Andrea Sikora Newsome

• Doctor of Pharmacy
• The University of Georgia College of Pharmacy

Purpose: ASHP Residency Standards consider research an important component of residency training. Publication of these projects is considered the gold standard for high quality research; however, residency research publication rates are low, with most reports suggesting less than 12% of projects are successfully published. This study reviewed post-...

Objectives To evaluate the relationship among ICU patient-to-pharmacist ratio, perceived quality of patient care, and pharmacist burnout. Design A prospective, multicenter, time-motion study conducted over a 10-month period (from May 1, 2022, to February 28, 2023). Setting Adult ICU, PICU, or neonatal ICU. SUBJECTS ICU clinical pharmacists Inte...

Background Large language models (LLMs) have demonstrated impressive performance on medical licensing and diagnosis-related exams. However, comparative evaluations to optimize LLM performance and ability in the domain of comprehensive medication management (CMM) are lacking. The purpose of this evaluation was to test various LLMs performance optimi...

Disclaimer In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with...

Background Fluid overload (FO) in the intensive care unit (ICU) is common, serious, and may be preventable. Intravenous medications (including administered volume) are a primary cause for FO but are challenging to evaluate as a FO predictor given the high frequency and time‐dependency of their use and other factors affecting FO. We sought to employ...

Purpose The medication regimen complexity intensive care unit (MRC-ICU) score has previously been associated with pharmacist workload and fluid overload. The purpose of this study was to determine the relationship of MRC-ICU score with pharmacist-driven fluid stewardship recommendations as a means of establishing its role in risk stratifying critic...

Artificial Intelligence (AI) has become essential in modern healthcare, with large language models (LLMs) offering promising advances in clinical decision-making. Traditional model-based approaches, including those leveraging in-context demonstrations and those with specialized medical fine-tuning, have demonstrated strong performance in medical la...

Background Critical care pharmacists are well‐established, valuable members of the intensive care unit interprofessional team with unique skills to perform comprehensive medication management in complex critically ill patients. However, standardized and consequential productivity metrics for critical care pharmacists have not been established. Obj...

The pursuit of research and scholarly productivity is critical for clinician scientists, yet achieving impactful outcomes often necessitates collaboration within a well‐structured team. This review explores the foundational elements of team building that support sustained research productivity among health care professionals and academicians. Drawi...

Background: Critically ill patients are managed with complex medication regimens that require medication management to optimize safety and efficacy. When performed by a critical care pharmacist (CCP), discrete medication management activities are termed medication interventions. The ability to define CCP workflow and intervention timeliness depends...

Background: Medication management in the intensive care unit (ICU) is causally linked to both treatment success and potential adverse drug events (ADEs), often associated with deleterious consequences. Patients with higher severity of illness tend to require more management. The purpose of this evaluation was to explore the effect of comprehensive...

This comprehensive study evaluates the performance of OpenAI's o1-preview large language model across a diverse array of complex reasoning tasks, spanning multiple domains, including computer science, mathematics, natural sciences, medicine, linguistics, and social sciences. Through rigorous testing, o1-preview demonstrated remarkable capabilities,...

Objective. Describe continuous infusion (CI) ketamine practices in pediatric intensive care units (PICUs) and evaluate its effect on pain/sedation scores, exposure to analgesics/sedatives, and adverse effects (AEs). Methods. Multicenter, retrospective, observational study in children <18 years who received CI ketamine between 2014 and 2017. Time sp...

Background: Large language models (LLMs) have shown capability in diagnosing complex medical cases and passing medical licensing exams, but to date, only limited evaluations have studied how LLMs interpret, analyze, and optimize complex medication regimens. The purpose of this evaluation was to test four LLMs ability to identify medication errors a...

Background: Large language models (LLMs) such as ChatGPT have emerged as promising artificial intelligence tools to support clinical decision making. The ability of ChatGPT to evaluate medication regimens, identify drug-drug interactions (DDIs), and provide clinical recommendations is unknown. The purpose of this study is to examine the performance...

Background Intravenous (IV) antibiotics have historically been considered standard of care for treatment of bloodstream infections (BSIs). Recent literature has shown sequential oral (PO) therapy to be noninferior to IV antibiotics for certain pathogens and disease states. However, a gap exists in the literature for BSI caused by Enterococcus faeca...

Objective Common data models provide a standard means of describing data for artificial intelligence (AI) applications, but this process has never been undertaken for medications used in the intensive care unit (ICU). We sought to develop a common data model (CDM) for ICU medications to standardize the medication features needed to support future I...

Background: In critically ill patients, complex relationships exist among patient disease factors, medication management, and mortality. Considering the potential for nonlinear relationships and the high dimensionality of medication data, machine learning and advanced regression methods may offer advantages over traditional regression techniques. T...

