Special Considerations in Pediatric Burn Patients Regarding Drug Dosage and Administration

Pediatric burn patients are a high-risk patient population to treat. These patients have altered physiologic function as a result of the burn injury, in addition to their smaller size and developing bodies. This creates unique challenges during treatment. Accommodations for these patients are made through unique drug dosages and routes of administration. When treating pediatric burn patients, properly assessing and treating pain promptly and effectively is of utmost importance. Nurses who utilize accurate and appropriate pain assessment scales will provide the best treatment of pain. Proper assessment allows the patient to receive the correct analgesic regime, ensuring a faster and more comfortable recovery process

Management of Hypertensive Emergencies in Pediatrics

As hypertension becomes more prevalent in the pediatric population, clinicians are more likely to encounter hypertensive emergencies in children, which require pharmacists and physicians to be educated on the therapeutic options for these emergencies. However, the strict governmental requirements on the testing of these drugs in pediatric patients have limited the amount of available evidence on which to base clinical decisions. This review will highlight the available evidence and preferred treatment options for the management of pediatric hypertensive emergencies

Effectiveness of a Pharmacist-Directed Tdap Immunization Program for a University Campus

Background/Objectives: Despite a slight increase in Tdap immunization rates, the total numbers are still low among adults. The purpose of this study is to determine the impact of a pharmacist-directed immunization program. The primary objective was to assess the increase in vaccination rates among the subjects indicated to receive the Tdap vaccine. The secondary objective was to assess changes in pre and post vaccine knowledge scores.Methods: Employees enrolled in the pharmacist-directed employee wellness clinic on a university campus in Ohio were screened forTdap vaccination at the annual employee health fair during Fall of 2016. Results were cross-referenced with the state vaccination database. Subjects were recruited via email to an educational program. Indicated patients were asked to schedule an appointment with a pharmacist. Assessment data on the educational program was collected before the presentation and after the appointment when the vaccine was administered. The efficacy endpoint for the primary objective was a 20% increase in baseline vaccination rates.Results: Of the 198 subjects recruited, a total of 54 received Tdap vaccination. The baseline vaccination rate of the study populationwas 37.4% and increased by 27.2% after the intervention to a total vaccination rate of 64.6% (p< 0.001). Six knowledge assessmentswere utilized for the secondary objective; however, these results did not show significance.Conclusions: A pharmacist-directed Tdap immunization program is effective at increasing vaccination rates. Even though the changein education assessment data proved more observational, the education provided will empower subjects to make informed healthcaredecisions

A Review of Dabigatran, an Oral Anticoagulant

Serious clinical complications associated with venous thrombotic embolism (VTE) necessitate prophylaxis in patient groups who are at high risk of VTE, specifically those recovering from orthopedic surgery with atrial fibrillation, with mechanical heart valves, at increased risk for stroke, or recovering post-MI. Currently, prophylaxis with warfarin, enoxaparin, or fondaparinux has been the standard of therapy, but these therapies each have their limitations. Dabigatran etexilate is an orally available pro-drug of dabigatran, a competitive, reversible, direct inhibitor thrombin (Factor lla). The agent is converted by esterases, and, thus, not associated with the complications of the CYP enzyme system. Dabigatran follows a linear dose-response curve simplifying dosing compared to other agents. In the BISTRO II study, a dose as low as 50 mg dabigatran was found to be non-inferior to the current standard of therapy of 40 mg enoxaparin, and BISTRO I and II, RE-NOVATE and RE-LY all found dabigatran was better or equivalent to warfarin therapy for post-hip and knee replacements. Dabigatran could be especially beneficial in patients who have a contraindication to warfarin, need long-term anticoagulation and require less patient monitoring. With FDA approval and release of this drug, time will provide safety and efficacy data to solidify dabigatran\u27s place in therapy along current anti-coagulation guidelines

Military maladaptation : counterinsurgency and the politics of failure

Tactical learning is critical to battlefield success, especially in a counterinsurgency. This article tests the existing model of military adaption against a ‘most-likely’ case: the British Army’s counterinsurgency in the Southern Cameroons (1960–61). Despite meeting all preconditions thought to enable adaptation – decentralization, leadership turnover, supportive leadership, poor organizational memory, feedback loops, and a clear threat – the British still failed to adapt. Archival evidence suggests politicians subverted bottom-up adaptation, because winning came at too high a price in terms of Britain’s broader strategic imperatives. Our finding identifies an important gap in the extant adaptation literature: it ignores politics.PostprintPeer reviewe

The Changing Landscape for Stroke\ua0Prevention in AF: Findings From the GLORIA-AF Registry Phase 2

Background GLORIA-AF (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients with Atrial Fibrillation) is a prospective, global registry program describing antithrombotic treatment patterns in patients with newly diagnosed nonvalvular atrial fibrillation at risk of stroke. Phase 2 began when dabigatran, the first non\u2013vitamin K antagonist oral anticoagulant (NOAC), became available. Objectives This study sought to describe phase 2 baseline data and compare these with the pre-NOAC era collected during phase 1. Methods During phase 2, 15,641 consenting patients were enrolled (November 2011 to December 2014); 15,092 were eligible. This pre-specified cross-sectional analysis describes eligible patients\u2019 baseline characteristics. Atrial fibrillation disease characteristics, medical outcomes, and concomitant diseases and medications were collected. Data were analyzed using descriptive statistics. Results Of the total patients, 45.5% were female; median age was 71 (interquartile range: 64, 78) years. Patients were from Europe (47.1%), North America (22.5%), Asia (20.3%), Latin America (6.0%), and the Middle East/Africa (4.0%). Most had high stroke risk (CHA2DS2-VASc [Congestive heart failure, Hypertension, Age  6575 years, Diabetes mellitus, previous Stroke, Vascular disease, Age 65 to 74 years, Sex category] score  652; 86.1%); 13.9% had moderate risk (CHA2DS2-VASc = 1). Overall, 79.9% received oral anticoagulants, of whom 47.6% received NOAC and 32.3% vitamin K antagonists (VKA); 12.1% received antiplatelet agents; 7.8% received no antithrombotic treatment. For comparison, the proportion of phase 1 patients (of N = 1,063 all eligible) prescribed VKA was 32.8%, acetylsalicylic acid 41.7%, and no therapy 20.2%. In Europe in phase 2, treatment with NOAC was more common than VKA (52.3% and 37.8%, respectively); 6.0% of patients received antiplatelet treatment; and 3.8% received no antithrombotic treatment. In North America, 52.1%, 26.2%, and 14.0% of patients received NOAC, VKA, and antiplatelet drugs, respectively; 7.5% received no antithrombotic treatment. NOAC use was less common in Asia (27.7%), where 27.5% of patients received VKA, 25.0% antiplatelet drugs, and 19.8% no antithrombotic treatment. Conclusions The baseline data from GLORIA-AF phase 2 demonstrate that in newly diagnosed nonvalvular atrial fibrillation patients, NOAC have been highly adopted into practice, becoming more frequently prescribed than VKA in Europe and North America. Worldwide, however, a large proportion of patients remain undertreated, particularly in Asia and North America. (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients With Atrial Fibrillation [GLORIA-AF]; NCT01468701