The Society for Post-Acute and Long-Term Care Medicine

Abstract Background Due to a 120% increase in patients living with HIV (PLWH) admitted to our institution over the prior 3-year period, a pharmacy resident-driven ARVSP was implemented to augment the existing antimicrobial stewardship program. This study evaluated the feasibility and impact of an ARVSP conducted by non-infectious diseases trained, post-graduate year 1 (PGY1) pharmacy residents at a large, academic medical center.Figure 1:Chart review documentation via an Epic i-Vent.Table 1:Summary Data.OI = Opportunistic Infections, PPx = Prophylaxis, TOC = Transitions of Care, DDI = Drug-Drug Interaction, EMR = Electronic Medical Record Methods This was a single-center, retrospective pilot study. From 7/1/2022 to 2/1/2023 the PGY1 ARVSP followed a standard operating procedure (SOP) for evaluating medication regimens of admitted PLWH on antiretroviral (ARV) therapy. The SOP included a checklist to minimize prescribing errors, drug-drug interactions (DDI), and optimize ARV regimens for admitted patients, particularly with changing clinical status. Daily chart reviews included external prescription history, outpatient notes, inpatient medications, and clinical status (Figure 1). Patient interviews were conducted to confirm ARV regimens, drug allergies, home medications, outpatient HIV follow-up plan, and barriers to medication access.Table 2:Drug Interaction Summary.CYP = cytochrome P450, High-risk = anticoagulants, antiplatelets, antiepileptics, antiarrhythmics, HMG-CoA reductase inhibitors, antipsychotics, and antibioticsTable 3:PGY1 individual survey responses.PGY1 = post graduate year 1; HIV = human immunodeficiency virus; ARVs = antiretrovirals Results A total of 220 patients were reviewed during the 7-month ARVSP pilot period. Over 100 unique interventions were identified by the ARVSP team, including DDI, dosage adjustments, need for opportunistic infection prophylaxis, incorrect route of administration, or incorrect dose/regimen resumed inpatient (Table 1). The majority of the DDI identified involved potential issues with drug absorption but a significant number of high-risk and CYP-mediated DDI were also found (Table 2). PGY1 residents were surveyed throughout the pilot and self-identified improvement to the level of independence in patient interviewing, reconciling medications, and documenting clinical activities in the medical record (Table 3). Conclusion PGY1 residents implemented ARVSP activities into their daily workflow without limiting their direct patient care responsibilities. They successfully identified ARV medication errors and reported improvements in their ability to manage ARV pharmacotherapy. PGY1 pharmacy residency programs can adapt similar ARVSPs to augment their training programs and support medication optimization in this high-risk patient population. Disclosures All Authors: No reported disclosures

Intestinal multidrug-resistant organism (MDRO) colonization is highly prevalent in long-term acute care hospital (LTACH) patients and is associated with MDRO infection and transmission. However, there are no therapies approved by the US Food and Drug Administration to reduce intestinal MDRO colonization. To determine the safety and acceptability of fecal microbiota transplantation (FMT) in LTACH patients. This single-center, open-label nonrandomized clinical trial was conducted from April to December 2023 at an LTACH in the Southeastern US with median 50-patient census and 28-day length of stay. Patients with MDRO colonization were identified by perirectal prevalence sampling. Patients colonized with at least 1 target MDRO were approached for informed consent for FMT. FMT recipients were compared with untreated controls with MDRO colonization. Data were analyzed from August 2024 to May 2025. Healthy donor fecal microbiota (50-100 g stool and 250 mL normal saline with 9% glycerol) instilled via gastrostomy tube or enema without antibiotic or bowel preparation conditioning. The primary outcome was frequency and severity of adverse events. Solicited adverse events were recorded for 7 days. Unsolicited adverse events were recorded for 6 months. Four weekly perirectal MDRO cultures were performed after FMT. A total of 42 patients, including 10 (mean [SD] age, 63.8 (14.5) years; 7 [70%] female) who received FMT and 32 contemporaneous controls (mean [SD] age, 64.0 [13.7] years; 13 [41%] female) were assessed. In 2 prevalence surveys, 23 of 32 (72%) and 26 of 34 (77%) perirectal cultures grew at least 1 MDRO. Among the FMT group, 5 patients received FMT via gastrostomy alone, 4 via enema alone, and 1 with both routes more than 30 days apart. No serious adverse events were attributed to FMT, and post-FMT solicited adverse events were mild. At final visit, all perirectal cultures from FMT recipients grew at least 1 MDRO. Post hoc analyses found numerically fewer FMT recipients had positive blood culture results (0 individuals vs 6 individuals [19%]; P = .31), pathogen intestinal dominance (2 of 8 individuals [25%] vs 4 of 8 individuals [50%]; P = .61), and 7 fewer days of antibiotic therapy per 1000 patient days (median [IQR], 12.6 [0-25.2] days vs 19.7 [6.5-36.1] days; P = .38) compared with controls in the 6 months after prevalence survey, although these differences were not statistically significant. Accounting for higher baseline FMT recipient antibiotic use, difference-in-differences analysis estimated 26 (95% CI, -64 to 12) fewer days of antibiotic therapy per 1000 patient-days after FMT, although this difference was also not statistically significant. In this nonrandomized pilot clinical trial, FMT was acceptable for LTACH patients without related serious adverse events. Although not powered to test these outcomes, this study found potential reductions in bacteremia, intestinal pathogen domination, and antibiotic use associated with FMT, suggesting FMT should be evaluated in larger, randomized trials. ClinicalTrials.gov Identifier: NCT05780801.

