Marilyn Bulloch - Academia.edu (original) (raw)

Papers by Marilyn Bulloch

Intensive Care Research

Background Achieving therapeutic doses of sedation and analgesia are necessary for the safety and... more Background Achieving therapeutic doses of sedation and analgesia are necessary for the safety and comfort of mechanically ventilated patients. Patients with complicated psychiatric histories, are neurocritical, and have acute respiratory distress syndrome usually require maximum sedation, making sedation weaning an arduous task. Case Presentation A 42-year-old female presented with a chief complaint of headache, hypertensive crisis, confusion, and nausea. Her past medical history is notable for hypertension, attention deficit hyperactivity disorder, bipolar II disorder, manic depression, agoraphobia, anxiety, and prior suicide attempts. Noncompliance with anti-hypertensive and psychiatric medications and prior substance abuse history was reported. A head computerized tomography scan revealed multifocal intraparenchymal hemorrhages and multifocal subarachnoid hemorrhages throughout the cerebrum. Within two hours, the patient became obtunded and required intubation. The patient’s seve...

Ovid Technologies (Wolters Kluwer Health), 2019

Critical Care Medicine, 2021

The large-scale Land-Uses and Land-Cover Changes (LULCC) in India in the past several decades is ... more The large-scale Land-Uses and Land-Cover Changes (LULCC) in India in the past several decades is primarily driven by anthropogenic factors that influence the climate from regional to global scales. Therefore, to understand the LULCC over the Indian region from 2002 to 2015 and its implications on temperature and precipitation, we performed Weather Research Forecast (WRF) model simulation using the European Centre for Medium-Range Weather Forecast (ECMWF) reanalysis data for the period 2009 to 2015 as a boundary condition with 2009 as spin-up time. The results showed moderate forest cover loss in major parts of northeast India, and the Himalayan region during 2002-2015. Such large LULC changes, primarily significant alteration of grassland and agriculture from the forest, led to increased precipitation due to increasing evapotranspiration (ET) similar to the forest-dominated regions. An increase in the precipitation patterns (>300 mm) was observed in the parts of eastern and western Himalayas, western Ghats, and the northwestern part of central India, while most parts of northeast Himalayas have an exceptional increase in precipitation (∼100-150 mm), which shows similar agreement with an increase of leaf area index (LAI) by ∼15%. The overall phenomenon leads to a greening-induced ET enhancement that increases atmospheric water vapor content and promotes downwind precipitation. In the case of temperature, warming was observed in the central to eastern parts of India, while cooling was observed in the central and western parts. The increase in vegetated areas over northwest India led to an increase in ET, which ultimately resulted in decreased temperature and increased precipitation. The study highlights the changes in temperature and precipitation in recent decades because of large LULCC and necessitates the formulation of sustainable land use-based strategies to control meteorological variability and augment ecological sustainability.

Critical Care Medicine, 2016

Introduction: Anaphylaxis is a rare, unpredictable reaction with sudden onset and can be fatal. I... more Introduction: Anaphylaxis is a rare, unpredictable reaction with sudden onset and can be fatal. It can occur with any drug, but is most commonly associated with β-lactam antibiotics. Though clindamycin has been associated with severe dermatologic and gastrointestinal effects, immediate hypersensitiv

Journal of Critical Care, 2018

Critical Care Medicine, 2016

Critical Care Medicine, 2012

In our previous report(lst Report), study was made on the stability of an injectable solution (EO... more In our previous report(lst Report), study was made on the stability of an injectable solution (EOMA) to be used in injection sclerotherapy (endoscopic embolization) for esophageal varix, which was prepared by mixing Ethanolamine Oleate Injection (EO) with a contrast medium, meglumine amidotrizoate injection. In the present study (2nd Report), another injectable sOhition (EOI) was prepared by mixing EO with non-ionic iopamidol injecion. With sterilized and unsterilized samples of EOI, observation was made on time-course changes in appearance, pH and the volume of each component for 8 weeks. Also, mucosity and osmotic pressure of EOI, EO and EOMA were measured. Except for slight development of a brown color in sterilized samples of EOI, no major change was observed in each test item during the 8-week storage in a dark and cold place. The results suggest that EOI is stable for at least 8 weeks in a dark, cold place. As the mucosity of EOI is lower than that of EOMA, EOI has great advantages in the filtration operation in manufacturing process of injections or in injection into affected parts.

