A consumer-led intervention to improve pharmacists' attitudes toward mental illness.

Introduction: Individuals with a severe and persistent mental illness often manage complex medication regimens and would benefit from support and education from their pharmacist. Past research has shown that community pharmacists have negative attitudes toward mental illnesses, and these attitudes affect willingness to provide services to patients with mental illnesses. Consumer-led interventions have shown benefit to improve student attitudes toward mental illness.

Adapting the ABCDEF Bundle to Meet the Needs of Patients Requiring Prolonged Mechanical Ventilation in the Long-Term Acute Care Hospital Setting: Historical Perspectives and Practical Implications.

When robust clinical trials are lacking, clinicians are often forced to extrapolate safe and effective evidence-based interventions from one patient care setting to another. This article is about such an extrapolation from the intensive care unit (ICU) to the long-term acute care hospital (LTACH) setting. Chronic critical illness is an emerging, disabling, costly, and yet relatively silent epidemic that is central to both of these settings.

Clinical Operations Variables are Associated With Blood Pressure Outcomes.

Background: Uncontrolled blood pressure (BP), among patients diagnosed and treated for the condition, remains an important clinical challenge; aspects of clinical operations could potentially be adjusted if they were associated with better outcomes.

Objectives: To assess clinical operations factors' effects on normalization of uncontrolled BP.

Research Design: Observational cohort study.

An evaluation of multiple phenotypic screening methods for Klebsiella pneumoniae carbapenemase (KPC)-producing Enterobacteriaceae.

Klebsiella pneumoniae carbapenemase (KPC)-producing Enterobacteriaceae may display MICs to carbapenems within susceptible or intermediate ranges, prompting confirmatory testing. Four phenotypic methods to detect KPC producers were evaluated against a collection of clinical Enterobacteriaceae isolates. Meropenem-phenylboronic acid double disk synergy testing demonstrated the best performance with 100% sensitivity and specificity.

The spectrum of statin therapy in cancer patients: is there a need for further investigation?

Although our understanding of the relationship between cancer and statin use continues to improve, it remains a complex association requiring further research focusing on both biologic and clinical end points in a wide range of patient populations. To date, most of the published results are from observational studies detailing the risk of incident cancers or from randomized controlled trials with cardiovascular primary end points and cancer only as a secondary end point. Although there is certainly great value in the information obtained from observational studies, they cannot prove a causal link between statins and cancer, and it would then seem appropriate to design and implement clinical trials.

A virtual patient software program to improve pharmacy student learning in a comprehensive disease management course.

Objective: To implement and assess the impact of a virtual patient pilot program on pharmacy students' clinical competence skills.

Design: Pharmacy students completed interactive software-based patient case scenarios embedded with drug-therapy problems as part of a course requirement at the end of their third year.

Assessment: Assessments included drug-therapy problem competency achievement, performance on a pretest and posttest, and pilot evaluation survey instrument.

Agitation during prolonged mechanical ventilation at a long-term acute care hospital: risk factors, treatments, and outcomes.

Introduction: The prevalence, risk factors, treatment practices, and outcomes of agitation in patients undergoing prolonged mechanical ventilation (PMV) in the long-term acute care hospital (LTACH) setting are not well understood. We compared agitation risk factors, management strategies, and outcomes between patients who developed agitation and those who did not, in LTACH patients undergoing PMV.

Methods: Patients admitted to an LTACH for PMV over a 1-year period were categorized into agitated and nonagitated groups.

Optimising the recognition of delirium in the intensive care unit.

Delirium affects up to 80% of critically ill patients and negatively influences patient outcome. Consensus guidelines advocate that a validated screening tool like the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) or the Intensive Care Delirium Screening Checklist (ICDSC) be used to identify delirium rather than a subjective approach. The CAM-ICU and ICDSC have the most rigorous psychometric data to support their use.

Pharmacologic prevention and treatment of delirium in critically ill and non-critically ill hospitalised patients: a review of data from prospective, randomised studies.

Delirium occurs commonly in acutely ill hospitalised patients, particularly in the elderly or in cardiac or orthopaedic surgery patients, or those in intensive care units (ICUs). Delirium worsens outcome. Pharmaceutical agents such as antipsychotics and, in the critically ill, dexmedetomidine, are considered therapeutic despite uncertainty regarding their efficacy and safety.

Teaching medication adherence in US colleges and schools of pharmacy.

Objective: To determine and describe the nature and extent of medication adherence education in US colleges and schools of pharmacy.

Methods: A mixed-methods research study was conducted that included a national survey of pharmacy faculty members, a national survey of pharmacy students, and phone interviews of 3 faculty members and 6 preceptors.

Results: The majority of faculty members and students agreed that background concepts in medication adherence are well covered in pharmacy curricula.

Follow-up assessment of a faculty peer observation and evaluation program.

Objective: To assess a previously described peer observation and evaluation program 2 years after implementation.