OBJECTIVES/GOALS: To determine if incorporating specific laboratory values and plasma biomarkers (club cell secretory protein (CC16), matrix metalloproteinase 3 (MMP3), interleukin 8 (IL-8), protein C) to the Lung Injury Prediction (LIP) Score improves the predictive value for development of acute respiratory distress syndrome (ARDS) in ICU patient...

Purpose: Critical care pharmacists are considered essential members of the healthcare team; however, justification and recruitment of new positions, especially in the evening or weekend shifts, remains a significant challenge. The purpose of this study was to investigate the number of interventions, type of interventions, and associated cost saving...

The purpose of this study was to compare performance of ChatGPT (GPT-3.5), ChatGPT (GPT-4), Claude2, Llama2-7b, and Llama2-13b on 219 multiple-choice questions focusing on critical care pharmacotherapy. To further assess the ability of engineering LLMs to improve reasoning abilities and performance, we examined responses with a zero-shot Chain-of-T...

INTRODUCTION: Intravenous (IV) medications are a fundamental cause of fluid overload (FO) in the intensive care unit (ICU); however, the association between IV medication use (including volume), administration timing, and FO occurrence remains unclear. METHODS: This retrospective cohort study included consecutive adults admitted to an ICU ≥72 hours...

Objectives A lack of pharmacist-specific risk-stratification scores in the electronic health record (EHR) may limit resource optimization. The medication regimen complexity-intensive care unit (MRC-ICU) score was implemented into our center’s EHR for use by clinical pharmacists. The purpose of this evaluation was to evaluate MRC-ICU as a predictor...

Purpose: The purpose of this study was to determine the relationship between medication regimen complexity-intensive care unit (MRC-ICU) score at 24 hours and medication errors identified throughout the ICU. Methods: A single-center, observational study was conducted from August to October 2021. The primary outcome was the association between MRC-I...

Purpose The medication regimen complexity-intensive care unit (MRC-ICU) score was developed prior to the existence of COVID-19. The purpose of this study was to assess if MRC-ICU could predict in-hospital mortality in patients with COVID-19. Methods A single-center, observational study was conducted from August 2020 to January 2021. The primary ou...

Fluid overload, while common in the ICU and associated with serious sequelae, is hard to predict and may be influenced by ICU medication use. Machine learning (ML) approaches may offer advantages over traditional regression techniques to predict it. We compared the ability of traditional regression techniques and different ML-based modeling approac...

Disclaimer In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with...

Objective: A lack of pharmacist-specific risk-stratification scores in the electronic health record (EHR) may limit resource optimization. The medication regimen complexity-intensive care unit (MRC-ICU) score was implemented into our centers EHR for use by clinical pharmacists. The purpose of this evaluation was to evaluate MRC-ICU as a predictor o...

Objective: Common Data Models provide a standard means of describing data for artificial intelligence (AI) applications, but this process has never been undertaken for medications used in the intensive care unit (ICU). We sought to develop a Common Data Model (CDM) for ICU medications to standardize the medication features needed to support future...

Rationale Duration of mechanical ventilation is associated with adverse outcomes in critically ill patients and increased use of resources. The increasing complexity of medication regimens has been associated with increased mortality, length of stay, and fluid overload but has never been studied specifically in the setting of mechanical ventilation...

BACKGROUND The workload of healthcare professionals including physicians and nurses in the ICU has an established relationship to patient outcomes, including mortality, length of stay, and other quality indicators; however, the relationship of critical care pharmacist workload to outcomes has not been rigorously evaluated and determined. The object...

In this study, we introduce PharmacyGPT, a novel framework to assess the capabilities of large language models (LLMs) such as ChatGPT and GPT-4 in emulating the role of clinical pharmacists. Our methodology encompasses the utilization of LLMs to generate comprehensible patient clusters, formulate medication plans, and forecast patient outcomes. We...

While medication regimen complexity, as measured by a novel medication regimen complexity-intensive care unit (MRC-ICU) score, correlates with baseline severity of illness and mortality, whether the MRC-ICU improves hospital mortality prediction is not known. After characterizing the association between MRC-ICU, severity of illness and hospital mor...

Objective: The challenge of irregular temporal data, which is particularly prominent for medication use in the critically ill, limits the performance of predictive models. The purpose of this evaluation was to pilot test integrating synthetic data within an existing dataset of complex medication data to improve machine learning model prediction of...

Background Matrix metalloproteinase-3 (MMP-3) is a proteolytic enzyme involved in acute respiratory distress syndrome (ARDS) pathophysiology that may serve as a lung-specific biomarker in ARDS. Methods This study was a secondary biomarker analysis of a subset of Albuterol for the Treatment of Acute Lung Injury (ALTA) trial patients to determine th...

Background Fluid overload, while common in the ICU and associated with serious sequelae, is hard to predict and may be influenced by ICU medication use. Machine learning (ML) approaches may offer advantages over traditional regression techniques to predict it. We compared the ability of traditional regression techniques and different ML-based model...

