OBJECTIVE: To compare withdrawal symptoms among pediatric intensive care patients receiving clonidine to those not receiving clonidine while being weaned from long-term dexmedetomidine. METHODS: This retrospective analysis evaluated Withdrawal Assessment Tool-1 (WAT-1) scores and hemodynamic parameters in pediatric patients on dexmedetomidine for 5 days or longer between January 1, 2009, and December 31, 2012. The primary objective was to compare withdrawal symptoms based on the number of elevated WAT-1 scores among patients on clonidine to those not on clonidine, while being weaned from long-term dexmedetomidine. The secondary objective was to describe withdrawal symptoms associated with long-term dexmedetomidine use. RESULTS: Nineteen patients (median age, 1.5 years; interquartile range [IQR], 0.67–3.3) received 20 treatment courses of dexmedetomidine for at least 5 days. Clonidine was received by patients during 12 of the treatment courses. The patients in the clonidine group had an average of 0.8 (range, 0–6) elevated WAT-1 scores 24 hours post wean compared to an average of 3.2 (0–8) elevated WAT-1 scores in the no clonidine group (p = 0.49). There were no significant difierences between prewean and postwean systolic or diastolic blood pressures among the 2 groups. The average heart rate during the postwean period was 112 beats per minute (bpm) (range, 88.5–151.5) in the clonidine group compared to 138.4 bpm (range, 117.8–168.3) in the no clonidine group (p = 0.003). In the clonidine group, the mean change in heart rate postwean compared to prewean was an increase of 3.6 bpm (range, −39.6 to 47.5), compared to a mean increase of 29.9 bpm (range, 5.5–74.7) in the no clonidine group (p = 0.042). CONCLUSIONS: There was no difierence in WAT-1 scores between groups, with the clonidine group displaying a trend towards fewer elevated WAT-1 scores during the 24 hours post dexmedetomidine wean. Patients who received clonidine had significantly lower heart rates than the no clonidine group.

In critically ill children, acute kidney injury occurred more in patients treated with vancomycin and piperacillin-tazobactam versus vancomycin plus ceftriaxone. After controlling for covariates, exposure to piperacillin-tazobactam was associated with an increased odds of acute kidney injury development.

Data extrapolated from other populations suggest that vancomycin and linezolid are appropriate first-line treatment options for the treatment of APE secondary to MRSA. Second-line options include doxycycline or minocycline and trimethoprim/sulfamethoxazole, each of which may be useful in patients coinfected with other respiratory pathogens, for which they may provide overlapping coverage. Ceftaroline and ceftobiprole are newer antibiotics that appear to have a potential role in the treatment of APE in CF, but the latter is not currently available to the US market. Although potentially useful, clindamycin is limited by high rates of resistance, telavancin is limited by its toxicity profile, and tigecycline is limited by a lack of demonstrated efficacy for infections that are similar to that seen in the CF population. Studies investigating the clinical utility of the above-cited antibiotics for APE in CF secondary to MRSA are desperately needed to broaden the treatment armamentarium for this medical condition.

The purpose of this study was to evaluate the effects of interprofessional high-fidelity simulation-based learning (SBL) on third-year pharmacy and senior nursing students' perceptions of interprofessional care. Students participated in an interprofessional high-fidelity SBL experience consisting of two hospital-based scenarios followed by a debriefing. The "Student Perceptions of Interprofessional Clinical Education-Revised" (SPICE-R) instrument was administered pre- and post-SBL. The "Student Satisfaction and Self-Confidence in Learning" (SSSCL) instrument, which uses a 5-point Likert scale, was administered post-SBL. A total of 104 (78%) pharmacy and 93 (77%) nursing students completed both the pre- and post-survey instruments. Baseline differences between pharmacy and nursing students included number of clinical hours completed [200 (190-240) vs. 210 (209-210); p < 0.001] and previous/current experiencing working directly with other healthcare professionals [71 (53%) vs. 88 (73%); p < 0.001]. Median score increases were observed for all SPICE-R items (p < 0.01) for pharmacy students and nine of ten SPICE-R items (p < 0.01) for nursing students. All students rated both the experience and their confidence highly on the SSSCL; however, nursing scores were higher than pharmacy scores for 7 of 13 items (p < 0.05). An interprofessional high-fidelity SBL experience increased pharmacy and nursing students' perceptions of interprofessional care.

Objective. To evaluate the impact of a large-scale interprofessional forum on pharmacy students' attitudes toward interprofessional collaborative practice. Methods. Pharmacy students were asked to complete the Interprofessional Attitudes Scale (IPAS) prior to and after completing a three-hour interprofessional forum. Scores for the total IPAS and each of the subscales were computed using the mean of students' responses to the items for each. Results. Of the 133 pharmacy students who participated in the forum, there were valid pre-and postintervention matched IPAS data for 124 (93.2%). In general, prior to the forum, students reported positive attitudes toward interprofessional collaborative practice as demonstrated by mean scores greater than 4.0 (agree) on the total IPAS scale and on all of the IPAS subscales except the Interprofessional Biases subscale). There was a significant increase from pre-to post-intervention scores on all the subscales except Patient-Centeredness. Based on the Cohen d measure of effect size, the greatest changes were in the Teamwork, Roles and Responsibilities and Community-Centeredness subscales, followed by the Interprofessional Biases subscale and Diversity and Ethics subscale. Conclusion.Prior to participating in an interprofessional student forum, pharmacy students generally had positive attitudes toward interprofessional collaborative practice. After participating in the forum, these attitudes become even more positive. Interprofessional education interventions, such as the forum, play an important role in shaping student's attitudes toward interprofessional collaboration.

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The purpose of this study was to extend our understanding of escape room pedagogical design by investigating the impact of escape room puzzle content on changes in student immediate recall knowledge and demonstration of interprofessional skills during a subsequent interprofessional simulation. Methods. Students from nursing, pharmacy and physical therapy programs were randomized to complete an escape room themed around acute management of sepsis (intervention group; n=133) or general acute care (control group; n=129) prior to participating in a simulated patient discharge case conference. Students completed a knowledge assessment before the escape room, immediately after the escape room and immediately after the simulation. Additionally, students completed the Interprofessional Socialization and Valuing Scale (ISVS-21) before and after the experience along with a postprogram evaluation. Faculty rated student achievement of interprofessional learning objectives during the simulation using a standardized rubric. Results. Students in the intervention group had higher scores on the knowledge test administered immediately after the escape room. ISVS-21 scores increased from pre to post for all participants. Interprofessional learning objectives, as evaluated by faculty, were met by 248 (94.7%) students.Conclusion. An interprofessional escape room with specific puzzle content improved students' immediate recall knowledge. In both groups, self-assessed interprofessional socialization improved and faculty assessed interprofessional learning objective attainment during subsequent simulation occurred. Escape rooms can be an innovative pedagogical tool that can positively impact immediate recall knowledge and interprofessional collaborative skills of health professions students.