Decreasing the Stress of Medication Management During Cardiac Arrest.

Cardiac arrest affects more than 500 000 people every year, with significant associated morbidity and mortality. In addition to high-quality cardiopulmonary resuscitation and early defibrillation, medications are included in treatment algorithms. Epinephrine and amiodarone are commonly used, with other medications being used in specific situations of cardiac arrest. Although participating in the care of a patient in cardiac arrest is complex and stressful, having a baseline understanding of the medications being used, routes of administration, and special considerations can be helpful in mitigating some of the stress in these situations.

Implementation of a Bowel Protocol to Improve Enteral Nutrition and Reduce Clostridium difficile Testing.

BACKGROUND: Underfeeding is common among adult patients receiving enteral nutrition. Constipation and diarrhea have been associated with low enteral nutrition volume in critically ill patients. In patients with diarrhea, Clostridium difficile is often suspected and tested for, although medications, illness, or enteral formulas are usually the cause. The use of bowel protocols to proactively address constipation, diarrhea, and inappropriate testing for hospital-onset C difficile infection, thereby improving enteral nutrition, remains unclear. OBJECTIVE: To evaluate the efficacy of implementing protocols to decrease constipation, diarrhea, and inappropriate testing for hospital-onset C difficile infection, and to deliver larger enteral nutrition volumes in a critical care unit. METHODS: A prospective convenience sample was used. The primary outcome was the proportion of patients receiving greater than or equal to 80% of their prescribed caloric volume 1 week (minimum 4 days) after initiating enteral nutrition. Rates of testing for hospital-onset C difficile infection were analyzed before and after the protocol was implemented. RESULTS: After the protocol was implemented, patients experienced significant increases in delivery of enteral nutrition volume-up to 78% of the goal volume (P = .048). The standardized infection ratio of hospital-onset C difficile infection decreased 43% (P = .04). CONCLUSIONS: The implementation of bowel protocols improved delivery of total enteral volumes and reduced inappropriate testing for hospital-onset infections with C difficile, and they may improve patient safety and facilitate positive patient outcomes.

Major publications in the critical care pharmacotherapy literature in 2015.

PURPOSE: Recently published practice guidelines and research reports on pharmacotherapy in critical care patient populations are summarized. SUMMARY: The Critical Care Pharmacotherapy Literature Update (CCPLU) Group is composed of over 50 experienced critical care pharmacists who evaluate 31 peer-reviewed journals monthly to identify literature pertaining to pharmacotherapy in critical care populations. Articles are chosen for summarization in a monthly CCPLU Group publication on the basis of applicability and relevance to clinical practice and strength of study design. From January to December 2015, a total of 121 articles were summarized; of these, 3 articles presenting clinical practice guidelines and 12 articles presenting original research findings were objectively selected for inclusion in this review based on their potential to change or reinforce current evidence-based practice. The reviewed guidelines address the management of intracranial hemorrhage (ICH), adult advanced cardiac life support (ACLS) and post-cardiac arrest care, and the management of supraventricular tachycardia (SVT). The reviewed research reports address topics such as nutrition in critically ill adults, administration of ß-lactams for severe sepsis, anticoagulant selection in the context of continuous renal replacement therapy, early goal-directed therapy in septic shock, magnesium use for neuroprotection in acute stroke, and progesterone use in patients with traumatic brain injury. CONCLUSION: Important recent additions to the critical care pharmacy literature include updated joint clinical practice guidelines on the management of spontaneous ICH, ACLS, and SVT.

Index of Learning Styles in a U.S. School of Pharmacy / Índice de Estilos de Aprendizaje en una facultad de farmacia de los Estados Unidos

Objective: The goal of this study was to assess for a predominance of learning styles among pharmacy students at an accredited U.S. school of pharmacy. Methods: Following approval by the Institutional Review Board, the Index of Learning Styles© was administered to 210 pharmacy students. The survey provides results within 4 domains: perception, input, processing, and understanding. Analyses were conducted to determine trends in student learning styles. Results: Within the four domains, 84% of students showed a preference toward sensory perception, 66% toward visual input, and 74% toward sequential understanding. Students showed no significant preference for active or reflective processing. Preferences were of moderate strength for the sensing, visual, and sequential learning styles. Conclusions: Students showed preferences for sensing, visual, and sequential learning styles with gender playing a role in learning style preferences. Faculty should be aware, despite some preferences, a mix of learning styles exists. To focus on the preferences found, instructors should focus teaching in a logical progression while adding visual aids. To account for other types of learning styles found, the instructors can offer other approaches and provide supplemental activities for those who would benefit from them. Further research is necessary to compare these learning styles to the teaching styles of pharmacy preceptors and faculty at schools of pharmacy (AU)

