylococcus isolates from the S/TICU were significantly more susceptible to erythromycin (81% vs. 57%; p=0.007) and trimethoprim-sulfamethoxazole (98% vs. 91%; p=0.034) than were the hospital isolates.For key respiratory pathogens, such as Pseudomonas, Acinetobacter, and Staphylococcus, surgical and trauma patients present greater susceptibility to several antibiotics. Although this information cannot be extrapolated to other institutions, it does provide a basis for comparable institutions to consider developing unit- and collection-site-specific antibiograms for infections that affect surgical/trauma patients commonly.

Contains fulltext : 177987.pdf (Publisher’s version ) (Open Access) BACKGROUND: Antimicrobial Stewardship Programs (ASPs) have been promoted to optimize antimicrobial usage and patient outcomes, and to reduce the emergence of antimicrobial-resistant organisms. However, the best strategies for an ASP are not definitively established and are likely to vary based on local culture, policy, and routine clinical practice, and probably limited resources in middle-income countries. The aim of this study is to evaluate structures and resources of antimicrobial stewardship teams (ASTs) in surgical departments from different regions of the world. METHODS: A cross-sectional web-based survey was conducted in 2016 on 173 physicians who participated in the AGORA (Antimicrobials: A Global Alliance for Optimizing their Rational Use in Intra-Abdominal Infections) project and on 658 international experts in the fields of ASPs, infection control, and infections in surgery. RESULTS: The response rate was 19.4%. One hundred fifty-six (98.7%) participants stated their hospital had a multidisciplinary AST. The median number of physicians working inside the team was five [interquartile range 4-6]. An infectious disease specialist, a microbiologist and an infection control specialist were, respectively, present in 80.1, 76.3, and 67.9% of the ASTs. A surgeon was a component in 59.0% of cases and was significantly more likely to be present in university hospitals (89.5%, p < 0.05) compared to community teaching (83.3%) and community hospitals (66.7%). Protocols for pre-operative prophylaxis and for antimicrobial treatment of surgical infections were respectively implemented in 96.2 and 82.3% of the hospitals. The majority of the surgical departments implemented both persuasive and restrictive interventions (72.8%). The most common types of interventions in surgical departments were dissemination of educational materials (62.5%), expert approval (61.0%), audit and feedback (55.1%), educational outreach (53.7%), and compulsory order forms (51.5%). CONCLUSION: The survey showed a heterogeneous organization of ASPs worldwide, demonstrating the necessity of a multidisciplinary and collaborative approach in the battle against antimicrobial resistance in surgical infections, and the importance of educational efforts towards this goal.

Intra-abdominal infections (IAI) are an important cause of morbidity and are frequently associated with poor prognosis, particularly in high-risk patients. The cornerstones in the management of complicated IAIs are timely effective source control with appropriate antimicrobial therapy. Empiric antimicrobial therapy is important in the management of intra-abdominal infections and must be broad enough to cover all likely organisms because inappropriate initial antimicrobial therapy is associated with poor patient outcomes and the development of bacterial resistance. The overuse of antimicrobials is widely accepted as a major driver of some emerging infections (such as C. difficile), the selection of resistant pathogens in individual patients, and for the continued development of antimicrobial resistance globally. The growing emergence of multi-drug resistant organisms and the limited development of new agents available to counteract them have caused an impending crisis with alarming implications, especially with regards to Gram-negative bacteria. An international task force from 79 different countries has joined this project by sharing a document on the rational use of antimicrobials for patients with IAIs. The project has been termed AGORA (Antimicrobials: A Global Alliance for Optimizing their Rational Use in Intra-Abdominal Infections). The authors hope that AGORA, involving many of the world's leading experts, can actively raise awareness in health workers and can improve prescribing behavior in treating IAIs.

Background Antimicrobial Stewardship Programs (ASPs) have been promoted to optimize antimicrobial usage and patient outcomes, and to reduce the emergence of antimicrobial-resistant organisms. However, the best strategies for an ASP are not definitively established and are likely to vary based on local culture, policy, and routine clinical practice, and probably limited resources in middle-income countries. The aim of this study is to evaluate structures and resources of antimicrobial stewardship teams (ASTs) in surgical departments from different regions of the world. Methods A cross-sectional web-based survey was conducted in 2016 on 173 physicians who participated in the AGORA (Antimicrobials: A Global Alliance for Optimizing their Rational Use in Intra-Abdominal Infections) project and on 658 international experts in the fields of ASPs, infection control, and infections in surgery. Results The response rate was 19.4%. One hundred fifty-six (98.7%) participants stated their hospital had a multidisciplinary AST. The median number of physicians working inside the team was five [interquartile range 4–6]. An infectious disease specialist, a microbiologist and an infection control specialist were, respectively, present in 80.1, 76.3, and 67.9% of the ASTs. A surgeon was a component in 59.0% of cases and was significantly more likely to be present in university hospitals (89.5%, p

