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2.  Identification of Patient Predictors for Dexmedetomidine Effectiveness for ICU Sedation 
Background
Effective sedation is paramount in the care of critically ill patients. Dexmedetomidine, a selective α2- adrenergic receptor agonist, is an agent that is being increasingly used in the ICU despite its variability of patient response.
Objective
To report dexmedetomidine effectiveness and to identify specific patient characteristics that play a role in the achievement of adequate sedation with dexmedetomidine.
Methods
We conducted a 6 month, pilot, prospective observational study in a medical intensive care unit (MICU) at an academic medical center. Patients receiving dexmedetomidine were followed until drug discontinuation and were grouped into non-responders and responders. Effective sedation was defined as the achievement of a Sedation Agitation Scale (SAS) score of 3-4 after the addition of dexmedetomidine. Patient characteristics, laboratory values, home and inpatient medications, and dexmedetomidine dosing information were collected to identify predictors of clinical response.
Results
Thirty eight patients received dexmedetomidine in a 6 month time period, with dexmedetomidine being ineffective in 19/38 (50%) patients, effective in 11/38 (28.95%) patients, and effectiveness was unable to be assessed in 8 patients due to clinical confounders. Based upon the standard multiple logistic regression analysis, patients with a lower APACHE II (β coefficient −0.24; 95% CI, −0.39 to −0.03) and patients that received home antidepressants (β coefficient 2.33; 95% CI, 0.23 to 4.43) were more likely to achieve successful sedation with dexmedetomidine as compared to patients with a higher APACHE II score or no home antidepressant use.
Conclusions
Variability in effective sedation occurred with dexmedetomidine use. Future large scale investigations should be conducted to confirm the association of a lower APACHE II score and home antidepressant use and dexmedetomidine effectiveness.
doi:10.4037/ajcc2014678
PMCID: PMC4132632  PMID: 24585165
Dexmedetomidine; critically ill; sedation
3.  Exploring successful community pharmacist-physician collaborative working relationships using mixed methods 
Background
Collaborative working relationships (CWRs) between community pharmacists and physicians may foster the provision of medication therapy management services, disease state management, and other patient care activities; however, pharmacists have expressed difficulty in developing such relationships. Additional work is needed to understand the specific pharmacist-physician exchanges that effectively contribute to the development of CWR. Data from successful pairs of community pharmacists and physicians may provide further insights into these exchange variables and expand research on models of professional collaboration.
Objective
To describe the professional exchanges that occurred between community pharmacists and physicians engaged in successful CWRs, using a published conceptual model and tool for quantifying the extent of collaboration.
Methods
A national pool of experts in community pharmacy practice identified community pharmacists engaged in CWRs with physicians. Five pairs of community pharmacists and physician colleagues participated in individual semistructured interviews, and 4 of these pairs completed the Pharmacist-Physician Collaborative Index (PPCI). Main outcome measures include quantitative (ie, scores on the PPCI) and qualitative information about professional exchanges within 3 domains found previously to influence relationship development: relationship initiation, trustworthiness, and role specification.
Results
On the PPCI, participants scored similarly on trustworthiness; however, physicians scored higher on relationship initiation and role specification. The qualitative interviews revealed that when initiating relationships, it was important for many pharmacists to establish open communication through face-to-face visits with physicians. Furthermore, physicians were able to recognize in these pharmacists a commitment for improved patient care. Trustworthiness was established by pharmacists making consistent contributions to care that improved patient outcomes over time. Open discussions regarding professional roles and an acknowledgment of professional norms (ie, physicians as decision makers) were essential.
Conclusions
The findings support and extend the literature on pharmacist-physician CWRs by examining the exchange domains of relationship initiation, trustworthiness, and role specification qualitatively and quantitatively among pairs of practitioners. Relationships appeared to develop in a manner consistent with a published model for CWRs, including the pharmacist as relationship initiator, the importance of communication during early stages of the relationship, and an emphasis on high-quality pharmacist contributions.
doi:10.1016/j.sapharm.2009.11.008
PMCID: PMC3004536  PMID: 21111388
Pharmacists; Physicians; Collaborative working relationships; Pharmacist-physician collaborative index; Community
4.  Instructor Satisfaction With a Technology-based Resource for Diabetes Education 
Objectives
To evaluate instructor use patterns and satisfaction with DM Educate, a comprehensive, Web-based diabetes course.
Methods
Instructors completed a post-course survey instrument to assess their use of course materials and components, as well as satisfaction with the course content, design, and technology utilized, and to solicit their suggestions for additional content areas.
Results
Thirty-eight percent of respondents utilized DM Educate as a standalone elective and 62% had integrated materials into existing courses. The pharmacotherapy module was the most utilized at 91% and slide sets were the most utilized course components at 63%. All instructors stated that they would use the course again the following year. Suggestions for improvement included incorporation of more active-learning activities and patient cases.
Conclusion
Instructors’ were highly satisfied with the course materials and technology used by DM Educate, a Web-based diabetes education course, and indicated they were able to customize the course materials both to establish new courses and supplement existing courses. All instructors planned to use the course again.
PMCID: PMC2703282  PMID: 19564988
diabetes; distance education; Internet; pharmacotherapy
5.  A Web-based Interprofessional Diabetes Education Course 
Objective
To develop a comprehensive diabetes management course for pharmacy students that is available to all colleges and schools of pharmacy via the Internet.
Design
DM Educate, a Web-based course consisting of 12 topic modules with video lectures, active-learning exercises, and test questions prepared by nationally recognized experts was developed. The modular design allows use as a standalone, 3-credit course or use of individual module content as a supplement to an existing course.
Assessment
Two pilot studies found the comprehensive, interprofessional nature of the material beneficial for learners. Students showed a significant increase in knowledge of the subject material by correctly answering 26 of 34 questions on the posttest compared to answering only 14 of 34 questions correctly on the pretest (p < 0.001). Student feedback was positive for the flexibility of the Web-based format.
Conclusion
Pilot studies demonstrated the effectiveness of the course, which became available in the 2006-2007 academic year.
PMCID: PMC2064891  PMID: 17998990
Internet; diabetes; distance instruction
6.  A Model for Supporting and Training Clinical Pharmaceutical Scientist PhD Students 
Objectives
To enhance the clinical training and financial support of graduate students in a Clinical Pharmaceutical Scientist PhD Program at the University of Pittsburgh School of Pharmacy.
Design
The School of Pharmacy and University of Pittsburgh Medical Center entered into a collaborative agreement to develop the Clinical Scientist Associate (CSA) program, as well as financially support students enrolled in a Pharmaceutical Sciences PhD program. These clinical training experiences are in addition to the didactic and laboratory experiences in the pharmaceutical sciences graduate program.
Assessment
Since 2002, three students have participated as CSAs, simultaneously working on their graduate research and meeting the requirements of the CSA program.
Conclusions
The CSA program is a novel model for clinical training and support of post-PharmD graduate students enrolled in a PhD clinical pharmaceutical scientist program.
PMCID: PMC1858615  PMID: 17533441
clinical pharmaceutical sciences; graduate education; research; financial support; clinical pharmacy training

Results 1-6 (6)