Abstract
Background
Optimized vancomycin dosing is associated with improved clinical outcomes, especially decreased acute kidney injury. Free, online, grey literature training materials are available for vancomycin dosing; however, their utility is unclear.
Objectives
This study evaluates the utility of these tools for just-in-time (e.g. refresher courses) training for general clinicians dosing vancomycin.
Methods
A structured grey literature review of websites was performed, and the Online Course Quality Review (OSCQR) rubric was modified for this study. Eligible resources included free, web-based tutorials aimed at general clinicians. The materials were evaluated using the rubric. Data were summarized as counts and proportions.
Results
A total of 65 online resources were identified. Seven resources were eligible for inclusion and reviewed. The OSCQR rubric was modified to include 17 relevant items. The average (range) number of elements per resource was 10 per resource (6–14). The resources with the largest proportions of elements were MemoryPharm (14/17, 82%), DoseMe (13/17, 76%) and ClinCalc (11/17, 65%). Evaluating only the High Impact Standards, MemoryPharm, DoseMe, and ClinCalc had (11/11, 100%), (9/11,82%), and (7/11,64%).
Conclusions
Memory Pharm, DoseMe, and ClinCalc performed highly using the OSCQR rubric. The additional resources may be useful in other domains, such as site-wide implementation or for more in-depth review. Further research is needed to understand the utility of these resources in clinical education.
Introduction
Vancomycin is a glycopeptide antibiotic that has been in clinical use for more than 60 years.1 Vancomycin is an integral part of the current armamentarium against resistant Gram-positive infections. It is a clinically important antibiotic as evidenced by its inclusion in multiple national guidelines2–6 and its dedicated dosing guideline.7 Globally, a point prevalence study of 303 hospitals in 53 countries demonstrated that vancomycin was the fourth most commonly prescribed antibiotic for healthcare-associated infections.8
Despite widespread use, vancomycin dosing can be challenging because of interpatient variability in pharmacokinetics (PK). The variable PK can lead to overexposure, which increases the risk of acute kidney injury, or underexposure, which increases the risk of therapeutic failures.7 As a result, therapeutic drug monitoring (TDM) is commonly performed. Given how frequently vancomycin is used and the challenges with individualized dosing, training resources are needed to help facilitate safe and effective vancomycin dosing.1,9,10
Just-in-time training is a method of instruction that pairs education near time of use.11,12 This contrasts with traditional ‘just-in-case’ training, where students learn a broad variety of concepts that they may not encounter. Just-in-time training is theoretically more advantageous as the short time between training and application interrupts the ‘forgetting curve.’11 This method of training has been advocated for by the World Health Organization.12 With regards to vancomycin, just-in-time training has the potential to help clinicians improve their vancomycin dosing.
Grey literature (i.e. information not controlled by commercial publishing) online resources are a potential source for training as they offer easy access to clinicians needing ‘just-in-time training.’ However, these resources are published ‘outside of the commercial review process.’13 The purpose of this study was to perform a structured evaluation of grey literature online resources focused on vancomycin dosing and TDM, using previously validated online education standards.14
Methods
To facilitate the goal of identifying ‘just-in-time’ training for front-line clinicians, the team followed a modified method as outlined by Staciu et al.15 Arksey and O’Malley16 and Levac et al.17 For the purposes of this study just-in-time training was defined as ‘training conducted immediately before an intervention.’18
Stage 1. Identifying the research question
The purpose of this review was to identify ‘just-in-time’ training for vancomycin dosing. The target audience is licensed clinicians without specialized infectious diseases training. To this effect, the team identified the following research question ‘Are grey literature resources for vancomycin dosing (1) accurate and (2) do they facilitate learning?’ The assessment of this two-pronged question was supported by a modified version of the online course quality review rubric (OSCQR, Table S1, available as Supplementary data).14 OSCQR has been previously validated to improve achievement of online educational outcomes in various settings, but, to our knowledge, has not been previously used to evaluate in healthcare grey literature.
