Comparison Between Pantoprazole Intermittent Dosing and Continuous Infusion in Suspected Upper Gastrointestinal Bleeding Prior to Endoscopy: Impact of a Pharmacist-Driven Protocol to Reduce Utilization of Pantoprazole Continuous Infusion

BACKGROUND

Current practice for patients with suspected or confirmed upper gastrointestinal bleeding (GIB) is to utilize a proton pump inhibitor (PPI) bolus followed by a continuous infusion for 72 hours. Literature has shown similar outcomes with intermittent bolus dosing compared to continuous infusion. Substitution would lead to reduced costs and utilization of resources.

METHODS

This was a retrospective case-control study conducted via chart review. Utilizing electronic healthcare record reports, patients in the control arm were screened for inclusion if they received a pantoprazole continuous infusion from December 1, 2020, to March 31, 2021. A total of 38 patients were included in the control arm. Patients in the experimental arm were screened for inclusion with pantoprazole intermittent therapy from January 1, 2022, to June 30, 2022. A total of 60 patients were included in the experimental arm. The primary outcome was a 30-day GIB recurrence. Secondary outcomes included 30-day hospital readmission, 30-day Clostridioides difficile (C. difficile), hospital length of stay (LOS), and number of pantoprazole vials utilized.

RESULTS

There was a 65% reduction in the 30-day GIB recurrence in the intermittent bolus arm compared to the continuous infusion arm. Thirty-day hospital readmission was 57% lower in the intermittent bolus arm compared to the continuous infusion arm. The LOS between the two arms was almost identical with the median being five days for the intermittent bolus arm and the median being four days for the continuous infusion arm. The 30-day C. difficile infection rate had 5% of patients acquiring C. difficile in the intermittent bolus arm and 2.5% in the continuous infusion arm. The intermittent bolus arm used 55% fewer pantoprazole vials than the continuous infusion arm.

CONCLUSION

In hospitalized patients, the utilization of pantoprazole intermittent bolus is not only comparably efficacious but potentially represents a safer and economically advantageous alternative compared to the current guideline recommendation of a 72-hour pantoprazole continuous infusion. Further studies could provide more robust data to support our findings and challenge the current recommendation for patients who meet the indication criteria.

Educators' Beliefs About Students' Socioeconomic Backgrounds as a Pathway for Supporting Motivation

Students' understandings of their socioeconomic status (SES) backgrounds have important implications for their motivation, achievement, and the emergence of SES-based educational disparities. Educators' beliefs about students' backgrounds likely play a meaningful role in shaping these understandings and, thus, may represent an important opportunity to support students from lower-SES backgrounds. We first experimentally demonstrate that educators can be encouraged to adopt background-specific strengths beliefs-which view students' lower-SES backgrounds as potential sources of unique and beneficial strengths (N_{Study 1} = 125). Subsequently, we find that exposure to educators who communicate background-specific strengths beliefs positively influences the motivation and academic persistence of students, particularly those from lower-SES backgrounds (N_{Study 2} = 256; N_{Study 3} = 276). Furthermore, lower-SES students' own beliefs about their backgrounds mediated these effects. Altogether, our work contributes to social-psychological theory and practice regarding how key societal contexts can promote equity through identity-based processes.

Concern about experiencing downward socioeconomic mobility generates precarious types of motivation among students of color

Students' beliefs about whether they will experience changes in their socioeconomic status influence their academic motivation. We propose that students who are concerned about downward socioeconomic mobility will focus their attention on negative academic outcomes and exhibit motivational goals oriented towards preventing negative possibilities and that this relationship will be particularly pronounced among students of color. Two studies investigated the relationship between college students' concerns about downward socioeconomic mobility and their adoption of academic achievement goals. The more that students of color expressed concerns about experiencing downward socioeconomic mobility, the more they adopted academic mastery-avoidance goals (β = 0.76), whereas there was no significant relationship between concerns about downward socioeconomic mobility and mastery-avoidance goals among White students (β = - 0.24; Study 1). Experimentally induced concerns about downward socioeconomic mobility increased academic mastery-avoidance goals among students of color (β =  - 0.58) but decreased mastery-avoidance goals among White students (β = 0.46; Study 2). Together, results indicate that there is a strong relationship between concerns about downward socioeconomic mobility and mastery-avoidance goals among students of color, highlighting the importance of understating how students of color make sense of their future socioeconomic prospects in order to most effectively support their academic trajectories positively.

Supplementary Information

The online version contains supplementary material available at 10.1007/s11218-023-09763-5.

The Ongoing Development of Strength-Based Approaches to People Who Hold Systemically Marginalized Identities

ACADEMIC ABSTRACT

Personality and social psychology have historically viewed individuals' systemically marginalized identities (e.g., as people of color, as coming from a lower-income background) as barriers to their success. Such a deficit-based perspective limits psychological science by overlooking the broader experiences, value, perspectives, and strengths that individuals who face systemic marginalization often bring to their societies. The current article aims to support future research in incorporating a strength-based lens through tracing psychology's journey away from an emphasis on deficits among people who contend with systemic marginalization and toward three distinct strength-based approaches: the universal strengths, difference-as-strength, and identity-specific strengths approaches. Through distinguishing between each approach, we advance scholarship that aims to understand systemically marginalized identities with corresponding implications for addressing inequality. Strength-based approaches guide the field to recognize the imposed limitations of deficit-based ideologies and advance opportunities to engage in research that effectively understands and values systemically marginalized people.

PUBLIC ABSTRACT

Inequalities, including those between people from higher- and lower-income backgrounds, are present across society. From schools to workplaces, hospitals to courtrooms, people who come from backgrounds that are marginalized by society often face more negative outcomes than people from more privileged backgrounds. While such inequalities are often blamed on a lack of hard work or other issues within marginalized people themselves, scientific research increasingly demonstrates that this is not the case. Rather, studies consistently find that people's identities as coming from groups that face marginalization in society often serve as a valuable source of unique strengths, not deficiencies, that can help them succeed. Our article reviews these studies to examine how future research in psychology may gain a broader understanding of people who contend with marginalization. In doing so, we outline opportunities for psychological research to effectively support efforts to address persistent inequalities.