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1.
Curr Pharm Teach Learn ; 13(7): 862-867, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34074519

RESUMO

BACKGROUND AND PURPOSE: The novel severe acute respiratory syndrome coronavirus 2 restricted student involvement in direct patient care. Virtual learning is an effective education strategy in pharmacy curriculums. This study aimed to evaluate student perceptions of virtual learning advanced pharmacy practice experiences (APPE) utilizing an electronic 12-question survey. EDUCATIONAL ACTIVITY AND SETTING: Virtual learning was developed and implemented, and students were surveyed at the end of the APPE. The survey was comprised of one open-ended and 11 Likert scale questions. It assessed implementation and use of virtual learning in place of a standard on-site APPE. FINDINGS: Responses were attained from 19 students. Questions regarding resources provided and virtual learning enabling autonomous, independent learning had the highest percent of strong agreement. No responses indicated strong disagreement. Three questions solicited >10% response rate of somewhat disagree, 16% associated with virtual learning helping the student become a better member of the healthcare team after graduation. Open-ended responses acknowledged appreciation of the virtual APPE and presented material. One in six students commented on the ability to apply the learned information to direct patient care. Feedback was delivered on consideration for increased utility of patient care-orientated applications to facilitate simulation of real-life patient cases. SUMMARY: Students who completed the virtual APPE were satisfied overall. Virtual teaching modalities may be incorporated into APPEs, particularly when direct patient care access is limited, but should not be used to completely replace the experience gained during direct patient care.


Assuntos
Currículo , Educação à Distância/métodos , Educação em Farmácia/métodos , Aprendizagem Baseada em Problemas/métodos , Competência Profissional , Estudantes de Farmácia , Humanos
2.
Am J Emerg Med ; 45: 682.e7-682.e9, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-33358897

RESUMO

Ketamine is a versatile analgesic that has become an increasingly popular recreational drug. Chronic ketamine use has been found to cause biliary duct damage and bladder dysfunction. Ketamine-induced cholangiopathy and ulcerative cystitis are uncommon diagnoses presenting with nonspecific symptoms, creating diagnostic challenges for emergency physicians. We report a case of a teenage patient with the rare simultaneous presentation of ketamine-induced cholangiopathy and ulcerative cystitis. Due to increased recreational and chronic ketamine use, cases of ketamine-induced cholangiopathy and ulcerative cystitis are likely to rise with the increased knowledge, awareness, and reporting of these entities by radiologists and emergency physicians.


Assuntos
Anestésicos Dissociativos/efeitos adversos , Colangite/induzido quimicamente , Cistite/induzido quimicamente , Ketamina/efeitos adversos , Adolescente , Anestésicos Dissociativos/farmacologia , Colangite/diagnóstico por imagem , Colangite/patologia , Cistite/diagnóstico por imagem , Cistite/patologia , Humanos , Ketamina/farmacologia , Masculino , Uso Recreativo de Drogas
3.
J Pharm Pract ; 32(5): 529-533, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29685062

RESUMO

BACKGROUND: The practice guidelines for the management of pain, agitation, and delirium (PAD) from the Society of Critical Care Medicine shifted from primarily focusing on the treatment of anxiety in 2002 to the treatment of pain in 2013. OBJECTIVE: This prospective, observational, multicenter study aimed to assess the degree of practice adherence to the PAD guidelines for ventilated patients in New Jersey intensive care units (ICUs). METHODS: Pharmacist investigators at 8 centers designated 4 days at least 10 days apart to evaluate all patients on mechanical ventilation. The primary outcomes included adherence to 4 guideline recommendations: treatment of pain before sedation, use of nonnarcotic analgesic medications, use of nonbenzodiazepine sedative medications, and use of goal-directed sedation. RESULTS: Of 138 patients evaluated, 50% had a primary medical diagnosis (as opposed to surgical, cardiac, or neurological diagnosis), and the median Sequential Organ Failure Assessment (SOFA) score was 7. Pain was treated prior to administration of sedatives in 55.4% of subjects, with fentanyl being the primary analgesic used. In addition, 19% received no analgesia, and 11.5% received nonopioid analgesia. Sedative agents were administered to 87 subjects (48 nonbenzodiazepine and 39 benzodiazepine). Of those receiving benzodiazepines, 22 received intermittent bolus regimens and 16 received continuous infusions, of which 5 were for another indication besides sedation. Validated scales measuring the degree of sedation were completed at least once in 56 (81.6%) patients receiving sedatives. CONCLUSIONS: Current sedation practices suggest that integration of evidence-based PAD guidelines across New Jersey adult ICUs is inconsistent despite pharmacist involvement.


Assuntos
Analgésicos/normas , Fidelidade a Diretrizes/normas , Hipnóticos e Sedativos/normas , Unidades de Terapia Intensiva/normas , Manejo da Dor/normas , Guias de Prática Clínica como Assunto/normas , Idoso , Idoso de 80 Anos ou mais , Analgésicos/administração & dosagem , Feminino , Humanos , Hipnóticos e Sedativos/administração & dosagem , Masculino , Pessoa de Meia-Idade , New Jersey/epidemiologia , Dor/tratamento farmacológico , Dor/epidemiologia , Manejo da Dor/métodos , Estudos Prospectivos
4.
J Crit Care ; 48: 198-202, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30232056

RESUMO

PURPOSE: To determine if a difference in hemodynamic stability would be identified in patients with abrupt withdrawal of steroids compared to patients who underwent a taper. MATERIAL AND METHODS: This retrospective cohort study identified patients who received vasopressors followed by IV hydrocortisone for treatment of septic shock from January 1, 2013 until January 1, 2015.The primary endpoint evaluated the percent of patients requiring vasopressor re-initiation during taper and 72 h following taper, or 72 h directly following abrupt withdrawal. Secondary endpoints evaluated include glycemic control, and ICU length of stay. RESULTS: A total of 87 patients were included for final analysis. Of the 87 patients, 7 out of 41 patients (17.1%) in the steroid taper group developed hemodynamic instability and required re-initiation of vasopressors compared to 1 out of 46 patients (2.2%) in the abrupt withdrawal group (p = 0.024). Patients in the taper group also had worse glycemic control (125.1 mg/dL abrupt vs. 150.8 taper; p < 0.001). There was no statistical difference found in the ICU length of stay (8.28 days abrupt vs.10.73 taper; p = 0.14). CONCLUSION: The abrupt withdrawal of steroids in patients with resolving septic shock did not impact hemodynamic stability and offers an opportunity to reduce medication burden and reduce adverse drug reactions.