Stage 2. Identifying resources
An investigator (K.W., librarian) conducted an initial literature search. Eligible grey literature types included free online educational resources for vancomycin dosing found on webpages, blogs, videos, podcasts, guidelines/protocols, social media, and unpublished papers. Freemium resources (i.e. mix of free and paid content) were also allowed if the vancomycin content was free. Grey literature was defined as ‘information produced on all levels of government, academia, business and industry in electronic and print formats not controlled by commercial publishing.’19 Only resources that included AUC or Bayesian calculations for dosing (versus trough-only based dosing) were selected as possible candidates for evaluation as they conform to current guidelines.7 Ineligible resources included accredited continuing education programmes, resources targeted at implementing dosing programmes, calculators without tutorials, and grey literature that was previously peer reviewed through a pedagogical lens.
To avoid filter bubbles, search engines used were Google Search in incognito mode and Duck Duck Go. Social media platforms, Facebook (Instagram) and YouTube, were also searched. PubMed was used to identify grey literature that was previously peer-reviewed.
Search terms included ‘vancomycin’, ‘vancomycin dosing’, ‘vancomycin calculations’, and ‘vancomycin dosing calculators’.
Subject Matter Expert (SME) team members were also allowed to recommend educational resources for inclusion consideration.
Stage 3. Selection of resources for review
The initial list of resources was screened by two investigators (JJC and EK) to determine which met the minimum criteria for review. The initial screening criteria dictated the resources must be (1) free to access, (2) focused on the adult population, (3) provide educational material such as tutorials in addition to a dosing calculator, and (4) audience targeted at individuals learning to dose vancomycin (rather than an organization trying to implement a programme). For criterion 1, websites with paid content were allowed if the vancomycin information was free to access.
Additional preliminary data were collected including authorship type (individual author, hospital, academic, corporate author [including non-profits, for-profit, and individual corporations]), and inclusion of problem sets with explanations, was also screened.
The preliminary list of resources was shared with investigators, who provided feedback on the fit and appropriateness of each resource. Considering these comments, the resources’ applicability to our target audience, and potential to fulfil the research question, a final list of 7 resources was created.20–26
Stage 4. Data extraction
Data were extracted using a modified version of the OSCQR rubric. JM (Instructional Designer) led the effort to modify the OSCQR rubric with input from JJC, EK, and KW. Seventeen elements were selected as being relevant to this analysis (Supplementary data). After relevant OSCQR criteria were selected, each team member received training instructions and videos for the OSCQR rubric (Table S2). In addition, investigators were asked to deduct from the section ‘course objectives/outcomes are clearly defined, measurable, and aligned to learning activities and assessments,’ if inaccuracies were noted.
Each resource was evaluated by at least three team members. One reviewer (LB, KD, TG, EH, WK, TM, MP, or BW) focused on rubric elements related to subject matter. Two members (JJC and EK) focused on non-subject matter items (i.e. pedagogical elements). If the non-subject matter team could not come to agreement on ratings, a third member (JM) was consulted for clarification.
Data were collected using an online portal which collected categorical agreement with the presence (>85%), partial presence (15–85%), or absence (<15%) of each standard. SMEs were also allowed to provide comments on each assessed standard.
Stage 5. Data summary and synthesis of results
A narrative description of each resource was produced by a single author (JJC) and reviewed by the team for accuracy/completeness. In the narrative description, the resources were free or freemium (i.e. a mix of free and paid content).
For each standard, data were summarized as counts and proportions of resources with presence, partial presence, or absence of each standard. Comments were summarized and incorporated into the manuscript draft. Analyses were further stratified by subject matter elements and pedagogical elements. Based on expert opinion (JM), elements were also classified as ‘High Impact’ or ‘Best Practices.’ High-impact elements were elements that are critical for learning, while best practice elements are those that enhance learning but are not critical for learning (Supplementary data). To compare the elements across the resources, elements were identified as mostly present, variably present, or rarely present based on the presence or partial presence of the element across the resources. The cutoffs were present/partially present in 5–7 resources, 3–4 resources, and 0–2 resources, for mostly, variably, and rarely present, respectively. This grouping describes the commonality of the element with the corpus of the reviewed tutorials.
Stage 6. Consultation
The group reviewed the results via e-mail and made suggestions for the interpretation of the data in the manuscript drafting and revisions phase.
