Douglas R. Oyler

The Fact of IgnoranceRevisiting the Socratic Method as a Tool for Teaching Critical Thinking

Critical thinking, while highly valued as an ability of health care providers, remains a skill that many educators find difficult to teach. This review provides an analysis examining why current methods of teaching critical thinking to health care students (primarily medical and pharmacy students) often fail and describes a premise and potential utility of the Socratic method as a tool to teach critical thinking in health care education.

Nonopioid management of acute pain associated with trauma: Focus on pharmacologic options.

Despite the prevalence of acute pain in the trauma setting and known complications of its improper management, including risk of chronic pain, delayed recovery, and poorer quality of life, recent survey data suggest little has changed in the overall management of pain in the acute setting during the

Getting the most from residency interviews

For Pharm.D. students who have submitted residency applications and are busy trying to balance rotation responsibilities with scheduling interviews, booking flights and hotels, and frantically searching for professional references in order to gain an edge and impress the targeted programs, it can be

Perceived Motivating Factors and Barriers for the Completion of Postgraduate Training Among American Pharmacy Students Prior to Beginning Advanced Pharmacy Practice Experiences

Objective. To examine perceived motivating factors and barriers (MFB) to postgraduate training (PGT) pursuit among pharmacy students. Methods. Third-year pharmacy students at 13 schools of pharmacy provided demographics and their plan and perceived MFBs for pursuing PGT. Responses were characterized using descriptive statistics. Kruskal-Wallis equality-of-proportions rank tests determined if differences in perceived MFBs existed between students based on plan to pursue PGT. Results. Among 1218 (69.5%) respondents, 37.1% planned to pursue PGT (32.9% did not, 30% were undecided). Students introduced to PGT prior to beginning pharmacy school more frequently planned to pursue PGT. More students who planned to pursue PGT had hospital work experience. The primary PGT rationale was, “I desire to gain more knowledge and experience.” Student debt was the most commonly cited barrier. Conclusion. Introducing pharmacy students early to PGT options and establishing work experiences in the hospital setting may increase students’ desire to pursue PGT.

Comprehensive Geriatric Assessment for Trauma: Operationalizing the Trauma Quality Improvement Program Directive

Elderly patients are the fastest growing trauma demographic and present some of the most complicated clinical challenges. This feasibility study employed observational data from a geriatric cohort. Comprehensive geriatric assessments (CGAs) were performed biweekly on eligible patients, 65 years or older, who met screening criteria. Mobility, activities of daily living impairment, frailty, and depression were screened and documented, and along with summative recommendations, were entered into the medical record, communicated to the patients primary care provider, and discussed with family. From September 1, 2015, to February 1, 2016, 65 comprehensive geriatric assessments were performed, with 2 repeats. Thirty-two (49%) were men. Mean age was 76.9 (range, 65–97) years. Motor vehicle collisions and falls accounted for the majority of trauma mechanisms (52% and 40%, respectively). New action items from the CGA were in 2 main categories: (1) home or inpatient medication changes and (2) additional physical therapist/occupational therapist intervention. Comprehensive geriatric assessment can be successfully organized and performed in centers without a designated geriatric service using standard trauma team members. Objective assessments for functional mobility, activities of daily living, frailty, and depression can be performed easily using current staff and the data easily incorporated into the CGA. Advanced practice providers can feasibly serve as clinical leads even if faculty/residents are unavailable.

Antiepileptic dosing for critically ill adult patients receiving renal replacement therapy

OBJECTIVES The aim of this review was to evaluate current literature for dosing recommendations for the use of antiepileptic medications in patients receiving renal replacement therapy (RRT). DATA SOURCES With the assistance of an experienced medical librarian specialized in pharmacy and toxicology, we searched MEDLINE, EMBASE, CINAHL, Web of Science, WorldCat, and Scopus through May 2016. STUDY SELECTION AND DATA EXTRACTION Four hundred three articles were screened for inclusion, of which 130 were identified as potentially relevant. Micromedex® DRUGDEX as well as package inserts were used to obtain known pharmacokinetic properties and dosage adjustment recommendations in RRT if known. DATA SYNTHESIS Data regarding antiepileptic drug use in RRT are limited and mostly consist of case reports limiting our proposed dosing recommendations. Known pharmacokinetic parameters should guide dosing, and recommendations are provided where possible. CONCLUSION Additional studies are necessary before specific dosing recommendations can be made for most antiepileptic drugs in critically ill patients receiving RRT, specifically with newer agents.