Developing patient-centered critical care pharmacist practice models requires thoughtful assessment of stakeholders, goals, and mechanisms.¹ With rising rates of burnout and attrition, development of sustainable models is increasingly important.² Pharmacist leaders may find it difficult to request additional pharmacist full-time equivalents (FTEs)...

Background Identifying patterns within ICU medication regimens may help artificial intelligence algorithms to better predict patient outcomes; however, machine learning methods incorporating medications require further development, including standardized terminology. The Common Data Model for Intensive Care Unit (ICU) Medications (CDM-ICURx) may pr...

Background Club cell secretory protein (CC16) has demonstrated utility as a lung-specific biomarker in predicting mortality in acute respiratory distress syndrome (ARDS). These findings have been observed in pre-clinical trials and a re-analysis of a large, randomized controlled trial of ARDS (Fluid and Catheter Treatment Trial (FACTT)). Objective...

Background: Acute respiratory distress syndrome (ARDS) confers high morbidity and mortality, with a death rate reaching 40%. Pre-clinical and clinical studies have cited sex-specific sex hormones as a critical contributor to divergent immunologic responses. Therefore, exploration of sex and sex hormone roles following lung injury and ARDS developm...

Background Critically ill patients are often prescribed both inhaled beta-agonists and intravenous vasoactive; however, the interaction of the additive beta-agonist effects of these 2 agents remains largely uncharacterized. Objective The purpose of this study was to evaluate how concomitant use of albuterol and vasoactive or inotropes affected ven...

The challenges of the research process have been well reviewed, but readily implementable strategies are often lacking for individual pharmacists.1,2 Here we propose that leveraging existing resources using 3 established constructs for professional success (team science, layered learning, and mentorship networks) may address the ongoing problem of...

Despite the established role of the critical care pharmacist on the ICU multiprofessional team, critical care pharmacist workloads are likely not opti- mized in the ICU. Medication regimen complexity (as measured by the Medication Regimen Complexity-ICU [MRC-ICU] scoring tool) has been proposed as a potential metric to optimize critical care pharma...

Reverse triggering is an underdiagnosed form of patient-ventilator asynchrony in which a passive ventilator-delivered breath triggers a neural response resulting in involuntary patient effort and diaphragmatic contraction. Reverse triggering may significantly impact patient outcomes, and the unique physiology underscores critical potential implicat...

Identification of novel therapies is a critical need in the treatment of coronavirus disease-19 (COVID-19) and acute respiratory distress syndrome (ARDS). Stromelysin-1, also known as matrix-metalloproteinase 3 (MMP3) has been investigated as both a diagnostic biomarker and a potential pharmacological target. Here, we discuss recent findings of Gel...

Objectives: Despite the established role of the critical care pharmacist on the ICU multiprofessional team, critical care pharmacist workloads are likely not optimized in the ICU. Medication regimen complexity (as measured by the Medication Regimen Complexity-ICU [MRC-ICU] scoring tool) has been proposed as a potential metric to optimize critical...

Unsupervised clustering of intensive care unit (ICU) medications may identify unique medication clusters (i.e., pharmacophenotypes) in critically ill adults. We performed an unsupervised analysis with Restricted Boltzmann Machine of 991 medications profiles of patients managed in the ICU to explore pharmacophenotypes that correlated with ICU compli...

Enjoy your achievements as well as your plans. Keep interested in your own career, however humble; it is a real possession in the changing fortunes of time. —Max Ehrmann, The Desiderata of Happiness We read with interest the letters by Rux et al¹ and Arendt et al² regarding burnout in pharmacy residents (and beyond). They discuss concerns about com...

Background: Propofol is a key component for the management of sedation and shivering during targeted temperature management (TTM) following cardiac arrest. The cardiac depressant effects of propofol have not been described during TTM and may be especially relevant given the stress to the myocardium following cardiac arrest. The purpose of this stud...

Introduction: Fluid stewardship targets optimal fluid management to improve patient outcomes. Intravenous (IV) medications, flushes, and blood products, collectively referred to as hidden fluids, contribute to fluid intake in the intensive care unit (ICU). The impact of specific IV medications on fluid intake is unknown. Objective: Characterize IV...

Introduction: The position paper on critical care pharmacy services describes two tiers of responsibilities: essential and desirable activities. Activities are categorized into five domains: patient care, quality improvement, research and scholarship, training and education, and professional development. Documentation of these activities can be imp...

We thank Drs. Haas and Dick for their thoughtful commentary on our team’s recent evaluation, which allows us to continue the vital discussion of optimizing critical care pharmacist services for critically ill patients.¹ We wholeheartedly agree that pharmacist workload (ie, the amount of work to be done) and productivity (ie, units of output divided...

