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Critical Care Training and Education | Fellowship in Critical Care

Critical Care Fellowship Program

The fellow will be based at Tufts Medical Center and will actively collaborate with members of the Department of Pharmacy Services and Department of Medicine, Pulmonary, Critical Care, and Sleep Division.

Description of Fellowship Program

A. Overview

The critical care fellowship at Northeastern University and Tufts Medical Center (TMC) is a new program. The primary goal of this postdoctoral fellowship program is to provide the ICU pharmacist with the skills to be able to answer pharmacotherapy-related questions posed in every day clinical practice through the design, implementation and and evaluation of methodologically-sound studies. The fellowship program will integrate didactic training, clinical experience and active participation in the development and completion of original research in critically ill patient populations. Development of laboratory-based analytical skills and proficiency in data analysis are additional major goals of the fellowship program. Research participation will account for more than 75% of the fellow’s activities.

Over the course of the two-year program, the fellow will be expected to assume responsibility for developing 2-3 research proposals for which the fellow will act as the principal investigator. Through these proposals, the fellow will gain experience at protocol development including methodological and statistical design considerations, budget preparation, the IRB submission process, grantsmanship, patient enrollment including obtainment of informed consent, chart documentation and adverse event reporting, appropriate study record keeping and data analysis. The fellow will also collaborate (co-investigator status) with the preceptor, other residents and fellows, and investigators outside the department in the design and implementation of several additional research proposals.

While independent research is the primary focus of the program, the fellow will also be exposed to multi-center Phase II, III and IV studies in terms of patient enrollment, case report documentation and IRB-related documentation. The fellow will be responsible for the preparation and submission of their research results for national presentation in the form of platform and/or poster presentation in addition to subsequent preparation and submission of a manuscript to an appropriate peer-reviewed journal for publication. The fellow will have the opportunity to didactically teach PharmD students and other health care professionals and to precept both pharmacy and PharmD students during their MICU rotation.

B. Length and Distribution of the Fellowship Activities

Duration of fellowship: 2 years

Percentage of the fellow’s time spent in each activity:

  • Research 75%
  • Teaching 15%
  • Patient Care 10%
C. Experiences Enabling the Fellow to Become an Independent Researcher

The fellow will gain clinical research experience at TMC and laboratory research experience in the laboratory of Dr. Barbara Waszczak at the Northeastern University School of Pharmacy and/or the Pulmonary Hyptertension Research Laboratory at Tufts Medical Center. (see below). Throughout the program, the fellow will be required to attend the weekly clinical pharmacy rounds at TMC, the bi-weekly department of pulmonary/critical care research rounds, and pertinent lectures at the School of Pharmacy at Northeastern University. The fellow will also be encouraged to attend all relevant seminars and workshops offered throughout the academic year at both Northeastern University and TMC including the monthly pharmacy colloquium, medical grand rounds, and visiting professor presentations.

1. Clinical Research
The fellow will gain experience developing a bedside pharmacotherapy-related question into a precise research hypothesis. Through interaction with the preceptor and collaboration with expert pharmacist and physician researchers, the fellow will learn how to develop a methodologically-sound, yet feasible research protocol. The fellow will learn how to identify appropriate research funding sources. An emphasis will be given to participation in the application process for competitive research grants by working with the preceptor in addition to members of the Division of Pulmonary and Critical Care Medicine at TMC, the Department of Pharmacy at TMC, and the Department of Pharmacy Practice at Northeastern University.

The fellow will learn how to develop a study budget that incorporates institutional or university overhead costs. Fellows will gain experience in identifying appropriate grant funding agencies from discussions with the preceptor, by example (preceptor, other faculty members), and by circulation of both Northeastern and Tuft’s University postings of potential grant funding agencies. The fellow will gain experience in the IRB application process (ie. drafting consent forms and completing protocol summary forms) in addition to gaining a general appreciation for the role of the IRB and the mandatory communications (e.g. adverse event reporting, protocol extensions etc) often necessary throughout the duration of the research protocol.

