Impact of Postgraduate Second-Year Pharmacy Training (PGY2) on Clinical, Financial, and Educational Outcomes: A Scoping Review.

OBJECTIVE: A scoping review was conducted to screen the published literature on the clinical, financial, and educational effect of postgraduate second year (PGY2) pharmacy residency training. FINDINGS: A search strategy was conducted in MEDLINE, EMBASE, CINAHL, Cochrane Central and Web of Science without study design, language, or time restrictions (inception to March 2022). Articles were reported using the PRISMA reporting items list. Studies were included if a measurable clinical outcome, a cost-avoidance calculation and/or involvement in teaching or research activities was reported. Studies were excluded if there was no mention of a PGY2 training. Of the 2534 articles that were screened, 21 articles met our inclusion criteria. Seven studies reported clinical outcomes, five reported cost avoidance, six reported educational outcomes and three studies reported both clinical and cost-avoidance outcomes. Four of the studies evaluating clinical outcomes took place in a psychiatric clinic setting. Better disease control was reported in four articles. Two studies evaluated readmission and emergency department visits at 30 days but only one showed significant reduction. The estimated cost avoidance reported ranged from $22,380 to $5,387,679 and two studies reported the services billed by the resident. In two studies, PGY2 pharmacists were more likely to be involved in teaching activities and were more likely to participate in research activities. CONCLUSION: Even though few studies evaluated the benefits of PGY2 pharmacy trainings, they showed to improve patient care, enhance involvement in teaching activities, and decrease financial burden for health-care systems. More studies should be done to reinforce the merits of such training.

Migration despite stabilization of an embolized transcatheter heart valve: A word of caution.

This case report describes an initially stabilized transcatheter heart valve that embolized in the ascending aorta, leading to a postprocedural acute type A aortic dissection.

Benzodiazepine resistant alcohol withdrawal: What is the clinician's preferred definition?

OBJECTIVES: Although alcohol withdrawal is common, the recognition of benzodiazepine-resistant alcohol withdrawal is a relatively new concept. To provide a framework for both literature review and future research, we assessed clinicians' personal definition of resistant alcohol withdrawal. METHOD: We developed a cross-sectional web-based survey. Administrators from collaborating toxicology and emergency medicine associations deployed the survey directly to their respective memberships. Only physicians, pharmacists, and other clinicians routinely treating alcohol withdrawal were eligible to participate. Respondents selected their preferred definition among the three most common author sources - JB Hack, NJ Benedict, D Hughes - or provided their own. Additional criteria to define resistant alcohol withdrawal were explored. RESULTS: 384 individuals answered the survey. Respondents were mostly attending physicians (79%), in full-time practice (90%), in emergency medicine (70%), and from North America (90%). The majority (64%) described resistant alcohol withdrawal as a high benzodiazepine dosage. Seizures (26%) and persistent tachycardia (16%) were also main characteristics. The median dose to describe high benzodiazepine dose (n = 146) was 40 mg per hour of diazepam equivalents (IQR 20-50). Available definitions were ranked equally as the preferred one: Hack (27%); Benedict (28%); Hughes (28%). CONCLUSION: Our results did not identify one single preferred definition for resistant alcohol withdrawal even though a high total dose of benzodiazepine is a major component. Hourly requirements of 40 mg of diazepam equivalents or more emerged as a possible threshold. These findings serve as a base to explore consensus guidelines or future research.

Optimizing concentrations of concomitant antiretrovirals by reducing etravirine doses: two case reports of complex drug-drug interactions.

We report the cases of two treatment-experienced HIV-infected patients with complex antiretroviral regimens that showed significant drug-drug interactions with etravirine. Unexpectedly high etravirine concentrations likely caused subtherapeutic levels of darunavir, elvitegravir and dolutegravir through concentration-dependent metabolic induction. Therapeutic drug monitoring allowed safe etravirine dose decreases to manage these interactions.