Disclaimer In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with...

Training in the scientific method and research design in doctor of pharmacy (Pharm.D.) curricula enables critical thinking, acquisition of reliable information, rigorous evaluation of emerging literature, and application of evidence‐based medicine in practice. Although research skills are essential for clinical pharmacists and many professional soc...

The response of ICU patients to continuously infused ketamine when it is used for analgesia and/or sedation remains poorly established. Objectives: To describe continuous infusion (CI) ketamine use in critically ill patients, including indications, dose and duration, adverse effects, patient outcomes, time in goal pain/sedation score range, expos...

Introduction Angiotensin II (Ang-2) is a non-catecholamine vasopressor that targets the renin-angiotensin-aldosterone system by agonism of the angiotensin type 1 receptor. Its utility as a vasopressor and a catecholamine-sparing agent was demonstrated in the pivotal ATHOS-3 trial, and numerous post-hoc analyses have shown reduced mortality in certa...

Disclaimer In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with...

Catecholamine upregulation is a core pathophysiological feature in critical illness. Sustained catecholamine β-adrenergic induction produces adverse effects relevant to critical illness management. β-blockers (βB) have proposed roles in various critically ill disease states, including sepsis, trauma, burns, and cardiac arrest. Mounting evidence sug...

We applaud Dr. Erstad’s commentary on justification of the value of critical care pharmacist services and share in the belief that every patient managed in an intensive care unit (ICU) should receive the care of a critical care pharmacist.¹ Yet, we want to caution both readers and future investigators against resting on the laurels of cost avoidanc...

Preexisting heart failure (HF) in patients with sepsis is associated with worse clinical outcomes. Core sepsis management includes aggressive volume resuscitation followed by vasopressors (and potentially inotropes) if fluid is inadequate to restore perfusion; however, large fluid boluses and vasoactive agents are concerning amid the cardiac dysfun...

Objectives Concern for late detection of bacterial pathogens is a barrier to early de-escalation efforts. The purpose of this study was to assess blood, respiratory and urine culture results at 72 h to test the hypothesis that early negative culture results have a clinically meaningful negative predictive value. Methods We retrospectively reviewed...

Purpose/Background: Percutaneous left ventricular assist devices (pVADs) require a continuous purge solution containing heparin to prevent pump thrombosis and device failure. Data regarding alternative options in patients who have suspected heparin-induced thrombocytopenia (HIT) are limited. Methods: In this report, we describe a 68-year-old white...

Purpose: The purpose of this study was to determine if national drug shortages of electrolyte replacement products negatively impact patient care. Methods: This study was a single-center, retrospective, observational cohort of adults admitted to the medical, surgical, or trauma intensive care unit (ICU) that were ordered or would have qualified for...

In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of recor...

Disclaimer In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final versi...

What gets measured, gets improved. —Robert Sharma Every critically ill patient requires care by a critical care pharmacist (CCP) for best possible outcomes. Indeed, these highly trained professionals generate benefit through direct patient care (eg, pharmacist-driven protocols, medication monitoring, etc), participation on the intensive care unit (...

Objective:. This case series describes the effect of angiotensin II administration on hemodynamics in patients with parenchymal lung injury due to submersion injury. Case Summary:. A 33-year-old female and a 72-year-old female were both brought to the emergency department after incidents of near drowning. Upon arrival to the emergency department, b...

Background The optimal vasopressor management for septic patients with left ventricular (LV) dysfunction has not been well established, and current evidence is conflicting regarding the optimal vasopressor discontinuation order. Objective The objective was to evaluate the impact of LV dysfunction on the hemodynamic management of septic shock by as...

Despite the frequent use of maintenance intravenous fluids (mIVF) in critically ill patients, limited guidance is available. Notably, fluid overload secondary to mIVF mismanagement is associated with significant adverse patient outcomes. The Four Rights (right drug, right dose, right duration, right patient) construct of fluid stewardship has been...

Background Critically ill patients are at increased risk for fluid overload, but objective prediction tools to guide clinical decision-making are lacking. The MRC-ICU scoring tool is an objective tool for measuring medication regimen complexity. Objective To evaluate the relationship between MRC-ICU score and fluid overload in critically ill patie...

Acute respiratory distress syndrome (ARDS) is a life-threatening form of acute lung injury (ALI) associated with hypoxemic lung damage and inflammation. Matrix metalloproteinase protein-3 (MMP3 or Stromelysin-1) is known to promote vascular injury in ALI/ARDS. Cisatracurium, a nicotinic neuromuscular blocker, is used in ARDS patients to decrease me...

The importance of intensive care unit (ICU)–specific antibiograms has not been well established but may have key patient care implications if resistance rates are significantly different between the institution and a specific ICU location. Here, we argue that institutions should investigate and develop ultra-localized antibiograms for each ICU, esp...