The fellow will develop skills to efficiently identify patients for both their own primary research projects in addition to those of the preceptor and attending pulmonologists. Experience will be gained in obtaining informed consent from both patients and next-of-kin, appropriate chart documentation, as well as overcoming the barriers that can arise during the enrollment phase. Familiarity with case report form reporting procedures will also be gained and the fellow will have the opportunity to participate in meetings with pharmaceutical study monitors, co-investigators, and research nurses. The fellow will learn to use the appropriate spreadsheet and statistical software to analyze, summarize, and interpret study results. Study results will be incorporated into an abstract and submitted for presentation to national meetings. Subsequently, the fellow will participate in the writing of a study manuscript for submission to a peer-reviewed journal.

2. Laboratory Research
The fellow will complete a two months of laboratory research in either: 1) the laboratory of Dr.Barbara Waszczak, Associate Professor of Pharmacology, School of Pharmacy, Northeastern University. Dr Waszczak’s research focuses on deciphering how dopamine regulates specific neuronal populations within the motor and limbic circuits to ultimately facilitate movement and mediate the reward functions of dopamine and/or 2) the Pulmonary Hypertension Research Laboratory at Tufts Medical Center under the direction of Dr. Ioanna Preston.

A number of different experimental approaches are used to study these disorders in rat models. Fellows will have an opportunity to become involved in electrophysiological, anatomical, or behavioural research aimed at determining how disruptions of the dopamine system change the output from the circuitry. Currently, experiments involve intracerebral microinjections of drugs into the rat brain to create an animal model of Parkinson’s disease, and then using electrophysiological methods to assess how the lesions change the firing of neurons downstream from the lesion. The laboratory training will include an overview of the OSHA safety guidelines for laboratories and the Good Laboratory Practice (GLP) regulations, performance of basic laboratory techniques, and assay validation. Fellows will be given training in basic laboratory skills, such as handling and dosing rats, small animal stereotaxic surgery, preparing solutions, pipetting, weighing, carrying out research protocols, monitoring of electrophysiologic responses, recording of data, management of a data notebook, and data analysis.

3. Educational Opportunities

  1. Coursework The fellow is required to complete coursework offered by the Graduate Program in Public Health, School of Medicine, Tufts University and/or Department of Biostatistics, College of Arts and Sciences, Northeastern University in the areas of Research Design, Epidemiology, and Biostatistics.
  2. Didactic or experiential teaching The fellow will be actively involved in two Northeastern University doctor of pharmacy courses: the research design course and the cardiology/critical care module of the therapeutics course. Other opportunities to teach medical students, medical residents, and other allied health professionals are available. The fellow will have the opportunity to preceptor both T-NEMC pharmacy residents and Northeastern University doctor of pharmacy students during their MICU rotation at T-NEMC. The fellow will also be expected to act as a clinical resource to the other pharmacists at T-NEMC. The fellow will also have the opportunity to complete rotations in the SICU and CCU while at T-NEMC. The fellow will not be required to provide clinical or distributive coverage.

4. Other Professional Experience
The fellow will actively participate with the preceptor in academic reviewing for Critical Care Medicine, Pharmacotherapy, Annals of Pharmacotherapy, and ACCP and SCCM research abstracts. The fellow will be encouraged to further develop critical appraisal and writing skills by participating in the preparation of review articles, textbook chapters, and letters to the editor. The fellow may also be required to perform minor administrative functions in the Department of Pharmacy Practice at Northeastern University.

D. Facilities Available

1. Clinical Research Facilities Founded at the Boston Dispensary in 1796, TMC is the oldest permanent medical facility in New England. The 474 bed medical center serves as the principal teaching hospital for Tufts University School of Medicine and is internationally renowned for its transplantation services, general surgery using both traditional and minimally invasive techniques, vascular surgery, cancer care, cardiology and cardiothoracic surgery. TMC is in the top five percent of all institutions nation-wide receiving National Institute of Health Funding. The 24 pharmacists in the Department of Pharmacy offer pharmaceutical care through a wide variety of patient care programs. Staff actively participate in educational and research programs with TMC, Tufts University School of Medicine, and the School of Pharmacy at Northeastern University. An active and well funded research program between the Department of Pharmacy and The Health Institute at the Medical Center is focused on the assessment of patient outcomes. Pharmacy residents have been trained in an ASHP-accredited training program for more than 25 years. In addition, the journal Pharmacotherapy is supported by and published at the Medical Center.

