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Objective: To assess the frequency of open-angle glaucoma (OAG) in Caucasian patients affected by idiopathic normal pressure hydrocephalus (iNPH) prior to ventriculo-peritoneal shunt surgery, and to evaluate the progression of optic nerve damage one-year post-surgery., Methods: Thirty-five consecutive patients diagnosed with iNPH were prospectively recruited between November 2021 and June 2023. Assessments included visual acuity, intraocular pressure (IOP), macular ganglion cells complex (GCC) thickness, retinal nerve fiber layer thickness (RNFL), visual field test, central corneal thickness (CCT), axial length (AL) and corneal hysteresis (CH). Patients with newly diagnosed OAG were initiated on IOP-lowering medications. Eighteen patients were re-evaluated after a mean of one year post-shunt surgery to assess the progression of optic nerve damage., Results: A total of 35 eyes of 35 iNPH patients were included. The mean age of participants was 75.75 ± 6.67, with 34.3% being females. Primary open-angle glaucoma (POAG) was identified in 22.8% of non-shunted iNPH patients, including 11.4% who received a new diagnosis. After a mean follow-up of 14.9 ± 4.8 months post-surgery, there were no significant changes in RNFL and GCC thickness, nor were there any observed progressions in visual field defects or significant alterations in corneal biomechanics (p > 0.05)., Conclusions: Approximately one in five non-shunted iNPH patients exhibited POAG, with 11% being undiagnosed. These findings indicate the importance of conducting ophthalmological evaluations at the time of iNPH diagnosis, as early intervention may mitigate optic nerve damage progression following shunt surgery., (Copyright © 2025 The Author(s). Published by Elsevier Inc. All rights reserved.)

Objectives: To study the density, spacing, and regularity of retinal cone photoreceptors using an Adaptive Optics (AO) retinal camera (Rtx1 TM , Imagine Eyes, Orsay, France) in patients with Primary Open Angle Glaucoma (POAG) and to compare the outcomes with those of healthy age-matched control subjects., Methods: The study included 43 eyes with POAG and 31 eyes of normal subjects. POAG patients were divided into three groups according to the severity of the visual field defect. The AO Rtx1 TM was used to obtain images of the parafoveal cone mosaic to calculate cone values. Analysis was performed at two and four degrees of eccentricity from the fovea along the four meridians (nasal, temporal, superior, inferior)., Results: In POAG eyes, the mean ± standard deviation (SD) cone density at 2° considering all meridians was significantly lower than in normal controls (23,058.6 ± 3532.0 cones/mm 2 , and 25,511.7 ± 3157.5 cones/mm 2 , respectively; p = 0.003). Cone spacing was 7.3 ± 0.5 µm in POAG and 7.0 ± 0.4 µm in normal controls (p = 0.005), and cone regularity was 90.5 ± 4.9% and 93.5 ± 1.9% in POAG and normal controls, respectively (p < 0.001). At 4° similar trends were observed. However, no significant differences were found among patients with different severity of POAG (p > 0.05)., Conclusions: Using AO Rtx1 TM , significant differences in retinal photoreceptors mosaic pattern were found between POAG eyes and age-matched controls, indicating a reduction in photoreceptors in POAG. No significant differences in retinal photoreceptor values were found among the three POAG groups., (© 2024. The Author(s).)