Methods: An pre-implementation survey assessed faculty needs and attitudes related to peer evaluation. Two years after implementation, the survey was repeated and additional questions asked regarding adherence to peer observation and evaluation policies and procedures, feedback received, and impact on teaching.

Pharmacology of commonly used analgesics and sedatives in the ICU: benzodiazepines, propofol, and opioids.

The ideal sedative or analgesic agent should have a rapid onset of activity, a rapid recovery after drug discontinuation, a predictable dose response, a lack of drug accumulation,and no toxicity. Unfortunately, none of the earlier analgesics, the benzodiazepines,or propofol share all of these characteristics. Patients who are critically ill experience numerous physiologic derangements and commonly require high doses and long durations of analgesic and sedative therapy.

Impact of quetiapine on resolution of individual delirium symptoms in critically ill patients with delirium: a post-hoc analysis of a double-blind, randomized, placebo-controlled study.

Introduction: We hypothesized that delirium symptoms may respond differently to antipsychotic therapy. The purpose of this paper was to retrospectively compare duration and time to first resolution of individual delirium symptoms from the database of a randomized, double-blind, placebo-controlled study comparing quetiapine (Q) or placebo (P), both with haloperidol rescue, for critically ill patients with delirium.

Methods: Data for 10 delirium symptoms from the eight-domain, intensive care delirium screening checklist (ICDSC) previously collected every 12 hours were extracted for 29 study patients.

Antipsychotics for the prevention and treatment of delirium in the intensive care unit: what is their role?

Delirium affects up to 80% of critically ill patients, worsens outcomes, and is frequently treated with antipsychotics despite uncertainty regarding their efficacy and safety. We identified published, English-language, randomized, controlled studies evaluating antipsychotics in ICU patients either with delirium or at risk for developing delirium. In 105 mechanically ventilated patients, the number of days spent alive without delirium or coma was similar between haloperidol (median, 14.

Patterns of antihypertensive treatment in patients with acute severe hypertension from a nonneurologic cause: Studying the Treatment of Acute Hypertension (STAT) registry.

Study Objective: To assess antihypertensive treatment practices and outcomes for patients with acute severe hypertension requiring hospitalization.

Design: Subanalysis of a multicenter, observational, cross-sectional study.

Data Source: The STAT registry (data from 25 hospitals).

Pharmacy student knowledge and communication of medication errors.

Objectives: To describe and evaluate pharmacy students' knowledge of and comfort in communicating, managing, and preventing medication errors.

Methods: Using a cross-sectional design, a survey instrument was administered to fifth-year pharmacy students. The survey instrument included both open- and close-ended questions to describe and examine factors associated with knowledge and comfort in communication of medication errors.

School-wide clinical intervention system to document pharmacy students' impact on patient care.

Objectives: To implement and evaluate a school wide, Web-based clinical intervention system to document types and impact of pharmacy students' clinical activities during advanced pharmacy practice experiences (APPEs).

Methods: A clinical intervention form was developed by pharmacy practice faculty consensus and uploaded to a secure Web site. Prior to APPEs, all pharmacy students were trained on the purpose and use of the system as well as strategies to document interventions appropriately.

Nonmedical use of prescription stimulants and depressed mood among college students: frequency and routes of administration.

Studies demonstrate associations between nonmedical use of prescription stimulants (NMUPS) and depressed mood; however, relevance of NMUPS route of administration and frequency of use have not been examined. We hypothesized frequent NMUPS and nonoral routes would be significantly associated with depressed mood. A Web survey was self-administered by a probability sample of 3,639 undergraduate students at a large U.

Adherence: a review of education, research, practice, and policy in the United States.

Objective: To describe the education, research, practice, and policy related to pharmacist interventions to improve medication adherence in community settings in the United States.

Methods: Authors used MEDLINE and International Pharmaceutical Abstracts (since 1990) to identify community and ambulatory pharmacy intervention studies which aimed to improve medication adherence. The authors also searched the primary literature using Ovid to identify studies related to the pharmacy teaching of medication adherence.

Efficacy and safety of quetiapine in critically ill patients with delirium: a prospective, multicenter, randomized, double-blind, placebo-controlled pilot study.

Objective: To compare the efficacy and safety of scheduled quetiapine to placebo for the treatment of delirium in critically ill patients requiring as-needed haloperidol.

Design: Prospective, randomized, double-blind, placebo-controlled study.

Setting: Three academic medical centers.

Romiplostim in chronic immune thrombocytopenic purpura.

Background: Immune thrombocytopenic purpura (ITP) is characterized by platelet deficiency due to platelet destruction and/or inadequate production. Initial therapy consists of corticosteroids or intravenous immunoglobulin (IVIg). Patients with chronic refractory disease might undergo splenectomy.

Physicians' pain management confidence versus competence.

Objective: To assess awareness of existing pain management guidelines and compare physicians' confidence versus competence in selected pain management skills.

Design: Prospective survey study.

Setting: A large urban tertiary medical center.