TMC provides care to the critically ill in a 14-bed medical intensive care unit (MICU), a 10-bed surgical ICU, a 12-bed coronary ICU, and a 10-bed cardiothoracic surgery ICU. More than 800 patients are admitted each year to the MICU at TMC. Members of the Pulmonary and Critical Care Division of the Department of Medicine lead a multidisciplinary approach to critical care that incorporates nursing, nutrition support, respiratory care, social work and pharmacy expertise. The MICU at TMC is a part of project IMPACT, is the site for numerous research studies, and will be the major practice, teaching and research site for the fellowship program. Dr. Devlin currently provides clinical pharmacy services in the MICU and has a number of research projects either underway or in the planning stage for this population. Dr. Devlin is a member of the Pulmonary and Critical Care Division and regularly participates in research-related meetings and rounds. Members of this division will take an active role in supporting the fellowship program.

2. Laboratory Research Facilities Dr. Wasczak has a 600 sq ft laboratory that is located on the 4th floor of the Mugar Life Sciences Building at Northeastern University. Two fully equipped stations for extracellular electrophysiology are available in separated, small rooms within the main laboratory. Each set-up is equipped with: David Kopf small animal stereotaxic with 2 electrode manipulators, hydraulic microdrive, Tektronix dual beam storage oscilloscope with 2 differential amplifiers and time base, microprobe amplifier and slope height window discriminator with timed counter, Datel printer, microiontophoresis unit, Gould physiological recorder, audio monitor, VCR and recorder adapter for taping experiments, YSI-telethermometer coupled to a small animal heating pad, Fintronics bi-polar constant current source. The following equipment is shared by users of both set-ups: Narashige PE-2 microelectrode puller, electrode impedance tester, David Kopf microinjection unit for stereotaxic delivery of microliter volumes into brain, Harvard Apparatus dual infusion pump for bilateral striatal drug infusions, oscilloscope camera, WPI interval generator with 2 pulse train modules and stimulus isolator. In addition to the above, a small room adjacent to the main laboratory is equipped as a dedicated surgical space for making lesions in rats. This room houses a Kopf small animal stereotaxic with adaptors to permit bilateral angled stereotaxic surgery, a hot bead instrument sterilizer, Harvard Apparatus dual infusion pump for intracerebral drug infusions, and routine surgical supplies. Also present in the main laboratory are the following: cryostat, AO microtome with freezing stage, light microscope, dissecting microscope, pH meter, analytical balance, refrigerator and other routine laboratory equipment.

3. Medical Library The Health Sciences Library has over 50,000 books in its collection and subscribes to over 900 medical journals. Tufts University patrons have access (through the combined collections of the 3 campus libraries) to over 13,000 electronic journals of which 3684 of these are biomedical titles.

4. Computer Facilities The fellow will be provided with office space that includes an IBM-compatible Pentium desktop computer and printer and access to a Pentium laptop. This computer is online with the TMC computerized LAN system and is hardwired to TMC’s internet facility. Software available to the fellow from their personal computer or form the LAN within the hospital includes: Word, Excel, Powerpoint, Access, SPSS 16.0, and Sigmaplot. There is strong information support at T-NEMC. The fellow will also be provided with a telephone having voicemail capabilities and an alpha numeric pager.

E. Other

1. Stipend and Benefits The fellow will receive an annual salary of $ 45, 000 per year plus full medical and dental coverage (32% of base salary). The fellow will receive two weeks of paid vacation each year. Additional benefits include: paid membership into the Society of Critical Care Medicine and paid expenses to attend professional meetings and symposiums.

