Medicine and Health Sciences Commons^™

A Competency-Based Approach To Faculty Development, Betsy Ripley Md, Jean Bailey Phd, Kenneth Warren Edd, Katherine J T Henderson Med

Publications from the Office of the Dean

Background—Faculty development at the Virginia Commonwealth University School of Medicine (VCU SOM) has previously focused on enhancing teaching and learning in the medical and clinical education settings. While this work is important, this narrow focus does not address all facets a faculty member’s role. To broaden their programming, the VCU SOM faculty development team adopted a competency-based approach to the development and planning of faculty development activities.

Summary of work—The Senior Associate Dean for Faculty Affairs completed a research project focused on successful medical faculty who promote through the tenure process and advance in their careers. She identified …

Speaking Up: Using Ostes To Understand How Medical Students Address Professionalism Lapses, Constance R. Tucker, Beth A. Choby, Andrew Moore, Robert Scott Parker Ii, Benjamin R. Zambetti, Sarah Naids, Jillian Scott, Jennifer Loome, Sierra Gaffney

Publications from the Office of the Dean

Background: Objective-structured teaching encounters (OSTEs) are used across many disciplines to assess teaching ability. The OSTE detailed in this paper assesses 191 fourth-year medical students’ (M4) ability to identify and address lapses in professionalism based on Association of American Medical Colleges’ professionalism competencies. The research questions addressed are:

• How frequently do M4s address professionalism lapses observed during an OSTE?
• What factors influence whether M4s provide feedback when they observe professionalism lapses in an OSTE?

Methods: Standardized patients (SPs) and standardized learners (SLs) were recruited and trained to participate in a standardized encounter with specific cognitive, social, and behavioral …

Surgical Infection Society Guidelines For Vaccination After Traumatic Injury, Thomas R. Howdieshell, Daithi Heffernan, Joseph T. Dipiro

Publications from the Office of the Dean

Background: Recommendations for vaccination of injured patients against infection are evolving. Newly-recognized infections, safety considerations, changing epidemiology, and redefinition of patient groups at risk are factors that may influence vaccine development priorities and recommendations for immunization. However, recommendations must often be formulated based on incomplete data, forcing reliance on expert opinion to address some crucial questions. These guidelines provide evidence-based recommendations for the prevention or treatment of infectious morbidity and mortality after traumatic injury, such as soft tissue wounds, human or animal bites, or after splenectomy.

Methods: A panel of experts conducted a thorough review of published literature, …

The Surgical Infection Society Guidelines On Antimicrobial Therapy For Intra-Abdominal Infections: An Executive Summary, John E. Mazuski, Robert G. Sawyer, Avery B. Nathens, Joseph T. Dipiro, Moshe Schein, Kenneth A. Kudsk, Charles Yowler

Publications from the Office of the Dean

The Surgical Infection Society last published guidelines on antimicrobial therapy for intra-abdominal infections in 1992 (Bohnen JMA, et al., Arch Surg 1992;127:83-89). Since then, an appreciable body of literature has been published on this subject. Therefore, the Therapeutics Agents Committee of the Society undertook an effort to update the previous guidelines, primarily using data published over the past decade. An additional goal of the Committee was to characterize its recommendations according to contemporary principles of evidence-based medicine. To develop these guidelines, the Committee carried out a systematic search for all English language articles published between 1990 and 2000 related to …

Aminoglycosides For Intra-Abdominal Infection: Equal To The Challenge?, John A. Bailey, Katherine S. Virgo, Joseph T. Dipiro, Avery B. Nathens, Robert G. Sawyer, John E. Mazuski

Publications from the Office of the Dean

Background: Aminoglycosides, combined with antianaerobic agents, have been used widely for the treatment of intra-abdominal infection. However, some prospective randomized controlled trials and other data suggested that aminoglycosides were less efficacious than newer comparators for the treatment of these infections. We therefore performed a meta-analysis of all prospective randomized controlled trials utilizing aminoglycosides to reevaluate the efficacy of these agents for the treatment of intra-abdominal infection.

Methods: Published English-language prospective randomized controlled trials comparing aminoglycosides with other agents for treatment of intra-abdominal infection were identified by MEDLINE search. For each study, data were collected regarding the number of …

The Surgical Infection Society Guidelines On Antimicrobial Therapy For Intra-Abdominal Infections: Evidence For The Recommendations, John E. Mazuski, Robert G. Sawyer, Avery B. Nathens, Joseph T. Dipiro, Moshe Schein, Kenneth A. Kudsk, Charles Yowler

Publications from the Office of the Dean

Revised guidelines for the use of antimicrobial therapy in patients with intra-abdominal infections were recently developed by the Therapeutic Agents Committee of the Surgical Infection Society (Mazuski et al., Surg Infect2002;3:161-173). These were based, insofar as possible, on evidence published over the past decade. The objective of this document is to describe the process by which the Committee identified and reviewed the published literature utilized to develop the recommendations and to summarize the results of those reviews. English-language articles published between 1990 and 2000 related to antimicrobial therapy for intra-abdominal infections were identified by a systematic MEDLINE search and …