Results
Literature review
A total of 65 resources were identified by the librarian and subsequently reviewed by team members (Figure 1); however, 58 resources were excluded for the following reasons: behind paywall (n = 16), calculators without tutorials (n = 16), non-individual focus (n = 10), paediatric focus (n = 7), authorship focus on specific location/hospital (n = 4), video only (n = 2), general PK website (n = 1), dialysis only focus (n = 1), length not appropriate for just-in-time training (n = 1). Therefore, 7 resources were evaluated by the SMEs.
Figure 1.
Summary of grey literature screening procedure.30 Source: Page MJ et al. BMJ 2021; 372: n71. doi: 10.1136/bmj.n71. This work is licensed under CC BY 4.0. To view a copy of this license, visit https://creativecommons.org/licenses/by/4.0/.
Narrative overview of educational resources
BestDose is free PK software developed by the Laboratory of Applied Pharmacokinetics and Bioinformatics. The software was developed by an interdisciplinary team of physicians, mathematicians, computer scientists, and others. The software accuracy has been peer reviewed, uses ‘non-parametric, multiple-model Bayesian adaptive control,’ and is developed for use by pharmacists and physicians. There is extensive documentation related to lab member publications.
Tuxuci is a free PK software funded by the Swiss government and developed by an international, interdisciplinary team including a software developer, clinical pharmacologist, clinical pharmacist, and senior scientist. Tuxuci features a stand-alone download and a web-based dosing platform. There is extensive documentation regarding the models used as Bayesian priors and peer-reviewed publications related to the software.
GlobalRPh is a free website that has vancomycin dosing calculators and background information on how to use and interpret the calculations. GlobalRPh also features a general website with broader pharmacy topics beyond vancomycin dosing. The site is managed by a pharmacist sole proprietor. Of note, this was the only website reviewed that was HONcode certified.
ClinCalc is a pharmacist-authored freemium website that features vancomycin and other dosing calculators. The website also has background information on how to use and interpret the calculations. ClinCalc states that it uses Bayesian modelling and lists PK models, but the optimization process is not described. The accuracy of this calculator has been previously peer-reviewed. ClinCalc also features a step-by-step tutorial on how to use the dosing calculator.
DoseMe via The Dosing Institute is freemium software and features multiple articles related to using the software, practical aspects of vancomycin dosing, and implementation strategy guidelines. The Dosing Institute features free modules on general PK and applied case studies using DoseMe. The accuracy of DoseMe has been previously peer reviewed.
TLDR is a pharmacist-authored freemium blog related to multiple aspects of pharmacy practice. The website states it is aimed at students and new practitioners. This narrative style blog covers a broad overview of vancomycin, including pharmacology and pharmacokinetics. The pharmacokinetics topics focus on the foundational aspects of calculations rather than the practical aspects of dosing.
MemoryPharm is a freemium website related to multiple aspects of pharmacy practice. The authors are a partnership between a pharmacist and graphic designer, and the website states it aims to ‘simplify medicine through art and humour.’ The website also self-identifies some aspects of their site that are well suited for visual learners (i.e. pharmacology colouring book). The site features PK modules with quizzes to check learner understanding. However, the focus is more on general vancomycin PK rather than support for individualized patients. Additional information on these resources is available in Figure 2.
Figure 2.
Summary of the resources reviewed. Resource web links: BestDose: https://www.lapk.org/pubsinfo/written_tutorials.php; ClinCalc Vancomycin Calculator: https://clincalc.com/vancomycin/; DoseMe: https://doseme-rx.com/vancomycin/dosing-calculator; GlobalRPh: https://globalrph.com/medcalcs/aminoglycosides-and-vancomycin-original-calculator/; https://globalrph.com/medcalcs/advanced-pharmacokinetics-2012-multiple-ke-choices/; Memory Pharm: https://www.memory-pharm.com/lesson-4-vancomycin-dosing/; TLDR Pharmacy Blog: https://www.tldrpharmacy.com/content/complete-guide-to-vancomycin-dosing. Full classification scheme available at http://bsac.org.uk/wp-content/uploads/2019/03/Educational-resource-review-classification-scheme.pdf. Resource type: (i) Website online reading material and other resource; (ii) Website primarily aimed at news items; (iii) Online/distance learning courses (MOOC, unfacilitated courses, online modules)/community of practice; (iv) Webinars, video, online lectures (including PowerPoint), podcasts, animation video, maps, photos; (v) Clinical practice AMS materials: PDFs, PowerPoints, newsletters, infographics, pamphlets, e-portfolios, workbooks; (vi) Guidelines, policies, handbooks; (vii) Material from face-to-face non-e-learning courses (programmes, teaching materials etc. from workshops, lectures, seminars); (viii) E-books via apps; (ix) Public, media, political awareness and engagement materials; (x) Commercial advertising (TV, radio, film, social media); (xi) Evidence: by systematic reviews/meta-analysis in relation to AMR; (xii) Datasets, compelling/illustrative case studies on AMS; (xiii) Patient stories. LI, low-income countries; LMIC, low- and middle-income countries; HMI, high- and middle-income countries; HIC, high-income countries.
