A national retrospective cohort study comparing of cefepime versus piperacillin-tazobactam on the development of severe acute kidney injury in patients with septic shock.

Background: Cefepime and piperacillin-tazobactam are commonly used broad-spectrum antibiotics used to treat patients with potential gram-negative bacterial sepsis. Piperacillin-tazobactam has been shown to be associated with acute kidney injury (AKI). However, it has not been compared to cefepime in patients with septic shock.

Nonopioid medications for managing opioid withdrawal in acute care settings: A scoping review.

Purpose: There are hospitalized patients with chronic opioid use who will experience signs and symptoms of opioid withdrawal who were not on medications for opioid use disorder (OUD) prior to admission, do not want to start or are unable to start medications for OUD during admission, and want to limit or avoid the use of opioids. The purpose of this scoping review was to assess the potential effectiveness and safety of using non-opioid agents for managing acute opioid withdrawal in acute care settings.

Methods: PubMed (inception to 2024), Embase (inception to 2024), and Cochrane Library (inception to 2024) were the databases evaluated for the literature search.

Philosophical and Ethical Underpinnings of the Medical Decision-Making Process: A Focus on Patient Values and Preferences.

Current clinical practice is based on the principles of evidence-based medicine (EBM) with clinical practice guidelines (CPGs) often serving as a source of information for the medical decision-making process. There are philosophical and ethical tenets underlying this process including those pertaining to patient values and preferences. Despite their importance, these tenets may receive less attention than the empirically derived recommendations in CPGs based on the principles of EBM.

Introduction to the concept of effective albumin concentration.

Purpose: The purpose of this article is to discuss how the structural and presumably functional integrity of albumin, as described by the concept of effective albumin concentration (eAlb), has potentially important clinical implications beyond the total albumin concentration (tAlb) routinely reported by clinical laboratories.

Summary: Albumin has several functions beyond its oncotic effects, including molecule binding, substance transport, detoxification actions, and serving as an antioxidant. However, there are conformational changes that occur during or following the manufacture of albumin and during its administration to patients with various disease states, such as decompensated liver disease, that often impair these functions.

Multicenter Retrospective Review of Ketamine Use in Pediatric Intensive Care Units (Ketamine-PICU Study).

Objective: Describe continuous infusion (CI) ketamine practices in pediatric intensive care units (PICUs) and evaluate its effect on pain/sedation scores, exposure to analgesics/sedatives, and adverse effects (AEs).

Methods: Multicenter, retrospective, observational study in children <18 years who received CI ketamine between 2014 and 2017. Time spent in goal pain/sedation score range and daily cumulative doses of analgesics/sedatives were compared from the 24 hours (H) prior to CI ketamine to the first 24H and 25-48H of the CI.

Challenges with current diagnosis and treatment strategies for precipitated opioid withdrawal in the emergency department and the role of the pharmacist.

Purpose: To demonstrate the challenges with current diagnosis and treatment strategies for precipitated opioid withdrawal secondary to naloxone the emergency department (ED) setting and describe the role of the emergency medicine (EM) pharmacist in its management.

Summary: There are no standardized criteria to define precipitated opioid withdrawal syndrome, so the diagnosis is typically based on sentinel signs and symptoms and time course. Complicating factors include a positive urine toxicology screen for nonopioid substances, comorbidities and associated medications prior to admission, medications given in the ED, and a fluctuating patient course during the ED stay that likely involves all these issues.

Implications of opioid-sparing medications in critically ill patients: A scoping review.

Objective: The purpose of this scoping review was to evaluate literature involving opioid-sparing medications in critically ill patients with a focus on clinically meaningful outcomes.

Design: Scoping review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews.

Setting: Intensive care unit.

Buprenorphine in the Intensive Care Unit: Commentary on the Unanswered Questions.

The removal of the X-waiver in the Mainstreaming Addiction Treatment (MAT) Act of 2023 has substantial implications for buprenorphine prescribing as one of the options to treat opioid use disorder. The purpose of this commentary is to discuss the unanswered questions regarding buprenorphine in the intensive care unit (ICU) including how the passage of the MAT Act will affect ICU providers, which patients should receive buprenorphine, what is the most appropriate route of administration and dose of buprenorphine, what medications interact with buprenorphine, and how can transitions of care be optimized for these patients.

Accuracy of a chatbot in answering questions that patients should ask before taking a new medication.

Background: The potential uses of artificial intelligence have extended into the fields of health care delivery and education. However, challenges are associated with introducing innovative technologies into health care, particularly with respect to information quality.

Objective: This study aimed to evaluate the accuracy of answers provided by a chatbot in response to questions that patients should ask before taking a new medication.

Evaluation of a Generative Language Model Tool for Writing Examination Questions.

Objective: To describe an evaluation of a generative language model tool to write examination questions for a new elective course focused on the interpretation of common clinical laboratory results being developed as an elective for students in a Bachelor of Science in Pharmaceutical Sciences program.

Methods: A total of 100 multiple-choice questions were generated using a publicly available large language model for a course dealing with common laboratory values. Two independent evaluators with extensive training and experience in writing multiple-choice questions evaluated each question for appropriate formatting, clarity, correctness, relevancy, and difficulty.

Recommended Methods of Drug Dosing Adjustment for Patients With Renal Impairment.

Since 2020, there have been changes in Food and Drug Administration guidance and in recommendations by national organizations with a focus on kidney diseases pertaining to the choice of equations used to estimate creatinine clearance and glomerular filtration rate in patients with renal impairment. This includes a recommendation by the National Kidney Foundation to avoid the use of the Cockcroft-Gault equation for drug dosing in patients with renal impairment. This commentary provides an overview of recent recommendations concerning kidney function assessment that have important implications for drug dosing in patients with renal impairment and provides suggestions for implementing these recommendations.