2. Other Pertinent Program Information A fellowship committee made up of the preceptor and representatives from the Northeastern University School of Pharmacy and the Division of Pulmonary and Critical Care Medicine at TMC will meet on a quarterly basis to evaluate progress during the fellowship.

Program Faculty

Director:
John W. Devlin, Pharm.D. BCPS FCCM FCCP

Associate Professor of Pharmacy, Northeastern University School of Pharmacy; Clinical Pharmacist, Medical ICU, Tufts-New England Medical Center; Adjunct Associate Professor of Medicine, Tufts University School of Medicine, Boston, MA

Dr. Devlin will have overall responsibility for the development of the fellow’s clinical research, practice and teaching skills. Dr. Devlin has worked in critical care pharmacy practice for more than 20 years and has a Bachelor of Science in Pharmacy and Doctor of Pharmacy both from the University of Toronto, a pharmacy practice residency, and a Fellowship in Critical Care Pharmacy from Henry Ford Hospital in Detroit, MI. His research and practice is based in the 14-bed medical intensive care unit at Tufts-New England Medical Center. To date he has obtained competitive research funding totally > $500,000 from the NIH, foundations and industry that has lead to the publication of more than 40 peer-reviewed research papers, most in high impact critical care subspecialty journals. He has published an additional 30 review papers, book chapters and editorials. Dr. Devlin has been invited to deliver more than 50 invited presentations pertaining to various critical care-related topics at local, state, national and international forums to pharmacists, physicians and nurses since 1996.

Dr. Devlin has successfully trained 3 critical care research fellows (focused 2 year program each) to date in his career: 1) Salmaan Kanji, PharmD, Clinical Scientist, University of Ottawa Health Research Scientist 2) Jeffrey Fong, PharmD, Assistant Professor, Massachusetts College of Pharmacy, Worcester, MA. 3) Russ Roberts, PharmD, Clinical Pharmacy Specialist, Critical Care, Tufts Medical Center. Boston, MA

Other Members

Edward Decker, Pharm.D.
Associate Director of Pharmacy, Tufts Medical Center

Erik Garpestad,
MD

Dr. Garpestead is an Associate Professor of Medicine, Tufts University and Director of the MICU at TMC. He is an active participant in the development of critical care-focused research projects at T-NEMC.

Nicholas Hill MD, FCCP
Dr. Hill is a Professor of Medicine, Tufts University and Chief of the Division of Pulmonary/Critical Care Medicine at TMC. He is a world authority on non-invasive mechanical ventilation and pulmonary hypertension and has authored numerous peer-reviewed articles in these areas.

Jack Reynolds, Pharm.D.
Dean, School of Pharmacy, Northeastern University

Russ Roberts, PharmD
Dr. Roberts is the clinical pharmacist specialist in the Medical ICU at Tufts Medical Center and is a key collaborator on many of the research endeavours of the Dr. Devlin and the fellow.

Barbara L. Waszczak, PhD
Dr. Waszczak, is an Associate Professor of Pharmacology at Northeastern University. Her research is focused on deciphering how dopamine regulates specific neuronal populations within the motor and limbic circuits to ultimately facilitate movement and mediate the reward functions of dopamine. She will supervise the two month laboratory experience for the fellowship program.

Application Procedure

Degree Requirements: Pharm.D. and residency training or commensurate clinical experience preferred. Please send a letter of interest, Curriculum Vitae, and arrange to have three letters of reference sent to:

John W. Devlin, Pharm.D., BCPS, FCCM
206 Mugar Life Science Building
Northeastern University
Boston, MA 02115
Phone: 617-373-8171
Fax: 617-373-7655
Email: j.devlin@neu.edu

Select Publications of the Program Director

1. Devlin, J.W, Roberts, R., Fong, J.J., Skrobik, Y., Riker R.R., Hill, N.S., Garpestad, E. Efficacy and safety of quetiapine for delirium in the ICU: A randomized, double-blind, placebo-controlled pilot study. Critical Care Medicine. Ahead of press Nov 4 2009

2. Roberts, R. Barletta, J., Fong, J., Schumaker, G., Gerlach, T., Voils, S., Kuper, P., Szumita, P., Anger, K., Papadopoulos, S., Grgurich, P., Kendall, E., Xamplas, R., Arpino, P., Ruthazer, R., Devlin, J.W. Incidence of the propofol infusion syndrome in critically ill adults. Critical Care. Crit Care. 2009 Oct 29;13(5):R169.