The Journal of Clinical Pharmacology, 2021

Kratom (Mitragyna speciosa) consists of over 40 alkaloids with two of them, mitragynine (MG) and ... more Kratom (Mitragyna speciosa) consists of over 40 alkaloids with two of them, mitragynine (MG) and 7-OH-mitragynine (7-OH-MG) being the main psychoactive compounds. MG and 7-OH-MG each target opioid receptors and have been referred to as atypical opioids. They exert their pharmacologic effects on the μ, δ, and κ opioid receptors. In addition, they affect adrenergic, serotonergic, and dopaminergic pathways. Kratom has been touted as an inexpensive, legal alternative to standard opioid replacement therapy such as methadone and buprenorphine. Other uses for kratom include chronic pain, attaining a "legal high," and numerous CNS disorders including anxiety depression and post-traumatic stress disorder (PTSD). Kratom induces analgesia and mild euphoria with a lower risk of respiratory depression or adverse central nervous system effects compared to traditional opioid medications. Nonetheless, kratom has been associated with both physical and psychological dependence with some individuals experiencing classic opioid withdrawal symptoms upon abrupt cessation. Kratom use has been linked to serious adverse effects including liver toxicity, seizures, and death. These risks are often compounded by poly-substance abuse. Further, kratom may potentiate the toxicity of coadministered medications through modulation of cytochrome P450, P-glycoprotein, and uridine diphosphate glucuronosyltransferase enzymes (UGDT). In 2016 the U.S. Drug Enforcement Administration (DEA) took steps to classify kratom as a federal schedule 1 medication; however, due to public resistance, this plan was set aside. Until studies are conducted that define kratom's role in treating opioid withdrawal and/or other CNS conditions, kratom will likely remain available as a dietary supplement for the foreseeable future. This article is protected by copyright. All rights reserved.

New Directions for Teaching and Learning, 2020

Critical Care Medicine, 2020

Journal of the American Pharmacists Association, 2019

OBJECTIVES To comparatively assess potentially inappropriate medication (PIM) use and subsequent ... more OBJECTIVES To comparatively assess potentially inappropriate medication (PIM) use and subsequent impact on clinical outcomes among older adults admitted to the intensive care unit (ICU) by means of 3 different screening criteria for PIMs. DESIGN Retrospective cohort study. SETTING AND PARTICIPANTS DCH Regional Medical Center ICU. Patients 65 years of age and older admitted to the medical ICU in 2014 (n = 346). MAIN OUTCOME MEASURES PIMs were identified with the use of the Beers criteria (2015 and 2012 versions) and the Screening Tool of Older People's Potentially Inappropriate Prescriptions (STOPP). The proportions of PIM use at admission and discharge and proportions of in-hospital mortality and ICU and hospital readmission within 2014 among patients with PIM use were compared among the 3 criteria. Multivariable Poisson regression models assessed the associations of PIMs at admission with hospital and ICU length of stay (LOS). Statistical significance was considered to be indicated at P < 0.05. RESULTS The proportions of patients with at least 1 PIM identified through 3 different criteria (2015 Beers, 2012 Beers, and STOPP, respectively; at admission: 68.5%, 58.1%, and 44.5%; at discharge: 77.4%, 63.6%, and 42.9%) were significantly different from each other (2012/2015 Beers vs. STOPP: P < 0.01). PIM use at admission as determined by STOPP was significantly associated with longer ICU stay (relative risk [RR] 1.24, 95% CI 1.11-1.38) and hospital LOS (RR 1.24, 95% CI 1.16-1.33). However, PIMs identified through the Beers criteria (2015 and 2012 versions) were associated with shorter ICU and hospital LOS. No differences were found in proportions of in-hospital mortality and ICU and hospital readmission among patients with PIM use identified through the 3 different criteria. CONCLUSION Although the Beers criteria demonstrated the ability to identify PIMs more frequently in the ICU setting, PIM use identified by means of STOPP was associated with longer ICU and hospital LOS. Clinical interventions aiming to reduce PIMs identified by STOPP in inpatient or ICU settings may decrease patients' inpatient or ICU LOS.