Assuntos
Hidrocortisona/uso terapêutico , Choque Séptico/tratamento farmacológico , Idoso , Estudos de Coortes , Esquema de Medicação , Feminino , Humanos , Hidrocortisona/administração & dosagem , Infusões Intravenosas , Unidades de Terapia Intensiva , Tempo de Internação , Masculino , Registros Médicos , New Jersey , Estudos Retrospectivos , Resultado do Tratamento
5.
Am J Manag Care ; 21(5 Suppl): S76-85, 2015 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-26167957

RESUMO

Chronic hepatitis C virus (HCV) infection is highly prevalent and associated with a wide range of hepatic and extrahepatic complications. The treatment landscape for HCV infection has evolved to include regimens without interferon formulations and/or ribavirin. This change simplifies therapy, improves tolerability, and decreases therapy duration, while improving virologic response rates. This article, the first in a series of 3, will provide an overview of the hepatitis C disease state, identify populations at risk for HCV, describe testing recommendations for the diagnosis of HCV infection, and distinguish new and emerging HCV therapies.


Assuntos
Antivirais/uso terapêutico , Hepatite C Crônica/tratamento farmacológico , Ensaios Clínicos como Assunto , Infecções por HIV/tratamento farmacológico , Hepacivirus , Hepatite C Crônica/diagnóstico , Hepatite C Crônica/epidemiologia , Hepatite C Crônica/transmissão , Humanos , Programas de Assistência Gerenciada , Medidas de Resultados Relatados pelo Paciente
6.
Pharmacotherapy ; 34 Suppl 1: 22S-26S, 2014 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-25521843

RESUMO

BACKGROUND: Intravenous (IV) acetaminophen may be an effective component of multimodal postoperative pain management. The primary objective of this study was to evaluate the impact of IV acetaminophen on total opioid use in postoperative patients. The secondary objective was to evaluate the effect of IV acetaminophen on hospital length of stay. METHODS: This retrospective, case-control study evaluated the impact of IV acetaminophen on total opioid use in surgical patients. Patients were included if they received at least one perioperative dose of IV acetaminophen and underwent a surgical knee procedure. Controls were matched and randomly selected based on procedure type, age, and severity of illness. Postoperative opioids were converted into oral morphine equivalents, and overall use was compared between groups. RESULTS: One hundred patients were enrolled, with 25 patients receiving IV acetaminophen and 75 matched controls. A total of 135 mg versus 112.5 mg oral morphine equivalents were used in the IV acetaminophen group and control group, respectively (p=0.987). There were 45 mg/day oral morphine equivalents used in the IV acetaminophen group versus 37.5 mg in the control group (p=0.845). The median hospital length of stay in both groups was 3 days (p=0.799). CONCLUSION: IV acetaminophen did not significantly decrease postoperative opioid use in patients who underwent surgical knee procedures. In addition, there was a nonsignificant trend toward increased opioid use in the IV acetaminophen group. There was no significant difference in hospital length of stay between the IV acetaminophen group and the control group. These findings require further study in larger patient populations and in other orthopedic procedures that typically require longer hospital stays.


Assuntos
Acetaminofen/uso terapêutico , Analgésicos não Narcóticos/uso terapêutico , Analgésicos Opioides/uso terapêutico , Artroplastia do Joelho/métodos , Dor Pós-Operatória/tratamento farmacológico , Acetaminofen/administração & dosagem , Idoso , Idoso de 80 Anos ou mais , Analgésicos não Narcóticos/administração & dosagem , Analgésicos Opioides/administração & dosagem , Estudos de Casos e Controles , Quimioterapia Combinada , Feminino , Humanos , Injeções Intravenosas , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
7.
Hosp Pharm ; 48(11): 936-57, 2013 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-24474835

RESUMO

BACKGROUND: It is unknown whether coagulation properties differ between renal transplant and nontransplant patients. OBJECTIVE: To assess whether renal transplant patients on intravenous (IV) heparin, titrated to therapeutic activated partial thromboplastin times (aPPT; 56-93 seconds), experienced a higher rate of bleeding compared to nontransplant patients. METHODS: Twenty-nine renal transplant and 29 nontransplant patients receiving IV heparin for a deep vein thrombosis, pulmonary embolism, atrial fibrillation, or acute coronary syndrome were randomly identified through a retrospective chart review. RESULTS: Renal transplant patients had higher bleeding rates on IV heparin therapy compared to nontransplant patients (31% vs 6.9%, respectively; P = .041). Renal transplant patients experienced a drop in hemoglobin of at least 1 g/dL or the need for a transfusion more often then nontransplant patients (69% vs 45%, respectively; P = .111), although the difference was not statistically significant. CONCLUSIONS: Further research is necessary to identify the factors contributing to increased rates of bleeding in renal transplant patients on IV heparin and to determine the ideal aPTT to appropriately balance anticoagulation in renal transplant patients.

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