The Annals of pharmacotherapy
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Comparative Study
Activated Factor 7 Versus 4-Factor Prothrombin Complex Concentrate for Critical Bleeding Post-Cardiac Surgery.
Recombinant and plasma-derived factor products, such as activated factor seven (rFVIIa) and four-factor prothrombin complex concentrate (4-factor PCC), have been used off-label for bleeding after cardiac surgery, but little evidence has been published regarding their efficacy and safety. ⋯ 4-Factor PCC may be an equally efficacious alternative to rFVIIa for patients experiencing significant bleeding during cardiac surgery. There is no difference in chest tube output; therefore, there is no difference in bleeding-either at 24 hours postoperatively or total.
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Chronic opioid therapy-clinical reminder (COT-CR) is a decision support tool to prompt providers to carefully assess patients prescribed chronic opioids. This tool was developed to address inappropriate opioid prescribing. ⋯ Completing the COT-CR was associated with reduced MEMD and RIOSORD values. This suggests that active monitoring can change prescribing patterns, thereby, reducing the overall risk of opioid overdose in at-risk veterans.
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To summarize and evaluate the existing literature regarding medications to treat opioid-induced constipation (OIC) in patients with chronic noncancer pain (CNCP). ⋯ With risk of bias determined to be low to moderate, published data to date suggest that methylnaltrexone, naloxegol, and naldemedine may be appropriate to treat OIC in patients with CNCP.
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Observational Study
Continuous Care Provided Through Comprehensive Medication Management in an Acute Care Practice Model.
Pharmacy practice models that foster pharmacists' accountability for medication-related outcomes are imperative for the profession. Comprehensive medication management (CMM) is an opportunity to advance patient care. ⋯ This study demonstrated successful implementation of a CMM model that positively affected organizational, patient, and financial outcomes.
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Severe sepsis and septic shock represent common presentations in the emergency department (ED) and have high rates of mortality. Guideline-recommended goals of care have been shown to benefit these patients, but can be difficult to provide. ⋯ This intervention significantly increased the proportion of patients provided with SSC goals of care. Such interventions have not been reported previously and could be meaningful in the management of severe sepsis and septic shock.