American Research Journal of Pharmacy, 2018

What is Known and Objective: Acute hyponatremia occurs when serum sodium declines to <135 mEq/L w... more What is Known and Objective: Acute hyponatremia occurs when serum sodium declines to <135 mEq/L within a 48-hour period. Tolvaptan, a vasopressin receptor antagonist, causes aquaresis without increased sodium loss. Details of the Case: A77 year-old male, with a history of glioblastoma, presented with a five-day history of weakness. Serum sodium on admission was 115 mEq/L, and normal saline was started. The following morning serum sodium was 114 mEq/L. Tolvaptan 15mg was given. By hospital day 3, the serum sodium increased to 124 mEq/L following titrated tolvaptan doses. What is New and Conclusion: Based on these results, tolvaptan may have a role in the treatment of acute hyponatremia.

Infectious Diseases in Clinical Practice, 2017

Background: Guidelines published in 2009 by the Infectious Diseases Society of America, the Ameri... more Background: Guidelines published in 2009 by the Infectious Diseases Society of America, the American Society of Health-System Pharmacists, and the Society of Infectious Diseases Pharmacists recommended targeting vancomycin troughs of 15 to 20 mg/L. No previous studies exist examining the effect of implementing these guidelines on kidney function. The objective of this study was to evaluate the effect of a dosing nomogram that incorporated recommendations for higher vancomycin goal trough vancomycin-induced nephrotoxicity (VIN). Methods: This study evaluated 300 adult inpatients with a pharmacokinetics consultation for vancomycin dosing. Two periods were evaluated: phase I (2008) assessed practice preguideline vancomycin dosing nomogram change, and phase II (2012) assessed practice postguideline vancomycin dosing nomogram change reflecting the higher trough targets. Groups were compared using χ 2 or Fisher exact tests for categorical variables and Mann-Whitney U tests for continuous variables. The a priori level of significance was set at 0.05. Results: A total of 300 inpatients (150 in 2008 and 150 in 2012) were included in the analysis. More patients from the 2012 group experienced VIN, according to the guideline definition (P = 0.03), but not per the 2007 Acute Kidney Injury Network definition (P = 0.88). There was no change in other adverse outcomes, including dialysis initiation (2 vs 0; P = 0.16), discharge on dialysis (1 vs 0; P = 0.32), transfer to another hospital for higher level of care (33 vs 34; P = 0.89), or death (15 vs 11; P = 0.41). Conclusions: Targeting higher vancomycin troughs resulted in transient VIN but did not cause adverse sequelae.

Hospital Pharmacy, 2016

Background: Prior to 2012, The Joint Commission (TJC) pneumonia core measure (PN-5) required anti... more Background: Prior to 2012, The Joint Commission (TJC) pneumonia core measure (PN-5) required antibiotic administration for suspected community-acquired pneumonia (CAP) within 6 hours of arrival to the emergency room (ER). In 2012, TJC issued PN-6 requiring antibiotic administration within 24 hours of presentation. Though PN-6 was anticipated to reduce overuse and inappropriate antibiotic use and improve appropriate antibiotic selection, the impact of PN-5 and PN-6 on optimizing care for CAP in the ER remains unknown. Objective: To investigate the impact of TJC pneumonia core measures on antibiotic use in the ER for suspected CAP. Methods: In this single-center study, medical records of patients 18 years old and older diagnosed with CAP in the ER during 2011 (PN-5) and 2012 (PN-6) and admitted for 1 day or longer were reviewed. Exclusion criteria included criteria for health care-associated pneumonia. Comparisons between groups were performed using descriptive statistics and contingency table analysis with chi-square or Fisher exact tests for categorical variables and t tests for continuous variables. Statistical analyses were performed using Microsoft Excel 2010 and SAS version 9.4. Results: Antibiotic use was comparable between PN-5 and PN-6. Approximately half of patients in each group received an appropriate empiric CAP regimen (52% vs 54%; P = .807). Among inappropriate regimens, the most common reason was use of a beta-lactam alone (69% vs 83%; P = .26). More patients had an ultimate diagnosis of CAP with PN-6 (78% vs 86%; P = .3). Conclusion: Changes in pneumonia core measure requirements did not have a significant impact on appropriate antibiotic use in the ER.