Purpose . This study was conducted to investigate the relationship between acculturation and diabetes risk among Arab Americans in Southeastern Louisiana. The secondary objective was to identify the prevalence of diabetes, hypertension, hyperlipidemia, and cardiovascular disease in the same population. Background . Research suggests that Arab Americans report disproportionate rates of diabetes and other chronic diseases. Methods . A cross-sectional study of 181 Arab Americans was conducted in Louisiana. Interviewers recruited participants to answer a 37-item survey with a five-dimension acculturation assessment and abridged National Institute of Health Survey and American Diabetes Association (2010) diabetes tool. Results were analyzed using factor analysis and Spearman’s correlation. Results . A negative correlation was found between Arab acculturation variables and diabetes risk among males (r=−.216, p=.044) and American acculturation variables among females (r=−.222, p=.032). Twelve percent reported being diagnosed with Type II diabetes by a primary care physician.

International outreach by schools and colleges of pharmacy is increasing. In this paper, we provide current practice guidelines to establish and maintain successful global/international advanced pharmacy practice experiences (G/I APPEs) with specific recommendations for home/host country and host site/institution. The paper is based on a literature review (2000-2014) in databases and Internet searches with specific keywords or terms. Educational documents such as syllabi and memoranda of understanding (MoUs) from pharmacy programs were also examined. In addition, a preliminary draft was developed and the findings and recommendations were reviewed in a 90-minute roundtable discussion at the 2014 American Association of Colleges of Pharmacy Annual Meeting. Recommendations for the host country include travel considerations (eg, passport, visa, air travel), safety, housing, transportation, travel alerts and warnings, health issues, and financial considerations. For the home country, considerations for establishment of G/I APPE site (eg, vetting process, MoU, site expectations) are described. The paper is a resource for development of new G/I APPEs and provides guidance for continuous quality improvement of partnerships focusing on G/I pharmacy education.

Intra-abdominal infections (IAI) are an important cause of morbidity and are frequently associated with poor prognosis, particularly in high-risk patients. The cornerstones in the management of complicated IAIs are timely effective source control with appropriate antimicrobial therapy. Empiric antimicrobial therapy is important in the management of intra-abdominal infections and must be broad enough to cover all likely organisms because inappropriate initial antimicrobial therapy is associated with poor patient outcomes and the development of bacterial resistance. The overuse of antimicrobials is widely accepted as a major driver of some emerging infections (such as C. difficile), the selection of resistant pathogens in individual patients, and for the continued development of antimicrobial resistance globally. The growing emergence of multi-drug resistant organisms and the limited development of new agents available to counteract them have caused an impending crisis with alarming implications, especially with regards to Gram-negative bacteria. An international task force from 79 different countries has joined this project by sharing a document on the rational use of antimicrobials for patients with IAIs. The project has been termed AGORA (Antimicrobials: A Global Alliance for Optimizing their Rational Use in Intra-Abdominal Infections). The authors hope that AGORA, involving many of the world's leading experts, can actively raise awareness in health workers and can improve prescribing behavior in treating IAIs., 0, SCOPUS: ar.j, info:eu-repo/semantics/published

Objective: To provide specific considerations for hosting non-U.S. pharmacy students at U.S.-based colleges/schools of pharmacy (C/SOP) for experiential clerkships and training. Findings: A literature review (2000-2016) in PubMed, Google Scholar and IPA databases was conducted using specific keywords. Recommendations and future directions for development of experiential rotations for non-U.S. students in U.S. experiential rotations are presented for both the home and host country. Summary articles and best practices across the disciplines, as well as expert opinion, were found across U.S. models for hosting non-U.S. students in advanced practice rotations in the medical disciplines. Consistent themes regarding legal agreements, acculturation, standardized calendars and social and safety considerations were considered for inclusion in the final document. Conclusion: Development of a successful experiential rotation/training for non-U.S. students requires consideration for well-developed objectives, qualified preceptors, multitude of legal and cultural considerations and recommendations for longevity and sustainability.