إن الدور المهم للقانون الدولي الإنساني وضع الحدود لاستهداف الممتلكات الثقافية في أثناء الحروب، ويعتمد الهدف الرئيس لهذا البحث التعرف على مدىفعالية القانون الدولي الإنساني في حماية الممتلكات الثقافية في النزاعات الدولية بصفة عامة، وفي الحرب الصهيونية على فلسطين على وجه الخصوص. وإشكالية الدراسة تكمن في السؤال الرئيس، وهو: ما مدى المسؤولية الدولية عن تدمير الممتلكات الثقافية ومكونات الهُوِيّة في فلسطين؟ وتعود أهمية البحث إلى قلة الدراسات التي تناولت موضوع المسؤولية الدولية عن تدمير الممتلكات الثقافية في فلسطين في ضوء القانون الدولي الإنساني. وتعتمد الدراسة المنهج الوصفي التحليلي من أجل الإجابة على تساؤلات البحث وهي: ما تداعيات الحرب الصهيونية على الممتلكات الثقافية في غزة وفلسطين؟ ما آليات القانون الدولي الإنساني المعنية بحماية الممتلكات الثقافية؟ هل تعتبر اللغة العربية والهُوِيّة الإسلامية ضمن الممتلكات الثقافية أم ضمن الشخصية الاعتبارية؟ هل القانون الدولي الإنساني بوضعه الحالي يكفل حماية الممتلكات الثقافية ومكونات الهُوِيّة؟ وتأتي هذه الدراسة في مقدمة وأربعة مباحث:- المبحث الأول: المبحث الأول: الثقافة ومكونات الهُوِيّة، وماهيّة المسؤولية الدولية، والقانون الدولي الإنساني: مصطلحات ومفاهيم. المبحث الثاني: الممتلكات الثقافية ومكونات الهُوِيّة في قطاع غزة. المبحث الثالث: دراسة تطبيقية للانتهاكات الصهيونية لمكونات الهُوِيّة الفلسطينية. المبحث الرابع: موقف القانون الدولي الإنساني من تدمير الممتلكات الثقافية ومكونات الهُوِيّة. وخاتمة تشمل أهم النتائج والتوصيات.

لا شك ان تطوير التعليم الجامعي باستخدام الإجراءات الحديثة أثبت فاعليته في تحسن كبير في العملية التعليمية لذا فان استخدام المستجدات الحديثة تزيل الحواجز التي تواجه التعليم والمتعلمين والتي يفرضها المكان والزمان وعليه لم يعد هناك ضرورة لاجتماع المتعلمين في نفس المكان ونفس الوقت للتعلم ، يهدف البحث الي يهدف البحث الي التعرف على فاعلية المحاضرات التدريسية باستخدام الدورات القصيرة في تحسين ناتج التحصيل المعرفي والناتج التطبيقي للمهارات التدريسية في مقرر مسابقات الميدان والمضمار ، استخدم المنهج الشبه تجريبي ذو القياسين القبلي البعدي حيث طبق علي عينة عددها ( 40 ) طالبة من طالبات الفرقة الثالثة شعبة تعليم بكلية التربية الرياضية للبنات ، جامعة الإسكندرية استخدمت أدوات القياس المعايرة في اختبار التحصيل المعرفي و المهارات التدريسية ، من اهم النتائج المحاضرات التدريسية باستخدام الدورات القصيرة أظهرت تأثيرا ايجابيا في التحصيل المعرفي والمهارات التدريسية ( التخطيط – التنفيذ – التقويم ) ، من اهم التوصيات استخدام المحاضرات التدريسية القائمة على الدورات القصيرة في تحسين المهارات التدريسية والتحصيل المعرفي في مسابقات الميدان والمضمار