Intensive Care Research

Background Achieving therapeutic doses of sedation and analgesia are necessary for the safety and... more Background Achieving therapeutic doses of sedation and analgesia are necessary for the safety and comfort of mechanically ventilated patients. Patients with complicated psychiatric histories, are neurocritical, and have acute respiratory distress syndrome usually require maximum sedation, making sedation weaning an arduous task. Case Presentation A 42-year-old female presented with a chief complaint of headache, hypertensive crisis, confusion, and nausea. Her past medical history is notable for hypertension, attention deficit hyperactivity disorder, bipolar II disorder, manic depression, agoraphobia, anxiety, and prior suicide attempts. Noncompliance with anti-hypertensive and psychiatric medications and prior substance abuse history was reported. A head computerized tomography scan revealed multifocal intraparenchymal hemorrhages and multifocal subarachnoid hemorrhages throughout the cerebrum. Within two hours, the patient became obtunded and required intubation. The patient’s seve...

Ovid Technologies (Wolters Kluwer Health), 2019

Critical Care Medicine, 2021

The large-scale Land-Uses and Land-Cover Changes (LULCC) in India in the past several decades is ... more The large-scale Land-Uses and Land-Cover Changes (LULCC) in India in the past several decades is primarily driven by anthropogenic factors that influence the climate from regional to global scales. Therefore, to understand the LULCC over the Indian region from 2002 to 2015 and its implications on temperature and precipitation, we performed Weather Research Forecast (WRF) model simulation using the European Centre for Medium-Range Weather Forecast (ECMWF) reanalysis data for the period 2009 to 2015 as a boundary condition with 2009 as spin-up time. The results showed moderate forest cover loss in major parts of northeast India, and the Himalayan region during 2002-2015. Such large LULC changes, primarily significant alteration of grassland and agriculture from the forest, led to increased precipitation due to increasing evapotranspiration (ET) similar to the forest-dominated regions. An increase in the precipitation patterns (>300 mm) was observed in the parts of eastern and western Himalayas, western Ghats, and the northwestern part of central India, while most parts of northeast Himalayas have an exceptional increase in precipitation (∼100-150 mm), which shows similar agreement with an increase of leaf area index (LAI) by ∼15%. The overall phenomenon leads to a greening-induced ET enhancement that increases atmospheric water vapor content and promotes downwind precipitation. In the case of temperature, warming was observed in the central to eastern parts of India, while cooling was observed in the central and western parts. The increase in vegetated areas over northwest India led to an increase in ET, which ultimately resulted in decreased temperature and increased precipitation. The study highlights the changes in temperature and precipitation in recent decades because of large LULCC and necessitates the formulation of sustainable land use-based strategies to control meteorological variability and augment ecological sustainability.

Critical Care Medicine, 2016

Introduction: Anaphylaxis is a rare, unpredictable reaction with sudden onset and can be fatal. I... more Introduction: Anaphylaxis is a rare, unpredictable reaction with sudden onset and can be fatal. It can occur with any drug, but is most commonly associated with β-lactam antibiotics. Though clindamycin has been associated with severe dermatologic and gastrointestinal effects, immediate hypersensitiv

Journal of Critical Care, 2018

Critical Care Medicine, 2016

Critical Care Medicine, 2012

In our previous report(lst Report), study was made on the stability of an injectable solution (EO... more In our previous report(lst Report), study was made on the stability of an injectable solution (EOMA) to be used in injection sclerotherapy (endoscopic embolization) for esophageal varix, which was prepared by mixing Ethanolamine Oleate Injection (EO) with a contrast medium, meglumine amidotrizoate injection. In the present study (2nd Report), another injectable sOhition (EOI) was prepared by mixing EO with non-ionic iopamidol injecion. With sterilized and unsterilized samples of EOI, observation was made on time-course changes in appearance, pH and the volume of each component for 8 weeks. Also, mucosity and osmotic pressure of EOI, EO and EOMA were measured. Except for slight development of a brown color in sterilized samples of EOI, no major change was observed in each test item during the 8-week storage in a dark and cold place. The results suggest that EOI is stable for at least 8 weeks in a dark, cold place. As the mucosity of EOI is lower than that of EOMA, EOI has great advantages in the filtration operation in manufacturing process of injections or in injection into affected parts.

