Examining an Interaction Between Plasma Exchange and Apixaban Resulting in an Acute Ischemic Stroke.

Objective: Therapeutic drug monitoring is not routinely considered necessary in patients undergoing plasma exchange; however, it is possible for serum concentrations of select medications to be impacted by this procedure. Case: We describe a 50-year-old patient who presented to our facility with new onset aphasia and right-sided weakness. Despite presenting with a National Institute of Health Stroke Severity (NIHSS) score of 23, the patient did not receive fibrinolytic therapy due to his being anticoagulated with apixaban for atrial fibrillation. The patient instead underwent an emergent thrombectomy which resulted in a post-operative Thrombolysis in Cerebral Infarction (TICI) score of 3. The patient had a significant past medical history including numerous previous strokes necessitating assistance with activities of daily living, atrial fibrillation, chronic kidney disease, and thrombocytopenic purpura, for which he was receiving twice weekly plasma exchange and immunomodulatory therapy. The patient's last plasma exchange session was approximately 24 hours prior to admission, leading us to hypothesize that the patient's plasma exchange may have been implicated in the removal of apixaban from the serum and precipitating a stroke. Discussion/Conclusions: Heterogeneity of data exists when evaluating the effect of plasma exchange on apixaban. Although the drug properties of apixaban, including its low volume of distribution and high plasma protein binding capacity, support the notion that it may be vulnerable to removal through plasma exchange, only one other case report has been published on this phenomenon.

Academic conference posters: Describing visual impression in pharmacy education.

Background: Academic conference posters are a key communication before journal articles. Attention to visual attributes can enhance academic poster communication. Objective: This investigation's purpose was to create a visual impression measurement instrument, and then to describe and compare visual impression among scientific posters from an academic conference. Methods: A mixed-approach rubric was created to quickly measure visual impression of academic posters. Then, posters from a pharmacy education conference were retrospectively reviewed and scored. Visual impression was compared for traditional versus contemporary poster-formats. Various poster characteristics (poster-format, summary statement presence, abstract presence, wordiness, QR-code presence, logical sequencing, visuals) that might have impacted visual communication were coded. These characteristics were regressed onto visual impression scores. Results: Three-hundred seventy-eight posters were scored with sound inter-rater reliability. Contemporary poster-format scored significantly higher than traditional. Poster-format, abstract absence, lack of wordiness, QR-code presence, logical sequencing, and number of visuals were significant when regressed. Conclusion: Posters at one academic conference had varied visual impression. While a contemporary poster-format appeared more helpful, it was not a panacea; variation from poor through exemplary was seen with both poster-formats. Posters are not text-filled articles; displaying a combination of visuals/text clearly and concisely can help effective communication with academic posters.

Evaluation of Vasopressor Dose and the Incidence of Pressure Injuries in Critically Ill Patients.

OBJECTIVE: To evaluate risk factors associated with vasopressor use and development of hospital-acquired pressure injuries (HAPIs). METHODS: The researchers conducted a retrospective chart review in a 12-bed medical ICU at a community hospital. A total of 123 patients who received a minimum of 24 hours of continuous vasopressor administration between January 2017 and January 2019 were included. The primary outcomes assessed were vasopressor dose and HAPI incidence, with a subgroup analysis based on type. Secondary outcomes included quantity of vasopressors, duration, mean arterial pressure, mechanical ventilation, time to injury, severity, and location. RESULTS: The overall incidence of HAPIs was 20.3%, with 17% incidence in the low-dose cohort and 22.4% in the high-dose cohort ( P = .317). There were no differences in the subgroup analysis based on vasopressor type. The most common locations for injuries were the sacrum and coccyx, with the majority being stage 1 or 2 based on the National Pressure Injury Advisory Panel severity staging. No correlations were found between HAPI incidence and factors such as multiple vasopressors use, mechanical ventilation, mean arterial pressure, or duration of vasopressor administration. The documentation of time to injury was significantly shorter in the high-dose cohort compared with the low-dose cohort (157.58 vs 330.86 hours, P < .05). CONCLUSIONS: The incidence of HAPIs did not differ between the low- and high-dose vasopressor cohorts. However, patients who received higher doses of vasopressors had documented pressure injuries sooner than the low-dose cohort, emphasizing the importance of close monitoring for HAPIs in patients receiving vasopressors.

Mental health functioning and severity of cannabis withdrawal among medical cannabis users with chronic pain.

PURPOSE: To describe patterns of cannabis withdrawal among a large sample of those who use medical cannabis and test the association between withdrawal symptomology and functioning. PROCEDURES: Adults ages 21 and older (N = 801) who were seeking medical cannabis certification (either for the first time or as a renewal) for chronic pain at medical cannabis clinics in southern Michigan completed baseline measures of cannabis use, withdrawal symptomology, functioning and other related constructs. Patients were included in the current study if they endorsed using cannabis at least weekly over the past three months. Of the persons in the baseline sample (N = 801), 83% endorsed using cannabis at this level of frequency and duration (N = 665). FINDINGS: Approximately two-thirds of the sample (67.8%) reported at least one moderate or severe withdrawal symptom. The most commonly observed symptom was sleep difficulties (50.3%), followed by anxiety (27.8%), irritability (26.7%), and appetite disturbance (25.2%). Patients with low mental functioning had significantly higher rates of withdrawal symptom endorsement than patients with high mental functioning. However, no association was observed between physical functioning and withdrawal symptom endorsement. These patterns of association were consistent in multivariate analyses that controlled for other potentially confounding variables. CONCLUSIONS: Cannabis withdrawal symptomology is highly prevalent among patients who use medical cannabis at least three times a week. Helping patients recognize the association between poorer functioning and withdrawal may be an effective way to highlight potentially negative consequences of regular and moderate heavy use.