3. Tanios, M.A., Epstein S.K., de Wit, M., Devlin, J.W. (2009). Perceived barriers to the use of sedation protocols and daily sedation interruption. A multidisciplinary survey. Journal of Critical Care 24;66-73.

4. Fong, J.J., Devlin, J.W., (2009) Can post-operative delirium be prevented pharmacologically? Critical Care Medicine 37:1825-6.

5. Devlin, J.W., Roberts R. (2009) Pharmacology of commonly used sedatives and analgesics in the ICU. Critical Care Clinics 25: 431-49.

6. Erstad, B.L., Brophy, G.M., Martin, S.M., Haas, C.E., Devlin, J.W., Welage, L.S., Dager, W. (in press) Articles and guidelines relative to intensive care init pharmacology: a 2009 update. Pharmacotherapy.

7. Devlin, J.W., Fong J., Howard, E., Skrobik, Y., McCoy N., Yasuda C., Marshall, J. (2008). Assessment of delirium in the intensive care unit: Nursing practices and perceptions. American Journal of Critical Care 17:555-65.

8. Fong, J., Sylvia, L., Ruthazer, R., Schumaker, G., KComt, M., Devlin, J.W., (2008). Predictors of mortality in patients with propofol infusion syndrome. Critical Care Medicine 36:2281-7.

9. Devlin, J.W. (2008) The pharmacology of oversedation in mechanically ventilated adults. Current Opinions in Critical Care 14:403-7.

10. Lancaster, J., Lawrence, K., Fong, J., Doron, S., Garpestad, E., Nasraway S, Devlin, J.W. (2008). Impact of an institutional hospital-acquired pneumonia protocol on the appropriateness of antibiotic therapy and patient outcomes. Pharmacotherapy. 28:852-62.

11. Olsen, K.M., Devlin, J.W. (2008). Comparison of oral and intravenous lansoprazole pharmacodynamic response in the critically ill. Alimentary Pharmacology and Therapeutics, 28:326-333.

12. De Wit, M., Devlin, J.W. (2008). Should sedation be standardized in the ICU? Critical Care Medicine, 36:1649-51.

13. Roberts, R., Welch, S., Devlin, J.W. (2008) Corticosteroids for the prevention of post-extubation laryngeal edema in adults. Annals of Pharmacotherapy, 42:686-91.

14. Barletta, J.F., Devlin, J.W. (2008). Sedation with dexmedetomidine vs lorazepam in mechanically ventilated patients. Journal of the American Medical Association, 299:1541.

15. Metz, D.C., Devlin, J.W., Vakily, M., Atkinson, S., Lloyd, S. (2008). Administering lansoprazole 30 mg as a 2-minute intravenous injection provides greater immediate gastric acid suppression than a 30-minute infusion. Pharmacotherapy,28:301-7.

16. Devlin, J.W., Marquis, F., Riker, R.R., Robbins, T., Garpestad, E., Fong, J.J., Didomenico, D. & Skrobik, Y.S. (2008). Combined didactic and scenario-based education improves the ability of ICU staff to recognize delirium at the bedside. Critical Care,12:R19. |

17. Devlin, J.W., Nasraway, S.A. (2008). Reversing oversedation in the ICU: The role of pharmacists in energizing guideline efforts and overcoming protocol fatigue. Critical Care Medicine,36:626-8.

18. Devlin, J.W., Fong, J.J., Schumaker, G., Ruthazer, R., O’Connor, H. & Garpestad, E. (2007). Use of a validated delirium assessment tool improves the ability of physicians to recognize delirium in medical intensive care unit (MICU) patients. Critical Care Medicine, 35; 2721-4.

