University of Missouri–Kansas City

Antimicrobial Stewardship (AS) is crucial for delivering high-quality care to patients, minimizing adverse effects and outcomes, mitigating antimicrobial resistance, and generating cost savings for the healthcare system and patients. Successful AS programs are often multi-disciplinary, with infectious diseases and antimicrobial stewardship pharmacists (ID/ASP) playing a key role in the implementation and coordination of care. This study evaluated the documentation of stewardship interventions following the implementation of an ID/ASP-led stewardship program in a large Midwestern academic medical center. This quasi-experimental study evaluated the impact of hiring an ID/ASP with subsequent AS education and feedback and updated documentation methods. It was conducted from January 2023 to September 2023 (pre-intervention) and October 2023 to December 2024 (post-intervention), and compared the impact of an ID/ASP pharmacist on the documentation of key AS interventions by non-ID pharmacists. The number and type of interventions and drugs used in interventions were assessed for adult and pediatric patients before and after the ID/ASP pharmacist was hired. The primary outcome was the average number of interventions documented by non-ID pharmacists per month in the pre-intervention period compared to the post-intervention period. A p-value < 0.05 was considered statistically significant. A total of 5606 non-ID pharmacist interventions occurred throughout the study. There was a statistically significant increase in average monthly documented interventions by non-ID pharmacists after the intervention compared to before (283 ± 102 vs. 152 ± 49, respectively; p = 0.002). Furthermore, the ID/ASP pharmacist contributed an additional average of 104 interventions per month and was able to perform high-impact AS interventions. This study demonstrated a positive impact of an ID/ASP pharmacist-led AS program in a large academic medical center. The number of documented AS interventions significantly increased in the post-intervention period. These data underscore the importance of ID/ASP in advancing the shared goal of antimicrobial stewardship.

Artificial intelligence (AI) is reshaping how biomedical knowledge is accessed, synthesized, and applied, raising important questions about the cognitive competencies medical education should cultivate. Although these concerns appear new, educational institutions have previously confronted similar disruptions when emerging technologies altered relationships among knowledge, expertise, and learning. Using a historical-comparative design informed by institutional adaptation theory, this article analyzes recurring patterns in educational responses to technological innovation across six dimensions: institutional resistance, pedagogical positioning, faculty gatekeeping, curricular reform, assessment transformation, and equity of access. The analysis suggests that technological integration in education tends to proceed through identifiable stages, beginning with resistance and concern about skill erosion, followed by supplemental integration, pedagogical reorientation, and eventual curricular adaptation. Based on these patterns, the article proposes a developmental trajectory model for integrating AI into professional education and suggests that medical education currently stands between supplemental integration and early pedagogical reorientation. Meaningful AI integration will require curricular reform, revised assessment models, faculty development, and governance frameworks for responsible use.

Objective: Feeding-tube weaning is conducted in both inpatient and outpatient settings, with significant logistical, financial, and structural barriers to both approaches. We sought to assess whether remote patient monitoring (RPM), using a mobile application, which would overcome many of these barriers, could be effective in helping patients tube wean. Methods: We prospectively enrolled patients with a feeding tube, aged 0-3 years. Enrolled families entered data daily into the remote application. Data were monitored by a nurse and reviewed weekly by a multidisciplinary team. A standard hunger provocation protocol was used, paired with medical, behavioral, oral motor, and nutrition interventions, as needed. We conducted a retrospective chart review to identify a comparison cohort. The chart review was collected first, then compared to the prospective, non-randomized trial of RPM tube weaning. Results: The chart review identified 141 children seen with a feeding tube from January 2023-June 2023. Of those, 17 children attempted a tube wean. The post-intervention group consisted of 38 children prospectively enrolled from the same clinic between November 2023-2024. In the pre-intervention group, 41% of the children (7/17) were successful in achieving all calories by mouth and 90% of children (34/38) in the post-intervention group were successful in tube weaning. Conclusions: RPM is a feasible and incredibly promising model for feeding-tube weaning in pediatric patients with a wide range of medical comorbidities, including patients with multiple comorbidities. RPM allowed for high-quality medical monitoring and for a dynamic intervention in response to patient data transferred to the medical team in real time.