Summary of OSCQR elements
The average (range) number of elements per resource was 10 (6–14). The resources with the largest proportions of elements were MemoryPharm (14/17, 82%), DoseMe (13/17, 76%) and ClinCalc (11/17, 65%). MemoryPharm, DoseMe, and ClinCalc had 11/11 (100%), 9/11 (82%), and 7/11 (64%) High Impact standards, respectively.
Quantitative assessment of subject matter elements
The overall results for the SME analysis are presented in Table 1. Elements that were ‘mostly present’ in the resources included orientation, layout, instructions, grammar, and copyright. Of note, for most of these elements, these items were partially present. However, all the sites reviewed were completely or partially free of grammatical and spelling errors, and the vast majority (n = 6, 86%) had easy-to-navigate layouts.
Table 1.
Subject matter elements
| Rubric | Yes n (%) | Partial n (%) | No n (%) |
|---|---|---|---|
| Overall orientation or overview, to make content, activities, and interactions predictable and easy to navigate/find. (ex. Welcome, about, getting started) | 2 (29%) | 3 (43%) | 2 (29%) |
| Objectives that are clearly defined, measurable, and aligned to learning activities and assessments | 1 (14%) | 0 (0%) | 6 (86%) |
| A logical, consistent, and uncluttered layout is established- easy to navigate (consistent colour scheme and icon layout, related content organized together, self-evident titles) | 4 (57%) | 2 (29%) | 1 (14%) |
| Instructions are provided and well written | 1 (14%) | 4 (57%) | 2 (29%) |
| Free of grammatical and spelling errors | 5 (71%) | 2 (29%) | 0 (0%) |
| Access to a variety of engaging resources to present content and support learning (exemplary work) | 2 (29%) | 2 (29%) | 3 (43%) |
| Activities that emulate real world applications of the discipline, such as experiential learning, case studies, and problem-based activities | 2 (29%) | 2 (29%) | 3 (43%) |
| Copyright, licensing status, citations, clearly stating permission to share where applicable. Offer, where possible, opinion on the credibility of the resource. Originality of the resource; if this resource can complement other resource(s) you are reviewing, suggest how they can be used together. Any obvious bias or errors | 1 (14%) | 4 (57%) | 2 (29%) |
| Predictable feedback is present, users can track progress. Suggestions are provided for supplemental learning and improving performance. | 0 (0%) | 2 (29%) | 5 (71%) |
| Frequent, appropriate, and authentic methods to assess the learners’ mastery of content (practice activity/pre-test, self-test with feedback, etc.) | 1 (14%) | 0 (0%) | 6 (86%) |
The second category of elements were those whose presence varied among the resources. This included elements that were present or partially present in 2 to 4 out of the 7 resources. This group included access to resources, activities that emulate real-world applications, and predictable feedback. For instance, predictable feedback was only present in 2/7 (29%) of the educational resources reviewed.
The final category of elements was those that were rarely present in the resources. These included the inclusion of learning objectives, and frequent, authentic methods of assessment. These elements were present in only 2/7 (29%) and 1/7 (14%) of educational resources, respectively.