19. Van Amburgh, J., Devlin, J.W., Kirwin, J., Qualters, D. (2007) The active learning inventory: A tool to measure active learning in the classroom. American Journal of Pharmacy Education,71:85-93.

20. Fong, J.J., Kanji, S., Dasta, J., Garpestad, E., & Devlin, J.W. (2007). Propofol is associated with a shorter duration of mechanical ventilation than scheduled intermittent lorazepam: A database analysis using Project IMPACT. Annals of Pharmacotherapy, 41:1986-1991.

21. Devlin, J.W., Nava, S., Fong, J.J., & Hill, N.S. (2007). Survey of sedation practices during noninvasive positive-pressure ventilation to treat acute respiratory failure. Critical Care Medicine, 35:2298-2302.

22. Fong, J.J., Cecere, K., Klee, M., Garpestad, E., Unterborn, J., & Devlin, J.W. (2007). Factors influencing variability in compliance rates and clinical outcomes among three different severe sepsis bundles. Annals of Pharmacotherapy, 41, 929-36.

23. Devlin, J.W., Fong, J., Fraser, G., & Riker, R. (2007) Delirium assessment in the critically Ill. Intensive Care Medicine, 33, 929-40.

24. Rea, R., Battistone, S., Fong, J., & Devlin, J.W. (2007). Atypical antipsychotics versus haloperidol for treatment of delirium in acutely ill patients. Pharmacotherapy, 27:588-594.

25. Devlin, J.W., Bakshi, A., Bungay, K.M., & Olsen, K.M. (2006) An in vitro comparison of different providers to deliver four proton pump inhibitor (PPI) products through a feeding tube. Alimentary Pharmacology and Therapeutics, 24,1603-1613.
26. Kane-Gill, S., & Devlin, J.W. (2006). Adverse drug event reporting in the intensive care unit: A survey of current practices. Annals of Pharmacotherapy, 40,1267-1273.

27. MacLaren, R., Devlin, J.W., Martin, S.J., Dasta, J.F., Rudis, M.I., & Bond, C.A. (2006). A national survey characterizing the practice of critical care pharmacists. Annals of Pharmacotherapy, 40, 612-618.

28. Devlin, J.W., Tanios, M., & Epstein, S.K. (2006). ICU sedation: Waking up clinicians to the gap between research and practice. Critical Care Medicine, 34, 556-557.

29. Devlin, J.W., & Olsen, K.M. (2006).Proton pump inhibitor formulary considerations in the acutely ill: Part 1: Pharmacology, pharmacodynamics and available formulations. (Author’s reply). Annals of Pharmacotherapy, 40, 997-998.

30. Devlin, J.W., Fong, J.J., & Schumaker, G. (2006) Identifying factors that could account for differences in duration of mechanical ventilation between intermittent lorazepam and propofol-treated patients. Critical Care Medicine, 34, 3063-3064.

31. Devlin, J.W., Lau, A.K., & Tanios, M. (2005). Propofol-associated hypertriglyceridemia and pancreatitis in the ICU: An incidence and risk factor analysis. Pharmacotherapy, 25,1348-1352.

32. Ahrens, C.L., Barletta, J.F., Kanji, S., Tyburski, J.G., Wilson, R.F., Janisse, J.J., & Devlin, J.W. (2005). The effect of low-calorie parenteral nutrition on the incidence and severity of hyperglycemia in surgical patients: A randomized, controlled trial. Critical Care Medicine, 33, 2507-2512.

33. Devlin, J.W., & Barletta, J.F. (2005). Reevaluating the role of albumin for fluid resuscitation: Implications of the saline versus albumin fluid evaluation (SAFE). American Journal of Health-System Pharmacy, 62, 637-642.

34. Devlin, J.W., Welage, L.S., & Olsen, K.M. (2005).Proton pump inhibitor formulary considerations in the acutely ill: Part 1: Pharmacology, pharmacodynamics and available formulations. Annals of Pharmacotherapy 2005, 39, 1667-1677.

