Part-Time and Cofunded Pharmacy Faculty and Their Perceptions of Professional and Organizational Identity Formation.

OBJECTIVE: To gain a better understanding of professional and organizational identity formation and workplace climate issues among part-time and cofunded pharmacy faculty. METHODS: This study had a cross-sectional, prospective design using a semistructured interview guide developed by the researchers of this study. The interview guide drew themes from motivating language theory, social provisions, and previous research on professional identity. Pharmacy faculty with varying part-time and cofunded appointments, representing a cross section of demographic characteristics, and working in different types of practice sites and institutions, were invited to participate. RESULTS: Data saturation was reached at 14 participants. Participants had a variety of professional roles, namely teaching and precepting, as well as clinical, research, service, and administrative responsibilities. Three general themes emerged: (1) the struggle with having multiple aspects of professional identity, (2) facing the perception that academia is a "lifestyle" that not all faculty can fully participate, and (3) the need for properly constructed and tailored communication from peers and supervisors. CONCLUSION: A key component to mitigating the struggle with multiple aspects of professional identity and the feeling that part-time and cofunded faculty cannot fully participate in the academic lifestyle seemed to be informed, empathetic, inclusive, and tailored communication from supervisors.

Reversing the anticoagulation effects of dabigatran.

The standard of care for oral anticoagulation therapy has primarily been warfarin, which is limited by its indirect mechanism-of-action, variable kinetics, tolerability, and routine monitoring concerns. The direct-acting oral anticoagulants (DOACs) have predictable pharmacokinetics and pharmacodynamics, and improved safety and efficacy compared to warfarin for the prevention of stroke in patients with nonvalvular atrial fibrillation and prevention or management of venous thromboembolism. Consequential bleeding is a concern with all anticoagulants. Vitamin K is not a rapid reversal agent for warfarin; rather it facilitates synthesis of new vitamin K-dependent clotting factors, which can take longer than 24 h. Other nonspecific agents, including recombinant activated factor VII, three- and four-factor prothrombin complex concentrates (PCC), and activated PCC or Factor Eight Inhibitor Bypassing Activity (FEIBA®), are options based on clinical need. Specific agents to quickly reverse the effects of DOACs have been under development, and idarucizumab, a monoclonal antibody fragment that rapidly binds dabigatran, has been approved for clinical use in cases of dabigatran-related life-threatening bleeding, or if a dabigatran-treated patient needs emergency surgery or an invasive procedure. Idarucizumab specifically and rapidly reverses dabigatran-induced anticoagulation as measured by established coagulation assays. However, this does not guarantee complete hemostasis, especially if a patient has underlying comorbidities such as renal or liver disease, or has experienced recent trauma that requires urgent surgery. In these cases, concomitant supportive therapy and/or administration of concentrated clotting factors may be considered. Emerging data from ongoing trials and clinical experience will further inform providers regarding optimal approaches for anticoagulation reversal.

Alvimopan use in laparoscopic and open bowel resections: clinical results in a large community hospital system.

BACKGROUND: Alvimopan has received Food and Drug Administration approval to accelerate the time to upper and lower gastrointestinal recovery following partial large or small bowel resection with primary anastomosis. OBJECTIVE: To assess the efficacy, safety, and economic benefit of alvimopan in patients undergoing open or laparoscopic bowel resection in a community hospital system setting. METHODS: This 6-month, open-label, multi-hospital, prospective study combined with a retrospective chart review compared postoperative length of stay and postoperative ileus-related morbidity (nasogastric tube insertion, hospital readmission) for patients undergoing open or laparoscopic bowel resection who received alvimopan 12 mg (n = 108) versus historical control bowel resection patients (n = 91) who would have been eligible to receive alvimopan. Multivariate analysis assessed the effects of age and surgery type on postoperative length of stay. Additional-day hospital costs were estimated using ordinary least-squares regression to calculate costs based on length of stay in the control cohort. RESULTS: Compared with historical controls, patients receiving alvimopan had a mean 1.8-day shorter postoperative length of stay (p = 0.01) and lower rates of nasogastric tube insertion (2% vs 15%, p < 0.001). Multivariate analysis revealed a statistically significant reduction in postoperative length of stay in the alvimopan group of approximately 1.2 days (p = 0.01), regardless of age or surgery type, with an even larger difference (3.2 days) observed in patients ≥70 years old. Mean cost savings associated with alvimopan use ranged from $531 (laparoscopic bowel resection) to $997 (open bowel resection) per patient. CONCLUSIONS: Consistent with clinical trial data, alvimopan use resulted in an approximately 1 day shorter postoperative length of stay and was associated with substantial cost savings.