Qualitative assessment of subject matter elements
For the ‘Information and Overview’ standards, SMEs commented on orientation depth, use of PK equations, and resources use of calculator. For orientation depth, there was wide variability in the observed orientation depth ranging from multiple videos, tutorials, and written documentation (DoseMe) to shorter orientations (GlobalRPh). For two specific resources, SMEs commented that these resources were more akin to dosing tools rather than comprehensive resources (GlobalRPh and ClinCalc). However, SMEs commented consistently that the orientation lacked objectives.
In the ‘Design and Layout’ standards, SMEs were mostly positive. The comments on the logical, consistent layout mainly centred on the uncluttered appearance (12/21, 57% of comments) and consistent design (7/21, 33%) that most of the educational resources appeared to have. With respect to the instructions provided, there was a large range of depth from minimal instructions/no instructions for calculators to full tutorials. Ease of navigation was also frequently cited by the SMEs (9/21, 43%).
For ‘Content and Activities’ standards, the SMEs’ comments reflected the large variability between the resources. For example, some dosing calculators (e.g. GlobalRPh) did not have any specific examples on their website, while websites such as MemoryPharm and DoseMe/Dosing Institute had multiple examples with assessment and feedback from the websites. Another theme that emerged was the different types of resources available. Lecture slides, text documents, streaming videos, and examples were available across the various sites.
Assessment of pedagogical elements
The presence of specific pedagogical standards within the resources ranged from 0% to 100% (Table 2). In summary, 3/7 standards were found to be highly prevalent (>71%), 1/7 standard was found intermittently (57%), and 3/7 standards were found less frequently (<29%). The items found to be highly prevalent were access to online technical help, opportunity for learners to get to know the authors, and accessible content. The standard that was found intermittently is linked to privacy policies for technology tools that store user data. Finally, the areas that were found less frequently were guidelines for technical requirements (e.g. browser version, mobile, secure content, pop-ups, browser issues), activities intended to support open communication, peer collaboration, and sharing of resources and experiences (e.g. a Q&A Bulletin Board, comment section, and dedicated discussion forums), and opportunity for learners to provide descriptive feedback on design, content, user experience, and technology. Additional data on accessibility is summarized in Table S1.
Table 2.
Pedagogical elements
| Description | Yes n (%) | Partial n (%) | No n (%) |
|---|---|---|---|
| Access to online technical help (FAQ, email, etc.) | 7 (100%) | 0 (0%) | 0 (0%) |
| Guidelines for technical requirements (e.g. browser version, mobile, secure content, pop-ups, browser issues) | 2 (29%) | 0 (0%) | 5 (71%) |
| Links to privacy policies for technology tools that store user data are provided | 4 (57%) | 1 (14%) | 2 (29%) |
| Learners have an opportunity to get to know the authors. | 6 (86%) | 1 (14%) | 0 (0%) |
| Activities intended to support open communication, peer collaboration, and sharing of resources and experiences (e.g. a Q&A Bulletin Board, comment section, and dedicated discussion forums). | 2 (29%) | 0 (0%) | 5 (71%) |
| Opportunity for learners to provide descriptive feedback on design, content, user experience, and technology | 0 (0%) | 0 (0%) | 7 (100%) |
| Content is Accessible | 5 (71%) | 2 (29%) | 0 (0%) |
Discussion
This grey literature review examined seven online resources with the goal of identifying a ‘just-in-time training tool’ for a general clinician needing to learn/review vancomycin dosing. The review was conducted by a multidisciplinary team of clinicians, a librarian, and an instructional designer. The main finding of this evaluation was that variation was common among the online educational resources. Of the tools reviewed, we identified MemoryPharm, DoseMe, and ClinCalc as the three resources with the highest proportion of OSCQR elements. These tools may be the most useful for ‘just-in-time’ training for a clinician needing to learn/review vancomycin. To our knowledge, this study is novel because it is the first time that the OSCQR rubric has been applied in this domain.
