Development and implementation of “handshake rounds”: An antibiotic stewardship intervention for hospitalized adult patients with hematologic malignancies

Abstract Objective: To design and implement “handshake rounds” as an antibiotic stewardship intervention to reduce inpatient intravenous (IV) antibiotic use in patients with hematologic malignancies. Design: Quasi-experimental analysis of antibiotic use (AU) and secondary outcomes before and and after handshake rounds were implemented. Setting: Quaternary-care, academic medical center. Patients: Hospitalized adults with hematologic malignancies receiving IV antibiotics. Methods: We performed a retrospective review of a preintervention cohort prior to the intervention. A multidisciplinary team developed criteria for de-escalation of antibiotics, logistics of handshake rounds, and outcome metrics. Eligible patients were discussed during scheduled handshake rounds between a hematology–oncology pharmacist and transplant–infectious diseases (TID) physician. Prospective data were collected over 30 days in the postintervention cohort. Due to small sample size, 2:1 matching was used to compare pre- to and postintervention AU. Total AU in days of therapy per 1,000 patient days (DOT/1,000 PD) was reported. Mean AU per patient was analyzed using Wilcoxon rank-sum test. A descriptive analysis of secondary outcomes of pre- and postintervention cohorts was performed. Results: Total AU was substantially lower after the intervention, with 517 DOT/1,000 PD compared to 865 DOT/1,000 PD before the intervention. There was no statistically significant difference in the mean AU per patient between the 2 cohorts. There was a lower rate of 30-day mortality in the postintervention cohort and rates of ICU admissions were similar. Conclusions: Conducting handshake rounds is a safe and effective way to implement an antibiotic stewardship intervention among high-risk patient population such as those with hematologic malignancies

2019 Update to the American College of Clinical Pharmacy Pharmacotherapy Didactic Curriculum Toolkit

Introduction: The American College of Clinical Pharmacy (ACCP) Pharmacotherapy Didactic Curriculum Toolkit was created by the 2008 ACCP Educational Affairs Committee to provide guidance to schools and colleges of pharmacy for didactic pharmacotherapy curricular development. The toolkit was revised and updated by the 2016 ACCP Educational Affairs Committee. Objectives: In accordance with the ACCP Board of Regents decision to update the toolkit every 3 years, the 2019 ACCP Publications Committee was charged with updating the 2016 toolkit to guide adequate disease state inclusion and depth of pharmacotherapy coverage in pharmacy curricula. Methods: The committee retained the competency-based tier definitions and organization of the 2016 toolkit. Multiple literature resources were reviewed to assess medical conditions responsive to drug therapy for inclusion in the 2019 toolkit. The committee also reviewed the tier designation for all toolkit entries for appropriateness, given recent advances in medical care and evolving patient care responsibilities of clinical pharmacists. Updates to the toolkit were made by consensus with electronic voting when required. Results: The 2019 toolkit contains 302 topics, including 94 (31%) tier 1, 133 (44%) tier 2, and 75 (25%) tier 3 entries. There are 26 additional topics in the updated toolkit, including 12 new tier 1 topics that are generally treated with nonprescription medications. Eleven new topics were added to tier 2, and 20 topics were added to tier 3 (including 11 topics in the Oncologic Disorders section). The tier classification of some conditions was changed to reflect current pharmacy practice expectations. Conclusion: As with the 2016 toolkit, the large number of tier 1 topics will require schools and colleges to employ creative teaching strategies to achieve practice competence in all graduates. The large number of tier 2 topics highlights the importance of postgraduate training and experience for pharmacy graduates desiring to provide direct patient care

[[alternative]]A study of learning outcomes of project-based learning for university students

