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St. Louis, MO, United States

St. Louis College of Pharmacy is a private and independent nonsectarian professional university in St. Louis, Missouri. It was founded in 1864. Located on a five acre campus in St. Louis' Central West End medical community, the St. Louis College of Pharmacy is the oldest college of pharmacy west of the Mississippi River. The College’s 6,000 living alumni represent 50 states and 11 foreign countries. Approximately 72 percent of practicing pharmacists in the St. Louis region are graduates of St. Louis College of Pharmacy.The College admits students directly from high school and integrates the liberal arts and science with a six-year professional curriculum leading to the PharmD degree. In 2014, the College will be expanding to a seven-year program which will allow students to obtain a Bachelor of Science degree after four academic years.Enrollment is currently at 1,260 students, with incoming freshmen classes of approximately 250 students. These students are taken directly from high school, with a handful of applicants allowed to transfer each year until the third year of the program. St. Louis College of Pharmacy is accredited by both the Accreditation Council for Pharmacy Education as well as the Higher Learning Commission North Central Association of Colleges and Schools, both out of Chicago. St. Louis College of Pharmacy is consistently ranked as one of the best and most respected pharmacy schools in the country. Wikipedia.

Pearce E.F.,St. Louis College of Pharmacy | Murphy J.A.,University of Toledo
Annals of Pharmacotherapy | Year: 2014

Objective: To evaluate the clinical literature and potential clinical role of vortioxetine (Brintellix) for the treatment of major depressive disorder (MDD). Data Sources: A MEDLINE search (1966-February 2014) was conducted using the search terms vortioxetine, Lu AA21004, and depression. Bibliographies of all articles retrieved were also reviewed. All references included were published between 1999 and 2014. Study Selection/Data Extraction: All studies that included humans and were published in English, with data describing vortioxetine for the treatment of MDD, were reviewed. Data Synthesis: Vortioxetine is a novel multimodal antidepressant agent, which inhibits the 5-HT transporter protein, acts as a 5-HT3 antagonist, 5-HT1A receptor agonist, 5-HT7 receptor antagonist, and a partial agonist of the 5-HT1B receptor. It has been studied in 10 short-term (6-8 weeks), 1 relapse-prevention, and 3 long-term extension trials. Vortioxetine demonstrated efficacy in reducing Montgomery-Asberg Depression Rating Scale or Hamilton Rating Scale for Depression scores in 6 of the short-term trials. The proportion of individuals who responded to treatment and achieved remission increased over time in all 3 long-term trials. The most common adverse effects, consistently reported by >10% of individuals in the clinical trials include nausea and headache. Conclusions: Vortioxetine is an effective agent for the treatment of MDD, but it does not have any clear advantages over other available treatment options. © The Author(s) 2014. Source

Vazquez-Guillamet C.,University of New Mexico | Scolari M.,University of Washington | Zilberberg M.D.,University of Massachusetts Amherst | Shorr A.F.,Washington Hospital Center | And 2 more authors.
Critical Care Medicine | Year: 2014

Objective: To assess appropriate antimicrobial therapy as an outcome determinant in severe sepsis and septic shock using the number needed to treat. Design: Single-center cohort study (January 2008 to December 2012). Setting: One thousand two hundred fifty-bed academic hospital. Patients: Two thousand five hundred ninety-four patients with positive blood culture. Interventions: We retrospectively identified patients with severe sepsis or septic shock. Inappropriate antimicrobial treatment was defined as an antimicrobial regimen that lacked in vitro activity against the isolated pathogen. Information regarding demographics, severity of illness, comorbidities, microbiology, and antimicrobial treatment was recorded. Logistic regression was used to identify risk factors for hospital mortality and inappropriate treatment. Measurements and Main Results: Seven hundred eighty-seven patients (30.3%) were nonsurvivors. Inappropriate antimicrobial treatment had the greatest adjusted odds ratio for hospital mortality (adjusted odds ratio, 3.4; 95% CI, 2.8-4.1; p < 0.001). Multivariate logistic regression analysis identified resistance to cefepime, resistance to meropenem, presence of multidrug resistance, nonabdominal surgery, and prior antibiotic use as being independently associated with the administration of inappropriate antimicrobial treatment. For the entire cohort, the number needed to treat with appropriate antimicrobial therapy to prevent one patient death was 4.0 (95% CI, 3.7-4.3). The prevalenceadjusted pathogen-specific number needed to treat (PNNT) with appropriate antimicrobial therapy to prevent one patient death was lowest for multidrug-resistant bacteria (PNNT = 20) followed by Candida species (PNNT = 34), methicillin-resistant Staphylococcus aureus (PNNT = 38), Pseudomonas aeruginosa (PNNT = 38), Escherichia coli (PNNT = 40), and methicillin-susceptible S. aureus (PNNT = 47). Conclusions: Our results support the importance of appropriate antimicrobial treatment as a determinant of outcome in patients with severe sepsis and septic shock. Our analyses suggest that improved targeting of empiric antimicrobials for multidrug-resistant bacteria, Candida species, methicillin-resistant S. aureus, and P. aeruginosa would have the greatest impact in reducing mortality from inappropriate antimicrobial treatment in patients with severe sepsis and septic shock. Copyright © 2014 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins. Source

Zhang D.,University of Washington | Micek S.T.,St. Louis College of Pharmacy | Kollef M.H.,University of Washington
Critical Care Medicine | Year: 2015

