Objective. To design and implement an advanced cardiac life support (ACLS) workshop featuring a human patient simulator (HPS) for third-year pharmacy students. Design. The ACLS workshop consisted of a pre-session lecture, a calculation exercise, and a 40-minute ACLS session using an HPS. Twenty-four 5-member teams of students were assigned roles on a code team and participated in a ventricular fibrillation/pulseless ventricular tachycardia case. Assessment. Students completed an anonymous postactivity survey instrument and knowledge quiz. Most students who completed the ACLS workshop agreed they would like to participate in additional simulation activities and that the HPS experience enhanced their understanding of ACLS and the pharmacist responsibilities during an ACLS event (99.2% and 98.3%, respectively). However, the median score on the knowledge-based questions was 25%. Conclusion. Pharmacy students agreed HPS enhanced their learning experience; however, their retention of the knowledge learned was not consistent with the perceived benefits of HPS to education.Keywords: advanced cardiac life support, simulation, pharmacotherapy, ventricular fibrillation INTRODUCTIONAdvanced cardiovascular life support (ACLS) is a complex, team-based set of treatment strategies essential for the survival of patients experiencing a life-threatening cardiac event. As members of the ACLS team, pharmacists prepare medications at the bedside, provide pharmacotherapy consultations, and document medication administration.1 Pharmacist participation on a resuscitation team in United States hospitals is a core clinical pharmacy service, as their participation decreases adverse drug reactions and hospital mortality.2,3 From an educational standpoint, ACLS represents an ideal integration of patient assessment skills, drug preparation skills, and pharmacotherapeutic knowledge into a process that requires immediacy and accuracy. The Accreditation Council for Pharmacy Education (ACPE) recommends the integration of ACLS into the doctor of pharmacy (PharmD) curriculum. 4 However, the best methods for incorporating ACLS knowledge and skill competencies into the curriculum have not been established.Patient care simulators have been used with increasing acceptance by schools of medicine, nursing, and pharmacy to train students for a variety of clinical scenarios. 5One example is high-fidelity simulation, a unique way to introduce students to ACLS while creating an activity that allows students to apply ACLS pharmacotherapeutic knowledge and skill sets. Simulations are typically case studies of a physical reality in which participants assume a role and address problems that arise during the simulation. 6 The fidelity of the simulations refers to the degree to which the simulation reflects reality and can be further characterized by environmental, equipment, psychological, and factual accuracy.7 Human patient simulators (HPSs) are a type of high-fidelity simulator that uses a mannequin integrated with a computer to produce dynamic physiologic out...

Surgical procedures are key drivers of pain development and opioid utilization globally. Various organizations have generated guidance on postoperative pain management, enhanced recovery strategies, multimodal analgesic and anesthetic techniques, and postoperative opioid prescribing. Still, comprehensive integration of these recommendations into standard practice at the institutional level remains elusive, and persistent postoperative pain and opioid use pose significant societal burdens. The multitude of guidance publications, many different healthcare providers involved in executing them, evolution of surgical technique, and complexities of perioperative care transitions all represent challenges to process improvement. This review seeks to summarize and integrate key recommendations into a “roadmap” for institutional adoption of perioperative analgesic and opioid optimization strategies. We present a brief review of applicable statistics and definitions as impetus for prioritizing both analgesia and opioid exposure in surgical quality improvement. We then review recommended modalities at each phase of perioperative care. We showcase the value of interprofessional collaboration in implementing and sustaining perioperative performance measures related to pain management and analgesic exposure, including those from the patient perspective. Surgery centers across the globe should adopt an integrated, collaborative approach to the twin goals of optimal pain management and opioid stewardship across the care continuum.

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Severe valvar aortic stenosis (VAS) and supravalvar aortic stenosis (SVAS) each may cause left ventricular (LV) subendocardial ischemia and infarction, even with patent coronary arteries. LV ischemia in VAS has been related to reduced coronary perfusion relative to raised metabolic requirements, whereas this mechanism of ischemia has not been widely accepted in SVAS because coronary perfusion pressure is higher than normal.LV subendocardial coronary blood flow (CBF) occurs predominantly in diastole and a diastolic pressure-time index (DPTI) was used to estimate it. LV oxygen requirements were estimated from the systolic pressure-time index (SPTI). The ratio DPTI:SPTI (supply:demand) was evaluated as an estimate of the adequacy of subendocardial flow. SVAS was produced acutely in nine dogs and phasic left CBF and distribution of CBF to the LV myocardium were measured. Although mean CBF always rose with aortic constriction, flow in diastole fell from a control of 80% to 34% (P <0.001) and LV myocardial flow distribution became inhomogeneous with the proportion of flow to subendocardial muscle decreasing 63% (P < 0.001). Departure from the normal homogeneous flow distribution to the LV was predictable from the ratio DPTI: SPTI; values below 0.7 were always associated with relative subendocardial underperfusion.DPTI:SPTI ratios in two patients, one with severe VAS (0.25) and one with SVAS (0.39) were well below values obtained in 18 control patients (1.03 + 0.23), and were similar to the ratios in dogs with SVAS (0.27 0.08). Both patients had ECG changes suggesting LV ischemia. The mechanism of subendocardial ischemia is thought to be the same in both types of stenosis and its presence is predictable from pressure measurements available at cardiac catheterization. Additional Indexing Words: Regional coronary blood flow Radioactive microspheres Myocardial supply:demand relationship Tension-time index Diastolic pressure time index L EFT VENTRICULAR SUBENDOCARDIAL pairment ISCHEMIA and infarction may occur in subendoca patients with valvar aortic stenosis and unobstructaortic sten ed coronary arteries.1-3 The cause of this ischemia develop ai is thought to be the concurrence of increased ings suggE myocardial oxygen requirements and relative imsubendoca reports by Phasic coronary blood flow Coronary perfusion pressure Systolic pressure time index of coronary flow to left ventricular rdial muscle. Patients with supravalvar osis and patent coronary arteries may also ngina pectoris, electrocardiographic findestive of left ventricular ischemia, and irdial fibrosis and infarction.4 Recent

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Current published guidelines for perioperative pharmacy services have limited information on the development and implementation of a robust clinical pharmacy program across the surgical continuum of care. This publication defines the responsibilities and scope of practice of the Perioperative Clinical Pharmacist (PCPh), supporting the PCPh as a critical member of the interprofessional surgical patient care team. Opportunities for pharmacist role integration into perioperative medication management processes are described along with published examples of successful PCPh practice models, including those with interventions targeted toward Enhanced Recovery Pathways (ERP). Recommended training and competencies for future and practicing perioperative pharmacists, in addition to considerations for precepting and scholarly activities, are also outlined. Finally, future developments in perioperative pharmacy practice are discussed, including technological advancements, improved predictive models, and expansion of collaborative practice agreements.