碩士[[abstract]]本研究旨在探討淡江大學大學生專題導向學習之學習成果調查研究，包含專案管理、批判性思考、創造力、團隊合作、溝通表達、資訊素養、自我成長共七個面向，並且瞭解大學生人口變項、課程實施變項對專題導向學習之學習成果影響，以提供專題導向學習課程設計規劃及課程發展建議。本研究採自編「大學生專題導向學習之學習成果調查研究問卷」進行調查，學習成果為學生自我認同之學習獲得情形，同意程度採Likert五點量表計分，本問卷之整體信度Cronbach’s α值為.964。本研究針對淡江大學102學年度專題導向學習課程學生，共計發放問卷365份，回收有效問卷285份，有效問卷回收率91%。 本研究結果如下： 一、學生參與專題導向學習整體習成果平均得分為3.95，顯示學生學習成果的獲得與學習感受良好。學習成果依面向由高至低排序為：溝通表達、團隊合作、自我成長、創造力、資訊素養、批判性思考、專案管理。 二、在學生的人口變項方面，性別變項在專題導向學習成果表現無顯著差異，學院變項在專題導向學習成果表現有顯著差異。 三、在課程實施變項中，小組角色、定期小組會議、定期檢視進度在專題導向學習成果表現有顯著差異。 本研究提出以下建議： 一、對實施專題導向學習課程之建議 （一）在專題導向學習課程，小組角色可輪流擔任，讓小組成員都有互相學習的機會。 （二）專題導向學習課程進行過程中，需要運用專案管理的專業知識及技術，建議在大學生課程設計或專題導向學習課程的實施，加強專案管理知識。 （三）專題指導老師在專題導向學習課程扮演重要的角色，在課程的設計上老師應適切的發揮其角色功能。 二、對未來研究的建議 （一）本研究因收集樣本較少，在研究之解釋性相對較低，建議未來研究者，可擴大抽取樣本面向及樣本數。 （二）本研究僅實施調查淡江大學，後續研究者可擴大學校數，全面了解大學校院專題導向學習的成果，並比較不同實施方式的學習成果。[[abstract]]The purpose of this study is to investigate learning outcomes of project-based learning by students of Tamkamg University; seven dimensions including , project- management, critical thinking, creativity, teamwork, communicative literacy, information literacy and personal development were considered. In order, to provide advice and suggestion, this study analyzed the variable differences in learning outcomes by understanding the effect of student population change, and project-based curriculum design. The results of the study provide suggestions for the improvement of future implementation of project-based lessons and curriculum design courses for Tamkang University. The research questionnaire titled, " The study of learning outcomes by university student through project-based learning questionnaire" was developed by using Likert scales ranging from 1 to 5 points to measure the effect of project-based learning learning outcomes. The questionnaires were sent to 365 students whom were enrolled in project-based lesson courses for the academic year of 2013 and there were 285 returned with 91% of valid rate. The reliability of the questionnaire is .964 of Cronbach’s α. The conclusion of the research were summarized as follows: 1.The average degree of learning outcomes whom had participated in project-based learning courses is 3.95, which means most of the students agreed that they have learned well from project-based learning. The 7 dimensions, the rankings of learning outcomes are listed from high to low as follows: (1)communicative literacy, (2)teamwork, (3)personal development, (4)creativity (5)computer literacy, (6)critical thinking, and (7) project-management. 2.The learning outcomes varied with different variables. The variable student population, showed that gender showed no significant difference in learning outcome for project-based learning. However, student in different academic department showed significant difference in learning outcome for project-based learning courses. 3.While the variables, implementation of project-based curriculum courses, significant difference in learning outcome for project-based learning were found in students'' team role, periodic team meetings, and periodic progress reviews. The following suggestions were made for the future practice and research: 1.Suggestions for Project-based curriculum design: (1) Students can rotate and take on different roles on the team for project-based learning lessons. So to provide every member with opportunity to gain different learning experiences. (2) During on-going project-based learning lessons, large amount of professional knowledge and expertise in project management needs to be applied. Thus it is advise that when designing and implementing project-based learning curriculums, emphasis on strengthening student project management knowledge is to be enforced. (3) Professors'' instructing, play an important role in project-based learning courses, it is recommended that the role of the instructor is to be defined. 2.Suggestions for future research (1) Due to the small sample size collected in this study, relatively low explanatory research association were made. Therefore, the expansion in the number of sample size is suggested for future research. (2) To investigate and compare the learning outcomes and implementation of different project-based learning programs among different universities.[[tableofcontents]]目次 第一章　緒論 1 第一節 研究背景與動機 1 第二節 研究目的與問題 8 第三節 名詞釋義 9 第四節 研究範圍與限制 11 第二章 文獻探討 13 第一節 專題導向學習意涵 13 第二節 專題導向學習成果及其影響因素 18 第三節 國內專題導向學習學習成果研究現況 32 第三章 研究設計與實施 39 第一節 研究架構 39 第二節 研究流程 41 第三節 研究對象與抽樣方法 43 第四節 研究工具之編製 46 第五節 研究實施程序 51 第六節 資料處理 52 第四章 研究結果與討論 55 第一節 專題導向課程學生基本資料 55 第二節 大學生專題導向學習之學習成果 61 第三節 基本資料變項對專題導向學習學習成果之差異分析 72 第五章 研究結論與建議 81 第一節 研究結論 83 第二節 建議 85 參考文獻 88 中文部份 88 英文部分 90 附錄一「專題導向學習成果」問卷 92 表次 表2-2-1專題導向學習成果「七個C」技能表： 21 表2-2-2專題導向學習學習成果內涵綜整表 25 表2-3-1國內大學生專題導向學習實證研究 35 表3-3-1淡江大學102學年度專題導向學習課程修課學生人數 43 表3-3-2淡江大學102學年度各學院專題導向學習課程修課學生人數 44 表3-3-3抽樣、發放與回收數量統計表 45 表3-4-1專題導向學習成果面向及題目內容對照表 48 表4-1-1學生人口變項分佈統計表 56 表4-1-2學生課程實施方式分佈統計表 58 表4-2-1學習成果各面向與各項目平均數排序統計表 62 表4-2-2專案管理面向之項目排序 65 表4-2-3批判性思考面向之項目排序 66 表4-2-4創造力面向之項目排序 67 表4-2-5團隊合作面向之項目排序 68 表4-2-6溝通表達面向之項目排序 68 表4-2-7資訊素養面向之項目排序 69 表4-2-8自我成長面向之項目排序 70 表4-3-1性別與學習成果面向t檢定差異分析表 72 表4-3-2學院與學習成果面向單因子變異數差異分析表 73 表4-3-3小組角色與學習成果面向t檢定差異分析表 75 表4-3-4 題目設定方式與學習成果面向t檢定差異分析表 76 表4-3-5課程有無分組與學習成果面向t檢定差異分析表 76 表4-3-6小組人數與學習成果面向單因子變異數差異分析表 77 表4-3-7小組工作會議頻率與學習成果面向t檢定差異分析表 79 表4-3-8老師每週檢視進度與學習成果面向單因子變異數差異分析表 80 圖次 圖3-1-1 研究架構 40 圖3-2-1 研究流程圖 42 圖3-3-1 抽樣程序圖 45[[note]]學號: 798730239, 學年度: 10

