Object The authors evaluated the rates of ventriculostomy-related infections (VRIs) after antibiotic-coated extraventricular drains (ac-EVDs) were introduced as the standard of care. Methods A retrospective chart review was conducted of adult patients admitted to NewYork-Presbyterian Hospital neurological intensive care unit in whom an EVD was placed between February 2007 and November 2009, excluding individuals receiving EVDs due to an infection of a primary device. Three time periods were defined depending on type of EVD in use: Period 1, conventional EVDs; Period 2, either ac-EVDs or conventional EVDs; and Period 3, ac-EVDs. Definite/probable VRIs that occurred during the 3 periods were evaluated and established as determinants of VRIs by using a Cox proportional hazards model. Prolonged systemic antibiotics were given for the duration of EVD placement in each of the 3 periods per institutional policy. Results Data from 141 individuals were evaluated; mean patient age was 53.8 ± 17.2 years and 54% were female. There were 2 definite and 19 probable VRIs. The incidence of definite/probable VRI (per 1000 person-catheter days) decreased from Period 1 to 3 (24.5, 16.2, and 4.4 in Periods 1, 2, and 3, respectively; p < 0.0001). Patients with VRIs were more likely to be female than male (23.7% vs 3.1%, p < 0.003) and have had an EVD in place for a longer duration, although there was no significant difference among the 3 periods (7.9 ± 6.7 [Period 1], 8.1 ± 7.1 [Period 2], and 8.6 ± 5.8 [Period 3] mean days; p = 0.87, ANOVA). Analysis of effect modification in a stepwise model showed that period, age, and age and female interaction were significant predictors of VRIs. The period was the strongest predictor of VRI (p = 0.0075). After adjustment for age and age and sex interaction, the survival rate was 53% at the end of Period 2 and 91% at the end of Period 3. Conclusions Rates of VRIs have decreased with the addition of ac-EVDs to the routine use of prolonged systemic antibiotics at the authors' institution.

This paper describes the goals of the American Society of Health-System Pharmacists' Pharmacy Practice Model Initiative (PPMI) and its recommendations for health-system pharmacy practice transformation to meet future patient care needs and elevate the role of pharmacists as patient care providers. PPMI envisions a future in which pharmacists have greater responsibility for medication-related outcomes and technicians assume greater responsibility for product-related activities. Although the PPMI recommendations have elevated the level of practice in many settings, they also potentially affect existing clinical pharmacists, in general, and clinical pharmacy specialists, in particular. Moreover, although more consistent patient care can be achieved with an expanded team of pharmacist providers, the role of clinical pharmacy specialists must not be diminished, especially in the care of complex patients and populations. Specialist practitioners with advanced training and credentials must be available to model and train pharmacists in generalist positions, residents, and students. Indeed, specialist practitioners are often the innovators and practice leaders. Negotiation between hospitals and pharmacy schools is needed to ensure a continuing role for academic clinical pharmacists and their contributions as educators and researchers. Lessons can be applied from disciplines such as nursing and medicine, which have developed new models of care involving effective collaboration between generalists and specialists. Several different pharmacy practice models have been described to meet the PPMI goals, based on available personnel and local goals. Studies measuring the impact of these new practice models are needed.

The availability of effective pangenotypic therapy for HCV may expand donor availability. The feasibility of early versus late treatment of HCV remains to be determined through formalized protocols. We hypothesize pharmacoeconomics to be the greatest limitation to widespread availability of this promising tool.

RESUMENCon el objetivo de sanear y detoxificar la carne de llama infectada con Sarcocystis aucheniae se evaluó el efecto de los métodos físicos de cocción (100 ºC por 10 min), horneado (105 ºC por 65 min), fritura y congelado (-20 ºC por 10 días). La inactivación de la toxicidad de la proteína sarcocystina se evaluó en 30 conejos de 4-5 meses de edad que fueron inoculados s.c. con 100 µg de proteína/kg de peso vivo, obtenida de un lisado de macroquistes de S. aucheniae proveniente de carnes tratadas con cada método físico y de carne sin tratar. Únicamente los conejos del control positivo (carne sin tratar) murieron. Los conejos del grupo de carne congelada presentaron sintomatología tóxica moderada. La interrupción del ciclo biológico del S. aucheniae se evaluó en 13 perros de 2-5 meses de edad que fueron alimentados con 200 g de carne de llama tratada o sin tratar. Los perros de los grupos de carne tratada no eliminaron esporoquistes en las heces a comparación de los perros del grupo control positivo que los eliminaron a partir de los 14 días de la ingestión de carne. Se concluye que la cocción, horneado y fritura (y la congelación en forma limitada) lograron desnaturalizar y detoxificar la sarcocystina de los macroquistes de Sarcocystis aucheniae; así mismo, los cuatro tratamientos afectaron la viabilidad de los quistes, eliminando el riesgo potencial de infección del hospedero definitivo.Palabras clave: Sarcocystis aucheniae, macroquistes, esporoquistes, conejos, perros ABSTRACTThe aim of the study was the sanitation and disinfecting llama meat naturally infected with macrocysts of Sarcocystis aucheniae through any of four physical methods: boiling (100 ºC for 10 min), baking (105 ºC for 65 min), frying and freezing (-20 ºC for 10 days). A lisis of macrocysts from treated and non-treated meats was prepared and inoculated (100 µg/kg of body weight, subcutaneously).into 30 rabbits of 4-5 months of age. Only rabbits of the positive control group (non-treated meat) died. Rabbits of the frozen meat group

When anticoagulation is indicated following lung transplantation, warfarin has long been the enteral anticoagulant of choice. However, with the advent of direct acting oral anticoagulants (DOACs), there has been a shift in practice toward these newer agents, but there are scant data to aid in anticoagulation decision making as solid organ transplant recipients are poorly represented in the literature. [1][2][3] DOACs have clear advantages over warfarin with more predictable kinetics, fewer drug-drug and drug-food interactions, and do not require therapeutic drug monitoring. 4,5 Furthermore, DOACs do not require peri-procedural bridging which may improve patient safety and reduce length of stay. 6 The lung transplant population has unique characteristics that necessitate caution with integration of DOACs into practice. Drug interactions are common as lung transplant patients are likely to receive concomitant CYP3A4 and P-glycoprotein (P-gp) inhibiting medications. Inhibition of CYP3A4 metabolic activity may decrease metabolism of substrates, such as apixaban, and hence increase serum concentrations. Inhibition of P-gp may increase intestinal absorption as well as systemic distribution of P-gp substrates, including apixaban. In lung transplant, common CYP3A4 inhibitors include azole antifungals and diltiazem. Medications such as cyclosporine, amiodarone, and itraconazole inhibit both CYP3A4 and P-gp. Management of these interactions is complicated by different degrees of CYP3A4 inhibition (eg, voriconazole is a more potent