Pharmacokinetics Of Vancomycin In Critically Ill Infants Undergoing Extracorporeal Membrane Oxygenation, R. Davis Maker, Joseph T. Dipiro, Jatinder Bhatia

Publications from the Office of the Dean

Extracorporeal membrane oxygenation (ECMO) is a widely used therapy for neonates with respiratory failure. Because of sepsis, many of these infants require antibiotics like vancomycin during ECMO treatment. ECMO transiently alters renal function and increases the circulating blood volume by 75%. Initial vancomycin pharmacokinetics were determined in 12 infants undergoing ECMO to determine an adequate drug administration regimen. Vancomycin dosage was based on current recommendations for weight and gestational age. Pharmacokinetic parameters were determined by fitting the data to a two compartment model. This study yielded a mean steady-state volume of distribution of 1.1 +/- 0.5 (range, 0.6 to 2.1) …

Lipopolysaccharide-Reactive Immunoglobulin E Is Associated With Lower Mortality And Organ Failure In Traumatically Injured Patients, Joseph T. Dipiro, Robert G. Hamilton, Thomas R. Howdieshell, N. Franklin Adkinson Jr., Arlie R. Mansberger Jr.

Publications from the Office of the Dean

Antilipopolysaccharide (anti-LPS) immunoglobulin G (IgG) and IgM have been associated with protection from LPS effects in vivo. We investigated the presence of IgE and anti-LPS in 32 patients that had experienced severe traumatic injury and in 35 healthy volunteers; we also investigated whether IgE anti-LPS was associated with important clinical events. Plasma samples were collected daily from patients in the intensive care unit and on one occasion from volunteers; the samples were assayed for IgE anti-LPS. IgE anti-LPS was assayed by enzyme-linked immunosorbent assay with monoclonal anti-human IgE as the capture antibody. Detection was accomplished with biotin-labeled LPS (Escherichia coli …

Facilitation Of Penicillin Haptenation To Serum Proteins., Joseph T. Dipiro, N. Franklin Adkinson Jr., Robert G. Hamilton

Publications from the Office of the Dean

Traditionally, penicillin binding to serum proteins was believed to be a passive chemical process; however, it appears to be facilitated by serum factors. The objectives of this in vitro investigation were to examine facilitated penicillin haptenation, to study the kinetics of haptenation, and to determine the nature of haptenation-facilitating factors. The model involved addition of [3H]benzylpenicillin to serum or albumin solutions (at pH 7.3 to 7.4) and incubation at 37 degrees C for up to 72 h. The extent of penicillin binding to proteins in serum was found to be four- to fivefold higher than with solutions having comparable concentrations …

In Vitro Protein Binding Of Cefonicid And Cefuroxime In Adult And Neonatal Sera., John M. Benson, F. Douglas Boudinot, Andrew T. Pennell, Francesca E. Cunningham, Joseph T. Dipiro

Publications from the Office of the Dean

The levels of in vitro protein binding of cefonicid and cefuroxime in human adult and neonatal sera were compared.Binding parameters for each drug were determined within the concentration range of 25 to 3,000 micrograms/ml.Cefonicid exhibited concentration-dependent protein binding in both types of sera, with more extensive binding in adultserum at all concentrations. Two classes of binding sites were found: a high-affinity, saturable site and a low-affinity, nonspecific site. Cefuroxime also showed two-class, concentration-dependent protein binding in adult serum, but bindingin neonatal serum was to a single class and was independent of drug concentration. Parameters for class 1 binding sites for …

Assessment Of Cefazolin And Cefuroxime Tissue Penetration By Using A Continuous Intravenous Infusion., John E. Connors, Joseph T. Dipiro, Ronald G. Hayter, K. Dale Hooker, Johnny A. Stanfield, Timothy R. Young

Publications from the Office of the Dean

A continuous intravenous infusion was used to assess the tissue penetration of cefazolin (14 subjects) and cefuroxime (15 subjects) in orthopedic surgery patients. Subjects were randomly assigned to receive a continuous intravenous infusion of cefazolin (mean, 178.6 mg/h) orcefuroxime (mean, 330.0 mg/h) at a rate estimated to achieve a target steady-state total concentration of 50 micrograms/ml in serum. The infusion was initiated 12 to 14 h before surgery, and blood and muscle tissue samples were collected intraoperatively at the times of incision and wound closure. Although there was a significant difference between the free concentrations ofcefazolin (at incision, 9.3 micrograms/ml; …

Pharmacokinetics Of Gentamicin In Neonates On Extracorporeal Membrane Oxygenation., W. Michael Southgate, Joseph T. Dipiro, Alex F. Robertson