Expression quantitative trait locus fine mapping of the 17q12–21 asthma locus in African American children: a genetic association and gene expression study

Background: African ancestry is associated with a higher prevalence and greater severity of asthma than European ancestries, yet genetic studies of the most common locus associated with childhood-onset asthma, 17q12–21, in African Americans have been inconclusive. The aim of this study was to leverage both the phenotyping of the Children's Respiratory and Environmental Workgroup (CREW) birth cohort consortium, and the reduced linkage disequilibrium in African Americans, to fine map the 17q12–21 locus. Methods: We first did a genetic association study and meta-analysis using 17q12–21 tag single-nucleotide polymorphisms (SNPs) for childhood-onset asthma in 1613 European American and 870 African American children from the CREW consortium. Nine tag SNPs were selected based on linkage disequilibrium patterns at 17q12–21 and their association with asthma, considering the effect allele under an additive model (0, 1, or 2 effect alleles). Results were meta-analysed with publicly available summary data from the EVE consortium (on 4303 European American and 3034 African American individuals) for seven of the nine SNPs of interest. Subsequently, we tested for expression quantitative trait loci (eQTLs) among the SNPs associated with childhood-onset asthma and the expression of 17q12–21 genes in resting peripheral blood mononuclear cells (PBMCs) from 85 African American CREW children and in upper airway epithelial cells from 246 African American CREW children; and in lower airway epithelial cells from 44 European American and 72 African American adults from a case-control study of asthma genetic risk in Chicago (IL, USA). Findings: 17q12–21 SNPs were broadly associated with asthma in European Americans. Only two SNPs (rs2305480 in gasdermin-B [GSDMB] and rs8076131 in ORMDL sphingolipid biosynthesis regulator 3 [ORMDL3]) were associated with asthma in African Americans, at a Bonferroni-corrected threshold of p<0·0055 (for rs2305480_G, odds ratio [OR] 1·36 [95% CI 1·12–1·65], p=0·0014; and for rs8076131_A, OR 1·37 [1·13–1·67], p=0·0010). In upper airway epithelial cells from African American children, genotype at rs2305480 was the most significant eQTL for GSDMB (eQTL effect size [β] 1·35 [95% CI 1·25–1·46], p<0·0001), and to a lesser extent showed an eQTL effect for post-GPI attachment to proteins phospholipase 3 (β 1·15 [1·08–1·22], p<0·0001). No SNPs were eQTLs for ORMDL3. By contrast, in PBMCs, the five core SNPs were associated only with expression of GSDMB and ORMDL3. Genotype at rs12936231 (in zona pellucida binding protein 2) showed the strongest associations across both genes (for GSDMB, eQTLβ 1·24 [1·15–1·32], p<0·0001; and for ORMDL3 (β 1·19 [1·12–1·24], p<0·0001). The eQTL effects of rs2305480 on GSDMB expression were replicated in lower airway cells from African American adults (β 1·29 [1·15–1·44], p<0·0001). Interpretation: Our study suggests that SNPs regulating GSDMB expression in airway epithelial cells have a major role in childhood-onset asthma, whereas SNPs regulating the expression levels of 17q12–21 genes in resting blood cells are not central to asthma risk. Our genetic and gene expression data in African Americans and European Americans indicated GSDMB to be the leading candidate gene at this important asthma locus.6 month embargo; published: 01 May 2020This item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at [email protected]