The elements that were commonly found were not surprising. Nonetheless, it should be noted that although many of those elements were foundational or required by regulatory bodies, these items can detract greatly from the educational experience when not present. For example, the ability to learn from the website may be limited if the content creator is not able to be contacted with questions. The unexpected finding from this study was the general inability to interact with other users and to practice using the sample cases. For example, for some online resources, there were no practice cases to validate if a user was using the tool correctly. These examples may help a learner assess if they learned how to correctly dose vancomycin. Therefore, it is recommended that as learners use sites without examples, they should seek out examples to help validate their understanding. In addition, as artificial intelligence tools continue to evolve, the creation of vancomycin dosing cases may be a place for automation as case creation can be broken down into a rule-based task.27,28
These findings have implications for clinical practice more broadly than the present study. Specifically, there are two broader considerations that can be gleaned from this study. First, we chose the OSCQR rubric for two main reasons: (1) it has been the topic of numerous peer-reviewed publications that have helped validate it as a tool for assessing online learning and (2), the tool is free to use through its Creative Common license making it a valuable resource for an international audience. To our knowledge, this is one of the first studies that integrates OSCQR (a pedagogical assessment) as a clinical tool. This method can be used as a template for antimicrobial stewardship programs seeking to help select and evaluate new resources. The second consideration is that this study method validates two anecdotally popular websites (DoseMe and ClinCalc) from a pedagogical perspective. The high scores on the OSCQR rubric may explain the widespread clinical adoption of these tools.
This evaluation is not without limitations. The literature review was limited by the number of team members available. As with any literature review, selection bias is a possibility. To limit the risk of selection bias, the literature search was conducted by a trained librarian, and the inclusion criteria were predefined. In addition, all SMEs had similar background training (all infectious diseases pharmacists), received the same training for the study, and used a highly structured rubric. Given the homogeneity within the group, we expect the reduction in bias from additional team members to be minimal compared to the additional resources required. Another potential limitation is that the ‘just-in-time’ focus may not have highlighted the utility of these other websites for other audiences. For example, BestDose refers to itself as a ‘program that assists physicians and pharmacists in finding optimal doses for individual patients’ as such it may be better suited for operations rather than ‘just-in-time’ training.26 Other tools that were not evaluated (i.e. Society of Infectious Diseases Pharmacists Vancomycin Dosing Tool Kit)29 are designed for organizations implementing a vancomycin dosing program, rather than an individual seeking ‘just-in-time’ training. These resources are incredibly valuable, but as this study focused on resources suited to individual and self-directed learning, materials developed for organizational implementation fell outside its scope. Lastly, this study did not evaluate the ability of artificial intelligence platforms to provide ‘just-in-time’ training for vancomycin dosing. Finally, the study did not compare the free resources to the commercial resources. This was done to try to increase the applicability of the findings across a global audience but could have also led to the exclusion of additional high-quality resources.
Conclusions
MemoryPharm, DoseMe, and ClinCalc were deemed high-quality options for ‘just-in-time training’ for vancomycin dosing. Depending on the practice setting and needs of the organization, these may have a valuable place in clinical practice. Other resources may play a valuable role for different audiences/purposes. Future studies are needed to evaluate the ability of these resources to improve clinician knowledge in the real-world setting.
Supplementary Material
Contributor Information
Emma S Kuska, Department of Pharmacy Practice, Albany College of Pharmacy and Health Sciences, Albany, NY, USA.
Jen Mlyniec, Center for Innovative Teaching and Learning, Albany College of Pharmacy and Health Sciences, Albany, NY, USA.
Kathleen L Wantuch, George and Leona Lewis Library, Albany College of Pharmacy and Health Sciences, Albany, NY, USA.
Logan Brock, Department of Pharmacy, University of Florida Health Shands Hospital, Gainesville, FL, USA.
Kathryn E Desear, Department of Pharmacy Education and Practice, University of Florida College of Pharmacy, Gainesville, FL, USA.
Timothy P Gauthier, Antimicrobial Stewardship Clinical Program Manager, Clinical Pharmacy Enterprise, Baptist Health South Florida, Miami, FL, USA.
Elizabeth B Hirsch, Department of Experimental and Clinical Pharmacology, University of Minnesota, College of Pharmacy, Minneapolis, MN, USA.
Wesley D Kufel, Department of Pharmacy Practice, State University of New York at Binghamton School of Pharmacy and Pharmaceutical Sciences, Binghamton, NY, USA; Division of Infectious Diseases, Department of Medicine, State University of New York Upstate Medical University, Syracuse, NY, USA.
Taylor Morrisette, Department of Clinical Pharmacy & Outcomes Sciences, Medical University of South Carolina College of Pharmacy, Charleston, SC, USA; Department of Pharmacy Services, Medical University of South Carolina Health, Charleston, SC, USA.
