ABSTRACT
Numerous studies have evaluated the role of vasopressors and inotropes in the management of septic shock. This review assesses available evidence for the use of specific vasopressors in the management of septic shock. Use of adjunctive vasopressor therapy is also evaluated, examining the potential value of individual agents. Lastly, inotropic agents are evaluated for use in patients with myocardial dysfunction.
ABSTRACT
Neurologic trauma, which consists of acute spinal cord injury and traumatic brain injury, is a leading cause of death and disability. In recent years, there have been improvements in the early recognition and prompt resuscitation of patients with neurologic trauma. However, there remain few pharmacologic treatments to reduce its secondary complications. Corticosteroids have been used in patients with neurologic trauma for more than 5 decades. Traditionally, their use has been to improve motor and sensory recovery. However, recently their utility to prevent and manage trauma-related pneumonia has been investigated. Given these new investigations, the purpose of this review article is to provide a comprehensive overview of the history and available scientific evidence surrounding the use of corticosteroids in neurologic trauma and caution against the use of these agents to prevent hospital-acquired pneumonia in this patient population.
Subject(s)
Adrenal Cortex Hormones/administration & dosage , Brain Injuries/drug therapy , Community-Acquired Infections/drug therapy , Cross Infection/prevention & control , Pneumonia/prevention & control , Spinal Cord Injuries/drug therapy , Adrenal Cortex Hormones/pharmacology , Adrenal Cortex Hormones/therapeutic use , Brain Injuries/physiopathology , Humans , Randomized Controlled Trials as Topic , Spinal Cord Injuries/physiopathologyABSTRACT
PURPOSE: The results of a survey comparing the similarities and differences in health-system pharmacy leadership pathways are reported. METHODS: The link to an online questionnaire was e-mailed to pharmacy leaders subscribing to ASHP's Pharmacy Practice Manager listserver. All respondents were asked to provide their career pathway, their thoughts on the most valued skill sets to a health-system pharmacy leader, and the influence that their leadership pathway had on these skill sets. Pharmacy middle managers were asked if they desired to become a health-system pharmacy director, and pharmacy directors were asked to provide their hiring preferences for new health-system pharmacy leaders. RESULTS: Two-hundred-five individuals responded to the survey. On-the-job experience (40%) was identified as the most common leadership pathway of current health-system pharmacy leaders. Respondents classified medication-use policy (26%), human resource management (20%), and interpersonal skills (18%) as the most valued skill sets to a health-system pharmacy leader. Residency and degree programs were most thought to prepare future health-system pharmacy leaders for interpersonal relations, ethical decision-making, and finance and budget management. Sixty percent of eligible respondents stated that they were interested in seeking health-system pharmacy director positions. The majority of director of pharmacy respondents stated that they preferred to hire leaders with previous on-the-job experience. CONCLUSION: On-the-job-experience was identified as the most common leadership pathway by survey respondents. Medication-use policy, human resource management, and interpersonal skills were identified by respondents as the most valued skill sets to a health-system pharmacy leader.