Considerations and limitations of buprenorphine prescribing for opioid use disorder in the intensive care unit setting: A narrative review.

Purpose: The purpose of this review is to discuss important considerations when prescribing buprenorphine for opioid use disorder (OUD) in the intensive care unit (ICU) setting, recognizing the challenges of providing detailed recommendations in the setting of limited available evidence.

Summary: Buprenorphine is a partial mu-opioid receptor agonist that is likely to be increasingly prescribed for OUD in the ICU setting due to the relaxation of prescribing regulations. The pharmacology and pharmacokinetics of buprenorphine are complicated by the availability of several formulations that can be given by different administration routes.

Management of Critically Ill Patients Receiving Medications for Opioid Use Disorder.

Topic Importance: Critical care clinicians are likely to see an increasing number of patients admitted to the ICU who are receiving US Food and Drug Administration-approved medications for opioid use disorder (MOUDs) given the well-documented benefits of these agents. Oral methadone, multiple formulations of buprenorphine, and extended-release naltrexone are the three types of MOUD most likely to be encountered by ICU clinicians; however, these drugs vary with respect to formulations, pharmacokinetics, and adverse effects.

Review Findings: No published clinical practice guidelines or consensus statements are available to guide decision-making in patients admitted to the ICU setting who are receiving MOUDs before admission.

Navigating the Path to Careers in Academic Pharmacy Administration.

The purpose of this commentary is to discuss the qualifications, responsibilities, and keys to success for pharmacy faculty considering a department (or division) chair (head) or dean (including assistant or associate dean) position. The perspectives are those of a department chair, vice dean, and past dean of colleges of pharmacy with extensive experience in pharmacy administration. The qualifications for these administrative positions vary by institution, particularly with respect to the institution's focus on research.

Best Practice Strategies for Retaining Faculty During Times of Rapid Change.

Faculty retention is an issue of concern to schools and colleges of pharmacy. The reasons why faculty leave are multifactorial but often involve a breach of unwritten contract obligations between the faculty member and the organization. This article provides strategies for retaining faculty based on published literature that include perceived breaches of unwritten contracts and our own perspectives as departmental and university administrators and senior faculty members who have been involved in devising and implementing institutional change.

Recommendations for Assessing the Quality of Clinical Faculty Members' Journal Publications.

Evaluation of clinical faculty involves an assessment of the quality of their publications in addition to quantity (number) of publications. In contrast to assessing quantity, assessing quality is difficult. The purpose of this paper is to discuss practical considerations and provide recommendations related to quality of publications that clinical faculty members should bear in mind as part of their overall scholarship activity.

International Analgesia and Sedation Weaning and Withdrawal Practices in Critically Ill Adults: The Adult Iatrogenic Withdrawal Study in the ICU.

Objectives: Iatrogenic withdrawal syndrome (IWS) associated with opioid and sedative use for medical purposes has a reported high prevalence and associated morbidity. This study aimed to determine the prevalence, utilization, and characteristics of opioid and sedative weaning and IWS policies/protocols in the adult ICU population.

Design: International, multicenter, observational, point prevalence study.

Hepatorenal Syndrome With Acute Kidney Injury: Diagnosis and Medical Management.

Objectives: To review the current definitions and diagnostic criteria for acute kidney injury (AKI) and type 1 hepatorenal syndrome (HRS) now termed HRS-AKI and discuss the challenges in deciding the most appropriate medication regimens to treat patients with HRS-AKI.

Data Sources: PubMed (inception to April 2023) with bibliographies of retrieved articles searched for additional articles; organizational websites for clinical practice guidelines (CPGs).

Study Selection And Data Extraction: Randomized controlled trials (RCTs) evaluating albumin and vasoconstrictors for HRS-AKI.

Fixed Versus Body-Sized-Based Dosing of Monoclonal Antibodies.

Monoclonal antibody products are an increasing portion of novel drug approvals. The labeling of initial drug approvals frequently involves body-size-based rather than fixed-dose administration regimens for adults without clear rationale for doing so. This presents challenges when prescribing these products for patients with extremes of body habitus who constitute a small portion of enrollment in pre-approval investigations.

Infection risk and management strategies for patients with cirrhosis taking proton pump inhibitors.

Purpose: The purpose of this review is to discuss infectious disease-related adverse effects associated with long-term proton pump inhibitor (PPI) therapy in patients with cirrhosis and to provide recommendations for appropriate use and choice of PPI when such therapy is indicated.

Summary: Long-term PPI therapy in patients with cirrhosis increases the risk of infections, with infections in turn increasing the risk of mortality in this patient population. Expert recommendations include restricting long-term PPI use in cirrhosis to patients with appropriate gastrointestinal indications, using a PPI for the shortest possible duration and at the lowest possible dose, and avoiding PPIs with unfavorable pharmacogenetic properties.

Medication dosing in adult patients with reduced lean body mass and kidney injury: A focus on cystatin C.

Purpose: Creatinine-based estimates of glomerular filtration rate (GFR) have been the standard for classifying kidney function and guiding drug dosing for over 5 decades. There have been many efforts to compare and improve different methods to estimate GFR. The National Kidney Foundation recently updated the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations without race for creatinine (CKD-EPIcr_R) and creatinine and cystatin C (CKD-EPIcr-cys_R), and the 2012 CKD-EPI equation based on cystatin C (CKD-EPIcys) remains.