35. Devlin, J.W., Welage, L.S., & Olsen, K.M. (2005) Proton pump inhibitor formulary considerations in the acutely ill: Part 2: Clinical efficacy, safety and economics. Annals of Pharmacotherapy, 39, 1844-1851.

36. Devlin, J.W. (2005).Treatment options and formulary considerations in the management of acid suppression in critically ill patients. American Journal of Health-System Pharmacy, 62(Suppl 2), S2-3.

37. Devlin, J.W. (2005). Proton pump inhibitors for acid suppression in the intensive care unit: Formulary considerations. American Journal Health-System Pharmacy 62, (Suppl 2), S24-30.

38. Devlin, J.W., Seta M.L., Kanji, S., & Somerville, A.L. (2004). Fenoldopam versus nitroprusside for the treatment of hypertensive emergency. Annals of Pharmacotherapy, 38, 755-759.

39. Diebel, L.N., Liberati, D.M., Baylor, A.E., Brown, W.J., & Devlin, J.W. (2004). Immunogloobulin A protease is a virulence factor for gram-negative pneumonia. Surgery, 136, 937-943.

40. Nguyen, C.M., Barletta, J.F., & Devlin J.W. (2004). Use of acid suppression agents following acute, non-variceal, upper gastrointestinal bleeding. Hospital Pharmacy, 39, 970-975.

41. Devlin, J.W., & Welage, L.S. (2004). The cost effectiveness of proton pump inhibitors for bleeding peptic ulcers: The unanswered questions. Critical Care Medicine, 32, 1415-1416.

42. Betancourt, M., McKinnon, P.S., Massanari, R.M., Kanji, S., Bach, D., & Devlin, J.W. (2003). An evaluation of the cost effectiveness of drotrecogin alfa (activated) relative to the number of organ system failures. PharmacoEconomics, 21(18), 1331-1340.

43. Kanji, S., McKinnon, P.S., Barletta, J.F., Kruse, J.A., & Devlin, J.W.(2003). Bioavailability of gatifloxacin by nasogastric administration with and without concomitant enteral feeding in critically ill patients. Critical Care Medicine, 31, 1347-1352.

44. Maccioli, G.A., Dorman, T., Brown, B.R., Mazuski, J.E., McLean, B.A., Kuszaj, J.M., Rosenbaum, S.H., Frankel, L.R., & Devlin, J.W. (2003). Clinical practice guidelines for the maintenance of patient physical safety in the intensive care unit: Use of restraining therapies – American College of Critical Care Medicine Task Force 2001-2002. Critical Care Medicine, 31, 2665-2676.

45. Kanji, S., Barletta, J.F., Janisse, J., Kruse, J.A., & Devlin, J.W. (2002). Tachyphylaxis associated with continuous cisatracurium versus pancuronium therapy. Pharmacotherapy, 22, 823-830.

46. Delgado, G., Barletta J.F., Kanji, S., Tyburski, J.G., Wilson, R.F., & Devlin, J.W. (2002). Characteristics of prophylactic antibiotic strategies following penetrating abdominal trauma at a level one urban trauma center: A comparison to the EAST Guidelines. Journal Trauma, 53, 673-678.

47. Vanscoy, G., Devlin, J.W., Ponzillo, J., & Kuhl, D.A. (2002). Implementing guidelines for drotrecogin alfa (activated): Three perspectives. Pharmacy and Therapeutics, 27, 1-15.

48. Devlin, J.W., & Kanji, S. (2002). Managing thrombosis syndromes. In: Critical Care Module, Pharmacy Self Assesssment Program (PSAP). 4th ed. Zarowitz, BJ. (Ed). Kansas City, MO, American College of Clinical Pharmacy.

49. Devlin, J.W., Tyburski, J.G., & Moed, B. (2001). Implementation and evaluation of enoxaparin deep vein thrombosis prophylaxis guidelines after major trauma. Pharmacotherapy, 21,740-747.

50. McKinnon, P.S., Goff, D.A., Kern, J.W., Devlin, J.W., Barletta, J.F., Sierawski, S.J., Mosenthal, A.C., Gore, P., Ambegaonkar, A.J., & Lubowski, T.J. (2001) Temporal assessment of candida risk factors in the surgical intensive care unit. Archives of Surgery, 136, 1401-1409.

