Although no significant ECG changes were observed, HR increased 5-7 beats/min and SBP increased 10 mm Hg after energy drink consumption.

Background-The effect of a hybrid intravenous and oral prophylactic amiodarone regimen on postcardiothoracic surgery (CTS) atrial fibrillation (AF) is unknown. The impact of active atrial septal pacing on post-CTS AF has not been well characterized. In addition, the effect of using both amiodarone and atrial septal pacing together to prevent atrial fibrillation is unknown. Methods and Results-Patients (nϭ160) were randomized to amiodarone or placebo and then to pacing or no pacing using a 2ϫ2 factorial design. All therapies began within 6 hours post-CTS. Amiodarone was given by intravenous infusion for the first 24 hours (1050 mg total) followed by oral therapy for 4 postoperative days (4800 mg total). Atrial septal pacing was given for 96 hours. Amiodarone reduced the risk of AF by 43% and the risk of symptomatic AF by 68% (Pϭ0.037 and Pϭ0.019) versus placebo. Atrial septal pacing did not reduce AF or symptomatic AF incidence versus no pacing. The risk of post-CTS AF in the patients receiving amiodaroneϩpacing was lower than the placeboϩno pacing and the placeboϩpacing groups (57.9% and 60.5% reductions, Pϭ0.047 and Pϭ0.040, respectively). Conclusions-Amiodarone given as both an intravenous and oral regimen is effective at reducing post-CTS AF but atrial septal pacing is ineffective. Combining amiodarone and pacing is better than placebo with or without pacing but not amiodarone alone.

Objectives. To determine the effectiveness and student acceptance of using a human patient simulation (HPS) training module focused on interdisciplinary teamwork skills. Design. During their second-professional year, all pharmacy students were in enrolled in Principles of Pharmacotherapy 4: Cardiovascular Diseases and Patient Care Lab IV, a problem-based learning course. As part of the patient care laboratory, students participated in a simulated case of an acutely ill patient with a hypertensive emergency. During the simulation, students performed a history and physical examination. They then worked as a team to make treatment recommendations to the nursing and physician staff members. Following the exercise, a facilitated debriefing session was conducted. Students completed satisfaction surveys to assess the quality and effectiveness of the session. Assessment. Over 98% of students agreed or strongly agreed that they learned material relevant to their current studies. When compared to student lectures, 90% of students felt that they learned clinical patient care better when using a HPS mannequin in simulated patient scenarios. Conclusion. HPS-based learning offers a realistic training experience through which clinical knowledge and interpersonal teamwork skills can be taught. Students enjoy the experience and find it relevant to their future practice. Simulation-based training may teach certain topics better than traditional lecture formats and as such could help to fill gaps in the current pharmacy curriculum.

BACKGROUND:Warfarin is implicated in approximately 30% of reported anticoagulant‐related errors. In order to improve anticoagulation management and safety, our institution implemented an inpatient Pharmacist‐Directed Anticoagulation Service (PDAS).OBJECTIVE:To evaluate the impact of this service on both transition of care and safety of patients receiving warfarin anticoagulation.DESIGN:Cluster randomized trial.SETTING:Large, urban teaching hospital and level 1 trauma center.PATIENTS:All patients receiving warfarin on two medical and two cardiology units.INTERVENTION:A PDAS provided dosing, monitoring, and coordination of transition from the inpatient‐to‐outpatient setting.MEASUREMENTS:Endpoints were assessed during hospitalization and 30 days after discharge. Transition of care was considered effective if compliance with all of the transition of care metrics occurred. The transition of care metrics included: appropriate enrollment in the anticoagulation clinic, documented inpatient‐to‐outpatient provider contact, documented inpatient provider‐to‐anticoagulation clinic communication and patient follow‐up with the anticoagulation clinic within five days of discharge. Safety was measured by the composite endpoint of thromboembolism, major bleeding, or international normalized ratio (INR) ≥5.RESULTS:This study included 500 patients. Transition of care metric compliance occurred in 73% more patients in the PDAS group (P < 0.001). There was also a 32% reduction in the composite safety endpoint in the PDAS group (P = 0.103). This finding was driven by a reduction in rate of INR ≥5 (P = 0.076).CONCLUSIONS:Implementation of a PDAS provides a net improvement in quality of care for the patient taking warfarin in the inpatient setting. Journal of Hospital Medicine 2011;6:322–328. © 2011 Society of Hospital Medicine