Publications from the Office of the Dean

Extracorporeal membrane oxygenation (ECMO) has been used in more than 1,000 infants in 50 centers in the United States. The extracorporeal circuit contains approximately 400 ml of blood, an amount exceeding the blood volume of most full-term neonates. The effect of this additional blood volume on drug disposition is unknown. In this study, we determined the pharmacokinetic parameters of gentamicin in 10 infants on ECMO. Gentamicin concentrations were determined by a fluorescence polarization immunoassay. Pharmacokinetic parameters were determined from these concentrations by using a two-compartment model. Our study demonstrated a mean steady-state volume of distribution of 0.51 +/- 0.11 liters/kg, …

Effect Of Hemorrhagic Shock On Cefazolin And Gentamicin Pharmacokinetics In Dogs., Paul L. Dickson, Joseph T. Dipiro, Katherine A. Michael, Richard P. F. Cheung, Edward M. Hall

Publications from the Office of the Dean

The physiologic response to traumatic injury may alter the disposition of drugs and thereby affect their therapeutic or toxic potential. A study was conducted in 10 mongrel dogs to determine theeffect of experimental hemorrhagic shock with resuscitation on the pharmacokinetics of gentamicinand cefazolin. Single simultaneous intravenous doses of gentamicin (3 mg/kg) and cefazolin (25 mg/kg) were administered to each animal on an initial study day, after which serial blood and urine collections were performed. After 1 week, a standard hemorrhagic shock model was applied to each animal. Shock was continued for 1 h, after which the animal was resuscitated with …

Intraoperative Ceforanide Pharmacokinetics And Protein Binding., Joseph T. Dipiro, Samir M. Bayoumi, Joseph J. Vallner, Robert R. Nesbit, Rajeev Gokhale, J. Peter Rissing

Publications from the Office of the Dean

The pharmacokinetics and protein binding of ceforanide were studied in 15 patients undergoing cholecystectomies. Each patient received ceforanide (20 mg/kg) intravenously on arrival in the operating room, after which serial blood samples were collected during the elimination phase for determination of total and free ceforanide concentrations in the serum. A high-pressure liquid chromatography assay was used, with a centrifugal filtration system for free-drug determinations. Serum concentration data for each individual were subjected to linear regression to determine the elimination rate constants (total and free drug), volumes of distribution, and systemic clearances. The mean elimination rate constants were 0.41 and 0.50 …

Lack Of Influence Of Commonly Used Drugs On Bioassay Indicator Organisms., Joseph T. Dipiro, A. Thomas Taylor, John C. H. Steele Jr.

Publications from the Office of the Dean

Many commonly used pharmaceutical agents have been found to inhibit bacterial growth in vitro. Determinations of antimicrobial concentrations in sera of patients taking nonrecognized antibacterial agents could possibly be altered if bioassay systems are utilized for the determinations. We therefore attempted to determine the in vitro effect of commonly used drugs on bioassay indicator organisms. Fifty-one different agents (antihistamines, anticholinergics, central nervous system agents, cardiovascular agents, analgesics, steroids, muscle blockers, and other miscellaneous agents) were tested for inhibition or enhancement of the growth of Bacillus subtilis, Staphylococcus aureus, Micrococcus luteus, and Klebsiella pneumoniae. None of the agents tested exhibited any …

[Beta]-(2-Hydroxyphenyl)Ethanolamine Hydrochloride [2-Amino-1-(2-Hydroxyphenyl)Ethanol Hydrochloride], Alexandros Makriyannis, James B. Anderson, Joseph T. Dipiro, Edward Kostiner, Gilbert Hite

Publications from the Office of the Dean

CsH~2NO2+.C1 -, m.p. 441-449 K (from ethyl acetate), P212~2 l, a = 7.363 (2), b = 21.824 (6), c = 5.790 (2)/~, Z = 4, D x = 1.354, D m = 1.356 Mg m -3 (flotation: CC14-C6H6). The structure was solved by MULTAN. Full-matrix least-squares refinement converged to R = 0.057 for the R configuration and to R = 0.056 for the S configuration (P < 0.05). This is consistent with spontaneous resolution of the title compound, single crystals of which provided optically active aqueous solutions. A partially occupied oxygen site O(1)' is attributed to the oxidation of the alkyl hydroxyl group to a ketone during the data collection. The CI- is hydrogen bonded to H2(N)554, H3(N)555, and 1-t(O2)655 (2.37, 2-19, and 2.10 A). Both O(1) and 0(2) are internally hydrogen bonded [HI(N)...O(1), 2.41 and H(O1)...O(2) = 2.24 A]. Intramolecular hydrogen bonding may account for the unusual pharmacological properties of this compound in which only the N-C(1)-C(2)-O(1) and the O(1)-C(2)- C(3)-C(4) and O(1)-C(2)-C(3)-C(8) torsion angles (-41, -60, +122 ° ) differ significantly from those of other phenylethanolamines.