Objective. To evaluate the efficacy of faculty-led problem-based learning (PBL) vs online simulated-patient case in fourth-year (P4) pharmacy students. Design. Fourth-year pharmacy students were randomly assigned to participate in either online branched-case learning using a virtual simulation platform or a small-group discussion. Preexperience and postexperience student assessments and a survey instrument were completed. Evaluation. While there were no significant differences in the preexperience test scores between the groups, there was a significant increase in scores in both the virtual-patient group and the PBL group between the preexperience and postexperience tests. The PBL group had higher postexperience test scores (74.8±11.7) than did the virtual-patient group (66.5±13.6) (p=0.001). Conclusion. The PBL method demonstrated significantly greater improvement in postexperience test scores than did the virtual-patient method. Both were successful learning methods, suggesting that a diverse approach to simulated patient cases may reach more student learning styles.

To the Editor. In August 2010, with the summer temperature of Doha, Qatar, reaching a balmy 125°F, I set out from Xavier University in New Orleans, Louisiana, to spend 1 academic year as a Fulbright Scholar at Qatar University's College of Pharmacy. Several aspects of this experience were in the realm of the familiar. Qatar University is a Canadian accredited college of pharmacy, with a pharmacy curriculum similar to that of US pharmacy schools. The mode of instruction is completely in English with the students being gleaned from the top 10% of high school graduates. Students supplement classroom lectures with clinical experience, with Western-based guidelines serving as the foundation of professional practice. It is here the similarities end. Qatar is a small, oil- and gas-rich country located on the Arabian Gulf. Only 20% of the population of 2 million are Qatari nationals. As such, they represent the second wealthiest, per capita, nation on Earth. The remaining 80% of the population, including my students, are expatriates - people of other nationalities who work in Qatar on a temporary basis, ranging from months to years. As a teacher, my student population was dynamic and diverse. The students, all of whom were female, came from 3 different continents. They represented nations from Mauritania to the Philippines. In light of the Arab Spring, which brought an awakening of the desire for democracy through the Middle East, it was difficult to find a student who was not personally impacted by global events. Qatar is a nation that is the center of the Middle East's discussions on democracy, human rights, and economic reform. The entire year, even though I went as a teacher, I felt like a perpetual student. The year was not all study; there were several opportunities for fun. Qatar, in 2010, became the first Arab country to win the bid to host the Federation Internationale de Football Association World Cup. Qatar, being situated between the Middle East, Africa, and Asia, is a culinary epicenter where a Persian dinner fused with Indian spices might be followed by traditional Arabic coffee. We even participated in the extreme sport of sand dune bashing (not recommended for the faint of heart). As a teacher, my experience was expanded when 2 fourth-year Xavier University College of Pharmacy students came for a 6-week Global Health/Academic rotation at Qatar University. The Xavier students served as both instructors and students throughout the rotation. They had several opportunities to engage in professional discussions with Qatari students. They discussed the challenges of pharmacy that are universal, particularly the challenges of the evolving career of clinical pharmacy. As a teacher, it was gratifying to see the students connect as aspiring professionals. All of these experiences were made possible by the flagship program of the Council of the International Exchange of Scholars, the Fulbright Program. The central mission of the Fulbright Program is to facilitate exchanges of teachers, scholars, and artists to serve as cultural ambassadors. Established under Senator J. William Fulbright in 1946, it has provided over 300,000 bilateral exchange opportunities for American and international scholars. The Fulbright Program, which can be accessed via www.cies.org, begins accepting applications in February 2012. When reviewing the rosters of previous Fulbright Scholars, pharmacy faculty are not as well-represented as other disciplines, with clinical pharmacy faculty having even less representation. Pharmacy faculty should be encouraged to pursue a Fulbright opportunity because international pharmacy exchange under the Fulbright program remains an unexplored domain. The Fulbright Program offers 3 grant opportunities: teaching grants, research grants, and a hybrid teaching-research grant. As a former “Fulbrighter,” I can tell you that the success of a grant depends on the qualifications of the candidate and how well the grantee meets the needs and interests of the host institution. A successful first step is to establish contacts at a host institution abroad. It is always helpful to have a former grantee to review applications. Most importantly, the program is not just about what a Fulbrighter can bring to the host country. Equally important is what the Fulbrighter hopes to bring back home. I have brought back opportunities for collaboration with international colleagues and I hope to facilitate student exchange-opportunities for Qatari and US pharmacy students. More importantly, I have a year of memories and colleagues and friends that cross 2 continents who enriched my experiences as a teacher, a student, and an American. This experience would not have been possible without the Fulbright Commission, Dr. Peter Jewesson, Ms. Carolyn Clark, Dr. Shaikha Bint Jabor Al Thani, Dr. Kathleen Kennedy, and Mr. Klaus Heyer.