Antimicrobial Pharmacokinetic Considerations in Extracorporeal Membrane Oxygenation.

Critical illness creates challenges for healthcare providers in determining the optimal treatment of severe disease, particularly in determining the most appropriate selection and dosing of medications. Critically ill patients experience endogenous physiologic changes that alter the pharmacokinetics (PKs) of medications. These alterations can be further compounded by mechanical support modalities such as extracorporeal membrane oxygenation (ECMO). Specific components of the ECMO circuit have the potential to affect drug PKs through drug sequestration and an increase in the volume of distribution. Factors related to the medications themselves also play a role. These PK alterations create problems when trying to properly utilize antimicrobials in this patient population. The literature seeking to identify appropriate antimicrobial dosing regimens is both limited and difficult to evaluate due to patient variability and an inability to determine the exact role of the ECMO circuit in reduced drug concentrations. Lipophilic and highly protein bound medications are considered more likely to undergo significant drug sequestration in an ECMO circuit, and this general trend represents a logical starting point in antimicrobial selection and dosing in patients on ECMO support. This should not be the only consideration, however, as identifying infection and evaluating the efficacy of treatments in this population is challenging. Due to these challenges, therapeutic drug monitoring should be utilized whenever possible, particularly in cases with severe infection or high concern for drug toxicity.

The Perfect Storm: Barriers to Heart Failure Treatment Optimization.

Despite advances in heart failure therapies with proven positive outcomes, treatment gaps in clinical practice persist and heart failure morbidity and mortality remain high. The lack of treatment intensification to evidence-based targets accounts for a significant portion of unattained treatment goals and has been characterized to involve 3 main elements: the provider initiating and titrating the medication(s), the patient themselves, and the system that serves as the gatekeeper and facilitator for health care needs. This article will examine the mechanisms and impact of these 3 factors, and present targeted initiatives to help improve patient outcomes and quality of care.

Which SSRI is safest for patients with CVD and major depressive disorder?

ABSTRACT: Major depressive disorder is a common mood disorder and presents increased morbidity and mortality risks for patients with comorbid cardiovascular disease (CVD). Selective serotonin reuptake inhibitors (SSRIs) are a cornerstone of treatment for major depressive disorder, given their relative safety and affordability compared with other antidepressant classes, and SSRIs frequently are used in patients with CVD. However, clinicians should carefully weigh safety considerations before prescribing SSRIs in these patients. This article reviews the safety of SSRIs in patients with CVD and discusses SSRI selection.

Evaluation of a Council Structure and Meeting Format for Pharmacy Student Government in the Co-Curriculum.

Objective. To evaluate student perceptions of a transformed pharmacy student government structure and meeting format. Methods. The structure and general assembly meeting format of the University of North Carolina at Chapel Hill (UNC) Eshelman School of Pharmacy Student Senate (ie, student government) underwent a transformation from that of a forum to that of a council in an effort to address concerns regarding limited information exchange, minimal discussion, and unengaged meeting participants. To evaluate student perceptions of the new senate council format, members who attended at least one council meeting during the academic year were asked to complete a 12-item survey evaluating interorganizational relations, communication, collaboration, and efficiencies. Descriptive statistics were used to summarize students' agreement with 10 survey items. Thematic analysis was employed to identify common themes in students' responses to the two open-ended survey items. Results. The majority of students agreed or strongly agreed that the senate council facilitated interorganizational relations (86%), communication (93%), and collaboration (86%). Ninety-three percent of respondents agreed or strongly agreed that the senate council improved efficiencies, while 96% preferred the new senate council meeting format over the previous senate meeting format. Common qualitative themes included improved engagement during council meetings because of the "no laptop" policy and facilitation of open conversation by having a roundtable format and smaller number of members in attendance. Overall, 93% of students indicated they were satisfied or highly satisfied with the new meeting format. Conclusion. Student perceptions suggest that the new senate council structure and meeting format was effective at improving interorganizational relations, communication, collaboration, and efficiencies within student body government.

The Psychology of Following Instructions and Its Implications.

The ability to follow instructions is an important aspect of everyday life. Depending on the setting and context, following instructions results in outcomes that have various degrees of impact. In a clinical setting, following instructions may affect life or death. Within the context of the academic setting, following instructions or failure to do so can impede general learning and development of desired proficiencies. Intuitively, one might think that following instructions requires simply reading instructional text or paying close attention to verbal directions and performing the intended action afterward. This commentary provides a brief overview of the cognitive architecture required for following instructions and will explore social behaviors and mode of instruction as factors further impacting this ability.