Background: Medication reconciliation has been shown to reduce medication-related errors in hospitalized patients, but the impact of pharmacy-led medication reconciliation in the intensive care unit (ICU) has not been extensively studied. Methods: This was a retrospective chart review of patients with a pharmacy-led medication reconciliation on admission to an ICU between January 1 st and March 31 st , 2018. Pharmacy-led medication reconciliations were completed by pharmacists, pharmacy residents, and pharmacy students. The objective of this study was to describe medication discrepancies identified by pharmacy-led medication reconciliation and to evaluate the interventions following. Results: A total of 288 patients were screened and 247 met inclusion criteria. There were 1148 medication discrepancies identified resulting in an average of 4.65 discrepancies per patient. Medication addition (54.25%) and medication deletion (45.75%) were most common. Within 24 hours of medication reconciliation, 214 interventions were made to active orders. No differences were observed between discrepancies identified and type of pharmacy staff completing the medication reconciliation. Conclusions: This study identified a high rate of medication discrepancies on admission to the ICU. Furthermore, it describes the types of pharmacist interventions following pharmacy-led medication reconciliation. This process may be impactful to incorporate as a standard practice in ICUs and warrants further investigation into value, cost, and pharmacist workflow., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Purpose: Idiopathic normal pressure hydrocephalus (iNPH) is associated with an increased prevalence of open-angle glaucoma, attributed to variations of the pressure gradient between intraocular and intracranial compartments at the level of the lamina cribrosa (LC). As ocular biomechanics influence the behavior of the LC, and a lower corneal hysteresis (CH) has been associated to a higher risk of glaucomatous optic nerve damage, in this study we compared ocular biomechanics of iNPH patients with healthy subjects., Methods:  Twenty-four eyes of 24 non-shunted iNPH patients were prospectively recruited. Ocular biomechanical properties were investigated using the ocular response analyzer (Reichert Instruments) for the calculation of the CH, corneal resistance factor (CRF), Goldmann-correlated intraocular pressure (IOPg), and corneal-compensated intraocular pressure (IOPcc). Results were compared with those of 25 eyes of 25 healthy subjects., Results:  In iNPH eyes, the median CH value and interquartile range (IQR) were 9.7 mmHg (7.8-10) and 10.6 mmHg (9.3-11.3) in healthy controls (p = 0.015). No significant differences were found in IOPcc [18.1 mmHg (14.72-19.92) vs. 16.4 mmHg (13.05-19.6)], IOPg [15.4 mmHg (12.82-19.7) vs. 15.3 mmHg (12.55-17.35)], and CRF [9.65 mmHg (8.07-11.65) vs. 10.3 mmHg (9.3-11.5)] between iNPH patients and controls., Conclusions:  In iNPH patients, the CH was significantly lower compared to healthy subjects. This result suggests that ocular biomechanical properties may potentially contribute to the risk of development of glaucomatous optic nerve damage in iNPH patients., (© 2024. The Author(s).)

Background: Private practice dentists represent 72% of United States dentists. We conducted a prospective cohort study of private practice dentists comparing antibiotic use before and after dental antibiotic stewardship education by infectious diseases (ID) antibiotic stewardship experts., Methods: Study phases were as follows: phase 1 (preeducation), 3 months of retrospective antibiotic data and a presurvey assessed baseline antibiotic knowledge; phase 2 (education), dentists attended 3 evening Zoom sessions; phase 3, (posteducation/interventions), 3 months of prospective audits with weekly feedback; phase 4, postsurvey and recommendations to reach more dentists., Results: Fifteen dentists participated. Ten had practiced >20 years. Presurvey, 14 were unfamiliar with dental stewardship. The number of antibiotic prescriptions pre/post decreased from 2124 to 1816 ( P  < .00001), whereas procedures increased from 8526 to 9063. Overall, appropriate use (prophylaxis and treatment) increased from 19% pre to 87.9% post ( P  < .0001). Appropriate prophylaxis was 46.6% pre and 76.7% post ( P  < .0001). Joint implant prophylaxis decreased from 164 pre to 78 post ( P  < .0001). Appropriate treatment antibiotics pre/post improved 5-fold from 15% to 90.2% ( P  = .0001). Antibiotic duration pre/post decreased from 7.7 days (standard deviation [SD], 2.2 days) to 5.1 days (SD, 1.6 days) ( P  < .0001). Clindamycin use decreased 90% from 183 pre to 18 post ( P  < .0001). Postsurvey responses recommended making antibiotic stewardship a required annual continuing education. Study participants invited ID antibiotic stewardship experts to teach an additional 2125 dentists via dental study clubs., Conclusions: After learning dental antibiotic stewardship from ID antibiotic stewardship experts, dentists rapidly optimized antibiotic prescribing. Private practice dental study clubs are expanding dental antibiotic stewardship training to additional dentists, hygienists, and patients across the United States., (© The Author(s) 2022. Published by Oxford University Press on behalf of Infectious Diseases Society of America.)

Objective To devise a pharmacy-specific, expanded entrustable professional activities (EPA) entrustment-supervision scale that would frame preceptor ratings in a prospective and retrospective manner for use in experiential learning settings. Methods A series of focus group sessions were conducted to solicit expert opinion on how to develop and refine two entrustment-supervision scales. Purposive sampling was used to identify experts from different professional groups (physicians, pharmacy experiential administrators, and pharmacy practice faculty) who had extensive knowledge regarding EPAs and at least one publication related to EPAs. Panelists were invited to participate via email. Three focus sessions were conducted via videoconferencing between June and September 2019. The primary outcome was development of a pharmacy-specific EPA entrustment-supervision assessment tool. Secondary outcomes were individual entrustment-supervision statements across five levels of the entrustment-supervision scale. Results The focus group consisted of four pharmacy practice faculty, two experiential administrators, and one academic physician. Four concepts emerged from the focus group discussion: need for more granularity in entrustment-supervision scales; limitations due to differences in licensure requirements across the United States; present and ongoing use of expanded scales by schools and colleges of pharmacy; and uncertainty regarding how to rate entrustment-supervision when a student exhibits unprofessional behavior. Conclusion A pharmacy-specific, expanded EPA entrustment-supervision scale will be useful to support longitudinal assessment of learners in experiential settings where an EPA framework is utilized. Determining when to use a prospective versus retrospective perspective requires further evaluation., (© 2022 American Association of Colleges of Pharmacy.)