The history of antipsychotics in nursing facilities is one piece of a much larger, more complex puzzle. In many ways, it reflects the virtues and limitations of the entire health care system and those who provide care. None of the issues related to the use of antipsychotics are specific to these medications or to nursing facilities. After decades of effort to reduce unwarranted antipsychotics use, the current situation is still a work in progress. Many widely held assumptions and standard narratives, such as those about behavior, the place of medications in person-centered care, and the causes of inappropriate medication use are only partially correct. This second of three articles is not intended to discuss how to diagnose and manage behavior disorders or choose medications. Instead, it addresses the diverse perspectives and key players that have been involved and the results of their efforts. Ultimately, this will set the stage for specific recommendations (part 3) about learning from past efforts surrounding antipsychotics to identify more definitive and lasting improvements in the future. Part 1 of this series covered the history of attempts to influence use of medications-especially, antipsychotics-in nursing facility care of residents with behavior, mood, and cognitive issues. These improvement efforts can be described as fragmented, often ineffectual, and politically fraught. After decades of effort, and despite a significant reduction in the indiscriminate use of antipsychotics, psychotropics are still widely used in nursing facilities.1 The extent of improvement overall in managing individuals with dementia and other diverse behavior, mood, and cognitive issues is unclear.

ABSTRACT Coronavirus disease 2019 (COVID-19) pandemic vaccination campaigns globally have been unlike any effort in history. In the United States, the success of these efforts, in part, has hinged on the timely capture and reporting of an unprecedented amount of data from a significantly greater number of administering providers than for routine vaccinations. The pandemic response has highlighted the need to explore the status and value of vaccination data as the critical glue that connects all aspects of the upstream US vaccine development and downstream vaccination delivery system. In this review, we examine immunization information systems and the role that data and staffing play in pandemic responses. We offer three strategic recommendations—regarding funding, expanded provider enrollment, and data reporting—informed by a literature review, a survey and focus group from a convenience sample of 22 immunization jurisdictions, and the vision for enhanced data flow to improve future pandemic responses and routine vaccination.

IntroductionIn the United States, emergency medical services (EMS) protocols vary widely across jurisdictions. We sought to develop evidence-based recommendations for the prehospital evaluation and treatment of chest pain of suspected cardiac origin and to compare these recommendations against the current protocols used by the 33 EMS agencies in the state of California.MethodsWe performed a literature review of the current evidence in the prehospital treatment of chest pain and augmented this review with guidelines from various national and international societies to create our evidence-based recommendations. We then compared the chest pain protocols of each of the 33 EMS agencies for consistency with these recommendations. The specific protocol components that we analyzed were use of supplemental oxygen, aspirin, nitrates, opiates, 12-lead electrocardiogram (ECG), ST segment elevation myocardial infarction (STEMI) regionalization systems, prehospital fibrinolysis and β-blockers.ResultsThe protocols varied widely in terms of medication and dosing choices, as well as listed contraindications to treatments. Every agency uses oxygen with 54% recommending titrated dosing. All agencies use aspirin (64% recommending 325mg, 24% recommending 162mg and 15% recommending either), as well as nitroglycerin and opiates (58% choosing morphine). Prehospital 12-Lead ECGs are used in 97% of agencies, and all but one agency has some form of regionalized care for their STEMI patients. No agency is currently employing prehospital fibrinolysis or β-blocker use.ConclusionProtocols for chest pain of suspected cardiac origin vary widely across California. The evidence-based recommendations that we present for the prehospital diagnosis and treatment of this condition may be useful for EMS medical directors tasked with creating and revising these protocols.