Matthew Pearsall, Pharmacy, Glens Falls Hospital, Glens Falls, NY, USA.
Bryan P White, Department of Pharmacy, OU Health, Oklahoma City, OK, USA.
Joseph J Carreno, Department of Pharmacy Practice, Albany College of Pharmacy and Health Sciences, Albany, NY, USA.
Funding
No funding sources to report.
Transparency declarations
EBH has received advisory board and consulting honoraria from GSK. WDK has received research support from Merck & Co., Shionogi, and Melinta Therapeutics and has received honoraria from Shionogi. TM is currently receiving grant funding through Stellus Rx, AbbVie Inc., and Merck Sharp & Dohme, has participated in scientific advisory boards for AbbVie Inc. and Shionogi Inc., has provided expert witness testimony to Copeland, Stair Valz & Lovell and Huff, Powell & Bailey, and has received honoraria from Shionogi Inc., Infectious Diseases Special Edition, and Managed Healthcare Executive. BPW is on the speaker’s bureau for Melinta Therapeutics. All other authors: none to declare.
Supplementary data
Tables S1 and S2 is available as Supplementary data at JAC-AMR Online.
References
- 1. Rybak M, Le J, Lodise T et al. Therapeutic monitoring of vancomycin: a revised consensus guideline and review of the American Society of Health-System Pharmacists, the Infectious Diseases Society of America, the Pediatric Infectious Diseases Society and the Society of Infectious Diseases Pharmacists. https://www.ashp.org/-/media/assets/policy-guidelines/docs/draft-guidelines/draft-guidelines-ASHP-IDSA-PIDS-SIDP-therapeutic-vancomycin.ashx.
- 2. Kalil AC, Metersky ML, Klompas M et al. Management of adults with hospital-acquired and ventilator-associated pneumonia: 2016 clinical practice guidelines by the Infectious Diseases Society of America and the American Thoracic Society. Clin Infect Dis 2016; 63: e61–111. 10.1093/cid/ciw353 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3. Woods CR, Bradley JS, Chatterjee A et al. Clinical practice guideline by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America: 2021 guideline on diagnosis and management of acute hematogenous osteomyelitis in pediatrics. J Pediatr Infect Dis Soc 2021; 10: 801–44. 10.1093/jpids/piab027 [DOI] [Google Scholar]
- 4. Stevens DL, Bisno AL, Chambers HF et al. Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the Infectious Diseases Society of America. Clin Infect Dis 2014; 59: 147–59. 10.1093/cid/ciu444 [DOI] [PubMed] [Google Scholar]
- 5. Tunkel AR, Hasbun R, Bhimraj A et al. 2017 Infectious Diseases Society of America’s clinical practice guidelines for healthcare-associated ventriculitis and meningitis. Clin Infect Dis 2017; 64: e34–65. 10.1093/cid/ciw861 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 6. Senneville É, Albalawi Z, van Asten SA et al. IWGDF/IDSA guidelines on the diagnosis and treatment of diabetes-related foot infections (IWGDF/IDSA 2023). Clin Infect Dis 2023. 10.1093/cid/ciad527. Epub ahead of print. Erratum in: Clin Infect Dis. 2024 Jul 19;79(1):286. doi: 10.1093/cid/ciae287. [DOI] [Google Scholar]
- 7. Rybak MJ, Le J, Lodise TP et al. Therapeutic monitoring of vancomycin for serious methicillin-resistant Staphylococcus aureus infections: a revised consensus guideline and review by the American Society of Health-System Pharmacists, the Infectious Diseases Society of America, the Pediatric Infectious Diseases Society, and the Society of Infectious Diseases Pharmacists. Am J Health Syst Pharm 2020; 77: 835–64. 10.1093/ajhp/zxaa036 [DOI] [PubMed] [Google Scholar]
- 8. Versporten A, Zarb P, Caniaux I et al. Antimicrobial consumption and resistance in adult hospital inpatients in 53 countries: results of an internet-based global point prevalence survey. Lancet Glob Health 2018; 6: e619–29. 10.1016/S2214-109X(18)30186-4 [DOI] [PubMed] [Google Scholar]
- 9. Pai MP, Neely M, Rodvold KA et al. Innovative approaches to optimizing the delivery of vancomycin in individual patients. Adv Drug Deliv Rev 2014; 77: 50–7. 10.1016/j.addr.2014.05.016 [DOI] [PubMed] [Google Scholar]
- 10. Lodise TP, Scheetz M, Carreno JJ et al. Associations between vancomycin exposure and acute kidney injury within the recommended area under the curve therapeutic exposure range among patients with methicillin-resistant. Open Forum Infect Dis 2022; 9: ofab651. 10.1093/ofid/ofab651 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 11. Yilmaz Y, Papanagnou D, Fornari A et al. The learning loop: conceptualizing just-in-time faculty development. AEM Educ Train 2022; 6: e10722. 10.1002/aet2.10722 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 12. World Health Organization . WHO implementation guidance on emergencies capacity-building. https://www.who.int/publications/i/item/9789240099630.