51. Tyburski, J.G., Dente, C., Wilson, R.F., Steffes, C., Devlin, J.W., Carlin, A., & Shanti, C. (2001). Differences in arterial and mixed venous IL-6 levels: The lungs as a source of cytokine storm in sepsis. Surgery, 130, 748-752.

52. Devlin, J.W., Fraser, G.F., Kanji, S., & Riker, R. (2001). Sedation assessment in critically ill adults. Annals of Pharmacotherapy, 35, 1624-1632.

53. Kanji, S., Devlin, J.W., Piekos, K., & Racine, E. (2001). Recombinant human activated protein C (drotrecogin alfa activated): A novel therapy for severe sepsis. Pharmacotherapy,
21, 1389-1402.

54. Devlin, J.W., Coplin, W.M., Murry, K.R., Rengachary, S.S., & Wilson, R.F. (2000). Nimodipine induced acute hypoxemia. Neurosurgery, 47, 1243-1247.

55. Devlin, J.W. Pain assessment in seriously ill patients: Can family members play a role? Critical Care Medicine, 28, 1660-1661.

56. Clemmer, T.P., Wallace, J.C., Spuhler, V.J., Bailey, P.P., & Devlin, J.W. (2000). Origins of the Motor Activity Assessment Scale score: A multi-institutional process. Critical Care Medicine 28, 3124.

57. Devlin, J.W. (2000). The role of low molecular weight heparin for DVT prophylaxis in acutely ill medical patients. Journal of Informed Pharmacotherapy 2000; 3, 300-308.

58. Devlin, J.W., Boleski, G., Mlynarek, M., Nerenz, D., Peterson, E., Horst, H.M., & Zarowitz, B.J. (1999). The Motor Activity Assessment Scale: A valid and reliable sedation scale for use in adult, mechanically ventilated, surgical ICU patients. Critical Care Medicine, 27, 1271-1275.

59. Mazur, J.E., Devlin, J.W., Peters, M.J., Jankowski, M., Iannuzzi, M.C., & Zarowitz, B.J. (1999) Single versus multiple doses of acetazolamide for metabolic alkalosis in critically ill medical patients: A randomized, double-blind trial. Critical Care Medicine, 27, 1257-1261.

60. Devlin, J.W., Claire, K.S., Dulchavsky, S.A., &Tyburski, J.G. (1999). Impact of trauma stress ulcer prophylaxis guidelines on drug cost and incidence of major gastrointestinal bleeding. Pharmacotherapy, 19, 452-460.

61. Devlin, J.W., Pettita, A., Shepard, A., & Obeid, F.N. (1998). Cost-effectiveness of enoxaparin versus low-dose heparin as prophylaxis against venous thrombosis after major trauma. Pharmacotherapy,18, 1335-1342.

62. Devlin, J.W., Peters, M., Ulep, S., Ben-Menachem, T., Fogel, R., & Zarowitz, B.J. (1998). Stress ulcer prophylaxis in medical ICU patients: Annual utilization in relation to the incidence of endoscopically-proven stress-related gastritis. Annals of Pharmacotherapy, 32, 869-874.

63. Makarechian, N., Agro, K.A., Devlin, J.W., Trepanier, E.R., Einarson, T., & Koren, G. (1998). Association between moderate alcohol consumption during pregnancy and spontaneous abortion, stillbirth, and premature birth: A meta-analysis. Canadian Journal of Clinical Pharmacology, 5(3),169-176.

64. Devlin, J.W., Holbrook, A.M., & Fuller, H.D. (1997). The effect of ICU sedation guidelines and pharmacist interventions on clinical outcomes and drug cost. Annals of Pharmacotherapy, 31, 689-695.

65. Devlin, J.W., Bailey, E.M., & Zarowitz, B.J. (1997). Administration of amphotericin B in lipid emulsion. Critical Care Medicine, 25, 892.

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