Desmopressin for Antiplatelet-Associated Intracranial Hemorrhage: A Concise Review.

OBJECTIVE: To provide a concise review of the literature on desmopressin use for antiplatelet reversal in patients with intracranial hemorrhage. DATA SOURCES: Source data were obtained from a PubMed literature review. STUDY SELECTION: Studies addressing desmopressin for antiplatelet reversal. DATA EXTRACTION: Relevant studies were reviewed and included through consensus of the authors. The following aspects of each study were identified, abstracted, and analyzed: study population, study design, methods, results, and relevant implications for practice. DATA SYNTHESIS: A growing body of evidence continues to provide mixed results for the use of desmopressin in patients presenting with antiplatelet-associated intracranial hemorrhage. The potential benefit outweighs the possible risks associated with a one-time dose. In addition to desmopressin, platelets should only be considered in patients undergoing a neurosurgical procedure until further and superior evidence is available. Guidelines recommend a weight-based approach for desmopressin dosing at 0.4 mcg/kg over 30 min. CONCLUSIONS: The available evidence supports desmopressin as potentially beneficial with minimal risk for use in patients with antiplatelet-associated intracranial hemorrhage.

Impact of Incorporating Pharmacy Residents Into a Pharmacist-Managed Culture Review Service During Weekend Staffing Commitments.

BACKGROUND: Clinical pharmacy continues to rapidly evolve as does the need to incorporate unique learning opportunities in pharmacy residency training (eg, transitions of care). OBJECTIVE: To describe the impact of incorporating pharmacy residents into a pharmacist-managed emergency department culture review service (CRS). METHODS: This retrospective study included 500 cultures with positive results evaluated by a pharmacy resident during weekend staffing shifts for patients discharged from the emergency department or urgent care center (UCC). The primary outcome of this study was the number of interventions performed by pharmacy residents. RESULTS: Of the 500 cultures evaluated, 275 (55%) required action by the pharmacy residents, resulting in 233 interventions. Modification of antimicrobial therapy occurred 70 times. When surveyed, a majority of residents strongly agreed that the CRS had a positive impact. Based on evaluations, residents achieved mastery of pertinent residency performance objectives. CONCLUSION: Incorporation of pharmacy residents into a pharmacist-managed emergency department CRS promotes safe and effective medication use to patients discharged from an emergency department or UCC while providing residents additional experience in designing a therapeutic regimen, providing education to patients, and communicating with health-care teams to manage medication therapy.

Role of high-dose intravenous nitrates in hypertensive acute heart failure.

BACKGROUND: Patients with hypertensive acute heart failure (H-AHF) can decompensate rapidly and require immediate medical attention; the use of high-dose nitroglycerin is a topic of growing interest in this patient population. OBJECTIVE OF THE REVIEW: The purpose of this review is to provide an evidence-based approach for the utilization of high-dose nitrates in the emergent management of H-AHF. DISCUSSION: Two randomized controlled trials, three prospective studies, two retrospective cohorts, two case series, and one case report were evaluated. Level of robust evidence and heterogeneity limit the ability to draw strong conclusions regarding the use of high-dose nitrates. Despite these limitations, high-dose nitrates appeared to have an overall beneficial effect across all studies reviewed, including lower rates of mechanical ventilation, improvement in blood pressure, shorter LOS, and lower rates of ICU admission. Adverse effects were mild and infrequently reported. CONCLUSIONS: High-dose nitrates are likely safe and may be effective, as demonstrated in the studies reviewed. High-dose NTG may be appropriate in H-AHF patients presenting with severe respiratory distress and SBP ≥160 mmHg or MAP ≥120 mmHg. Future well-designed randomized controlled trials are needed to elucidate optimal dosing strategies and confirm safety and efficacy of high-dose nitrates.

Assessing Hyperbaric Oxygen for Carbon Monoxide Poisoning in Trauma Patients: A Call for Representation in Future Studies.

Although carbon monoxide (CO) poisoning presents infrequently, it is a consequential and serious component of burn-related injuries, especially those injured via structure fire. A multitude of retrospective reviews and prospective trials have attempted to establish evidence demonstrating the ideal modality for oxygen administration in CO-poisoned patients; however, a consensus recommendation has not been reached. Given that half of fire-related patients succumb to CO poisoning, this is an imperative area of research.

Update in Therapeutics: Prophylactic Antibiotics in Open Fractures.

Acute management of open fractures is associated with high morbidity and mortality. Recommended antibiotic regimens for all Gustilo-Anderson fracture grades include first-, second-, and third-generation cephalosporins. Expanded gram-negative coverage is recommended for Grade II and III fractures if a first- or second-generation cephalosporin is selected, and additional anaerobic coverage is required if the open fracture is contaminated with organic or farm-related material. Open fractures endure a high rate of bacterial contamination, and antibiotics have demonstrated effectiveness at reducing infection rates when initiated early. Provided that the expected microbial spectrum is covered, antibiotics should be selected on the basis of patient-specific factors and hospital protocols.

Debate as an alternative method for medical literature evaluation.

BACKGROUND AND PURPOSE: To determine the student impression of utilizing a debate style journal club as an alternative approach for preceptors to teach medical literature evaluation skills to pharmacy students undergoing Advance Pharmacy Practice Experiences (APPE) in both acute care and ambulatory care. EDUCATIONAL ACTIVITY AND SETTING: Students were asked to debate on a controversial topic or two drugs with similar indications. Each side had to research supporting evidence based medicine and use literature appraisal skills to incorporate the information logically into an oral debate style format. Approximately fifteen minutes were allotted for each debate, allowing five minutes for each opening argument, three minutes for each rebuttal, and two minutes for each closing argument. Students were then asked to complete a post-debate survey using a Likert Scale to evaluate their perception of the debate style journal club. FINDINGS: Following implementation of the debate style journal club, students reported being more confident with their ability to find, compare, and retain information from primary literature with a mean of 4.1, 4.2, and 4.4 respectively on a Likert Scale. Students also reported overall enjoyment and satisfaction with a mean of 4.0. SUMMARY: Debate style journal clubs have the capability to teach pharmacy students vital literature appraisal skills, and are a well-liked alternative to the traditional style journal club. Incorporating this method improved student interest as well as increased their ability to find, compare, and retain the information gathered from primary literature.

Impact of Pharmacy Students on a Level II Trauma Center.

This study aims to quantify the benefits of allowing advanced pharmacy practice experience (APPE) students to make medical interventions while on rotation by analyzing their interventions made and the resulting cost avoidance. This retrospective, observational cohort study was completed using self-reported data of APPE student interventions made at a Level II trauma center, under the supervision of a clinical pharmacist. Interventions were analyzed for their impact on patient care and cost avoidance through a comprehensive literature search and online Quantifi reference. A total of 187 interventions over a 7-month study period resulted in an estimated cost avoidance of $26,175. Advanced pharmacy practice experience students acting as pharmacist extenders resulted in a monthly cost avoidance of $3,739, which corresponds to $44,871 per year. Incorporating student pharmacists as active members of an interprofessional team enhanced patient care by increasing medical interventions, leading to increased cost avoidance by optimizing medication regimens.