Objetivo: El objetivo de este estudio fue evaluar la predominancia de los estilos de aprendizaje entre los estudiantes de farmacia en una facultad de farmacia acreditada en los Estados Unidos. Métodos: Después e la aprobación de la Junta de Revisión Institucional, se administró el Index of Learning Styles© a 210 estudiantes de farmacia. El cuestionario proporciona resultados en 4 dominios: percepción, entradas, procesamiento, y comprensión. Se realizaron análisis para determinar las tendencias en los estilos de aprendizaje de los alumnos. Resultados: En los 4 dominios, el 84% de los estudiantes mostró preferencias hacia la percepción sensorial, el 66% hacia las entradas visuales, y el 74% hacia la comprensión secuencial. Los estudiantes no mostraron preferencias significativas hacia el procesamiento activo o reflexivo. Las preferencias fueron de intensidad moderada hacia los estilos de aprendizaje sensorial, visual y secuencial. Conclusión: Los estudiantes mostraron preferencias por los estilos de aprendizaje sensorial, visual y secuencial, con el género jugando un papel en las preferencias de estilo de aprendizaje. Los académicos deberían ser conscientes, a pesar de algunas preferencias, que existe una mezcla de estilos de aprendizaje. Para centrarse en las preferencias encontradas, los docentes deberían centrar la enseñanza en una progresión lógica, a medida que van aumentando las ayudas visuales. Para tener en cuenta los otros tipos de estilos de aprendizaje, los docentes pueden ofrecer otros abordajes y proporcionar actividades suplementarias para los que se puedan beneficiar de ellas. Se necesita más investigación para comparar estos estilos de aprendizaje con los estilos docentes de los tutores y profesores en las facultades de farmacia (AU)

Index of learning styles in a u.s. School of pharmacy.

OBJECTIVE: The goal of this study was to assess for a predominance of learning styles among pharmacy students at an accredited U.S. school of pharmacy. METHODS: Following approval by the Institutional Review Board, the Index of Learning Styles© was administered to 210 pharmacy students. The survey provides results within 4 domains: perception, input, processing, and understanding. Analyses were conducted to determine trends in student learning styles. RESULTS: Within the four domains, 84% of students showed a preference toward sensory perception, 66% toward visual input, and 74% toward sequential understanding. Students showed no significant preference for active or reflective processing. Preferences were of moderate strength for the sensing, visual, and sequential learning styles. CONCLUSIONS: Students showed preferences for sensing, visual, and sequential learning styles with gender playing a role in learning style preferences. Faculty should be aware, despite some preferences, a mix of learning styles exists. To focus on the preferences found, instructors should focus teaching in a logical progression while adding visual aids. To account for other types of learning styles found, the instructors can offer other approaches and provide supplemental activities for those who would benefit from them. Further research is necessary to compare these learning styles to the teaching styles of pharmacy preceptors and faculty at schools of pharmacy.

Role of tipranavir in treatment of patients with multidrug-resistant HIV.

The worldwide emergence of multidrug-resistant human immunodeficiency virus (HIV)-1 strains has the driven the development of new antiretroviral (ARV) agents. Over the past 5 years, HIV-entry and integrase inhibitor ARVs, as well as improved non-nucleoside reverse transcriptase inhibitors (NRTIs) and protease inhibitors (PIs), have become available for treatment. It is important to assess how these new ARVs might be most judiciously used, paying close attention to viral susceptibility patterns, pharmacodynamic parameters, and the likelihood that patients will adhere to their therapy. Herein we review published material in Medline, EMBASE, and ISI for each antiretroviral agent/classes currently approved and summarize the available data on their efficacy, safety, and pharmacologic parameters. We focus on the role of tipranavir, a recently approved nonpeptidic PI, for treating HIV-infected children, adolescents, and adults with a history of multidrug-resistant HIV.

Effects of garlic on blood pressure in patients with and without systolic hypertension: a meta-analysis.

BACKGROUND: Garlic has been suggested to lower blood pressure; however, studies evaluating this parameter have provided conflicting results. OBJECTIVE: To examine the effect of garlic on blood pressure in patients with and without elevated systolic blood pressure (SPB) through meta-analyses of randomized controlled trials. METHODS: A systematic search of MEDLINE, CINAHL, and the Cochrane Central Register of Controlled Trials was conducted to identify randomized controlled trials in humans evaluating garlic's effect on blood pressure. All databases were searched from their inception through June 26, 2008, using the key words garlic, Allium sativum, and allicin. A manual search of published literature was used to identify additional relevant studies. To be included in the analysis, studies must have been written in English or German and reported endpoints of SBP or diastolic blood pressure (DBP). Studies whose population had a mean baseline SBP greater than 140 mm Hg were evaluated separately from those whose population had lower baseline blood pressures. Garlic's effect on SBP and DBP was treated as a continuous variable and weighted mean differences were calculated using a random-effects model. RESULTS: Ten trials were included in the analysis; 3 of these had patients with elevated SBP. Garlic reduced SBP by 16.3 mm Hg (95% CI 6.2 to 26.5) and DBP by 9.3 mm Hg (95% CI 5.3 to 13.3) compared with placebo in patients with elevated SBP. However, the use of garlic did not reduce SBP or DBP in patients without elevated SBP. There was only a minor degree of heterogeneity in the analyses and publication bias did not appear to influence the results. CONCLUSIONS: This meta-analysis suggests that garlic is associated with blood pressure reductions in patients with an elevated SBP although not in those without elevated SBP. Future research should focus on the impact of garlic on clinical events and the assessment of the long-term risk of harm.