PHarmacist Avoidance or Reductions in Medical Costs in CRITically Ill Adults: PHARM-CRIT Study.

Unlabelled: To comprehensively classify interventions performed by ICU clinical pharmacists and quantify cost avoidance generated through their accepted interventions.

Design: A multicenter, prospective, observational study was performed between August 2018 and January 2019.

Setting: Community hospitals and academic medical centers in the United States.

PHarmacist Avoidance or Reductions in Medical Costs in Patients Presenting the EMergency Department: PHARM-EM Study.

Unlabelled: To comprehensively classify interventions performed by emergency medicine clinical pharmacists and quantify cost avoidance generated through their accepted interventions.

Design: A multicenter, prospective, observational study was performed between August 2018 and January 2019.

Setting: Community and academic hospitals in the United States.

Four-factor Prothrombin Complex Concentrate for Reversal of Factor Xa Inhibitors versus Warfarin in Life-threatening Bleeding.

Introduction: Factor Xa (fXa) inhibitor reversal for life-threatening bleeding is controversial due to a lack of high-quality evidence. The purpose of this study was to determine the hemostatic efficacy of four-factor prothrombin complex concentrate (4F-PCC) for the reversal of fXa inhibitors compared to warfarin for life-threatening bleeding.

Methods: This was a multicenter, retrospective cohort study at two academic medical centers between January 1, 2014-December 31, 2019, which included patients who presented to the emergency department with a life-threatening bleed necessitating anticoagulation reversal with 4F-PCC.

Vancomycin Dosing Practices among Critical Care Pharmacists: A Survey of Society of Critical Care Medicine Pharmacists.

Introduction: Critically ill patients and their pharmacokinetics present complexities often not considered by consensus guidelines from the American Society of Health-System Pharmacists, the Infectious Diseases Society of America, and the Society of Infectious Diseases Pharmacists. Prior surveys have suggested discordance between certain guideline recommendations and reported infectious disease pharmacist practice. Vancomycin dosing practices, including institutional considerations, have not previously been well described in the critically ill patient population.

Evaluating the Risk of Developing Thrombocytopenia Within Five Days of Continuous Renal Replacement Therapy Initiation in Septic Patients.

Background: The differential diagnosis for thrombocytopenia in critical illness is often extensive. This study was performed to determine the incidence of thrombocytopenia in septic patients undergoing continuous renal replacement therapy (CRRT) versus those not undergoing CRRT.

Objective: The primary outcome of this study was to compare the development of thrombocytopenia, defined as a platelet count ≤ 100 × 10/mm, in septic patients within 5 days of time zero.

Evaluation of Vasopressor Exposure and Mortality in Patients With Septic Shock.

Objectives: The objectives of this study were to: 1) determine the association between vasopressor dosing intensity during the first 6 hours and first 24 hours after the onset of septic shock and 30-day in-hospital mortality; 2) determine whether the effect of vasopressor dosing intensity varies by fluid resuscitation volume; and 3) determine whether the effect of vasopressor dosing intensity varies by dosing titration pattern.

Design: Multicenter prospective cohort study between September 2017 and February 2018. Vasopressor dosing intensity was defined as the total vasopressor dose infused across all vasopressors in norepinephrine equivalents.

International Survey of Thrombolytic Use for Treatment of Cardiac Arrest Due to Massive Pulmonary Embolism.

Objectives: This survey sought to characterize the national prescribing patterns and barriers to the use of thrombolytic agents in the treatment of pulmonary embolism, with a specific focus on treatment during actual or imminent cardiac arrest.

Design: A 19-question international, cross-sectional survey on thrombolytic use in pulmonary embolism was developed, validated, and administered. A multivariable logistic regression was conducted to determine factors predictive of utilization of thrombolytics in the setting of cardiac arrest secondary to pulmonary embolism.

Short Versus Extended Duration Vancomycin and Piperacillin/Tazobactam and the Incidence of Acute Kidney Injury in Noncritically Ill Patients.

Background: Vancomycin plus piperacillin-tazobactam (VPT) is a commonly used empiric combination of antimicrobials. Recently, studies have demonstrated an increase in acute kidney injury (AKI) associated with combination therapy of VPT. However, the majority of studies required patients to be on VPT for a minimum of 48 to 72 hours to be considered for inclusion and had extended treatment durations longer than most empiric, short course regimens.

Characterization of clinical knowledge and problem-solving assessments employed in postgraduate year 1 pharmacy residency interviews.

Purpose: Attainment of postgraduate year 1 (PGY1) residency positions has become increasingly competitive. Inclusion of clinical knowledge and problem-solving assessments in onsite interviews has increased in recent years. Characterization of these assessments is necessary for applicants to best prepare for interviews and for mentors to provide guidance.

Effect of Cefepime on Neurotoxicity Development in Critically Ill Adults With Renal Dysfunction.

Background: Pharmacodynamic and pathophysiologic changes in critically ill adults receiving cefepime may increase the risk of adverse events.

Research Question: What is the impact of cefepime exposure on neurotoxicity development in critically ill adults with renal dysfunction?

Study Design And Methods: Critically ill adults with creatinine clearance < 60 mL/min who received cefepime for ≥ 48 hours between January 1, 2014 and July 31, 2018 were evaluated for cefepime-associated neurotoxicity (CAN) development. Higher- and lower-dose cefepime exposure groups stratified by moderate (≥ 8 g vs < 8 g in first 48 hours) or severe (≥ 4 g vs < 4 g in first 48 hours) renal dysfunction were compared.