The Journal of Clinical Pharmacology, 2021

Kratom (Mitragyna speciosa) consists of over 40 alkaloids with two of them, mitragynine (MG) and ... more Kratom (Mitragyna speciosa) consists of over 40 alkaloids with two of them, mitragynine (MG) and 7-OH-mitragynine (7-OH-MG) being the main psychoactive compounds. MG and 7-OH-MG each target opioid receptors and have been referred to as atypical opioids. They exert their pharmacologic effects on the μ, δ, and κ opioid receptors. In addition, they affect adrenergic, serotonergic, and dopaminergic pathways. Kratom has been touted as an inexpensive, legal alternative to standard opioid replacement therapy such as methadone and buprenorphine. Other uses for kratom include chronic pain, attaining a "legal high," and numerous CNS disorders including anxiety depression and post-traumatic stress disorder (PTSD). Kratom induces analgesia and mild euphoria with a lower risk of respiratory depression or adverse central nervous system effects compared to traditional opioid medications. Nonetheless, kratom has been associated with both physical and psychological dependence with some individuals experiencing classic opioid withdrawal symptoms upon abrupt cessation. Kratom use has been linked to serious adverse effects including liver toxicity, seizures, and death. These risks are often compounded by poly-substance abuse. Further, kratom may potentiate the toxicity of coadministered medications through modulation of cytochrome P450, P-glycoprotein, and uridine diphosphate glucuronosyltransferase enzymes (UGDT). In 2016 the U.S. Drug Enforcement Administration (DEA) took steps to classify kratom as a federal schedule 1 medication; however, due to public resistance, this plan was set aside. Until studies are conducted that define kratom's role in treating opioid withdrawal and/or other CNS conditions, kratom will likely remain available as a dietary supplement for the foreseeable future. This article is protected by copyright. All rights reserved.

New Directions for Teaching and Learning, 2020

Critical Care Medicine, 2020

Journal of the American Pharmacists Association, 2019

OBJECTIVES To comparatively assess potentially inappropriate medication (PIM) use and subsequent ... more OBJECTIVES To comparatively assess potentially inappropriate medication (PIM) use and subsequent impact on clinical outcomes among older adults admitted to the intensive care unit (ICU) by means of 3 different screening criteria for PIMs. DESIGN Retrospective cohort study. SETTING AND PARTICIPANTS DCH Regional Medical Center ICU. Patients 65 years of age and older admitted to the medical ICU in 2014 (n = 346). MAIN OUTCOME MEASURES PIMs were identified with the use of the Beers criteria (2015 and 2012 versions) and the Screening Tool of Older People's Potentially Inappropriate Prescriptions (STOPP). The proportions of PIM use at admission and discharge and proportions of in-hospital mortality and ICU and hospital readmission within 2014 among patients with PIM use were compared among the 3 criteria. Multivariable Poisson regression models assessed the associations of PIMs at admission with hospital and ICU length of stay (LOS). Statistical significance was considered to be indicated at P < 0.05. RESULTS The proportions of patients with at least 1 PIM identified through 3 different criteria (2015 Beers, 2012 Beers, and STOPP, respectively; at admission: 68.5%, 58.1%, and 44.5%; at discharge: 77.4%, 63.6%, and 42.9%) were significantly different from each other (2012/2015 Beers vs. STOPP: P < 0.01). PIM use at admission as determined by STOPP was significantly associated with longer ICU stay (relative risk [RR] 1.24, 95% CI 1.11-1.38) and hospital LOS (RR 1.24, 95% CI 1.16-1.33). However, PIMs identified through the Beers criteria (2015 and 2012 versions) were associated with shorter ICU and hospital LOS. No differences were found in proportions of in-hospital mortality and ICU and hospital readmission among patients with PIM use identified through the 3 different criteria. CONCLUSION Although the Beers criteria demonstrated the ability to identify PIMs more frequently in the ICU setting, PIM use identified by means of STOPP was associated with longer ICU and hospital LOS. Clinical interventions aiming to reduce PIMs identified by STOPP in inpatient or ICU settings may decrease patients' inpatient or ICU LOS.

