A drug interactions elective course.

Objectives: To evaluate the impact of a drug interactions elective course on student knowledge and skills.

Design: A drug interactions elective which focused on assessment and application of drug interaction information and identification and management of commonly encountered drug interactions by therapeutic category was offered to third-year PharmD students. Students were expected to (1) determine whether a given interaction was clinically significant or required pharmacist intervention, and (2) make rational, scientifically sound, practical recommendations for management of drug interactions.

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

Opioids, benzodiazepines, and propofol remain the mainstay by which to optimize patient comfort and facilitate mechanical ventilation in patients who are critically ill. Unfortunately none of these agents share all of the characteristics of the ideal sedative or analgesic agent: rapid onset, rapid recovery, a predictable dose response, a lack of drug accumulation, and no toxicity. To optimize care, critical care clinicians should be familiar with the many pharmacokinetic, pharmacodynamic, and pharmacogenetic variables that can affect the safety and efficacy of these sedatives and analgesics.

A Nutrition Journal and Diabetes Shopping Experience to improve pharmacy students' empathy and cultural competence.

Objectives: To implement and assess the effectiveness of an exercise designed to develop pharmacy students' empathy toward patients regarding diabetes and obesity and encourage cultural and "economic" competence.

Design: Students in the Nutrition Journal and Diabetes Shopping Experience attended a nutrition and weight management lecture, monitored their own nutritional intake by maintaining an online nutrition and exercise journal, and grocery shopped based on an assigned patient scenario. Scenarios varied in terms of income, ethnicity, insurance coverage, family size, grocery store, and medication lists.

The impact of a standardized patient program on student learning of communication skills.

Objective: Determine the quantitative and qualitative value of a lecture-laboratory course with standardized patients on student communication skills.

Methods: A blinded retrospective analysis was conducted on the counseling tapes of 127 students who took a lecture-laboratory course with standardized patients. A Communication Skills Assessment Form (CSAF) was used to evaluate baseline, midpoint and final tapes.

Development of a peer teaching-assessment program and a peer observation and evaluation tool.

Objectives: To develop a formalized, comprehensive, peer-driven teaching assessment program and a valid and reliable assessment tool.

Methods: A volunteer taskforce was formed and a peer-assessment program was developed using a multistep, sequential approach and the Peer Observation and Evaluation Tool (POET). A pilot study was conducted to evaluate the efficiency and practicality of the process and to establish interrater reliability of the tool.

Assessment of delirium in the intensive care unit: nursing practices and perceptions.

Background: Despite practice guidelines promoting delirium assessment in intensive care, few data exist regarding current delirium assessment practices among nurses and how these practices compare with those for sedation assessment.

Objectives: To identify current practices and perceptions of intensive care nurses regarding delirium assessment and to compare practices for assessing delirium with practices for assessing sedation.

Methods: A paper/Web-based survey was administered to 601 staff nurses working in 16 intensive care units at 5 acute care hospitals with sedation guidelines specifying delirium assessment in the Boston, Massachusetts area.

Predictors of mortality in patients with suspected propofol infusion syndrome.

Objectives: To identify predictors of mortality in patients with suspected propofol infusion syndrome and to develop a simple scoring system to identify patients with suspected propofol infusion syndrome who are most at risk of death.

Design: Retrospective, database analysis.

Setting: MEDWATCH system.

The pharmacology of oversedation in mechanically ventilated adults.

Purpose Of Review: To review pharmacological-related factors that affect the incidence of oversedation in mechanically ventilated adults.

Recent Findings: Recent epidemiologic studies have identified a high frequency of oversedation in the ICU that is attributable, in part, to a number of pharmacokinetic, pharmacogenetic, and pharmacodynamic factors. New evidence suggests that the administration of benzodiazepines, even when dosed intermittently, will lead to more oversedation than either propofol or dexmedetomidine and is associated with greater healthcare costs.

Impact of an institution-specific hospital-acquired pneumonia protocol on the appropriateness of antibiotic therapy and patient outcomes.

Study Objective: To evaluate the impact of a hospital-acquired pneumonia (HAP) protocol on appropriateness of empiric antibiotic therapy, antibiotic deescalation, antibiotic duration, patient mortality, and length of stay.

Design: Before- and after-study of protocol implementation.

Setting: A 450-bed, academic medical center.

Nonbloody, red stools from coadministration of cefdinir and iron-supplemented infant formulas.

Cefdinir is an extended-spectrum, third-generation cephalosporin that may be used for treatment of acute otitis media in patients allergic to penicillin. When administered with iron-containing products, including infant formulas, cefdinir or one of its metabolites may bind to ferric ions, forming a nonabsorbable complex that imparts a reddish color to the stool. We describe a 9-month-old infant with failure to thrive and acute otitis media who developed an erythematous maculopapular rash during treatment with amoxicillin-clavulanate.

Improving glycemic control in medical inpatients: a pilot study.

Background: Inpatient hyperglycemia is associated with poor patient outcomes. Current guidelines recommend that in an inpatient non-ICU setting there be treatment to achieve a glucose level below 180 mg/dL.

Methods: Objectives of this prospective quality-improvement pilot study were to implement a subcutaneous insulin protocol on a general medicine service, to identify barriers to implementation, and to determine the effect of this protocol on glycemic control.

Use of a validated delirium assessment tool improves the ability of physicians to identify delirium in medical intensive care unit patients.

