A Retrospective Study of Dexamethasone, Remdesivir, and Baricitinib in Severe COVID-19.

Purpose: RECOVERY, ACTT-1, and ACTT-2 trials have demonstrated that utilization of dexamethasone, remdesivir, or a combination of remdesivir with baricitinib leads to mortality benefit and faster time to recovery, respectively. However, no studies have investigated the benefit of triple therapy of dexamethasone, remdesivir, and baricitinib. We investigate the benefits of triple therapy compared to dual therapy of dexamethasone with remdesivir in patients with severe COVID-19 on HFNC.

COVID-19 pneumonia: What APRNs should know.

COVID-19-associated pneumonia is a complex acute care diagnosis that requires careful evaluation and management. This article includes pertinent recommendations for management of acutely ill patients with COVID-19 pneumonia.

Implementation and evaluation of a virtual learning advanced pharmacy practice experience.

Background And Purpose: The novel severe acute respiratory syndrome coronavirus 2 restricted student involvement in direct patient care. Virtual learning is an effective education strategy in pharmacy curriculums. This study aimed to evaluate student perceptions of virtual learning advanced pharmacy practice experiences (APPE) utilizing an electronic 12-question survey.

Descriptive analysis of the unwarranted continuation of antipsychotics for the management of ICU delirium during transitions of care: A multicenter evaluation across New Jersey.

Purpose: Nearly half of intensive care unit (ICU) patients will develop delirium. Antipsychotics are used routinely for the management of ICU delirium despite limited reliable data supporting this approach. The unwarranted continuation of antipsychotics initiated for ICU delirium is an emerging transitions of care concern, especially considering the adverse event profile of these agents.

Impact of a Nurse-Driven Opioid Titration Protocol on Quality of Orders at End of Life.

At our community teaching hospital, orders for end of life often lacked instructions to titrate opioids based on evidence-based principles and failed to address nonpain symptoms. An order set and a nursing-driven opioid titration protocol were implemented in August 2016 after extensive education. The purpose of this retrospective preintervention and postintervention study was to evaluate the impact of this intervention on the quality of end-of-life orders.

Integrating high fidelity patient simulation into a skills-based doctor of pharmacy curriculum: A literature review with focus on the bedrock pilot course.

Introduction: Simulation-based teaching is an effective instructional strategy gaining momentum in pharmacy education but remains variable across programs. This is the first known report depicting the development of a multifaceted, integrated simulation program during concurrent initiation of a new skills-based pharmacy curriculum.

Methods: A significant infrastructure expansion created simulation areas whose availability corresponded with the initiation of a new skills-based curriculum.

Esmolol Use in Dual Axis Defibrillation Resistant Ventricular Fibrillation.

Cardiac arrest in an event of acute myocardial infarction most commonly results in life-threatening ventricular tachycardia or ventricular fibrillation (VF). Patients who remain in VF despite optimal epinephrine, amiodarone, and three or more attempts at 200 joules of biphasic current defibrillation are known to be in an electrical storm. Here, we describe a case of defibrillation refractory VF responding to intravenous esmolol resulting in a successful return of spontaneous circulation.

Cerebellar Haemorrhage Leading to Sudden Cardiac Arrest.

Introduction: Intracranial haemorrhage (ICH) is a known, but a rare cause of out of hospital cardiac arrest (OHCA). It results in the development of non-shockable rhythms such as asystole or pulseless electrical activity (PEA).

Case Report: A 77- years old male had an OHCA without any prodrome.

Prospective Observational Evaluation of Sedation and Pain Management Guideline Adherence Across New Jersey Intensive Care Units.

Background: The practice guidelines for the management of pain, agitation, and delirium (PAD) from the Society of Critical Care Medicine shifted from primarily focusing on the treatment of anxiety in 2002 to the treatment of pain in 2013.

Objective: This prospective, observational, multicenter study aimed to assess the degree of practice adherence to the PAD guidelines for ventilated patients in New Jersey intensive care units (ICUs).

Methods: Pharmacist investigators at 8 centers designated 4 days at least 10 days apart to evaluate all patients on mechanical ventilation.

Significant Bradycardia in Critically Ill Patients Receiving Dexmedetomidine and Fentanyl.

Purpose: To report a case series of three patients who developed significant bradycardia while receiving the combination of dexmedetomidine and fentanyl for sedation and analgesia.

Materials And Methods: This is a case series of patients obtained from a mixed medical, surgical, and cardiac ICU in a community teaching hospital. Three intubated patients receiving fentanyl and dexmedetomidine infusion developed sudden bradycardia requiring intervention.

Direct Thrombin Inhibitor Resistance and Possible Mechanisms.

To report 3 cases in which doses of bivalirudin higher than commonly used in clinical practice were required in order to achieve therapeutic anticoagulation as monitored by the activated partial thromboplastin time (aPTT). The medical records of 3 patients who required large doses of bivalirudin to remain therapeutic were thoroughly reviewed. In all 3 patients, bivalirudin was initiated at a rate appropriate for the patients' renal function and titrated using a nurse-driven protocol with recommended dose adjustments based on aPTT.

Efficacy of Intravenous Chlorothiazide for Refractory Acute Decompensated Heart Failure Unresponsive to Adjunct Metolazone.

Study Objective: To assess the efficacy of intravenous chlorothiazide in patients with acute decompensated heart failure (ADHF) who were determined to be loop diuretic resistant and refractory to metolazone.

Design: Retrospective cohort study with patients serving as their own controls.

Setting: Large, academic, tertiary care hospital.