- 13. National Library of Medicine . (Other) grey literature sources. https://www.nlm.nih.gov/oet/ed/stats/03-600.html.
- 14. Online Learning Consortium I . OSCQR—SUNY online course quality review rubric. https://oscqr.suny.edu/.
- 15. Staicu ML, Jeffres MN, Jones BM et al. Penicillin-allergy delabelling resources for clinicians practicing in resource-limited settings: a full educational resource review of the grey literature. JAC Antimicrob Resist 2023; 5: dlad014. 10.1093/jacamr/dlad014 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 16. Arksey H, O’Malley L. Scoping studies: towards a methodological framework. Int J Soc Res Methodol 2005; 8: 19–32. 10.1080/1364557032000119616 [DOI] [Google Scholar]
- 17. Levac D, Colquhoun H, O’Brien KK et al. Scoping studies: advancing the methodology. Implement Sci 2010; 5: 69. 10.1186/1748-5908-5-69 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 18. Easton G, Page M, Rezaian M et al. Just-in-time interprofessional training: lessons from the NHS Nightingale London. Future Healthc J 2023; 10: 129–36. 10.7861/fhj.2022-0100 [DOI] [Google Scholar]
- 19. University of Exeter Library . Grey literature https://libguides.exeter.ac.uk/c.php?g=670055&p=4756572.
- 20. McAuley D. Aminoglycosides and vancomycin dosing (original calculator). https://globalrph.com/medcalcs/aminoglycosides-and-vancomycin-original-calculator/.
- 21. Dyson B. The complete (but practical) guide to vancomycin dosing. https://www.tldrpharmacy.com/content/complete-guide-to-vancomycin-dosing.
- 22. Tucuxi . Tucuxi. https://www.tucuxi.ch/.
- 23. ClinCalc.com. Vancomycin CalculatorPharmacokinetic calculator with Bayesian modeling. 2025. https://clincalc.com/vancomycin/.
- 24. DoseMe LLC . Vancomycin dosing calculator AUC & trough DoseMeRx. https://doseme-rx.com/vancomycin/dosing-calculator.
- 25. Memory Pharm . Vancomycin dosing course—memory pharm. https://www.memory-pharm.com/vancomycin-dosing-course/.
- 26. Laboratory of Applied Pharmacokinetics and Bioinformatics . BestDose software. https://www.lapk.org/bestdose.php.
- 27. Kufel WD, Hanrahan KD, Seabury RW et al. Let’s have a chat: how well does an artificial intelligence chatbot answer clinical infectious diseases pharmacotherapy questions? Open Forum Infect Dis 2024; 11: ofae641. 10.1093/ofid/ofae641 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 28. Microsoft . What is RPA? https://www.microsoft.com/en-ca/power-platform/products/power-automate/topics/robotic-process-automation/what-is-rpa.
- 29. Society of Infectious Diseases Pharmacists; McCreary E, Pogue J. Vancomycin AUC toolkit. https://sidp.org/Vancomycin-AUC-Implementation-Toolkit-Guide.
- 30. Page MJ, McKenzie JE, Bossuyt PM et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021; 372: n71. 10.1136/bmj.n71 [DOI] [PMC free article] [PubMed] [Google Scholar]
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