Objective: Although medical intensive care unit nurses at our institution routinely use the Intensive Care Delirium Screening Checklist (ICDSC) to identify delirium, physicians rely on traditional diagnostic methods. We sought to measure the effect of physicians' use of the ICDSC on their ability to detect delirium.

Design: Before-after study.

Traditional management of chronic stable angina.

The clinical syndrome of chronic stable angina is an age-related condition that is one common manifestation of coronary artery disease (CAD). The presence of angina significantly affects quality of life when patients must limit their activities of daily living in an effort to prevent the occurrence of anginal attacks. In addition, patients are at risk for significant complications of CAD such as myocardial infarction, heart failure, stroke, and death.

Survey of sedation practices during noninvasive positive-pressure ventilation to treat acute respiratory failure.

Objectives: Noninvasive positive-pressure ventilation (NPPV) is increasingly used in patients with acute respiratory failure, but few data exist regarding current sedation practices during NPPV. We sought to characterize current practices and attitudes regarding sedation during NPPV.

Design: Cross-sectional Web-based survey.

Delirium assessment in the critically ill.

Objective: To compare available instruments for assessing delirium in critically ill adults that have undergone validity testing and provide clinicians with strategies to incorporate these instruments into clinical practice.

Design: Medline (1966-September 2006) was searched using the key words: delirium, cognitive dysfunction, assessment, intensive care unit, and critical illness to identify assessment tools that have been used to evaluate delirium in critically ill adults. A special emphasis was placed on delirium assessment tools that have been properly validated.

Development of progressive oral presentations in a therapeutics course series.

Objectives: To develop and implement a series of progressive evidence-based, oral presentation activities within the therapeutics series to strengthen interprofessional oral communication and literature evaluation skills.

Design: A step-wise progression of oral presentations was created to establish interprofessional communication skills and reinforce such skills in successive modules. Students progressed from a basic oral presentation to a brief clinical trial presentation, followed by a full journal club, culminating with a therapeutic debate.

Gefitinib: an adverse effects profile.

Gefitinib, an epidermal growth factor receptor inhibitor, is currently approved for use in patients with advanced non-small cell lung cancer who have failed previous chemotherapy or who are not suitable for chemotherapy in > 30 countries. The approved dose in patients with non-small cell lung cancer is 250 mg/day. The most common adverse effects are rash, diarrhoea, acne, dry skin, nausea and vomiting.

NXY-059: review of neuroprotective potential for acute stroke.

Objective: To review available literature on the pharmacology, pharmacokinetics, efficacy, and tolerability of NXY-059, an investigational agent with a potential role in the treatment of acute stroke.

Data Sources: Information was obtained from a MEDLINE search (1966-February 2006) of English-language literature utilizing the following search terms: NXY-059, cerovive, nitrones, neuroprotection, free radical trapper, and secondary neurologic injury.

Study Selection And Data Extraction: Data from animal and human trials were evaluated to summarize the mechanism of action, efficacy, and safety of NXY-059.

Proton pump inhibitors for acid suppression in the intensive care unit: formulary considerations.

Purpose: The rationale for limiting the proton pump inhibitor (PPI) products included in an institutional formulary, factors to consider when making formulary decisions about PPI products, the results and limitations of cost-effectiveness analyses of PPI therapy in critically ill patients, the role of clinical practice guidelines in improving PPI use in the intensive care setting, and how these guidelines can be developed are discussed.

Summary: Therapeutic interchange may make it possible to limit the number of PPI products included in the formulary and reduce costs without compromising the efficacy or safety of drug therapy. The results of studies comparing the pharmacokinetics, pharmacodynamics, and efficacy of different PPI dosage forms and routes of administration; practical considerations; safety; and costs are among the factors to consider when making formulary decisions.

Gefitinib: a new antineoplastic for advanced non-small-cell lung cancer.

Purpose: The pharmacology, pharmacokinetics, and safety of gefitinib and its role in the management of non-small-cell lung cancer are reviewed.

Summary: Gefitinib is indicated for patients with locally advanced or metastatic non-small-cell lung cancer who have not responded to chemotherapy with platinum-based regimens or docetaxel. Gefitinib is administered orally at a dosage of 250 mg/day.

Spironolactone use in patients with heart failure.

Background: The addition of spironolactone, an aldosterone antagonist, to standard therapy can reduce the risk of both morbidity and mortality in patients with severe heart failure.

Objective: To evaluate the use of spironolactone in class III and IV heart failure patients in four urban teaching hospitals.

Methods: We conducted a concurrent medical record review of 163 patients with documented heart failure admitted to a general medicine service over a 5-week period.

Monoclonal antibodies in the treatment of cancer, Part 2.

Monoclonal antibodies used in the treatment of cancer are discussed. Monoclonal antibodies are a new class of agents targeted at specific receptors on cancer cells. In addition to having direct cellular effects, antibodies can carry substances, such as radioactive isotopes, toxins, and antineoplastic agents, to the targeted cells.

Monoclonal antibodies in the treatment of cancer, Part 1.

Monoclonal antibodies used in the treatment of cancer are discussed. Monoclonal antibodies are a new class of agents targeted at specific receptors on cancer cells. In addition to having direct cellular effects, antibodies can carry substances, such as radioactive isotopes, toxins, and antineoplastic agents, to the targeted cells.