Pharmacy discharge counseling was associated with reduced 30-day readmission rates in those patients at moderate risk for readmission.

Steroids are used for specific indications in the perioperative period to reduce laryngeal or spinal cord edema, or for prophylaxis and treatment of postoperative nausea and vomiting. Given the other potential causes for hemodynamic alterations in the perioperative setting, it is important for physicians to be aware of cardiovascular side effects of short term steroids. Changes in blood pressure and heart rate, cardiac dysrhythmias, and even death have been described in patients receiving short term intravenous steroids. Bradycardia has been reported following short term methylprednisolone and dexamethasone therapy in both adult and pediatric patients. There are only two case reports in the literature of bradycardia following short term intravenous dexamethasone use in adult patients. This is the first case report that describes bradycardia following the use of dexamethasone in the postoperative setting for management of laryngeal edema in an adult. Telemetry and twelve lead electrocardiograms revealed sinus bradycardia and correlated directly with administration of dexamethasone in our patient. Bradycardia resolved following discontinuation of dexamethasone. We advocate for hemodynamic monitoring in patients receiving more than one dose of intravenous steroid therapy in the perioperative period, especially those with known cardiac and hepatic comorbidities and those taking medications with negative chronotropic effects.

Results from recent trials have evaluated the potential clinical advantages of metformin in patients with cardiac disease and HF. These studies have illustrated a favorable morbidity and mortality profile for the use of metformin in these patient populations. While large prospective trials are still needed to display conclusive evidence, the recent clinical trials suggest a benefit in areas where metformin use has previously been discouraged.

dispensation was analyzed during the 6-month follow-up period. The impact of formulary restriction on likelihood of prescribed AED's successful dispensation was assessed using multivariable Cox proportional hazards model. Results: There were 9,529 and 3,081 patients in the approved and rejected claim cohorts, respectively. The proportion of patients with an index claim for a generic AED was higher in the approved (95.9%) vs. the rejected (88.9%) cohort. Mean (SD) time to first dispensation was 2.1 (11.9) and 7.4 (21.5) days for the approved and rejected cohort, respectively. The proportion of patients with a successful index AED dispensation at 6 months was higher in the approved (92.8%) vs. rejected (75.7%) cohort. After adjustment, formulary-related rejection of an index AED was associated with lower likelihood of its successful dispensation [hazard ratio: 0.73; p,0.001]. Conclusions: Formulary restrictions may lead to an average delay of 5.3 days and reduced likelihood of successful dispensation of AED treatment for pediatric patients diagnosed with FS.