Ghosts and Ghosting in Digital Communications.

Ghosting, professionally and personally, occurs when there is an abrupt end to communication between 2 individuals without any explanation or when an individual does not follow through on commitments to others associated with their communication. The increase in the available communication channels and speed at which messages can now be transmitted between individuals is resulting in a greater incidence of ghosting or perceived ghosting in our colleges/schools of pharmacy. The impact of ghosting is the disruption of effective communication and communication strategies that are essential to the development of positive and thriving cultures and subcultures in our institutions. The causes of ghosting (real or perceived) in our pharmacy academy could be attributed to increased workload and speed of communication, increased workload and productivity expectations, and increased workload and information volume. The consequences of ghosting in our colleges/schools can result in decreased psychological safety in our cultures, adversely impacting individual well-being, resiliency, grit, and satisfaction and adversely impacting student academic performance and success. There are simple steps that individuals and institutions can implement to minimize ghosting or the perception of ghosting that may occur with online communication channels used by our faculty, staff, students, and outside individuals.

A new lexicon for polypharmacy: Implications for research, practice, and education.

Previous research suggests that polypharmacy is a significant challenge for health care systems. However, polypharmacy has been defined in at least 24 distinct ways, which has understandably caused confusion among researchers, educators, and students in health care. Previous definitions of polypharmacy capture what could be both inappropriate therapy, i.e. too many medications, as well as evidence-based therapy that is appropriate. Previous research has tried to focus on the number of medications a patient is prescribed to define polypharmacy; however only focusing on the number of medications a patient is taking may be of limited value in determining whether that patient will experience an adverse event. This paper proposes a lexicon change for polypharmacy. It suggests that in future research, polypharmacy be defined as patients going to more than one pharmacy for their prescriptions. The authors also proffer a new term, 'extraordinary prescribing,' to define patients who are taking medications that are either grossly excessive or not beneficial for that patient. This definition is different than the current use of polypharmacy because the number of medications a patient is taking is irrelevant, especially if that patient has multiple chronic diseases. This paper is meant to start a dialog within the health services research community to inform future research that examines why inefficient prescribing may harm patients and the broader health care system.

Critical illness polyneuromyopathy.

PURPOSE: The clinical characteristics of and treatment approaches for critical illness polyneuromyopathy (CIPNM) are reviewed. SUMMARY: CIPNM is an acute axonal sensory-motor polyneuropathy that tends to occur after the development of respiratory insufficiency in patients with systemic inflammatory response syndrome, sepsis, or multiple-organ dysfunction syndrome. Numerous mechanisms have been proposed to explain the pathophysiology of CIPNM, most of which are complex and not fully understood or proven. While the rate of intensive care unit-acquired weakness varies greatly among patients, an estimated 25-85% of critically ill adult patients will develop neuromuscular weakness, most commonly CIPNM, during hospitalization. While no specific pharmacologic treatments exist for CIPNM, the outcome for most patients is related to the severity of the illness and neuromyopathy, as well as early intervention to treat the underlying condition. Electrophysiologic studies, such as electromyography, electroneurography, and muscle and nerve biopsies, are considered the gold standard for aiding in the diagnosis of CIPNM. Preventive measures such as the early provision of appropriate nutrition, glucose control, physical rehabilitation, and the cautious use of medications such as corticosteroids and neuromuscular blocking agents (NMBAs) can help reduce the occurrence of CIPNM. CONCLUSION: CIPNM is an acute axonal sensory-motor polyneuropathy commonly seen in critically ill patients with sepsis and multiorgan failure. While no specific pharmacologic treatments exist, preventive measures such as the early provision of appropriate nutrition, glucose control, physical rehabilitation, and the cautious use of medications, including corticosteroids and NMBAs, can help reduce the incidence of CIPNM.