Immunosuppressive aspects of analgesics and sedatives used in mechanically ventilated patients: an underappreciated risk factor for the development of ventilator-associated pneumonia in critically ill patients.

OBJECTIVE: To evaluate the evidence describing the immunosuppressive and pharmacokinetic properties of commonly used analgesic and sedation agents in critically ill patients. DATA SOURCES: MEDLINE (January 1980-September 2013) was searched. STUDY SELECTION AND DATA EXTRACTION: All in vitro and in vivo studies that evaluated the immune-modulating properties of analgesic and sedation agents commonly used in the critically ill were included. Full-text and abstract-only articles (noted) were included in this review. Inclusion criteria were met by 46 studies and were evaluated. DATA SYNTHESIS: Analgesic and sedation agents have been shown to be immunosuppressive in a variety of models. In vitro models use a variety of immune cells to demonstrate the immunosuppressive properties of opioids, benzodiazepines, and to a lesser extent, propofol. In each case, animal studies provide more robust data supporting the concept that opioids, benzodiazepines, and propofol exhibit immunosuppressive activities ranging from innate to adaptive immune alterations. Human studies, though more limited, provide further support that these agents inhibit the immune response. In contrast, data have shown that dexmedetomidine may attenuate the immune system. Clinical trial data evaluating the immunosuppressive properties of these agents is limited. CONCLUSIONS: Analgesic and sedation agents have clearly been shown to alter cellular function and other mediators of the immune system; yet the clinical impact remains to be fully elucidated. The mechanism by which sedation interruption reduces ventilator-associated pneumonia may in fact be a reduction in immunosuppressive effects. Studies linking the immune-modulating effects of analgesic and sedation agents in critically ill patients are needed.

Using educational games to promote the seeking of a pharmacist and to teach key medication use messages: results from an inner city health party.

BACKGROUND: Low health literacy affects 80-90 million Americans with low-income, minority populations being more vulnerable to this condition. One method of addressing limited literacy that may be particularly well accepted within vulnerable populations is the use of educational board games in order to emphasize seeking health information from reliable sources such as pharmacists. OBJECTIVE: The research objective was to determine if the use of educational board games could impact community pharmacy patron intentions to seek pharmacist advice in an urban, minority, economically-disadvantaged population. METHODS: Four medication-related educational games were played at an urban community pharmacy under the leadership of pharmacy students in the setting of a health party. Game messages, design, and evaluation processes were uniquely guided by community members' input. A verbally administered questionnaire measured game impact via knowledge and perception questions with responses compared between a non-randomly allocated intervention group and a control group. RESULTS: Ninety-nine adults were included in the intervention (or game) group and 94 adults were in the control group. Game participants were significantly more likely than the control group to indicate they would seek pharmacist medication advice in the future. CONCLUSION: Educational board games played in the setting of a health party can be a fun and effective way to convey selected health messages within an urban, minority, economically disadvantaged population. Community input into game development and layering multiple strategies for overcoming health literacy barriers were essential components of this initiative.