Objective. To cross reference the core entrustable professional activities (EPAs) to a complete set of educational guidance documents for the Doctor of Pharmacy (PharmD) curriculum to create a map for pharmacy educators. Methods. The Mapping EPAs Task Force consisted of nine members who first worked independently and then together in small working groups to map five assigned educational guidance documents (eg, Center for the Advancement of Pharmacy Education [CAPE] Outcomes, Accreditation Council for Pharmacy Education [ACPE] Standards 1-4, and the Essential Elements for Core Advanced Pharmacy Practice Experiences [APPEs]) to the Core Entrustable Professional Activities for New Pharmacy Graduates. Four working groups completed the mapping process during phases 1 and 2, which was followed by an independent quality assurance review and consensus in phase 3. Results. All 15 core EPA statements were mapped to one or more of the educational documents. One item from the CAPE Outcomes could not be mapped to a core EPA statement. The first five EPA statements mapped directly to the five elements of the Pharmacists' Patient Care Process: collect, assess, plan, implement, and follow-up: monitor and evaluate. Conclusion. This comprehensive EPA map is the first curriculum crosswalk that encompasses a complete set of educational guidance documents including the Essential Elements for Core APPEs for the Doctor of Pharmacy curriculum. If adopted by the Academy, this curriculum crosswalk will provide pharmacy schools with a common interpretation of important educational guidance documents; serve as the foundation for curricular development, revision, and assessment; and ensure student pharmacists are prepared to enter the pharmacy profession., (© 2020 American Association of Colleges of Pharmacy.)

CA19-9 is the most specific biomarker for pancreas cancer. We investigated the prognostic significance of normal (≤ 37 U/mL) versus elevated (>37 U/mL) CA19-9 levels in patients with resected and advanced pancreas cancer. Relevant data were obtained from patients treated for early-stage or advanced pancreatic adenocarcinoma at our institution. Log-rank tests were used to evaluate relationship between CA19-9 and clinical outcomes of interest for both early- and advanced-stage patients. A total of 123 patients were included (Group A: N = 30 stage I/II; Group B: N = 93 stage III/IV). In group A, elevated preoperative CA19-9 was significantly associated with lymph node involvement (p = 0.031), tumor ≥ 3 cm (p = 0.011), and lack of tumor differentiation (p = 0.048). Failure of postoperative CA19-9 to normalize predicted significantly worse DFS (p = 0.021). For group B, elevated baseline CA19-9 was associated with shorter OS on chemotherapy (p = 0.0008) and decline in CA19-9 >25 % with treatment was a significant predictor of improved OS (p = 0.0099). Higher than normal CA19-9 level is an adverse prognostic factor in both early and advanced settings and may prove to be useful in the selection of patients for more aggressive therapy in future trials. CA19-9 level decrease of >25 % predicts improved survival in advanced disease on chemotherapy.

Objectives: Hepatocellular carcinoma (HCC) is the fifth most common cancer worldwide. Sorafenib is considered the standard of care for patients with advanced HCC., Methods: We conducted a retrospective analysis of our cancer center's experience with sorafenib in patients with advanced HCC. Eligible patients were required to have measurable disease and were allowed to have been refractory (with documented progression) to prior systemic therapies before starting on sorafenib., Results: Twenty-six patients (median age = 56 years) who were treated at the Ohio State University with sorafenib were included in this study. Thirty-eight percent had exposure to prior systemic therapy. The median time to tumor progression was 5.4 months and the median overall survival 7 months. For the patients with exposure to prior systemic therapy, the median time to tumor progression was 9.1 months and is the median overall survival 9.83 months. There were no unexpected toxicities., Conclusion: Sorafenib has interesting activity and acceptable tolerability in patients with advanced HCC, including those who failed prior therapies., (Copyright 2010 S. Karger AG, Basel.)