The effect of grit on postgraduate year-one pharmacy residents' pursuit of additional training.

Introduction: Although much is known about the perceived motivating factors and barriers to individuals pursuing postgraduate year-one (PGY1) residency training, determinants for pursuit of further training after PGY1 are unclear.

Methods: Residents at accredited programs were surveyed regarding grit, residency program and resident characteristics, and pursuit of additional post-graduate training (PGT) intentions and behaviors. Two respondent groups were developed: Pursued Additional PGT and Did Not Pursue Additional PGT.

Narrative Review of Controversies Involving Vasopressin Use in Septic Shock and Practical Considerations.

To summarize literature evaluating vasopressin use, focusing on clinical controversies regarding initiation, dosing, and discontinuation and interaction of vasopressin with other therapies in septic shock patients. : A PubMed English-language literature search (January 2008 to December 2019) was performed using these terms: , and . Citations, including controlled trials, observational studies, review articles, guidelines, and consensus statements, were reviewed.

Professional Benefits of a Web-based Journal Club for Critical Care Residents and Their Mentors.

To identify the perceptions and benefits of participation in a web-based journal club by the critical care pharmacy residents who presented and their mentors. Former and current resident presenters and their mentors were invited to complete one of three electronic surveys created to assess their perceptions of their experiences with a web-based journal club sponsored by the Clinical Pharmacy and Pharmacology (CPP) Section of the Society of Critical Care Medicine (SCCM). Descriptive statistics were used to analyze the data gathered.

Balanced Crystalloids Versus Saline in Critically Ill Adults: A Systematic Review and Meta-analysis.

The optimal resuscitative fluid remains controversial. To assess the association between crystalloid fluid and outcomes in critically ill adults. Methods: Cumulative Index to Nursing and Allied Health Literature, Scopus, PubMed, and Cochrane Central Register for Controlled Trials were searched from inception through July 2019.

A Case Report of Hypertensive Emergency and Intracranial Hemorrhage Due to Intracavernosal Phenylephrine.

Intracavernosal injection of phenylephrine is a commonly used therapy for ischemic priapism and is typically well tolerated with few severe adverse side effects. We report a case of intracranial hemorrhage related to hypertensive emergency due to intracavernosal phenylephrine. A 43-year-old Caucasian man with history of hypertension, diabetes mellitus type I, end-stage renal disease status post a combination kidney-pancreas transplant, and recurrent idiopathic priapism presented to emergency department with an episode of priapism.

Perceptions regarding vasopressin use and practices in septic shock, and cost containment strategies.

Background: Clinician preferences and practices regarding appropriate vasopressin use in light of its increased acquisition cost secondary to rebranding has not been evaluated or described since the most recent iteration of the Surviving Sepsis Campaign Guideline was published.

Objective: To assess vasopressin cost containment initiatives and pharmacists' opinions regarding appropriate vasopressin use.

Methods: A scenario-based survey was distributed to critical care and emergency medicine pharmacists.

Major publications in critical care pharmacotherapy literature in 2018.

Purpose: To summarize selected original critical care pharmacotherapy research published in 2018.

Materials And Methods: The Critical Care Pharmacotherapy Literature Update (CCPLU) Group screened 32 journals monthly for impactful articles and reviewed 100 articles during 2018. Grading of Recommendations, Assessment, Development and Evaluations (GRADE) criteria were applied to all relevant articles included in the monthly CCPLU.

Midodrine as an Adjuvant to Intravenous Vasopressor Agents in Adults With Resolving Shock: Systematic Review and Meta-Analysis.

Purpose: To evaluate the effects of midodrine in addition to intravenous vasopressor therapy on outcomes in adults recovering from shock.

Materials And Methods: PubMed, Scopus, Clinicaltrials.gov, and published abstracts were searched from inception to November 2018 for studies comparing outcomes in shock after midodrine initiation versus no midodrine.

Critical Care PGY-2 Graduate Perceptions and Practices Regarding Residency Project Publication.

To characterize the practices and perceptions of recent post-graduate year 2 (PGY2) critical care pharmacy (CCP) residents surrounding the completion and publication of their primary research project. Potential factors and perceptions influencing primary research project publication success were identified and incorporated in a validated electronic survey distributed to 2011 and 2012 PGY2 CCP residency program graduates. Among the 94/124 (76%) respondents, 26% had published their research project (67% were first authors; 50% were successful on first submission), while 36% still planned to pursue publication, and 38% had no plans for their manuscript.

Norepinephrine and Vasopressin Compared With Norepinephrine and Epinephrine in Adults With Septic Shock.

The optimal adjuvant vasopressor to norepinephrine in septic shock remains controversial. To compare durations of shock-free survival between adjuvant vasopressin and epinephrine. A retrospective, single-center, matched cohort study of adults with septic shock refractory to norepinephrine was conducted.

Spirituality and Religiosity of Pharmacy Students.

To characterize the religiosity and spirituality of final year pharmacy students and examine the impact on performance in pharmacy school and future practice. An electronic survey was sent to 308 students in their final year of pharmacy school at four universities (two private and two public institutions). There were 141 respondents to the survey for a response rate of 46%.