Administration of intradermal hyaluronidase after amiodarone extravasation was associated with decreased expansion of erythema and warmth as well as an improvement in patient-reported pain scores without any noted adverse effects.

Background:Food and Drug Administration–approved daptomycin dosing uses actual body weight, despite limited dosing information for obese patients. Studies report alterations in daptomycin pharmacokinetics and creatine phosphokinase elevations associated with higher weight-based doses required for obese patients. Limited information regarding clinical outcomes with alternative daptomycin dosing strategies in obesity exists.Objective:This study evaluates equivalency of clinical and safety outcomes in obese patients with daptomycin dosed on adjusted body weight versus a historical cohort using actual body weight.Methods:This retrospective, single center study compared equivalency of outcomes with two one-sided tests in patients with body mass index ⩾30 kg/m2 who received daptomycin dosed on actual body weight versus adjusted body weight. The primary outcome was clinical failure. Secondary outcomes included 90-day readmission and 90-day mortality. A combined safety endpoint included creatine phosphokinase elevation, patient-reported myopathy, and rhabdomyolysis.Results:A total of 667 patients were screened for inclusion; 101 patients were analyzed with 50 in the actual body weight cohort and 51 in the adjusted body weight cohort. The two regimens were statistically equivalent for clinical failure (2% actual body weight versus 4% adjusted body weight; p < 0.001 for equivalency). The two regimens were also statistically equivalent for 90-day mortality (6% actual body weight versus 4% adjusted body weight; p = 0.0014 for equivalency). Limitations include single center, retrospective design, and sample size. Daptomycin dosing intensified throughout the study period.Conclusion:The two daptomycin dosing cohorts were statistically equivalent for both clinical failure and 90-day mortality. More data are needed to assess outcomes with higher (⩾8 mg/kg/day) daptomycin doses in this patient population.

Disclaimer In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Purpose The University of Oklahoma College of Pharmacy (OUCOP) implemented an individualized residency research committee and skill development program to facilitate completion and publication of research projects. The purpose of this study was to evaluate the outcomes the program had on project publication rates and subsequent publications after graduation for postgraduate year 1 (PGY1) and postgraduate year 2 (PGY2) residents. Methods This study included OUCOP PGY1 and PGY2 residents from classes graduating from 2011 through 2019. Literature searches for all resident projects and subsequent publications were performed. Data collection included residency type (PGY1 vs PGY2), initial position after residency, and project type. The primary objective was to identify the publication rate of research projects. Secondary objectives included a comparison of the number of publications after residency graduation between residents who did and did not publish their residency project and analysis of factors associated with subsequent publications. Zero-inflated Poisson regression was utilized to analyze subsequent publication status controlling for other factors. Statistical analyses were performed using SAS/STAT with an a priori P value of &lt;0.05. Results Eighty-two projects were completed by 73 residents. Forty-three of 82 projects were published (52.4%) by 39 of 73 residents (52.1%). After residency graduation, 54 residents (74.0%) had a subsequent publication. Factors associated with subsequent publications were initial position in an academic role and completion of additional training after residency. Conclusion After implementation of the program, the majority of residents published their projects and had subsequent publications. Future efforts should be taken to identify opportunities to foster independence in research and scholarship for residents.

Objective: To determine the functional and radiographic outcome of supra-syndesmotic fibular fractures associated with syndesmotic disruption treated with syndesmosis-only fixation.Methods: A retrospective observational study was performed in 12 patients who had fracture patterns amenable to syndesmosisonly fixation. According to the Lauge-Hansen classification, 10 were pronation external rotation injuries and 2 were pronation abduction injuries. The treatment plan was followed only if the fibular length could be restored and if the syndesmosis could be anatomically reduced. Through a percutaneous or mini-open reduction and clamp stabilization of the syndesmosis, all but one patient each had a single tricortical cortical screw fixation across the syndesmosis. Patients were kept non-weight bearing for 6 weeks followed by screw removal at an average of 8 weeks. Outcomes were assessed using an objective (Olerud and Molander Scale) ankle scoring system and by radiographic assessment of the ankle mortise.Results: Ankle mortise was reduced in all cases and all but one fibular fracture united without loss of fixation. At a mean follow up of 13 months, functional outcome score was 75. Six patients had more than one malleolar injury needing either screw or anchor fixations. One patient with trimalleolar fracture had residual ankle stiffness which responded to intensive physiotherapy. One patient had late diastasis after removal of the syndesmotic screw and underwent revision surgery with bone grafting of fibula.Discussion: With the length of the fibula restored and the syndesmosis reduced anatomically, internal fixation using a plating device may not necessary for fibular fractures combined with diastasis of inferior tibio-fibular joint. In our series, good or excellent results were obtained in majority of the patients. The patient with late diastasis after syndesmotic screw removal was probably due to early screw removal before union of the fibular fracture. Essential to this method of treatment are restoration of the fibular length, anatomical reduction of the syndesmosis and delaying screw removal till the fibular fracture heals.Conclusions: Syndesmotic-only fixation for supra-syndesmotic fibular fractures associated with syndesmotic disruption is a safe and effective method.

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