Rectal propranolol controls paroxysmal sympathetic hyperactivity: a case report.

Paroxysmal sympathetic hyperactivity (PSH) affects approximately 10% of survivors of acquired brain injury and is associated with substantial morbidity. The most effective maintenance therapies include oral β‐blockers and α‐2 antagonists. We report the use of rectal propranolol for symptomatic control of PSH in a critically ill patient with an altered gastrointestinal tract for whom oral intake was contraindicated. A 15‐year‐old Caucasian male with no past medical history was admitted status post all‐terrain vehicle rollover with multiple intra‐abdominal injuries. On hospital day 40, the patient experienced cardiac arrest with a subsequent anoxic brain injury, which was complicated by the development of PSH on post‐arrest day 1. Because of his altered gastrointestinal tract, he was symptomatically managed with propranolol 40 mg per rectum every 6 hours in the form of specially prepared suppositories, intravenously infused morphine and dexmedetomidine, and a transdermal clonidine patch. The patient improved clinically during this treatment and was transferred to a rehabilitation facility. This is the first case report to describe successful use of propranolol suppositories in a clinical environment. This case supports the use of propranolol suppositories as a potential alternative route when oral administration is not possible.

Analgesia, Sedation, and Delirium in the ICU

Pain, agitation, and delirium in the ICU are common occurrences; and inappropriate management of these conditions is clearly associated with poorer outcomes, including increased length of mechanical ventilation, length of ICU stay, and risk of mortality. Within this chapter we discuss the best practices regarding both assessment and treatment of these conditions as well as the pharmacology of available agents for analgesia, sedation, and delirium management. A comprehensive approach to improving patient care and comfort is also proposed.

Redefining “bowel regimen”: Pharmacologic strategies and nutritional considerations in the management of small bowel fistulas

Enterocutaneous fistulae (ECF) and enteroatmospheric fistulae (EAF) are difficult complications that primarily arise after abdominal surgical procedures. Development of an ECF or EAF carries significant mortality and morbidity. Effective management of patients with these disease states requires a multidisciplinary approach, which includes surgical, pharmacotherapeutic, and nutritional interventions. This review focuses on the medical and nutritional management of ECF/EAF, providing background on drug agents and nutritional strategies that may be helpful in reducing effluent volume, optimizing fistula healing, and maintaining nutritional health.

Minimizing opioid use after acute major trauma

Purpose Results of an initiative at an academic medical center to reduce prescription opioid use in patients with acute traumatic injuries are reported. Methods In 2014, the University of Kentucky Hospital trauma service implemented a pain management strategy consisting of patient and provider education emphasizing the use of nonopioid analgesics to minimize opioid use without compromising analgesia effectiveness. To assess the impact of the initiative, a retrospective analysis of data on cohorts of patients admitted with acute trauma before (n = 489) and after (n = 424) project implementation was conducted. The primary endpoint was opioid use (prescribed daily milligram morphine equivalents [MME]) at discharge. Secondary endpoints included inpatient opioid and alternative analgesic use, pain control, ileus development, length of stay, and discharge disposition. Results Compared with the preintervention cohort, the postintervention cohort had a lower median daily discharge MME overall (45 MME versus 90 MME, p < 0.001); after stratification of MME data by baseline opioid use, this finding held true only for patients with no opioid prescription at admission. Although utilization of gabapentinoids, skeletal muscle relaxants, and clonidine increased during the postintervention period, inpatient opioid use did not differ significantly in the 2 cohorts. Utilization of both nonsteroidal antiinflammatory drugs and acetaminophen was lower in the postintervention cohort versus the preintervention cohort. Conclusion Targeted provider and patient education on minimizing opioid use was associated with a reduction in MME on discharge from the hospital after traumatic injury.