The present research findings are congruent with current literature related to the constructs used by clinical supervisors in health professional student workplace-based assessment and provide additional insight into cross-national perspectives in pharmacy. As previously determined in social work and medicine, further study of how evaluation instruments and associated processes can integrate these judgements should be pursued in this discipline.

Agitation is a frequent problem in trauma ICU and is mainly related to the type of sedation and poor outcomes in terms of prolonged mechanical ventilation and development of nosocomial pneumonia. Therefore, understanding the main predictors of agitation facilitates early risk-stratification and development of better therapeutic strategies in trauma patients.

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Hyperparathyroidism is a common endocrine disorder characterized by hypersecretion of parathyroid hormones due to abnormal activity of one or more parathyroid glands. Several cardiac abnormalities have been reported due to hyperparathyroidism. In this case report, a case of cardiac arrest due to hyperparathyroidism and hypercalcemia is presented and discussed. A female patient, 73 years old, was admitted to surgical ward (SICU) with malignant goiter extending to the retrosternum. She was a known case of hyperparathyroidism and hypercalcemia. After the operation, the patient was shifted to SICU for further management. Suddenly, the patient had sudden cardiac arrest and was successfully resuscitated within 2 minutes. The ECG showed a new Right Bundle Branch Block (RBBB) changes. Patient remained on ventilator, not obeying commands, and opened her eyes spontaneously with cough reflex. A week after, percutaneous tracheostomy was performed, and patient became hemodynamically stable, weaned from ventilator and allowed to breathe spontaneously. Although cardiac arrest is a rare complication, it should be expected by health care providers when dealing with patients with hyperparathyroidism and hypercalcemia.

Abstract:-Background: Acetaminophen is one of the most treatments used to reduce the temperature in ICU patients. However, it is still unclear whether the use of acetaminophen improves patients' survival and hospital length of stay. This study aims to analyze the main literatures which studied the use of acetaminophen in ICU patients with fever due to infections or other non-infectious insults. Methods:Severaldatabases including Cochrane library database, Academic Search Complete, and PubMed were searched for studies on acetaminophen in ICU patients. The search was limited to randomized controlled trials, cohort studies, adult human critically ill patients, treatment with acetaminophen in one arm and no treatment (placebo) in the other arm. The outcomes assessed were the ICU and hospital length of stay, mortality rate, ICU-free days and changes in temperature. Results:Two randomized control trials and one cohort study covering 32,408 patients were included. There wereno differences in ICU and hospital length of stay between the group treated with acetaminophen and placebo. In addition, the mortality rate did not differ between the two groups in patients with fever due to infection; however, a difference was shown in patients with fever due to non-infectious insults. Finally, there was a significant reduction in temperature in acetaminophen group compared to placebo. Conclusion: The use of acetaminophen for fever in critically ill patients was not associated with better outcome in terms of ICU and hospital length of stay and mortality ratecompared to placebo especially when the fever is due to infections.

Background:Self-extubation is a common clinical problem associated with mechanical ventilation in trauma patients worldwide.Objectives:This study aimed to evaluate the predisposing factors, complications, and outcomes of self-extubation in patients with head injury.Methods:This was a retrospective cohort study.Settings:The study was conducted in a trauma intensive care unit (TICU).Patients:All intubated patients with head injury admitted to TICU between 2013 and 2015 were included in the study.Interventions:Planned compared to selfextubation during weaning from sedation.Measurements:Risk, predictors, and outcomes of self-extubation were measured.Main Results:A total of 321 patients with head injury required mechanical ventilation, of which 39 (12%) had self-extubation and 12 (30.7%) had reintubation. The median Glasgow Coma Scale, head abbreviated injury score, and injury severity score were 9, 3, and 27, respectively. The incidence of self-extubation was 0.92/100 ventilated days. Self-extubated patients were more likely to be older, develop agitation (P = 0.001), and require restraints (P = 0.001) than those who had planned extubation. Furthermore, self-extubation was associated with more use of propofol (P = 0.002) and tramadol (P = 0.001). Patients with self-extubation had higher Ramsay sedation score (P = 0.01), had prolonged hospital length of stay (P = 0.03), and were more likely to develop sepsis (P = 0.003) when compared to the planned extubation group. The overall in-hospital mortality was significantly higher in the planned extubation group (P = 0.001). Age-adjusted predictors of self-extubation were sedation use (adjusted odds ratio [aOR]: 0.06; P = 0.001), restraint use (aOR: 10.4; P = 0.001), and tramadol use (aOR: 7.21; P = 0.01).Conclusions:More than one-tenth of patients with traumatic head injury develop self-extubation; this group of patients is more likely to have prescribed tramadol, develop agitation, and have longer hospital length of stay and less sedation use. Further prospective studies are needed to assess the predictors of self-extubation in TICU.