Objective: To assess the timing of appropriate antibiotic therapy as a determinant of postinfection hospital and ICU lengths of stay in patients with sepsis. Design: Single-center retrospective cohort study (January 2008-December 2012). Setting: One thousand two hundred fifty-bed academic hospital. Patients: One thousand fifty-eight consecutive blood culture positive patients. Interventions: We retrospectively identified adult patients with severe sepsis or septic shock. Timing of appropriate antibiotic therapy was determined from blood culture collection time to the administration of the first dose of antibiotic therapy with documented in vitro susceptibility against the identified pathogen. We constructed generalized linear models to examine the determinants of attributable lengths of stay. Measurements and Main Results: The median (interquartile range) time from blood culture collection to the administration of appropriate antibiotic therapy was 6.7 hours (0.0-23.3 hr). Linear regression analysis adjusting for severity of illness and comorbid conditions identified time to appropriate antibiotic therapy to be an independent determinant of postinfection ICU length of stay (0.095-d increase per hr of time to deliver appropriate antibiotic therapy; 95% CI, 0.057-0.132 d; p < 0.001) and postinfection hospital length of stay (0.134-d increase per hr of time to deliver appropriate antibiotic therapy; 95% CI, 0.074-0.194 d; p < 0.001). Other independent determinants associated with increasing ICU length of stay and hospital length of stay were mechanical ventilation (both ICU and hospital lengths of stay) and incremental peak WBC counts (hospital length of stay only). Incremental changes in severity of illness assessed by Acute Physiology and Chronic Health Evaluation II scores and comorbidity burden assessed by the Charlson comorbidity score were independently associated with decreases in ICU length of stay and hospital length of stay. Conclusions: We identified time to appropriate antibiotic therapy in patients with sepsis to be an independent determinant of postinfection ICU and hospital lengths of stay. Clinicians should implement local strategies aimed at timely delivery of appropriate antibiotic therapy to improve outcomes and reduce length of stay. Copyright © 2015 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved. Source

Boyer A.F.,University of Washington | Schoenberg N.,University of Washington | Babcock H.,University of Washington | McMullen K.M.,Barnes Jewish Hospital | And 2 more authors.
Chest | Year: 2015

Background: The Centers for Disease Control and Prevention has shifted policy away from using ventilator-associated pneumonia (VAP) and toward using ventilator-associated conditions (VACs) as a marker of ICU quality. To date, limited prospective data regarding the incidence of VAC among medical and surgical ICU patients, the ability of VAC criteria to capture patients with VAP, and the potential clinical preventability of VACs are available. Methods: This study was a prospective 12-month cohort study (January 2013 to December 2013). Results: We prospectively surveyed 1,209 patients ventilated for ≥ 2 calendar days. Sixty-seven VACs were identified (5.5%), of which 34 (50.7%) were classified as an infection-related VAC (IVAC) with corresponding rates of 7.0 and 3.6 per 1,000 ventilator days, respectively. The mortality rate of patients having a VAC was significantly greater than that of patients without a VAC (65.7% vs 14.4%, P < .001). The most common causes of VACs included IVACs (50.7%), ARDS (16.4%), pulmonary edema (14.9%), and atelectasis (9.0%). Among IVACs, 44.1% were probable VAP and 17.6% were possible VAP. Twenty-five VACs (37.3%) were adjudicated to represent potentially preventable events. Eighty-six episodes of VAP occurred in 84 patients (10.0 of 1,000 ventilator days) during the study period. The sensitivity of the VAC criteria for the detection of VAP was 25.9% (95% CI, 16.7%-34.5%). Conclusions: Although relatively uncommon, VACs are associated with greater mortality and morbidity when they occur. Most VACs represent nonpreventable events, and the VAC criteria capture a minority of VAP episodes. © 2015 American College Of Chest Physicians. Source

Hetland A.,St. Louis College of Pharmacy | Carr D.B.,Washington University in St. Louis
Annals of Pharmacotherapy | Year: 2014

Objective: To describe the association of specific medication classes with driving outcomes and provide clinical recommendations. Data Sources: The MEDLINE and EMBASE databases were searched for articles published from January 1973 to June 2013 on classes of medications associated with driving impairment. The search included outcome terms such as automobile driving, motor vehicle crash, driving simulator, and road tests. Study Selection and Data Extraction: Only English-language articles that contained findings from observational or interventional designs with ≥ 10 participants were included in this review. Cross-sectional studies, case series, and case reports were excluded. Data Synthesis: Driving is an important task and activity for the majority of adults. Some commonly prescribed medications have been associated with driving impairment measured by road performance, driving simulation, and/or motor vehicle crashes. This review of 30 studies identified findings with barbiturates, benzodiazepines, hypnotics, antidepressants, opioid and nonsteroidal analgesics, anticonvulsants, antipsychotics, antiparkinsonian agents, skeletal muscle relaxants, antihistamines, anticholinergic medications, and hypoglycemic agents. Additional studies of medication impact on sedation, sleep latency, and psychomotor function, as well as the role of alcohol, are also discussed. Conclusions: Psychotropic agents and those with central nervous system side effects were associated with measures of impaired driving performance. It is difficult to determine if such associations are actually a result of medication use or the medical diagnosis itself. Regardless, clinicians should be aware of the increased risk of impaired driving with specific classes of medications, educate their patients, and/or consider safer alternatives. © The Author(s) 2014. Source

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