Pharmacy residents' preparedness for the emotional challenges of patient care.

Purpose: Results of a survey to determine levels of pharmacy resident exposure to and preparedness for emotionally unsettling clinical scenarios are presented.

Methods: A pretested electronic survey was distributed to 1501 U.S.

Vancomycin clearance in high-volume venovenous hemofiltration.

Objective: To report the pharmacokinetic and pharmacodynamic properties of vancomycin in 4 patients undergoing high-volume continuous venovenous hemofiltration (CVVH).

Case Summary: Data from 4 patients prescribed high-volume CVVH for acute renal failure treated with vancomycin were analyzed. Vancomycin plasma concentrations were measured 4 and 24 hours after the end of a 1-hour vancomycin infusion.

Preventing the harm of a closer look: contrast-induced nephropathy in adults.

Contrast media is administered to many patients in hospitals nationwide. Although the use of contrast and dyes is widespread and has a well accepted use among the medical profession, contrast-induced nephropathy can be a common and potentially harmful complication. Identifying patients at risk, attempting to minimize risk, and using preventative strategies should be priorities to decrease the harmful effects that are associated with the administration of contrast media.

Current controversies in critical illness-related corticosteroid insufficiency and glucocorticoid supplementation.

The stress response, which is triggered by a number of factors, including surgery, results in activation of the hypothalamic pituitary adrenal axis and subsequent release of cortisol from the adrenal glands. Critical illness-related corticosteroid insufficiency is an inadequate corticosteroid response relative to a patient's illness; patients with critical illness-related corticosteroid insufficiency have both insufficient circulating cortisol and impaired cellular use of glucocorticoids. Corticosteroids, such as hydrocortisone, have been cited to improve survival, oxygenation, duration of mechanical ventilation, and intensive care unit-free days in critically ill patients.

Interrater variability of a severity-of-illness score in critically ill adults.

Background: Critically ill patients often require sedation and analgesia. Scales have been developed to provide clinicians with sedation targets. Daily interruption of continuous infusions of sedatives and sedation protocols improve patients' outcomes.

Recombinant human erythropoietin therapy in critically ill Jehovah's Witnesses.

Blood transfusions and blood products are often given as a life-saving measure in patients with critical illness. However, some patients, such as Jehovah's Witnesses, may refuse their administration due to religious beliefs. Jehovah's Witnesses accept most available medical treatments, but not blood transfusions or blood products due to their religion's interpretation of several passages from the Bible.

Effects of a pharmacist-to-dose computerized request on promptness of antimicrobial therapy.

Objectives: To examine the effects of computerized requests for pharmacist-to-dose (PTD), an advanced clinical decision support tool for dosing guidance, on antimicrobial therapy with vancomycin and aminoglycosides, describe PTD request utilization, and identify factors that may prolong this process.

Design: A retrospective review was conducted of patients hospitalized from Jan 2004 to Jun 2006 with suspected pneumonia who received vancomycin, tobramycin, or gentamicin via PTD (study) or routine provider order entry (control).

Measurements: The primary endpoint was time to pharmacist completion of PTD request.

Delirium dilemma.

With understanding of diagnostic criteria as well as predisposing and precipitating factors, clinicians can impact the morbidity and mortality of delirium.

Pharmacy resident participation in cardiopulmonary resuscitation events.

Purpose: An electronically administered cross-sectional survey was conducted to establish the rate of pharmacy resident participation in cardiopulmonary resuscitation (CPR) events at pharmacy residency programs throughout the United States and Puerto Rico.

Methods: A 46-item questionnaire was developed and sent by e-mail to pharmacy residency program directors. The recipients were given one month to complete the survey.

Supplemental glucocorticoid therapy.

Supplemental glucocorticoid therapy is a topic widely debated in the medical field. Patients present with various signs, symptoms and etiologies making diagnosis of the condition elusive. There is wide inter-patient variability in cortisol response during stress so defining normal response concentrations of cortisol is difficult.

Pharmacokinetic alterations in obesity.

Although some medications have established dosing adjustments for obesity (Table 2), it remains unknown for the majority of medications if dosing adjustment is warranted. It is important to remember dosage adjustments may not be as simple as doubling an antibiotic dose because a patient is morbidly obese. Individualizing drug dosing is imperative in the obese, postoperative patient to ensure they simultaneously have therapeutic serum concentrations without drug toxicity.

Rhabdomyolysis during therapy with daptomycin.

The use of daptomycin has been associated with an elevation in creatine phosphokinase level, with a reported incidence of 2.8% in phase III clinical trials. Published case reports have documented the presence of myopathy in patients who received daptomycin; however, there have been no previously reported cases of rhabdomyolysis in animals or humans to date.

Changing the paradigm for transfusing the anemic patient in an acute care environment.

Blood is a precious and vital resource in medicine. Its importance in maintaining human life is second only to the oxygen it transports. Nearly 300,000 blood product transfusions occurred in Kentucky last year.

Prolonged cardiac repolarization after tacrolimus and haloperidol administration in the critically ill patient.

A 42-year-old woman who underwent single lung transplantation who received tacrolimus and a 58-year-old woman with pneumonia and multiple comorbidities who received haloperidol both experienced drug-induced prolongation of cardiac repolarization. The second woman also developed torsade de pointes. Critically ill patients are particularly susceptible to developing torsade de pointes due to various comorbidities, electrolyte disturbances, and receipt of numerous drugs.