American Research Journal of Pharmacy, 2018

What is Known and Objective: Acute hyponatremia occurs when serum sodium declines to <135 mEq/L w... more What is Known and Objective: Acute hyponatremia occurs when serum sodium declines to <135 mEq/L within a 48-hour period. Tolvaptan, a vasopressin receptor antagonist, causes aquaresis without increased sodium loss. Details of the Case: A77 year-old male, with a history of glioblastoma, presented with a five-day history of weakness. Serum sodium on admission was 115 mEq/L, and normal saline was started. The following morning serum sodium was 114 mEq/L. Tolvaptan 15mg was given. By hospital day 3, the serum sodium increased to 124 mEq/L following titrated tolvaptan doses. What is New and Conclusion: Based on these results, tolvaptan may have a role in the treatment of acute hyponatremia.

Infectious Diseases in Clinical Practice, 2017

Background: Guidelines published in 2009 by the Infectious Diseases Society of America, the Ameri... more Background: Guidelines published in 2009 by the Infectious Diseases Society of America, the American Society of Health-System Pharmacists, and the Society of Infectious Diseases Pharmacists recommended targeting vancomycin troughs of 15 to 20 mg/L. No previous studies exist examining the effect of implementing these guidelines on kidney function. The objective of this study was to evaluate the effect of a dosing nomogram that incorporated recommendations for higher vancomycin goal trough vancomycin-induced nephrotoxicity (VIN). Methods: This study evaluated 300 adult inpatients with a pharmacokinetics consultation for vancomycin dosing. Two periods were evaluated: phase I (2008) assessed practice preguideline vancomycin dosing nomogram change, and phase II (2012) assessed practice postguideline vancomycin dosing nomogram change reflecting the higher trough targets. Groups were compared using χ 2 or Fisher exact tests for categorical variables and Mann-Whitney U tests for continuous variables. The a priori level of significance was set at 0.05. Results: A total of 300 inpatients (150 in 2008 and 150 in 2012) were included in the analysis. More patients from the 2012 group experienced VIN, according to the guideline definition (P = 0.03), but not per the 2007 Acute Kidney Injury Network definition (P = 0.88). There was no change in other adverse outcomes, including dialysis initiation (2 vs 0; P = 0.16), discharge on dialysis (1 vs 0; P = 0.32), transfer to another hospital for higher level of care (33 vs 34; P = 0.89), or death (15 vs 11; P = 0.41). Conclusions: Targeting higher vancomycin troughs resulted in transient VIN but did not cause adverse sequelae.

Hospital Pharmacy, 2016

Background: Prior to 2012, The Joint Commission (TJC) pneumonia core measure (PN-5) required anti... more Background: Prior to 2012, The Joint Commission (TJC) pneumonia core measure (PN-5) required antibiotic administration for suspected community-acquired pneumonia (CAP) within 6 hours of arrival to the emergency room (ER). In 2012, TJC issued PN-6 requiring antibiotic administration within 24 hours of presentation. Though PN-6 was anticipated to reduce overuse and inappropriate antibiotic use and improve appropriate antibiotic selection, the impact of PN-5 and PN-6 on optimizing care for CAP in the ER remains unknown. Objective: To investigate the impact of TJC pneumonia core measures on antibiotic use in the ER for suspected CAP. Methods: In this single-center study, medical records of patients 18 years old and older diagnosed with CAP in the ER during 2011 (PN-5) and 2012 (PN-6) and admitted for 1 day or longer were reviewed. Exclusion criteria included criteria for health care-associated pneumonia. Comparisons between groups were performed using descriptive statistics and contingency table analysis with chi-square or Fisher exact tests for categorical variables and t tests for continuous variables. Statistical analyses were performed using Microsoft Excel 2010 and SAS version 9.4. Results: Antibiotic use was comparable between PN-5 and PN-6. Approximately half of patients in each group received an appropriate empiric CAP regimen (52% vs 54%; P = .807). Among inappropriate regimens, the most common reason was use of a beta-lactam alone (69% vs 83%; P = .26). More patients had an ultimate diagnosis of CAP with PN-6 (78% vs 86%; P = .3). Conclusion: Changes in pneumonia core measure requirements did not have a significant impact on appropriate antibiotic use in the ER.